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Diarrhea in Libyan children presentation
 

Diarrhea in Libyan children presentation

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    Diarrhea in Libyan children presentation Diarrhea in Libyan children presentation Presentation Transcript

    • ‫بسم ا الرحمن الرحيم‬ Diarrhea in Libyan Children: Causative agents, Clinical features, Treatment and Prevention Ghenghesh KS, Ali MB, Abeid S, Tawil KA, Taher IA, Tobgi R, and Franka EA
    • INTRODUCTION • Diarrhea remains one of the principle causes of morbidity and mortality in children worldwide. • In Libya, studies on the causative agents of children diarrhea are few. • However, from the available data, the causative agents, clinical features, treatment and prevention of childhood diarrhea in Libya will be presented in this lecture.
    • Causative Agents of Childhood Diarrhea in Libya
    • Agent Rate of occurrence ----------------------------------------------------------------------------------------• Single 35-44% • Multiple 6-13% • Not-identified 43-59% • Bacteria 1. EPEC* 4-11% 2. EAEC** NK# 3. EHEC*** 7% 4. Salmonella sp. 6-11% 5. Shigella sp. 4-6% 6. Yersinia enterocolitica <1% 7. Campylobacter sp. 2-6% 8. Aeromonas sp. 0-15% • Parasitic 1. Entamoeba histolyitca/disapr 12% 2. Giardia lamblia 1% 3. Cryptosporidium 13% • Rotavirus 24-31% #Not known *Enteropathogenic Escherichia coli **Enteroaggregative E. coli. ***Enterohemorrhagic E. coli
    • Age distribution of causative agents of childhood diarrhea in Zliten % positive Agents <12m >12m (n=124) (n=45) ----------------------------------------------------------------------------------------------• Single 44 44 • Multiple 13 11 • Rotavirus 34* 7 • Salmonella 18* 2 • Shigella 0 13** • Aeromonas 2 13** • Cryptosporidium 16.5* 0 • Entamoeba histolytica/dispar 5 31** • Giardia lamblia 1 2 • Not-identifiable 43 45
    • Seasonal distribution of causative agents of childhood diarrhea in Zliten % positive Agent Spr Sum Aut Wi (n=25) (n=62) (n=51) (n=31) --------------------------------------------------------------------------------------------------------• Single 40 45 45 45 • Multiple 8 6.5 10 32*** • Rotavirus 32 19 25.5 39*** • Salmonella 12 3 20*** 26*** • Shigella 4 5 4 0 • Aeromonas 8 11* 0 0 • Cryptosporidium 0 6 2 35.5*** • Entamoeba histolytica/ 0 18* 14** 6.5 dispar • Giardia lamblia 0 2 0 3 • Not-identifiable 52 48 45 23
    • Nosocomial Children Diarrhea • Salmonella • Multiple agents • Rotavirus??
    • • Salmonella is the major bacterial cause of childhood diarrhea in Libya • Over the years different Salmonella serotypes associated with children diarrhea were reported from different Libyan cities.
    • Salmonella Serotypes Isolated from Diarrhoeic Faeces in Tripoli (1975-1980) – S. Wien – S. Muenchen – S. Typhimurium Salmonella Serotypes Isolated from Children with Diarrhoea in Tripoli (1992-1993) – S. Saintpaul – S. Muenchen Salmonella Serotypes Isolated from Children with Diarrhoea in Zliten (2000-2001) – S. Heidelberg – S. Enteritids
    • Clinical Features • Fever and severe dehydration are common clinical features among diarrheic children particularly those affected by rotavirus. • Around 10% of children with diarrhea were given oral rehydration salts (ORS) before stool collection.
    • Table 2. Information about Libyan children with diarrhea in Tripoli and their Shigella isolates Patient Sex Age (Mo) Month of Length of Episode Species and occurrence diarrhea per day serotype of (days) Shigella ------------------------------------------------------------------------------------------------------1. F 11 Sep 1 5 S. sonnei 2. F 30 Sep 2 3 S. flexneri type2 3. M 27 Oct 1 6 S. sonnei 4. F 18 Oct 1 8 S. flexneri type2 5. F 36 Oct 2 5-7 S. flexneri type2 6. M 7 Dec 7 7-8 S. flexneri type1 7. M 7 Apr 1 10 S. flexneri type2 8. M 13 Jun 10 6-7 S. flexneri type3 9. M 32 Jul 1 4 S. sonnei
    • Information about Libyan children with diarrhea and their Shigella isolates Faeces with Patient Mucus Presence of Blood Fever Vomiting Species and serotype of Shigella --------------------------------------------------------------------------------------------------------------------1. + + --S. sonnei 2. ----S. flexneri type2 3. --+ -S. sonnei 4. ----S. flexneri type2 5. + + + -S. flexneri type2 6. --+ -S. flexneri type1 7. + + + + S. flexneri type2 8. + + + + S. flexneri type3 9. + + + + S. sonnei
    • Table 2: Frequency distribution of clinical features in relation to different enteropathogens. Benghazi Clinical Features (% of patients) Agent Rotavirus Salmonella spp. Shigella spp. Campylobacter spp. Vomiting 97 89 88 100 Fever 71 85 94 94 Tenesmus Severe dehydration 21 31 12 0 6 12 6 13 Cough 30 39 18 25
    • Breast Feeding • A statistically significant association was observed between the diarrheic children and artificial feeding and between controls and breast – feeding. • In a Benghazi study, about 50% of diarrheic children were bottle-fed, while only 14% of breast-fed children were diarrheic. • Similar findings were reported from studies carried out in Tripoli and Zliten.
    • Emergence of multi-resistant enteric pathogens from Libyan children with Diarrhea
    • • The emergence of antimicrobialresistant enteric bacterial pathogens in this population has been noted and may complicate treatment options. • The ease by which antimicrobial agents can be obtained over the counter in Libya may a play role in the emergence of this problem.
    • Resistance of Salmonella Isolated from Libyan Children with Diarrhea to Antibiotics % resistant Antibiotic Zliten Tripoli Benghazi (n=23) (n=21) (n=26) ---------------------------------------------------------------------------------------------------Ampicillin 100@ 52 84 Amoxicillin+ clavulanic acid 87 NT 76 Cefoxitin 87 43 84 Chloramphenicol 96 52 65 Doxycycline 91 14* 68* Nalidixic acid 4 NT 12 Norfloxacin 0.0 0.0** NT Gentamicin 78 43*** 44 Trimethoprim+ sulphamethoxazole 4 NT 52 ---------------------------------------------------------------------------------------------*Tetracycline, **Ciprofloxacin, ***Tobramycin, NT=not tested.
    • Availability of antibiotics in local pharmacies of Zliten Antibiotic Pharmacies (n=5) ------------------------------------------------------------------------------------Ampicillin 100 Amoxicillin+ clavulanic acid 100 Cefoxitin 100 Chloramphenicol 100 Doxycycline 100 Nalidixic acid 0.0 Norfloxacin 0.0 Gentamicin 100 Trimethoprim+ sulphamethoxazole 0.0
    • • A strong relationship was observed between the availability of antibiotics in the pharmacies of Zliten city and resistance of the isolated salmonellae to these drugs.
    • TRANSMISSION • Fecal to oral contact – – – – • • • • Nurseries Schools Play grounds Others Contaminated food Water supply Poor sanitary conditions Pets • Important: – Children to adults transmission
    • TREATMENT • Maintaining Fluid and Electrolyte Balance. • Antibiotics – Usually contraindicated >> WHY? – Used in: • Severe cases >> systematic infections – e.g. Enteric fever • Bacillary dysentery and cholera if the organisms are susceptible. – disease duration diminished
    • CONTROL AND PREVENTION • Hand Washing – Parents, care-providers in nurseries, and older children. • Breast Feeding >> very important • Proper Sewage Disposal and Water Standards Be Observed (i.e. chlorination of water). • Food Cooked Properly – Bottled milk should be prepared hygienically. • FLIES >>>>>>>>>>>>>>>> • Vaccination: – Two new oral rotavirus vaccines, developed by Merck & Co. and GlaxoSmithKline Biologicals, prevented at least 98% of severe cases of gastroenteritis, or intestinal inflammation. – Must be tailored for strains unique to certain countries or geographical regions.
    • SUMMARY • Viral, bacterial and parasitic pathogens play an important role in the etiology of diarrhea in children in Libya with rotavirus, salmonellae and Cryptosporidium as the major agents. • The misuse of antibiotics by the community and clinicians may be an important factor in the emergence of multi-resistance among the enteric bacterial pathogens isolated from diarrheic Libyan children to the commonly used antibiotics.
    • RECOMMENDATIONS • A vigorous educational program that promotes the benefits of using ORS and breast feeding is needed. • • Also, the introduction of a rotavirus vaccine into the vaccination program in Libya to protect the pediatric population should be taken into consideration.