versão On-line ISSN 1683-9803
DA SILVA MELLO DE MARTINEZ, María Elsa. Acute Diarrheal Disease in Children: Most Common Causative Agents in the Central Chaco. Pediatr. (Asunción) [online]. 2011, vol.38, n.3, pp.191-198. ISSN 1683-9803.
Introduction: Acute diarrheal disease (ADD) is one of leading causes of morbidity in underdeveloped countries and causes high rates of medical consultation and hospitalization for pediatric patients. Diarrhea is the third-most common presenting complaint after fever and cough, and constitutes a serious public health problem. Infectious agents are a common cause of acute diarrhea. Objectives: To determine the incidence of causal agents and the treatment profiles instituted for acute diarrheal disease. Material and Methods: We conducted a retrospective cross-sectional study. Our universe consisted of the 560 medical records of children aged 2 months to 16 years for whom fecal cultures were done at the Hospital in Filadelfia, Paraguay from January 2008 to April 2011. Age, symptoms, fecal analysis, isolates, time of progression, days hospitalized, and treatments were analyzed. Results: We analyzed 560 patient records and fecal culture results from patients with diarrhea. Of those, 167 were aged from 2 months to 16 years, with 74% age 1-3 years, 16% age 4-9 years, and 10% age 10-16 years. Shigella spp. were isolated in 8.38% of cases, of which S. flexneri constituted 86%, S. sonnei 7%, and other Shigella spp. 7%. Salmonella spp. were isolated in 7.78%, and Campylobacter in 4.19%. Rotavirus was identified in 13.17%, with 91% (20/22) of those being under age 5 years. Giardia was the only parasite isolated. Resistance to commonly used antimicrobials was tested; R versus ciprofloxacin was found to be 9% for Shigella and 14% for Campylobacter; and R versus ampicillin was 82% for Shigella and 9% for Salmonella; while R was 8% for Shigella and was sensitive to Salmonella. Salmonella spp. and Shigella spp. were sensitive to cefixime. Progression prior to consultation was from 1 to 8 days with a mean of 4.5 days, while 96 children were hospitalized. Symptoms were associated with different causative agents: vomiting was present in 95% of those infected by rotaviruses and 68% of those with bacterial infections while fever was presented in 82% with bacterial infections and 86% of those with rotaviruses. Abdominal pain was reported by 68% with bacterial infections and 55% of those with rotaviruses. Samples showed Leukocytes in 88%, red blood cells in 85%, and mucus in 59% of those with bacterial infections, and in 36%, 32%, and 32% of those from rotavirus-infected patients. Dehydration was found in 60%. Serum IVs were used in 53% of patients and oral rehydration solution for 35%. Conclusions: Shigella spp. and salmonella spp. were the most commonly isolated bacteria. These findings are influences by the local situation including geography, the lack of potable water, and the poverty of most of the population including indigenous persons and workers arriving from other parts of the country. Rotaviruses were the non-bacterial agent most commonly isolated. Due to the vaccine introduced a year-and-a-half ago, we expect this situation to be reversed.
Palavras-chave : Acute diarrheal disease; causative agents; incidence; treatment.