Clinical and Microbiology Profile and Outcome of Diarrhea by Coccidian Parasites in Immunocompetent Children.

ABSTRACT

BACKGROUND: Several studies have reported prevalence of pediatric coccidian parasitic diarrhea, but there is little information about their clinical profile, management and outcome. This study reviews the clinical profile and treatment outcome of coccidian parasitic diarrhea in immunocompetent children. METHODS: Five thousand one hundred and twenty-three immunocompetent children younger than 15 years of age presenting with acute diarrhea to a tertiary care pediatric hospital during a period of 4 years (2009-2012) were included in the study. Their demographic details and clinical course were recorded, and feces specimens received in the microbiology laboratory were subject to microbiology culture, wet mount microscopy, modified Ziehl-Neelsen staining to detect intestinal coccidian parasites and rotavirus sandwich enzyme-linked immunosorbent assay test (if age less than 2 years). RESULTS: The prevalence of coccidian parasitic diarrhea in immunocompetent children was 1.13% (58 cases) with Cryptosporidium spp. accounting for 1.09% (56 cases). Most Cryptosporidium infections were in children younger than 2 years [38 (67.85%)] and during the monsoon season [32 (57.14%)] with common clinical features being watery or liquid feces [44 (78.57%)], vomiting [40 (71.43%)] and fever [35 (62.5%)]. Thirteen (81.25%) of the 16 cases of cryptosporidiosis with dehydration were less than 2 years of age. Fifty-one (87.93%) of the 58 children were hospitalized. Thirty-eight (67.85%) children with cryptosporidiosis received empiric antimicrobial agents for suspected enteric bacterial and protozoan parasitic infection, which were discontinued after coccidian parasites were detected. Median duration of hospitalization was 2 days with no mortality reported. CONCLUSIONS: Coccidian parasitic diarrhea affects immunocompetent children of all age groups. Unnecessary administration of antimicrobial agents to these children can be avoided by routinely screening pediatric diarrheal fecal specimens for coccidian parasites by a cost-effective method such as modified Ziehl-Neelsen staining.