Jafar Pasand Masoumi, Muhammad Saeed Anwar.
Infantile diarrhea associated with potential pathogens.
Pak Paed J Jan ;19(4):133-40.

The study was conducted to determine the bacterial agents of diarrhea other than common enteropathogens among 603 infants from birth to 12 months of age residing in low socio-economic areas of Lahore, Pakistan. These infants suffered from one or more diarrheal episodes with a total of 1964 episodes. Microbiological investigation of the diarrheal samples was done by the standard methods. Out of the 1964 diarrhea episodes, 146 (7.4%) stool samples showed pure or predominant growth of Klebsiella pneumoniae, Aeromonas hydrophila and Citrobacter freundii. All of these samples were found to be negative for common enteric pathogens. The most frequently isolated potential pathogen was K. pneumoniae (4.2%), followed by A. hydrophila (2.1%) and C. freundii (1.1%). Upto three months of age, no infant had diarrhea associated with these pathogens. In 7-12 months age the occurrence of K. pneumoniae diarrhea was almost three times higher (3.1%) as compared to that in 4-6 months (1.1%). Diarrhea associated with K. pneumoniae and C. freundii was more in spring season (40.2% and 39.1%, respectively) as compared to other seasons, whereas A. hydrophila associated diarrhea was seen to be considerably higher in summer (58.6%). The major clinical symptoms observed in infants with A. hydrophila diarrhea was fever (41.5%). While vomiting, watery stools and dehydration were not seen in most of these infants. Similar features were observed in infants with K. pneumoniae and C. freundii associated diarrhea, except that fever was not a prominent feature in these infants. Majority of the infants having diarrhea associated with all these organisms had low frequency of stool, no blood in stool on gross examination and no leukocytes or leukocytes in very small numbers. All these features suggest that these enteric infections are not of an invasive nature. In the light of these observations, these organisms may be strongly incriminated as the etiological agents of diarrhea in these infants.

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