Clinical and Laboratory Effects of Foodborne Illness in Children

Introduction

Foodborne diseases (FD) are a group of diseases that are common and sometimes causes death (Brown et al., 2021; Dos Santos et al., 2022; Walter et al., 2020; Madoroba et al., 2022). Gazu et al.'s (2023) meta-analysis, based on 128 articles, reveals that, in recent years, the majority of FD articles have focused on biological hazards. These studies mainly highlight the risks in food-related settings and communities, with fewer investigations in health care facilities, often limited by recording system deficiencies (Gazu et al., 2023). Among these limited studies, a minority address the acute effects of FD in children. However, a report emphasized higher fatality rates during the acute phase (Holland et al., 2023). Therefore, understanding the impact of FD on children is crucial because the immaturity of children's immunity causes a more dangerous impact of FD on children (Dietert et al., 2000).

In developing countries like Turkey, the utilization of rapid methods for detecting food contamination in pediatric emergency services is not yet at a sufficient level. Rapid methods, such as biosensors, are commonly applied in the food production chain. Cultures from body samples are available but require a significant time for results (Yeni et al., 2014). Hence, they aren't preferred for acute cases like FD incidents in emergency departments. In some African nations with high prevalence of FD, laboratory examinations are not readily accessible, exacerbating the situation (Bisholo et al., 2018). Therefore, a thorough understanding of the clinical course of FD in children becomes essential.

In our exploration of “foodborne diseases, children, Turkey” on Google Scholar and PubMed, we found only a few studies on this topic in Turkey, despite examining records dating back to the 1990s (Öz et al., 2014; Ogur, 2016; Bucak et al., 2020; Sahin et al., 2023). Our study aimed to examine clinical and laboratory aspects of FD in pediatric patients, focusing specifically on children under 5 years, a gap that was overlooked in previous Turkish research. Our study's distinct focus on the clinical and laboratory findings during the acute phase of FD aims to benefit physicians in understanding its effects on children. Additionally, we believe that our study will contribute to estimating the global burden of FD.

Materials and Methods

Results

In 2022, our emergency department received 17,091 pediatric cases, with 106 identified as FD at a rate of 0.62%. The average age was 7.65 ± 6.51 years, and 94.3% of cases were male, while 5.7% were female.

In the age group comparison, children aged 5–18 exhibited more symptoms than those under 5 years (χ² = 61.06; p = 0.00), indicating a significant difference in symptomatology within the 5–18 age group (Table 1). Significant differences were also found in symptoms such as nausea and vomiting, tachycardia, hypotension, and electrolyte status (p = 0.00, p = 0.01, p = 0.00, and p = 0.01, respectively). In our study, 20.8% of patients had electrolyte disturbances. The most common was hyponatremia (7.5%), followed by the combination of hypocalcemia and hyponatremia (5.7%), and the combination of hyponatremia and hypercalcemia (3.8%). In the comparison between age groups, significant differences in electrolyte status symptoms were observed between children aged 5–18 and those under 5 years old (p = 0.01). Hyperkalemia was observed only in children under 5 years old, while hyponatremia, hypocalcemia, and hypercalcemia were more frequent in the 5–18 age group (p = 0.01) (Table 1).

Children's hospitalization duration significantly differed between age groups (Z = −7.77; p = 0.00) based on the Mann–Whitney U test (Table 2 in Supplementary Data). The significant difference originated from children under 5 years old, indicating that these children had longer hospital stays.

When the treatment options administered to the patients were analyzed, it was found that 28.3% of them received hydration and 1.9% of them received gastric lavage. Gastric lavage was significantly more common in the under-5 age group (20%) than none in the 5–18 age group (p = 0.01). Metpamid was not administered to under-5 age group, in contrast to 39.5% in the 5–18 age group, though not statistically significant (p = 0.70). Observation was a common strategy, employed in 40% of under-5 years of age cases, while older children received Panto and refused treatment more frequently (Table 3 in Supplementary Data). Mortality was observed in any of the patients in the study.

Discussion

Our study observed a higher prevalence of FD among boys, accounting for 94.3% of cases, while girls represented 5.7%. Previous study in Turkey have also indicated a higher FD prevalence among males (Ogur, 2016). The high imbalance detected in our study may be attributed to the limited sample size, emphasizing the need for further research with larger pediatric cohorts to validate these results.

The World Health Organization estimates that food- and waterborne diarrheal diseases collectively account for ∼2.2 million deaths annually, with 1.9 million of these tragic fatalities occurring among children. The majority of these deaths stem from underdeveloped countries (Asaad et al., 2014). The results of no cases requiring admission to the pediatric intensive care unit or resulting in mortality in our study's findings indicate very low death rates in the region. A recently published study conducted in Denmark, a developing European country, similarly indicates very low mortality rates comparable to those in Turkey, reinforcing the positive impact of well-established health care systems (Pires et al., 2022). Our study's findings, shown to all physicians, suggest a decline in mortality rates within a well-resourced health care environment.

Significantly, the analysis of emergency department admissions for asymptomatic cases highlighted instances where asymptomatic children sought medical assistance as a family, accompanied by symptomatic parents. However, majority of our study participants (94.3%) exhibited symptoms in acute phase. These observations align with recent global studies. The most frequently symptom was nausea and vomiting (67.9%), highlighting gastrointestinal symptoms as predominant clinical features (Holland et al., 2023). Furthermore, 40% of cases under 5 years of age were symptomatic, while 60% asymptomatic. In contrast, FD cases in the 5–18 age group were all symptomatic, but there was a paradox that none required hospitalization after emergency department treatment. On the other hand, in the under-5 age group, 25% progressed to hospitalization. Another study determined that 67.2% of children aged 3–11 were treated with hospitalization (Ogur, 2016). This situation highlights the importance of considering age as a factor in understanding and managing FD cases. Our observations are in line with other international study.

Hyperkalemia was only observed in children under 5 years old, but hyponatremia being the most prevalent overall (7.5%), aligning with existing literature (Rius-Peris et al., 2022).

Conclusion

Considering resource constraints in developing regions like Turkey, implementing expensive rapid diagnostic tests in all hospitals is unfeasible due to budget limitations. Therefore, we advocate for alternative solutions like, affordable and locally produced rapid diagnostic kits. Most importantly, introducing simple data collection tools for local health care providers to effectively record FD cases is crucial. We believe that the findings and proposed solutions presented in this article are crucial for developing countries.