Salmonellosis in Poland in 2000

In 2000, 22,799 cases of salmonellosis were reported to the sanitary epidemiological stations, incidence rate = 59.0 per 100,000 population. Above 65% of patients were hospitalized. The seasonal peak was noted in May and June. Most of cases (70%) were laboratory confirmed by isolation Salmonella strains types. Salmonella Enteriditis was the most frequent type: 91% of cases and 70% of infected healthy persons. Other serotypes--Typhimurium, Infantis, Hadar and Virchow, caused 5% Salmonella cases only. Seven types not registered in the country up to 2000 were identified (S. Bargny, Kimuenza, Kisii, Limete, Nitra, Rissen, Winterthur). The most affected age group were children under five (337.3/100,000). The most serious clinical syndromes and extraintestinal manifestations like septicaemia, arthritis, meningitis, osteomyelitis pneumonia and other, were observed in 87 patients with at least one non-fecal specimen culture-positive for non-typhoidal Salmonella. In older patients, other diseases like carcinoma, leukaemia, lupus erythematosus, contributed to Salmonella infection. Twelve of those patients had died.     

Salmonellosis in Poland in 2003

Total number of salmonellosis cases sharply decreased. In 2003, 16 617 cases were reported (20 688 in previous year), incidence rate = 43.5 per 100 000 population. 72.7% of patients were hospitalized, but percentage of hospitalized cases with extraintestinal manifestations was much higher--above 90%. The seasonal peak was observed as in previous years in July and August. The most frequent isolated type remained Salmonella Enteritidis--above 85% of cases. Only three other serotypes (Hadar, Typhimurium and Infantis) were detected in all of 16 voivodeships of Poland. The age, sex, urban/rural distribution of salmonellosis cases remains stable; the highest incidence was registered among children aged 2 (425.5/100 000). Extraintestinal manifestations of salmonellosis (septicemia, meningitis, pneumonia peritonitis and other) were observed in 121 patients (the highest number since 1994).     

Clinical presentation of non-typhoidal Salmonella bacteraemia in Malawian children

We report the clinical presentation and outcome of 299 Malawian children with non-typhoidal Salmonella (NTS) bacteraemia and no evidence of focal sepsis, admitted to Queen Elizabeth Central Hospital (QECH), Blantyre, over a 26-month period (February 1996-April 1998). A peak incidence during the rainy season was noted. Salmonella typhimurium (79%) and S. enteritidis (13%) were the commonest isolates. For children aged > 6 months, NTS bacteraemia was significantly associated with malarial parasitaemia (RR 1.5 [1.2, 2.2], P < 0.01) and with severe anaemia (RR 7.2 [3.4, 15.3], P < 0.0001), when compared to other common pathogens causing childhood bacteraemia. Clinical overlap with malaria and anaemia, and the presence of malarial parasitaemia on admission, may delay diagnosis. NTS bacteraemia was commonly diagnosed following blood transfusion. Resistance in vitro to ampicillin (79%), co-trimoxazole (72%) and gentamicin (55%) was very common, and was rare to chloramphenicol (0.3%) which is the antibiotic of choice for NTS sepsis at QECH. Overall mortality was high (23%). Young age and clinical HIV infection were risk factors for mortality. Recurrences of NTS bacteraemia following antibiotic therapy were common among children with clinical HIV infection.     

A community--wide outbreak of Salmonella enterica serotype Typhimurium infection associated with eating a raw milk soft cheese in France

In 1997, a community-wide outbreak of Salmonella enterica serotype Typhimurium (S. typhimurium) infection occurred in France. The investigation included case searching and a case-control study. A case was defined as a resident of the Jura district with fever or diarrhoea between 12 May and 8 July 1997, from whom S. typhimurium was isolated in stool or blood. One hundred and thirteen cases were identified. Thirty-three (83 %) of 40 cases but only 23 (55 %) of 42 community controls, matched for age and area of residence, reported eating Morbier cheese (Odds ratio: 6.5; 95 % Confidence Interval: 1.4-28.8). Morbier cheese samples taken from the refrigerators of two case-patients and one symptom-free neighbour cultured positive for S. typhimurium of the same phage type as the human isolates. The analysis of distribution channels incriminated one batch from a single processing plant. These findings show that an unpasteurized soft cheese is an effective vehicle of S. typhimurium transmission.     

Pediatric salmonellosis at the Tokoin's teaching hospital, Lomé (Togo)

OBJECTIVE: The authors had for aim to describe the epidemiological, clinical, and bacteriological aspects and outcome of pediatric Salmonella enterica, Salmonella septicemia, over the last 10 years. PATIENTS AND METHODS: We analyzed the case history of 132 patients hospitalized for Salmonellasepticemia (positive blood culture) between 1995 and 2004. RESULTS: Salmonellosis accounted for 0.36% of all hospitalizations. The mean age of patients was 5.86 plus or minus 4.06 years, significantly higher in patients with S. ser. Typhi (7.14+/-4.04 years) than in patients with other serotypes (4.95+/-3.8 years). The clinical presentation was severe in many children (with dehydration (34.8%) and emaciation (55.3%)), so HIV was suspected and investigated in 51 patients (38.6%). Eight patients were HIV positive. Three serotypes of S. enterica were predominant: S. ser. Typhi, 55 cases (41.7%), S. ser. Enteritidis, 32 cases (24.2%), and S. ser. Typhimurium, 19 cases (14.4%). The bacterial susceptibility to antibiotics was good for ceftriaxone and ciprofloxacin (100%). But 78.8% of the serotypes were resistant to amoxicillin, 75.4% to chloramphenicol, and 69.4% to cotrimoxazole. The mean duration of hospitalization was 13.7 plus or minus 7.4 days (range 4-34 days). Complications occurred in 15.9% of cases, dominated by digestive bleeding (10.6%), and 6.1% of patients died.     

Salmonellosis in Poland in 2001

Total number of salmonellosis cases has been gradually falling down since the year 1988. In 2001, 19,881 cases were reported to the sanitary epidemiological stations, incidence rate = 51.5 per 100,000 population (22,799 in the previous year). Over 52% of patients were hospitalized, but percentage of cases with extraintestinal manifestations was higher--over 88%. The seasonal peak was noted in July and August, which was two months later than in 2000. The decreasing trend in confirmation of clinical diagnosis can be observed since 1995 when Salmonella strains were isolated in 91% of patients, but in 2000 only 66% of cases were bacteriologically confirmed. Salmonella Enteritidis was the most frequent type: 88% of cases and 69% of infected healthy persons. Only four other serotypes (Typhimurium, Infantis, Hadar and Virchow) were identified in all of 16 voivodeship of Poland. The age, sex, urban/rural distribution of salmonellosis remain stable. The highest incidence was registered among children one year old (423/100,000). Extraintestinal manifestations of salmonellosis (septicaemia, meningitis, pneumonia, peritonitis, appendicitis and other), were observed in 93 patients with at least one non-fecal specimen culture-positive for non-typhoidal Salmonella. In older patients, other diseases like carcinoma, leukaemia, lupus erythematosus, contributed to Salmonella infection. Twelve of those patients died.     

广东省2008－2009 年沙门菌监测

目的 了解广东省腹泻患者中沙门菌的感染及沙门菌暴发的情况以及沙门菌株的血清型别、耐药性和分子特征.方法 对纳入研究的腹泻病患者进行沙门菌的检测,对日常监测中分离到的菌株和暴发监测收集到的菌株进行血清分型、药物敏感试验和脉冲场凝胶电泳(PFGE)分型.结果 2008年共检测1922份粪便标本,分离到7l株沙门菌,阳性率为3.7%;2009年检测2110份粪便标本,分离到85株沙门菌,阳性检出率为4.0%;156株菌共分37种血清型,鼠伤寒和肠炎沙门菌居多;监测到10起由沙门菌污染引起的食物中毒事件,其中有4起由肠炎沙门菌引起,有3起由鼠伤寒沙门菌引起;发现1起疑似肠炎沙门菌暴发,并开展流行病学调查,结果提示4名病例中有2名病例是感染同一来源的肠炎沙门菌;229株沙门菌对头孢类和喹诺酮类抗菌药物敏感率达80%以上,59.3%是多重耐药沙门菌.结论 在广东省引起感染性腹泻和食物中毒的沙门菌主要为肠炎沙门菌和鼠伤寒沙门菌.

Abstract：

Objective To understand the infection of Salmonella (S.) in patients with diarrhea and outbreaks caused by Salmonella to identify the serotypes, resistance to antibiotics and PFGE types of the strains from the surveillance program in Guangdong province. Methods S. strains from patients with diarrhea were detected, and all the positive strains collected in routine and outbreak surveillance programs, were tested by serum agglutination, antibiotic susceptibility and PFGE.Results 71 S. strains were isolated from 1922 stool samples in 2008, with positive rate as 3.7%.85 S. strains were isolated from 2110 stool samples in 2009, with positive rate as 4.0%. All the 156 strains were divided into 37 serotypes, with S. serotype typhimurium and enteritidis as the most common serotypes. 10 incidents of food poisoning were detected, of which 4 were caused by enteritidis and 3 by typhimurium. A suspected outbreak by enteritidis was discovered and under epidemiological investigation. The findings indicated that 2 of the 4 patients from this outbreak were infected with identical enteritidis isolates. 80% of the 229 isolates were found susceptible to cephalosporins and quinoione and 59.3% of them were muitiresistant to the antibiotics. Conclusion S. enteritidis and S. typhimurium were the most common serotypes that caused infectious diarrhoea and food poisoning in Guangdong province.     

An outbreak due to echovirus type 30 in a neonatal unit in France in 1997: usefulness of PCR diagnosis.

Between February and August 1997, 53 patients with enterovirus meningitis were hospitalized in Clermont-Ferrand, France. All but one were children. Echovirus type 30 was involved in 70% of cases with identified serotype. The outbreak ceased on August 8. Two months later, a neonate was admitted to the neonatal unit with an echovirus type 30 meningitis thought to be acquired at delivery. Twenty days later a nosocomial outbreak of echovirus type 30 involving five neonates occurred. Two of them presented with meningitis and two with febrile seizure; One was asymptomatic. The retrospective examination of the maternal sera in a neutralization test, using the index case strain as a source of antigen, showed that none of the neonates was passively immunized before hospitalization. The use of genome detection in cerebrospinal fluid allowed rapid diagnosis and infection was contained by re-inforcing hygiene measures. Prospective examination of stools in the neonatal and paediatric units showed no further occurrences of the disease. No sporadic case was observed in the general population. Hence, nosocomial infections can occur a long time after an outbreak in the general population; rapid diagnosis with molecular tools is useful both for a definite diagnosis in patients already hospitalized, and to act as a rapid alert, even in intervals between seasonal outbreaks.     

Salmonellosis in Poland in 2002

Total number of salmonellosis cases slightly increased. In 2002, 20,688 cases were reported (19,881 in previous year), incidence rate = 54.1 per 100,000 population. 68% of patients were hospitalized, but percentage of hospitalized cases with extraintestinal manifestations was much higher--above 91%. The seasonal peak was observed as in previous year in July and August. Since 1995 (when Salmonella strains were isolated in 91% patients) decreasing trend in confirmation of clinical diagnosis is observed. The most frequent isolated type remained Salmonella Enteritidis--above 86% of cases. Only four other serotypes (Typhimurium, Hadar, Virchow and Infantis) were detected in all of 16 voivodeships of Poland. The age, sex, urban/rural distribution of salmonellosis cases remains stable; the highest incidence was registered among children aged 2 (474.0/100,000). Extraintestinal manifestations of salmonellosis (septicaemia, meningitis, pneumonia peritonitis and other) were observed in 113 patients (the highest number since 1994).     

Epidemiology of salmonellosis in California, 1990-1999: morbidity,mortality, and hospitalization costs

Salmonella is a common cause of bacterial foodborne illness in the United States. The epidemiology and costs of nontyphoidal salmonellosis in California from 1990 through 1999 are described using surveillance, hospitalization, and death data. Trends in Salmonella rates and factors associated with prolonged hospitalization were evaluated using Poisson and linear regression models, respectively. There were 56,660 reported cases, 11,102 hospitalizations, and 74 deaths attributed to Samonella. Reported case and hospital discharge rates have decreased since 1996. Among reported cases, infants had the highest rate (121 cases per 10(5) person-years), followed by children 1-4 years of age (40 cases per 10(5) person-years). The highest hospitalization rates were among the elderly and young children. Most deaths occurred among persons aged 65 or more years (59%). Among hospitalizations, gastroenteritis (61%) and septicemia (23%) were the most common Salmonella diagnoses. Salmonella pneumonia patients were the oldest (median age, 55 years) and Salmonella meningitis patients the youngest (median age, 0.3 years). These two diagnoses were the costliest, approaching 30,000 dollars (median) per hospitalization. Having an acquired immunodeficiency syndrome diagnosis or multiple Salmonella diagnoses was independently associated with prolonged hospitalization. The estimated 10-year hospitalization costs for Salmonella were $200 million. Salmonellosis is a costly disease that disproportionately affects the young and elderly.     

Serratia marcescens-contaminated baby shampoo causing an outbreak among newborns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

During November 2008 to January 2009, 11 babies in the neonatal intensive care (NICU) and three babies in the nursery were infected with Serratia marcescens at King Abdulaziz University Hospital in Saudi Arabia. Overall, fifteen infections were identified among 11 newborns in the NICU: septicaemia (five cases), purulent conjunctivitis (three), urinary tract infection (two), meningitis (two) and cellulitis (one). Three newborns in the nursery had three infections: purulent conjunctivitis (two cases) and omphalitis (one). Thirteen of 14 babies recovered fully but one died from S. marcescens meningitis and septicaemia. All infections were traced to intrinsically contaminated baby shampoo introduced to the units five days before the first reported case. The outbreak terminated following withdrawal of the shampoo product.     

Salmonellosis in Poland in 1999

In 1999, 23,436 cases of salmonellosis were reported to the sanitary epidemiological stations, incidence rate = 60.6 per 100,000 population. The cases occurred throughout the year, but the seasonal peak was noted in July and August. More than 75% of cases were laboratory confirmed by isolation Salmonella strains (56 serotypes). 75 serotypes were identified by bacteriological testing of different groups of persons (ill and healthy). The most frequent serotype--S. Enteritidis: was identified in specimens taken from 92% of cases and 75% of Salmonella infected healthy persons. Other serotypes--Typhimurium, Infantis, Hadar and Virchow, caused 5% Salmonella cases only. Nearly 63% of patients were hospitalized. As in the previous years, children aged five and less comprised the most affected age group (347.3/100,000). The extraintestinal manifestations were observed in 55 patients with at least one non-fecal specimen culture-positive for non-typhoidal Salmonella. Half of the patients had immunocompromising conditions. Five of those patients died.     

High incidence of extra-intestinal infections in a Salmonella Havana outbreak associated with alfalfa sprouts

OBJECTIVE: To determine a vehicle and point source for an outbreak of Salmonella Havana. METHODS: The authors conducted a case-control study and traceback investigation of 14 residents of California and four from Arizona with onsets of illness from Apr 15, 1998, to June 15, 1998, and Salmonella Havana infections with identical PFGE patterns. RESULTS: Seventeen of 18 patients were women. Seventeen were adults 20-89 years of age. Nine (50%) had diarrheal illness, 6 (33%) had urinary tract infections, 2 (11%) had sepsis, and one had an infected surgical wound after appendectomy. Four patients were hospitalized, and one died. Eating alfalfa sprouts was associated with S. Havana infection (OR = 10.0; 95% confidence interval 1.2, 83.1; P = 0.01). CONCLUSIONS: This outbreak resulted in a high incidence of extra-intestinal infections, especially urinary tract infections, and high morbidity. Raw alfalfa sprouts, often considered a safe "heath food," can be a source of serious foodborne disease outbreaks.     

Typing of extended-spectrum beta-lactamase-producing Salmonella typhimurium strains isolated in a pediatric unit

Extended-spectrum b-lactamases (ESBLs) derive mainly from TEM and SHV b-lactamases. These enzymes confer resistance to all oxyimino cephalosporins and monobactams except cephamycins and carbapems. ESBLs are often encoded by large plasmids that carry resistance determinants to multiple antibiotics and spread among the members of the Enterobacteriaceae. Since the first outbreak of Klebsiella pneumoniae expressing an extended-spectrum beta-lactamase reported in 1984, nosocomial infections due to Enterobacteriaceae species which produce ESBLs have been generally recovered from patients hospitalized in intensive care units. The most frequently isolated ESBL-producing strains belong to the genus Klebsiella, Escherichia, Enterobacter and Proteus; ESBLs are rarely associated with the genus Salmonella. The first Salmonella were detected in France in 1984 (Salmonella typhimurium), in Tunisia in 1988 (Salmonella wien) and in Argentina in 1991 (Salmonella typhimurium). In 1994, 10 isolates of Salmonella typhimurium expressing an extended-spectrum beta-lactamase were isolated for the first time from 10 children hospitalized in a pediatric unit of the hospital Ibn-Rochd, Casablanca. Previous study showed that all isolates belonged the same serotype, and biotype, and showed a resistance to oxyimino beta-lactams, gentamycin, tobramycin and trimethoprim-sulfamethoxazole but remained susceptible to tetracycline, chloramphenicol and quinolones. Oxyimino beta-lactams resistance determinant of all strains of Salmonella typhimurium was transferred by conjugation to Escherichia coli; Resistance to gentamycin and trimethoprim-sulfamethoxazole was also cotransferred. In this study, we characterized the relationship between all isolates by comparing plasmid profiles and patterns of proteins because there appear to be the more effective method for evaluating epidemiologic relationship between Salmonella species, and the protein profiles method has been used for many bacterial species. These two methods have the advantages of speed and simplicity. All isolates presented the same plasmid pattern characterised by three plasmids and the same pattern of proteins composed of 36 bands. We concluded by combining results that this outbreak involved the spread of the same strain of Salmonella typhimurium between the ten children. As this type of resistance is easily transferred by these isolates to other bacterial species, the major risk would be its transfer to Salmonella typhi.     

成都市未成年人群腹泻沙门氏菌血清型、耐药及分子分型研究

目的 了解成都市未成年腹泻人群中沙门氏菌感染的血清型分布及耐药性。方法 2012—2019年于成都市各区、市的哨点医院采集18岁以下腹泻患者粪便标本,按照GB4789.4进行沙门氏菌的分离鉴定和血清分型,随机选择部分样本进行微量肉汤稀释法药敏试验和脉冲场凝胶电泳（PFGE）分型。结果 共检出611份腹泻粪便来源沙门氏菌,可分为36种血清型,其中鼠伤寒和肠炎沙门氏菌占据主要优势,分别为68.2%和11.0%。耐药方面,沙门氏菌对氨苄西林的耐药率排首位（76.5%）,其次为四环素（70.5%）、甲氧氨苄嘧啶/磺胺甲噁唑（44.5%）、氯霉素（40.0%）和氨苄西林/舒巴坦（38.0%）;对一、二、三代头孢类抗生素的耐药率有较大差异（4.5%~33.0%）,对亚胺培南均敏感。多重耐药现象严重,以氨苄西林-四环素-甲氧氨苄嘧啶/磺胺甲噁唑（AMP-TET-SXT,占39.0%）,氨苄西林-氨苄西林/舒巴坦-四环素（AMP-AMS-TET,占32.0%）等为主。95株鼠伤寒沙门氏菌PFGE聚类相似度为53%,分为87种带型,其中5种带型各含2~3株相同带型。结论 成都市未成年腹泻患者沙门氏菌主要血清型是鼠伤寒沙门氏菌和肠炎沙门氏菌。多重耐药较严重,AMP-TET-SXT耐药率最高,优势沙门氏菌PFGE型别呈现多样性,存在散在沙门氏菌引起食物中毒的可能。     

Outbreak of Salmonella Livingstone infection in Norway and Sweden due to contaminated processed fish products

In Europe, the number of reported sporadic human cases of Salmonella Livingstone infection is low, and outbreaks are rare. We report the largest S. Livingstone outbreak described in the literature having an identified source of infection. In February 2001, an increased incidence of infection caused by S. Livingstone was observed in Norway and Sweden. By July 2001, 44 cases were notified in Norway and 16 in Sweden. The median age was 63 years, and 40 were women. There were three deaths, and 22 patients were hospitalized. Based on standardized questionnaires and retrospective studies of S. Livingstone strains in Norway and Sweden, food items with egg powder were suspected, and S. Livingstone was subsequently recovered from a processed fish product at the retail level. Analysis by pulsed-field gel electrophoresis documented that isolates from the fish product belonged to the same clone as the outbreak strain.     

The Middleton outbreak: 125 cases of foodborne salmonellosis resulting from cross-contaminated food items served at a picnic and a smorgasbord.

One hundred and twenty-five of 173 people who ate at a picnic and/or a smorgasbord prepared by a bar-restaurant in a Midwestern town in September 1973 developed diarrhea, abdominal cramps, and other symptoms 23 hours (median time) later. Eleven were hospitalized. Stool cultures from 18 ill individuals grew Salmonella infantis, Salmonella agona, and Salmonella schwarzengrund. Stool cultures from 5 of 8 restaurant employees grew S. infantis or S. agona. Cultures of remaining foods and food-contact surfaces were negative. Food-specific attack rates, based on interviews with 121 eaters, implicated potato salad and chicken dressing as vehicles of transmission, both likely contaminated when prepared in pans that shortly before contained uncooked, chicken pieces suspected to have harbored salmonellae. Chickens were eventually traced to 3 farms where feed samples were found to contain Salmonella typhimurium and Salmonella cubana, raising the possibility that other feed samples may have contained the serotypes responsible for the outbreak. The main control measure was temporarily closing the food service, which was to have catered a large church picnic the next day. The outbreak had an economic impact estimated at $28,733.     

Salmonellosis in 1998

Gradual decrease of salmonellosis is observed in Poland since 1988. In 1998, 26,739 cases of salmonellosis were noted, incidence rate = 69.2 per 100,000 population. Above 80% of cases were laboratory confirmed by isolation Salmonella strains (57 serotypes). Laboratory-based surveillance led to the identification 82 serotypes among examined persons; the most frequent serotype was Enteritidis: 90% of cases and 70% of Salmonella infected healthy persons. Serotypes: Typhimurium, Virchow, Hadar and Infantis caused 6% Salmonella infections. Nearly 53% of patients were hospitalized. Like in the previous years, the most affected age group were children under five (361/100,000). The extraintestinal Salmonella infections were observed in 64 patients for whom at least 1 nonfecal specimen was culture-positive for non-typhoidal Salmonella. Twenty eight patients had positive blood cultures (26--Enteritidis, 2--Typhimurium). The other positive specimens included subdural fluid (3), pleural fluid (3), joint fluid (2), urine (11) and pus (15). Half of the patients had immunocompromising conditions. Other diseases contributed to infection, especially in older patients, who had hematologic and nonhematologic malignancy, lupus erythematosus, diabetes, cirrhosis. There were 11 deaths (17%).     

Meningitis and pneumonia in Guatemalan children: the importance of Haemophilus influenzae type b and Streptococcus pneumoniae.

OBJECTIVE: To determine the epidemiology of Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae invasive infections in hospitalized Guatemalan children. This is an important issue since Hib vaccine has not been incorporated into the routine immunization program in Guatemala and information from hospital records in 1995 indicated a low incidence of Hib and S. pneumoniae as causes of meningitis and invasive infections. METHODS: Children who were hospitalized in Guatemala City with clinical signs compatible with bacterial infections were evaluated for evidence of Hib or S. pneumoniae infection. Normally sterile body fluids were cultured, and antigen detection was performed on cerebrospinal fluid (CSF) and pleural fluid. RESULTS: Of 1 203 children 1-59 months of age hospitalized over a 28-month period, 725 of them (60.3%) had a primary diagnosis of pneumonia, 357 (29.7%) of meningitis, 60 (5.0%) of cellulitis, and 61 (5.1%) of sepsis and other conditions. Hib was identified in 20.0% of children with meningitis and S. pneumoniae in 12.9%. The average annual incidence of Hib meningitis was 13.8 cases per 100 000 children under 5 years of age, and 32.4% of meningitides caused by Hib and 58.7% of S. pneumoniae meningitides occurred prior to 6 months of age. Case fatality rates were 14.1%, 37.0%, and 18.0%, respectively, for children with Hib, S. pneumoniae, and culture-negative and antigen-negative meningitis. Prior antibiotic therapy was common and was associated with significant reductions in CSF-culture-positive results for children with other evidence of Hib or S. pneumoniae meningitis. CONCLUSIONS: Improvements in case detection, culture methods, and latex agglutination for antigen detection in CSF resulted in identification of Hib and S. pneumoniae as important causes of severe disease in Guatemalan children. Using a cutoff of > 10 white blood cells per cubic millimeter in CSF would improve the sensitivity for detection of bacterial meningitis and help estimate the burden of bacterial meningitis in Guatemala and other developing countries.     

Acute diarrhea and malnutrition: lethality risk in hospitalized infants

OBJECTIVES: Acute diarrhea is a very frequent disease in developing countries and is the first cause of death in infants under two years of age. This study was designed to evaluate the clinical and epidemiological factors associated to the death of 17 out of 511 infants hospitalized due to severe acute diarrhea between January 1989 and December 1995. PATIENTS AND METHODS: The patients were divided into two groups according to their clinical evolution: Group I--Death and Group II--Survival. The following parameters were evaluated: birth weight, gender, age, duration of diarrhea (days) prior to admission, nutritional status, hydration, presence of an enteropathogenic agent in the stools, food intolerance and duration of hospitalization. RESULTS: The analyzed factors have shown a significant association with death for the following variables: age, relative factor of death (RFD)=4.0 for infants less than six months of age, identification of an enteropathogenic Escherichia coli (EPEC) strain in the stools (RFD=3.3), severe malnutrition at admission to the hospital (RFD=4.5), occurrence of food intolerance during hospitalization (RFD=2.7). Some enteropathogenic agent was identified in the stools of 253 infants (54.9%), among the 461 (90.2%) studied. Group I revealed the presence of an enteropathogenic agent in 75% of the cases. The most frequent agents identified in Group I were: EPEC (56.3%) and Shigella (12.5%), while in Group II EPEC was identified in 26.5% of the patients. CONCLUSIONS: The association of some factors, such as age less than six months, severe malnutrition, food intolerance and the identification of EPEC strains in the stool culture, indicate a high risk of death in infants hospitalized due to severe acute diarrhea.