Etiology of outpatient pediatric nondysenteric diarrhea: a multicenter study in the United States

Background. Few data have been published recently on the etiology of outpat ient pediatric diarrhea in the US. Methods. We determined the etiology of acute, nondysenteric diarrhea among 147 children between 2 and 11 years old presenting to 9 outpatient clinics in various regions of the US between August, 1991, and August, 1993, Entero pathogens were sought by conventional laboratory methods. The various diarr heagenic Escherichia coli were sought. Results. A recognized etiologic agent was detected in the stools of 89 (60. 5%) children and 15 (10%) patients had multiple agents detected. Rotavirus was found in 43 (29.3%) of the children, with a spring and winter peak in o ccurrence. Giardia lamblia was identified in 22 (15%) cases with a spring p eak. HEp-2 cell-adherent E. coli were found in 15 (10.2%), Other agents fou nd included: enteric adenovirus in 7 (4.8%); Salmonella in 5 (3.4%); entero hemorrhagic E. coli in 5 (3.4%); enteropathogenic E. coli in 2 (1.4%); ente rotoxigenic E. coli in 2 (1.4%); Entamoeba histolytica in 1 (0.7%); and Cam pylobacter jejuni in 1 (0.7%). Conclusions. In addition to the presence of conventional enteropathogens, d iarrheagenic E. coli (HEp-2 cell-adherent E. coil, enterohemorrhagic E. coi l, enteropathogenic E. coli and enterotoxigenic E. coil) were associated wi th endemic pediatric diarrhea in the US.