Persistent diarrhoea following gastroenteritis.

Abstract

The persistent diarrhoea of greater than 14 days' duration in 17 infants, comprising 1% of 1672 patients who were admitted to a South African Hospital during January 1985-July 1987 for a study on acute gastroenteritis, is described. The age of the patients was between 20 days and 31 months (7.4 +/- 7.8 months), 11 of whom were of less than 6 months and the majority (13) were boys. Fifteen had the nutritional status below the 3rd weight-for-age centile. On admission, gastroenteritis was graded as mild in three patients, moderate in nine and severe in five. Seven, six and four patients had mild, moderate and severe dehydration respectively. Twelve patients required infusion of intravenous (i.v.) fluids for greater than or equal to 14 days to maintain hydration. Complications, such as bronchopneumonia and septicaemia, were present in five and three patients respectively. Nine of the 17 patients shed rotavirus in their stools, 7 of whom continued to do so for 10 to 18 days, and 3 of whom had associated infections either with Salmonella or with enteropathogenic Escherichia coli or both. Any causal agent was not detected in six patients. The mainstay of treatment was oral rehydration therapy with i.v. fluid when necessary and a normal diet of cow's milk-based formula to all except the two breast-fed infants. A failure to improve patients' condition led to the following graded additions to the treatment regimen: lactose-free soya diet, administration of oral gentamicin plus cholestyramine and feeding of semi-elemental formula ("Alfaré," R). The last one gave encouraging results, though the study was not a controlled therapeutic trial.