ABSTRACT
Faecal samples were obtained from 190 children, aged 0 to 5 years, admitted to a public hospital in Belém, Pará, Brazil. These patients were placed in a pediatric ward with 40 beds distributed in six rooms. Case were classified into three groups: (a) nosocomial: children who developed gastroenteritis 72 hr or later after admission; (b) community-acquired: patients admitted either with diarrhoea or who had diarrhoea within 72 hr following admission; (c) non-diarrhoeic: those children who had no diarrhoea three days before and three days after collection of formed faecal sample. Specimens were routinely processed for the presence of rotaviruses, bacteria and parasites. Rotaviruses were detected through enzyme-linked immunosorbent assay (ELISA) and subsequently serotyped/electrophoretyped. Rotaviruses were the most prevalent enteropathogens among nosocomial cases, accounting for 39 porcento (9/23) of diarrhoeal episodes; on the other hand, rotaviruses ocurred in 8.3 por cento (11/133) and 9 por cento (3/34) of community-acquired and non-diarrhoeic categories, respectively. Mixed infections involving rotavirus and Giardia intestinalis and rotavirus plus G. intestinalis and Entamoeba histolytica were detected in frequencies of 8.6 and 4.3 por cento, respectively, in the nosocomial group. The absence of bacterial pathogens in this category, and the unusual low prevalence of these agents in the other two groups may reflect the early and routine administration of antibiotics following admission to this hospital. Rotavirus serotype 2 prevailed over the other types, accounting for 77.8 por cento of isolates from nosocomial diarrhoeal episodes. In addition, at least five different genomic profiles could be observed, of which one displayed an unusual five-segment first RNA cluster. Dehydration was recorded in all cases of hospital-acquired, rotavirus-associated diarrhoea, whereas in only 57 por cento of nosocomial cases of other aetiology. It was also noted that nosocomial, rotavirus-associated diarrhoeal episodes ocurr earlier (7 days), following admission, if compared with those hospital-acquired cases of other aetiology (14 days).
Subject(s)
Humans , Child , Diarrhea, Infantile , Rotavirus , Rotavirus InfectionsABSTRACT
No periodo de fevereiro a setembro de 1988 foram recruta-das e submetidas a acompanhamento sistematico, 78 criancas habitantes de um bairro periferico de Belem, Brasil. Observou-se que cinco (6,4%) desses individuos foram excluidos no decurso do estudo, uma ves que passaram a morar em outra areada cidade. Visitas domiciliares, duas vezes por semana, foram empreendidas por agentes de campo, sendo os cuidados medicos proporcionados por dois profissionaisde nosso grupo. Foram registrados 67 episodios de diarreia, obtendo-se especimesfecais para exames em 62 (92.5%) deles. Rotavirus foram detectados em 4 (6.4%) dos episodios analisados laboratorialmente, todos classificados como subgrupo II(perfil eletroforetico de ARN longo). De 60 especies fecais processados quanto apresenca de enteropatogenos bacterianos, logrou-se obter 7(11,7%) isolamentos deEscherichia coli enteropatogenicas, 3 (5,0%) de Sjigella sonnei e 1 (1,7%) deSalmonella grupo C1. Detectou-se, ainda, Campilobacter sp em 2 (4,9%) dos 41 es-pecimes fecais cultivados com o proposito especifico de detectar-se esse agente Cryptosporidium sp. foi observado em apenas 1 (2.7%) dos 37 especimes fecais analisados. A maior incidencia de diarreia, 24,5%, ocorreu em abril, enquanto que amenor, 9,3%, em marco. Das 78 criancas recrutadas, 52 (66.7%) apresentaram diarreia. A taxa de ataque clinico especifica por idade nao exibiu diferencas niti-das nos intervalos de 0 a 3 e 5 a 8 meses, porem, configurou-se um pico aos 4. Ataxa de diarreia cumulativa atingiu a cifra de 1,4 episodio por crianca, aos oi-to meses. As frequencias de vomitod (75%), febre (50%) e desidartacao (50%) revelaram-se superiores aos mesmos parametros avaliados no grupo de diarreias relacionadas a outros agentes etiologicos.