Souza Eloisa C, Martinez Marina B, Taddei Carla R, Mukai Lilian, Gilio Alfredo E, Racz Maria L, Silva Luzinete, Ejzenberg Bernardo, Okay Yassuhiko
Universidade de São Paulo (USP), SP, Brazil.
J Pediatr (Rio J). 2002 Jan-Feb;78(1):31-8.
To evaluate the etiologic profile of acute diarrhea in socioeconomically deprived children assisted at a regional pediatric emergency care service. METHODS: During two years all children with acute diarrhea assisted at a previously established day and week time schedule were included in the study. Other selective criteria were: a) age less than 5 years; b) nonuse of antibiotics in the previous month; and c) no travel outside the city in the previous month. Stool examination was used for the detection of the following microorganisms: a) rotavirus (immunofluorescence and counterimmunoelectrophoresis); b) bacteria - culture in MacConkey agar, SS agar, Columbia agar, bright green, serotyping, detection of toxins - INV, LT,ST,SLT I, SLT II, Sereny test, detection of virulence factors- EAF, eae, BFP; and c) protozoa (Hoffman and Faust). In the same period, a control group without diarrhea was also evaluated for the same fecal pathogens. RESULTS: Between March 1994 and June 1996, 154 children with acute diarrhea (AD) and 42 control children (WAD), that is, without acute diarrhea, were selected. In the AD group, intestinal pathogens were detected in 112 (72.8%) cases, and in 9 (21.5%) cases in the WAD group. The association of two or more intestinal pathogens occurred in 47 (30.5%) cases in the AD group, and in 3 (7.1%) cases in the WAD group. The pathogens identified in the AD cases were: Rotavirus: 32 (20.8%), bacteria: 53 (34.4%), both: 25 (16.2%), and 2 (1.4%) with Giardia lamblia (in one case associated with Rotavirus and in another one associated with bacteria). In the WAD group, only bacteria were detected in 8 (19.1%) cases, and bacteria associated with Giardia lamblia in 1 (2.4%) case. Altogether, there were 105 bacteria isolated in the AD group: 90 were Escherichia coli (EPEC 27, DAEC 24, ETEC 21, EAEC 18), 12 were Shigella sp, 2 were Salmonella sp, and one was Yersinia sp. Children with mixed infections (viral and bacterial) had increased incidence of severe vomiting, dehydration and hospitalization. CONCLUSIONS: Bacteria were the most frequent pathogens detected in acute diarrhea cases, among which Escherichia coli was highly predominant. The majority of Escherichia coli strains belong to non-EPEC varieties, strains that are not routinely evaluated in clinical laboratories of pathology. Rotavirus was found in a great number of diarrhea cases, often associated with bacteria. Protozoa showed reduced importance.
评估在某地区儿科急诊服务机构接受治疗的社会经济条件较差儿童急性腹泻的病因谱。方法：在两年时间里，将按照预先确定的日间和周间时间表接受治疗的所有急性腹泻儿童纳入研究。其他入选标准为：a)年龄小于5岁；b)前一个月未使用抗生素；c)前一个月未离开本市。粪便检查用于检测以下微生物：a)轮状病毒（免疫荧光和对流免疫电泳）；b)细菌——在麦康凯琼脂、SS琼脂、哥伦比亚琼脂、亮绿培养基上培养，血清分型，毒素检测——侵袭性肠毒素（INV）、不耐热肠毒素（LT）、耐热肠毒素（ST）、志贺样毒素I（SLT I）、志贺样毒素II（SLT II），塞雷尼试验，毒力因子检测——肠集聚性大肠杆菌黏附因子（EAF）、肠上皮细胞黏附素（eae）、束状菌毛（BFP）；c)原虫（霍夫曼法和福斯特法）。在同一时期，还对一组无腹泻的对照组儿童进行相同粪便病原体的评估。结果：1994年3月至1996年6月，选取了154例急性腹泻（AD）儿童和42例对照儿童（WAD），即无急性腹泻儿童。在AD组中，112例（72.8%）检测到肠道病原体，WAD组中有9例（21.5%）检测到。AD组中两种或更多种肠道病原体合并感染的情况有47例（30.5%），WAD组中有3例（7.1%）。AD病例中鉴定出的病原体为：轮状病毒：32例（20.8%），细菌：53例（
