OJMM  Vol.4 No.2 , June 2014
Microbial Agents Responsible for Diarrheal Infections in Flood Victims: A Study from Karachi, Pakistan
ABSTRACT
The present study was aimed to determine the frequency of water borne diarrheal infections and gastroenteritis in two of the flood affected camps of Karachi and nearby areas. Each year approximately, 579,732 people are adversely affected by this phenomenon, putting Pakistan 9th in terms of flood-affected countries worldwide. Patients and Methods: All patients suffering from diarrhea (more than 3 stools per day for the last 2 days), abdominal pain, vomiting or fever who were residing in the camps were included in the study. After taking consent, a fresh stool sample for D/R and C/S, and 5 ml of venous blood sample for CP and ALT and other viral markers were collected from each patient suffering from any of the symptoms like jaundice, diarrhea, vomiting, fever and abdominal pain during past 2-3 days. Direct microscopy of the stools was done to see any protozoal or bacterial infection. Culture of stool was also set up simultaneously. Hemoglobin % age was noted for each patient. Serology of Hepatitis E and A virus using ELISA (Anti HEV-IgM, and anti HAV IgM) was done in those with more than 2 times raised ALT level. Results: A total of 500 samples collected from refugee camps of flood affected areas near Karachi were included in this study. All patients were mal nourished, having below normal Hb% ages, and were suspected cases or patients of diarrhea with elevated ALT (Alanine Transaminase) values. Occult blood was found positive in 40% (200) specimens; protozoa were also seen i.e., trophozoit stage of Giardia lamblia in 45% (225) of specimens; Entamoeba coli in 95% (475) and Balantidium coli in 20% (100) of stool specimens, while cyst forms of Entamoeba histolytica were present in 35% (175) specimens. Bacteriological analysis showed high bacterial prevalence of E. coli with 63% (315), followed by Enterobacter specie with 55% (275), then 20% (100) and 12% (60) of Klebseilla oxytoca and Klebseilla pneumoniae respectively. Proteus vulgaris and Citrobacter freundii found in the same ratio of 8% (40, 39) with 2% (10) specimens of no microbial growth. Overall <0.05 P value and 95% of confidence interval level was observed. Further serological evidences for water associated viral hepatitis revealed 4% (20) positive specimens for anti-HEV IgM antibodies, and 2.6% (13) positive specimens of anti-HAV IgM antibodies. Conclusion: The present study reveals the presence of HEV and HAV associated viral diarrhea along with the presence of protozoal and bacterial infections in the flood relief camps. It is suggested that there is a strong need of natural disaster associated awareness program for general population in order to minimize the mortality and morbidity ratio associated with diseases, which can be easily controlled by managing proper sanitary conditions and supply of safe and clear water.

Cite this paper
Hakim, S. , Afaque, F. , Javed, S. , Kazmi, S. and Nadeem, S. (2014) Microbial Agents Responsible for Diarrheal Infections in Flood Victims: A Study from Karachi, Pakistan. Open Journal of Medical Microbiology, 4, 106-114. doi: 10.4236/ojmm.2014.42012.
References
[1]   http://english.ntdtv.com/ntdtv_en/ns_asia/2010-08-19/230444340731.html

[2]   Peron, J.M., Menusy, J.M., Izopet, J. and Vinel, J.P. (2006) Hepatitis E Virus: An Emerging Disease. Sante, 16, 239-243.

[3]   Khuroo, M.S. (1980) Study of an Epidemic of Non-A, Non-B Hepatitis. Possibility of Another Human Hepatitis Virus Distinct from Post-Transfusion Non-A, Non-B Type. American Journal of Medicine, 68, 818-824.
http://dx.doi.org/10.1016/0002-9343(80)90200-4

[4]   Malik, I.A., et al. (1988) Epidemics of Non-A, Non-B Hepatitis in Pakistan. Tropical Doctor, 18, 99-101.

[5]   Ministry of Health, Pakistan (2010) Priority Disease Report (2005-2006).
http://www.statpak.gov.pk/depts/fbs/statistics/social_statistics/priority_disease_report.pdf

[6]   http://www.usaid.gov/stories/pakistan/fp_pakistan_water.html

[7]   Bradley, D.W. (1990) Enterically-Transmitted Non-A, Non-B Hepatitis. British Medical Bulletin, 46, 442-461.

[8]   Parashar, U.D., Gibson, C.J., Bresee, J.S. and Glass, R.I. (2006) Rotavirus and Severe Childhood Diarrhea. Emerging Infectious Diseases, 12, 304-306.
http://dx.doi.org/10.3201/eid1202.050006

[9]   Parashar, U.D., Hummelman, E.G., Bresee, J.S., Miller, M.A. and Glass, R.I. (2003) Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerging Infectious Diseases, 9, 565-572.
http://dx.doi.org/10.3201/eid0905.020562

[10]   Parashar, U.D., Burton, A., Lanata, C., et al. (2009) World Health Organization Estimates of the Global Mortality from Rotavirus in Children in the Year 2004. The Journal of Infectious Diseases, in Press.

[11]   Khan, R.U., Beeching, N.J., Tong, C.W., et al. (1995) Sporadic Hepatitis E in Pakistan. Annals of Tropical Medicine and Parasitology, 89, 95-97.

[12]   Akram, M. (1975) A Study of Epidemic Infectious Hepatitis in the Field. CENTO (Central Treaty Organization) Medical Conference Papers.

[13]   Rab, M.A., Bile, M.K., Mubarik, M.M., et al. (1997) Water-Borne Hepatitis E Virus Epidemic in Islamabad, Pakistan: A Common Source Outbreak Traced to the Malfunction of a Modern Water Treatment Plant. The American Journal of Tropical Medicine and Hygiene, 57, 151-157.

[14]   Rab, M.A., et al. (1997) Water-Borne Hepatitis E Virus Epidemic in Islamabad, Pakistan: Common-Source Outbreak Traced to the Malfunction of a Modern Water Plant. The American Journal of Tropical Medicine and Hygiene, 57, 151-157.

[15]   Malik, I.A. and Tariq, W.U.Z. (1995) The Prevalence and Pattern of Viral Hepatitis in Pakistan. Journal of the College of Physicians and Surgeons Pakistan, 5, 2-3.

[16]   Shams, R., Khero, R.B., Ahmed, T. and Hafiz, A. (2001) Prevalence of Hepatitis E Virus (HEV) Antibody in Pregnant Women of Karachi. Journal of Ayub Medical College Abbottabad, 13, 31-35.

[17]   Saeedi, M.I., Mahmood, K., Amanullah, Ziauddin, M., Ilyas, N. and Zarif, M. (2004) Frequency and Clinical Course of Hepatitis E in Tertiary Care Hospitals. Journal of the College of Physicians and Surgeons Pakistan, 14, 527-529.

[18]   Bryan, J.P., Iqbal, M., Tsarev, S., et al. (2002) Epidemic of Hepatitis E in a Military Unit in Abbotrabad, Pakistan. The American Journal of Tropical Medicine and Hygiene, 67, 662-668.

[19]   Alavian, S.M. (2007) Hepatitis E Virus Infection: A Neglected Problem in Our Region. Hepatitis Monthly, 7, 119-1121.

[20]   Van Cuyck-Gandré, H., Zhang, H.Y., et al. (1995) Partial Sequence of HEV Isolates from North Africa and Pakistan: Comparison with Known Sequences. In: Buisson, Y., Coursaget, P. and Kane, M., Eds., Enterically-Transmitted Hepatitis Viruses, La Simarre, Tours, 301-310.

[21]   Van Cuyck-Gandré, H., Zhang, H.Y., et al. (1997) Characterization of Hepatitis E Virus (HEV) from Algeria and Chad by Partial Genome Sequence. Journal of Medical Virology, 53, 340-347.
http://dx.doi.org/10.1002/(SICI)1096-9071(199712)53:4<340::AID-JMV5>3.0.CO;2-7

[22]   Noji, E. (1997) Public Health Consequences of Disasters. Oxford University Press, New York.

[23]   Ahern, M., Kovats, R.S., Wilkinson, P., Few, R. and Matthies, F. (2005) Global Health Impacts of Floods: Epidemiologic Evidence. Epidemiologic Reviews, 27, 36-46.
http://dx.doi.org/10.1093/epirev/mxi004

[24]   Watson, J.T., Michelle, G. and Maire, A.C. (2007) Epidemics after Natural Disasters. Emerging Infectious Diseases, 13, 1.

[25]   Krawezynski, K., Kamili, S. and Aggarwal, R. (2001) Global Epidemiology and Medical Aspects of Hepatitis E. Forum (Genova), 11, 166-179.

[26]   Aggarwal, R. and Krawczynski, K. (2000) Hepatitis E: An Overview and Recent Advances in Clinical and Laboratory Research. Journal of Gastroenterology and Hepatology, 15, 9-20.

[27]   Balayan, M.S. (1997) Type E Hepatitis: State of the Art. International Journal of Infectious Disease, 2, 113-120.
http://dx.doi.org/10.1016/S1201-9712(97)90093-X

[28]   Balayan, M.S., Andjaparidze, A.G., Savinskaya, S.S., et al. (1983) Evidence for a Virus in Non-A, Non-B Hepatitis Transmitted via the Fecal-Oral Route. Intervirology, 20, 23-31.
http://dx.doi.org/10.1159/000149370

[29]   Quiroga, J.A., Cotonat, T., Castillo, I., Carreno, I. and Carreno, V. (1996) Hepatitis E Virus Seroprevalance in Acute Viral Hepatitis in a Developed Country Confirmed by a Supplemental Essay. Journal of Medical Virology, 50, 16-19.
http://dx.doi.org/10.1002/(SICI)1096-9071(199609)50:1<16::AID-JMV4>3.0.CO;2-W

[30]   Iqbal, T., et al. (2011) Isolation and Characterization of Two New Hepatitis E Virus Genotype 1 Strains from Two Mini-Outbreaks in Lahore, Pakistan. Virology Journal, 8, 94.

[31]   World Health Organization Acute Jaundice Syndrome (2006) Weekly Morbidity and Mortality Report.

[32]   Haider, N. (2006) Living with Disasters: Disaster Profiling of Districts of Pakistan. National Disaster Management Authority, Islamabad, 65.

[33]   Baqir, M., et al. (2012) Infectious Diseases in the Aftermath of Monsoon Flooding in Pakistan. Asian Pacific Journal of Tropical Biomedicine, 2, 76-79.

[34]   Schlauder, G.G., Desai, S.M., Zanetti, A.R., Tassopoulos, N.C. and Mushahwar, I.K. (1999) Novel Hepatitis E Virus (HEV) Isolates from Europe: Evidence for Additional Genotypes of HEV. Journal of Medical Virology, 57, 234-251.
http://dx.doi.org/10.1002/(SICI)1096-9071(199903)57:3<243::AID-JMV6>3.0.CO;2-R

[35]   Uchida, T. (1992) Hepatitis E: Review. Gastroenterology of Japan, 27, 687-696.

[36]   Khan, R.U., Beeching, N.J., Tong, C.W., et al. (1995) Sporadic Hepatitis E in Pakistan. Annals of Tropical Medicine and Parasitology, 89, 95-97.

[37]   Meng, X.J., Purcell, R.H., Halbur, P.G., et al. (1997) A Nevel Virus in Swine Is Closely Related to the Human Hepatitis E Virus. Proceedings of the National Academy of Sciences of USA, 94, 9860-9865.
http://dx.doi.org/10.1073/pnas.94.18.9860

 
 
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