ACUTE DIARRHEA IN INFANCY

Abstract

An analysis of acute diarrheas in infancy is made, based on the clinical study of two groups of patients: the first is made up of 1,505 infants who had 3,391 diarrheal episodes in a period of six years; and the second, of 199 infants who had a dysentery-like diarrhea in a period of one year's observation.

Out of the 3,391 diarrheal episodes 3,020 showed an infection of parenteral origin, 210 enteral, and 161 no demonstrable infection.

We consider every acute diarrhea in infancy as having an infectious origin either parenteral or caused by specifically enteric exogenous germs as well as the nonspecific intestinal flora.

In the great majority of our diarrhea cases (2,060 or 60.7%) there was a coexisting metabolic impairment and this was almost general in the enteral infection group, having a mortality rate of 17%.

The isolation of a specific enteric germ (salmonella, shigella) was only possible in approximately 30% in both groups, the first one with 210 cases of enteral infection, and the other of 199 children with dysentery-like diarrhea.

The highest incidence of diarrhea in this country is in spring and summer seasons. Most of the affected children were previously undernourished.

Postmortem examinations in fatal cases failed to show a relationship between the severity of intestinal lesions and the type and origin of the infection. Neither could we demonstrate a definite parallelism between cause and character of the diarrhea, although specific enteric infections had certain predominance of inflammatory stools (salmonella, shigella).

From a diagnostic, therapeutic and prophylactic standpoint, we have indicated the importance of two main elements in any given case of diarrhea: its metabolic impairment and the infectious etiologic factor. We think neither element alone justifies the denomination and classification of acute diarrhea in infancy.

The preservation of a good nutritional state and the sanitary control of food, water. sewage, etc., as well as the elimination of carriers, seem to be of the foremost prophylactic importance.

In the individual case treatment should correct the metabolic impairment and infection.