SAN FRANCISCO — Go beyond the usual questions about travel to other countries or the keeping of nontraditional pets, when asking parents about potential environmental exposures to diarrhea-causing agents, Dr. Sarah S. Long advised.
Ask about two increasingly recognized sources of infection—petting zoos and swimming pools, said Dr. Long, chief of infectious diseases at St. Christopher's Hospital for Children, Philadelphia.
Agricultural fairs, petting zoos, and their equivalents are prime grounds for enteropathogens that can cause acute and often bloody diarrhea, especially in children younger than age 3 years who carry pacifiers, bottles, toys, or food in the vicinity of animals.
“I don't think we spend enough time asking about whether they've traveled to places where there are animals,” Dr. Long said at the annual meeting of the American Academy of Pediatrics.
Whether someone brings animals to a day care center or a family visits a local 4-H fair, the transient nature of most petting zoo environments usually results in poor hygiene. They often feature high-risk animals such as baby chicks, which harbor Salmonella species, or neonatal calves, which can transmit Escherichia coli. Children under age 5 years should not touch these animals, she said.
Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth, and avoid eating food prepared there if possible. Most importantly, everyone should use hand sanitizer when leaving, whether they touched anything or not.
The summer of 2007 saw 400 cases of Cryptosporidium-associated vomiting and diarrhea from an outbreak of infections around swimming pools in Philadelphia. Cryptosporidium species also can be transmitted in day care centers and from farm animal contacts.
This protozoan is very chlorine resistant and remains in the stool of infected people for about 2 weeks after the diarrhea stops, unlike other agents that cause acute diarrhea. “We did anticipatory treatment of an awful lot of children” this past summer, Dr. Long said.
Routine lab tests for ova and parasites will not detect Cryptosporidium. “You want to ask about swimming pools,” and order specific antigen detection on stool specimens if you suspect Cryptosporidium. Treatment with 3 days of nitazoxanide is approved for children aged 1 year or older.
To prevent this infection, advise parents of all young children not to change diapers at poolside. A child with diapers in the pool should be checked frequently and taken to the bathroom to clean their diapers and wash up. Anyone with a diarrheal illness in the very recent past should stay out of the pool. A pool associated with Cryptosporidium infection should be shut for 2 weeks and hyperchlorinated.
Advise parents that when they take children to these environments, bring nothing that a child might put in his or her mouth. Everyone should use hand sanitizer when leaving, whether they touched anything or not. LOUISE A. KOENIG/ELSEVIER GLOBAL MEDICAL NEWS