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 Table of Contents  
ORIGINAL ARTICLES
Year : 2022  |  Volume : 12  |  Issue : 1  |  Page : 14-17

A clinical and bacteriological study on patients presented with acute diarrhea admitted in Silchar Medical College and Hospital, Cachar District, Assam


1 Department of Medicine, Diphu Medical College and Hospital, Diphu, Assam, India
2 Department of Microbiology, Silchar Medical College and Hospital, Silchar, India
3 Department of Community Medicine, Diphu Medical College and Hospital, Diphu, Assam, India

Date of Submission14-Dec-2021
Date of Acceptance11-Feb-2022
Date of Web Publication18-Apr-2022

Correspondence Address:
Paramita Roy
Department of Medicine, Diphu Medical College and Hospital, Diphu, Karbi Anglong 782462, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajoim.ajoim_22_21

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  Abstract 

Background: Acute diarrheal infection is a leading cause of outpatient visits, hospitalizations, and lost quality of life. It is defined as the passage of three or more loose or liquid stools per day. The Centers for Disease Control and Prevention (CDC) has estimated 47.8 million cases occurring annually in the United States. According to NFHS-5, the prevalence of diarrhea among under-five children in Assam is 5.5%. Aims and Objective: The aim of this work was to study the clinical and bacteriological spectrum in the recent outbreak of acute gastroenteritis in Silchar Medical College and Hospital. Materials and Methods: A cross-sectional study was conducted on patients with diarrhea admitted in the Medicine Department of Silchar Medical College and Hospital for the time period of January 2016 to March 2016. Result: In our study, a total of 327 patients were enrolled. The median age of patients was 36 years with the majority being female and belong to Hindu religion. All were presented with loose stool, followed by vomiting (85%). The most common pathogen isolated from stool was Escherichia coli (71.2%) followed by Klebsiella (16.2%). More than 50% of cases with E. coli infection are resistant to Piperacillin, Doxycycline, while in cases with Klebsiella infection, more than 50% are resistant to Doxycycline followed by Azithromycin. Conclusion: This study may provide valuable information about the clinical features and microbiology of patients with diarrheal diseases to the Medical practitioners which might help in diagnosis and management.

Keywords: Acute diarrhea, bacteriological, clinical, Silchar Medical College and Hospital


How to cite this article:
Roy P, Sen SS, Barman P. A clinical and bacteriological study on patients presented with acute diarrhea admitted in Silchar Medical College and Hospital, Cachar District, Assam. Assam J Intern Med 2022;12:14-7

How to cite this URL:
Roy P, Sen SS, Barman P. A clinical and bacteriological study on patients presented with acute diarrhea admitted in Silchar Medical College and Hospital, Cachar District, Assam. Assam J Intern Med [serial online] 2022 [cited 2022 Aug 19];12:14-7. Available from: http://www.ajimedicine.com/text.asp?2022/12/1/14/343428




  Introduction Top


Acute diarrheal infection is a leading cause of outpatient visits, hospitalizations, and lost quality of life occurring in both domestic settings and among those traveling abroad.[1]

The Centers for Disease Control and Prevention (CDC) has estimated 47.8 million cases occurring annually in the United States, at an estimated cost upwards of US$150 million to the health-care economy.[2]

According to NFHS-5, the prevalence of diarrhea among under-five children in Assam is 5.5% and among them, 53.5% were taken to a health facility or health provider.[3]

Acute diarrhea is defined as the passage of three or more loose or liquid stools per day.

Some definitions require the passage of increased frequency of stools of decreased form from the normal lasting 14 days.[4]

The etiological agents may be bacteria, viruses, and parasites; however, in developed nations, diarrhea is mostly due to noninfective causes like irritable bowel syndrome, coeliac disease, and malignancies.[1]

Acute diarrhea of infectious etiology is generally associated with other clinical features suggesting enteric involvement including nausea, vomiting, abdominal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal urgency. Acute diarrheal infection is also often referred to as gastroenteritis.[4]

The bacterial agents may cause diarrhea by either secretion of toxins which act on the small intestine to cause outpouring of fluids into the lumen as seen in Vibrio cholera, Enterotoxigenic Escherichia coli, Clostridium perfringens, Staphylococcus aureus, and Bacillus cereus, or there may be damage to mucosa mainly in ileum and colon due to inflammation or cytotoxicity resulting in dysentery where fecal leucocytes can be seen on microscopy.[5]

Aims and objectives

  1. To study the clinical and bacteriological spectrum in the recent outbreak of acute gastroenteritis in Silchar Medical College and Hospital.



  Materials and Methods Top


The study was conducted on patients with diarrhea admitted in the Medicine Department of Silchar Medical College and Hospital for the time period of January 2016 to March 2016.

Type of study

Cross-sectional study

Exclusion and inclusion criteria

Inclusion criteria

Patients aged >13 years presented with diarrhea

Exclusion criteria

Patients in whom stool culture was negative

Ethical consideration

Ethical clearance was obtained from Institutional Ethics Committee. Written informed consent was taken from all participants above 18 years. Assent was taken from those aged below 18 years along with informed consent from their guardians.

Study tool

Data were collected by interviewing the participants using a predesigned proforma.

Statistical analysis

Data were entered and analyzed by SPSS V-16.0. Data were presented in number and proportion.


  Result Top


In our study, a total of 327 patients were enrolled and the same number of stool specimens (one from each patient) was submitted to the central laboratory for microbiological analysis.

[Table 1] summarizes the demographic features of patients. The median age of patients was 36 years (range, 13 years to 92 years) and majority of them 48.6% were between 13 and 33 years age group. Approximately 55% were female and 52.9% belonged to Hindu religion.
Table 1: Demographic profile of cases (n = 327)

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[Figure 1] shows the clinical profile of cases. All were presented with loose stool, followed by vomiting (85%), shock (63.3%), AKI (30%), and hemodialysis (1.5%).
Figure 1: Clinical profile of cases (n = 327)

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Regarding the laboratory findings, 20.2% were having increased WBC count, 11.3% having hyperkalemia, and 8.2% hypokalemia [Figure 2].
Figure 2: Clinical profile of cases

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[Table 2] shows the bacteriological profile of cases. The most common pathogen isolated from stool was E. coli (71.2%) followed by Klebsiella (16.2%), pseudomonas (5.8%) and both Proteus and Vibrio (3.4%).
Table 2: Bacteriological profile of cases (n = 327)

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[Table 3] shows antimicrobial resistance of bacteria among cases. More than 50% of cases with E. coli infection are resistant to Piperacillin, Doxycycline, Ceftriaxone, and Amikacin.
Table 3: Antimicrobial resistance of bacteria isolated from diarrheal stool

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While cases with Klebsiella infection, more than 50% are resistant to Doxycycline followed by Azithromycin (43.4%) and Piperacillin (35.85%).

Cases with Vibrio infection, 90% are resistant to Ceftriaxone and 82% to piperacillin.

Regarding Proteus infection, 18% are resistant to Meropenam, piperacillin, Ciprofloxacin, and doxycycline.

Approximately 21% of cases with Pseudomonas infection are resistant to Piperacillin and 16% to Amikacin, Doxycycline, and ciprofloxacin.


  Discussion Top


In our study, majority of patients (48.6%) presented with diarrhea were between 13 and 33 years age group, while several authors also observed a cluster history of diarrheal disease more frequently among patients more than 18 years in their studies[5],[6].

In a study by Chi et al.,[6] fever, bloody stool, and abdominal cramping pain were commonly reported in patients with bacterial infections; however, in our study we observed that most commonly reported symptoms among patients with bacterial infection were loose stool with vomiting.

In the study done by de Wit et al.,[7] Campylobacter species was the predominant bacterial agent in patients with diarrheal diseases but in our study, E. coli was found to be the most predominant enteropathogens in patients.

Regarding antimicrobial resistance of bacteria among cases, Most of the cases with E. coli, Klebsiella and Vibrio, Proteus, and Pseudomonas infection are resistant to Piperacillin, Doxycycline, and Ceftriaxone.


  Conclusion Top


In conclusion, our study showed that E. coli were the predominant enteropathogens among patients who were admitted for diarrheal diseases in Silchar Medical College and hospital. Additionally, we observed that loose stool and vomiting were the most common presentation among patients. Laboratory findings like increased WBC count, hypokalemia, hyperkalemia were the other featured findings in this study.

Overall, this study may provide valuable information about the clinical features and microbiology of patients with diarrheal diseases to the Medical practitioners which might help in diagnosis and management.

It also may guide in selection of antibiotics in acute diarrhea due to local bacterial infection as there is emergence of antibiotic resistance among enteric pathogens.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Riddle MS, DuPont HL, Connor BA ACG clinical guideline: Diagnosis, treatment, and prevention of acute diarrheal infections in adults. The American Journal of Gastroenterology2016;111:602-22.  Back to cited text no. 1
    
2.
Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM Foodborne illness acquired in the united states–unspecified agents. Emerg Infect Dis 2011;17:16-22.  Back to cited text no. 2
    
3.
International Institute for Population Sciences (IIPS). 2021. National Family Health Survey (NFHS-5), 2019-2020, India: Key findings. Mumbai: IIPS. p. 28.  Back to cited text no. 3
    
4.
Park K Park’s Textbook of Preventive and Social Medicine. 24th ed. Jabalpur: M/s Banarasidas Bhanot Publishers. p. 236-37.  Back to cited text no. 4
    
5.
Tejan N, Datta P, Gupta V Bacterial diarrhoea: A comprehensive review. Int J Pharm Sci & Res 2018;9:5015-31.  Back to cited text no. 5
    
6.
Chi C-Y, Liao L-N, Ho C-M, Chou C-H, Ho M-W, Wang J-H Epidemiology, clinical features, and microbiology of patients with diarrhea in community clinics in Taiwan. Journal of Microbiology, Immunology and Infection 2018;51:527-34.  Back to cited text no. 6
    
7.
de Wit MA, Koopmans MP, Kortbeek LM, van Leeuwen NJ, Vinjé J, van Duynhoven YT Etiology of gastroenteritis in sentinel general practices in the Netherlands. Clin Infect Dis 2001;33:280-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Materials and Me...
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