Abstract
Background: Enteric viruses (mainly rotaviruses) are the most common cause of infectious diarrhea in infants. One of the pathophysiologic mechanisms in rotaviral gastroenteritis is the reduction of the surface activity of enterocyte disaccharidases and osmotic diarrhea. Aim: To determine the clinical significance of metabolic activity of intestinal microbiota in the formation of the osmotic component of viral diarrhea in children of various ages. Materials and methods: The study involved 139 children aged from 1 month to 14 years admitted to the hospital in the first 24 to 72 hours of moderate-degree viral gastroenteritis. Rotaviral infection was the most prevalent (90%). Viral etiology was confirmed by the reaction of indirect hemagglutination and multiplex real-time PCR (in feces). Total carbohydrate content in the feces was measured and fecal microflora was investigated by two methods: bacteriological and gas liquid chromatography with the determination of short-chain fatty acids. Results: The mean carbohydrate content in the feces of children below 1.5 years of age was higher than that in older children (p = 0.014). There was an inverse correlation between the concentration of rotaviral antigens and carbohydrate contents (r = -0,43, p < 0.05) and the production of acetic and propionic acids (R = -0,35, p < 0.01). The carbohydrate content in acute stage of the disease was linearly associated with time to normalization of the stool (r = +0,47, p < 0.01). Previous acute respiratory or intestinal infections within 2 months (odds ratio [OR], 14.10; 95% confidence interval [CI] 3.86–51.53), previous hospitalizations (OR = 14.17; 95% CI 2.74–74.32) and past history of intestinal dysfunction (OR 5.68; 95% CI 1.67–19.76) were predictive of severe carbohydrate malabsorption in children below 1.5 years of age. Conclusion: The lack of microbiota functional activity (assessed by production of short-chain fatty acids) determines the development of osmotic phenotype of diarrhea, that marks the total carbohydrate contents in the feces. Its predisposing factors should be taken into account when making a decision to hospitalize.
Highlights
Enteric viruses are the most common cause of infectious diarrhea in infants
of the pathophysiologic mechanisms in rotaviral gastroenteritis is the reduction of the surface activity of enterocyte disaccharidases
139 children aged from 1 month to 14 years admitted to the hospital
Summary
Цель – определить клиническое значение ферментативной активности кишечной микрофлоры в формировании осмотического компонента вирусной диареи у детей разного возраста. Среднее содержание углеводов в фекалиях у детей младше полутора лет было выше, чем у детей старшего возраста (р = 0,014). Перенесенные за 2 месяца до настоящей госпитализации острые респираторные или кишечные инфекции (отношение шансов (ОШ) 14,10; 95% доверительный интервал (ДИ) 3,86–51,53), предшествующие госпитализации в стационар (ОШ 14,17; 95% ДИ 2,74–74,32) и кишечные дисфункции в анамнезе (ОШ 5,68; 95% ДИ 1,67–19,76) стали предикторами развития выраженной мальабсорбции углеводов у детей младше полутора лет. Дефицит функциональной активности микрофлоры (оцениваемый по продукции короткоцепочечных жирных кислот) определяет развитие осмотического фенотипа диареи, который маркирует общее содержание углеводов в фекалиях. Цель исследования – определить клиническое значение ферментативной активности кишечной микрофлоры в формировании осмотического компонента вирусной диареи у детей разного возраста
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