DIARRHEA AND ABDOMINAL
PAIN IN CHILDREN IN PEDIATRIC PRACTICE PREVALENCE OF PROTOZOAL AND OTHER
INTESTINAL INFECTIONS
De Nef JJEM1,
Hilhorst MI1, Mank TG2
1 Spaarne Hospital,
Haarlem, the Netherlands
2 Public Health Laboratory, Haarlem, the Netherlands
Objective: to describe the prevalence of protozoal,
bacterial, and viral intestinal infections in children who consulted their
pediatrician with persistent diarrheal complaints and/or abdominal pain. In
order to assess causal relationships between symptoms and protozoal species
including those which are missed with the conventional methods for stool
examinations, like Dientamoeba
fragilis, stool samples of asymptomatic children were examined as well.
Subjects and Methods: during our one-year
prospective study, stool samples were collected from two groups of
patients. One group comprised patients with complaints of diarrhea and/or
abdominal pain (N=214) of which 129 were referred to the policlinic unit,
and 85 were hospitalized. The second group comprised pediatric patients
without gastrointestinal complaints (N=50). All included cases collected a
stool sample using a stool collection kit. The samples were placed into two
vials, one empty, the other containing the SAF-fixative. In addition, all
included cases (or their parents/nursing staff) were asked to complete a
questionnaire including e.g. use
of medication, and complaints. From the SAF preserved stool samples a
parasitological examination was performed including permanent stained
smears and a Giardia lamblia
specific EIA. Of the non-preserved stool samples, a stool culture and a
virological examination were performed.
Results: Potentially pathogenic protozoa (19.6%) rather
than bacteria (5.6%) and enteropathogenic viruses (7.9%) were found in the
symptomatic patients. G. lamblia
en D. fragilis appeared to be the most commonly found protozoan
species in these children (prevalence 10.7% and 9.3% respectively). In the
asymptomatic subjects all stool cultures appeared to be negative. G. lamblia was found in 6% of these
children, whereas D. fragilis was
never detected.
Conclusions: The results of our study show that
intestinal protozoal infections are frequently found in children with
diarrheal complaints and/or abdominal pain. In addition, our study results
are suggestive for the causative role of G. lamblia and D.
fragilis in the development of these complaints in children.