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STUDY OF BACTERIAL AGENTS CAUSING DIARRHEA IN CHILDREN

BELOW 5 YEARS OLD AT HOSPITAL TUNKU AMPUAN JEMAAH,


SABAK BERNAM

PUNITHA A/P TANAGOBAL

DIPLOMA IN MEDICAL LABORATORY TECHNOLOGY


Faculty of Allied Health Sciences
SEGi College Subang Jaya

2016

STUDY OF BACTERIAL AGENTS CAUSING DIARRHEA IN CHILDREN


BELOW 5 YEARS OLD AT HOSPITAL TUNKU AMPUAN JEMAAH,
SABAK BERNAM

Mini thesis submitted in partial fulfillment for the Diploma in


Medical Laboratory Technology

PUNITHA A/P TANAGOBAL

Faculty of Allied Health Sciences


SEGI College Subang Jaya

2016

ACKNOWLEDGEMENTS
I would like to express deepest gratitude to my supervisor Miss.Nursyuhada
Ismail for her full support expert guidance, understanding and encouragement
throughout my study research. Without her incredible patience & timely wisdom &
council. My thesis work would have been a frustrating & overwhelming pursuit. In
addition, I express my appreciation to Miss.Valarmathy Mathivannan &
Miss.Balvinder Kaur for their thoughtful questions and comments were valued
greatly. I would like to thank my colleagues, who have supported me throughout
entire process, both by keeping me harmonious and helping me putting pieces
together.

TABLE OF CONTENTS
Content

Page

TITLE PAGE

CERTIFICATE

ii

ACKNOWLEDGEMENTS

iii

ABSTRACT

iv

TABLE OF CONTENTS

LIST OF FIGURES

vi

LIST OF TABLES

vii

LIST OF SYMBOLS AND ABBREVIATIONS

viii

LIST OF APPENDICES
CHAPTER 1 INTRODUCTION
1.1
1.2
1.2.1
1.2.2
1.3
1.3.1
1.3.2
1.4

Background Study
Objective
General objective
Specific objective
Hypothesis
Null hypothesis
Alternative hypothesis
Problem statement

CHAPTER 2 LITERATURE REVIEW

ix

2.1
2.2
2.3
2.4

Diarrhoea in children
Common bacteria agent
Made of transmission
Treatment

CHAPTER 3 METHODOLOGY
3.1 Sample collection
3.2 Stool FEME
3.3 Identification of bacteria
GANTT CHART
REFERENCES

CHAPTER 1
INTRODUCTION

1.1 Background Study


Common bacterial causes of diarrhea include campylobacter, salmonella,
shigella and Escherichia coli. Diarrhea caused by bacteria and parasites can be
common when traveling in developing countries and is often called traveler's
diarrhea.Diarrhoel disease is the second leading cause of death in children under
five years old. Diarrhoea can last several days, and can leave the body without the
water and salts that are necessary for survival. Most people who die from diarrhoea
actually die from severe dehydration and fluid loss. Diarrhoea is usually a
symptoms of an infection in the intestinal tract, which can be caused by a variety of
bacterial, viral and parastic organisms. Infection is spread through contaminated
food or drinking-water, or from person -to-person as a result of poor hygiene.
Diarrhoea is a major cause of malnutrition, and malnourished children are more
likely to fail ill from diarrhoea.
The list of possibilities is long. It could be caused by a viral or bacterial
infection. It might also be the result of a parasite, a course of antibiotics, or
something he ate. Viral infection. Any number of viruses like the rotovirus,
adenovirus, calicivirus, astrovirus, and influenza can cause diarrhea, as well as
vomiting, abdominal pain,fever, chills, and achiness. Bacterial infection.
Bacteria such as salmonella, shigella, staphylococcus, campylobacter, or E. coli can
also be responsible for diarrhea. If your toddler has a bacterial infection, he may

have severe diarrhea, accompanied by cramps, blood in the stool, and a fever. (He
may or may not be vomiting.)
Toddlers diarrhea the persistent diarrhea that lasts a few weeks is much
less common than diarrhea caused by a stomach virus, which virtually all kids
experience at least a few times before they reach school age. Toddlers diarrhea is
usually the result of an out-of-whack diet. Its normally caused by a diet low in fats
and proteins and high in sugar and fluids. Drinking too much juice is associated
with toddlers diarrhea. The specific germs that cause diarrhea can vary among
geographic regions depending on their level of sanitation, economic development,
and hygiene contaminate crops or drinking water.
1.2
1.2.1

1.2.2

Objective
General objective
To identify bacteria agent causing diarrhoea in children below 5 years
old.
Specific objective
To study the rate of diarrhoea infection in children below 5 years old
at Hospital Tunku Ampuan Jemaah, Sabak Bernam.

1.3

Hypothesis

1.3.1

Null hypothesis
Salmonella sp. causing higher infection rate for diarrhoea in children
below 5 years old.

1.3.2

Alternative hypothesis
Rotavirus causing higher infection rate for diarrhoea in children below
5 years old.

1.4

Problem Statement
In 2011, diarrhoea accounted for 700,000 deaths in children under five
years of age in worldwide making it the second leading cause of child
mortality. The highest rates of child mortality are in Sub-Saharan Africa
and Southeast Asia. An estimated 1.7 billion episodes of diarrhoea,
equaling approximately 2.9 episodes per child per year, created health

system costs of about 7 billion US dollars. The majority of diarrhoeal


diseases can be prevented by implementing water, sanitation and hygiene
programs, which all aim at interrupting faecaloral transmission pathways.
Even though diarrhoea morbidity and mortality has decreased since the
1990s, the overall disease burden remains unacceptably high, particularly
in low and middle-income countries. Diarrhoea is a leading cause of
malnutrition in children under five years old.
DR. Anil Gupta (2014)

CHAPTER 2

LITERATURE REVIEW

2.1

Diarrhoea in children

Diarrhoea disease is the second leading cause of death in children under five years
old, and is responsible for killing around 760 000 children every year. Diarrhoea
can last several days, and can leave the body without the water and salts that are
necessary for survival. Diarrhoea is usually a symptom of an infection in the
intestinal tract, which can be caused by a variety of bacterial, viral and parasitic
organisms. Children who die from diarrhoea often suffer from underlying
malnutrition, which makes them more vulnerable to diarrhoea. Each diarrhoeal
episode, in turn, makes their malnutrition even worse. Diarrhoea is a leading cause
of malnutrition in children under five years old. The majority of diarrhoeal diseases
can be prevented by implementing water, sanitation and hygiene (WASH)
programs, which all aim at interrupting faecaloral transmission pathways,
commonly referred to as the five F (fluids, fields, flies, fingers and food). Several
studies have attempted to evaluate the effects of combined or single water, hygiene
and sanitation interventions on diarrhoea as an outcome variable.

2.2

Common bacteria in children

The most common cause is an infection of the intestine due to either a virus,
bacteria or parasite; a condition known as gastroenteritis. These infections are often
acquired from food or water that has been contaminated by stool, or directly from
another person who is infected. It may be divided into three types which is short
duration watery diarrhea, short duration bloody diarrhea and more than two weeks,
persistent diarrhea.
The short duration watery diarrhea may be due to an infection by cholera. If blood
present it is also result in diarrhea, including hyperthyroidism, lactose intolerance,
inflammatory bowel disease, a number of medications, and irritable bowel
syndrome. In most cases, stool cultures are not required to confirm the exact cause.
Causing the bacteria agent virus. Viruses that can cause diarrhea include Norwalk
virus, cytomegalovirus and viral hepatitis. Rota virus is a common cause of acute
childhood diarrhea. Common bacterial causes of diarrhea include campylobacter,
salmonella shigella and Escherichia coli. Diarrhea caused by bacteria and parasites
can be common when traveling in developing countries and is often called
travelers diarrhea.
2.3

Mode of transmission

All of the more common childhood diarrhea caused by pathogenic bacteria &
viruses are transmitted via the faecal oral route. The phategenes discharge in a
faeces of an infected person may enter the body of another susceptible person
through the mouth. This may occur among children ingesting food/ water
contaminated in human excreta. Direct transmission among persons in close contact
is also possible. Such transmission could occur via unclean hands or through
contaminated objects such as bad linen kitchen utensils & tableware. Files &
cockroaches play a role as vectors of the infections agent of faecal origin. Most of
the pathogenic organisms that cause Diarrhea and all the pathogens that are known
to be major causes of Diarrhea are transmitted primarily or exclusively by the
faecooral route. Faeco oral transmission may be waterborne, food borne, or direct
transmission which implies an array of other faeco oral routes such as via fingers,
or fomites, or dirt which may be ingested by young children. Acute diarrhoeal
diseases usually spread by contaminated hands or ingestion of contaminated food
or drinks, and occasionally by aerosol. Outbreaks may occur in settings like
institutions and child care centers.

2.4

Treatment

2.4.1 Probiotics
Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy bacteria
in the gastro intestinal track.Yougurt is the easiest source of probiotics. Give
children to two to six once of yogurt twice daily. Today, almost all yogurts are
active culture which means that they contains life and active bacteria. Probiotic
supplements in granules tablets or capsule are also can be given which available in
health food stalls.
Medicine such as bismuth subsalicylate (Pepto-ismol, Kaopectate) or lope amide
(medium) which are available as liquids/tablets. Follow the instructions on the
package. If you have itching, burning, soreness or pain in your rectal area because
you have a lot of bowel movements, try these tips to feel better. Take a warm both.
Afterwards, pat the area dry (do not rub) with a clean, soft towel. Use a hemorrhoid
cream or try white petroleum jelly. Do your best to stay hydrated.You should drink
at least six 8-ounce glasses of fluid each day? Choose fruit juice without pulp, broth
or soda (without caffeine).Chicken broth (without the fat), tea with honey or sports
drinks are also good choice.
2.4.2

Prebiotics

Taking prebiotics for diarrhea relief is still an underutilized tool, but it is quickly
gaining popularity as we learn more about how the digestive system functions. The
digestive system contains a certain amount of beneficial bacteria and if the level of
these bacteria gets too low, it can leave you susceptible to a number of
uncomfortable conditions, including diarrhea. Maintaining the proper bacteria
levels in your digestive system is precisely where prebiotics can be a big help.
Prebiotics are a form of carbohydrate that does not break down as it passes through
the digestive tract. It is then used as a food source by probiotics, or beneficial
bacteria. It is this beneficial bacteria that can help you to fight off diarrhea.
Prebiotics have been shown to have multiple benefits including increased
absorption of calcium and magnesium increased immune system effectiveness
inhibition the growth the lesions in the gut, such as adenomas and carcinomas,
therefore reducing risk factors associated with diseases in the rectum and colon

CHAPTER 3

METHADOLOGY

3.1 SAMPLE COLLECTION


100 stool samples will be collected below 5 years old at Hospital Sabak Bernam.
3.2 Stool FEME
Fecal samples (one from each subject) from children without diarrhea were
collected in a clean container. From the children with diarrhea, one stool specimen
was collected within 24 hours of admission. All feces were collected in special
containers with CaryBlair transport medium, kept at 4 C and transported to the
microbiological laboratory within 24 hours. (Look under microscope.)
3.2 Stool culture
Stools will be cultured on MacConkey agar for the selection of Escherichia coli,
TCBS agar for the selection of Vibrio species; and XLD agar for the selection of
Shigella spp and Salmonella spp. A stool (feces) sample can provide doctors with
valuable information about what's going on when a child has a problem in the
stomach, intestines, or other part of the gastrointestinal (GI) system and incubate at
body tempreture for 24 hours.A stool culture helps the doctor determine if there's a
bacterial infection in the intestines. A technician places small stool samples in
sterile plastic dishes containing nutrients that encourage the growth of certain

bacteria. The targeted bacteria will only grow if they're already present in the stool
sample. If bacterial colonies form, the technician evaluates them using a
microscope and chemical tests to identify the organism.
3.3

Identification of bacteria

3.3.1 Escherichia coli on Mac Conkey agar


Streak plate isolation of E. coli on MacConkey Agar grown for 24 hrs at 37
degrees. E. coli demonstrates strong lactose fermentation indicated by the
bright pink halo, bile precipitant around the colonies, and pink colony
growth
Thiosulfate-citrate-bile salts-sucrose agar or TCBS agar is a type of selective
agar culture plate that is used in microbiology laboratories to
isolate Vibrio spp. TCBS Agar is highly selective for the isolation of V.
cholerae and V. parahaemolyticus as well as other vibrios. Xylose Lysine
Deoxycholate (XLD) Agar was developed by Taylor for the differentiation,
isolation, and identification of enteric pathogens, and to support the growth
of more fastidious enteric organisms. XLD Agar was especially designed to
allow the growth of Shigella species, and is a proven medium for the
isolation of this organism. It has also been found to be an excellent medium
for isolating Salmonella species as well. The disease is characterised by
vomiting and watery diarrhoea lasting for three to eight days. Fever and
abdominal pain occur frequently. Treatment is symptomatic. Maintenance of
hydration is the most important measure. Diagnosis may be made by rapid
antigen detection of rotavirus in stool specimens. Strains may be further
characterised by enzyme immunoassay or reverse transcriptase polymerase
chain reaction. Stools for these tests should be collected in the acute phase of
illness.

GANTT CHART
November
Title Selection

January

February

March

Proposal
preparation/
Update literature
review
Proposal
Presentation

Data collection
Thesis
Completion
Preparation
Final
presentation
Final
Presentation

April

for


REFERENCE

DR. Anil Gupta (2014). Study of the prevalence of diarrhoea in children under the
age of five years: its association with wasting. Indian J.Sci.Res. 7 (1): 1315-1318,
2014

Katharina Diouf (2014). Diarrhoea prevalence in children under five years of age in
rural Burundi: an assessment of social and behavioral factors at the household
level.
Retrieved
from
http://www.globalhealthaction.net/index.php/gha/article/view/24895.