Symptoms of food-borne diseases and gastroenteritis in Kyushu, Japan

In this study we analyzed the symptoms of gastroenteritis or food-borne disease caused by the 10 most prevalent pathogens: Norovirus, Salmonella, Vibrio parahaemolyticus, Campylobacter jejuni, Clostridium perfringens, Shiga toxin-producing Escherichia coli (STEC), enterotoxigenic E. coli (ETEC), Shigella sonnei/flexneri (Shigella), Staphylococcus aureus, and emetic-type Bacillus cereus. The symptoms diarrhea, vomiting, fever, abdominal pain, and headache, and the incubation period in 646 cases in 10 districts of Kyushu between January 2000 and December 2004 were recorded. The pathogen with the shortest mean incubation period was B. cereus (0.8 h), and was followed by S. aureus (3.3 h), C. perfringens (10.7 h) and V. parahaemolyticus (16.4 h). All the patients infected with B. cereus and S. aureus developed symptoms within 6 hours, and those infected with V. parahaemolyticus and C. perfringens developed symptoms within 24 hours. Bloody diarrhea was associated with STEC and Shigella, but rare with other pathogens. Vomiting was associated with almost all cases of S. aureus and B. cereus infection, and occurred in 71.5% of the Norovirus cases and 56.1% of the V. parahaemolyticus cases. Vomiting was less common in the C. perfringens (22.0%) and the ETEC and STEC (both about 5%). Bloody diarrhea, abdominal pain, and vomiting were statistically significantly more common with STEC 0157 infection than with STEC non-0157 infection. Since the cases analyzed in this study included all degrees of illness, mild to severe, and a wide range of ages, the information obtained will serve as a good reference material for administrative and laboratory work when an outbreak takes place.     

Campylobacter jejuni in hospitalized children with diarrhoea in Chiang Mai, Thailand

In this hospital based study, Campylobacter jejuni, although endemic in Northern Thailand was not found in a significantly higher percentage of diarrhoea than in control children. It was isolated from the stools of 14 of 208 diarrhoea (6.7%) and 6 of 108 (5.5%) control patients. Ten of the 14 positive diarrhoea cases were mixed infections, other pathogens isolated simultaneously were enteropathogenic E. coli 4x, Shigella spp. 3x, Salmonella spp. 4x, rotavirus 3x, Plesiomonas shigelloides 1x and parasites 3x. Infection with Campylobacter jejuni occurred mainly in the 1-2 year age group and was not found in patients over 5. It was distributed over the year without seasonal peaks. In four of the 14 positive C. jejuni cases no other pathogens were found. One of these suffered 2nd degree malnutrition with measles and one was a chronic diarrhoea case with a history of antibiotic use and past Salmonella and Shigella infections. The remaining two cases had no underlying or associated illnesses. It was concluded that Campylobacter jejuni may be important as an associated pathogen in complicated diarrhoea infections but is rare as a sole causative agent.     

The role of Shigella spp., enteroinvasive Escherichia coli, and other enteropathogens as causes of childhood dysentery in Thailand

Shigella spp. were isolated from 44%, Pleisomonas shigelloides from 22%, Campylobacter spp. from 16%, and Salmonella spp. from 10% of 200 Thai children with mucoid or bloody diarrhea. Enteroinvasive Escherichia coli (EIEC) was identified by examining isolates of E. coli for plasmids larger than 120 megadaltons (MDa), by identifying E. coli with a virulence marker antigen in an ELISA, and by performing DNA hybridization with a 17-kilobase (kb) EcoRI digestion fragment of plasmid pWR100 (a 140-MDa plasmid of Shigella flexneri 5). Sixty-four isolates of EIEC from 10 (5%) of the children were identified by these methods and confirmed by the Sereny test. All isolates of EIEC fermented lactose, and isolates of EIEC from seven children belonged to recognized serotypes of EIEC (O28ac:H- and O29:H-), whereas isolates of EIEC from three children were untypable. Examination of DNA from the total fecal growth with the 17-kb probe identified 9 of 10 children from whom EIEC were isolated and 2 of 102 children from whom EIEC or Shigella spp. were not isolated. Detection of EIEC by ELISA and DNA hybridization are important advances in defining the etiology of dysentery.     

Clinic-based surveillance for bacterial- and rotavirus-associated diarrhea in Egyptian children

To identify enteropathogens for vaccine development, we implemented clinic-based surveillance for severe pediatric diarrhea in Egypt's Nile River Delta. Over 2 years, a physician clinically evaluated and obtained stool samples for microbiology from patients with diarrhea and less than 6 years of age. In the first (N = 714) and second clinic (N = 561), respectively, 36% (N = 254) and 46% (N = 260) of children were infected with rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter, or Shigella. When excluding mixed rotavirus-bacterial infections, for the first and second clinic, 23% and 10% had rotavirus-associated diarrhea, and 14% and 17% had ETEC-associated diarrhea, respectively. Campylobacter-associated diarrhea was 1% and 3%, and Shigella-associated diarrhea was 2% and 1%, respectively, for the two clinics. Rotavirus-associated diarrhea peaked in late summer to early winter, while bacterial agents were prevalent during summer. Rotavirus-associated cases presented with dehydration, vomiting, and were often hospitalized. Children with Shigella- or Campylobacter-associated diarrhea reported as watery diarrhea and rarely dysentery. ETEC did not have any clinically distinct characteristics. For vaccine development and/or deployment, our study suggests that rotavirus is of principle concern, followed by ETEC, Shigella, and Campylobacter.     

Diarrhoea in elderly people: aetiology, and clinical characteristics

We examined the characteristics of elderly people attending the Dhaka Hospital of ICDDR,B. The hospital has a diarrhoeal disease surveillance system that enrols a 2% systematic sample of all patients visiting the hospital. We reviewed data of all patients enrolled into the surveillance system (n = 13,782) over the period 1996-2001 to identify patients aged 60 y and above for inclusion into the current study (4% of all surveillance patients; n = 478). V. cholerae O1 was the most common enteric pathogen isolated from faecal culture of the patients (20%), followed by ETEC (13%), Shigella (11%), V. cholerae O139 (10%), Campylobacter jejuni (5%), Salmonella (3%), EPEC (2%), rotavirus (4%), and E. histolytica (2%). The isolation rate of V. cholerae O139 and Shigella was higher among the elderly compared to adults (15-59 y of age, 10% vs 6%, and 11% vs 7% respectively; p < 0.05 for both comparisons). Compared to 15-59-y-olds, a significantly higher proportion of the elderly had visible blood in stools (8% vs 5%), required short-stay ward admission (86% vs 82%) or referral (1% vs < 1%) to a health facility. Early initiation of oral or i.v. rehydration therapy, prompt referral, and immediate clinical diagnosis for assessment of the need for antibiotic therapy might be beneficial for the elderly.     

Etiology of acute childhood diarrhoea in Calcutta

Of the 152 cases of acute diarrhoea, 124 (81.5%) revealed potential pathogens. Altogether 27 (21.2%) out of 127 strains of Escherichia coli, Klebsiella pneumoniae, Enterobacter, Proteus and Acinetobacter produced enterotoxin. Single pathogenic bacteria (40 cases 26.3%), parasite (6; 6%), rota virus (6; 6%), toxigenic bacteria (19; 12.5%) and mixed agents (37; 24.24.3%) were recorded in 108 cases (71.0%). Another 14 (9.2%) cases exclusively revealed moderate to heavy growth of suspected enteric pathogens like K. pneumoniae, Proteus, Enterobacter, Pseudomonas aeruginosa, anaerogenic E. coli and Citrobacter and 2 (1.3%) had high counts of T'. hominis. Of the known pathogens, the preponderance of A. hydrophila (24.4%), rota virus (15.7%) and Aeromonas hydrophila (14.0%) in 1-4 y, Vibrio cholerae (45.6%) and Trichuris trichiura (13.0%) in 4-14 y age group is highlighted. Other pathogenic bacteria were non-01 V. cholerae (3.2%), V. parahaemolyticus (2.6%), V. fluvialis (0.6), Plesiomonas shigelloides (3.9%), Salmonella (2.6%), Shigella (1.9%), EPEC (1.9%), EEC (5.2%) and Campylobacter jejuni (3.9%) and the parasites were Entamoeba histolytica (2.6%) and Giardia intestinalis (2.6). Comparative study of age matched controls with those of diarrhoea suggested the pathogenic role of E. histolytica and T. hominis.     

Shigella and enteroinvasive Escherichia coli infections in households of children with dysentery in Bangkok.

Shigellae and enteroinvasive Escherichia coli (EIEC) were identified in children with dysentery and their household contacts in Bangkok. Shigellae were isolated from 49% and EIEC from 6% of 306 children with dysentery seen at the outpatient department of Children's Hospital on weekdays during January through June 1989 and October 1989 through October 1990. The same serotype infecting the index child was isolated from 21 (4%) of 522 household contacts of 151 index children with Shigella infections and from none of 60 household contacts of 19 index children with EIEC infections. Amplification of DNA sequences coding for the invasion-associated locus (ial) by polymerase chain reaction increased the identification of Shigella and EIEC infections from 57% (111/193) to 68% (132/193). ial sequences were identified in 3 of 20 drinking water specimens from which shigellae or EIEC were not isolated. Amplification of ial sequences identified more shigellae and EIEC than did bacteriologic and colony hybridization methods in children with dysentery and in drinking water in Bangkok.     

Case-control study of endemic diarrheal disease in Thai children

In a year-long, case-control study of endemic diarrheal disease among 1230 Thai children less than five years of age, rotavirus was detected in 20%, Campylobacter in 13%, Shigella in 13%, Salmonella in 12%, and enterotoxigenic Escherichia coli (ETEC) in 9%. The differences in detection of enteric pathogens between patients and controls was significant for rotavirus (P less than .001), Shigella (P less than .001), ETEC that produced heat-labile and heat-stable toxins (LT and ST; P = .005), and ST only (P less than .001). C. jejuni was most significantly associated with diarrhea in children less than 12 months [corrected] old (P = .037) and Salmonella in children less than three months of age (P = .003). Enteropathogenic E. coli (EPEC) that adhered in a localized pattern to HeLa cells was isolated from 7% of patients and 3% of controls less than six months of age. Only 50% of these E. coli strains were of EPEC serotypes. Enteroinvasive E. coli was isolated from 7% of patients more than two years of age, and new serotypes were identified.     

Surveillance of various enteropathogenic bacteria from diarrheal cases during 1989-1999 in Kobe City]

Incidence of various enteropathogenic bacteria was examined from diarrheal faecal samples that were collected from the patients of Kobe City General Hospital and some station hospitals (23,862), and from overseas travelers (2,855) over a period of decade (1989-1999) in Kobe. A total of 1,580 strains were isolated from domestic and 331 strains from overseas travelers. The results are as follows. 1) Thirteen kinds of enteropathogenic bacteria were isolated from domestic diarrheal cases (6.6%). Salmonella was the most predominant bacteria followed by Campylobacter, Vibrio parahaemolyticus, enteropathogenic Escherichia coli and Shigella. 2) Eleven kinds of enteropathogenic bacteria were isolated from overseas diarrheal travelers (11.6%). The most frequently isolated species was Salmonella, followed by Vibrio parahaemolyticus, Shigella and Plesiomonas shigelloides. 3) Of Salmonella strains isolated from domestic and overseas diarrheal cases, serovar Enteritidis was the most predominant. Other frequent serovars in both cases were Typhimurium, Tennessee, Hadar, Infantis, Blockley and Montevideo. 4) Antibiotics resistant rate of the isolated Salmonella strains was 42.6% for domestic samples and 29.3% for overseas diarrheal cases. In domestic cases. Enteritidis was resistance to streptomycin only and the multiple antibiotic resistance was observed in Typhimurium serovars. In overseas samples, the multiple antibiotic resistance was seen in a few Typhimurium, Anatum and Blockley strains. 5) Among Shigella, S. sonnei was isolated from both domestic and overseas cases. The frequency of acquiring infection was the highest in India, followed by Indonesia, Thailand and Nepal. 6) With reference to the incidence of the members of the genus Vibrio, Aeromonas and Plesiomonas, V. parahaemolyticus were abundant from domestic samples where as V. parahaemolyticus, P. shigelloides, Vibrio cholerae non-O1 and Vibrio cholerae O1 were isolated more frequently from overseas samples. The frequency of acquiring infection was the highest in Thailand, followed by Indonesia and India.     

A comparative study of enterotoxigenic Escherichia coli, Shigella, Aeromonas, and Vibrio as etiologies of diarrhea in northeastern Thailand

The incidence of enterotoxigenic Escherichia coli (ETEC), Shigella, Aeromonas, and Vibrio was determined in patients with diarrhea seen at a hospital in northeastern Thailand, and compared with the incidence of these bacteria in household contacts and their neighbors. ETEC was identified in 17%, Shigella in 9%, Aeromonas in 9%, V. parahaemolyticus in 5%, and non-01 V. cholerae in 2% of 299 patients with diarrhea. These five species of bacteria were isolated more often from patients with diarrhea than persons without diarrhea (P less than 0.001). ETEC was found more often in household contacts (22/141) and neighbors (18/147) of index cases than in persons living in homes not associated with ETEC infections (32/1,318; P less than 0.001). While Shigella was isolated less often in family contacts (3/76) and neighbors (4/93) of patients with shigellosis, this enteric pathogen was also isolated more often from contacts than persons not associated with Shigella infection (13/1,437; P less than 0.001). Both Aeromonas and non-01 V. cholerae can also be enteric pathogens; further efforts should be made to define the enteropathogenicity of these bacteria.     

Microbiologic and clinical study of acute diarrhea in children in Aswan, Egypt

Children with diarrhea presenting to a Government Rehydration Center in Aswan, Egypt, were investigated to determine the etiology and clinical presentation of acute childhood diarrhea in southern Egypt. Among 126 outpatients and 25 inpatients with diarrhea (mean age 18 months), enterotoxigenic Escherichia coli (ETEC) (17% of cases), Cryptosporidium (9%), Salmonella spp. (7%), Campylobacter jejuni/coli (7%), and Shigella spp. (5%) were the most common enteropathogens identified during the high incidence season of July. Enteropathogens were isolated as often from inpatients as outpatients, except for Salmonella spp. and Cryptosporidium, which were recovered more often from inpatients. Salmonella-infected children, in particular, were more ill, feverish, and dehydrated on presentation than other children, resulting in more frequent hospitalization. Except for Salmonella-infected children, children with acute diarrhea usually presented without severe dehydration, which may have been due to frequent initiation of oral rehydration therapy (ORT) by mothers trained by local health care providers. A potential environmental source of ETEC was identified in clay water storage containers commonly used in this area.     

High prevalence of enteroinvasive Escherichia coli isolated in a remote region of northern coastal Ecuador

Enteroinvasive Escherichia coli (EIEC) causes dysentery; however, it is less widely reported than other etiological agents in studies of diarrhea worldwide. Between August 2003 and July 2005, stool samples were collected in case-control studies in 22 rural communities in northwestern Ecuador. Infection was assessed by PCR specific for LT and STa genes of enterotoxigenic E. coli (ETEC), the bfp gene of enteropathogenic E. coli (EPEC), and the ipaH gene of both enteroinvasive E. coli and Shigellae. The pathogenic E. coli most frequently identified were EIEC (3.2 cases/100 persons) and Shigellae (1.5 cases/100 persons), followed by ETEC (1.3 cases/100 persons), and EPEC (0.9 case/100 persons). EIEC exhibited similar risk-factor relationships with other pathotypes analyzed but different age-specific infection rates. EIEC was the predominant diarrheagenic bacteria isolated in our community-based study, a unique observation compared with other regions of the world.     

Prevalence of Campylobacter jejuni and enteric bacterial pathogens among hospitalized HIV infected versus non-HIV infected patients with diarrhoea in southern India

A prevalence study on Campylobacter jejuni and other enteric bacterial pathogens was carried out in 200 HIV infected and 200 non-HIV infected subjects with diarrhoeal symptoms at an AIDS Hospital in southern India. Diarrhoeal specimens were inoculated onto standard culture media as well as onto Columbia and Campylobacter blood agar media for C. jejuni isolation. All the C. jejuni isolates were tested for antimicrobial susceptibility using Kirby-Bauer's method. A significant difference in recovery rates was observed between the 2 groups in relation to C. jejuni (p < or = 0.02; 95% CI 5.5 (1-10) and Shigella spp. (p < or = 0.02; 95% CI 6.5 (1-12). 21 isolates of Shigella spp., 16 C. jejuni, 5 Salmonella typhi, 3 Arcobacter spp., 3 Yersinia enterocolitica, and 2 Aeromonas hydrophila were recovered from the HIV infected cases. All the C. jejuni isolates were sensitive to ciprofloxacin whereas 1 strain was resistant to nalidixic acid. Interestingly, all the 29 Shigella spp. (21 from HIV and 8 from non-HIV cases) were resistant to erythromycin and most were resistant to many other antibiotics used. Our observations underline the need for epidemiological investigations to screen C. jejuni and Shigella spp. in HIV infected subjects with diarrhoea and analyse their antibiograms periodically to minimize disease burden in HIV/AIDS.     

The detection of enteropathogens in acute diarrhea in a family cohort population in rural Egypt

In 8 villages of rural northeastern Egypt, a 2-year study of the etiologic agents associated with episodes of diarrhea was carried out. Stool specimens (3,243) from 3,513 episodes of diarrhea were processed for enteropathogens. The most commonly identified agents in the group with diarrhea were Giardia lamblia (44%), heat stable enterotoxin (ST)-producing enterotoxigenic Escherichia coli (ETEC) (15%), heat labile toxin (LT)-producing ETEC (12%), enteropathogenic E. coli (EPEC) (4%), rotavirus (3%), Shigella (2%) and Salmonella (1%). Isolation rates were increased in cases compared to controls for all agents except G. lamblia and EPEC strains. Rotavirus, Salmonella and ST-producing ETEC were more frequently isolated during cooler months and Shigella and LT-ETEC occurred more commonly in warmer months. Campylobacter, EPEC, Giardia and E. histolytica did not show a discernable seasonal pattern. Rotavirus was primarily associated with diarrhea in infants only. Forty-four percent of children experienced at least 1 bout of rotavirus diarrhea by the age of 3 years. Vomiting was reported in 65% of cases of rotavirus infection. Dehydration was reported in greater than 40% of those with rotavirus-, Salmonella-, Campylobacter-, LT-ETEC- and EPEC-associated illness and in those without an identifiable agent. While rotavirus was implicated in 3% of cases overall, when vomiting or vomiting plus dehydration occurred, rotavirus was identified with a rate of 10% and 12%, respectively. Dysentery was common only in Shigella cases, occurring in 24%. A decrease in occurrence of rotavirus, Campylobacter and possibly EPEC illness was seen in the infants less than 6 months of age who were breast-fed when compared to those who were not.     

The catalase reaction of Shigella species and its use in rapid screening for epidemic Shigella dysenteriae type 1

As epidemic dysentery caused by Shigella dysenteriae type 1 is associated with high mortality, early identification of outbreaks is important. Since S. dysenteriae type 1 differs from most of the Enterobacteriaceae in that it does not produce catalase, a test for catalase may provide a useful screening method. The ability of a catalase test to provide rapid identification of S. dysenteriae type 1 has now been assessed, using isolates of this pathogen from five continents, Shigella of other species, and entero-invasive (EIEC) and Shiga-toxin-producing Escherichia coli (STEC). All of the isolates of S. dysenteriae type 1, as well as S. dysenteriae of types 3, 4, 6, 9, 11 and 12 and S. boydii of type 12, were found catalase-negative. All the other bacteria tested were positive for catalase. In an epidemic setting in South Africa, 406 xylose-negative and lysine-decarboxylase-negative isolates, collected from xylose-lysine-deoxycholate (XLD) agar, were tested for catalase. All 356 of the catalase-negative isolates were confirmed to be of S. dysenteriae type 1. None of the catalase-positive isolates were of S. dysenteriae type 1. The catalase test is useful in the rapid, presumptive identification of S. dysenteriae type 1, from appropriate culture media, because of its high predictive value, simplicity and speed. It would be particularly useful during dysentery outbreaks, when other Shigella would be uncommon. There was no association between the absence of catalase activity and the production of Shiga toxin.     

The current status of infectious enteritis in Japan--reports of the "Research Group for Infectious Enteric Diseases,Japan" in the last 5 years (1996-2000)

The patients or carriers with infectious enteritis admitted to the Hospitals for infectious diseases in the last 5 years (1996-2000) were studied. The total number of cases admitted in each year were 969, 1,113, 981, 637 and 573 respectively. A total of 1,527 Shigella spp. strains including 1,078 strains from overseas travelers' cases were isolated. The isolates of Salmonella spp. excluding S. Typhi and S. Paratyphi A were 562 in number. A total of 61 Vibrio cholerae O1 strains including 44 strains from overseas travelers was isolated. These V. cholerae O1 strains were all of El Tor type. Entamoeba histolytica, Giardia lamblia, Cryptosporidium parvum and Isospora belli were detected in 225, 46, 3 and 3 cases respectively. Abdominal pain, nausea and vomiting were frequently observed in the cases caused by Vibrio parahaemolyticus. The highest body temperature and the highest frequency of bowel movements were revealed in the cases caused by Salmonella spp. Bloody stool was observed in 55.3% of the cases due to Escherichia coli, in 40.5% of the cases due to Campylobacter spp. and in 24.1% of cases due to Shigella spp. As for shigellosis and salmonellosis, the clinical symptoms were more serious in the domestic cases than those in travelers. OFLX-resistant strains accounted for 1.7% of Shigella spp. isolates. No strains of Salmonella spp. were resistant to OFLX. The incidence of drug-resistant isolates of Campylobacter jejuni were 26.0% for OFLX and 2.5% for EM.     

Epidemiology, etiology and pathophysiology of traveler's diarrhea

Traveler's diarrhea (TD) is the most frequent health problem in travelers to developing countries. Several personal and environmental risk factors are at the basis of TD acquisition and are discussed in this paper. TD is caused by a wide range of infectious organisms, ETEC and EAEC bacteria strains being the main enteropathogens incriminated in TD. Other causative bacteria are: Shigella spp., Campylobacter spp., Vibrio spp., Aeromonas spp., Salmonella spp., and Plesiomonas spp. Parasite species are also included: Cyclospora cayetanensis, Giardia lamblia, Cryptosporidium, Entamoeba histolytica, as well as viruses: rotavirus, adenovirus, Norwalk virus. Due to the great diversity of pathogens incriminated, several pathophysiological mechanisms have been described and some of them are still poorly understood. The clinical symptoms present are also quite variable, although inflammatory and non-inflammatory diarrhea have been established as a classical and basic classification of diarrhea.     

The seasonal variation in the microbial agents implicated in the etiology of diarrheal diseases among children in Lao People's Democratic Republic

During 1994-1995, the etiological structure of children's diarrhea was monitored in outpatients at Mahosot Hospital, Vientiane, Lao PDR. Of the 191 children studied, 42% had stool specimens positive for enteropathogens; 22% had rotavirus, 21.5% enteropathogenic E. coli, 4.7% Shigella flexneri, 2.9% Campylobacter jejuni, 2.1% Shigella sonnei, and 0.5% each of Giardia intestinalis and Entamoeba histolytica. No Vibrio cholerae and Salmonella spp. was detected in this monitoring. In children under five years, rotaviruses were detected almost all round the year with a maximum prevalence in January in the dry season. Shigella species were highly detected in June to July in the rainy season.     

Clinical studies on the treatment of Campylobacter enteritis--emergence of quinolone-resistant Campylobacter jejuni after treatment with new quinolones]

In recent years, new quinolones such as ofloxacin (OFLX) and tosufloxacin (TFLX) have been frequently used in the treatment of bacterial enteritis caused by unknown organisms. The agent of first choice for the treatment of Campylobacter enteritis is one of the macrolides, but new quinolones are often administered accidentally to adult patients with Campylobacter enteritis. We have detected quinolone-resistant strains of Campylobacter jejuni (C. jejuni) after the treatment of some patients with new quinolones, and accordingly we reviewed the treatment of Campylobacter enteritis. We experienced 178 adult patients with Campylobacter enteritis from January 1989 to November 1991 at our hospital. From them, we selected 52 patients (32 males and 20 females) in whom stool culture were performed both before and after treatment. The initially administered antimicrobial agent was a macrolide (rokitamycin, RKM) in 6 cases, a new quinolone in 22 cases, and kanamycin (KM) in 24 cases. The new quinolone used was OFLX in 17 cases, TFLX in 3 cases, and norfloxacin (NFLX) in 2 cases. Fifty-one of the 52 C. jejuni strains isolated before treatment were susceptible to OFLX and erythromycin (EM) according to antimicrobial disc susceptibility tests. C. jejuni was eradicated in all patients treated with RKM or KM. However, treatment failed to achieve bacteriological cure in 8/22 (36.4%) patients given new quinolones. In these patients, the strains of C. jejuni isolated before treatment were susceptible to OFLX, but the strains isolated after treatment were all resistant to OFLX according to disc susceptibility tests.(ABSTRACT TRUNCATED AT 250 WORDS)     

Antimicrobial resistance of bacterial pathogens associated with diarrheal patients in Indonesia

The antimicrobial susceptibility patterns for 2,812 bacterial pathogens isolated from diarrheal patients admitted to hospitals in several provinces in the cities of Jakarta, Padang, Medan, Denpasar, Pontianak, Makassar, and Batam, Indonesia were analyzed from 1995 to 2001 to determine their changing trends in response to eight antibiotics: ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, tetracycline, cephalothin, ceftriaxone, norfloxacin, and ciprofloxacin. Vibrio cholerae O1 (37.1%) was the pathogen most frequently detected, followed by Shigella spp. (27.3%), Salmonella spp. (17.7%), V. parahaemolyticus (7.3%), Salmonella typhi (3.9%), Campylobacter jejuni (3.6%), V. cholerae non-O1 (2.4%), and Salmonella paratyphi A (0.7%). Of the 767 Shigella spp. isolated, 82.8% were S. flexneri, 15.0% were S. sonnei, and 2.2% were S. dysenteriae (2.2%). The re-emergence of Shigella dysenteriae was noted in 1998, after an absence of 15 years. Shigella spp. were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, and tetracycline. Salmonella typhi and Salmonella paratyphi A were susceptible to all antibiotics tested, while Salmonella spp. showed various resistance patterns according to species grouping. A small number of V. cholerae O1 were resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, and tetracycline; however, they were still sensitive to ceftriaxon, norfloxacin, and ciprofloxacin. Similar results were shown for V. cholerae non-O1. Campylobacter jejuni showed an increased frequency of resistance to ceftriaxone, norfloxacin, and ciprofloxacin, but was susceptible to erythromycin. This study shows that except for C. jejuni and V. parahaemolyticus, which appeared to be resistant to ciprofloxacin, the majority of the enteric pathogens tested were still susceptible to fluoroquinolones.