Academic journal article Journal of Health Population and Nutrition

Prevalence of Viral, Bacterial and Parasitic Enteropathogens among Young Children with Acute Diarrhoea in Jeddah, Saudi Arabia

Academic journal article Journal of Health Population and Nutrition

Prevalence of Viral, Bacterial and Parasitic Enteropathogens among Young Children with Acute Diarrhoea in Jeddah, Saudi Arabia

Article excerpt


Diarrhoeal diseases are the most important cause of morbidity and mortality in developing countries. Five hundred million cases of acute diarrhoea occur annually in children aged less than five years throughout the world (1,2).

Although several pathogens are incriminated as the cause of acute diarrhoea, rotavirus is now recognized as the major cause of diarrhoea in infants and young children in both developed and developing countries (3). In addition, rotavirus has also been incriminated as the aetiologic agent of diarrhoea in older children and adults (4). In western Saudi Arabia, the incidence of rotavirus- associated infections in hospitalized infants and young children was found to be 42.4% over a five-year study period (5,6). In a study at the diarrhoea control centre in eastern Saudi Arabia, rotavirus was found in 37.5% of the diarrhoeal cases in children aged less than five years (7). Also in Riyadh, a study covering two years showed that rotavirus was present in 44.3% of the diarrhoeal stool specimens collected from children aged less than two years, admitted to two central hospitals (8). Rotavirus was isolated from 15.28% of the hospitalized children suffering from gastroenteritis during a study covering over one year in Delhi (9). In the USA, rotavirus is considered to be the major cause of dehydrating diarrhoea in children (10). Studies in temperate countries reveal that rotavirus-associated gastroenteritis occurs mainly in colder months (11).

Common enteropathogens after rotaviruses are: Salmonella, Shigella, Campylobacter jejuni, enteropathogenic Escherichia coli (EPEC), and enterotoxigenic E. coli (ETEC). Yersinia enterocolitica has also been recognized as a common cause of bacterial gastroenteritis (8,12).

In developing countries, Campylobacter-associated enteritis is common in young children (13). In Zaire, C. jejuni is the most commonly-isolated organism from children with diarrhoea (14). A recent study in Saudi Arabia showed that Campylobacter is considered a potential aetiological agent of bacterial enteritis both in children and young adults, second in prevalence to Salmonella and nearly similar to Shigella (15).

Parasitic agents, especially Cryptosporidium and Giardia, have also been aetiological agents of diarrhoea in children. A study from a day-care centre in the USA detected Cryptosporidium in 49% of children with diarrhoea and found that children aged less than three years were at high risk (16).

A longitudinal study of young children in Kenya showed that Giardia lamblia was the common aetiologic agent of diarrhoea, accounting for 44.7% of cases (17). Furthermore, there seems to be a clear Giardia-diarrhoea relationship in the age group of 19-24 months (18).

The present study was undertaken to investigate the prevalence of viral, bacterial and parasitic pathogens which cause infectious diarrhoea among children aged less than five years in Jeddah, Saudi Arabia.


Patients and stool specimens

In total, 576 faecal samples were collected during 15 December 1995-31 October 1996 from infants and young children, aged less than five years, with diarrhoea. Two hundred seventeen patients were admitted, and 20 were attending an outpatient clinic at the Maternity and Children's Hospital in Jeddah. This is a major referral hospital in Jeddah metropolitan area. Also, 339 samples were collected from the Al-Ansar Polyclinic in North Jeddah. Samples were stored at the hospital or clinic at 4 °C without dilution, and were collected and transferred to the laboratory three times a week.

For bacteriological examination, Cary-Blair Medium was used as a transport medium. For parasites and fungal studies, fresh stools were examined; otherwise, part of the specimens were frozen or preserved in 10% buffered formalin solution. For rotavirus study, part of the specimens were stored at -20 °C without dilution until used.

Identification of rotavirus

Stool specimens were screened for the presence of rotavirus using the commercially-available ELISA kit (DAKO, Denmark), and the test was performed in the procedure as recommended by the manufacturer. …

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