IMPORTANCE OF MICROSCOPIC STOOL EXAMINATION IN PATIENTS WITH DIARRHOEA
AbstractBackground: Loose motion is a common symptom in patients reporting to our hospital. As it is a small set up where only facility for microscopic stool examination is available, we designed this study to know how much microscopic stool examination can help us in management of patients with diarrhoea. Methods: This cross-sectional descriptive study was conducted from January 2010 to April 2012, at Thall Scout Hospital, Hangoo, Khyber Pukhtoon Khwa, Pakistan. All the patients presenting with acute diarrhoea were included in the study. Patients older than 12 years of age were labelled as adults and those 12 years or younger as child. Stool specimens were collected using proper procedure and were examined microscopically. Results: Of 494 stool specimens examined, 117 (23.68%) were positive for parasites or their ova, 34 (6.88%) had numerous pus and red blood cells and 343 (69.43%) patients had only stool of loose/soft consistency. Of 117 stool specimens positive for parasites, Giardia lamblia was detected in 67 (57.26%) patients, Entamoeba histolytica in 22 (18.80%) patients, H. nana in 10 (8.55%) patients, Tenea saginata in 8(6.84%) patients, hook worm in 6 (5.13%) patients, ascaris in 2 (1.71%) and Trichuris trichura in 2 (1.71%) patients. Conclusion: Among the parasitic causes of diarrhoea, giardia is the most common cause in our study with entameoba the second most common cause.Keywords: Parasite, diarrhoea, protozoa, helminthes, Giardia lamblia
Organization WH, Organization WH. The rational use of drugs in the management of acute diarrhoea in children: World Health Organization; 1990.
Cheng AC, McDonald JR, Thielman NM. Infectious diarrhoea in developed and developing countries. J Clin Gastroenterol 2005;39(9):757–73.
Farrell J, Ciarán K, Feldman M, Friedman L. Sleisenger & Fordtran's gastrointestinal and liver disease. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 2002.
Webber R. Communicable disease epidemiology and control: A global perspective: Cabi; 2009.
Elliott EJ. Acute gastroenteritis in children. BMJ. 2007;334(7583):35–40.
Grimwood K, Forbes DA. Acute and persistent diarrhoea. Pediatr Clin North Am 2009;56(6):1343–61.
Global networks for surveillance of rotavirus gastroenteritis, 2001–2008. Wkly Epidemiol Rec 2008;83(47):421–5.
Eckardt AJ, Baumgart DC. Viral gastroenteritis in adults. Recent Patents on anti-infective drug discovery. 2011;6(1):54–63.
Wheeler JG, Sethi D, Cowden JM, Wall PG, Rodrigues LC, Tompkins DS, et al. Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. BMJ 1999;318(7190):1046–50.
Black RE. Epidemiology of travelers' diarrhoea and relative importance of various pathogens. Rev Infect Dis 1990;12(Supplement 1):S73–S9.
Barnes GL, Uren E, Stevens KB, Bishop RF. Etiology of acute gastroenteritis in hospitalized children in Melbourne, Australia, from April 1980 to March 1993. J Clin Microbiol 1998;36(1):133–8.
Petersen AM, Nielsen SV, Meyer D, Ganer P, Ladefoged K. Bacterial gastroenteritis among hospitalized patients in a Danish county, 1991–93. Scand J Gastroenterol 1996;31(9):906–11.
Presterl E, Nadrchal R, Wolf D, Rotter M, Hirschl A. Enteroaggregative and enterotoxigenic Escherichia coli among isolates from patients with diarrhoea in Austria. Eur J Clin Microbiol Infect Dis 1999;18(3):209–12.
Svanteson B, Thorén A, Castor B, Barkenius G, Bergdahl U, Tufvesson B, et al. Acute diarrhoea in adults: aetiology, clinical appearance and therapeutic aspects Scand J Infect Dis 1988;20(3):303–14.
Stoll BJ, Glass RI, Banu H, Huq MI, Khan M, Ahmed M. Value of stool examination in patients with diarrhoea. Br Med J (Clin Res Ed). 1983;286(6383):2037–40.
Stintzing G, Bäck E, Tufvesson B, Johnsson T, Wadström T, Habte D. Seasonal fluctuations in the occurrence of enterotoxigenic bacteria and rotavirus in paediatric diarrhoea in Addis Ababa. Bull World Health Organ 1981;59(1):67–73.
Ewing WH. Edwards and Ewing's identification of Enterobacteriaceae: Elsevier Science Publishing Co. Inc.; 1986.
Yolken R, Kim H, Clem T, Wyatt R, Kalica A, Chanock R, et al. Enzyme-linked immunosorbent assay (ELISA) for detection of human reovirus-like agent of infantile gastroenteritis. Lancet 1977;2(8032):263–7.
Dean AG, Ching Y-C, Williams RG, Harden LB. Test for Escherichia coli enterotoxin using infant mice: application in a study of diarrhoea in children in Honolulu. J Infectious Dis 1972;125(4):407–11.
Sack DA, Sack RB. Test for enterotoxigenic Escherichia coli using Y-1 adrenal cells in miniculture. Infect Immun 1975;11(2):334–6.
Wolff H. The faecal smear in the therapy of diarrhoeas. Trop Geogr Med 1969;21(4):427–35.
Pickering L, DuPont H, Olarte J, Conklin R, Ericsson C. Fecal leukocytes in enteric infections. Am J Clin Path 1977;68(5):562–5.
Korzeniowski OM, Barada FA, Rouse JD, Guerrant RL. Value of examination for fecal leukocytes in the early diagnosis of shigellosis. Am J Trop Med Hyg 1979;28(6):1031–5.
Tinuade O, John O, Saheed O, Oyeku O, Fidelis N, Olabisi D. Parasitic etiology of childhood diarrhoea. Indian J Pediatr 2006;73(12):1081–4.