Made available in DSpace on 2014-06-11T19:23:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-04-26Bitstream added on 2014-06-13T18:09:50Z : No. of bitstreams: 1 pizzolitto_n_me_arafcf.pdf: 428241 bytes, checksum: 7f12808d8c56c81553b87cd1604bdff5 (MD5) / Universidade Estadual Paulista (UNESP) / A diarréia do viajante é o problema de saúde, mais comum, associado ao turista em termos de freqüência e impacto econômico contribuindo para a perda de rendimentos obtidos pelo turismo, em países em desenvolvimento. O objetivo da presente pesquisa foi identificar os agentes etiológicos mais freqüentes, nos surtos de doença transmitida por alimentos e/ou água em núcleos receptores turísticos, conhecer a sazonalidade e caracterizar a população segundo a idade e os alimentos suspeitos. Baseou-se nas notificações enviadas à Divisão de Doença de Transmissão Hídrica e Alimentar (DDTHA), Centro de Vigilância Epidemiológica (CVE), Secretaria Estadual de Saúde (SES) do Estado de São Paulo, no período 2002 a 2005 e informações das Vigilâncias Sanitárias da Direção Regional de Saúde (DIR). Os núcleos receptores turísticos selecionados foram: cidade de São Paulo e alguns municípios do interior como Águas de São Pedro, Campinas, Campos de Jordão, Franca, Jundiaí, Piracicaba, Pirassununga, Ribeirão Preto, São José dos Campos, São José do Rio Preto e do litoral como Guarujá, Peruíbe, Praia Grande, Santos e Ubatuba. Os resultados mostraram que o núcleo receptor turístico cidade de São Paulo, notificou 304 surtos, 3382 casos/doentes e dois óbitos. Do interior foram notificados 116 surtos e 8016 casos/doentes e três óbitos. Do litoral foram notificados 11 surtos, 253 casos/doentes e três óbitos, compreendendo um total de 431 surtos, sendo 129.340 comensais, 11.651 casos/doentes e 8 óbitos. Os agentes etiológicos mais freqüentes foram : vírus (58,08%), bactérias (72,72%), protozoários (4,67%), helmintos (0,83%), fungos (0,15%) e produtos químicos (0,12%). A freqüência dos agentes etiológicos foi: Rotavirus 31,86%; coliformes 28,38%; Salmonella sp. 13,55% (Salmonella Enteritidis 5,08% e Salmonella Typhimurium 2,88%)... / Travelers' diarrhea is the most common travel-related health problem in terms of frequency and economic impact. Travelers' diarrhea also contributes to loss of income from tourism in developing countries. The aim of the present study was to find the principle pathogens involved in outbreaks of food poisoning in tourist centers, and discover in what season the outbreaks occur, and age of the population. This study was based on informations sent to Divisão de Doença de Transmissão Hídrica e Alimentar (DDTHA), Centro de Vigilância Epidemiológica (CVE), Secretaria Estadual de Saúde (SES) do Estado de São Paulo and Vigilâncias Sanitárias da Direção Regional de Saúde (DIR) from 2002 - 2005. The tourist centers selected for the study were: São Paulo city; Águas de São Pedro, Campinas, Campos de Jordão, Franca, Jundiaí, Piracicaba, Pirassununga, Ribeirão Preto, São José dos Campos, São José do Rio Preto; Guarujá, Peruíbe, Praia Grande, Santos, and Ubatuba. The results showed that São Paulo city reported 304 outbreaks, 3,382 cases/disease and two deaths. From the interior of the state of São Paulo (116 outbreaks), 8016 cases/disease and 3 deaths were registered. From the coast (11 outbreaks), 253 cases/disease and 3 deaths were registered. In total there were 431 outbreaks, 129,340 persons exposed, 11,651 cases/disease and 8 deaths. The etiological agents were bacteria (72.72%), virus (58.08%), protozoa (4.67%), nematodes (0.83%), fungi (0.15%) and chemical products (0.12%). The frequency of causative pathogens was: Rotavirus 31.86%, coliforms 28.38%... (Complete abstract click electronic access below)

A qualitative study was conducted to explore and describe the knowledge and perceptions of parents and caregivers on the causes of diarrhoea among children under five years living in the rural areas of the Eastern Cape Province, South Africa. The aim was to assist in correcting the negative perceptions of the causes of under five child diarrhoea through improved educational interventions. Data were collected through individual, semi-structured and face-to-face interviews from seven participants who were parents and caregivers of under-five children presenting with diarrhoea or admitted for the management of diarrhoea at a specific hospital and thematic analysis was done. The findings revealed that the participants had inadequate knowledge and lacked understanding of diarrhoea and its causes. Participants could not mention all the causes and risk factors associated with diarrhoea. Noteworthy is that the participants’ perceived diarrhoea as a serious condition. The study recommends that the implementation of policies regarding public education and health promotion programmes be targeted at educating parents and caregivers / Health Studies / M.A. (Public Health)

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-03T17:40:16Z No. of bitstreams: 1 Tese Maria Yury Ichihara. 2014.pdf: 2248119 bytes, checksum: 821a02dd8be59ca78df05111c9fdd559 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-07T13:52:13Z (GMT) No. of bitstreams: 1 Tese Maria Yury Ichihara. 2014.pdf: 2248119 bytes, checksum: 821a02dd8be59ca78df05111c9fdd559 (MD5) / Made available in DSpace on 2014-10-07T13:52:13Z (GMT). No. of bitstreams: 1 Tese Maria Yury Ichihara. 2014.pdf: 2248119 bytes, checksum: 821a02dd8be59ca78df05111c9fdd559 (MD5) / A diarréia é uma das causas mais freqüentes de atendimentos ambulatoriais e de hospitalização em menores de 5 anos. Bactérias e o rotavírus são os principais agentes etiológicos envolvidos nas diarréias graves, sendo o rotavírus responsável por 22% a 38% das admissões hospitalares. Para abordar o tema sobre a internação de crianças brasileiras menores de 2 anos devido a diarréia foram realizados três estudos casos-controles com base hospitalar. Inicialmente, foi estimada a associação dos fatores de risco e a internação por diarréia aguda (exceto àquela causada por rotavírus) de acordo com as rotas de transmissão dos agentes etiológicos, as várias fontes de infecção e as condições de vida das populações. Foi demonstrado que os principais fatores de risco associados à internação por diarréia foram a falta de esgotamento sanitário e de água de boa qualidade e ter uma ou mais internações prévias devido à diarréia. Em relação à diarréia aguda causada por rotavírus, a OMS recomenda o uso de duas vacinas licenciadas no mundo (Rotarix® e RotaTeq®). A vacina oral monovalente contra rotavirus (G1P[8], Rotarix®) foi introduzida no Programa Nacional de Imunização do Brasil em 2006. A eficácia e efetividade da vacina variam entre países com renda alta e baixa, embora exista forte evidência de proteção cruzada para os genótipos G1-G4 e G9. Avaliamos a efetividade global e genótipo-específica da vacina oral monovalente na prevenção de internação de crianças brasileiras com diarréia causada por rotavirus. Além disso, estimamos a efetividade da vacina global e genótipo-específica por tempo de vacinação após a segunda dose da vacina (até dois anos) e EV para as Regiões brasileiras. Elevadas efetividades geral e genótipo-específica da vacina foram observadas, mesmo num contexto de grande diversidade genotípica e com predominância do genótipo G2P[4]. A duração da proteção global e genótipo-específica da vacina permaneceu até dois anos e foi maior para G1P[8] do que para G2P[4]. Por outro lado, consideramos plausível que a EV poderia variar em diferentes populações e em diferentes períodos de tempo, mediante a grande diversidade genotípica, a ocorrência de genótipos incomuns, de combinações mistas de G e P e de emergência de novas cepas advindas de combinações inter-espécies (homem e animal). Analisamos a EV estratificada por Regiões brasileiras e ficou demonstrado que a EV para a Região Norte foi similar à EV global. Porém a EV para as outras Regiões foi menor, talvez devido ao pequeno número de casos. Baseado nos resultados dos estudos nós recomendamos: 1) implementar ações voltadas para o domínio público (ambiente, saneamento, higiene na comunidade e acesso a serviços de saúde) para reduzir a morbidade por diarréia; 2) a continuidade do uso da vacina oral monovalente no Programa Nacional de Imunização; e 3) o monitoramento de genótipos para detecção precoce de cepas novas e incomuns. Além disso, novos estudos precisam ser conduzidos para avaliar variações da efetividade da vacina entre as Regiões, as sub-regiões e as áreas mais vulneráveis do Brasil. Será importante realizar estudos de custo-efetividade para subsidiar a política nacional de imunização. / Diarrhea has been a frequent reason of visits to the health services and hospitalization among children under five. Bacteria and rotavirus are the main agents involved in severe diarrhea, in which rotavirus is responsible from 22% to 38% of children hospital admissions. To address the issue of hospitalization of Brazilian children under 2 years due to diarrhea, we conducted three hospital based case-control study. Initially, we aimed to estimate the association of risk factors and acute diarrhea hospitalization (except those caused by rotavirus) according to the routes of transmission of etiologic agents, the various sources of infection and the living conditions of populations. It was demonstrated that the main risk factors were lack of sewage and water of good quality, and already having one or more hospitalizations due to diarrhea. In relation to the rotavirus acute diarrhea, the World Health Organization has been recommended the use of two licensed vaccines worldwide (Rotarix ® and RotaTeq ®). The oral monovalent rotavirus vaccine (G1[P8] strain, Rotarix®) was introduced in Brazilian National Immunization Program in 2006. The vaccine efficacy and effectiveness vary between high and low income countries, although there is strong evidence of cross-protection for G1-G4 and G9 genotypes. We evaluated overall and genotype-specific oral monovalent rotavirus VE in preventing RV-A diarrhea hospital admission of Brazilian children. Also, we estimated overall and genotype-specific VE by time since second dose vaccination (up to two years) and VE according to Brazilian Regions. High overall and genotype-specific VE were observed, even though there was a great diversity of rotavirus genotypes circulating in Brazil and a predominance of G2P[4] genotype. The overall and genotype-specific VE lasted for two years after second dose vaccination and it was higher for G1P[8] than G2P[4]. Besides, we considered that it was plausible that RV-A VE could vary in different populations (Regions) and in different periods of time, since there was a great genotype diversity, an occurrence of unusual genotypes, mixed combinations of G and P and emergence of new strains from combinations of inter-species (human and animal). We analyzed the VE for Brazilian Regions and we demonstrated that the VE for Northern Region was similar to the overall VE. However, the VE for other Regions was lower than VE for Northern Region, maybe because of the small number of the cases. Based on the findings of the studies we recommend: 1) to implement actions of the public domain (environment, sanitation, hygiene in the community and access to health services) to reduce the diarrhea morbidity; 2) the continued use of oral monovalent rotavirus vaccine in the National Immunization Program; and 3) the monitoring for early detection of unusual and novel rotavirus genotypes. In addition, new studies should be conducted to evaluate the variations of rotavirus VE in different Regions, sub-Regions and vulnerable areas in Brazil. It might be useful to conduct cost-effectiveness studies to inform national immunization policy.

The aim of this study was to assess and explore the household environmental health factors associated with the occurrence of diarrhoea in under five children in Sebeta town of Ethiopia, in order to develop environmental health strategies for prevention of childhood diarrhoea. A descriptive, quantitative, contextual and cross-sectional study, using stratified random sampling method, was used to conduct the research. The data collection was carried out from November 6 to 28, 2013 using structured interview schedules and a total of 477 households’ mothers/caregivers with under five children had participated in the study. In analyzing data, both bivariate and multivariate analyses were employed using SPSS software. The finding of the study shows that the prevalence of childhood diarrhoea was 9.9%. A number of risk factors including socio-demographic variables, water and hygienic practices, and knowledge risk factors showed significant association with childhood diarrhoea on bivariate analysis using chi-squared and Fischer's exact tests. Multivariate analysis using binary logistic regression was conducted to examine the significance of identified risk factors in bivariate analysis. The results of multivariate regression analysis shows that four variables were associated with risk of childhood diarrhoea; including type of toilet facility (AOR: 0.37; 95% CI 0.16 – 0.87; p=0.023), availability of specific place for handwashing (AOR: 0.40; 95% CI 0.18 – 0.90; p=0.026), availability of handwashing facility (AOR: 0.20; 95% CI 0.06 – 0.70; p=0.012) and mothers’ knowledge on diarrhoea causation (AOR: 3.09; 95% CI 1.24 – 7.68; p=0.015). Although childhood diarrhoea was found to be less prevalent as compared to national and regional prevalence rates, diarrhoea remains one of the causes of morbidity in children of the studied households. The findings of the study concludes that childhood diarrhoea has a number of environmental determinants, notably due to environmental health risk factors associated with lack of improved sanitation and hand-washing facilities and poor knowledge on diarrhoea causation. The study thus recommends that effective measures to curtail prevalence of diarrhoea in urban contexts should be substantially increased by enhancing urban sanitation promotion programmes with emphasis on accelerating universal access to improved sanitation and handwashing facilities, together with efforts in promoting proper hygiene behaviours. / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of this study was to assess and explore the household environmental health factors associated with the occurrence of diarrhoea in under five children in Sebeta town of Ethiopia, in order to develop environmental health strategies for prevention of childhood diarrhoea. A descriptive, quantitative, contextual and cross-sectional study, using stratified random sampling method, was used to conduct the research. The data collection was carried out from November 6 to 28, 2013 using structured interview schedules and a total of 477 households’ mothers/caregivers with under five children had participated in the study. In analyzing data, both bivariate and multivariate analyses were employed using SPSS software. The finding of the study shows that the prevalence of childhood diarrhoea was 9.9%. A number of risk factors including socio-demographic variables, water and hygienic practices, and knowledge risk factors showed significant association with childhood diarrhoea on bivariate analysis using chi-squared and Fischer's exact tests. Multivariate analysis using binary logistic regression was conducted to examine the significance of identified risk factors in bivariate analysis. The results of multivariate regression analysis shows that four variables were associated with risk of childhood diarrhoea; including type of toilet facility (AOR: 0.37; 95% CI 0.16 – 0.87; p=0.023), availability of specific place for handwashing (AOR: 0.40; 95% CI 0.18 – 0.90; p=0.026), availability of handwashing facility (AOR: 0.20; 95% CI 0.06 – 0.70; p=0.012) and mothers’ knowledge on diarrhoea causation (AOR: 3.09; 95% CI 1.24 – 7.68; p=0.015). Although childhood diarrhoea was found to be less prevalent as compared to national and regional prevalence rates, diarrhoea remains one of the causes of morbidity in children of the studied households. The findings of the study concludes that childhood diarrhoea has a number of environmental determinants, notably due to environmental health risk factors associated with lack of improved sanitation and hand-washing facilities and poor knowledge on diarrhoea causation. The study thus recommends that effective measures to curtail prevalence of diarrhoea in urban contexts should be substantially increased by enhancing urban sanitation promotion programmes with emphasis on accelerating universal access to improved sanitation and handwashing facilities, together with efforts in promoting proper hygiene behaviours. / Health Studies / D. Litt. et Phil. (Health Studies)

PhD (Microbiology) / Department of Microbiology / Diarrhoea is still a major problem worldwide. Enteric pathogens such as Enteroaggregative E. coli (EAEC), Enteropathogenic E. coli (EPEC) and Enterotoxigenic E. coli (ETEC) have been reported to cause diarrhoea in children under the age of 5 years. The incidences of these pathogens are due to factors such as poor water quality, sanitation and hygiene practices. Infections with these pathogens result in diarrhoea and have been reported to result in severe disease outcomes more especially in children under 2 years of age. EPEC infections have been well studied using in vitro analyses, with studies highlighting the adherence traits, proteins and virulence genes involved in pathogenesis and inflammatory responses. EPEC is characterized by localized adherence with microcolony formation at the site of infection. In vivo studies have reported on human EPEC infection. However, the current animal models have not been able to replicate clinical outcomes (such as diarrhoea and weigh loss) of EPEC infection similar to humans. Therefore, there is still a need for a suitable small animal model that mimic clinical outcomes of human EPEC infections in vivo. Children living in poor environmental conditions are more susceptible to diarrhoeal pathogens. Furthermore, the incidences of children being exposed to co-infections (more than one pathogen at the same time) is relatively high. The EAEC/EPEC (A/P) and EPEC/ETEC (P/T) co-infections have been increasingly detected in children with and without diarrhoea. It has been suggested that patients infected with these co-infections might result in severe disease outcome than those infected with single pathogens. Pathogens are constantly evolving and the microbe-microbe interaction in the host can result in these pathogens competing for the same niche and thus result in increased virulence. Interaction of co-infections can lead to increased inflammatory responses thus affecting the infected host. The first objective of this study was to develop an EPEC murine model using weaned C57BL/6 mice that have been pretreated with antibiotic cocktail. Mice were orally infected with wild-type (WT) typical EPEC, bfp- and escN mutant strains. The WT had transient weight loss and wet stools with mucous; and the bfp- infected mice also had transient weight loss and bloody stool appearance. Increase in inflammatory biomarkers MPO, LCN-2, CRP, IL-6 and SAA were observed in the WT and bfp- infected mice. The mice infected with escN mutant did not exhibit any weight changes and the stools were similar to the uninfected mice. Furthermore, no inflammatory biomarkers were observed in mice infected with the escN mutant. Metabolic perturbations were observed in WT EPEC infected mice at day 3 post infection with the TCA cycle metabolites (reduced succinate, citrate, fumarate, cis-aconitate) being excreted at lower quantities indicating that the energy production in the infected mice was greatly affected. The second objective of this study was to determine the interaction between the P/T coinfections using in vitro and in vivo analyses. In vitro, human colorectal tumour 8 (HCT-8) cells were infected with single strains of ETEC, EPEC and both the pathogens and incubated for 3 hours. After infection the cells were analysed for bacterial adherence using real-time PCR. The single strains adhered at the same rate similar to the P/T coinfected cells. IL-8, as a marker of inflammatory response, was measured using ELISA. The results indicated that the P/T co-infected cells had a significant increase in IL-8 response higher than the single infections. The P/T co-infections were further analysed in vivo using the EPEC murine model developed in this study. Interestingly, mice infected with P/T co-infections developed severe diarrhoea accompanied with significant increased weight loss and some mice died during the 3-day infection period. The inflammatory responses MPO, LCN-2 and SAA were higher in the co-infected mice indicating a synergistic effect. The bfp and eltA virulence genes were significantly increased in the P/T co-infections. The third objective of this study was to determine the interaction between A/P coinfections using in vitro and in vivo analyses. HeLa cells and HCT-8 cells were infected with EAEC, EPEC and both the pathogens at the same time in order to determine adherence and inflammatory responses. EAEC adherence was higher than EPEC and A/P co-infections adherence. A/P co-infections did not have increased IL-8 response in HCT-8 cells when compared to EAEC alone. The virulence genes involved in EPEC adherence and Type 3 Secretion System (bfp, eae, tir, ler, per, espB and espA) were significantly reduced in A/P co-infected cells. An interesting adherence trait was observed between the A/P co-infections in HeLA cells, EAEC was found to adhere around EPEC altering the localized adherence pattern. The A/P co-infections were further analysed using the EPEC murine model developed in this study. The A/P infected mice had diminished weight changes and EAEC shedding was enhanced when EPEC was present. Faecal inflammatory biomarkers MPO and LCN-2 in A/P infected mice did not have any additive effect. The findings of this study contributed significantly to the knowledge of human EPEC infection in weaned C57BL/6 mice, highlighting clinical outcomes, inflammatory responses and metabolic perturbations. Furthermore, this study also highlighted the interaction of P/T and A/P co-infections using in vitro and in vivo analyses in order to determine the disease severity and outcomes. It was observed in this study that coinfections can result in either synergistic or antagonistic effects. Further studies are therefore, required in order to understand the underlying mechanisms that are involved during co-infections and this can further assist in the development of therapeutic interventions. / NRF

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

Para determinar a prevalência e epidemiologia dos enteropatógenos bacterianos e parasitários na diarréia aguda infantil, foram estudadas 290 crianças menores de 24 meses com diarréia e 290 crianças controles, que procuraram o serviço de emergência do Hospital Infantil Arlinda Marques em João Pessoa, Nordeste do Brasil. Enteropatógenos foram identificados em 78,2% dos casos e em 12,4% dos controles; Escherichia coli enteroagregativa (EAEC) foi o patógeno mais freqüente sendo detectada em 25% dos casos e em 8,3% dos controles; seguida por E. coli enteropatogênica (EPEC) em 11% dos casos (dos quais 9,3% foram cepas atípicas) e em 0,3% dos controles; E. coli Enterotoxigência (ETEC) em 10% dos casos e 2,8% dos controles; Salmonella sp em 7,9% dos casos; Shigella sp em 4,1% dos casos; E. coli enteroinvasora (EIEC) em 1,7% dos casos; Campylobacter sp em 2,4% dos casos e enteroparasitas foram detectados em 15,5% dos casos e 1,0% dos controles. Infecções mistas foram verificadas em 32 (11%) casos e em apenas 1 (0,3%) controle. A faixa etária mais atingida foi a dos menores de um ano e as associações mais frequentes ocorreram entre EAEC + Salmonella e EAEC + EPEC atípica. Neste estudo foram identificados fatores de risco associados com episódios de diarréia em crianças de acordo com o agente etiológico bacteriano. As análises estatísticas demonstram uma importante associação de EAEC com diarreia aguda infantil em João Pessoa, Brasil, sendo a ingestão de leite de vaca em pó e a exposição a aglomerados e creche os fatores de risco mais associados a diarreia causada por EAEC. / In order to determine the prevalence and epidemiology of enteropathogens in acute infantile diarrhoea, 290 infants younger than 24 months of age with diarrhoea and 290 age-matched control subjects who came to ER of the Hospital Infantil Arlinda Marques in João Pessoa, Northeastern of Brazil were studied. Enteropathogens were identified in 78,2% of case infants and 12,4% of controls. Enteroagregative Escherichia coli (EAEC) was the most frequently found pathogen and was detected in 25,0% of cases and 8,3% of controls. The second most frequent pathogen was Enteropathogenic E. coli (EPEC), in 11,0% of cases and 0,3% of controls, followed by Enterotoxigenic E. coli (ETEC) in 10% of cases and 2,7% of controls; Salmonella sp was found in 7,9% of cases, Shigella sp in 4,1% of cases, Enteroinvasive E. coli (EIEC) in 1,7% of cases and Campylobacter sp in 2,4% of cases. Enteroparasites were detected in 15,5% of cases and 1,0% of controls. Mixed infections (more than one pathogen) were found in 32 (11%) of cases and in only 1 (0,3%) control. The most affected age group was of those smaller than 1 year of age and the most frequent associations were of EAEC + Salmonella e EAEC + atypical EPEC. In this study risk factors associated with episodes of diarrhoea among infants by bacterial etiological pathogens were identified. Statistical analysis demonstrated a significant association of Enteroagregative E. coli (EAEC) with acute infantile diarrhoea in João Pessoa, Brazil. The risk factors most strongly associated diarrhoea caused by EAEC were the ingestion of powdered cow milk and exposure to crowds and day care centres.

Para determinar a prevalência e epidemiologia dos enteropatógenos bacterianos e parasitários na diarréia aguda infantil, foram estudadas 290 crianças menores de 24 meses com diarréia e 290 crianças controles, que procuraram o serviço de emergência do Hospital Infantil Arlinda Marques em João Pessoa, Nordeste do Brasil. Enteropatógenos foram identificados em 78,2% dos casos e em 12,4% dos controles; Escherichia coli enteroagregativa (EAEC) foi o patógeno mais freqüente sendo detectada em 25% dos casos e em 8,3% dos controles; seguida por E. coli enteropatogênica (EPEC) em 11% dos casos (dos quais 9,3% foram cepas atípicas) e em 0,3% dos controles; E. coli Enterotoxigência (ETEC) em 10% dos casos e 2,8% dos controles; Salmonella sp em 7,9% dos casos; Shigella sp em 4,1% dos casos; E. coli enteroinvasora (EIEC) em 1,7% dos casos; Campylobacter sp em 2,4% dos casos e enteroparasitas foram detectados em 15,5% dos casos e 1,0% dos controles. Infecções mistas foram verificadas em 32 (11%) casos e em apenas 1 (0,3%) controle. A faixa etária mais atingida foi a dos menores de um ano e as associações mais frequentes ocorreram entre EAEC + Salmonella e EAEC + EPEC atípica. Neste estudo foram identificados fatores de risco associados com episódios de diarréia em crianças de acordo com o agente etiológico bacteriano. As análises estatísticas demonstram uma importante associação de EAEC com diarreia aguda infantil em João Pessoa, Brasil, sendo a ingestão de leite de vaca em pó e a exposição a aglomerados e creche os fatores de risco mais associados a diarreia causada por EAEC. / In order to determine the prevalence and epidemiology of enteropathogens in acute infantile diarrhoea, 290 infants younger than 24 months of age with diarrhoea and 290 age-matched control subjects who came to ER of the Hospital Infantil Arlinda Marques in João Pessoa, Northeastern of Brazil were studied. Enteropathogens were identified in 78,2% of case infants and 12,4% of controls. Enteroagregative Escherichia coli (EAEC) was the most frequently found pathogen and was detected in 25,0% of cases and 8,3% of controls. The second most frequent pathogen was Enteropathogenic E. coli (EPEC), in 11,0% of cases and 0,3% of controls, followed by Enterotoxigenic E. coli (ETEC) in 10% of cases and 2,7% of controls; Salmonella sp was found in 7,9% of cases, Shigella sp in 4,1% of cases, Enteroinvasive E. coli (EIEC) in 1,7% of cases and Campylobacter sp in 2,4% of cases. Enteroparasites were detected in 15,5% of cases and 1,0% of controls. Mixed infections (more than one pathogen) were found in 32 (11%) of cases and in only 1 (0,3%) control. The most affected age group was of those smaller than 1 year of age and the most frequent associations were of EAEC + Salmonella e EAEC + atypical EPEC. In this study risk factors associated with episodes of diarrhoea among infants by bacterial etiological pathogens were identified. Statistical analysis demonstrated a significant association of Enteroagregative E. coli (EAEC) with acute infantile diarrhoea in João Pessoa, Brazil. The risk factors most strongly associated diarrhoea caused by EAEC were the ingestion of powdered cow milk and exposure to crowds and day care centres.