trimethoprim--sulfamethoxazole-drug-combination and Rotavirus-Infections

There is limited information available regarding the etiology of gastrointestinal infections in Burkina Faso. The aim of this study was to investigate the prevalence and epidemiology of enteric pathogens causing gastroenteritis in young children, with a focus on rotavirus, and to investigate the levels of malnutrition and other clinical factors in association with the severity of diarrhea.. A prospective study was undertaken from May 2009 to March 2010, covering the rainy and dry seasons, at the Saint Camille Medical Center in Ouagadougou, Burkina Faso. A total of 309 children less than 5 years of age with diarrhea were enrolled and examined for rotavirus, bacterial, and parasitic infections, as well as clinico-epidemiological aspects.. At least one enteropathogen was detected in 57.9% (n=179) of the children. Of these, 32.4% had rotavirus infections, 16.8% bacterial infections (enteropathogenic Escherichia coli 9.7%, Shigella spp 5.8%, and Salmonella spp 2.3%), and 18.8% parasitic infections (Giardia lamblia 11.3%, Trichomonas intestinalis 6.8%, Entamoeba histolytica/dispar 1.3%). During the cold dry period from December 2009 to February 2010, we observed a large increase in diarrhea cases, which was mainly attributed to rotavirus infections, as 63.8% of these diarrhea cases were positive for rotavirus. In contrast, no rotavirus infection was observed during the rainy season (June-September 2009), when the frequency of parasitic infections was high. Rotavirus and parasitic infections were age-related, with rotavirus being more prevalent in young children (<12 months) and parasites more common in older children (>12 months), while bacteria were equally prevalent among all age groups. Rotavirus infections exhibited more severe symptoms compared to bacteria and parasites, and were associated with fever, vomiting, and severe dehydration. Malnutrition, especially acute malnutrition (wasting), was significantly associated with more severe symptoms in rotavirus-induced diarrhea. The undernourished children also exhibited a prolonged duration of diarrheal episodes.. This study demonstrates rotavirus as the main etiological agent in pediatric diarrhea in Burkina Faso, and further shows the great severity of rotavirus-induced diarrhea in undernourished children in Burkina Faso.

Topics: Age Factors; Anti-Infective Agents; Bacterial Infections; Burkina Faso; Child, Preschool; Diarrhea; Drug Resistance, Bacterial; Female; Gastroenteritis; Humans; Infant; Male; Malnutrition; Parasitic Diseases; Prevalence; Rotavirus Infections; Seasons; Trimethoprim, Sulfamethoxazole Drug Combination

OBJECTIVE We sought to determine the etiologies, manifestations, and risk factors for persistent (> or =7 days) diarrhea in human immunodeficiency virus type 1 (HIV-1)-infected persons in Peru.. The present study is a case-control study of 147 HIV-1-infected case subjects with persistent diarrhea and 147 HIV-1-infected control subjects without diarrhea.. We obtained clinical, demographic, and exposure data, CD4 lymphocyte counts, and stool samples for detection of enteric parasitic and bacterial pathogens and rotavirus.. One or more enteric pathogen was identified in 55% of case subjects and 21% of control subjects (odds ratio adjusted for CD4 lymphocyte count, 3.8; 95% confidence interval, 2.2-6.5). The median CD4 lymphocyte count was highest with pathogen-free diarrhea and lowest with Cryptosporidium infection. Cryptosporidium species (the most frequent pathogen), Giardia lamblia, Aeromonas species, Campylobacter species, and rotavirus were all significantly associated with diarrhea. Bacterial pathogens were significantly associated with G. lamblia and rotavirus infection. Of the bacterial pathogens (Aeromonas, Campylobacter, Salmonella, and Vibrio species and enterotoxigenic Escherichia coli), only 24% were susceptible to cotrimoxazole, whereas 90% were susceptible to ciprofloxacin. In no case did the sensitivity or positive predictive value of specific clinical and laboratory findings for curable enteric infections exceed 50%.. Several enteric pathogens were associated with diarrhea in HIV-1-infected case subjects in Peru, especially among those who were heterosexual. Clinical findings were poor predictors of detectable microbial etiology. The guidelines for initial management of chronic diarrhea with sulfamethoxazole-trimethoprim in HIV-1-infected persons require revision, at least in settings where prophylaxis with this agent is common.

Topics: Adult; Aeromonas; Animals; Anti-Infective Agents; Bacterial Infections; Campylobacter; Case-Control Studies; CD4 Lymphocyte Count; Ciprofloxacin; Cryptosporidium; Diarrhea; Escherichia coli; Feces; Female; Giardia lamblia; HIV Infections; Humans; Male; Middle Aged; Peru; Protozoan Infections; Risk Factors; Rotavirus; Rotavirus Infections; Salmonella; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio