Study of Bacterial, Viral and Parasitic Enteropathogens Associated with Diarrhea among Displaced Communities at Khartoum State

Abstract

Over a period of 2 years (From January 2006 to January 2008), 710 faecal samples were collected from residents of two internally displaced persons camps, Khartoum State, with acute or chronic diarrhea, and investigated for bacterial, viral, and parasitic enteropathogens. Specimens were collected from patients who were attending clinics (all age groups were included) using standard method, microbiological investigations were performed using conventional and molecular methods. The results revealed that 77.5% of patients with diarrhea were infected with enteropathogens, among them 35.2% had a parasitic, 26.8% a bacterial, 13.9% a viral, and 1.5% had mixed infections. Shigella spp. was the pathogen most frequently detected, accounting for 15.5% of all positive findings in the patients, followed by Rotavirus (14.8%), Hymenolepsis nana (13.4%), however, Schistosoma mansoni and Cryptosporidium spp. were the least detected pathogens (1.1% each). Most of patients affected with diarrhea were children under five years (46.5%), and Rotavirus was the most prevalent enteropathogen in this age group with 29.6% frequency rate, however it was Shigella spp. among adults, and children over 5years (18.3% both), and most of Shigella spp. were S. dysenteriae (42.5%). Further characterization of identified Rotavirus isolates was done using real time polymerase chain reaction (RT-PCR), revealed that, they were type A (95.2% ), and type C (4.8%). Out of the total bacterial pathogens, high resistance was observed against amoxicillin (70.9%) then erythromycin (48.7%), and co-trimoxazole (45.2%). And the lowest resistance to cefuroxime (26.6%). Most of the Shigella spp. isolates were sensitive to cefuroxime (65.5%), but high degree of resistance was observed against amoxicillin (73.6%). Most of the patients consumed untreated drinking water, depend on donkey carts as water source, live in very poor condition, they suffering from crowdness, and had no disposal latrines; all of them were risk factors for acquiring diarrhea. In conclusion, these results revealed that most of diarrhea cases in displaced camps were of parasitic etiology. The most affected group was children under five years. The most frequently identified pathogen was Shigella spp., and most of it were multidrug resistant. Rotavirus had big role in diarrhea, mainly type A especially among children under five years. Further research is needed to adapt and simplify interventions, and to explore novel diagnostics, vaccines, and therapies.