Prospective study of diarrheal illnesses in northeastern Brazil: patterns of disease, nutritional impact, etiologies, and risk factors.

Diarrhea is a leading cause of death in tropical countries. One of the highest childhood mortalities is in northeastern Brazil, where little is known about the morbidity, etiology, and risk factors of diarrhea. Prospective village surveillance over 30 months revealed diarrhea attack rates of more than seven episodes per child-year at six to 11 months of age among the children of the poorest families. Other risk factors included early weaning and the lack of toilets. Diarrhea led to weight loss and stunted growth. Enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens, accounting for 21% and 19% of cases, respectively, followed by Shigella species (8.0%), Campylobacter jejuni (7.5%), Giardia species (6.7%), Strongyloides species (5.3%), and enteropathogenic E coli serotypes (4.6%). Most (84%) enterotoxigenic E coli were isolated during the rainy season of October to March (P less than 0.03), whereas 71% of rotaviral illnesses occurred during the drier months of June to October (P less than 0.03). In the present study, the early occurrence and nutritional impact of diarrhea and weaning, as well as the major etiologic agents of diarrhea and their different seasonal patterns have been defined for this region in which life-threatening diarrhea is endemic.

[1]  M. Blaser,et al.  Salmonellosis at rural and urban clinics in Bangladesh: epidemiologic and clinical characteristics. , 1982, American journal of epidemiology.

[2]  A. J. Mcadams,et al.  A clinicopathologic study of enterocyte-adherent Escherichia coli: a cause of protracted diarrhea in infants. , 1982, Gastroenterology.

[3]  R. Guerrant,et al.  Comparison of paired whole milk and dried filter paper samples for anti-enterotoxin and anti-rotavirus activities , 1982, Journal of clinical microbiology.

[4]  R. Sack,et al.  Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama. , 1982, The New England journal of medicine.

[5]  R. Black,et al.  Longitudinal studies of infectious diseases and physical growth of children in rural Bangladesh. I. Patterns of morbidity. , 1982, American journal of epidemiology.

[6]  R. Guerrant,et al.  Electrolyte/glucose concentration and bacterial contamination in home-prepared oral rehydration solution: a field experience in northeastern Brazil. , 1981, The Journal of pediatrics.

[7]  R. Black,et al.  INCIDENCE AND SEVERITY OF ROTAVIRUS AND ESCHERICHIA COLI DIARRHOEA IN RURAL BANGLADESH Implications for Vaccine Development , 1981, The Lancet.

[8]  R. Yolken,et al.  A Two-Year Study of Bacterial, Viral, and Parasitic Agents Associated with Diarrhea in Rural Bangladesh , 1980, The Journal of infectious diseases.

[9]  J. Hughes,et al.  Turista among members of the Yale Glee Club in Latin America. , 1980, The American journal of tropical medicine and hygiene.

[10]  J. Hughes,et al.  Etiology of summer diarrhea among the Navajo. , 1980, The American journal of tropical medicine and hygiene.

[11]  M. Ulshen,et al.  Pathogenesis of escherichia coli gastroenteritis in man--another mechanism. , 1980, The New England journal of medicine.

[12]  R. Guerrant,et al.  Value of examination for fecal leukocytes in the early diagnosis of shigellosis. , 1979, The American journal of tropical medicine and hygiene.

[13]  K S Warren,et al.  Selective primary health care: an interim strategy for disease control in developing countries. , 1979, The New England journal of medicine.

[14]  B. Rowe The role of Escherichia coli in gastroenteritis. , 1979, Clinics in gastroenterology.

[15]  R. Sack,et al.  Use of colony pools for diagnosis of enterotoxigenic Escherichia coli diarrhea , 1979, Journal of clinical microbiology.

[16]  H. Dupont,et al.  Pooling Method for Screening Large Numbers of Escherichia coli for Production of Heat-Stable Enterotoxin, and Its Application in Field Studies , 1979, Journal of clinical microbiology.

[17]  Daniel S Waterman,et al.  ESCHERICHIA COLI STRAINS THAT CAUSE DIARRHŒA BUT DO NOT PRODUCE HEAT-LABILE OR HEAT-STABLE ENTEROTOXINS AND ARE NON-INVASIVE , 1978, The Lancet.

[18]  B. Rowe,et al.  A prospective study of enteropathogenic Escherichia coli in endemic diarrheal disease. , 1978, Journal of Infectious Diseases.

[19]  D. Palmer,et al.  Comparison of sucrose and glucose in the oral electrolyte therapy of cholera and other severe diarrheas. , 1977, The New England journal of medicine.

[20]  R. Yolken,et al.  Enzyme-linked immunosorbent assay for detection of Escherichia coli heat-labile enterotoxin , 1977, Journal of clinical microbiology.

[21]  J. Wells,et al.  Epidemic diarrhea at Crater Lake from enterotoxigenic Escherichia coli. A large waterborne outbreak. , 1977, Annals of internal medicine.

[22]  S. Donta,et al.  Enterotoxigenic Escherichia coli and diarrheal disease in Mexican children. , 1977, The Journal of infectious diseases.

[23]  R. Giannella Suckling mouse model for detection of heat-stable Escherichia coli enterotoxin: characteristics of the model , 1976, Infection and immunity.

[24]  R. Chanock,et al.  Human reovirus-like agent as the major pathogen associated with "winter" gastroenteritis in hospitalized infants and young children. , 1976, New England Journal of Medicine.

[25]  R. Martorell,et al.  Acute morbidity and physical growth in rural Guatemalan children. , 1975, American journal of diseases of children.

[26]  R. Guerrant,et al.  Role of toxigenic and invasive bacteria in acute diarrhea of childhood. , 1975, The New England journal of medicine.

[27]  Ellen Jo Baron,et al.  Manual of clinical microbiology , 1975 .

[28]  A. Gilman,et al.  Cyclic Adenosine Monophosphate and Alteration of Chinese Hamster Ovary Cell Morphology: a Rapid, Sensitive In Vitro Assay for the Enterotoxins of Vibrio cholerae and Escherichia coli , 1974, Infection and immunity.

[29]  G. Spivey,et al.  Oral fluid therapy of Apache children with acute infectious diarrhoea. , 1972, Lancet.

[30]  A. Dean,et al.  Test for Escherichia coli enterotoxin using infant mice: application in a study of diarrhea in children in Honolulu. , 1972, The Journal of infectious diseases.

[31]  R. Sack,et al.  Replacement of water and electrolyte losses in cholera by an oral glucose-electrolyte solution. , 1969, Annals of internal medicine.

[32]  C. Serrano,et al.  The inter-American investigation of mortality in childhood. , 1968, World health statistics report. Rapport de statistiques sanitaires mondiales.

[33]  E. Neter Enteritis due to enteropathogenic Escherichia coli; present-day status and unsolved problems. , 1959, The Journal of pediatrics.

[34]  J. Bray Isolation of antigenically homogeneous strains of Bact. coli neapolitanum from summer diarrhœa of infants , 1945 .

[35]  M. Rahaman,et al.  Direct Nutrient Loss and Diarrhea , 1983 .

[36]  J. Hughes,et al.  Etiology of childhood diarrhea and oral rehydration therapy in northeastern Brazil. , 1981, Bulletin of the Pan American Health Organization.

[37]  J. Yunes Evolution of infant mortality and proportional infant mortality in Brazil. , 1981, World health statistics quarterly. Rapport trimestriel de statistiques sanitaires mondiales.

[38]  L. Mata The children of Santa María Cauqué: a prospective field study of health and growth. , 1978 .

[39]  William S. Jordan,et al.  Illness in the home : a study of 25,000 illnesses in a group of Cleveland families , 1964 .

[40]  B. Serény Experimental shigella keratoconjunctivitis; a preliminary report. , 1955, Acta microbiologica Academiae Scientiarum Hungaricae.