European Journal of Scientific Research - EuroJournals

Aetiology and Epidemiology of Sever Infantile Diarrhoea in Baghdad, Iraq 368
study, a large majority of the infants developing rotavirus diarrhoea were at age when the infants
would have little contact with other children. Increases incidence of rotavirus infection was associated
with infants who were breast-fed and who were nursed by their mothers, rather than by others.
Although adults rarely suffer from rotavirus diarrhoea, it has been shown that the level of serum
rotavirus antibodies increases with age in females, reaching a peak during their child-bearing years
[36].
EPEC is second to Rotavirus as the most common of the enteric pathogens isolated, other
similar result was reported by [37].
Infection by Rotavirus and Salmonella are more important clinically than infections due to
Campylobacter which has a shorter duration, although it was uncommon that the above described
infection may be complicated by secondary infection and this usually resulted in more protracted
diseases with greater loss of body weight.
Over third of the diarrhea episodes presently investigated had no identifiable cause. Some of
which were presumably of a non-infectious aetiology while others may have been caused by enteric
pathogens not presently investigated. The latter may include other enteric viruses such as adenovirus
and Norwalk agent, or other parasites.
Age presented as a prominent factor influencing the frequency of isolation of enteric pathogens
associated with diarrhea. The majority of the infection occurred between 7 and 12 months of age,
isolation of enteric pathogens exhibited 3 peaks, at 7-12 months(45%), 1-6 months(30.5%) and 13-24
months of age(23.5%) respectively. These age periods corresponded with the times when infants were
being nursed, after they had been weaned and when they began to walk. Presumably diarrhea occurring
during the first two periods may be chiefly due to food-borne infections, while the environment may
provide additional sources of infection when the infants begin to walk. Consequently, personal and
food hygiene may be expected to be important influencing factors in the development of diarrhea
during early infancy, and this may be the reason to had a high findings results detected in Ethiopia
were Rotavirus detected in 49% EPEC in 19% and Campylobacter in 13% [37], a different result were
reported by Mahmood & Feachemt in 1987[35] as the peak admissions of all infantile diarrhea
occurred in the 2-3 months age group.
Thirty years ago the aetiologic agent used to be undetermined in the majority of acute
diarrhoeal infections. Recent advance in the laboratory techniques had remarkable increased the
recovery rate of significant enteropathogens in the stool of patient of patient with diarrhea. Rotavirus,
Campylobacter, and ETEC were considered the most significant newly discovered enteropathogens
[14, 9].The most frequent enteropathogen recovered in this study , as in most similar studies, was
Rotavirus , the present isolation rate for campylobacter is considered about the average for developing
countries which is in the range of 5-13% [37]. The isolation rate of pathogenic E. coli were 12.5% and
2.5% for EPEC and ETEC, it could be higher if we had facilities to recover heat labile ETEC. Positive
blood culture seemed to be rare in this studied cases 93 out of 157). Thus routine blood culture is
probably an unnecessary procedure for management of acute diarrhea.
Antimicrobial therapy was used prior to admission in 47.5% of the present cases.This rate is
higher than the unacceptable high figure (40.3%) reported in this country before [38].With the
exception of certain invasive bacterial and parasitic infections there is no evidence that antibiotics can
reduce fluid loss in diarrhoeal diseases. It is justifiable to administer specific antimicrobial therapy for
Shigella, campylobacter, G.lamblia and E. histolytica infections. Otherwise blind antimicrobial therapy
would not be beneficial in the majority of patients and possibly harmful in others [39, 40].
Many pediatrician over suspected septicaemia on clinical ground to give themselves
justification for giving intensive antimicrobial agent treatment , forgetting that the sever clinical
manifestations appearing on their patients are most likely due to pathophysiological disturbances
associated with diarrhea rather than to septicemia.
Prevention of diarrhea requires vast, complex and expensive medical, sociological and
environmental improvements designed to reduce contact of enteric pathogens, increase awareness of