الفهرس 
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Abstract
Diarrheal disease, which is most often caused by infectious pathogens, is a significant cause of morbidity and mortality worldwide, especially in children. This is particularly true in developing countries. In our study, a total of 200 fecal samples from childern (under 5 years of age) admitted with acute diarrhea to El-Minia University for children, El-Minia General and El-Minia tropical hospitals were examined. The data showed that 62(31%) were aged 0-6 months, followed by 45(22.5%) were aged >6-12 months, 30(15%) were aged >12-24, 30(15%) were aged >24-36, 16(8%) were aged>36-48 and 17(8.5%) were aged >48-60. The prevalence of acute diarrhea among males 110 (55%) was greater than among females 90(45%). Among 200 stool samples, the highest prevalence was with both bacteria and virus (60.25% and 39.75%, respectively) while, no parasites were detected in the examined samples. Regarding the identified microorganisms among bacteria, the highest prevalence was with E. coli (37.24%), followed by P. aeruginosa (12.55%), S. aureus (8.37%), and Klebsiella sp. (2.09%). Rotavirus was found in 39.75% of childern suffering from acute diarrhea.
It was found that the frequency of occurrence of enteropathogens decreased with increase in the age of childern with diarrhea. Childern aged 0-6 months old recorded the highest frequency of enteropathogens, followed by those aged 6-12 months old. Among these two age groups, E. coli (53.22 and 44.44%), followed by P. aeruginosa (16.12 and 15.55%), S. aureus (9.67-8.88%), Klebsiella sp. (4.83and 4.44%), and Rotavirus (56.45 and 44.44%) were the most predominant etiological agents detected.
The mixed prevalence with two or more microorganisms was documented in 38 (19%). The most common correlation of two microorganisms was between bacteria and virus which was found in 37 (18.5%) cases, followed by bacteria, bacteria and virus in 1 (0.5%).
Our study determined the clinical characteristics of the examined childern suffering from acute diarrhea in relation to isolated microorganism. Of the 200 childern with diarrhea, 162 (81%) had watery diarrhea and 38 (19 %) had mucoid diarrhea. Vomiting was apparent in 50 (25%) of the childern and dehydration in 150 (75%). Watery diarrhea was most commonly found in diarrheal cases due to E. coli and rotavirus followed by mucoid diarrhea and no bloody diarrhea was detected.
The elevated incidence of diarrhea correlated with months from August to April months. The viral infections tended to occur during winter, the bacterial infections during summer and spring.
The antibiotic resistance pattern of E. coli, where E. coli isolates showed high resistance to cefazolin (98.87%), cefuroxime (57.3%), amoxicillin /clavulunic acid (55%) and cefatriaxone (52.8%), moderate resistance to cefipime (33.7%), ampicillin/sulbactam (22.47%) and low resistance to gentamicin (8.98%), ofloxacin (7.86%), imipenem (4.49%) and amikacin (3.37%).
Clinical P. aeruginosa isolates were completely resistant to cefazolin, cefuroxime, amoxicillin /clavulunic acid, ampicillin/sulbactam and imipenem, showed high resistance to amikacin (90%), gentamicin (86.67%), cefatriaxone (66.67%), moderate resistance to cefipime (60%), and low resistance to ofloxacin (3.33%).
The antibiotic resistance pattern of S. aureus isolates were completely resistant to cefazolin, showed high resistance to cefatriaxone (75%), moderate resistance to cefuroxime and amoxicillin/clavulunic acid (60%), and no resistance to ampicillin /sulbactam, cefipime, gentamicin, amikacin, ofloxacin and imipenem.
The antibiotic resistance pattern of Klebsiella sp. where Klebsiella sp. isolates were completely resistant to cefazolin, cefuroxime, showed high resistance to cefatriaxone (60%), moderate resistance to ampicillin/sulbactam (40%), low resistance to amoxicillin/clavulunic acid and cefipime (20%) and finally, no resistance to imipenem, gentamicin, ofloxacin and amikacin.
Genomic analysis of 89 E. coli stool samples from diarrheal childern were detected by using PCR to detect the prescence of Stx1, Stx2,eaeA and bfpA genes. Escherichia coli strains that harboured Stx (Stx1 and/or Stx2) genes and were positive or negative for eaeA were identified as STEC and strains that were negative for Stx (Stx1 and/or Stx2) genes but possessed eaeA gene were considered as EPEC, while occurrence of bfp gene indicated the prescence of tEPEC and its abscense indicated the prescence of aEPEC.
Stx1 and Stx2 showed PCR products at 180bp and 255bp respectively, while eaeA showed PCR products at 890bp. No products were obtained from bfpA gene.
Out of total E. coli isolates, 40 (44.94%) STEC and 1(1.11%) aEPEC were identified which was eae-A positive and bfp negative. Among STEC isolates 24 strains were Stx1positive, 8 strains were Stx2 positive, 8strains were Stx1and Stx2 positive and no strain was bfp positive.