Characteristics of Rotavirus, ETEC, and <i>Vibrio Cholerae</i> Among Under 2-year Children Attending an Urban Diarrheal Disease Hospital in Bangladesh.

Abstract

Information on comparative clinical and host characteristics of under-2 children with watery diarrhea caused by rotavirus, <i>Enterotoxigenic Escherichia coli</i> (ETEC), and <i>Vibrio cholerae</i> as single pathogens is lacking. We sought to investigate the sociodemographic, clinical, and host characteristics of under-2 children hospitalized due to these pathogens. We conducted a hospital-based case-control study using the icddr,b Diarrheal Diseases Surveillance System. Children of either sex, <2 years with diarrhea, who attended the hospital during 2014 to 2018, constituted the study population. Stool specimens having a single pathogen like rotavirus, ETEC, or <i>Vibrio cholerae</i> constituted the cases and stool specimens having no detectable common enteropathogens comprised the controls. Multinomial logistic regression analysis was done where control was the reference group. A total of 14 889 patients were enrolled, 6939 of whom were under-2 children, and 5245 (76%) constituted our study population. Among them 48% (n = 2532), 3% (n = 148) and 1% (n = 49) had rotavirus, ETEC, and <i>Vibrio cholera</i>, respectively. A control group (diarrhea without these 3 or <i>Shigella</i>, <i>Salmonella</i>, <i>Aeromonas</i>) accounted for 48% (n = 2516). In multinomial regression model, children with rotavirus (adjusted odds ratio [aOR], 1.36; 95% confidence interval [95% CI], 1.19-1.55) less often presented with dehydrating diarrhea compared to those with ETEC (aOR, 1.54; 95% CI, 1.05-2.26) and cholera (aOR, 2.25; 95% CI, 1.11-4.57). Rotavirus diarrhea was associated (aOR, 1.25; 95% CI, 1.07-1.46) with those who received antimicrobials prior to hospital admission and protectively associated with drinking tap water (aOR, 0.84; 95% CI, 0.73-0.95); however, ETEC diarrhea had protective association (aOR, 0.62; 95% CI, 0.43-0.92) with children who received antimicrobials prior to hospital admission and was associated with drinking tap water (aOR, 1.78; 95% CI, 1.19-2.66). Use of intravenous fluid was associated with cholera (aOR, 10.36; 95% CI, 4.85-22.16) and had protective association with rotavirus episodes (aOR, 0.64; 95% CI, 0.45-0.91). Clinical presentations and host characteristics of rotavirus, ETEC, and <i>Vibrio cholerae</i> diarrhea differed from each other and the information may be helpful for clinicians for better understanding and proper management of these children.