Determination of Causes of Acute Diarrhea among Children Attending Kirkuk Hospitals-Iraq

Background: Infectious diarrhea is one of the leading causes of childhood morbidity and mortality throughout the world. It is due to infection of the intestinal tract that can disrupt intestinal function. It leads to high death rate in children especially in developing countries.Objectives: This study was planned to determine the causes of acute diarrhea and to show the correlation between entamoeba histolytica/E. dispar and pathogenic bacteria.Methods: The etiological screening of enteropathogens was carried out on 800 children suffering from diarrhea who were attending Kirkuk Hospitals province during the period from the beginning of February 2007 to the end of January 2009, as well as another 100 children samples of the near ages of the patients as a control group. The ages of children are ranging from below one month to 12 years old. Stool samples were collected from each individual and were examined for parasitic infestation and cultured on different media for identification of bacteria.Results: The following variables were significantly associated with an increased risk of diarrhoea: Young age, maternal age (less than thirty years), illiterate mothers, and big families. The highest rate appeared in summer followed by spring, autumn and winter respectively.The rates of pathogenic bacteria, E. histolytica/E. dispar associated with bacteria are highest among the age group 7- 12 months 39.53%, 30.17% respectively, while the distribution of E. histolytica is highest among 2-6 months 32.64%. Furthermore, the predominant age group distribution of O157: H7 E. coli diarrhoeal cases are among 19-24 months.The bacteria most frequently encountered are enteopathogenic E. coli (EPEC), 40 (5%); Enteroinvasive Escherichia coli (EIEC), 33 (4.12%); Shigella spp., 23 (2.87%); and Pseudomonas. aeruginosa, 21 (2.62%). While E. histolytica were 340 (42.5%); E. histolytica/E. dispar associates with bacteria, 116 (14.5%); E. histolytica/E. dispar associated with Giardia. lamblia were 6 (0.75%); E. histolytica/E. disparassociated with Cryptosporidium. parvum, 3 (0.37%); and E. histolytica/E. dispar associated with more than one pathogens (Triple infections), 5 (0.62%).Enterohemorrhagic E. coli O157: H7, 8 isolates and P. shigellodies, 13 isolates were recorded for the first time in Kirkuk province from diarrheal cases.Shigella flexneri was the most frequently identified serotype and it was the only serotype associated with E. histolytica/E. dispar, Serogroup O1 is distributed among P. aeruginosa alone and P. aeruginosa associated with G. lamblia, while only serogroup O2 is distributed among P. aeruginosa associated with E. histolytica/E. dispar. EPEC I and II serogroups associated with E. histolytica/E. dispar were, 25 (92.6%); and 2, (7.4%) respectively.Co-incidence of E. histolytica/E. dispar with pathogenic bacteria is found in 116 (14.5%) of total mixed infections as the following: P. aeruginosa, 40 (5%); EPEC I 24, (3%), EIEC, 24 (3%); Shigella. flexneri 12, (1.5%); Salmonella. typhi, 10 (1.25%); non O157: H7 E. coli, 3 (0.37%); and Plesiomonas. shigellodies, 3 (0.37%).The predominant aerobic faecal flora was Echerichia coli that were higher in control groups than in patients.Bloody diarrhea was associated with all O157: H7 E. coli (100%); EIEC, 30 (90.9%); Shigella spp., 12 (52.17%); and E. histolytica, 110 (32.36%) respectively. Where as in EIEC, non O157:H7 E. coli associated with E. histolytica/E. dispar is (100%).Conclusions: E. histolytica/E. dispar is mostly associated with P. aeruginosa followed by EPEC, EIEC, S. flexneri, S. typhi, non O157: H7 E. coli and P. shigellodies respectively.E. coli O157 is common, mainly among young children. Enterohemorrhagic E. coli O157: H7 and P. shigellodies were isolated from diarrhoeal cases of children in Kirkuk province for the first time.