The detection of enteropathogens in acute diarrhea in a family cohort population in rural Egypt.

In 8 villages of rural northeastern Egypt, a 2-year study of the etiologic agents associated with episodes of diarrhea was carried out. Stool specimens (3,243) from 3,513 episodes of diarrhea were processed for enteropathogens. The most commonly identified agents in the group with diarrhea were Giardia lamblia (44%), heat stable enterotoxin (ST)-producing enterotoxigenic Escherichia coli (ETEC) (15%), heat labile toxin (LT)-producing ETEC (12%), enteropathogenic E. coli (EPEC) (4%), rotavirus (3%), Shigella (2%) and Salmonella (1%). Isolation rates were increased in cases compared to controls for all agents except G. lamblia and EPEC strains. Rotavirus, Salmonella and ST-producing ETEC were more frequently isolated during cooler months and Shigella and LT-ETEC occurred more commonly in warmer months. Campylobacter, EPEC, Giardia and E. histolytica did not show a discernable seasonal pattern. Rotavirus was primarily associated with diarrhea in infants only. Forty-four percent of children experienced at least 1 bout of rotavirus diarrhea by the age of 3 years. Vomiting was reported in 65% of cases of rotavirus infection. Dehydration was reported in greater than 40% of those with rotavirus-, Salmonella-, Campylobacter-, LT-ETEC- and EPEC-associated illness and in those without an identifiable agent. While rotavirus was implicated in 3% of cases overall, when vomiting or vomiting plus dehydration occurred, rotavirus was identified with a rate of 10% and 12%, respectively. Dysentery was common only in Shigella cases, occurring in 24%. A decrease in occurrence of rotavirus, Campylobacter and possibly EPEC illness was seen in the infants less than 6 months of age who were breast-fed when compared to those who were not.

The relationship of oral rehydration solution to hypernatremia in infantile diarrhea.

PIP: A major criticism of the use of oral rehydration solution (ORS) in the treatment of diarrhea has been that the high sodium content of the solution might predispose the development of hypernatremia in infants not allowed access to additional free water and in whom glomerular filtration rate and urinary concentrating ability may be low. A study was undertaken in 1980 in Cairo, Egypt to assess the use of ORS. The study included 100 children under age 1, mean age 6.7 months, with dehydration secondary to diarrhea, and 17% were hypernatremic on admission, 27% hyponatremic and 56% isonatremic; the hypernatremic infants were found to be more dehydrated than the others. 24% of the hypernatremic infants had taken Rehydran whereas only 5% of the others had taken it and none had been given the medication in a proper fashion. Of the 17 with hypernatremia 16 completed the course of oral rehydration therapy and 63% had normal serum sodium values by 6 hours of therapy. It was found that the treatment of hypernatremic infants with ORS was successful while with the unsupervised use of Rehydran the risk of this condition was enhanced; errors made in the home included prolonged use of the solution and failure to use water. It is believed that because of widespread illiteracy sole reliance upon written instructions is potentially dangerous.^ieng