الفهرس 
Introduction & Aim of workOnly 14 pages are availabe for public view
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Abstract
Infectious diarrhea is a significant cause of morbidity and mortality among infants and young children in developing countries and its clinical presentation varying from loose, watery or bloody stool. Also fever, vomiting, malaise and myalgia are common. According to causative agents of infectious diarrhea its may be due to parasite, virus or bacteria and it most frequently related to age, geographical location, associated medical condition and social circumstances. E.coli is the commonest bacterial pathogens associated with endemic form of childhood diarrhea. And its gram negative usually motile rods and may be capsulated. Salmonella is endemic in both developed and developing countries as it affects 16.000.000 cases and causes 600.000 deaths each year. And its gram negative actively motile non sporing and non-capsulated organisms. Shigella species cases bacillary dysentery with Shigella dysenteriae being the most virulent and it causes major epidemics of bacillary dysentery in developing countries. Aeromonas is the causative agent of a variety of human infections. However, the most commonly associated clinical infection is diarrhea. Rotavirus is the commonest cause of watery diarrhea in children by damaging the mucosa of the small intestine so prevents the normal absorption of sugars that lead to water and electrolytes being drawn into the lumen of intestine. The aim of the present study was to evaluate the role of microbial agents causing diarrhea among children attending Pediatric Hospital Mansoura University and to identify their sensitivity to different antimicrobial agents. Also to detect Rotavirus antigen in stool by ELISA. This study was carried on 130 cases of children suffering from diarrhea among them there were 73 males and 57 females with age ranging from 3 months to 8 years. Stool samples were collected from all patients and were examined physically for colour, consistency, presence of pus, mucus or blood and microscopically for detection of parasites and bacteriologically by stool culture on MacConkey, Salmonella-Shigella and Aeromonas agars. Also Rotavirus antigen was detected by ELISA. The isolated colonies of stool culture were identified by manual method and automated system ’Sensititre’. The antibiotic susceptibility of isolated organisms was performed by using manual disk diffusion method. The results obtained from this study showed that the most common isolated microbes were E. histolytica (30.7%) followed by Rotavirus (22.3%), E.coli and Salmonella (13%) for each, Oxyuris (12.3%), Aeromonas (11.5%), G.lamblia (8.5%), H.nana (7.7%), Shigella (2.3%) and Ascaris (0.8%). As regard Salmonella in this study, it was isolated from 17 cases (13%). The highest isolation rate (58.8%) was in age group 2-5 years. The females were more infected (70.6%) than males (29.4%). The serotypes detected were Salmonella ”O” group B in (64.7%) and Salmonella ”O” group D in ( 35.3%). The infection in this age may be due to the lower immunocompetence status of these patients making them more prone to acquired infection. In this study, the most common clinical presentation among patients with gastroenteritis due to Salmonella was fever in all cases followed by vomiting (94%), abdominal colic (82.3%) and dehydration in (23.5%) with statistically significant association with vomiting. Also all cases of Salmonella were associated with mucus or/and blood and it was statistically significant. In this study, the antibiotyping results revealed that the sensitivity of Salmonella was (95%) for ceftriazone, (50%) for streptomycin while it was resistant to augmentin in (67%), to piperacillin in (76%), to colistin in (82%), to gentamycin in (88%), to ampicillin in (44%) and to chloramphenical in (100%). The high resistance pattern of salmonella for antibiotic could be explained by that in Egypt, as in most developing countries, the 1st line of antibiotics for treatment of Salmonella infection empirically are ampicillin, chloramphenical and augmentin while antimicrobial such as ceftriazone and ciprofloxacin are expensive for most patients. As regards the prevalence of Shigella in this study, it was isolated from 3 cases (2.3%) and all of them were Shigella dysentery. As regard age, there was one case in each age group. And all of them were males but there was no statistically significant association as the number of cases was small. In this study, the most common clinical presentation among patients with of gastroenteritis due to Shigella was fever and abdominal colic in all cases and vomiting (66%) while no of them had dehydration. In this study, E.coli was isolated from 17 cases (13%) and 3 of them were O157. As regards the age, the frequency of E.coli isolation was higher (53%) in age group ? 2 years. This finding could be attributed to the starting of weaning diet which associated with exposure to infection. In this study, the most common clinical presentation among patients with gastroenteritis due to E.coli was fever (88%) followed by abdominal colic (64%), vomiting (47%) and dehydration (23%). In this study, the antibiotyping results revealed that the sensitivity of E.coli was (100%) for ceftriazone, (70.6%) for gentamycin and (59%) for augmentin while it was resistant to chloramphenical in (76%), to streptomycin in (82%) and to ampicillin in (100%).