Acute Diarrhea Group Research Articles

Is There a Correlation Between Vitamin D Levels and Acute Diarrhea in Children?

Background: Some studies have shown that low vitamin D is a risk factor for infectious diarrhea, but some have rejected it. Objectives: Considering the high prevalence of infectious diarrhea among children, the high prevalence of vitamin D deficiency, and the possible mutual effect of these two, the present study aimed to measure vitamin D in children with acute diarrhea. Methods: This study enrolled 222 children aged 2 - 14 in healthy control and acute diarrhea groups. The 25-hydroxyvitamin D (25(OH)D) level was measured in all samples by the Chemiluminescent Immunoassays (CLIA) method. Results: The mean age of the participants was 5 ± 2.7 years. Patients with acute diarrhea had lower vitamin D than healthy controls (P = 0.04). The frequency of deficient and insufficient vitamin D levels was higher in the acute diarrhea group than in the healthy control group, but insignificantly (P = 0.146). Conclusions: The present study revealed an association between insufficient vitamin D and acute diarrhea. Hence, low vitamin D is a risk factor for acute diarrhea.

Glutamine Supplementation Effects on Reducing Inflammation in The Ileum of Acute and Chronic Diarrhea Rats Induced by Enteropathogenic Escherichia coli

BACKGROUND: Glutamine, a non-essential amino acid, is the main fuel in the gastrointestinal mucosa. It is thought to protect the intestinal mucosa against local or systemic injury from diarrhea. This study aimed to determine the relationship between glutamine supplementation and ileum histopathology in acute and chronic diarrhea rats induced by enteropathogenic Escherichia coli (EPEC).METHODS: A randomized post-test only control group design was conducted. Thirty Rattus norvegicus Wistar strain were divided into 5 groups: one negative control group, two acute, and two chronic diarrhea groups. All four diarrhea groups were induced by EPEC at a dose of 108 CFU/mL. One acute and one chronic groups were supplemented with glutamine at a dose of 810 mg/200 g body weight for 14 days. While the other two diarrhea groups were not treated. The intestinal histopathology of each group was assessed and the level of inflammation was classified.RESULTS: Significant differences in inflammation levels were found among the groups (p<0.05). The highest inflammation level was observed in the acute diarrhea group without glutamine supplementation. Inflammation levels of both acute and chronic diarrhea with glutamine supplementation groups were significantly lower than the inflammation levels of acute and chronic diarrhea without glutamine supplementation groups.CONCLUSION: Supplementation of glutamine reduces the level of inflammation and leads to the histopathological improvement of the rat’s ileum.KEYWORDS: enteropathogenic Escherichia coli, glutamine, gastrointestinal tract, histopathology, ileum

The Effect of Glutamine Supplementation on Ileum Histopathology of Rats with Acute and Chronic EPEC-Induced Diarrhea

BACKGROUND: Glutamine is a non-essential amino acid as the main fuel in the gastrointestinal mucosa. By its various gastrointestinal functions, glutamine is thought to increase the protection of the intestinal mucosa against local or systemic injury from diarrhea. 
 AIM: This study aims to determine the relationship between glutamine supplementation and ileum histopathology in rats with acute and chronic diarrhea induced by EPEC.
 MATERIAL AND METHODS: The research was conducted in an experimental laboratory with a randomized posttest-only control group design. A total of 30 Rattus novergicus strain Wistar were divided into 5 groups. The treatment group was induced to have diarrhea using EPEC at a dose of 108 CFU/ml, after each group diagnosed by acute and chronic diarrhea, followed by glutamine supplementation at a dose of 810 mg/200 g for 14 days. The intestinal histopathology of each group was assessed and their levels of inflammation classified based on the Barthel-Mandja inflammatory score.
 RESULT: The result showed that significant differences in inflammation levels between the negative control group, acute diarrhea group, chronic diarrhea group, acute diarrhea group with glutamine, and chronic diarrhea group with glutamine were found (p<0.05). The highest level of inflammation was found in the acute diarrhea group.
 CONCLUSION: This study concluded that glutamine supplementation has an effect on the ileum histopathology of rats with acute and chronic diarrhea.
 Keywords: Enteropathogenic E. Coli, Glutamine, gastrointestinal tract, pathology, ileum.

Serum zinc levels and effect of zinc and vitamin A supplementation in children with diarrhea: a randomized control study

Background: Zinc deficiency affects about two billion people in the developing world and is associated with many diseases. Zinc is crucial for normal development and function of cells mediating nonspecific immunity such as neutrophils and natural killer cells. Zinc supplementation has been shown to be effective for preventing diarrhea in children. Vitamin A helps to regulate the immune system, which helps to prevent or fight off infections by making white blood cells that destroy harmful bacteria and viruses.Methods: In this randomized control study 82 children aged 6months to 5 years were randomized 52 in the group of acute diarrhoea and 30 in the control group. Blood samples were drawn for estimation of serum zinc levels. Children in the acute diarrhoea group 23 received zinc alone and 23 received zinc and vitamin A and followed up for 6 months.Results: The serum zinc levels were significantly lower in children with acute diarrhea (66.7µg/dl) as compared to that of the children in the control group (80.5433 µg/dl) (p=<0.001). The children with malnourishment had a mean zinc level that was significantly lesser (p=<0.01). In the acute diarrhea group, children receiving zinc supplementation alone, 10 of the children had at least 1 episode of diarrhea over the next 6 months. Children receiving zinc and vitamin A supplementation, there were only 5 such children with at least 1 episode of acute diarrhea.Conclusions: Combination of zinc and vitamin A supplementation in acute diarrhea decreases the chances of recurrence of diarrhoea and reduces the hospital stay significantly.

Occurrence and antimicrobial drug susceptibility patterns of commensal and diarrheagenic Escherichia coli in fecal microbiota from children with and without acute diarrhea

Acute diarrhea is a public health problem and an important cause of morbidity and mortality, especially in developing countries. The etiology is varied, and the diarrheagenic Escherichia coli pathotypes are among the most important. Our objectives were to determine the occurrence of commensal and diarrheagenic E. coli strains in fecal samples from children under five years old and their drug susceptibility patterns. E. coli were isolated from 141 fresh fecal samples; 84 were obtained from clinically injured donors with acute diarrhea (AD) and 57 from clinically healthy donors without diarrhea (WD). Presumptive phenotypic species identification was carried out and confirmed by amplification of specific 16S ribosomal RNA encoding DNA. Multiplex PCR was performed to characterize the diarrheagenic E. coli strains. Drug susceptibility patterns were determined by the disc-diffusion method. In total, 220 strains were recovered from the fecal specimens (61.8% from AD and 38.2% from WD). Diarrheagenic E. coli was identified at a rate of 36.8% (n=50) in diarrheic feces and 29.8% (n=25) in non-diarrheic feces. Enteroaggregative E. coli was the most frequently identified pathotype in the AD group (16.2%) and the only pathotype identified in the WD group (30.9%). Enteropathogenic E. coli was the second most isolated pathotype (10.3%), followed by Shiga toxin-producing E. coli (7.4%) and enterotoxigenic E. coli (2.9%). No enteroinvasive E. coli strains were recovered. The isolates showed high resistance rates against ampicillin, tetracycline, and sulfamethoxazole-trimethoprim. The most effective drugs were ceftazidime, ceftriaxone, imipenem and piperacillin-tazobactam, for which no resistance was observed. Differentiation between the diarrheagenic E. coli pathotypes is of great importance since they are involved in acute diarrheal diseases and may require specific antimicrobial chemotherapy. The high antimicrobial resistance observed in our study raises a broad discussion on the indiscriminate or improper use of antimicrobials, besides the risks of self-medication.

Fecal alpha-1 antitrypsin concentration in protein-losing enteropathies caused by Rotavirus and enteropathogenic bacteria infection

Background An increase in protein loss through the intestinallumen is commonly found in children with intestinal inflammation. Measurement of fecal alpha-1 antitrypsin (FAA T) concentration has been used to detect the loss of protein through the digestive system. FAAT concentration increases in diarrhea patients due to Rotavirus, Adenovirus, Shigella, Enterotoxigenic E. coli (ETEC), and Salmonella infection.Objective To determine the relationship between types ofpathogen, acute diarrhea, and alpha-1 antitrypsin concentrationin children with acute diarrhea caused by Rotavirus andenteropathogenic infection.Methods Descriptive statistics and proportion difference betweenthe two non-related groups were used to assess the proportion ofprotein-losing enteropathy (PLE) in children with acute diarrheaand was analyzed using chi square test.Results In this study, PLE group comprised 25% (24/95) subjectswithout unknown cause of diarrhea, 50% (4 7 /95) had one typeof pathogen, and in 23% (22/95) subjects had 2 or more types of pathogens. The most common pathogen found in PLE group was Rotavirus, found in67 (53%) subjects and E. coli in 41 (33%) subjects. In non-PLE group, we also found similar pathogen pattern. The mean alpha-1 antitrypsin (AAT) concentration in acute diarrhea group due to Rotavirus infection was significantly higher (P= 0.003) compared to acute diarrhea groups caused by non-Rotavirus infection. The mean AAT concentration in acute diarrhea group due to E. coli infection did not differ significantly (P= 0.735) compared to acute diarrhea group caused by non-E. coli infection.Conclusion Rotavirus was a more significant cause of PLEcompared to E.coli.

Perfil etiológico das diarréias agudas de crianças atendidas em São Paulo

Objetivo: determinar o perfil etiologico das diarreias agudas de um grupo de criancas de baixo nivel socioeconomico atendidas em um servico regional de pronto-atendimento pediatrico. Metodo: durante dois anos, as criancas com diarreia aguda atendidas durante um horario pre-estabelecido do dia e da semana foram incluidas no estudo. Os outros criterios seletivos eram: a) idade inferior a 5 anos; b) nao utilizacao de antibiotico no mes precedente; c) ausencia de viagem para fora da cidade no mes precedente. Foram pesquisados nas fezes: a) rotavirus (imunofluorescencia e contra-imunoeletroforese); b) bacterias - cultura em agar MacConkey, agar SS, agar Columbia, verde brilhante, soroaglutinacao, deteccao de toxinas - INV, LT,ST,SLT I, SLT II, teste de Sereny, deteccao de fatores de virulencia -- EAF, eae ,BFP; c) protozoarios (Hoffman e Faust). No mesmo periodo, um grupo controle sem diarreia foi tambem avaliado para os mesmos patogenos fecais. Resultados: no periodo de marco de 1994 a junho de 1996, foram selecionadas para o estudo 154 criancas com diarreia aguda (GDA) e 42 criancas sem diarreia (GSDA). Foram detectados agentes enteropatogenicos em 112 casos (72,8%) do GDA, e em 9 (21,5%) do GSDA. A associacao de dois ou mais enteropatogenos ocorreu em 47 (30,5%) casos do GDA, e em 3 (7,1%) do GSDA. Os patogenos encontrados por caso, do GDA, foram: rotavirus 32 (20,8%), bacterias 53 (34,4%), ambos 25 (16,2%), e 2 (1,4%) com Giardia lamblia (em um caso associada a rotavirus e noutro a bacteria). No GSDA, foram detectadas bacterias em 8 casos (19,1%), e bacteria associada a Giardia lamblia em 1 (2,4%) caso. Das 105 bacterias isoladas no GDA, 90 eram Escherichia coli (EPEC 27, DAEC 24, ETEC 21, EAEC 18), 12 eram Shigella sp, 2 eram Salmonella sp, e uma era Yersinia sp. As criancas com infeccao mista - viral e bacteriana - apresentaram maior ocorrencia de vomitos repetidos, desidratacao e internacao.Conclusoes: as bacterias foram os enteropatogenos mais detectados nos casos de diarreia aguda, sendo a Escherichia coli a mais frequente. Na maior parte, as cepas de Escherichia coli eram de biovariedade nao-EPEC, habitualmente nao investigadas nos laboratorios de patologia clinica. O rotavirus foi encontrado em grande parcela dos casos, muitas vezes em associacao com as bacterias. Os protozoarios tiveram importância reduzida.

Etiologic profile of acute diarrhea in children in São Paulo

OBJECTIVE: To evaluate the etiologic profile of acute diarrhea in socioeconomically deprived children assisted at a regional pediatric emergency care service. METHODS: During two years all children with acute diarrhea assisted at a previously established day and week time schedule were included in the study. Other selective criteria were: a) age less than 5 years; b) nonuse of antibiotics in the previous month; and c) no travel outside the city in the previous month. Stool examination was used for the detection of the following microorganisms: a) rotavirus (immunofluorescence and counterimmunoelectrophoresis); b) bacteria - culture in MacConkey agar, SS agar, Columbia agar, bright green, serotyping, detection of toxins - INV, LT,ST,SLT I, SLT II, Sereny test, detection of virulence factors- EAF, eae, BFP; and c) protozoa (Hoffman and Faust). In the same period, a control group without diarrhea was also evaluated for the same fecal pathogens. RESULTS: Between March 1994 and June 1996, 154 children with acute diarrhea (AD) and 42 control children (WAD), that is, without acute diarrhea, were selected. In the AD group, intestinal pathogens were detected in 112 (72.8%) cases, and in 9 (21.5%) cases in the WAD group. The association of two or more intestinal pathogens occurred in 47 (30.5%) cases in the AD group, and in 3 (7.1%) cases in the WAD group. The pathogens identified in the AD cases were: Rotavirus: 32 (20.8%), bacteria: 53 (34.4%), both: 25 (16.2%), and 2 (1.4%) with Giardia lamblia (in one case associated with Rotavirus and in another one associated with bacteria). In the WAD group, only bacteria were detected in 8 (19.1%) cases, and bacteria associated with Giardia lamblia in 1 (2.4%) case. Altogether, there were 105 bacteria isolated in the AD group: 90 were Escherichia coli (EPEC 27, DAEC 24, ETEC 21, EAEC 18), 12 were Shigella sp, 2 were Salmonella sp, and one was Yersinia sp. Children with mixed infections (viral and bacterial) had increased incidence of severe vomiting, dehydration and hospitalization. CONCLUSIONS: Bacteria were the most frequent pathogens detected in acute diarrhea cases, among which Escherichia coli was highly predominant. The majority of Escherichia coli strains belong to non-EPEC varieties, strains that are not routinely evaluated in clinical laboratories of pathology. Rotavirus was found in a great number of diarrhea cases, often associated with bacteria. Protozoa showed reduced importance.

Immunological background in children with persistent diarrhea in Ghana.

Persistent diarrheal diseases have become one of the most serious medical problems in developing countries, but few studies have been conducted to determine the risk factors. In the present study, we investigated the nutritional and immunological background in children with persistent diarrhea in comparison with those with acute diarrhea. Children with diarrhea who were brought to the Oral Rehydration Salt Clinic of Princess Marie Louise Children's Hospital in Accra were evaluated from an immunological and nutritional aspect. In the follow-up visit, the cases whose diarrhea stopped within 2 weeks after onset were classified into the acute diarrhea group; those with diarrhea lasting more than 2 weeks were classed in the persistent group. Nutritional and immunological data at the initial visit were compared between these two groups. In general, the diarrhea cases had a tendency to undernutrition and impaired cellular immunity compared with healthy control. Persistent cases had lower values for longer half-life, rapid turn-over proteins. Persistent cases had a higher percentage of CD8+ cells and lower CD4/CD8 ratio. CD25 expression in CD4+ cells stimulated by anti-CD3 antibody was lower in the persistent diarrhea group. These results appear to support the hypothesis that more severe nutritional status and impairment of cellular immunity is related to the persistence of diarrhea.

Acute diarrhea in children less than 3 years of age: Enteropathogens isolated in patient's stools, compared with a control group

OBJECTIVES: To observe the occurrence of different etiological agents of acute diarrhea (AD) in stool specimens of patients and children in a control group. MATERIAL AND METHODS: 100 children less than three years of age with AD were studied as well as 100 controls, between November 1993 and May 1994. Stool specimens were collected in both groups and the following enteropathogens were searched for: Rotavirus, Escherichia coli (EPEC, ETEC, EIEC, EHEC), Salmonella sp, Shigella sp, Campylobacter jejuni, Campylobacter coli, Yersinia enterocolitica, Cryptosporidium sp, Giardia lamblia, Entamoeba histolytica. Statistical analysis using the exact Fisher test (at significance level p<0,05) was done. The mean age was 12,5 months, with more cases in patients less than 6 months (35%). Children were seen at the emergency section on an average fifth day after the start of the diarrhea. Most came from homes with basical sanitary conditions. Watery diarrhea was more frequent than bloody diarrhea with mucus, at a proportion of 4:1. RESULTS: Rotavirus was the most frequent agent: 21% in the AD group and 3% in the control group (p= 0,0001). Shigella sp was isolated in 7% of the AD group and none of the control group (p= 0,0140). EPEC was detected in 13% of AD cases and 7% in the control group (p= 0,2381) but the classical subgroups O55, O111, O119 were only isolated from the patients with AD. The other enteropathogens were infrequently detected or in equal proportion in both groups. Rotavirus and EPEC were the more frequently isolated agents in watery diarrhea, while Shigella sp was the predominant agent found in bloody stools with mucus. CONCLUSIONS: Rotavirus was the most common causative agent in AD. The detection of Rotavirus and Shigella sp nearly exclusively in patients with AD confirms the high patogenicity of these etiological agents when compared to the others. Escherichia coli (EPEC) diagnosed by polyvalent sera does not confirm its respective diarrheogenic property due to isolation in the same proportion among patients with AD and controls. Monovalent antisera made possible the detection of classical subgroups of EPEC O111, O119, O55 isolated only from AD patients, confirming the already known high patogenicity of these strains.