On every year,  according to the World Health Organization (WHO) and UNICEF data, there are about 2 billion cases of diarrheal disease worldwide . 1.9 million children younger than 5 years of age, mostly in developing countries,  perish from diarrhea each year. In industrialized countries, relatively few patients die from diarrhea, but even so, the disease continues to be an important cause of morbidity associated with substantial health care costs. However in the world, the morbidity from diarrheal diseases has remained relatively constant during the past 2 decades [4]. Because of all this, it was studied in the  Epidemiology Department, from the Public Health  Institute,  during  2017 – 2020,  the morbidity caused by infectious diarrhea, appeared in Transylvania region from Romania. Despite the economic and societal burdens of diarrheal illnesses, there are still few clinical guidelines,  which exist in correct use  for the diagnosis and treatment of persons with such suspected or relevant infectious diarrheas. That for, considerable clinical practice have been observed for to   demonstrate a clear need of a clinical diagnostic, improved by specific guidelines.

An analytical descriptive epidemiological study was used to analyze the 3577 cases of infectious diarrheas, in the population from Transylvania region. It was figured out all representative aspects of the pathology for: children, adults and elderly people. Data recruitment was ordered by the existing pathology in Ro by the National Public Health Guidelines. Obtained data   were transmitted by the territory  sanitary police units and  were analyzed in the Public Health Institute , on each year, almost during  5 months,  from May to November, in all the studied years from  2017-2020. All data offered to   realize an epidemiologic analyze and data interpretations during the entire mentioned time period.

(Figure 1)  Present the 3577 infectious diarrheas appeared during 2017 to 2020 in Transylvania region from Romania.

Figure 1:  Number of Infectious diarrheas.

Most of the disease was present in the first year of the study, in 37%. In the second year this were followed by 35, 5 % and at least in the third study year, in 29, 5%. In all this 3 years, the infectious pathology appeared in the summer season, almost during July and August. In the studied territory it was not a significant estimate difference. The case incidence was 65%, for the sum. Significant to be figured out is here, that infectious diarrhea, existed in the study, at each age decade.  More significant it appeared to be in children, with 63%, as Figure 2 present data. 

Figure 2:  Age of infectious diarrheas.

Data made relevant that the disease was present in children, on 0-14 age.  In adults, infectious diarrhea was remarked in 17%, as well in elderly people this pathology was represented in the same order of cases - in 17%. 27% of children and adults have needed short hospitalization days, because of dehydration.  For such disorders, it was used a specific adequate fluid and electrolyte replacement,  as the key to the treatment and managing of diarrheal illnesses. 3 children under 5 years of age died, even after this specific therapy, because other severe organic complications and organic fails caused their deaths.   International data, present a growing awareness of the potential impact, of long-term disability, caused by repeated early childhood enteric infections. Worldwide, there are 3.1 million deaths due to diarrhea per year (18400 per day), mostly in young children in developing areas [1]. Annual deaths due to diarrhea globally occur mainly in young children, and the number of deaths is 1000-fold higher than in the United States, where most of those who die of diarrheal illness, are elderly people [2]. Always, the clinical and epidemiological evaluation must define the severity and type of this illness. Collaborative activity and work between clinicians and public health practitioners can make to get less severe evolution of the infectious diarrheas cases. That for clinicians, can early put the diagnosis of an acute episode of diarrhea and can lead to interventions that alleviate symptoms and prevent secondary possible other disease transmissions. For public health practitioners, prompt notification of pathogen-specific diagnoses and bacterial isolates through public health surveillance, can lower the rates of transmission and lead to timely detection and control of any disease outbreaks. Because both clinicians and public health practitioners share overlapping responsibilities for such diagnosis, management, and prevention of infectious diarrheal diseases, must contain specific recommendations and specific guidelines for both groups of specialists 5.  Diarrheal illness is a problem worldwide, with substantial regional variation in the prevalence of specific pathogens. Testing of stool specimens is always indicated for each patient with enteric disorders. This had to be ordinate up to an existing national guideline, for to can identify all microbiological specimens. That for, it was figured out, the etiological aspects concerning all detected cases of infectious diarrheas. Data were received from several territory laboratories, where it was realized pertinent microbiological investigations. All these data were identified, in order to present the microorganisms and their aspects. With, it was possible to make an overview, concerning the heterogenic microorganisms, who made the appearance of the infectious diarrhea diseases,  present in the Transylvania population study. The incidence of these aspects, is presented in Figure 3 , which it is shown out all identified germs. 

Figure 3: Detected microbiological aspects.

Most of germs species belonged to the Enterobacteriaceae Family, represented by  E coli in  27 % , Salmonella spp. in  20 %;   Shigella spp.,  in   17%. Important is to be figured out is, that the death of the 3 children under 5 age were caused by invasive E. coli, present in their stool samples.  It is also important to be remarked the presence of Yersinia spp. in 8 % and of Campylobacter spp. in 6 %,   in other patients samples. The presences of the many different bacterial species were different identified:  E. Coli in children faces and all other germs were present in adults, or in the elderly people samples. The observation mentions the presence, in 17 % of Rotavirus, which mostly were present in the infectious diarrhea of the children. 3 % of children have had even Giardia in their samples and 1% of elderly people have had Fungi in their preserved tools. Many of these organisms can easily be transmitted through infected food or water, or from person to person, as the epidemiological study figured out in the Transylvania territory infectious diarrhea cases. There are various interpretations of what is considered medically indicated for evaluating persons with infectious diarrhea today. Stool cultures are often viewed as important tests, with a high result significances [3]. With the rapid globalization and industrialization of our food supply, more recognized pathogens can appear or can be figured out worldwide. More with a multiplicity of recognized pathogens, new Laboratory diagnostic of tool samples can be done and so can even change the known before aspects.  The challenges of determining optimal, cost-effective means for such appropriate diagnosis, clinical management, and public health control of diarrheal illnesses knowledge [6]. This will continue to evolve as improved understanding of pathogenesis and development and can bring in use more rapid tests, who will improve the diagnosis and management of infectious diarrheal illness. It had to be accepted that this diseases are one of the most common clinical syndromes in our society. That’s why the lack of a specific diagnosis today, can hinder appropriate management and treatment of many such infections.  Observation of patients is a recommendation, for to provide always to clinicians and public health practitioners, consensus-based correct document.  These will aid in the management of acute diarrheas, by addressing data,   which patients to be tested, what tests to order, what medical treatments to be used, and what steps to take to ensure, that appropriate public health actions, are always implemented, well enough.

1. Adkins HJ, Escamilla J, Santiago LT, et al. Two-year survey of etiologic agents of diarrheal disease at San Lazaro Hospital, Manila Republic of the Philippines. J Clin Microbiol 1987; 25: 1143-1147.
2. Matthew R. Riley R, Dorsey Bass, in Pediatric Gastroenterology, 2008
3. Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, et al.; Infectious Diseases Society of America. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001; 32: 331-351.
4. Snyder JD, Merson MH. The magnitude of the global problem of acute diarrheal disease: a review of active surveillance, data. Bull, WHO 1982; 60:605-613.
5. WHO Program for the Control of Diarrheal Diseases. CD update on persistent diarrhea.1989.
6. The management and prevention of acute diarrhea: practical guidelines. 3rd edition Geneva: World Health Organization.