Author(s)

Sumon Kumar Das, Mohammod Jobayer Chisti, Shahnawaz Ahmed, Mohammad Abdul Malek, Fahmida Dil Farzana, Farzana Ferdous, Jonathan Latham, Abu Syed Golam Faruque

Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
London School of Hygiene and Tropical Medicine, London, UK.

The study aimed to determine the epidemiological, clinical characteristics, and etiology of adults aged ≥20 years presented with prolonged acute diarrhea (≥7 days). A total of 18,210 adults aged ≥20 years were enrolled in the Diarrheal Disease Surveillance System of icddr,b between 1993-2012 and included into the analysis. Of these, 17,631 (97%) had duration of diarrhea ≤6 days, 418 (2%) diarrhea presented with a duration of 7 - 13 days and rest 161 (1%) had history of diarrhea ≥14 days. A higher proportion of adult individuals who had duration of diarrhea ≥14 days (70% vs. 56%; p < 0.001) and 7 - 13 days (62% vs. 56%; p = 0.006) compared to those ≤6 days were male. At least 73% of all patients used oral rehydration solution; but proportion was lower among prolonged acute diarrhea groups. Use of antimicrobials was higher among those with duration 7 - 13 days (81%) and ≥14 days (81%). Diarrhea lasting ≥14 days, 47% were suffering from chronic energy deficiency and 30% had history of smoking. Individuals with diarrhea ≥7 days less frequently presented with vomiting, watery stool, frequency of stool >10 times/24 hours, drowsy or lethargy, fast breathing, some or severe dehydration, received intravenous saline for initial corrections of dehydration and stayed for longer duration in hospital (≥24 hours) but more often presented with abdominal pain. Stool microscopic examination showed less frequent presence of red blood cells (36% vs. 44%; p = 0.043) and fecal leucocytes (50% vs. 59%; p = 0.029) among individuals with diarrhea ≥14 days compared to those with ≤6 days. None was infected with Vibrio cholerae (≥14 days) (3% for 7 - 13 days); however, isolation rate of Aeromonas was higher among adults with duration for ≥14 days (11%). Only 15% with ≥14 days were positive for Shigella contrary to 19% (7 - 13 days) and 56% (≤6 days). Differences in sociodemographic, clinical presentation and etiology varied with duration of diarrhea among adults.

Adult; Bangladesh; Diarrhea; Prolonged Acute Diarrhea

Das, S. , Chisti, M. , Ahmed, S. , Malek, M. , Farzana, F. , Ferdous, F. , Latham, J. and Faruque, A. (2013) Prolonged acute diarrhea in adults: Decades of observation from epidemiological perspective in urban Bangladesh. Open Journal of Gastroenterology, 3, 208-213. doi: 10.4236/ojgas.2013.33034.