Utilidad del estudio de las heces para el diagnóstico y manejo de lactantes y prescolares con diarrea aguda

Objective. To analyze the results of a stool work-up protocolin a series of infants and preschoolers with acute diarrhea.Material and Methods. A cross-sectional descriptive studywas conducted between April 1999 and March 2000, among288 children seen at a pediatric office in Guadalajara, Mexico.The mean age (±1SD) was 23.1±13.9 months; 43% werefemales. Data were collected on demographic and clinicalcharacteristics. The stool work-up consisted of fresh smearand methylene blue and Kinyoun smears, as well asdetermination of pH and reducing substances. Stool culturewas performed in samples with ³ 3 leukocytes/microscopicfield and rotavirus antigen detection only in selected cases.Data were analyzed using descriptive statistics, c2, odds ratios,and 95% confidence intervals. Results. Enterophatogens (%)identified were: rotavirus 47.1, Campylobacter jejuni 27.4,Salmonella spp. 5.1, Shigella spp. 4.3, Cryptosporidium parvum2.8, Giardia lamblia 2.4, Blastocystis hominis 1.4, Entamoebahistolytica 0.7. An OR of 5.7 was obtained for isolation ofenteroinvasive bacteria in the presence of fecal leukocytes.Lactose intolerance was detected in 19.1%. The frequenciesof rotavirus antigen identification and lactose intolerance weresignificantly higher in infants; the OR for lactose intolerancein infants with rotavirus was 21. Mucus and blood in the stoolswere associated to enteroinvasive bacteria and Cryptosporidiumparvum. Conclusions. The current stool work-up protocolallowed the identification of enteropathogenic parasites,rotavirus and lactose intolerance in a short period of time.Leukocytes in stools were associated to the isolation ofenteroinvasive bacteria. The frequency of agents associatedto diarrheal disease was similar to that from other nationalstudies. This stool work-up protocol could be useful as a toolto limit the unnecessary prescription of drugs and to followuniversal recommendations for dietary management of thesepatients. The English version of this paper is available at: http://www.insp.mx/salud/index.html