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Category: Volume 07 Issue 07 July 2019
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Title: Clinicoetiological Study of Acute Diarrhea in Children under 5 Years Age Group

Authors: Shruti Dhale, Harshali Vankar, Jyothi Janardhanan, Sagar Walhekar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.99

Abstract

Introduction: The trends of bacterial enteropathogens causing gastroenteritis keep on changing with change in standard of living and environmental hygiene. The definition of diarrhea depends on what is normal for the individual. According to K. Armon, diarrhoea is defined as a change in bowel habit for the individual child resulting in substantially more frequent and/or looser stools In developing countries.[1] 50% - 60% cases are of bacterial (Enteropathogenic Esherichia coli 25%, Campylobacter jejuni 10% - 18%, Salmonella spp. and Shigella spp. 5% each), 35% of viral (15% - 25% rotavirus) origin, and in many the cause is unidentified or mixed.[2-5]

Aims and Objectives: To find out clinical features and study etiological factors of acute diarrhoea of under 5 years age group.

Methodology: A prospective study was done in a tertiary care hospital during the period of January 2017 to June 2018-12-05.All paediatric cases in the age group of below 5 years were included. A total number of 149 patients were included in the study.

Inclusion Criteria: All children presenting with acute diarrhoea in the age group of below 5 years of age admitted in paediatric ward.

Exclusion Criteria:

  •  Neonates are excluded
  •  Children who are critically ill.
  • Persistent diarrhoea more than 14 days
  • Malabsorbtion syndrome.
  • Diarrhoea due to metal poisoning (Cadmium, Arsenic, copper, mercury,etc.).

After selection, a complete history was obtained from parents, a through general examination and systemic examination was done and findings were recorded in a specially designed proforma. Data analysis was done with use of SPSS and EXCEL Graphs and tables were prepared by MS-EXCEL. A p value <0.05 was considered significant.

Results: In this study 6mo-1 year age group children were highly affected (47 %) with no sex predilection. Among the common organisms isolated 55% were Ecoli, 4.7% were K.pneumonia, 2%were enterococcus species, 1.4% were shigella flexneri species. As per the previous records Rotavirus caused majority of the childhood diarrhoea. Due to lack of facilities in the institution isolation of 74 rotavirus and recognised classes of Escherichia coli (EPEC, ETEC, EHEC, EAEC and EIEC) could not be done. It was observed that out of all 50% of S. flexneri suffered from severe dehydration, 28.6% of all k. pneumonia were severily dehydrated followed by 23.2% of all ecoli. [p value <0.0001(very highly significant)].  In Class V SES 44.4% suffered from severe dehydration, class IV 21.4% suffered from severe dehydration. In grade IV malnutrition 57.1% suffered from some dehydration and 42.9% suffered from severe dehydration. Fever is the predominant symptom making 53.7% of all diarrheal patients. Association of fever presented in 100% of cases of of shigella flexneri, 66.7% of enterococcus species presented with fever, 65.9% of ecoli followed by 57.1% of K. pneumoniae followed by commensals. [p value <0.002(highly significant)]. Hyponatremia was common finding in all children. Mean sodium of 123 was found with severe dehydration with SD 3.255, in AGE with some dehydration mean sodium was 127.77 with SD 2.860 and in AGE with no dehydration mean sodium was 130.28 and SD 2.058.This association of serum sodium and severity was significant. Uremia and metabolic acidosis were other common findings in our study. Cotrimoxazole showed highest resistance among all organisms.100%with shigella flexneri, E.coli 63.4%, 57.14% K. pneumonia. 

Conclusion:  This study will help us in better understanding of diarrheal disease. Emphasis should be given to behavioral factors, such as improved access to sanitation, promotion of young child feeding practices, hygienic practices, and implementation of vaccines against etiologic agents, which are the burden of disease severity and also malnutrition as a whole.

Keywords: diarrhea, dehydration , shigella, E.coli.

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Corresponding Author

Jyothi Janardhanan

M.D. Pediatrics, Department of Pediatrics , Grant Govt Medical College, Mumbai

Postal Address: Kallelam house, Kozhummal, Kannur, Kerala, India