CLINICAL-EVALUATION AND BACTERIAL SURVEY IN INFANTS AND YOUNG-CHILDREN WITH DIARRHEA IN THE SANTA-CRUZ DISTRICT, BOLIVIA

Clinical and laboratory studies on a total of 211 of infants and young children admitted to the National Santa Cruz General Hospital for var ious types of diarrhoea during 1991-1992 are described. A peak cluster was observed in children aged 1 year of which 80 per cent were acute diarrhoea and the remaining 20 per cent were prolonged or chronic diar rhoea. The major bacterial pathogen was enteropathogenic Escherichia c oli. Other bacterial pathogens such as Klebsiella, Shigella, Cholera, etc., were detected. Ascaris, E. histolytica, Giardia and Ankylostoma were also detected. Many of the patients infected with enteropathogeni c E. coli showed elevated serum titre to these bacterial antigens. Mos t of the detected E. coli and Shigella revealed that they were resista nt to ampicillin, trimethoprim/sulfamethoxazole, and erythromycin, and some were resistant to gentamycin and chloramphenicol in vitro tests. It was difficult to make a diagnosis by clinical diagnosis alone for cholera of the el Tor Ogawa type. The detection of faecal leukocytes s eems to be an useful predictor for diagnosis of invasive diarrhoea wit h mucobloody stools. Faecal pH and erythrocytes did not seem to be rel iable diagnostic predictors. Fourteen cases (7 per cent) died of diarr hoeal disease. Many of them had complications with marked dehydration, hypoelectrolytaemia, malnutrition and infections, and rapid deteriora tion within 10 days despite rehydration therapy. Timely rapid rehydrat ion and restoration of electrolytes followed by suitable management of complications are necessary.