Acute Diarrhea Diseases Research Articles

Effect of COVID-19 pandemic on the incidence of acute diarrheal disease and pneumonia among under 5 children in Ethiopia- A database study.

COVID-19 has had a devastating impact on preventable and treatable pediatric diseases in Ethiopia. This study looks at the impact of COVID-19 on pneumonia and acute diarrheal diseases in the country, as well as the differences between administrative regions. In Ethiopia, we conducted a retrospective pre-post study to assess the impact of COVID-19 on children under the age of five who had acute diarrhea and pneumonia and were treated in health facilities during the pre-COVID-19 era (March 2019 to February 2020) and the COVID-19 era (March 2020 to February 2021). From the National Health Management District Health Information System (DHIS2, HMIS), we retrieved data on total acute diarrheal disease and pneumonia, along with their regional and monthly distribution. We calculated incidence rate ratios comparing the rates of acute diarrhea and pneumonia during the pre-and post-COVID-19 eras and adjusted for the year, using Poisson regression. The number of under-five children treated for acute pneumonia decreased from 2,448,882 before COVID-19 to 2,089,542 ((14.7% reduction (95%CI;8.72-21.28), p<0.001)) during COVID-19. Similarly, the number of under-five children treated for acute diarrheal disease decreased from 3,287,850 in pre-COVID-19 to, 2,961,771((9.91% reduction (95%CI;6.3-17.6%),p<0.001)) during COVID-19. In the majority of the administrative regions studied, pneumonia and acute diarrhea diseases decreased during COVID-19, but they increased in Gambella, Somalia, and Afar. During the COVID-19 period, the greatest reduction of children with pneumonia (54%) and diarrhea disease (37.3%) was found in Addis Ababa (p<0.001). The majority of administrative regions included in this study have seen a decrease in pneumonia and acute diarrheal diseases among children under the age of five, while three regions namely, Somalia, Gambela, and Afar saw an increase in cases during the pandemic. This emphasizes the importance of using tailored approaches in mitigating the impact of infectious diseases such as diarrhea and pneumonia during situations of a pandemic such as COVID-19.

Epidemiologic and Clinical Characteristics of Human Bocavirus Infection in Children with or without Acute Gastroenteritis in Acre, Northern Brazil.

Human bocavirus (HBoV) is an emerging virus detected around the world that may be associated with cases of acute gastroenteritis (AGE). However, its contribution to AGE has not been elucidated. This study aimed to describe the frequency, clinical features, and HBoV species circulation in children up to 5 years with or without AGE symptoms in Acre, Northern Brazil. A total of 480 stool samples were collected between January and December 2012. Fecal samples were used for extraction, nested PCR amplification, and sequencing for genotyping. Statistical analysis was applied to verify the association between epidemiological and clinical characteristics. Overall, HBoV-positivity was 10% (48/480), with HBoV-positive rates of 8.4% (19/226) and 11.4% (29/254) recorded in diarrheic and non-diarrheic children, respectively. The most affected children were in the age group ranging between 7 and 24 months (50%). HBoV infection was more frequent in children who live in urban areas (85.4%), use water from public networks (56.2%), and live with adequate sewage facilities (50%). Co-detection with other enteric viruses was 16.7% (8/48) and the most prevalent coinfection was RVA+ HBoV (50%, 4/8). HBoV-1 was the most frequent species detected in diarrheic and non-diarrheic children, responsible for 43.8% (21/48) of cases, followed by HBoV-3 (29.2%, 14/48) and HBoV-2 (25%, 12/48). In this study, HBoV infection was not always associated with AGE, as most HBoV cases belonged to the non-diarrheal group. Future studies are warranted in order to determine the role of HBoV in causing acute diarrhea disease.

Prevalence of Intestinal Coccidia: First Description of Cyclosporidiosis Associated with Diarrhea in Children in Colombia

Background: In Colombia, the studies about the etiology of acute diarrhea disease (ADD) in children by using standard stool culture techniques methods and DNA detection tools for intestinal virus show that viral origin was the most frequent, however still between 16 to 45% of the cases of unknown etiology. Specific staining techniques or high sensitivity molecular methods for the intestinal coccidia Cryptosporidium sp and Cyclospora sp have been not applied in the Colombian studies, for this reason, the current situation of these intestinal coccidia in Colombia as cause of diarrhea is unknown. Objective: To estimate the frequency of Cryptosporidium sp. and Cyclospora sp. and to analyze the association between infection and clinical manifestations on children with acute diarrhea consulting the pediatrics emergency service of a third level Hospital. Methods: An observational descriptive study was performed in 150 children that consulted the emergency service at the Hospital San Juan de Dios in Armenia, Colombia, in the period between April 1st and May 31st of 2022. We applied questionnaires and collected primary data from clinical records of children, as well as stool samples of each child after receiving informed consent from the parents and/or legal guardian of the minors. To identify the pathogenic intestinal coccidia (Cryptosporidium sp. and Cyclospora sp.), we used stool fresh preparations with 1% iodine and stained by a modified Ziehl Nielsen coloration protocol (Kinyoun stain). Samples were examined by expert microbiologists on a light microscope with a 40x objective. Prevalence and odds ratios were estimated. For statistical analysis differences in proportions among groups were compared via the X2 test and Fisher exact test. For non-parametric data, differences of means between two groups were analyzed through a Kruskall-Wallis test. Differences of medians were analyzed via Kruskal-Wallis test for non-parametric variables and analysis of variance (ANOVA) for parametric variables; statistical significance was considered when p ≤ 0.05. Statistical calculations were made by using software factors in Epi Info 7.2 Epi-Info version 3.5.1 (CDC, Atlanta). Results: The prevalence of infection in the children that went to the urgency service was of 19,7% by Cryptosporidium sp. and 10,9% by Cyclospora sp. The 59,2% of children with cryptosporidiosis and 66,6% of children with cyclosporidiosis were hospitalized. There was a statistically significant association between the presence of parasite in stools and fever in cyclosporidiosis (93,3% of children with cyclosporidiosis vs. 56% by other causes, OR 10,7 IC95% 1,3-84; p= 0,004). Conclusions: The study results indicate the need to use specific diagnostic techniques to identify Cryptosporidium sp and Cyclospora sp in children with diarrhea, because they are frequent and are treatable with specific antiparasitic medication. We recommend that its search should be done systematically.

Conditionally pathogenic agents of the family Enterobacteriaceae (Klebsiella and Enterobacter) causing acute diarrhea diseases

Acute diarrheal disease (ADD) presents a major public health problem, and the identification of pathogens serves both to identify the sources of spread of infections and to establishing the correct treatment. In this context, the purpose of this research was to identify the conditionally pathogenic agents from the Enterobacteriaceae family, which more frequently caused acute diarrheal diseases during the study period. The research was conducted in 2017 – 2021, the clinical samples (fecal masses) were collected from patients from the Public Health Medical Institution of AMT Buiucani. A total of 3752 samples were investigated, 462 strains (12.3%) were isolated, of which 342 strains (9.12%) belong to the Klebsiella spp. and 120 strains (3.2%) to Enterobacter spp., Klebsiella spp. being dominant. During the study period, acute diarrheal diseases were more frequently caused by Klebsiella spp. (6.0% - 12.9%) and Enterobacter spp. (1.2% - 5.8%). Most cases of infection by Klebsiella spp. and Enterobacter spp., reported in the Buiucani sector, Chisinau municipality, according to laboratory data, were recorded in 2017-2018.The highest share of Klebsiella spp. was recorded in 2017 – 34.20%, and the lowest in 2020 – 13.16%. The highest share of Enterobacter spp. was recorded in 2018, constituting 40.83%, and the lowest in 2017 – 11.67%.

‘Metastatic seed’ of cholera in Edo State, Nigeria: a case report

There were reported cholera epidemics in some States in Nigeria. Cholera is an acute diarrhea disease with marked epidemic propensity, caused by colonization of the small intestine by Vibrio cholerae serogroup 01 or 0139. Cholera, like other infectious diseases epidemics, has propensity for sending metastatic seed to any susceptible remote community. If the metastatic seed can be promptly diagnosed and managed appropriately, the spread and development of new epicenter can be aborted. This report is a case of metastatic cholera who presented in a tertiary hospital in Edo State, Nigeria. The case was promptly detected and effectively managed using good surveillance system, inter-departmental collaboration, swift responses, good laboratory practices, patient isolation and infection prevention and control measures, coupled with appropriate fluid and antimicrobial treatments. This prevented cholera epidemic in the hospital and Edo State in general.

Behavioral and environmental determinants of acute diarrhea among under-five children from public health facilities of Siyadebirena Wayu district, north Shoa zone, Amhara regional state, Ethiopia: Unmatched case-control study.

Acute diarrhea is a major public health problem in the world. Next to pneumonia, it is the leading cause of death in children under five years old. Globally, even though childhood diarrhea disease kills millions, the interaction of socio-demographic, behavioral, and environmental factors of acute diarrhea in children aged 6-59 months is not investigated yet in the current study area. To determine behavioral and environmental predictors of acute diarrhea among under-five children from public health facilities of Siyadebirena Wayu district, North Shoa, Amhara Regional State, Ethiopia, 2019. A facility-based unmatched case-control study was conducted from March 12, 2019, to May 12, 2019. A total of 315 under-five children were included in the study (105 cases and 210 controls). A systematic random sampling technique was used to select study participants. Data were collected by a structured questionnaire and analyzed by using SPSS. To analyze the data, bivariable and multivariable logistic regression analysis was used. The study showed that average family monthly income of 12-23 USD (AOR = 6. 22; 95% CI: 1.30, 29.64), hand washing practice of mothers/ care givers with water only (AOR = 3.75; 95% CI: 1.16, 12.13), improper disposal of infant feces (AOR = 11.01; 95% CI: 3.37, 35.96), not treating drinking water at home (AOR = 9.36; 95% CI: 2.73, 32.08), children consuming left-over food stored at room temperature (AOR = 5.52; 95% CI: 1.60, 19.03) and poor knowledge of the respondents about the risk factors for diarrhea were the determinants that significantly associated with acute childhood diarrhea. The potential predictors of childhood diarrhea morbidity were improper hand-washing practice, not treating drinking water at home, unsafe disposal of children's feces, children consuming left-over food stored at room temperature, and having poor knowledge about the major risk factors for diarrhea. Thus, awareness of the community on hygiene and sanitation focusing on proper handling of human excreta, safe water handling, proper hand washing practice, and proper management of leftover food should be enhanced to prevent children from acute diarrhea diseases.

Optimal control and effect of poor sanitation on modelling the acute diarrhea infection

Acute diarrhea disease has a greater threat to human population especially in poor sanitary or hygienic environments, which caused enormous mortality and mobility in the Society. In this paper, we proposed a model to describe the transmission of the acute diarrhea disease and optimal control strategies in a community. The reproduction number and global dynamics of the model are obtained. Global Stability of the Disease free and endemic state of the model equations is determined. It was found that, the Disease Free Equilibrium is globally asymptotically stable in feasible region Ω if R0≤1 and Endemic state is globally asymptotically stable when R0&gt;1. The Optimal control problem is designed with two control strategies, namely, the prevention through minimizing the contact between the infected with acute diarrhea infectious and susceptible, and treatment of an individual. The existence of optimal control model is obtained. Numerical results of the dynamics of the disease are presented. It was found that, as the effective contact rate increases, it increases the reproduction number of the model equations, also as the effectiveness of compliance of good hygiene increases, it decreases the reproduction number of the model by varying the contact rate and more so, as production rate of acute diarrhea bacteria increases, it increases the secondary cases of the infected individuals.

U-Omp19 from Brucella abortus increases dmLT immunogenicity and improves protection against Escherichia coli heat-labile toxin (LT) oral challenge

Acute diarrhea disease caused by bacterial infections is a major global health problem. Enterotoxigenic Escherichia coli (ETEC) is one of the top causes of diarrhea-associated morbidity and mortality in young children and travelers to low-income countries. There are currently no licensed vaccines for ETEC. Induction of immunity at the site of entry of the bacteria is key to prevent infection. Current approaches to ETEC vaccines include a less toxic mutant form of E. coli heat-labile toxin (double-mutant heat-labile enterotoxin -dmLT-) with both antigenic and immunostimulatory properties. U-Omp19 is a protease inhibitor from Brucella spp. with immunostimulatory properties that has been used as oral adjuvant. In this work, we use U-Omp19 as adjuvant in an oral vaccine formulation against ETEC containing dmLT in outbred and inbred mice. To evaluate antigen dose sparing by U-Omp19 three different immunization protocols with three different doses of dmLT were evaluated. We demonstrated that U-Omp19 co-delivery increases anti-LT IgA in feces using a mid-dose of dmLT following a prime-boost protocol (after one or two boosts). Oral immunization with U-Omp19 induced protection against LT challenge when co-formulated with dmLT in CD-1 and BALB/c mice. Indeed, there was a significant increase in anti-LT IgG and IgA avidity after a single oral administration of dmLT plus U-Omp19 in comparison with dmLT delivered alone. Interestingly, sera from dmLT plus U-Omp19 vaccinated mice significantly neutralize LT effect on intestine inflammation in vivo compared with sera from the group immunized with dmLT alone. These results demonstrate the adjuvant capacity of U-Omp19 to increase dmLT immunogenicity by the oral route and support its use in an oral subunit vaccine formulation against ETEC.

Warm Spells and Climate Risk to Human Health in the Mexico City Metropolitan Area

AbstractDuring the second half of the twentieth century, rapid demographic growth and urban expansion led to the development of the Mexico City metropolitan area (MCMA) urban heat island (UHI). The thermal gradient between rural and urban regions is used to define the UHI in the transition zone along the 26°C isotherm of mean maximum temperature. As the MCMA expands, more natural vegetation is replaced with urbanization, and the spatial extent of the 26°C isotherm grows. The loss of natural vegetation, in a densely populated region of Mexico, leads to the formation of a canopy-layer UHI. The intensification of the MCMA UHI results in an increase in the frequency of daily maximum temperatures above 30°C (above 26°C on a weekly average), a threshold value that constitutes a natural hazard. Warm-spell occurrences are related to an increase in the number of acute diarrhea diseases (ADD), mainly in zones of the MCMA where the socioeconomic and environmental conditions are low (e.g., insufficient access to potable water). Vulnerable people are mostly located in new settlements along the periphery of the MCMA, where large numbers of hospital discharges due to ADD are reported. The combined effect of more frequent warm spells and increasing vulnerability results in higher levels of risk of suffering this type of health problem, mainly during the warmest part of the year. This analysis may serve to develop UHI mitigation strategies and early warning systems to manage high levels of ADD risk during warm spells.

Intestinal parasitic infestation among paediatric diarrhoea patients attending hospitals in Port Blair, Andaman and Nicobar Islands.

Acute childhood diarrhoea remains one of the leading causes of childhood morbidity and mortality in developing countries. The present study was conducted to estimate the prevalence of various intestinal parasitic infestation among children aged 5years and less suffering from acute diarrhoea disease attending hospitals in Andaman Islands. During the period from January 2012 to December 2013, a total of 675 acute diarrhoea patients were included in the study. Among these samples, 476 (70.5, 95% CI 66.9, 73.9) harboured ova/cyst of one or more intestinal parasites. Ova/cyst and trophozite of intestinal protozoan parasite was present in the stool samples of 390 (57.8, 95% CI 54.0, 61.5) children whereas ova of helminth parasite was observed in the stool samples of 105 (15.6, 95% CI 12.9, 18.5) children. Among all the parasites, Giardia lamblia trophozite had the highest prevalence of 30.5% followed by Entamoeba histolitica cyst (21.0%). The high prevalence of intestinal protozoan parasites is an indicator of a probably high carrier rate of these parasites in the community. The study is two issues that are important from public health points of view. Protozoan infestations could be the cause of diarrhoea, particularly watery diarrhoea, in a substantial proportion of the childhood diarrhoea patients attending the hospitals and anti-protozoan therapy needs to be part of the treatment regimen for watery diarrhoea among childhood diarrhoea patients. The second is the need for instituting a community based programme for controlling intestinal protozoan carriage in children as well as in adults as a step towards diarrhoea control.

Epidemiology of rotavirus A diarrhea in Chókwè, Southern Mozambique, from February to September, 2011.

Acute diarrhea disease caused by Rotaviruses A (RVA) is still the leading cause of morbidity and mortality in children ≤5 years old in developing countries. An exploratory cross-sectional study was conducted between February and September, 2011 to determine the proportion of acute diarrhea caused by RVA. A total of 254 stool specimens were collected from children ≤5 years old with acute diarrhea, including outpatients (222 children) and inpatients (32 children), in three local health centers in Chókwè District, Gaza Province, South of Mozambique. RVA antigens were detected using enzyme immunoassay (EIA); the RVA G (VP7) and P (VP4) genotypes were determined by RT-PCR or analysis sequencing. Sixty (24%) out of 254 fecal specimens were positive for RVA by EIA; being 58 (97%) from children ≤2 years of age. RVA prevalence peaks in June and July (coldest and drier months) and the G[P] binary combination observed were G12P[8] (57%); G1P[8] (9%); G12P[6] (6%); and 2% for each of the following genotypes: G1P[6], G2P[6] G4P[6], and G9P[8]. Non-Typeable (NT) G and/or P genotypes were observed as follows: G12P [NT] (6%); G1P [NT], G3P[NT] and GNTP[NT] (4%). Considering the different GP combinations, G12 represented 67% of the genotypes. This is the first data showing the diversity of RVA genotypes in Mozambique highlighting the epidemiological importance of these viruses in acute diarrhea cases in children ≤2 years old. In addition, these findings will provide a baseline data before the introduction of the RVA monovalent (Rotarix(®) ) vaccine in the National Immunization Program in September 2015. J. Med. Virol. 88:1751-1758, 2016. © 2016 Wiley Periodicals, Inc.

The impact of phenomena El Niño and La Niña and other environmental factors on episodes of acute diarrhoea disease in the population of Aguascalientes, Mexico: a case study

Abstract. Acute diarrhoea diseases (ADDs) are one of the major health problems in Aguascalientes, Mexico. Due to the risk of significant increases of ADDs in the hot season, it has been necessary to determine the weather conditions that might lead to escalating ADD events. The effects of El Niño and La Niña phenomena on the morbidity rate of ADD (MRADD) in the State of Aguascalientes were determined during the period of 2000–2010. The MRADD was calculated from cases reported by the State Health Department. The Oceanic Niño Index (ONI) was obtained from the US National Oceanic and Atmospheric Administration. The impact of El Niño and La Niña on the MRADD was determined using the Pearson correlation coefficient and analysis of variance (ANOVA). The results gave a significant inverse correlation between El Niño phenomenon and MRADD (r = −0.55, P = 0.001), but a correlation was not observed on the La Niña phenomenon (r = −0.022, P = 0.888). Field data showed significant inverse influence of El Niño on MRADD for the years 2000–2010.

A clinical and epidemiological study of viral gastroenteritis in Mexican children

Infectious gastroenteritis is one of the most common illnesses among children and is caused by many etiological agents; however, viruses are responsible for 50 to 75% of all cases. A laboratory-based study was carried out from 2005–2006 aiming to describe epidemiological aspects of rotavirus (RV), astrovirus, and adenovirus associated with gastroenteritis in Mexican children. Children younger than 5 years with acute diarrhea from four clinics and eight daycare centers were studied. The presence of RV was determined using polyacrylamide gel electrophoresis (PAGE) with silver staining. Negative samples were further tested for RV, adenovirus, and astrovirus using immunoassays. A total of 727 children were studied. The RV prevalence by PAGE was 56.8% (413/727). Out of 314 samples that were PAGE negative, 18.1% (57/314) were positive for any virus; the prevalence for the specific viruses was 9.5% (30/314); for RV, 4.4% (14/314); for astrovirus; 3.8% (12/314); for adenovirus, and 0.3% (1/314) with RV and astrovirus mixed infection. Viruses are responsible of more than 60% of acute diarrhea diseases among Mexican children.

English

OBJECTIVE: The purpose of this study was to investigate cholera from 2008 August to 2009 August, and create public health importance, in acute diarrhea diseases. Epidemic of cholera have been reported from various parts of our country.(1)(2) A total fecal specimen 562 were collected, isolation and identification of pathogen was done according to standard methodology.(3) Antibiotic susceptibility pattern of the isolates were studied, and picked up randomly positive 25 isolates and were sent to national institute of cholera and enteric diseases (NICED) Kolkata for confirmation and Phage typing. RESULTS: Of the 562 of patients 57 (10.142%) isolates were found to be positive for vibrio. Cholera o1 and non 01/non-0139, out of 25 isolates 19 (76%). The vibrio Cholera 01 ogawa serotype, biotype Eltor and phage type T 27, T 24, T 21, T 13, along with 6 isolates (24%) of Non- 0139 was also noticeable as per the report of the (NICED) Kolkata. Majority of the clinical isolate were found to be resistant to more than one drug. (1)(2)

Diagnosis and prevalence of enteropathogenic bacteria in children less than 5 years of age with acute diarrhea in Tehran children's hospitals

Acute diarrhea disease is the second cause of death among all infectious diseases in children younger than 5 years of age worldwide. The aim of this study was to employ a combination of biochemical, microbiological and molecular diagnostic techniques to investigate the stools of Iranian children with acute diarrhea for bacterial enteropathogens. Diarrheagenic Escherichia coli, Shigella spp., Salmonella spp., Campylobacter spp. and Yersinia spp., were investigated from June 2003 to June 2005, in 1087 children less than 5 years old with acute diarrhea. Stool specimens from children were studied for enteropathogens both by standard culturing and molecular methods. This study was designed on hospital based. The highest incidence values were found in the summer and in children less than 1-year-old (42.7%). The Pathogenic bacteria recovered out from fecal samples of 555 (55.1%) patients had the following profile: Shigella spp. (26.7%) was the most prevalent bacterial pathogen and Shiga-like toxin producing E. coli (STEC) and Enteroaggregative E. coli (EAEC) 105 (18.9%) and 92 (16.6%) had the second and third highest prevalence, respectively. Enteropathogenic E. coli (EPEC), Campylobacter, Salmonella and Enterotoxigenic E. coli (ETEC) were found in 70 (12.6%), 60 (10.8%), 42 (7.6%), and 38 (6.8%) positive samples, respectively. In this study neither Yersinia nor E. coli O157:H7 were found. Of the 30 co-infections detected, Shigella flexneri and Campylobacter jejuni accounted for more than 50%. Information about the prevalence of wide-range Shigella and STEC may facilitate the control and management of infant diarrhea diseases in Iran. The results of this study suggest that comprehensive surveys are needed in different parts of the country in order to identify the incidence of different enteropathogenic diarrhea, especially diarrheagenic E. coli in children in Iran.

Case-Control Study of acute diarrhea in Children.

To determine the risk factor for acute diarrhea disease in children. In the survey, 220 cases and 220 controls were involved. Cases were children with loose watery feces, pathologically diagnosed as acute diarrhea by the physician, and enrolled from the Emergency Ward as the Incident Cases in Dr. Sheykh Hospital, Mashhad, northeast of Iran. Control group too, was enrolled from the same cases and the members were children whose risk factors disease were not the risk factor for acute diarrhea, and were enrolled from emergency ward of burn patients, accidents, acute respiratory diseases and eligible patients. By using univariate logistic regression models, variables consisting used milk up to 6 months age, antibiotic usage during the last 15 days, mother's employment, mother's acquaintance with ORS, occupancy, and water slack during the week before illness, were significantly related with acute diarrhea. In a multiple logistic regression, the relationship between the said factors as the independent variables and acute diarrhea was studied. Use of formulas before 6 month age with (95% CI 1.77- 5.79) OR=3.21, and tenantry with (95% CI 1.24-2.71) OR=1.83, and mother's employment with (95%CI 1.2-5.06) OR= 2.48 were factors affecting acute diarrhea which remained in the multiple logistic model and had significant relationship with the disease. During this study, important environmental risk factors were recognized. Endangered groups and mothers with children under 5 years old should be aware of these risk factors in order to prevent their children's diseases. Prevention of acute diarrhea in children can reduce massive detriments to health system.

Enfermedades Diarreicas Agudas asociadas a Rotavirus

ABSTRACT Acute diarrhea diseases associated to Rotavirus In the period of 2001-2002, a total of 1163 fecal samples were collected from children less than five years ofage with diarrhea, at the Hospital Albina Patino and other health centers in Cochabamba city. Rotavirusinfection general prevalence was 19% (220), distributed among hospitalized children 24% (77) andoutpatients 17% (143). Rotavirus infections were observed along the whole study period, with highestprevalence in coldest months: April (24%), May (34%) and June (28%) and lowest frequencies (8-15%) inFebruary, August, and September. Major rotavirus outbreak was significantly associated with the driestand colder season. The highest percentage of rotavirus infections (36,3%) was found among childrenbetween 7-12 months of age. Moderate dehydration, vomits and fever were the clinical symptoms morefrequently associated with rotavirus acute gastroenteritis, being dehydration more common in hospitalizedpatients. The distribution of P and G genotypes analyzed by RT-PCR was: G1 (44%), G2 (6%), P[8] (24%)and P4 (15%). A co-infection P[8]P[6] was observed in 3 samples (4%). Genotype P[6] was foundassociated to outpatients. These findings, highlight that rotavirus is an important cause of acutegastroenteritis and that any of the currently available vaccines would potentially be protective againstcirculating strains found in the city of Cochabamba.(

Paralytic ileus, a serious complication in acute diarrhoea disease among infants in developing countries.

Intestinal hypomotility is a common late complication in infants with acute diarrhoeal disease in pakistan. Among the infants admitted to our gastrointestinal unit with a history of acute diarrhoea, 35% developed abdominal distension and 12% developed the full clinical picture of paralytic ileus. The infants with ileus were treated with decompression and total parenteral nutrition; in this group the mortality rate was 25%. We compared 30 infants who developed ileus (group A) with an age-matched control group of infants (group B) who were admitted because of acute diarrhoea but did not develope ileus. The use of antimotility drugs was significantly more frequent in group A. Serum-K was not different in in group A (3.92 +/- 0.22 mmol/l) and group B (4.32 +/- 0.18 mmol/1). However, there were more patients who had serum-K below 3 mmol/l in group A (8/30) than in group B (5/30). We conclude that the use of antimotility drugs predisposes to the development of ileus in infants with acute diarrhoea. Hypokalemia may contribute to ileus in a few cases but is generally not a prerequisite.