A PERSPECTIVE ON INFECTIOUS ETIOLOGY OF CHRONIC DIARRHOEA IN INDIA

Introduction: Diarrheal diseases are major causes of childhood morbidity and mortality in developing countries. Although advances have been made in our understanding of acute diarrhea, there is scanty information regarding microbial etiology of chronic diarrheal illness from developing countries.

Objectives: To evaluate the prevalence of enteropathogens causing chronic diarrhea and antimicrobial resistance of bacterial enteropathogens in North India.

Methods: Stool samples from a total of 599 cases of community acquired chronic diarrhea during 2009-2011 were evaluated. The microbiological work up included conventional culture for enteropathogens and a multiplex PCR assay for diarrhoeagenic E. coli. Antibiotic susceptibility was performed as per CLSI guidelines. Parasitic work up for included saline and iodine mounts, modified Ziehl Neelsen staining and calcoflour white staining.

Results and Discussion: Majority of the cases were above 15 years of age whereas 71(11.85%) were below 15 years of age. 59.9% of patients were males. The enteropathogens were found in 15.77% of cases. Giardia, E. histolytica/dispar, Cryptosporidium, Isospora, Cyclospora, Microsporidia and Strongyloides were found in 3.3, 1.0, 0.7, 0.22, 0.01, 0.18 and 0.06% of cases respectively. Among bacteria, EAEC, Shigella, EPEC, non typhoidal Salmonella (NTS), and Aeromonas were isolated from 4.3, 3.3, 1.7, 0.83 and 0.16% of cases respectively. We observed a high level of resistance to amoxicillin and cefotaxime in diarrheagenic E. coli isolates. Overall EPEC was more resistant to different antimicrobials as compared to EAEC. Salmonellae showed 100% sensitivity to ciprofloxacin and cotrimoxazole whereas EAEC, EPEC and Shigellae showed high levels of resistance. All enteropathogens showed 100% susceptibility to furazolidine whereas high levels of resistance were seen against flouroquinolones and third generation cephalosporins