Bacteriology Unit, National Institute for Health and Welfare (THL), P.O. Box 30, Helsinki 00271, Finland.
BMC Pediatr. 2013 Mar 19;13:36. doi: 10.1186/1471-2431-13-36.
Diarrhea is the most frequent health problem among children in developing countries. This study investigated the bacterial and viral etiology and related clinical and epidemiological factors in children with acute diarrhea in Ouagadougou, Burkina Faso.
Stool specimens were collected from 283 children under 5 years of age visiting hospital due to acute diarrhea and from 60 healthy controls of similar age. Pathogens were investigated by using conventional culture techniques, PCR and immunochromatographic testing. Salmonella and Shigella strains were serotyped and their susceptibility to 23 antimicrobial agents was determined by the agar dilution method.
At least one pathogen was detected in 64% of the 283 patients and in 8% of the 60 controls (p < 0.001). Rotavirus was found in 30% of the patients, followed by diarrheagenic Escherichia coli (24%), Salmonella enterica ssp. enterica (9%), Shigella spp. (6%), adenovirus (5%) and Campylobacter spp. (2%). Multiple pathogens were found in 11% of the patients and in 2% of the controls (p = 0.028). Viruses were found mainly in children of ≤ 2 years of age, whereas bacteria were equally prevalent among all the age groups. Viral infections occurred mostly during the cool dry season and the bacterial infections during the rainy season. Fever (64%) and vomiting (61%) were the most common symptoms associated with diarrhea. Only one Salmonella strain was resistant to nalidixic acid and ciprofloxacin. Of the Shigella strains, one was resistant to nalidixic acid but 81% to trimethoprim- sulfamethoxazole, 63% to streptomycin and 50% to ampicillin. Most of all the other Salmonella and Shigella strains were sensitive to all antimicrobials tested.
Rotaviruses and diarrheal E. coli were the most predominant pathogens associated with acute diarrhea in Burkinabe children. Constant antimicrobial surveillance is warranted to observe for the emergence of enteric bacteria resistant to antimicrobials that are important in treatment also of severe infections.
腹泻是发展中国家儿童最常见的健康问题。本研究调查了布基纳法索瓦加杜古急性腹泻儿童的细菌和病毒病因及相关临床和流行病学因素。
采集 283 名 5 岁以下因急性腹泻就诊的儿童和 60 名年龄相似的健康对照者的粪便标本。采用常规培养技术、PCR 和免疫层析试验检测病原体。对沙门氏菌和志贺氏菌进行血清型鉴定，并采用琼脂稀释法测定其对 23 种抗菌药物的敏感性。
283 例患者中至少有一种病原体的检出率为 64%，60 例对照者中为 8%（p<0.001）。轮状病毒在患者中的检出率为 30%，其次是致泻性大肠埃希菌（24%）、肠沙门氏菌血清型肠炎亚种（9%）、志贺氏菌（6%）、腺病毒（5%）和弯曲菌（2%）。11%的患者和 2%的对照者中发现了多种病原体（p=0.028）。病毒主要在≤2 岁的儿童中发现，而细菌在所有年龄组中同样常见。病毒感染主要发生在凉爽干燥的季节，细菌感染主要发生在雨季。发热（64%）和呕吐（61%）是与腹泻最常见的症状。只有一株沙门氏菌对萘啶酸和环丙沙星耐药。63%的志贺菌对链霉素耐药，50%的志贺菌对氨苄西林耐药，81%的志贺菌对复方磺胺甲噁唑耐药。所有其他沙门氏菌和志贺氏菌菌株对所有测试的抗菌药物均敏感。
轮状病毒和致泻性大肠埃希菌是导致布基纳法索儿童急性腹泻的最主要病原体。需要进行持续的抗菌药物监测，以观察对抗生素耐药的肠细菌的出现，这些细菌对抗生素的耐药性也会影响严重感染的治疗。
