ETIOLOGY OF BLOODY DIARRHEA IN CHILDREN AND PREVALENCE OF E. COLI O157:H7

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
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.