ASSOCIATED INFECTIONS IN PERSISTENT DIARRHEA - ANOTHER PERSPECTIVE

Seventy-eight children diagnosed as cases of persistent diarrhoea (PD) from 1 month to 5 years of age (mean age 8.92 months) hospitalized du ring a 2-year study period were screened for the presence of nongastro intestinal infections, Clinical screening suggested acute respiratory infection (ARI) in 30 per cent cases, urinary tract infection (UTI) in 19 per cent and acute suppurative otitis media (ASOM) in 10 per cent of cases, Investigations revealed pneumonia on chest X-ray (39 per cen t), positive urine culture (32 per cent), leucocytosis (31 per cent) a nd positive blood culture (22 per cent), Seven cases (9 per cent) of p neumonia and 10 cases (13 per cent) diagnosed to have UTI were not ide ntified on clinical screening and could be detected only after investi gations, E, coli was the commonest organism isolated from urine cultur e (23 per cent) and blood culture (14 per cent); 54 per cent of cases had one or the other associated infection and 28 per cent were sufferi ng from more than one infection, Bacterial pathogens were more frequen tly isolated from blood in children < 6 months (P < 0.01), with vomiti ng (P < 0.001), and severe malnutrition (P < 0.05); from urine in asso ciation with fever (P < 0.001), duration of diarrhoea > 4 weeks (P < 0 .05), and vomiting (P < 0.001), Pneumonia was detected on chest radiog raph more frequently in children with severe malnutrition (P < 0.001), Sixty eight per cent of cases were successfully treated with dietary management and appropriate treatment of associated infections and 18 p er cent of cases died, Mortality was highest in association with sever e oral thrush, severe malnutrition, septicaemia, and ARI. Our results suggest that majority of cases of PD are associated with one or the ot her nongastrointestinal infections particularly UTI and ARI which may be missed on clinical examination unless efforts are made to investiga te these children, Early detection and appropriate management of these infections can considerably modify hospital course and outcome.