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ETIOLOGY OF BLOODY DIARRHEA IN CHILDREN AND PREVALENCE OF E. COLI O157:H7
ETIOLOGY OF BLOODY DIARRHEA IN CHILDREN AND PREVALENCE OF E. COLI O157:H7
Twana Fakhradeen Kareem a and Sherko Ali Omer b
Twana Fakhradeen Kareem a and Sherko Ali Omer b
a Sulaimani Directorate of Health, Kurdistan Region, Iraq.
b Department of Microbiology, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 4/1/2020; Accepted: 1/12/2020; Published: 21/12/2020
DOI Link: https://doi.org/10.17656/jsmc.10274
ABSTRACT
Background
Infectious diarrhea continues to be a health burden worldwide especially in children living in developing countries. The main etiologies of bloody diarrhea in developing regions are Entamoeba histolytica and bacteria such as Shigella and other bacteria.
Objectives
To determine the causative agents of bloody diarrhea in children and the prevalence of Enterohemorrhagic Escherichia coli in children with bloody diarrhea.
Materials and Methods
A cross-sectional study conducted at Dr.Jamal Ahmad Rashid Teaching Pediatric Hospital in Sulaimani city from October 2018 to August 2019. We examined stool specimens from inpatient children with diarrhea using fresh mount. We further investigated the bloody stools by cultivation on several bacteriological media. Growth was identified and the causative agents were determined based on culture, Gram stain, biochemical tests, Serological test and VITEK® 2 system. Finally, we used multiplex PCR to identify EHEC O157:H7 and Shiga toxin genes.
Results
From 2589 fresh mount stool examination, 117 (4.5%) were identified as bloody diarrhea based on finding RBCs. Of the 117 cultivated stool specimens, bacteria were identified as the cause of bloody diarrhea in 73(62.4%), E. histolytica/ E. dispar in 36 (30.8 %), bacteria and E.histolytica/ E. dispar in 6 (5.1%), while in 2 (1.7%) specimen, the cause remain unidentified. The isolated bacteria were Shigella spp. (56, 69%), Slamonella spp. (11, 14%), Enteroinvasive Escherichia coli (6, 7%), Campylobacter spp. (3, 4%) and Enterohemorrhagic Escherichia coli (3, 4 %). Two EHEC showed shiga toxin type two gene.
Conclusion
Shigella spp. and E. histolytica were the most prevalent agents of bloody diarrhea in children aged 7 months to 12 years. Enterohemorrhagic Escherichia coli harboring shiga toxin type 2 gene was identified in bloody diarrhea but in fewer cases compared to other bacteria.
KEYWORDS
Children bloody diarrhea; E. histolytica; Shigella; Enterohemorrhagic Escherichia col; EHEC; O157:H7.
References
1. Gomez-Duarte OG, Bai J, Newell E. Detection of Escherichia coli, Salmonella spp., Shigella spp., Yersinia enterocolitica, Vibrio cholerae, and Campylobacter spp. enteropathogens by 3-reaction multiplex polymerase chain reaction. Diagnostic microbiology and infectious disease. 2009;63(1):1-9.
2. Humphries RM, Linscott AJ. Laboratory diagnosis of bacterial gastroenteritis. Clin Microbiol Rev. 2015;28(1):3-31.
3. Jill W. Ahs WT, Jenny Löfgren and Birger C. Forsberg. Diarrheal Diseases in Low- and Middle-Income Countries: Incidence, Prevention and Management. The Open Infectious Diseases Journal. 2010;4:113-24.
4. Khalili M. Acute Bacterial Dysentery in Children. International Journal of Infection. 2014;1(3).
5. Bawankule R, Shetye S, Singh A, Singh A, Kumar K. Epidemiological investigation and management of bloody diarrhea among children in India. PloS one. 2019;14(9):e0222208.
6. Brown JD, Willcox SJ, Franklin N, Hazelton B, Howard P, Reinten T, et al. Shigella species epidemiology and antimicrobial susceptibility: the implications of emerging azithromycin resistance for guiding treatment, guidelines and breakpoints. The Journal of antimicrobial chemotherapy. 2017;72(11):3181-6.
7. Pacheco AR, Sperandio V. Shiga toxin in enterohemorrhagic E.coli: regulation and novel anti-virulence strategies. Frontiers in cellular and infection microbiology. 2012;2:81.
8. Belay A, Dube L, Berhanu S. Determinants of Acute Bloody Diarrhea among Adult Outpatient Visits in Bibugn District, Northern Ethiopia. Quality in Primary Care. 2018;26 (1): : 13-9.
9. Rajeshwari K, Mishra M, Dubey AP, Uppal B, Anurandha S. Spectrum of dysentery in children presenting to a tertiary level teaching hospital in New Delhi. Int J Med Med Sci. 2013;5(4):158-62.
10. Sang WK, Boga HI, Waiyaki PG, Schnabel D, Wamae NC, Kariuki SM. Prevalence and genetic characteristics of Shigatoxigenic Escherichia coli from patients with diarrhoea in Maasailand, Kenya. J Infect Dev Ctries. 2010;6(2):102-8.
11. Pianciola L, Rivas M. Genotypic Features of Clinical and Bovine Escherichia coli O157 Strains Isolated in Countries with Different Associated-Disease Incidences. Microorganisms. 2018;6(2).
12. Ramotar K, Henderson E, Sumski R, Louie TJ. Impact of Free Verotoxin Testing on Epidemiology of Diarrhea Caused by Verotoxin-Producing Escherichia coli. J CLIN MICROBIOL. 1995;33(5):1114–20.
13. Lahmer RA, Williams PA, L. Jones DL. Escherichia Coli O157:H7 in Food with Health-Related Risks. Journal of Research in Health Science. 2017;1(1):5-30.
14. Alsharif G, Ahmad S, Islam MS, Shah R, Busby SJ, Krachler AM. Host attachment and fluid shear are integrated into a mechanical signal regulating virulence in Escherichia coli O157:H7. Proceedings of the National Academy of Sciences of the United States of America. 2015;112(17):5503-8.
15. Prasanthi K, Jyothi P, Kamala P. Prevalence of STEC O157 in paediatric diarrhoeas and evaluating efficacy of SMAC and O157 antigen detection in the diagnosis of O157 E.coli. Sch J App Med Sci. 2016;4(8):2767-70.
16. Parija SC, Mandal J, Ponnambath DK. Laboratory methods of identification of Entamoeba histolytica and its differentiation from look-alike Entamoeba spp. Tropical parasitology. 2014;4(2):90-5.
17. Mushi MF, Paterno L, Tappe D, Deogratius AP, Seni J, Moremi N, et al. Evaluation of detection methods for Campylobacter infections among under-fives in Mwanza City, Tanzania. The Pan African medical journal. 2014;19:392.
18. Kahsay AG, Teklemariam Z. Prevalence of Shigella among diarrheic children under-5 years of age attending at Mekelle health center, north Ethiopia. BMC research notes. 2015;8:788.
19. Alam M, Khan MSR, Nesa MK. Isolation, Identification and Characterization of Salmonella Serovars from Diarrhoeic Stool Samples of Human. Bangladesh Journal of Veterinary Medicine. 2012;9(1):85-93.
20. Perez JM, Cavalli P, Roure C, Renac R, Gille Y, Freydiere AM. Comparison of four chromogenic media and Hektoen agar for detection and presumptive identification of Salmonella strains in human stools. Journal of clinical microbiology. 2003;41(3):1130-4.
21. Saleh DS, Ali SM. Detection of Campylobacter species from Children with Bloody Diarrhea Using Locally Prepared Charcoal-Based Selective Medium. Proceeding of 3rd scientific conference of the College of Science, University of Baghdad; 24 to 26 March 2009; Baghdad-Iraq 2009. p. 1298-303.
22. Tafa B, Sewunet T, Tassew H, Asrat D. Isolation and Antimicrobial Susceptibility Patterns of Campylobacter Species among Diarrheic Children at Jimma, Ethiopia. International journal of bacteriology. 2014;2014:560617.
23. Vieira N, Solberg OD, Ponce K, Bates SJ, Trueba G, Riley LEE, et al. High Prevalence of Enteroinvasive Escherichia Coli Isolated in a Remote Region of Northern Coastal Ecuador. The American journal of tropical medicine and hygiene. 2007;76(3):528-33.
24. Ngbede JE, Jideani IA, Agbo EB. Prevalence of Escherichia coli 0157:H7 from diarrhoeal patients in Jos hospitals, Nigeria. Journal of Food, Agriculture & Environment. 2006;4(3):20-2.
25. Paton AW, Paton JC. Detection and Characterization of Shiga Toxigenic Escherichia coli by Using Multiplex PCR Assays for stx1, stx2, eaeA, Enterohemorrhagic E. coli hlyA, rfbO111, and rfbO157. J CLIN MICROBIOL. 1998;36(2):598–602.
26. Maktabi S, Zarei M, Mohammadpour H. Isolation and Molecular Characterization of Non-Sorbitol Fermenting Escherichia coli Isolated From Fresh Ground Beef. Jundishapur J Health Sci. 2008;8(1):20-4.
27. Virpari PK, Nayak JB, Thaker HC, Brahmbhatt MN. Isolation of pathogenic Escherichia coli from stool samples of diarrhoeal patients with history of raw milk consumption. Veterinary world. 2013;6(9):659-63.
28. Shen H, Zhang J, Li Y, Xie S, Jiang Y, Wu Y, et al. The 12 Gastrointestinal Pathogens Spectrum of Acute Infectious Diarrhea in a Sentinel Hospital, Shenzhen, China. Frontiers in microbiology. 2016;7:1926.
29. Traa BS, Walker CL, Munos M, Black RE. Antibiotics for the treatment of dysentery in children. International journal of epidemiology. 2010;39 Suppl 1:i70-4.
30. Pfeiffer ML, DuPont HL, Ochoa TJ. The patient presenting with acute dysentery--a systematic review. The Journal of infection. 2012;64(4):374-86.
31. Rabatti AA, Rasheed NE. Etiology of Bloody Diarrhea among Children Admitted to Maternity and Children’s Hospital-Erbil. Al-Kindy Col Med J 2008. 2008;4(2):19-24.
32. Al-Kubaisy W, Al Badre A, Al-Naggar RA, Shamsidah NIN. Epidemiological study of bloody diarrhoea among children in baghdad in Iraq. iMedPub Journals. 2015;8(4):1-9.
33. Townes JM, Quick R, Gonzales OY, Linares M, Damiani E, Bopp CA, et al. Etiology of Bloody Diarrhea in Bolivian Children: Implications for Empiric Therapy. The Journal of infectious diseases. 1997;175(6):1527-30.
34. Zaidan AA, Al Jiboory RK. Occurrence of Amoebic Versus Bacillary Dysentery among Children Under Five Years of Age in Baghdad City. KCMJ. 2013;9(2):35-9.
35. Al-Jnabee NA, Al-Ouqaili MT. Molecular Detection of Shigella spp. and Entamoeba histolytica Causing Bacillary and Amoebic Dysentery Among Children in Ramadi City. Anb Med J. 2015;14(1):64-74.
36. Rolfo F, Marin GH, Silberman M, Pattin J, Giugnio S, Gatti B, et al. Epidemiological study of shigellosis in an urban area of Argentina. J Infect Dev Ctries. 2012;6(4):324-8.
37. von Seidlein L, Kim DR, Ali M, Lee H, Wang X, Thiem VD, et al. A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology. PLoS medicine. 2006;3(9):e353.
38. Nunes MC, Magalhães PP, Penna FJ, Nunes JM, Mendes EN. Diarrhea associated with Shigella in children and susceptibility to antimicrobials. Jornal de Pediatria. 2011.
39. Victor O, Raphael G, Moses E, Paul T, Abimiku A, Augustina O, et al. Prevalence of Entamoeba histolytica Infection Using Microscopy and Adhesin Detection Methods among School Children in Central Nigeria. Asian Journal of Biology. 2017;2(4):1-9.
40. Bazzaz AA, Shakir OM, Alabbasy RH. Prevalence of Two Gastrointestinal Parasites Entamoeba histolytica and Giardia lamblia within Samarra City, Iraq. Advances in Bioscience and Biotechnology. 2017;08(11):399-410.
41. Ngeiywa MM, Odityo GA. Risk factors for the prevalence of Entamoeba histolytica in children aged under five years in a slum settlement in Nairobi, Kenya. Merit Res J Microbiol Biol Sci. 2016;4(5):68-73.
42. Harb A, Abraham S, Rusdi B, Laird T, O'Dea M, Habib I. Molecular Detection and Epidemiological Features of Selected Bacterial, Viral, and Parasitic Enteropathogens in Stool Specimens from Children with Acute Diarrhea in Thi-Qar Governorate, Iraq. International journal of environmental research and public health. 2019;16(9).
43. Harb A, O'Dea M, Hanan ZK, Abraham S, Habib I. Prevalence, risk factors and antimicrobial resistance of Salmonella diarrhoeal infection among children in Thi-Qar Governorate, Iraq. Epidemiology and infection. 2017;145(16):3486-96.
44. Zaidi MB, Estrada-Garcia T, Campos FD, Chim R, Arjona F, Leon M, et al. Incidence, clinical presentation, and antimicrobial resistance trends in Salmonella and Shigella infections from children in Yucatan, Mexico. Frontiers in microbiology. 2013;4:288.
45. Tabo DA, Granier SA, Diguimbaye CD, Marault M, Brisabois A, Mama B, et al. Are Salmonella-Induced Gastroenteritis Neglected in Developing Countries? Feedback from Microbiological Investigations in N'Djamena Hospitals, Chad. PloS one. 2015;10(8):e0136153.
46. Olobatoke RY. Public health burden of non-typhoidal Salmonella strains in sub-Saharan Africa. International Research Journal of Public and Environmental Health. 2017;4(6):112-9.
47. Eguale T, Gebreyes WA, Asrat D, Alemayehu H, Gunn JS, Engidawork E. Non-typhoidal Salmonella serotypes, antimicrobial resistance and co-infection with parasites among patients with diarrhea and other gastrointestinal complaints in Addis Ababa, Ethiopia. BMC infectious diseases. 2015;15:497.
48. Leung DT, Das SK, Malek MA, Ahmed D, Khanam F, Qadri F, et al. Non-typhoidal Salmonella gastroenteritis at a diarrheal hospital in Dhaka, Bangladesh, 1996-2011. The American journal of tropical medicine and hygiene. 2013;88(4):661-9.
49. Kaakoush NO, Castano-Rodriguez N, Mitchell HM, Man SM. Global Epidemiology of Campylobacter Infection. Clin Microbiol Rev. 2015;28(3):687-720.
50. Brooks TB, Shapiro RL, Kumar L, Wells JG, Phillips-Howard PA, Ya-Ping Shi, et al. Epidemiology of sporadic bloody diarrhea in rural Western Kenya. Am J Trop Med Hyg. 2003;68(6):671–7.
51. El-Shabrawi M, Salem M, Abou-Zekri M, El-Naghi S, Hassanin F, El-Adly T, et al. The burden of different pathogens in acute diarrhoeal episodes among a cohort of Egyptian children less than five years old. Przeglad gastroenterologiczny. 2015;10(3):173-80.
52. Blaser MJ. Epidemiologic and Clinical Features of Campylobacter jejuni Infections. JID. 1997;176(2):103-5.
53. Faten A A, Al –Dawmy and Afaf,Abdulrahman Yousif. Prevalence of E.coli O157:H7 in intestinal and Urinary tract infection in children. International Journal of Advanced Research. 2013;1(8):111-20.
54. Hassan JS. Antimicrobial Resistance Patterns of Escherichia Coli O157:H7 Isolated from Stool Sample of Children. Iraqi JMS. 2015;33(3):259-63.
55. Aspan A, Eriksson E. Verotoxigenic Escherichia coli O157:H7 from Swedish cattle; isolates from prevalence studies versus strains linked to human infections--a retrospective study. BMC veterinary research. 2010;6:7.
56. Abbasi P, Kargar M, Doosti A, Mardaneh J, Dalini SJ, Dehyadegari MA. Real Time PCR for Characterization of Enteroinvasive E. coli (EIEC) in Children with Diarrhea in Shiraz. Annals of Colorectal Research. 2014;2(3):1-5.
57. Krishnan Rajeshwari MM, A. P. Dubey, Beena Uppal and S. Anuradha. Spectrum of dysentery in children presenting to a tertiary level teaching hospital in New Delhi. Int J Med Med Sci. 2013;5(4):158-62.
58. Bodhidatta L, Vithayasai N, Eimpokalarp B, Pitarangsi C, Serichantalergs O, Isenbarger D. Bacterial Enteric Pathogens in Children with Acute Dysentery in Thailand: Increasing Importance of Quinolone-Resistant Campylobacter. South Asia J Trop Med Puplic Health. 2002;33(4):752-7.
59. Faundez G, Figuroa G, Trancoso M, Cabello FC. Characterization of Enteroinvasive Escherichia coli Strains Isolated from Children with Diarrhea in Chile. J CLIN MICROBIOL. 1988;26(5):928-32.
60. Ud-Din A, Wahid S. Relationship among Shigella spp. and enteroinvasive Escherichia coli (EIEC) and their differentiation. Brazilian Journal of Microbiology. 2014;45(4):1131-8.
61. Beutin L, Gleier K, Kontny I, Echeverria P, Scheutz F. Origin and characteristics of enteroinvasive strains of Escherichia coli (EIEC) isolated in Germany. Epidemiology and infection. 1997;118(3):199-205.
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