Diarrhoea and Associated Clinical Features in Different Pathotypes of Diarrheagenic E. coliIsolated in Children: A Case-Control Study in a Tertiary Care Hospital

Background: Acute gastroenteritis remains to be a major health problem in children causing high morbidity and mortalityIn India, diarrhoea is the third most common cause of death in children younger than 5 years of age, with an estimation of 300,000 deaths each year. Diarrheagenic Escherichia coli (DEC) being one of the important bacterial agents, the present hospital-based study was done to enlighten on the occurrence of different pathotypes and clinical features associated with DEC related diarrhoea. Methods:The case-control study was carried out in SCB Medical College, Odisha from October 2014 to September 2016 on the childhood diarrhoea cases (≤ 14 years of age). Stool samples were collected and processed to isolate the causative bacterial agent by standard biochemical test, serotyping and multiplex PCR. Results: 350 cases and 100 controls were included in the study. The different pathotypes of DEC were isolated significantly more in cases than control group (P value = 0.0205) with an isolation rate of 7.4% in cases. 12 (46.2%) of DEC were in 0-1 year age group followed by 1-5 year of age group i.e. 11 (42.3%) and least in 5-14 years of age group i.e. 3 (11.5%). The most common pathotype was Enterotoxigenic E. coli (ETEC) followed by Enteropathogenic E.coli (EPEC). Fever is the most common symptom associated with DEC diarrhoea; the other two common symptoms were watery diarrhoea and vomiting. Exclusive breastfeeding was the protective factor. Seasonal variation of DEC was found more among the cases in the rainy season. Conclusion: Different pathotypes of DEC being associated commonly with childhood diarrhoea, the correct identification of various types of DEC along with the clinical knowledge is important to reduce the morbidity and mortality caused by it.