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Background  Diarrhea is the most frequent health problem among children in developing countries. This study investigated the bacterial and viral etiology and related clinical and epidemiological factors in children with acute diarrhea in Ouagadougou, Burkina Faso.    Methods  Stool specimens were collected from 283 children under 5 years of age visiting hospital due to acute diarrhea and from 60 healthy controls of similar age. Pathogens were investigated by using conventional culture techniques, PCR and immunochromatographic testing.  Salmonella  and  Shigella  strains were serotyped and their susceptibility to 23 antimicrobial agents was determined by the agar dilution method.    Results  At least one pathogen was detected in 64% of the 283 patients and in 8% of the 60 controls ( p  < 0.001). Rotavirus was found in 30% of the patients, followed by diarrheagenic  Escherichia coli  (24%),  Salmonella enterica  ssp.  enterica  (9%),  Shigella  spp. (6%), adenovirus (5%) and  Campylobacter  spp. (2%). Multiple pathogens were found in 11% of the patients and in 2% of the controls ( p =  0.028). Viruses were found mainly in children of ≤ 2 years of age, whereas bacteria were equally prevalent among all the age groups. Viral infections occurred mostly during the cool dry season and the bacterial infections during the rainy season. Fever (64%) and vomiting (61%) were the most common symptoms associated with diarrhea. Only one  Salmonella  strain was resistant to nalidixic acid and ciprofloxacin. Of the  Shigella  strains, one was resistant to nalidixic acid but 81% to trimethoprim- sulfamethoxazole, 63% to streptomycin and 50% to ampicillin. Most of all the other  Salmonella  and  Shigella  strains were sensitive to all antimicrobials tested.    Conclusion  Rotaviruses and diarrheal  E. coli  were the most predominant pathogens associated with acute diarrhea in Burkinabe children. Constant antimicrobial surveillance is warranted to observe for the emergence of enteric bacteria resistant to antimicrobials that are important in treatment also of severe infections.

Bacterial and viral etiology of childhood diarrhea in Ouagadougou, Burkina Faso