Etiology of childhood diarrhea in Zliten, Libya

OBJECTIVE: To determine the etiological agents of diarrhea in children from a small semi-urban city in Libya and the association of age, gender, seasonal variation, breast-feeding, source of water for drinking, or antibiotic use with the isolation of enteropathogens and whether such agents are community or hospital acquired.

METHODS: Using standard microbiological techniques we examined stool samples from 169 children (70 females) aged a few days to 12 years with acute diarrhea for viral, bacterial and parasitological agents. We used the disc diffusion method to determine the susceptibility of bacterial pathogens to antimicrobial agents. We carried out the study between April 2000 to March 2001.

RESULTS: We detected a single agent in 44.4%, rotavirus in 26.6%, Salmonella in 13.6%, and Cryptosporidium in 13% of patients and other enteric pathogens, Shigella in 3.6%, Aeromonas in 5.5%, Entamoeba histolytica/dispar in 11.8, and Giardia lamblia in 1.2%. Serotyping of isolated Salmonella resulted in 21 being Salmonella enteric serotype heidelberg and 3 Salmonella enteritidis. We detected both serotypes in one child. More than 75% of the isolated Salmonella were resistant to 6 different commonly used antimicrobial agents.

CONCLUSION: We found rotavirus, non-typhoid Salmonella and Cryptosporidium to be the most important enteric agents associated with childhood diarrhea in Zliten. The isolated bacterial pathogens showed high resistant rates, particularly among the Salmonella, to the commonly used antimicrobial agents. The ease of which one can obtain these drugs in Zliten may play a role in such resistance.