Prospective study of enteropathogens in two communities of Misiones, Argentina

Vergara, Marta; Quiroga, Marina; Grenon, Sandra; Pegels, Eduardo; Oviedo, Patricia; Deschutter, Jorge; Rivas, Marta; Binsztein, Norma; Claramount, Raul

doi:10.1590/S0036-46651996000500004

Abstracts

Children under five years of age, from two communities of different socio-economic strata (97 from Zaiman and 55 from Las Dolores) were examined epidemiologically during 2 years, by means of quarterly visits of the working team, who carried out the collection of faecal samples. During the study, one or more enteropathogens were identified in 73.9% of samples in children from Zaiman and in 58.3% of the samples from Las Dolores, being associated to diarrhoea in 70.5% and to asymptomatic infections in 65.7%. The number of diarrheic episodes was higher in Zaiman (15.45%) than in Las Dolores (12.35%), being more frequent in the spring-summer seasons. In Zaiman, the bacterial enteropathogen proportion was relevantly higher (p< 0.005) in children with diarrhoea, whereas the presence of parasites was more frequent in asymptomatic children (p< 0.01). Rotavirus had an even distribution within diarrheic and asymptomatic children. In Las Dolores, no relevant differences were found in the detection of enteroparasites between diarrheic and asymptomatic children. Mixed infections were detected; enterotoxigenic Escherichia coli (ETEC)-rotavirus and ETEC-parasites being the most frequent ones. ETEC was involved in 85% of these infections. These data, together with the high enteropathogen carriage, suggest an elevated level of environmental contamination. The latter plays an important role in diarrheic diseases, and added to the most extreme poverty, it affects children's lives.

Acute diarrhoea; Epidemiology; Infection; Risk factor; Morbidity

Niños menores de cinco años de edad de dos comunidades de diferente condición socio-económica (97 del Barrio Zaimán y 55 del Barrio Las Dolores), fueron vigilados epidemiologicamente durante 2 años, mediante visitas trimestrales del equipo de trabajo, el que realizó la toma de muestras fecales. Durante el estudio, se identificaron uno o más enteropatógenos en el 73,9% de las muestras de niños del Barrio Zaimán y en el 58,3% de Las Dolores, estando asociados a diarrea en un 70,5% y en infecciones asintomáticas en un 65,7%. El número de episodios de diarrea fue superior en Zaimán (15,5%) que en Las Dolores (12,4%), presentándose con mayor frecuencia en los meses de primavera-verano. En el Barrio Zaimán la proporción de enteropatógenos bacterianos fue significativamente mayor (p < 0.005) en los niños con diarrea, mientras que los parásitos se presentaron con mayor frecuencia en niños asintomáticos (p < 0.01). Rotavirus tuvo una distribución comparable en niños con diarrea y asintomáticos. En el Barrio Las Dolores, no se encontraron diferencias significativas en la deteccion de enteroparásitos entre asintomáticos y niños con diarrea. Se detectaron infecciones mixtas, siendo ECET-rotavirus y ECET-parásitos, las mas frecuentes. ECET estuvo involucrado en el 85%; de las mismas. Estos datos y la elevada portación de enteropatógenos, sugieren un alto nivel de contaminación ambiental, la cual juega un rol importante en la enfermedad diarreica, que sumada a la pobreza más extrema, afecta la vida de los niños

EPIDEMIOLOGY

Prospective study of enteropathogens in two communities of Misiones, Argentina

Estudio prospectivo de enteropatógenos en dos comunidades de Misiones, Argentina

Marta Vergara^I; Marina Quiroga^I; Sandra Grenon^I; Eduardo Pegels^I; Patricia Oviedo^I; Jorge Deschutter^I; Marta Rivas^II; Norma Binsztein^II; Raul Claramount^III

^INational University of Misiones, Félix de Azara 174. (3300) Posadas, Misiones, Argentina

^IINational Institute of Microbiology "Dr. Carlos Malbrán". Velez Sarsfileld 563. (1281) Buenos Aires, Argentina

^IIIPublic Health Department of Misiones, Junín y Tucumán. (3300) Posadas, Misiones, Argentina

^{Correspondence to} Correspondence to: Dra. Maria VERGARA National University of Misiones Félix de Azara 174 (3300) Posadas, Misiones, Argentina FAX 0054-752-27687/25414

SUMMARY

Children under five years of age, from two communities of different socio-economic strata (97 from Zaiman and 55 from Las Dolores) were examined epidemiologically during 2 years, by means of quarterly visits of the working team, who carried out the collection of faecal samples.

During the study, one or more enteropathogens were identified in 73.9% of samples in children from Zaiman and in 58.3% of the samples from Las Dolores, being associated to diarrhoea in 70.5% and to asymptomatic infections in 65.7%. The number of diarrheic episodes was higher in Zaiman (15.45%) than in Las Dolores (12.35%), being more frequent in the spring-summer seasons.

In Zaiman, the bacterial enteropathogen proportion was relevantly higher (p< 0.005) in children with diarrhoea, whereas the presence of parasites was more frequent in asymptomatic children (p< 0.01). Rotavirus had an even distribution within diarrheic and asymptomatic children. In Las Dolores, no relevant differences were found in the detection of enteroparasites between diarrheic and asymptomatic children. Mixed infections were detected; enterotoxigenic Escherichia coli (ETEC)-rotavirus and ETEC-parasites being the most frequent ones. ETEC was involved in 85% of these infections.

These data, together with the high enteropathogen carriage, suggest an elevated level of environmental contamination. The latter plays an important role in diarrheic diseases, and added to the most extreme poverty, it affects children's lives.

Keywords: Acute diarrhoea; Epidemiology; Infection; Risk factor; Morbidity.

RESUMO

Niños menores de cinco años de edad de dos comunidades de diferente condición socio-económica (97 del Barrio Zaimán y 55 del Barrio Las Dolores), fueron vigilados epidemiologicamente durante 2 años, mediante visitas trimestrales del equipo de trabajo, el que realizó la toma de muestras fecales.

Durante el estudio, se identificaron uno o más enteropatógenos en el 73,9% de las muestras de niños del Barrio Zaimán y en el 58,3% de Las Dolores, estando asociados a diarrea en un 70,5% y en infecciones asintomáticas en un 65,7%. El número de episodios de diarrea fue superior en Zaimán (15,5%) que en Las Dolores (12,4%), presentándose con mayor frecuencia en los meses de primavera-verano.

En el Barrio Zaimán la proporción de enteropatógenos bacterianos fue significativamente mayor (p < 0.005) en los niños con diarrea, mientras que los parásitos se presentaron con mayor frecuencia en niños asintomáticos (p < 0.01). Rotavirus tuvo una distribución comparable en niños con diarrea y asintomáticos.

En el Barrio Las Dolores, no se encontraron diferencias significativas en la deteccion de enteroparásitos entre asintomáticos y niños con diarrea.

Se detectaron infecciones mixtas, siendo ECET-rotavirus y ECET-parásitos, las mas frecuentes. ECET estuvo involucrado en el 85%; de las mismas.

Estos datos y la elevada portación de enteropatógenos, sugieren un alto nivel de contaminación ambiental, la cual juega un rol importante en la enfermedad diarreica, que sumada a la pobreza más extrema, afecta la vida de los niños.

Full text available only in PDF format.

Texto completo disponible sólo en PDF.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENTS

This paper was carried out with the contribution of the Public Health Department of Misiones, the Foundation of Exact, Chemistry and Sciences Faculties of the National University of Misiones and the Swedish Agency for Research and Cooperation with Developing Countries (SAREC).

To Lidia Schiavonni, anthropologist, for the elaboration of the socio-economic analysis of both communities.

Recebido para publicação em 03/08/1996

Aceito para publicação em 18/10/1996

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2. BEAVER, P.C. - The standardization of fecal smears for estimating egg production and worm burden. J. Parasit., 36: 451-456, 1950.
3. BENASSI, F.; MARTINEZ VAZQUEZ, F.; EUIGUER, T.; BENDERSKY, S. & MARTOS, A. - Aislamientos de nuevas serovariedades de Salmonella en cursos de agua. Rev. argent. Microbiol., 17: 149-155, 1985.
4. BINSZTEIN, N.; RIVAS, M.; LIFSHITZ, M. et al. - Estudio prospective de infecciones y reinfecciones por Escherichia coli enterotoxigenico en dos comunidades de Argentina. In: CONGRESO LATIONAMERICANO DE INFECTOLOGIA PEDIATRICA, 4., CONGRESO CHILENO DE INFECTOLOGIA, 7., Santiago de Chile, 1991.
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10. CHAN, F. & MACKENZIE A. - Enrichment medium and control system of isolation of Campylobacter fetus subsp. jejuni from stools. J. clin. Microbiol., 15: 12-15, 1982.
11. CRAVIOTO, A.; REYES, R.; ORTEGA, R. et al. - Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolation pathogens during the first two years of life. Epidem. Infect., 101: 123-134, 1988.
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13. ECHEVERRIA, P.; BLACKLOW, N. & SMITH, D. - Role of heal labile toxigenic Escherichia coli and reovirus-like agent in diarrhoea in Boston children. Lancet, 2: 1113-1116, 1975.
14. EDWARD, P.R. & EWING, W.H. -The genus Shigella and the genus Salmonella, in: EDWARD, P.R. & EWING, W.H., ed. Identification of Enterobacteriaceae. 3. ed. Minneapolis. Burgess Pub., 1972. p. 108-139, p. 146-205.
15. EVANS, D.; OLARTE, J.; DUPONT, H. et al. - Enteropathogens associated with pediatric diarrhoea in Mexico city. J. Pediat., 91: 65-68, 1977.
16. FELDMAN, R.A.; BHAT, P. & KAMATH, K.R. - Infection and disease in a group of South Indian families. Bacteriologic methods and a report of the frequency of enteric bacterial infection in preschool children. Amer. J. Epidem., 92: 367-375, 1970.
17. FIGUEROA, G.; TRONCOSO, M.; ARAYA, M.; ESPINOZA, J. & BRUNSER, Q. - Enteropathogen carriage in healthy individuals living in a contamined environment. J. Hyg., 91: 499-507, 1983.
18. GARCIA, L.S.; BRENVER, T.C.; BRUCKNER, D.A. & SHIMUZU, R.B. - Acid-fast staining of Cryptosporidium from human faecal specimens. Clin. Microbiol. Newsl., 5: 60-62, 1983.
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20. CORDON, J.E.; GUZMAN, M.A.; ASCOLI, W. et al. - Acute diarrhoeal diseases in less developed countries: patterns of epidemiological behaviour in rural Guatemalan villages. Bull. Wld. Hlth. Org., 31: 9-20, 1964.
21. GUERRANT, R.L.; KIRCHHOFF, L.V.; SHIELDS, D.S. et al.- Prospective study of diarrhoeal illnesses in northeastern Brazil: patterns of disease, nutritional impact, etiologies and risk factors, J. infect. Dis., 148: 986-997, 1983.
22. GUERRANT, R.L.; LOHR, J. & WILLIAMS, E. - Acute infectious diarrhoea. Epidemiology, etiology and pathogenesis. Pediat. infect. Dis., 5: 353-359, 1986.
23. GUERRANT, R.L.; MOORE, R.; KIRCHENFELD, P. & SANDE, M. - Role of toxigenic and invasive bacteria in acute diarrhoea of childhood. New Engl. J. Med., 293: 567-573, 1975.
24. GURWITH, M. & WILLIAMS, T. - Gastroenteritis in children: a two-year prospective review in Manitoba. J. infect. Dis., 136: 239-247, 1977.
25. JANDA, J.M.; BOTTONE, E.J.; SKINNER, C.V. & CALCATERRA, D. - Phenotypic markers associated with gastrointestinal Aeromonas hydrophila isolated from symptomatic children. J. clin. Microbiol., 17: 588-591, 1983.
26. KAIN, K.; BARTELUK, R.; KELLY, M. et al. - Etiology of childhood diarrhoea in Beijing, China. J. clin. Microbiol., 29: 90-95, 1991.
27. LORTIE, L.A.; DUBREUIL, J. & HAREL, J. - Characterization of Escherichia coli strains producing heat-stable enterotoxin b (STb) isolated from humans with diarrhoea. J. clin. Microbiol., 29: 656-659, 1991.
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31. MATA, L.J.; SIMHON, A.; PADILLA, R. et al. - Diarrhoea associated with rotaviruses, enterotoxigenic Escherichia coli, Camhylohacter, and other agents in Costa Rican children, 1976-1981. Amer. J. trop. Med. Hyg., 32: 146-153, 1983.
32. MONTEJO de ARAMAYO, I.; GALANTERNIK, L.; BOTTO, L. et al. - Agentes patógenos entéricos aislados en nińos con diarrea aguda asistidos en el Hospital de Nińos "R. Gutierrez". Arch. argent. Pediat., 85: 181-189, 1987.
33. NOTARIO, R.; MORALES, E.; CARMELENGO, E. et al. - Microorganismos enteropatógenos en nińos con diarrea aguda en dos hospitales de Rosario, Argentina. Medicina (B. Aires), 53: 289-299, 1993.
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35. PRADO, V.; SIRI, M.T.; AVEDAÑO,L.F. et al. - Prevalencia de agentes enteropatógenos en síndrome diarreico agudo en nińos hospitalizados y ambulalorios. Rev. chil. Pediat., 58: 285-290, 1987).
36. REIS, M.H.; GUTH, B.; GOMES, T.; MURAHOVSCHI, J. & TRABULSI, L. - Frequency of Escherichia coli strains producing heat-labile toxin or heat-stable toxin or both in children with and without diarrhoea in Săo Paulo. J. clin. Microbiol., 15: 1062-1064, 1982.
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Correspondence to:

Dra. Maria VERGARA

National University of Misiones

Félix de Azara 174 (3300)

Posadas, Misiones, Argentina

FAX 0054-752-27687/25414

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Oct 1996

History

Accepted
18 Oct 1996
Received
03 Aug 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARAYA, M.; FIGUEROA, G.; ESPINOZA, J.; ZARUR, X. & BRUNSER, O. - Acme diarrhoea and asymptomatic infection in children preschoolers of low and high socio-economic strata. Acta pediat. stand., 75: 645-651, 1986.

[2] 2. BEAVER, P.C. - The standardization of fecal smears for estimating egg production and worm burden. J. Parasit., 36: 451-456, 1950.

[3] 3. BENASSI, F.; MARTINEZ VAZQUEZ, F.; EUIGUER, T.; BENDERSKY, S. & MARTOS, A. - Aislamientos de nuevas serovariedades de Salmonella en cursos de agua. Rev. argent. Microbiol., 17: 149-155, 1985.

[4] 4. BINSZTEIN, N.; RIVAS, M.; LIFSHITZ, M. et al. - Estudio prospective de infecciones y reinfecciones por Escherichia coli enterotoxigenico en dos comunidades de Argentina. In: CONGRESO LATIONAMERICANO DE INFECTOLOGIA PEDIATRICA, 4., CONGRESO CHILENO DE INFECTOLOGIA, 7., Santiago de Chile, 1991.

[5] 5. BLACK, R.; BROWN, K.; BECKER, S.; ABDUL ALIM, A. & HUG, I. Longitudinal studies of infectious diseases and physical growth of children in rural Bangladesh. Amer. J. Epidem., 115: 315-324, 1982.

[6] ⁶
BOLETIN EPIDEMIOLOGICO NACIONAL - Sistema Nacional de Vigilancia de las Enfermedades. Ministerio de Salud y Acción Social de la República Argentina. Boletin Anual, 1990.

[7] 7. BRUSSOW, H.; SIDOTI, J.; LINK, H. et al. - Age-specific prevalence of antibody to enterotoxigenic Escherichia coli in Ecuadorian and German children. J. infect. Dis., 162: 974-977, 1990.

[8] 8. BUTZLER, J.P. - Isolation of Campylobacter from human faeces. In: BUTZLER, J.P. Campylobacter infection in man and animals. Boca Raton. CRC Press, 1984. p. 39-50.

[9] 9. CHAMPSAUR, H.; QUESTIAUX, E.; PREVOT, J. et al. - Rotavirus carriage: asymptomatic infection and disease in the first two years of life. I. Virus shedding. J. infect. Dis., 149: 667-674, 1984.

[10] 10. CHAN, F. & MACKENZIE A. - Enrichment medium and control system of isolation of Campylobacter fetus subsp. jejuni from stools. J. clin. Microbiol., 15: 12-15, 1982.

[11] 11. CRAVIOTO, A.; REYES, R.; ORTEGA, R. et al. - Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolation pathogens during the first two years of life. Epidem. Infect., 101: 123-134, 1988.

[12] 12. DANIEL, W. Estimación de los parámetros de la población. In: DANIEL, W. Estadística con aplicación a las ciencias sociales y a la educatión. Bogotá. McGraw-Hill Latinoamericana, 1981. p. 141-187.

[13] 13. ECHEVERRIA, P.; BLACKLOW, N. & SMITH, D. - Role of heal labile toxigenic Escherichia coli and reovirus-like agent in diarrhoea in Boston children. Lancet, 2: 1113-1116, 1975.

[14] 14. EDWARD, P.R. & EWING, W.H. -The genus Shigella and the genus Salmonella, in: EDWARD, P.R. & EWING, W.H., ed. Identification of Enterobacteriaceae. 3. ed. Minneapolis. Burgess Pub., 1972. p. 108-139, p. 146-205.

[15] 15. EVANS, D.; OLARTE, J.; DUPONT, H. et al. - Enteropathogens associated with pediatric diarrhoea in Mexico city. J. Pediat., 91: 65-68, 1977.

[16] 16. FELDMAN, R.A.; BHAT, P. & KAMATH, K.R. - Infection and disease in a group of South Indian families. Bacteriologic methods and a report of the frequency of enteric bacterial infection in preschool children. Amer. J. Epidem., 92: 367-375, 1970.

[17] 17. FIGUEROA, G.; TRONCOSO, M.; ARAYA, M.; ESPINOZA, J. & BRUNSER, Q. - Enteropathogen carriage in healthy individuals living in a contamined environment. J. Hyg., 91: 499-507, 1983.

[18] 18. GARCIA, L.S.; BRENVER, T.C.; BRUCKNER, D.A. & SHIMUZU, R.B. - Acid-fast staining of Cryptosporidium from human faecal specimens. Clin. Microbiol. Newsl., 5: 60-62, 1983.

[19] 19. GOMES, T.A.T.; RASSI, V.; MACDONALD, K.L. et al. - Enteropathogens associated with acute diarrhoeal disease in urban infants in Săo Paulo, Brazil. J. infect. Dis., 164: 331-337, 1991.

[20] 20. CORDON, J.E.; GUZMAN, M.A.; ASCOLI, W. et al. - Acute diarrhoeal diseases in less developed countries: patterns of epidemiological behaviour in rural Guatemalan villages. Bull. Wld. Hlth. Org., 31: 9-20, 1964.

[21] 21. GUERRANT, R.L.; KIRCHHOFF, L.V.; SHIELDS, D.S. et al.- Prospective study of diarrhoeal illnesses in northeastern Brazil: patterns of disease, nutritional impact, etiologies and risk factors, J. infect. Dis., 148: 986-997, 1983.

[22] 22. GUERRANT, R.L.; LOHR, J. & WILLIAMS, E. - Acute infectious diarrhoea. Epidemiology, etiology and pathogenesis. Pediat. infect. Dis., 5: 353-359, 1986.

[23] 23. GUERRANT, R.L.; MOORE, R.; KIRCHENFELD, P. & SANDE, M. - Role of toxigenic and invasive bacteria in acute diarrhoea of childhood. New Engl. J. Med., 293: 567-573, 1975.

[24] 24. GURWITH, M. & WILLIAMS, T. - Gastroenteritis in children: a two-year prospective review in Manitoba. J. infect. Dis., 136: 239-247, 1977.

[25] 25. JANDA, J.M.; BOTTONE, E.J.; SKINNER, C.V. & CALCATERRA, D. - Phenotypic markers associated with gastrointestinal Aeromonas hydrophila isolated from symptomatic children. J. clin. Microbiol., 17: 588-591, 1983.

[26] 26. KAIN, K.; BARTELUK, R.; KELLY, M. et al. - Etiology of childhood diarrhoea in Beijing, China. J. clin. Microbiol., 29: 90-95, 1991.

[27] 27. LORTIE, L.A.; DUBREUIL, J. & HAREL, J. - Characterization of Escherichia coli strains producing heat-stable enterotoxin b (STb) isolated from humans with diarrhoea. J. clin. Microbiol., 29: 656-659, 1991.

[28] 28. MANUAL DE LABORATORIO DE INEECCIONES ENTERICAS AGUDAS - Análisis primario de muestras fecales. Washington, Organización Panamericana de la Salud. Oficina Regional de la Organizatión Mundial de la Salud, 1983.

[29] 29. MATA, L.J. - The children of Santa Maria Cauqué: a prospective field study on health and growth. Cambridge, MIT Press, 1978.

[30] 30. MATA, L.J. - Epidemiology of acute diarrhoea in childhood. An overview. In: BELLATI, J.A., ed. Acute diarrhoea: its nutritional consequences in children. New York, Raven Press, 1983. p. 3-22.

[31] 31. MATA, L.J.; SIMHON, A.; PADILLA, R. et al. - Diarrhoea associated with rotaviruses, enterotoxigenic Escherichia coli, Camhylohacter, and other agents in Costa Rican children, 1976-1981. Amer. J. trop. Med. Hyg., 32: 146-153, 1983.

[32] 32. MONTEJO de ARAMAYO, I.; GALANTERNIK, L.; BOTTO, L. et al. - Agentes patógenos entéricos aislados en nińos con diarrea aguda asistidos en el Hospital de Nińos "R. Gutierrez". Arch. argent. Pediat., 85: 181-189, 1987.

[33] 33. NOTARIO, R.; MORALES, E.; CARMELENGO, E. et al. - Microorganismos enteropatógenos en nińos con diarrea aguda en dos hospitales de Rosario, Argentina. Medicina (B. Aires), 53: 289-299, 1993.

[34] 34. ORGANIZACION PANAMERICANA DE LA SALUD - Manual de tratamiento de la diarrea. Washington, 1987. (Serie PALTEX para ejecutores de programs de salud Nş 13).

[35] 35. PRADO, V.; SIRI, M.T.; AVEDAÑO,L.F. et al. - Prevalencia de agentes enteropatógenos en síndrome diarreico agudo en nińos hospitalizados y ambulalorios. Rev. chil. Pediat., 58: 285-290, 1987).

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Prospective study of enteropathogens in two communities of Misiones, Argentina

Estudio prospectivo de enteropatógenos en dos comunidades de Misiones, Argentina

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