Incidence of enteroadherence in diarrhoegenic Escherichia coli in infants in Delhi.

Fifty-six isolates of Escherichia coli including 40 isolates from diarrhoeic infants and 16 from non-diarrhoeic infants were investigated. Twenty-two of the diarrhoeic isolates were typable, the most common serogroup being 086 (33%). None of the non-diarrheic isolates are typable with EPEC antisera with enteropathogenes. Adherence tests with HEp-2 cell line revealed localized adherence in 23%, diffuse adherence in 14% and aggregative adherence in 5.7% of the 35 isolates tested. Aggregative adherence was not observed in any of the EPEC isolates. None of the isolates in the control group exhibited localized or aggregative adherence. However, 25% of these isolates showed diffuse adherence (DA) which was not significantly different from the incidence of DA (34%) in the test group (p > 0.05). The importance of serogrouping and studying adherence pattern of E. coli isolates in establishing their pathogenic potential is thus emphasized.

Clinical profile of cholera in young children--a hospital based report.

Clinical profile of cholera was studied in children attending Diarrhea Training and Treatment Unit from January-December 1993. Out of a total 8714 cases of acute watery diarrhea, 64 children (0.7%) were suspected to have cholera on the basis of acute onset loose water/rice watery stools, high purge rate with or without excessive vomiting and/or severe dehydration. Stool culture was positive for cholera in 33 cases (51.6%). All the isolates were V. cholerae 01 biotype El Tor serotype Ogawa. Sixty four per cent of stool culture positive cases were below 5 years of age. The results assume importance because out of 28 children < 2 years with clinical suspicion of cholera, 11 cases (39.3%) were culture positive for V. cholerae, youngest child being 3 months old. Comparison of various parameters revealed that presence of vomiting > 4 episodes/ day (p < 0.005), frequency of stools >12/24 hours (p <0.002), rice watery stools (p < 0.01) and presence of severe dehydration (p < 0.01) were significant parameters associated with positive stool culture. Beside examination of stool sample by hanging drop method was an excellent diagnostic tool (p < 0.001) with a sensitivity of 51.5%, specificity 100% and positive predictive value of 100%. The isolates of V. cholerae were susceptible to furazolidone, cephelexin, nalidixic acid, norfloxacin and gentamicin. Our observations indicate that cholera is not uncommon in infants and young children. Like children in the older age group, acute onset diarrhea with watery/rice watery stools and high purge rate with or without excessive vomiting and/or rapid development of severe dehydration should arouse suspicion of cholera in younger children also. They should be investigated for cholera even in non-endemic areas and in the absence of cholera outbreaks.

Cryptosporidiosis in north Indian children.

Stool samples of 100 children (below 2 years of age) with acute diarrhea as study group and 50 non-diarrheal stools of children (age and sex matched) as control were examined for parasites. The samples were processed and examined by direct wet mounts, concentration technique and modified Ziehl-Neelsen staining. The prevalence of cryptosporidium was 5.0% in the study group while none of the controlled samples showed it. In all cryptosporidium positive cases, no other bacterial or parasitic pathogen could be detected. Diarrhea persisted for 6-16 days and was moderate resulting in dehydration, which was rapidly corrected by oral/or intravenous fluids. Out of 5 cryptosporidium positive children 4 were breast-fed while 1 received bottle feeding. Only one positive case had contact with petdog.