OCCULT BLOOD AND FECAL LEUKOCYTES AS SCREENING-TESTS IN CHILDHOOD INFECTIOUS DIARRHEA - AN OLD PROBLEM REVISITED

During a 24-month period 446 children with diarrhea and 16 controls ha d examination of their stools for leukocytes and for occult blood. Fec al leukocytes were found in 36, 16 and 18% of children with Salmonella -Shigella-Campylobacter, rotavirus or enterotoxigenic Escherichia coli , or cryptosporidial diarrhea, respectively. Similarly 43, 39 and 38% of these groups, respectively, as well as 13% of controls had occult b lood. Notably 70% of 10 Shigella cases had fecal leukocytes. In 166 ch ildren with mixed pathogens leukocytes were seen in 27 and 8% of child ren with Salmonella-Shigella-Campylobacter or noninvasive pathogen, re spectively. Likewise 44 and 18% of these groups had occult blood. Agre ement between both tests being positive was poor, the highest result b eing 50% for Shigella. Dysentery combined with both tests positive was associated with 15 (88%) cases of invasive agents present in stool cu ltures, and combination of dysentery with fecal leukocytes was associa ted with 21 (72%) cases of invasive agents recovered. The results of t hese tests should be interpreted in the context of the clinical situat ion. A combined clinical-epidemiologic and screening tests-based appro ach to infectious diarrhea of childhood is suggested.