In many communities the stool of infants is considered harmless. However, infants are frequently infected with enteric pathogens and their stool are actually an important source of infection for others. This is true both of infants with diarrhea and for infants with other fecal-associated infection.
Fecal Flora of Infants
For normally health infants, the microbial population of feces is high. The numbers of aerobic and anaerobic bacteria reach as high as 10 /g weight. The composition of fecal flora in healthy infants consists of approximately 20 genera and 100 species to include:
- Bifidobacterium breve
- Closstridium paraputrificum
- C. perfringens
- Bacillus subtilis
- Lactobacillus acidophilus
- Escherichia coli
- Streptococcus bovis
- Pseudomonas aeruginosa, etc.
The presence of bacterial overgrowth and a quantitative and qualitative alteration of intestinal / fecal microflora is an important factor for the severity and persistence of the diarrhea and other fecal-associated infections.
Diarrhea is very common and can be life-threatening because of the dehydration and malnutrition it causes when untreated. Diarrhea is the second most frequent cause of death in children after pneumonia. It claims the lives of more than 2,000,000 children each year worldwide.
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About 10% of diarhea episodes in children less than 5 years of age have visible blood in the stool, and these account for about 15% of diarrhea-associated deaths in this age group worldwide. Compared with watery diarrhea, bloody diarrhea usually lasts longer, is associated with more complications, is more likely to adversely affect a child’s growth, and has a higher case fatality rate.
Rotavirus infections are the most common cause of severe gastroenteritis among infants and young children worldwide. Other common diarrheal diseases and illness include:
- Cholera caused by Vibrio cholerae
- Giardiasis caused by Giardid lamblia
- Cryptosporidiosis caused by Cryptosporidium parvum
Enteroaggreative Escherica coli (EAEC), an increasingly recognized cause of diarrhea in developing countries, has been particularly associated with persistent diarrhea (more than 14 days), a major cause of illness and death.
A number of interventions have been proposed for preventing diarrhea in young children and infants. Most of which involve measures related to infant feeding practises, personal hygiene, cleanliness of food, provision of safe water, safe disposal of feces, and immunization. For example, studies in Bangladesh have shown that safe disposal of young children, handwashing with soap and water before handling food, and handpump-water use for drinking and washing significantly reduced the diarrhea incidence in children in aged 6-23 months, compared to children living n households where none or only one of these practises was observed. As another example, Baltazar and Solon studied the relationship of disposal of feces of children under two years old and diarrheal incidence from a clinical-based case-control study in the Philippines. The results of this study showed that unsanitary disposal of young children’s stools was associated with an increase in clinically diagnose diarrhea and also in increase in pathogen-positive diarrhea relative to those who were following sanitary practises.
Hepatitis A is an infection of the liver caused by the hepatitis A virus (HAV). Young children and infants often have no symptoms or very mild symptoms of disease.
Adults and older children are more likely to have typical symptoms, which include fever, loss of appetite nausea, diarrhea, and generally ill feeling (malaise). The skin and whites of the eyes take on a yellow color (jaundice). Importantly, a person who has no symptoms can still be infectious to others.
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HAV is spread by the fecal-oral route. This means the disease is spread by putting something in the mouth that has been contaminated with the stool of an infected person. It can also be spread when a person eats food or drinks beverages which have been handled by a person infected with HAV and not subsequently cooked.
Outbreaks of hepatitis A among children and infants attending child care centers and persons employed at these centers have been, recognized since the 1970s. Because infection among children is usually mild or asymptomatic and people are infectious before they develop symptoms, outbreaks are often only recognized when adult contacts (usually the parents), become ill.
Poor hygienic practices among staff who change diapers and also prepare food contribute to the spread of hepatitis A. Children in diapers are likely to spread the diseases because of contact with contaminated feces. Good hand washing and hygiene practices are recommended to prevent the infection from spreading to other children and families.
Non-polio enteroviruses are common and distributed worldwide. Infection with them often has no consequences for the affected patient. However, these viruses are also associated with occasional outbreaks in which a larger-than-usual number of patients develop clinically-identifiable diseases, some of them with fatal consequences.
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Replication of the enterovirus begins in the gastrointestinal or respiratory tract and once the virus is present in the blood stream, the disease may affect various tissue and organs, causing a variety of distinctive diseases. Transmission of the virus occur easily and the majority of infections are symptomless or mild in nature, the most common effect being a non-specific illness, with fever. Other manifestations include exanthems (rashes), herpangina (vesicular eruption and inflammation of the throat), acute respiratory disease, conjunctivitis, aseptic meningitis, encephalitis (inflammation of the brain), myopericarditis (inflammation of the heart tissue), and, occasionally, paralytic diseases.
Many enteroviruses are associated with specific syndromes, for example, the group B coxsackieviruses more commonly cause meningitis or myopericarditis and enterovirus 71 causes hand-loot-mouth disease (vesicular eruption and inflammation of the throat and mouth with rash) with or without encephalitis.
Many adults may have been infected with enterovirus 71 as children and, therefore, may be immune to reinfection. Infants, children, and adolescents ale less likely to have previously been infected with enterovirus 71 and are more likely to be susceptible to infection.
Measures that can be token to avoid getting infected with enterovirus 71 include frequent handwashing, especially after diaper changes; disinfection of contaminated surfaces by household disinfectants such as bleach (20 ml/litre of water) or rubbing alcohol (70% isopropyl); and washing soiled articles of clothing.
All enteroviruses infecting humans are found worldwide and humans are the only known natural hosts. Young children and infants are most susceptible to infection. In less developed areas, children may become infected during early infancy while in more socio economically advanced areas, first infection may not occur until adolescence. Transmission 6 is usually by the fecal-oral or by the respiratory route where there is an associated respiratory illness. Improved sanitation and general hygiene are important preventive measures.