Intestinal amoebiasis in children and its effect on nutritional status

ABSTRACT

To determine the frequency and clinical presentation of amoebic diarrhea in children and its effect on the nutritional status of the affected children. Descriptive. Department of Diarrhea Treatment Unit [DTU], Dow Medical College and Civil Hospital, Karachi, from November 1998 to April 2001. Paediatric patients between the ages of > 1 month to 15 years were included, who visited the DTU of the department with diarrhea. Stool samples of all these patients were checked under microscope for the vegetative forms of Entamoeba histolytica [E.h.]. Patients who were positive for E.h. were evaluated for the symtomatology including the type of diarrhea [acute watery diarrhea [AWD] or dysentery], abdominal pain, tenesmus and nausea/vomiting. Examination carried out was assessed for state of hydration, fever and anaemia and nutritional status of those less than 5 years of age. The patients were divided into three age groups to assess the association of the age with severity and type of clinical presentation. Chi- square test was applied to calculate the p-values. P-values of 0.05 or less were considered statistically significant. The stool samples of 3870 patients with diarrhea were examined under microscope. Three hundred and twenty eight [8.47%] of these samples were positive for E.h. The difference between the number of patients presenting with acute watery diarrhea n=157, 47.86% and with dysentery n=171, 52.13% was found to be statistically non-significant [p=0.364]. Two hundred and seventy seven [84.45%] patients had tenesmus, while abdominal pain was present in 287 [87.5%]. Fever and malnutrition were present in 169 [51.52%] patients each. Malnutrition was significantly most frequent in 1-5 years of age groups [n=98, 57.98%, p=0.026]. The nutritional evaluation of the 272 under-5 children with amoebic diarrhea showed a significantly normal status in 123 [45.55%, p-value <0.001]. All the signs and symptoms followed a similar trend with 1 -5 years age group being the most affected group. However, the frequency of blood in stools increased in direct proportion to the increasing age. Although dysentery was the more common presenting complaint, almost half of the patients presented with watery diarrhea. Most of the patients with dysentery were under the age of 5 years. Fever was present in a high number of patients. The age group most affected by amoebiasis and malnutrition was 1-5 years