Aetiology of diarrhoea in adequately nourished young African children in Durban, South Africa

SUMMARY

Two inter-related hospital-based studies on the causes of diarrhoea in African children who were not overtly malnourished, were performed over a period of two years in Durban, South Africa. The first study involved 126 inpatients selected for previously untreated diarrhoea of less than 96 h duration. On examination and culture of the stools of these children bacteria were identified in 60%, rotavirus in 20% and parasites in 4%. No pathogens were identified in 33%. The bacteria most frequently encountered were Campylobacter jejuni (21%), enteropathogenic Escherichia coli (EPEC) (18%), enterotoxigenic Escherichia coli (ETEC) (11%) and salmonella (8%). Of those cases having an identifiable cause 16% had more than one organism. The majority of children had mild disease and recovered clinically in 5.4 (13) days (Mean (S.D.)). The second study included 352 outpatients with diarrhoea who were randomly selected without regard to duration of disease or prior treatment. The results of faecal investigations were as follows: 28% had bacterial pathogens, 34% rotavirus, 15% parasites and 61% no pathogens. The bacteria most frequently detected were C. jejuni 7%, EPEC 7%, salmonella 6%, and shigella 5%. Ten per cent of positive cases had more than one pathogen. The most likely reason for the higher percentage with no identifiable pathogen is the prolonged duration of diarrhoea in 19% for more than seven days.

In 128 control children without diarrhoea, stool samples were investigated during the same period as the two studies: 13% had bacteria, 2% rotavirus and 14% parasites. The bacteria involved were C. jejuni (5%). EPEC (5%), salmonella (2%) and shigella (2%).