Fecal Leukocytes in Enteric Infections

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Abstract
Ninety adult and 200 pediatric patients had feces examined for the presence of fecal leukocytes and enteric pathogens during episodes of acute diarrhea. Fecal leukocytes were demonstrated in specimens from 24 of 35 patients (69%) with diarrheal stools from which a shigella strain was isolated, and in 4 of 11 (36%) specimens from patients with stools from which salmonella was isolated. A significantly (P < 0.001) greater number of patients with shigella isolated from their stools had fecal leukocytes when compared with 27 of 158 patients (17%) from whose stools no pathogen was isolated or to 8 of 56 patients (14%) from whose stools other bacterial and protozoal pathogens were isolated (P < 0.05). Eighteen patients had an invasive bacterial strain isolated from stool as determined by guinea pig eye testing. Eleven of 13 invasive shigella isolates (85%) were associated with numerous leukocytes in the feces, while none of five other invasive bacteria were related to leukocyte-positive stools. Leukocytes were rarely found in stools of patients with diarrhea felt to be due to viruses (2/36), Giardia lamblia (0/6), Entamoeba histolytica (0/4), or toxigenic E. coli (4/35). The lack of total correlation between the presence of leukocytes and recovery of an invasive pathogen reflects the complex interaction of enteric pathogens and host.