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Diarrhoea in general practice: a sixteen-year report of investigations in a microbiology laboratory, with epidemiological assessment

Published online by Cambridge University Press:  15 May 2009

Thomas E. M. Mair  and
Hilary E. Tillett
Thomas E. M. Mair
Affiliation:
Epidemiological Research Laboratory, Central Public Health Laboratory, Colindale Avenue, London, NW9 5HT
Hilary E. Tillett
Affiliation:
Epidemiological Research Laboratory, Central Public Health Laboratory, Colindale Avenue, London, NW9 5HT
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Summary

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Results are presented of the laboratory examination of faeces specimens from 20,273 patients with acute diarrhoea. These were household index cases seen in general practice in a London borough during the years 1953–68. An annual average of about 2% of households in the area were affected, but there was considerable fluctuation with year and season. Half the patients were children although only one-fifth of the population at risk was under 15 years of age. The greatest incidence of diarrhoea was among children under 5 years old. Male children, but female adults predominated.

Specimens were sent for laboratory diagnosis at the discretion of the general practitioner. The laboratory found some abnormality in nearly a third and there were indications that transmissible infection was involved in about one-fifth of patients. The most common diagnosis was Sonne dysentery (9%) which came in epidemic waves and made its greatest impact among young school children. Microscopy was useful, and giardiasis was diagnosed in 1·4% of index patients. Other parasites were less commonly found. Fatty globules characteristic of an infectious condition we have called ‘fatty diarrhoea’ were frequently observed by microscopy in stools from young children and occasionally from older persons. Blood or pus cells were seen in less than half the shigella and salmonella infections and in a much smaller proportion of the remainder. A test for occult blood performed on specimens from all patients of 40 years or older was positive, in the absence of visible red cells, in a tenth of these cases.

Other studies on the bacteriology of diarrhoea in general practice are referred to and some epidemiological comparisons made. The possible place of unidentified infective agents in the aetiology of undiagnosed diarrhoeas and of ‘fatty diarrhoea’ is discussed.

Type
Research Article
Information
Journal of Hygiene , Volume 74 , Issue 2 , April 1975 , pp. 183 - 194
Copyright
Copyright © Cambridge University Press 1975

References

REFERENCES

British Medical Journal (1972). Viruses of vomiting. British Medical Journal iv, 442.Google Scholar
Buscho, R. F., Wyatt, R. G., Dolin, R., Blacklow, N. R., Dupont, H. L. & Chanock, R.M. (1973). Recurrent institutional outbreaks of acute infectious nonbacterial gastroenteritis: epidemiology and etiology. American Journal of Epidemiology 98, 192.CrossRefGoogle ScholarPubMed
Carswell, F., Gibson, A. A. M. & McCallister, T. A. (1973). Giardiasis and coeliac disease. Archives of Disease in Childhood 48, 414.CrossRefGoogle ScholarPubMed
Clarke, S. K. R., Cook, G. T., Egglestone, S. I., Hall, T. S., Miller, D. L., Reed, S. E., Rubenstein, D., Smith, A. J. & Tyrrell, D. A. J. (1972). A virus from epidemic vomiting disease. British Medical Journal iii, 86.CrossRefGoogle Scholar
CDS (1973). Shigellosis in North East Scotland (1929–71). Communicable Diseases (Scotland) Report 73/7, iii.Google Scholar
Cramblett, H. G. & Siewers, C. M. F. (1965). The etiology of gastroenteritis in infants and children, with emphasis on the occurrence of simultaneous mixed viral-bacterial infections. Pediatrics 35, 885.CrossRefGoogle ScholarPubMed
Department of Education and Science and Department of Health and Social Security (1971). Memorandum on the Control of Infectious Diseases in Schools. London: H.M.S.O.Google Scholar
Dupont, H. L., Formal, S. B., Hornick, R. B., Snyder, M. J., Libonati, J. P., Sheahan, D. G., LaBrec, E. H. & Kalas, J. P. (1971). Pathogenesis of Escherichia coli diarrhoea. New England Journal of Medicine 285, 1.CrossRefGoogle Scholar
Fukumi, H., Nakaya, R., Hatta, S., Noriki, H. & Yunoki, H. (1957). An indication as to identity between the infectious diarrhoea in Japan and the afebrile infectious non-bacterial gastroenteritis by human volunteer experiments. Japanese Journal of Medical Science and Biology 10, 1.CrossRefGoogle Scholar
Hobbs, B. C., Thomas, M. E. M. & Taylor, J. (1949). School outbreak of gastroenteritis associated with a pathogenic paracolon bacillus. Lancet ii, 530.CrossRefGoogle Scholar
Hodges, R. G., McCorkle, L. P., Badger, G. F., Curtiss, C., Dingle, J. H. & Jordan, W. S. Jnr. (1956). A study of illness in a group of Cleveland families. XI. The occurrence of gastrointestinal symptoms. American Journal of Hygiene 64, 349.Google Scholar
Knox, J. D. E., MacNaughtan, G., Laurence, A. R. & Robertson, A. A. (1967). Diagnosis of diarrhoea in general practice. Lancet ii, 1392.CrossRefGoogle Scholar
Logan, W. P. D. & Cushion, A. A. (1958). Morbidity statistics from general practice, Vol. I (General). Studies on Medical and Population Subjects, No. 14. London. H.M.S.O.Google Scholar
McCorkle, L. P., Badger, G. F., Curtiss, C., Dingle, J. H., Hodges, R. G. & Jordan, W. S. Jnr. (1956). A study of illness in a group of Cleveland families. XII. The association of respiratory and gastrointestinal symptoms: an estimation of the magnitude and time relations of the association. American Journal of Hygiene 64, 357.Google Scholar
Middleton, P. J., Szymanski, M. T., Abbott, G. D., Bortolussi, R. & Hamilton, J. R. (1974). Orbivirus acute gastroenteritis of infancy. Lancet i, 1241.CrossRefGoogle Scholar
Murphy, A. M. (1964). The isolation of an unclassified virus from an outbreak of infantile diarrhoea. Journal of Hygiene 62, 425.Google ScholarPubMed
Ormiston, G., Taylor, J. & Wilson, G. S. (1942). Enteritis in a nursery home associated with Giardia lamblia. British Medical Journal ii, 151.CrossRefGoogle Scholar
Petersen, H. (1972). Giardiasis. Scandinavian Journal of Gastroenterology 7, supplement 14.Google Scholar
Public Health Laboratory Service (1974). Gastroenteritis from cheese. British Medical Journal ii, 2.Google Scholar
Ridge, L. E. L. & Thomas, M. E. M. (1955). Infection with the providence type of paracolon bacillus in a residential nursery. Journal of Pathology and Bacteriology 69, 335.CrossRefGoogle Scholar
Rowe, B., Taylor, J. & Bettelheim, K. A. (1970). An investigation of travellers’ diarrhoea. Lancet i, 1.CrossRefGoogle Scholar
Sexton, M., Davidson, G. P., Bishop, R. F., Townley, R. R. W., Holmes, I. H. & Ruck, B. J. (1974). Viruses in gastroenteritis. Lancet ii, 355.CrossRefGoogle Scholar
Sinha, A. K. & Tyrrell, D. A. J. (1973). Changes in the clinical pattern of gastrointestinal infections in North West London 1968/70. British Journal of Clinical Practice 27, 45.Google ScholarPubMed
Smither, W. J. (1953). Gastroenteritis in general practice. A study of 90 unselected cases. British Medical Journal i, 376.CrossRefGoogle Scholar
Thomas, M. E. M. (1952). ‘Epidemic’ abdominal colic associated with steatorrhoea. British Medical Journal i, 691.CrossRefGoogle Scholar
Thomas, M. E. M. (1957). Enteritis from tortoises. Monthly Bulletin of the Ministry of Health and the Public Health Laboratory Service 16, 29.Google ScholarPubMed
Thomas, M. E. M. & Charter, R. E. (1956). The aetiology of juvenile diarrhoea. British Medical Journal ii, 339.CrossRefGoogle Scholar
Thomas, M. E. M.. & Mogford, H. E. (1970). Salmonellosis in general practice. Observations of cases and their households in Enfield. Journal of Hygiene 68, 663.Google ScholarPubMed
Thomas, M. E. M. & Tillett, H. E. (1973 a). Dysentery in general practice: a study of cases and their contacts in Enfield and an epidemiological comparison with salmonellosis. Journal of Hygiene 71, 373.CrossRefGoogle Scholar
Thomas, M. E. M. & Tillett, H. E. (1973 b). Sonne dysentery in day schools and nurseries: an eighteen-year study in Edmonton. Journal of Hygiene 71, 593.CrossRefGoogle ScholarPubMed
Thompson, R. G., Karandikar, D. S. & Leek, J. (1974). Giardiasis, an unusual cause of epidemic diarrhoea. Lancet i, 615.CrossRefGoogle Scholar
Tillett, H. E. & Thomas, M. E. M. (1974). Culture of the faeces in the diagnosis of Sonne dysentery: a statistical method for estimating the true isolation rate. International Journal of Epidemiology 3, 177.CrossRefGoogle ScholarPubMed
Tuckman, E., Chapple, P. A. L., Franklin, L. M., Manser, I. N., Woodall, J. T., Randall, K. J. & McDonald, J. C. (1962). Acute gastrointestinal illness in general practice. British Medical Journal i, 135.CrossRefGoogle Scholar
Walker, A. B. & Robertson, W. (1968). Enquiry irto incidence of diarrhoeal diseases in the working population in Edinburgh. Health Bulletin.Scottish Home and Health Department 26 (4), 55.Google Scholar