{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:02:40Z","timestamp":1793642560691,"version":"4.5.1"},"reference-count":35,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,11]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Diarrhea is a common cause of morbidity and mortality among children younger than 5 years in developing countries. Children from 3 to 60 months of age were recruited from two hospitals in Nepal\u2014 Bharatpur Hospital, Bharatpur, and Kanti Children\u2019s Hospital, Kathmandu\u2014in 2006 to 2009. Stool specimens collected from 1,200 children with acute diarrhea (cases) and 1,200 children without diarrhea (control subjects) were examined for a broad range of enteropathogens by standard microbiology, including microscopy, enzyme immunoassay for viral pathogens (adenovirus, astrovirus, and rotavirus) and protozoa (<jats:italic>Giardia<\/jats:italic>, <jats:italic>Cryptosporidium<\/jats:italic>, and <jats:italic>Entamoeba histolytica<\/jats:italic>), as well as by using reverse transcription real-time polymerase for norovirus. Antimicrobial susceptibility testing was performed using the disk diffusion method. Overall, rotavirus (22% versus 2%), norovirus (13% versus 7%), adenovirus (3% versus 0%), <jats:italic>Shigella<\/jats:italic> (6% versus 1%), enterotoxigenic <jats:italic>Escherichia coli<\/jats:italic> (8% versus 4%), <jats:italic>Vibrio<\/jats:italic> (7% versus 0%), and <jats:italic>Aeromonas<\/jats:italic> (9% versus 3%) were identified significantly more frequently in cases than control subjects. <jats:italic>Campylobacter<\/jats:italic>, <jats:italic>Plesiomonas<\/jats:italic>, <jats:italic>Salmonella<\/jats:italic>, and diarrheagenic <jats:italic>E. coli<\/jats:italic> (enteropathogenic, enteroinvasive, enteroaggregative) were identified in similar proportions in diarrheal and non-diarrheal stools. <jats:italic>Campylobacter<\/jats:italic> was resistant to second-generation quinolone drugs (ciprofloxacin and norfloxacin), whereas <jats:italic>Vibrio<\/jats:italic> and <jats:italic>Shigella<\/jats:italic> were resistant to nalidixic acid and trimethoprim\/sulfamethoxazole. This study documents the important role of rotavirus and norovirus in acute diarrhea in children younger than 5 years, followed by the bacteria <jats:italic>Shigella<\/jats:italic>, enterotoxigenic <jats:italic>E. coli<\/jats:italic>, <jats:italic>Vibrio cholera<\/jats:italic>, and <jats:italic>Aeromonas<\/jats:italic>. Data on the prevalence and epidemiology of enteropathogens identify potential pathogens for public health interventions, whereas pathogen antibiotic resistance pattern data may provide guidance on choice of therapy in clinical settings.<\/jats:p>","DOI":"10.4269\/ajtmh.21-1219","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T15:03:05Z","timestamp":1670252585000},"page":"174-180","source":"Crossref","is-referenced-by-count":20,"title":["Etiology of Acute Diarrheal Disease and Antimicrobial Susceptibility Pattern in Children Younger Than 5 Years Old in Nepal"],"prefix":"10.4269","volume":"108","author":[{"given":"Sanjaya K.","family":"Shrestha","sequence":"first","affiliation":[{"name":"Walter Reed\/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal;"},{"name":"Centre for International Health, University of Bergen, Bergen, 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