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Aetiology and Epidemiology of Sever Infantile Diarrhoea in Baghdad, Iraq 360 fatal, resulting in the deaths of 5 to 18 million children [3]. A later study in the same areas estimated 3 to 5 billion cases of diarrhea and 5 to 10 million diarrhea-associated deaths in 1 year, ranking diarrhea first among infectious diseases in the categories of both frequency and mortality, with the burden greatest in infants and young children [2]. Infant gastroenteritis remains a critical public health problem all over the world as was recognized by WHO [3] and acute diarrhea due to bacterial infections is one of the main causes of childhood morbidity and mortality especially in developing countries [4]. Despite the importance of this disease, the agents of a large proportion of diarrhoeal illnesses of infants and young children were not known until relatively recently [2]. Up to 70% of the 1400 million episodes of diarrhea worldwide in children under age 5 years cause this morbidity and mortality may be due to pathogens which is transmitted through food [5] or drinking water [6]. Among the causative agents, the following bacteria have been reported: Enterotoxigenic Escherichia coli (ETEC), Shigella, Salmonella, and Campylobacter [7, 8]). Among the viruses, rotavirus seems to be the most common [9]. Food contamination is one major route for the transmission of enteropathogens, especially under the hygienic conditions prevailing in a rural setting. Various studies have reported that the source of the enteropathogens was either water or food [10]. Rotavirus is the leading cause of severe gastroenteritis among children worldwide [11]. Annually rotavirus is estimated to cause 352,000-592,000 deaths, 2 million hospitalizations and 25 million clinic visits globally among children younger than 5 years of age [12], mortality and hospitalization rates vary significantly depending on access to health care in developing settings. Depending on the setting and studies, rotavirus was found in 13-71% of diarrhea cases requiring inpatient or outpatient medical care in infants and young children [13, 14]. Most cases of gastroenteritis have a viral etiology and are self-limited. However, more severe or prolonged cases of gastroenteritis can result in dehydration with significant morbidity and mortality. This is often the scenario in third-world countries, where gastroenteritis results in 3 million deaths annually [15]. The main risk of gastroenteritis in children, particularly babies and young children is that they become dehydrated. This can occur very quickly in babies because they do not need to lose a lot of fluid to lose significant percentage of total body fluid [16]. The most effective treatment and intervention method for acute diarrhea and for the control of diarrhoeal mortality has been the use of oral rehydration therapy (ORT). The aim of ORT is to restore the initial fluids deficits and to replace ongoing stool losses until diarrhea ceases [17]. The ORT fluid composition is presented in table (1). New diagnostic laboratory techniques as well as modifications of standard ones have been used by investigators to identify viral, bacterial, and parasitic agents of outbreaks of gastroenteritis [18].This study was designed to determine the causative agents of diarrhoea in children less than 2 year of age in Baghdad / Iraq and to assess the efficacy and safety of using ORT treatment in management of infantile diarrhoeal dehydration.
361 E. N. Al-kaissi, M. Makki and M. Al- Khoja Table 1: Comparison of Oral Rehydration Solutions Solutions Glucose Sodium Composition Potassium Chloride Commercial solutions (g per dL) (mEq per L) (mEq per L) (mEq per L) WHO solution 2.0 90 20 80 Hydra-Lyte 1.2 84 10 59 Rehydralyte 2.5 75 20 65 Pedialyte 2.5 45 20 35 Generic pediatric solution* 2.5 45 20 35 Lytren 2.0 50 25 45 Resol 2.0 50 20 50 Infalyte 2.0 50 20 40 Ricelyte Starch polymers 50 25 45 Home remedies (not recommended) Jell-O(one-half strength) 8.0 6 to 17 0.2 -- Gatorade 5.0 24 3 17 Soft drinks 7.0 to 12.0 1 to 7 0.1 to 0.4 -- Apple juice 12.0 0.1 to 3.5 24 to 43 -- Broth -- 250 -- -- WHO=World Health Organization. *--Similar to Pedialyte. Information from reference (MMWR2003). Materials and Methods 200 cases admitted to the medical city hospital Baghdad/ Iraq for rehydration were included in this work, they were children between the age of 0-2 years and their diarrhoeas of less than 6 days duration prior to admission to hospital. The study extended for one year. Evaluation of the degree of dehydration was performed on admission [19]. ORT (WHO formula- table 1) was offered to all patients irrespective of age. Laboratory investigation A-Blood samples were sent to the Laboratory for biochemical investigation including: serum Na + , K + , CL - , BUN, protein(by Technicon- Microlyzer) and acid-base study by Micro-Astup).) B-isolation of enteric pathogens A total of 200 stool specimens were collected from the children, the specimens were collected in sterile specimen bottles having the names and ages of the patients. All the samples were transferred immediately to the laboratory for analysis. General stool examinations were done as well as inoculation into standard appropriate culture media, Selective and differential solid media as well as enrichment broth were used for primary isolation of enteric organisms. These include: MacConkey's agar (Oxoid), deoxycholate citrate agar (Oxoid), and selenite F (Oxoid) as enrichment broth for entopathogenic Escherichia coli, Salmonella and Shigella as described [20], and Campylobacter selective agar, which contains vancomycin, polymyxinB sulphate and trimethoprim (WHO supply) for campylobacter species.All solid media plates were incubated aerobically at 35-37ºc for 18h except campylobacter selective agar plates which were incubated under microaerobic condition at 42ºc for 48h [21]. Biochemical tests such as methyl red, motility, kligler iron agar, indole, catalase, urease and oxidase were carried out on the bacterial isolates using conventional techniques of [22]. E. coli colonies from non inhibitory agar medium were screened for classical enteropathogenic serotypes by the slide agglutination tests using commercially available antisera (Wellcome Diagnostics, Temple
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