A relationship between causative agents of infectious diarrhea and fatal outcomes in pre-school children

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Abstract

Infectious diarrhea is one of the leading causes of fatal outcomes in young children. Differential diagnostics of such infections within the first hours of illness poses significant objective obstacles. Data from laboratory studies of autopsy material and pathological studies provide valuable information for understanding the spectrum of differential diagnostics and etiological structure of infectious diarrhea with fatal outcomes in young children. Materials and methods. There were analyzed 100 cases of fatal outcomes in children under the age of six years registered in Russia from November 2011 to December 2019, who was diagnosed with infectious diarrhea at different levels of the healthcare system. The data were assessed based on available medical case reports and the laboratory testing of autopsy samples performed by using nucleic acid amplification methods. Results. The diagnosis of infectious diarrhea was revised in 24 patients, based on the data of a set of intravital and post-mortem studies. In patients with unconfirmed diagnosis of acute intestinal infections, pneumonia was the most often detected — in 45.8% (11/24), sepsis — in 29.2% (7/24), meningitis/meningoencephalitis, acute surgical pathology and asphyxiation associated with vomit aspiration — in 16.7 % (4/24) cases. The causative agents of infectious diarrhea were identified in 71 of 76 patients with confirmed diagnosis of acute intestinal infections. Most prevalent were group A rotaviruses — 52.6% (40/76), group F adenoviruses — 17.1% (13/76), and noroviruses — 13.2% (10/76). Combination of pathogens was detected in 29 cases (38.2%). Prehospital lethal outcomes in patients with infectious diarrhea were observed in 17 cases (22.4%). In total, rate of neonatal deaths due to acute intestinal infections accounted for 62.2% and 2-year-old toddlers — 20.3%. 64 of 76 (84%) children had no unfavorable premorbid background. The most common pathologies associated with infectious diarrhea with developing fatal outcomes were pneumonia (including aspiration pneumonia) in 22.4% (17/76) and aspiration asphyxia in 6.6% (5/76). Hemolytic-uremic syndrome associated with diarrhea was diagnosed in 7.9% (6/76) of children. Conclusions. Within the first years of life children comprise a risk group for developing fatal outcomes during infectious diarrhea. Lack of unfavorable premorbid background should not be considered as a reliable positive prognostic criterion. Diagnostics of pneumonia should be included in the mandatory examination plan for children with severe infectious diar rhea. Based on study of clinical and autopsy material, group A rotaviruses were the lead causative agents among those resulting in infectious diarrhea with fatal outcomes in young children. Special attention should be paid to preventing vomit aspiration within the first days after disease onset.

About the authors

A. T. Podkolzin

Central Research Institute of Epidemiology

Author for correspondence.
Email: apodkolzin@pcr.ru
ORCID iD: 0000-0002-0044-3341

Aleksander T. Podkolzin,  PhD, MD (Medicine), Deputy Director for Epidemiology

111123, Moscow, Novogireevskaya str., 3A

Phone: +7 (495) 974-96-46 

Russian Federation

T. A. Kozhakhmetova

Central Research Institute of Epidemiology

Email: epid-oki@pcr.ru
ORCID iD: 0000-0002-4821-7992

Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

D. Kh. Kyasova

Central Research Institute of Epidemiology

Email: kyasova@cmd.su
ORCID iD: 0000-0001-5651-6362

Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

Z. Kh. Dalelova

Central Research Institute of Epidemiology

Email: dalelova@cmd.su
ORCID iD: 0000-0003-3337-8432

Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

K. V. Kuleshov

Central Research Institute of Epidemiology

Email: konstantinkul@gmail.com
ORCID iD: 0000-0002-5238-7900

PhD (Biology), Senior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

A. N. Guseva

Central Research Institute of Epidemiology

Email: anguseva@cmd.su
ORCID iD: 0000-0002-7199-6103

Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

A. S. Pavlova

Central Research Institute of Epidemiology

Email: a.pavlova@cmd.su
ORCID iD: 0000-0003-4619-9337

Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

O. A. Veselova

Central Research Institute of Epidemiology

Email: oveselova@cmd.su
ORCID iD: 0000-0002-5041-4370

Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

N. V. Parkina

Central Research Institute of Epidemiology

Email: parkina@cmd.su
ORCID iD: 0000-0003-3948-1385

Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

T. A. Konovalova

Central Research Institute of Epidemiology

Email: tnikolaeva@cmd.su
ORCID iD: 0000-0001-7030-2010

Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Intestinal Infections

Moscow 

Russian Federation

S. B. Yatsyshina

Central Research Institute of Epidemiology

Email: svetlana.yatsyshina@cmd.su
ORCID iD: 0000-0003-4737-941X

PhD (Biology), Head of the Scientific Group of New Methods of Diagnostics of Acute Respiratory Infections, Head of the Reference Center for Monitoring Pathogens of Upper and Lower Respiratory Tract Infections

Moscow 

Russian Federation

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Copyright (c) 2021 Podkolzin A.T., Kozhakhmetova T.A., Kyasova D.K., Dalelova Z.K., Kuleshov K.V., Guseva A.N., Pavlova A.S., Veselova O.A., Parkina N.V., Konovalova T.A., Yatsyshina S.B.

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