Relative Importance of Viruses and Bacteria in the Etiology of Pediatric Diarrhea in Taiwan

Of 80 children with acute gastroenteritis in Taiwan, 75 were tested for evidence of infection with a reovirus-like agent (RVLA) by electron microscopic examination of stools and/or by assays of complement-fixing and immunofluorescent antibody responses to the serologically related Nebraska calf diarrhea virus; 42 (56%) were positive. Of children whose stools contained the agent, 90% showed a fourfold or greater rise in titer of immunofluorescent antibodies, and 85% developed a fourfold or greater rise in titer of complement-fixing antibodies to the agent. Strains of Escherichia coli producing only heat-labile toxin (LT) were isolated from 7% of 57 ill children who had not received previous antibiotics and from 4% of 131 healthy control children (P = 0.49). Strains of E. coli producing only heat-stable toxin (ST) were isolated from five (9%) of 57 age-matched children in the group of 131 healthy controls tested. Invasive E. coli were not found. In addition, three of six children with bacterial and/ or serological evidence of an infection with LT-producing E. coli and four of five children infected with ST-producing E. coli had infections with RVLA. RVLA appeared to be the major cause of diarrheal illness in Taiwan during the summer of 1975, whereas toxigenic E. coli appeared to be responsible for a smaller proportion of pediatric enteritis.