Causes of Childhood Diarrhea,Investigation for Diarrhea

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Gastrointestinal Disorders in Children

Acute Childhood Diarrhea

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ACUTE CHILDHOOD DIARRHEA: A REVIEW OF RECENT ADVANCES IN THE STANDARD MANAGEMENT

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Diarrhea Introduction

Acute Childhood Diarrhea Management

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Cholera

SEEMA ALAM RAJEEV KHANNA UZMA FIRDAUS
Pediatric Gastroenterology Section, Department of Pediatrics, JNMC, AMU, Aligarh

Corresponding Author :

Dr Seema Alam, Reader, Department of Pediatrics, JN Medical College, AMU, Aligarh, UP. Email seema_alam@hotmail.com

The causes of childhood diarrhea vary with location, season and population. With the advent of AIDS, various enteric pathogens are now being associated with diarrheal diseases. In a report 4 presented to World Health Organization in October 2002 a database was prepared on the proportion of diarrheal illness caused by each diarrheal pathogen, at the community and health facility level for each of the WHO regions and 14 sub-regions. This was done for the under-five children in the period 1990-2000. Table 2 represents the global and SEARO D ( India , Bangladesh , Myanmar and Nepal ) region data. According to the study globally ETEC was the main cause of diarrhea in the community while rotavirus infection was of major concern at the facility level. On the other hand in the Indian subcontinent mixed infections are one of the major problems at the community level and outpatient level while rotavirus is causing almost one fifth of all cases at the inpatient level.

Table 2: Median percentages of diarrheal illness caused by various Enteropathogens in diarrhea of below five years at the community and facility level (1990 to 2000).

Agents	COMMUNITY		OUTPATIENT		INPATIENT
	Global	SEARO D	Global	SEARO D	Global	SEARO D
Salmonella	0.9	0.6	3.2	1.4	4.4	4.2
Shigella	4.6	4.4	5.8	10.4	5.6	9.2
Campylobacter	7.5	8.9	12.6	16.3	4.5	3.7
V.Cholerae	0.6	2.2	1.6	3.7	4	11.7
ETEC	4.1	13.3	8.7	15.3	9.5	9.7
EPEC	8.8	9.1	9.1	9	15.6	21.1
Rotavirus	8	11.6	18	17.9	25.4	20.8
Giardia	10.1	5.6	3	1.9	1.6	1.6
Cryptosporidium	5.7	3.9	2.5	3.2	3.4	1.3
Entamoeba	3.2	5.1	0.6	0.3	1	0.6
Coinfection	10.7	18.8	12	19.9	12.1	11.7
Unknown	25.4	16.6	23	0.7	13.2	4.4

No investigations are routinely required in acute diarrhea. Majority of the cases need no investigations. In a small proportion the following situations may require investigations.

Stool culture should be done in cases of bloody diarrhea and cholera only.

When diarrhea is prolonged beyond 5 days than stool examination for giardiasis and amebiasis is justified. Confirmation is with a fresh stool sample showing trophozoites.

To confirm a case of secondary lactose intolerance stool pH and reducing sugar can be done.

Diarrhea associated with clinical signs of electrolyte imbalance or metabolic acidosis may need serum sodium, serum potassium or blood gas analysis.

Complete blood count, peripheral blood smear, chest radiography, urine culture should be done wherever needed in case of sepsis or if extra-intestinal infection is clinically evident.

Next : Acute Childhood Diarrhea Management

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