Hospitalizations due to bloody diarrhea in a pediatric reference center in Uruguay
Abstract
Introduction: Bloody diarrhea is a common reason for hospital admission in children with acute gastroenteritis; In most cases these are mild and self-limiting infections, but serious complications can occur.
Goals: To describe the etiology and clinical-evolutionary characteristics of children under 15 years of age hospitalized for bloody diarrhea at the Pediatric Hospital, Centro Hospitalario Pereira Rossell between the years 2012-2023.
Materials and methods: Retrospective study through review of histories and laboratory records. Variables: demographics, nutritional status, hydration, reason for hospitalization, intensive care unit (ICU) admission, enteropathogens, treatments, evolution.
Results: 229 children were included, median age 8 months; male sex 61%; eutrophic 88%, well hydrated 55%, with comorbidities 11%, prematurity 6.5%. The reason for hospitalization was bloody diarrhea/dysentery without other symptoms 45%. Coprovirological/coproculture was requested in 98% and detection by nucleic acid techniques in fecal matter was requested in 5,2%. At least one pathogenic agent was identified in 34,3%: Shigella sp. 38%; Salmonella sp 19,5%; coinfections in 12%. Antibiotics were indicated for 86%; ceftriaxone 62%, azithromycin 35%.
Were admitted to the ICU 6,5% (15), 10/14 had complications, 5 had acute kidney failure and 3 had alterations in the internal environment. The majority had a good evolution.
Conclusions: Bloody diarrhea/dysentery continues to be an important cause of hospitalization, affecting mostly healthy children under 5 years of age. The most frequently detected pathogens were bacteria, mainly Shigella sp., Salmonella sp. and diarrheagenic E coli. High prescription of antibiotics was reported, complying in most cases with the recommendations
Downloads
References
Organización Mundial de la Salud. Enfermedades diarreicas. Ginebra: OMS, 2017. Disponible en: http://www.who.int/mediacentre/factsheets/fs330/es/. [consulta: 3 enero 2024].
GBD Diarrhoeal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(9):909-948.
Herrera-Benavente IF, Comas-García A, Mascareñas-de los Santos AH. Impacto de las enfermedades diarreicas agudas en América Latina. Justificación del establecimiento de un Comité de Enfermedades Diarreicas en SLIPE. Rev Latin Infect Pediatr 2018; 31 (1): 8-16.
Ramírez Y, Pastorini J, Russi J, Ferrari AM. Enfermedad diarreica aguda. Características de la población asistida en el CASMU. Abril 1997- abril 1998. Arch Pediatr Urug 2001; 72(2):110-115.
Pérez W, Melogno A, Piriz M, Pastorino H, Pereira ML, Pinchak C, et al. Diarrea aguda infantil: Admisión hospitalaria en menores de tres años. Año 2005. Arch Pediatr Urug 2007; 78(2): 94-8.
Varela G, Chinen I, Gadea P, Miliwebsky E, Mota MI, González S, et al. Detección y caracterización de Escherichia coli productor de toxina Shiga a partir de casos clínicos y de alimentos en Uruguay. Rev Argent Microbiol 2008;40: 93-100
Viettro A, Monteverde N, Pinchak C. Características clínicas y etiológicas de la enfermedad diarreica aguda en niños menores de 5 años hospitalizados en el Hospital Central de las Fuerzas Armadas 2004-2006. Arch Pediatr Urug 2009; 80(1):16-22.
Mota MI, Gadea MP, González S, González G, Pardo L, Sirok A, et al. Bacterial pathogens associated with bloody diarrhea in Uruguayan children. Rev Argent Microbiol 2010; 42: 114-117.
Pérez W, Decia M, Guzzo F, Montano A. Gastroenteritis aguda en lactantes: admisión en el Centro Hospitalario Pereira Rossell 2006-2007. Arch Pediatr Urug 2011; 82(1): 4-9.
Notejane M, Pandolfo S, García L, Parada M, Coedo V, Betancor L, et al. Gastroenteritis aguda: formas de presentación clínica y etiología en niños hospitalizados en el Hospital Pediátric, Centro Hospitalario Pereira Rosell, año 2012. Arch Pediatr Urug 2015; 86 (2):91-97
Varela G, Batthyány L, Bianco MN, Pérez W, Pardo L, Algorta G, et al. Enteropathogens Associated with Acute Diarrhea in Children from Households with High Socioeconomic Level in Uruguay. Int J Microbiol 2015;592953. doi.org/10.1155/2015/592953.
García L, Algorta G, Pírez MC, Rubio I, Montano A. Diarrea con sangre. Etiología y tratamiento con antibióticos en niños asistidos en el CHPR. Enero 2003-abril 2004. Arch Pediatr Urug 2005; 76(4): 285-288.
Giugno S, Oderiz S. Etiología bacteriana de la diarrea aguda en pacientes pediátricos. Acta Bioquím Latinoam 2010; 44(1):63-9.
Gastroenteritis aguda. En: Assandri E, Casuriaga A, Le Pera V, Notejane M, Vázquez M, Zunino C. Atención Pediátrica. Normas Nacionales de Diagnóstico, Tratamiento y Prevención. 9ª Edición. Oficina del Libro. FEFMUR. Montevideo, 2020. p:455-470.
Gutiérrez P, Polanco A, Salazar E. Manejo de la gastroenteritis aguda en menores de 5 años: un enfoque basado en la evidencia. Guía de práctica clínica Ibero-Latinoamericana. An Pediatr (Barc) 2010; 72 (3):220.e1-220.e20.
Albert de la Torre L, Roa Francia MA. Gastroenteritis aguda (v.4/2011). Guía-ABE. Infecciones en Pediatría. Guía rápida para la selección del tratamiento antimicrobiano empírico. actualizado el 12-dic-2011; Disponible en: http://www.guia-abe.es/temas-clinicos-gastroenteritis-aguda.[consulta: 3 enero 2024].
Bruzzese E, Giannattasio A, Guarino A. Antibiotic treatment of acute gastroenteritis in children [version 1; referees: 2 approved] F1000Research 2018, 7(F1000 Faculty Rev):193. doi: 10.12688/f1000research.12328.1.
Buss SN, Leber A, Chapin K, Fey PD, Bankowski MJ, Jones MK, et al. Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol. 2015 Mar;53(3):915-25. doi: 10.1128/JCM.02674-14.
Chung N, Wang SM, Shen CF, Kuo FC, Ho TS, Hsiung CA, et al. Clinical and epidemiological characteristics in hospitalized young children with acute gastroenteritis in southern Taiwan: According to major pathogens. J Microbiol Immunol Infect. 2017 Dec;50(6):915-922. doi: 10.1016/j.jmii.2017.07.015.
Tam CC, O'Brien SJ, Tompkins DS, Bolton FJ, Berry L, Dodds J, et al. Changes in causes of acute gastroenteritis in the United Kingdom over 15 years: microbiologic findings from 2 prospective, population-based studies of infectious intestinal disease. Clin Infect Dis. 2012 May;54(9):1275-86. doi: 10.1093/cid/cis028.
Fernandez-García M, Fernandez Rodríguez C, Martínez Furé G, Pérez Ramos E, Cuza Arribas C, Acosta López J. Etiología de la diarrea con sangre en menores de 5 años. Rev cuba pediatr. 2004; 76(4).
Notejane M, Reyes X, Rodríguez D, Vomero A, García L, Pírez C. Evaluación del cumplimiento de las normas nacionales de abordaje terapéutico para gastroenteritis aguda en un centro de referencia de Uruguay. Arch Pediatr Urug 2020; 91(5):287-293.
Ren Z, Kong Y, Wang J, Wang Q, Huang A, Xu H. Etiological study of enteric viruses and the genetic diversity of norovirus, sapovirus, adenovirus, and astrovirus in children with diarrhea in Chongqing, China. BMC Infect Dis. 2013 Sep 3;13:412. doi: 10.1186/1471-2334-13-412.
Lucero AY. Etiología y manejo de la gastroenteritis aguda infecciosa en niños y adultos. Rev. Med. Clin. Condes. 2014; 25(3): 463-472.
Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8a ed. Philadelphia. Elsevier 2019.
Barrios P, Badía F, Misa V, Mota MI, Martínez A, Mariño H, et al. Un quinquenio de experiencia (2005-2010) con infecciones por Salmonella spp en un centro nacional de referencia en pediatría. Rev Chilena Infectol. 2017; 34 (4): 359-364.
da Cruz Gouveia MA, Lins MTC, da Silva GAP. Acute diarrhea with blood: diagnosis and drug treatment. J Pediatr (Rio J). 2020;96 (Suppl1):20-28. doi: 10.1016/j.jped.2019.08.006.
Barreto M, Castillo-Ruiz M, Retamal P. Salmonella enterica: una revisión de la trilogía agente, hospedero y ambiente, y su trascendencia en Chile. Rev. Chil. Infectol. 2016; 33 (5): 547-557.
Torres ME, Pírez MC, Schelotto F, Varela G, Parodi V, Allende F, et al. Etiology of children 's diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates. J Clin Microbiol. 2001 Jun;39(6):2134-9. doi: 10.1128/JCM.39.6.2134-2139.2001. PMID: 11376047; PMCID: PMC88101.
Kotloff KL, Platts-Mills JA, Nasrin D, Roose A, Blackwelder WC, Levine MM. Global burden of diarrheal diseases among children in developing countries: Incidence, etiology, and insights from new molecular diagnostic techniques. Vaccine. 2017 Dec 14;35(49 Pt A):6783-6789. doi: 10.1016/j.vaccine.2017.07.036. Epub 2017 Jul 29. PMID: 28765005.
Gadea del P, Varela G, Bernadá M, Sirok A , Mota MI, Sabelli R, et al. Primer aislamiento en Uruguay de Escherichia coli productora de toxina Shiga del serotipo O157:H7 en una niña con síndrome urémico hemolítico. Rev. Méd. Urug. 2004; 20 (1): 79-81.
Varela G, Schelotto F. Síndrome urémico hemolítico en Uruguay. Aspectos microbiológicos y clínicos, aportes para su conocimiento regional. Rev. Fac. Cienc. Salud. UDES. 2015;2(1):25-30.http://dx.doi.org/10.20320/rfcsudes-201521-416
Carbonari CC, Ricciardo M, Rodríguez Calvo A, Montes A, Deza NL, Conde Valentino MA, et al. An Stx- EAEC O59:NM(H19) strain isolated from a hemolytic uremic syndrome case in Argentina. Rev Argent Microbiol. 2020;52(1):31-35. https://doi.org/10.1016/j.ram.2019.03.006
Pardo L, Mota MI, Giachetto G, Parada M, Pírez C, Varela G. Adenitis mesentérica por Yersinia enterocolítica. Rev. Méd. Urug. 2007; 23( 4 ): 383-386.
Bentancor L, Gadea P, Parada M, Cabezas L, Martínez A, Yim S, et al. Diversidad genética en aislamientos Uruguayos de Campylobacter sp. asociados a diarrea aguda infantil y alimentos de origen avícola. XXI Congreso Latinoamericano de Microbiología. Brasil, 2012.
Omatola CA, Olaniran AO. Rotaviruses: From Pathogenesis to Disease Control-A Critical Review. Viruses. 2022 Apr 22;14(5):875. doi: 10.3390/v14050875.
Clark A, Black R, Tate J, Roose A, Kotloff K, Lam D, et a. Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements. PLoS One. 2017 Sep 11;12(9):e0183392. doi: 10.1371/journal.pone.0183392.
Lee B, Damon CF, Platts-Mills JA. Pediatric acute gastroenteritis associated with adenovirus 40/41 in low-income and middle-income countries. Curr Opin Infect Dis. 2020;33(5):398-403. doi:10.1097/QCO.0000000000000663
Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. doi: 10.1093/cid/cix669. PMID: 29053792; PMCID: PMC5850553.
Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L. Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries. Evid Based Child Health. 2013 Jul;8(4):1123-37. doi: 10.1002/ebch.1932. PMID: 23877938.
Ashida H, Ogawa M, Kim M, Suzuki S, Sanada T, Punginelli C, et al. Shigella deploy multiple countermeasures against host innate immune responses. Curr Opin Microbiol. 2011 Feb;14(1):16-23. doi: 10.1016/j.mib.2010.08.014. Epub 2010 Oct 8. PMID: 20934372.
Khan WA, Griffiths JK, Bennish ML. Gastrointestinal and extra-intestinal manifestations of childhood shigellosis in a region where all four species of Shigella are endemic. PLoS One. 2013 May 17;8(5):e64097. doi: 10.1371/journal.pone.0064097. PMID: 23691156; PMCID: PMC3656950.
Onwuezobe IA, Oshun PO, Odigwe CC. Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. Cochrane Database Syst Rev. 2012 Nov 14;11(11):CD001167. doi: 10.1002/14651858.CD001167.pub2. PMID: 23152205; PMCID: PMC6532567.
Donnenberg MS, Finlay BB. Combating enteropathogenic Escherichia coli (EPEC) infections: the way forward. Trends Microbiol. 2013 Jul;21(7):317-9. doi: 10.1016/j.tim.2013.05.003. PMID: 23815982; PMCID: PMC4312613.
Kaakoush NO, Castaño-Rodríguez N, Mitchell HM, Man SM. Global Epidemiology of Campylobacter Infection. Clin Microbiol Rev. 2015 Jul;28(3):687-720. doi: 10.1128/CMR.00006-15. PMID: 26062576; PMCID: PMC4462680.
World Health Organization Media Centre: Campylobacter: Factsheet No 255, 2016. http://www.who.int/mediacentre/factsheets/fs255/en/.[consulta: 3 enero 2024].
Costa E, Mota MI, Varela A, Gutiérrez C, Algorta G. Susceptibilidad a azitromicina en aislamientos de Shigella spp. XXXIII Congreso Uruguayo de Pediatría. Montevideo, Uruguay. 21-24 set. 2021.
Ardissino G, Tel F, Possenti I, Testa S, Consonni D, Paglialonga F, et al. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. Pediatrics. 2016 Jan;137(1). doi: 10.1542/peds.2015-2153. Epub 2015 Dec 7. PMID: 26644486.
de Buys Roessingh AS, de Lagausie P, Baudoin V, Loirat C, Algrain Y. Gastrointestinal complications of post-diarrheal hemolytic uremic syndrome. Eur J Pediatr Surg. 2007; 17(5):328- 334. DOI: 10.1055/s-2007-965013.
Fakhouri F, Zuber J, Frémeaux-Bacchi V, Loirat C. Haemolytic uraemic syndrome. Lancet. 2017 Aug 12;390(10095):681-696. doi: 10.1016/S0140-6736(17)30062-4. Epub 2017 Feb 25. Erratum in: Lancet. 2017 Aug 12;390(10095):648. PMID: 28242109.
De Rauw K, Detemmerman L, Breynaert J, Piérard D. Detection of Shiga toxin-producing and other diarrheagenic Escherichia coli by the BioFire FilmArray® Gastrointestinal Panel in human fecal samples. Eur J Clin Microbiol Infect Dis. 2016 Sep;35(9):1479-86. doi: 10.1007/s10096-016-2688-7.
Copyright (c) 2024 Martin Notejane, María Inés Mota, Alejandra Vomero, Claudia Móttola, Asif Raza, Marcos Canto, Loreley García, Adriana Varela
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain their copyright and assign to the journal the right of first publication of their work, which will be simultaneously subject to the Creative Commons Attribution 4.0 International License. that allows sharing the work as long as the initial publication in this magazine is indicated.
