A Two-Year Study of Bacterial, Viral, and Parasitic Agents Associated with Diarrhea in Rural Bangladesh

Enteric pathogens associated with diarrhea were studied for two years at a diarrhea treatment center in rural Bangladesh. Enterotoxigenic Escherichia coli (ETEC) was the most frequently identified pathogen for patients of all ages. Rotavirus and ETEC were isolated from 1'\.150070 and 1'\.125010, respectively, of patients less than two years of age. A bacterial or viral pathogen was identified for 70 % of these young children and for 56% of all patients with diarrhea. Most ETEC isolates were obtained in the hot dry months of March and April and the hot wet months of August and September. Rotavirus identi-fication peaked in the cool dry months of December and January, but infected patients were found year-round. The low case-fatality rates for patients with watery diarrhea and substantial dehydration further document the usefulness of treating patients with diarrhea with either a glucose- or sucrose-base electrolyte solution such as those used in this treatment center. Diarrhea, especially in children, is a major cause of morbidity and mortality in developing coun-tries [1]. Although classic enteric bacterial pathogens are not isolated from most patients with diarrhea, recent studies indicate that enterotoxigenic Escherichia coli (ETEC) and rotaviruses may frequently cause diarrhea [2-4]. Although these agents have been isolated from pa-tients in developing countries, the studies have been brief, and the results do not permit an ac-curate assessment of the relative importance of the various causative agents. We therefore studied pa-tients during a two-year period at a treatment center in rural Bangladesh to determine the fre-quency, severity, and seasonality of diarrhea associated with ETEC, rotavirus, and other enteric agents