The study included three hundred and three diarrhoeal children less than 5 years of age during the study period. . The highest number of patients (n=118) were from age group 7–12 months. There were 207 (68.3%) male and 96 (31.7%) female patients.
Detection rate of pathogens
The study was focused on detection of rotavirus and Campylobacter spp., and at least one of these pathogens were detected in 233 (76.9%) samples. Among 303 children with acute watery diarrhea, rotavirus mono-infection was detected in 61 (20.1%), Campylobacter mono-infection was detected in 81 (26.7%), co-infection was detected in 91 (30.0%) (Figure 1).
Age wise distribution of different infections in children
The highest number of rotavirus mono-infection was detected in 7-12 months age group category which accounted 29 (47.5%) of total rotavirus mono-infection. Similarly, highest number of Campylobacter mono-infection 34 (42.0%) was found in the <6 months age group. The co-infection was observed highest (35; 38.5%) in 7-12 months of age (Table 1). Distribution of different infections in children less than 5 years was not statistically significant (χ2test, p>0.05).
Risk factors for different infections in children
In multivariate analysis, infection in February was associated with a decreased risk of rotavirus mono-infection [adjusted odds ratio (AOR)=0.26, 95% CI=0.07-0.98, p=0.047] than in November. Except for the age group of 25-36 months, all age groups were significantly associated with decreased risk of Campylobacter mono-infection compared to <6 months age. No soil contact (AOR=0.06, 95%CI=0.01-0.47, p=0.008) was significantly associated with a decreased risk of Campylobacter mono-infection compared to frequent soil contact. Infection in January (AOR=11.34, 95%CI=1.27-101.27, p=0.030) and February (AOR=25.32, 95%CI=2.68-238.69, p=0.005) were significantly associated with a higher risk of co-infections compared to November (Table 2).
Clinical features in different infections with diarrhea
Among children with diarrhoea, clinical presentations were as follows: 23.8%, 49.2% and 27.1% cases had 3-6, 7-9 and >9 loose motions/day respectively. 64.7% cases had fever, and 85.8% had vomiting. 75.2% had no dehydration, 23.8% had mild to moderate dehydration and 1% had severe dehydration. 31.4% cases had abdominal pain. 35.6% had diarrhoea for less than 3 days, 45.9% had diarrhoea for 3-5 days, 17.5% had diarrhoea for 6-9 days, and only 1% had diarrhoea for more than 9 days. 70.6% of patients were from Out Patient Department (OPD) and only 29.4% were from In Patient Department (IPD). 60.7% had mucus in the stool and 30.0% had pus cells in the stool.
Abdominal pain and presence of pus cells in stool were less common features, which were significantly associated with rotavirus mono-infection in multivariate analysis. Pus cells in stool was common clinical feature, while fever and vomiting were less prevalent but significantly associated with Campylobacter mono-infection in multivariate analysis. More than nine loose motions per day, fever, vomiting, and presence of mucus in stool were most striking clinical features. Mild to moderate dehydration were less common compared with no dehydration but were significantly associated with co-infections in multivariate analysis (Table 3).
Antibiotic resistance patterns in Campylobacter spp.
A total of 172 Campylobacter isolates were tested for antibiotic susceptibility. Among them, resistance to different antibiotics were: ampicillin (93.6%), cephalexin (88.4%), erythromycin (73.8%), nalidixic acid (72.1%) and cotrimoxazole (59.9%). Resistance to ampicillin/sulbactam, norfloxacin, azithromycin and tetracycline were 35.1%, 40.1%, 46.5% and 47.1% respectively. Campylobacter isolates were resistant to gentamicin (11.6%), chloramphenicol (15.7%) and ciprofloxacin (35.1%) (Figure 2).