Acute diarrhoeal disease in Nigeria: detection of enteropathogens in a rural sub-Saharan population

Part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984-2005

The global incidence of Shigella infection has been estimated at 80-165 million episodes annually, with 99% of episodes occurring in the developing world. To identify contemporary gaps in the understanding of the global epidemiology of shigellosis, we conducted a review of the English-language scientific literature from 1984 to 2005, restricting the search to low and medium human development countries. Our review yielded 11 population-based studies of Shigella burden from seven countries. No population-based studies have been conducted in sub-Saharan Africa or in low human development countries. In studies done in all age groups, Shigella incidence varied from 0.6 to 107 episodes/1000 person-years. S. flexneri was the most commonly detected subgroup in the majority of studies. Case-fatality rates ranged from 0% to 2.6% in population-based studies and from 0% to 21% in facility-based studies. This review highlights the large gaps in data on the burden of Shigella infections for low human development index countries and, more specifically, for sub-Saharan Africa.

Characterization of Escherichia coli strains from cases of childhood diarrhea in provincial southwestern Nigeria

In a study carried out in small-town and rural primary health care centers in southwestern Nigeria, 330 Escherichia coli strains isolated from 187 children with diarrhea and 144 apparently healthy controls were examined for virulence traits. Based on the results of colony blot hybridization, strains were categorized as enteropathogenic E. coli (1.8%), enterotoxigenic E. coli (2.4%), enteroinvasive E. coli (1.2%), enterohemorrhagic E. coli (0.6%), enteroaggregative E. coli (10.3%), diffusely adherent E. coli (7.9%), cell-detaching E. coli (6.9%), and cytolethal distending toxin-producing E. coli (0.9%). E. coli strains that hybridized with a Shiga toxin gene probe but lacked other characteristics usually present in enterohemorrhagic E. coli constituted 8.4% of the isolates. Ninety-seven E. coli isolates adhered to HEp-2 cells in an aggregative fashion but did not hybridize with any of the probes employed in the study. Overall the pathotypes, apart from cytolethal distending toxin-producing E. coli, were recovered both from children with diarrhea and from children without diarrhea, though to a lower extent from the healthy children. All diarrheagenic E. coli strains were associated with diarrhea (P < 0.02). Heat-stable-enterotoxin-producing enterotoxigenic E. coli showed significant association with diarrhea (P < 0.02), as did strains that demonstrated aggregative adherence to HEp-2 cells (P < 0.04), but not those that hybridized with the CVD432 enteroaggregative probe.

Vibrio-associated gastroenteritis in the lower Cross-River Basin of Nigeria

A total of 120 Vibrio species were isolated from 588 patients with acute diarrheal disease during an outbreak of gastrointestinal tract infections at different locations in the lower Cross River Basin of Nigeria. Vibrio cholerae O1, biotype El Tor, serotype Ogawa, was the prominent organism isolated from the Vibrio-associated diarrheal cases. During the 3 months of study, V. cholerae non-O1 was recovered from 10 patients while Vibrio parahaemolyticus was recovered from 19 patients. The significance of this study is the recognition that there is an ecological niche which supports V. cholerae non-O1 and V. parahaemolyticus in the Cross River Basin of Nigeria.

Diarrhoea in Australian Aborigines

Infectious diarrhoea has been recognised as a serious public health problem for Aboriginal Australians, particularly infants and young children, for more than two decades. These diseases are caused by bacterial, viral and parasitic infections which are spread mainly by the faecal-oral route and which must be interrupted if prevention is to be effective. This paper reviews published reports on this subject and interventions which have been used elsewhere to reduce the incidence of infectious diarrhoea. These reports have important implications for Aboriginal health but interventions and strategies to overcome this problem must recognise the unique circumstances of Aboriginal people in Australia.