RESUMO
The aetiology of sporadic summer diarrhoea and enterotoxin (LT) antibody titres was studied among 43 adult patients in southern Brazil who had an acute, untreated diarrhoeal illness and 43 age- and sex-matched controls from the same area. A potential pathogen was identified in 33 of 34 patients and in 17 of 43 controls (p less than 0.01). 10 Shigella, one invasive Escherichia coli, one Salmonella and one Entamoeba histolytica were identified in 17 patients with inflammatory diarrhoea (faecal polymorphonuclear neutrophil leucocytes (PMN) present). In the other four only enterotoxigenic strains of E. coli were identified. Among 26 patients with non-inflammatory (no faecal PMN) diarrhoea, heat-stable (ST) toxin-producing coliforms were the most common pathogens isolated (27%). Heat-labile (LT) toxin-producing coliforms or serological rises to LT were seen in five patients, Strongyloides larvae in five, Giardia lamblia trophozoites in four and an LT-producing Salmonella in one. No pathogen was found in 10 patients with non-inflammatory diarrhoea. Among 43 controls, 11 LT coliforms, two Shigella and two Strongyloides larvae were found. 40 of 41 controls had detectable serum anti-LT antibody. A single ST-producing E. coli was found in one other control. No pathogen was identified in 26 controls. No rotaviruses or Norwalk-like viral agents were seen by direct or immune electron microscopy of stool filtrates. While LT-producing E. coli are frequently associated with endemic summer childhood diarrhoea in southern Brazil and are recognized causes of travellers' diarrhoea, this study shows that they are often carried asymptomatically by adults living in this region.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Diarreia/microbiologia , Proteínas de Escherichia coli , Adolescente , Adulto , Idoso , Toxinas Bacterianas/biossíntese , Brasil , Diarreia/etiologia , Diarreia/parasitologia , Entamoeba histolytica/isolamento & purificação , Enterotoxinas/biossíntese , Escherichia coli/isolamento & purificação , Escherichia coli/metabolismo , Fezes/microbiologia , Feminino , Giardia/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Salmonella/isolamento & purificação , Shigella/isolamento & purificação , Strongyloides/isolamento & purificaçãoRESUMO
PIP: This study was conducted from January 1977 to June 1978 in Fortaleza, Brazil, to evaluate the oral rehydration treatment recommended by the World Health Organization for children admitted with acute diarrhea; admission peaked in January-March of both years and children treated came from the lowest socioeconomic strata of the popultion. Initial treatment consisted of intravenous administration of normal saline or 5% glucose with saline solution; intravenous therapy was continued until objective signs of improvement were evident. Of the 53 children observed 24 continued with intravenous therapy, and 29 were administered oral rehydration therapy with a glucose-electrolyte solution containing 90 milliequivalent per liter of sodium ion. Mean age in the intravenous and in the oral groups were 10 and 8 months, respectively. The major symptoms were feverishness and vomiting. Stools from 37 patients were examined for disease agents; enterotoxigenic E. coli were identified in stools from 27% of these patients; ST-producing E. coli in 21.6%, and LT-producing E. coli in the remaining 5.4%. During the initial rehydration period there were no significant differences between the 2 groups as to duration of therapy or amount of fluid given. During the subsequent study period members of the oral treatment group required significantly less fluid and less treatment than members of the intravenous group, average amount of fluid required per kg of body weight being 67.3 ml in the intravenous group, and 32.3 ml in the oral group. Progress toward a normal level of consciousness was significantly greater among members of the oral rehydration group; the mothers of the children were able to administer the oral therapy quite effectively, thus saving time for physicians and nurses.^ieng