Incidence of cholera in children under two years of age at the Dr. Soetomo Hospital, Surabaya.

Stool cultures from 510 patients, admitted to the Children's Ward of the Dr. Soetomo Hospital with gastroenteritis, were examined. Fifty-six cases were found to have para Cholera El Tor (10.98%) and 56 patients showed positive E. coli (10.98% ). The clinical features of para Cholera El Tor have been discussed, and compared with E. coli infections. We also reviewed the clinical observations of other writers. Clinically Cholera El Tor and E. coli have similar signs and symptoms. They differ only in : (a) Age (El Tor is usually found in older age groups). (b)Nutritional State (El Tor is found among the undernourished), (c) State o f dehydration (El Tor causes dehydration more rapidly), and (d) Faeces (El Tot excretes more faeces per movement). Received 2nd June 1975. 2 2 0 H A RO EN N O E R A SID E T A L. Introduction To make a diagnosis of cholera in a baby ¿0 very difficult indeed, becau­ se it is often thought to be an ordi­ nary gastroenteritis, due to lack of classical signs and symptoms as in adults. Following the first article about pa­ ra Cholera El Tor outside Sulawesi iin adults by Gan Koen Han (1958), ma­ ny otiher article© have been published he. from Semarang, litem and Liem (1961) wrote about Cholera in chil­ dren aged 14 month — 12 years; from Jakarta, Widodo Talogo eit al. (1984) reported its incidence in chil­ dren with an average age of 6 years. Erwin et al. (1965) from Bandung, Manoerong et al. (1965) from Jakar­ ta, Dewanoto (1968) from Bandung mentioned briefly about the incidence of para Cholera El Tor in babies aged between 0 — 2 years. We believe that there is no descrip­ tion yet of the clinical features of pa­ ra Cholera El Tor especially in babies of 0 — 2 years. Clinically para Cho­ lera El Tor is very hard to differen­ tiate from gastroenteritis caused by other organisms as it can cause mild to severe dehydration (Erwin et al., 1965); Gan Koen Han, 1965; Manoe roeng et al,, 1965), The pathogenesis of diarrhoea in Cholera has a great deal of similarity with E . coli infections (Pierce, 1971). The high incidence of para Cholera E l Tor in babiles and the similarity of its pathogenesis with E. coli, lead us to study further and recognize the signs and symptoms of para Cholera El Tor, especially in children under 2 years of age. Material and method Patients include! in the study were dehydrated children with gastroenter­ itis, Who were admitted to the Chil­ dren’s Ward of the Dr. Soetomo Hos­ pital. Four rectal -swabs were taken from each patient, and cultured imme­ diately into the medium provided by the local Government’s laboratory. We selected only patients with Cho­ lera and Enteropathogenic E . coli for study. We recorded the type of food they had consumed, when they started to vomit, when the diarrhoea com­ menced and its frequency, the nutri­ tional state of the patients, the deg­ ree of dehydration, complications, associated diseases and the death rate. Routine laboratory tests included faeces, blood urine examination, smear and culture. Results From 510patients with gastroen­ teritis we found 56 patients with El Tor (10.98%) and 56 patients with E. coli positive cultures (10.98% ). There was no sex difference in the incidence of either infection (Ta­ ble 1). Excluding deaths from associated diseases, both infections had similar mortality rates (8 deaths from 56 patients). IN C ID E N C E O P C H O LER A 221 T A -B LE 1 : Num ber of childrem with Cholera/E. coli infection by sex and mortality. ? £ Total M o r t a 1 i t y Cholera 20 36 56 11 8 without complications 3 with complications E . coli 21 35 56 9 8 without complications 1 with complications