Prolonged acute diarrhea in adults: Decades of observation from epidemiological perspective in urban Bangladesh

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.

DOI: 10.4236/ojgas.2013.33034                

Abstract

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.

Keywords

Adult; Bangladesh; Diarrhea; Prolonged Acute Diarrhea

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Boschi-Pinto, C., Velebit, L. and Shibuya, K. (2008) Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ, 86, 710-717.
[2]	Fischer Walker, C.L., Sack, D. and Black, R.E. (2010) Etiology of diarrhea in older children, adolescents and adults: A systematic review. PLoS Neglected Tropical Diseases, 4, e768. doi:10.1371/journal.pntd.0000768
[3]	Manatsathit, S., Dupont, H.L., Farthing, M., et al. (2002) Guideline for the management of acute diarrhea in adults. Journal of Gastroenterological Hepatology, 17, S54-S71.
[4]	Walker, C.L. and Black, R.E. (2010) Diarrhoea morbidity and mortality in older children, adolescents, and adults. Epidemiology and Infection, 138, 1215-1226. doi:10.1017/S0950268810000592
[5]	Juckett, G. and Trivedi, R. (2011) Evaluation of chronic diarrhea. American Family Physician, 84, 1119-1126.
[6]	Lopman, B.A., Hall, A.J., Curns, A.T., et al. (2011) Increasing rates of gastroenteritis hospital discharges in US adults and the contribution of norovirus, 1996-2007. Clinical Infectious Diseases, 52, 466-474. doi:10.1093/cid/ciq163
[7]	Lamberti, L.M., Fischer Walker, C.L. and Black, R.E. (2012) Systematic review of diarrhea duration and severity in children and adults in lowand middle-income countries. BMC Public Health, 12, 276.
[8]	Das, S.K., Chisti, M.J., Huq, S., et al. (2013) Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh. Food and Nutrition Sciences, 4, 233-239. doi:10.4236/fns.2013.43031
[9]	Schilling K.A. (2010) Characteristics and etiology of moderate-to-severe diarrhea of acute, prolonged acute, and persistent duration among children less than 5 years old in rural western Kenya, 2008-2010. Georgia State University.
[10]	Bhutta, Z.A., Nelson, E.A., Lee, W.S., et al. (2008) Recent advances and evidence gaps in persistent diarrhea. Journal of Pediatric Gastroenterology and Nutrition, 47, 260-265. doi:10.1097/MPG.0b013e318181b334
[11]	WHO (1987) Programme for control of diarrheal disease. In Manual for laboratory investigation of acute enteric infections. World Health Organization, Geneva.
[12]	Qadri, F., Azim, T., Chowdhury, A., et al. (1994) Production, characterization, and application of monoclonal antibodies to Vibrio cholerae O139 synonym Bengal. Clinical and Diagnostic Laboratory Immunology, 1, 51-54.
[13]	Rahman, M., Sack, D.A., Mahmood, S., et al. (1987) Rapid diagnosis of cholera by coagglutination test using 4-h fecal enrichment cultures. Journal of Clinical Microbiology, 25, 2204-2206.
[14]	Haque, R., Mondal, D., Karim, A., et al. (2009) Prospective case-control study of the association between common enteric protozoal parasites and diarrhea in Bangladesh. Clinical Infectious Diseases, 48, 1191-1197. doi:10.1086/597580
[15]	Haque, R., Neville, L.M., Hahn, P., et al. (1995) Rapid diagnosis of Entamoeba infection by using Entamoeba and Entamoeba histolytica stool antigen detection kits. Journal of Clinical Microbiology, 33, 2558-2561.
[16]	Rahman, M., De Leener, K., Goegebuer, T., et al. (2003) Genetic characterization of a novel, naturally occurring recombinant human G6P[6] rotavirus. Journal of Clinical Microbiology, 41, 2088-2095. doi:10.1128/JCM.41.5.2088-2095.2003
[17]	Weil, A.A., Khan, A.I., Chowdhury, F., et al. (2009) Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clinical Infectious Diseases, 49, 1473-1479. doi:10.1086/644779
[18]	Khan, A.I., Chowdhury, F., Harris, J.B., et al. (2010) Comparison of clinical features and immunological parameters of patients with dehydrating diarrhoea infected with Inaba or Ogawa serotypes of Vibrio cholerae O1. Scandinavian Journal of Infectious Diseases, 42, 48-56. doi:10.3109/00365540903289688
[19]	Sigman, M. and Luchette, F.A. (2012) Cholera: Something old, something new. Surgical Infections (Larchmt), 13, 216-222. doi:10.1089/sur.2012.127
[20]	Alam, N.H. and Ashraf, H. (2003) Treatment of infectious diarrhea in children. Paediatric Drugs, 5, 151-165.
[21]	Echeita Sarrionandia, M.A., Leon, S.H. and Baamonde, C.S. (2011) Invasive gastroenteritis, anything new? Enfermedades Infecciosas y Microbiologia Clinica, 29, 55-60.
[22]	Lai, S.W., Lin, H.C., Lin, C.C., et al. (2000) Clinical analysis of a dysentery outbreak in Taichung. Acta Paediatrica Taiwanica, 41, 18-21.
[23]	Stein, J.R., Hartmann, F. and Dignass, A.U. (2010) Diagnosis and management of iron deficiency anemia in patients with IBD. Nature Reviews Gastroenterology & Hepatology, 151.
[24]	Hopman, W.M., Harrison, M.B., Coo, H., Friedberg, E., Buchanan, M. and VanDenKerkhof, E.G. (2009) Associations between chronic disease, age and physical and mental health status. Chronic Diseases in Canada, 29, 108116.
[25]	Massarrat, S. (2008) Smoking and gut. Archives of Iranian Medicine, 11, 293-305.
[26]	Thomas, G.A., Rhodes, J. and Ingram, J.R. (2005) Mechanisms of disease: nicotine—A review of its actions in the context of gastrointestinal disease. Nature Clinical Practice Gastroenterology & Hepatology, 2, 536-544.
[27]	Wu, W.K. and Cho, C.H. (2004) The pharmacological actions of nicotine on the gastrointestinal tract. Journal of Pharmacological Science, 94, 348-358. doi:10.1254/jphs.94.348
[28]	Aeromonas detection: What does it mean? Water: Unregulated Contaminant Monitoring Program. http://water.epa.gov/lawsregs/rulesregs/sdwa/ucmr/data_aeromonas.cfm
[29]	Baqui, A.H., Sack, R.B., Black, R.E., et al. (1992) Enteropathogens associated with acute and persistent diarrhea in Bangladeshi children less than 5 years of age. The Journal of Infectious Diseases, 166, 792-796. doi:10.1093/infdis/166.4.792
[30]	Osterholm, M.T., MacDonald, K.L., White, K.E., et al. (1986) An outbreak of a newly recognized chronic diarrhea syndrome associated with raw milk consumption. JAMA, 256, 484-490. doi:10.1001/jama.1986.03380040058029
[31]	Pawlowski, S.W., Warren, C.A. and Guerrant, R. (2009) Diagnosis and treatment of acute or persistent diarrhea. Gastroenterology, 136, 1874-1886. doi:10.1053/j.gastro.2009.02.072