Acute Diarrheal Diseases Research Articles

Determinants of Virulence and Antimicrobial Susceptibility in Non-O1, Non-O139 Vibrio cholerae Isolates.

ABSTRACT INTRODUCTION In the Caribbean region, acute diarrheal diseases caused by the Vibrio genus have increased in recent years, following the 2010 earthquake in Haiti. Based on its capsular lipopolysaccharide, Vibrio cholerae is classified into more than 200 serogroups, divided into O1, O139 and non-O1, non-O139. Non-O1 serogroups produce clinical features ranging from mild diarrhea to severe dehydration. In Cuba, circulation of non-O1, non-O139 V. cholerae has been reported both in outbreaks and sporadic cases. OBJECTIVE Describe the antimicrobial susceptibility of V. cholerae to the drugs of interest used in its treatment and verify the presence of enzymatic virulence factors. METHODS A descriptive, cross-sectional study was conducted in January through November 2014, based on 125 non-O1, non-O139 V. cholerae isolates obtained during 2013 and 2014 from patients with acute diarrheal disease (isolates from the National Reference Laboratory for Acute Diarrheal Diseases of the Pedro Kouri Tropical Medicine Institute, Havana). Bacteriological identification was performed according to conventional methods. Antimicrobial susceptibility was determined by the Bauer-Kirby agar diffusion method. The technique described by Robinson in 1986 was used to determine virulence factors, hemolytic activity and enzyme factors (DNase, elastase, gelatinase), and Karagozova’s method for the enzyme lecithinase. RESULTS Highest percentages of sensitivity were obtained for azithromycin (98.4%), doxycycline (97.6%) and ciprofloxacin (96.8%), and highest resistance values for ampicillin (60%), sulfonamide (46.4%) and trimethoprim–sulfamethoxazole (32%). Six resistance patterns were detected, four found in Cuba for the first time, as well as six patterns of multidrug resistance (4.8%). All isolates had at least two extracellular enzymes as virulence factors. The most frequent were gelatinase (90.4%) and lecithinase (77.6%). The percentage of virulence factors was lower in the group of isolates resistant to ≥2 antimicrobials. An inverse relationship was found between presence of enzymatic virulence factors and resistance in the isolates studied. CONCLUSIONS The results suggest that azithromycin, doxycycline and ciprofloxacin should continue to be used for treatment of V. cholerae-caused infections, and confirmed the presence of four new resistance patterns in isolates circulating in Cuba.

Laboratory surveillance of Salmonella enterica from human clinical cases in Colombia 2005–2011

IntroductionSalmonella is an enteropathogen acquired through contaminated food or water. In Colombia, Salmonella spp. is included in the national surveillance of Acute Diarrhoeal Diseases and typhoid fever initiated in 1997. This report shows the phenotype and genotype results obtained from 2005 to 2011. MethodsA total of 4010 isolates of Salmonella enterica were analysed by serotyping with Kauffmann–White–LeMinor, antimicrobial resistance patterns, and pulse-field gel electrophoresis (PFGE). ResultsA total of 93 serovars were identified, of which, Typhimurium, Enteritidis, Typhi, Dublin, Panama, Derby, Braenderup, Saintpaul, and Uganda were prominent. The highest levels of resistance were found for tetracycline and nalidixic acid. Susceptibility was observed in 52.4% (2101/4010) of the isolates. Multi-resistance was recorded in 54.9% of Typhimurium isolates, with 81 different combinations. Using PFGE, 51.9% (2083/4010) isolates were analysed in 34 serovars, and 828 electrophoretic patterns were obtained. From these, 8 patterns were found in at least two Latin-American countries. ConclusionThe surveillance of Salmonella spp. provides information on the serovar distribution, antimicrobial resistance, and clonal distribution in Colombia, as well as information to treat this disease and control the spread of antimicrobial bacterial resistance.

DEHYDRATION DUE TO DIARRHEA;

Background objective: Acute diarrheal diseases leading to dehydration,are among the leading causes of mortality in infants and young children in many developingcountries. The objective of our study was to to assess knowledge, attitude and practice ofmothers about use of oral rehydration salt for management of dehydration due to diarrhea inchildren less than five years of age. Study Design: Hospital based cross-sectional descriptivestudy. Setting: Oral rehydration center of Government Infectious Disease Children HospitalPeshawar. Period: February 16th, 2009 to March, 17th 2009. Patients and Methods: We enrolled115 mothers of infants and children less than five years old by systematic random sampling.We included willing mothers for this study, children less than five years old showing some orno signs of dehydration due to three or more than three episodes of diarrhea within 24 hours.Exclusion criteria included unwilling mothers, severe dehydration due to diarrhea, complaintsof severe vomiting and those having dysentery. Results: We evaluated 115 mothers, withmajority 88 (76%) were 15-25 years age group and 27 (24%) were 26-36 years who visited oralrehydration center respectively. Majority of mothers were uneducated 97 (84%), Housewives103 (90%), 59 (51%) had 4-6 children, 72 (63%) were living in Kacha house and about 84 (73%)had monthly family income less than 5000 rupees. It was found that 72 (63%) mothers knewbenefits of oral rehydration salt in diarrheal dehydration. About 67 (58%) mothers were able totell correct method of ORS preparation. 47 (41%) mothers knew that ORS should be discardedafter one day usage, while 42 (37%) did not know. Doctors, 83 (72%) were found to be the mostcommon source of information regarding ORS usage, followed by mothers-in-law, 21 (18%)and lady health workders (LHWs), 10 (10%) Conclusion: We concludedm young mothers anduneducated motheres of children below five years were of opinion that only medicine is the bestmanagement for diarrheal dehydration.

Viral diarrhea in children: Time to start rapid diagnosis and vaccination

Background: Acute diarrheal diseases are the most common cause of morbidity and mortality in children under 5 years of age throughout the world. This study was done to find out the incidence of rotavirus and adenovirus infection in children below 5 years of age. Materials and Methods: A total of 105 stool samples were collected from hospitalized children below 5 years of age with diarrhea from a private children hospital and tested for rotavirus and adenovirus antigen detection by rapid immunochromatography (RICT). Results: Of the 105 patients tested, 44 (42%) were positive for rotavirus, and two (2%) were positive for adenovirus by RICT. None of the children were positive for both rotavirus and adenovirus. Out of 105 children, only two had received rotavirus vaccine. They were negative for both rotavirus and adenovirus. Conclusion: The rotavirus vaccine can be included in the Universal Immunization Programme. Although the sensitivity and specificity of RICT were reported as 75% and 95% only, it is useful to detect viral diarrhea at the point of care for effective management and containment of diarrheal outbreaks at field level.

Study to assess the knowledge, attitude, and practice about acute respiratory infections among school going children and their parents in rural Maharashtra

Background: More than 12 million children die every year due to acute respiratory illness in developing countries die before they reach their fifth birthday, many during the 1st year of life. Among all illnesses of childhood, acute respiratory tract infections, malnutrition, and diarrheal diseases are the principal causes of morbidity and mortality in the developing countries. A significant determinant of child health is the attitude and knowledge of the child’s mother toward these diseases. Mother is the main caregiver for the child in almost all societies. Hence, the knowledge, attitude, and health practices of the mothers directly imply on the health status and survival of the child. Objectives: To find out the knowledge, attitude, and practice (KAP) toward acute respiratory diseases among school going children and their parents. Materials and Methods: A restructured and pretested questionnaires were used to assess the KAP of children’s at school and their mothers at home. A scoring system was developed and was compared among children’s and their mothers. Results: More than half of children had average knowledge, but attitude and practice regarding diarrheal diseases were found very poor. Overall, KAP score was also between poor and average whereas mothers were having very poor KAP about acute respiratory infection. Conclusion: A major determinant of child health is the health and knowledge of the child’s mother. Hence by improving the knowledge, attitude and health practices of the mothers regarding acute respiratory illness directly reflects on the health and vitality of the child.

Health inequality on results and access indicators for children in Mexico: analysis of national health surveys

To analyze inequalities in health care indicators of children 0 to 9 years old in Mexico reporting gap and gradient measures. Cross-sectional analysis of national health surveys in 2000, 2006 and 2012, measuring absolute and relative gap measures as well as the Slope Index of Inequality for four health care indicators (vaccination, care for acute respiratory infections, care for acute diarrheal diseases, and care for accidents) with socioeconomic stratification, as well as absolute gaps by sex, urbanicity and ethnic background. Between 2000 and 2012, immunological equity was reached in Mexico, as well as elimination in the socioeconomic gap related to care for accidents; nevertheless, there is a persistent socioeconomic gap of care for acute respiratory infections that is also there regarding rural residence and indigenous population. In Mexico, there is a trend to the elimination of socioeconomic differences in the probability of receiving adequate health care among children, although some socioeconomic gaps remain in particular related to provision of services that require more participation of health personnel. There is a need to ensure homogenous access to effective services for all.

Health Economic Burden of Acute Diarrheal Diseases in a Tertiary Care Hospital, Cairo, Egypt

Health Economic Burden of Acute Diarrheal Diseases in a Tertiary Care Hospital, Cairo, Egypt

PIH54 - Inequalities in Acute Diarrheal Diseases Mortality in Children Under Five Years in Colombia

PIH54 - Inequalities in Acute Diarrheal Diseases Mortality in Children Under Five Years in Colombia

Designing an efficient multi-epitope peptide vaccine against Vibrio cholerae via combined immunoinformatics and protein interaction based approaches

Cholera continues to be a major global health concern. Among different Vibrio cholerae strains, only O1 and O139 cause acute diarrheal diseases that are related to epidemic and pandemic outbreaks. The currently available cholera vaccines are mainly lived and attenuated vaccines consisting of V. cholerae virulence factors such as toxin-coregulated pili (TCP), outer membrane proteins (Omps), and nontoxic cholera toxin B subunit (CTB). Nowadays, there is a great interest in designing an efficient epitope vaccine against cholera. Epitope vaccines consisting of immunodominant epitopes and adjuvant molecules enhance the possibility of inciting potent protective immunity. In this study, V. cholerae protective antigens (OmpW, OmpU, TcpA and TcpF) and the CTB, which is broadly used as an immunostimulatory adjuvant, were analyzed using different bioinformatics and immunoinformatics tools. The common regions between promiscuous epitopes, binding to various HLA-II supertype alleles, and B-cell epitopes were defined based upon the aforementioned protective antigens. The ultimately selected epitopes and CTB adjuvant were fused together using proper GPGPG linkers to enhance vaccine immunogenicity. A three-dimensional model of the thus constructed vaccine was generated using I-TASSER. The model was structurally validated using the ProSA-web error-detection software and the Ramachandran plot. The validation results indicated that the initial 3D model needed refinement. Subsequently, a high-quality model obtained after various refinement cycles was used for defining conformational B-cell epitopes. Several linear and conformational B-cell epitopes were determined within the epitope vaccine, suggesting likely antibody triggering features of our designed vaccine. Next, molecular docking was performed between the 3D vaccine model and the tertiary structure of the toll like receptor 2 (TLR2). To gain further insight into the interaction between vaccine and TLR2, molecular dynamics simulation was performed, corroborating stable vaccine-TLR2 binding. In sum, the results suggest that our designed epitope vaccine could incite robust long-term protective immunity against V. cholera.

Vigilancia por laboratorio de Salmonella enterica en casos clínicos humanos en Colombia 2005 a 2011

IntroductionSalmonella is an enteropathogen acquired through contaminated food or water. In Colombia, Salmonella spp. is included in the national surveillance of Acute Diarrhoeal Diseases and typhoid fever initiated in 1997. This report shows the phenotype and genotype results obtained from 2005 to 2011. MethodsA total of 4010 isolates of Salmonella enterica were analysed by serotyping with Kauffmann-White-LeMinor, antimicrobial resistance patterns, and pulse-field gel electrophoresis (PFGE). ResultsA total of 93 serovars were identified, of which, Typhimurium, Enteritidis, Typhi, Dublin, Panama, Derby, Braenderup, Saintpaul, and Uganda were prominent. The highest levels of resistance were found for tetracycline and nalidixic acid. Susceptibility was observed in 52.4% (2101/4010) of the isolates. Multi-resistance was recorded in 54.9% of Typhimurium isolates, with 81 different combinations. Using PFGE, 51.9% (2083/4010) isolates were analysed in 34 serovars, and 828 electrophoretic patterns were obtained. From these, 8 patterns were found in at least two Latin-American countries. ConclusionThe surveillance of Salmonella spp. provides information on the serovar distribution, antimicrobial resistance, and clonal distribution in Colombia, as well as information to treat this disease and control the spread of antimicrobial bacterial resistance.

Burden of acute infections (except respiratory and diarrheal) and its risk factors among under-five children in India: A systematic review and meta-analysis

Acute infections of eyes, ears, skin, and others are a common cause of morbidity in under-five children. The overall burden of other infections and their risk factors is not known. Available literature was searched comprehensively using PubMed for acute infections (except acute respiratory and diarrheal diseases) using the relevant medical subject heading terms. Extracted articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 10 articles were abstracted and reviewed to identify the reported prevalence and risk factors for acute infections among children. The pooled prevalence of infections (not including acute respiratory and diarrhea) between 2002 and 2013 was 18.42 (95% confidence interval: 9.30-30.62), with reported range of 3.7-50.8%. The significantly positively associated factors reported in single studies were young age of the child, malnutrition, poor breastfeeding, low socio-economic status, animal rearing near household and mothers' illiteracy for independent morbidities. The evidence on risk factors including breastfeeding, vaccination, age, and sex that predispose under-five Indian children to different infections is inconclusive. There is a need to conduct more studies on acute infections other than acute respiratory and diarrhea, to establish their determinants in Indian children.

The effect of maternal education on child health: some evidence from Ghana

Ghana has witnessed marked improvement in child health over the past three decades, albeit the progress has been slow and unevenly distributed across the country. The country's under-five mortality rate, though better than the average for sub-Saharan Africa, lags behind that of some low and middle-income countries in the sub-region. The situation is not different from the incidence of diseases such as acute respiratory infection (ARI), diarrhoeal diseases and fever among children in Ghana. While a number of studies have been conducted to investigate the factors that influence child health, there is limited evidence regarding the effect of maternal education on child health in Ghana. This paper seeks to examine the effect of maternal education on under-five morbidity particularly the incidence of ARI, diarrhoea and fever in Ghana. Using the 2008 Ghana Demographic and Health Survey (GDHS) and employing logistic regression, the paper shows that higher maternal education significantly and consistently reduces the incidence of diarrhoea, ARI and fever among children aged under-five in Ghana. The paper recommends the integration of maternal education in maternal and child health policies in Ghana.

ANAFERON FOR KIDS: EFFECTIVENESS AND SAFETY OF THE THERAPEUTIC AND PREVENTIVE USE IN ACUTE INTESTINAL VIRAL INFECTIONS. LITERATURE REVIEW

Acute infectious diarrheal diseases by the terminology of the World Health Organization or acute intestinal infections (AII) as they are called in Russia is a large group of acute infectious diseases characterized by development in patient of the diarrheal syndrome. The article provides statistical data on the incidence rate of AII among children that take one of the leading places in the structure of the infectious pathology and characterizing by the high mortality rate. Special attention is given to pathogenesis and therapy of acute viral intestinal diseases.

Effectiveness of Package for Behaviour Change of Mothers in Prevention of Diarrhoea in Children less than 2 Years of Age in a Resettlement Colony

Diarrhea is a major health issue in developing countries with high morbidity and mortality rate among children below 2 years of age. Hygiene practices of mothers are associated with occurrence of diarrhea in children. We carried out an intervention to assess the effectiveness of behaviour change package on the prevention of diarrhoea in children ≤2 years of age. The sample was taken by stratified systemic random sampling technique. A total of 101 mothers, 50 in intervention group and 51 in control group were enrolled for study. In the intervention group mothers were educated on hygienic practices by using flash cards. In the subsequent 5 visits, mothers were reinforced about the hygiene and sanitation practices. These visits were also used to observe practices of mothers and recording diarrheal episodes among children. In the control group, after three months behavioural practices of mothers were observed and diarrheal episodes among children were recorded. Implementation using a package brought a significant improvement in mothers’ practices related to hygiene and sanitation. Diarrhea was 4.3 times higher in control group as compared to intervention group. Behaviour change practices related to hygiene and sanitation of mothers is effective in prevention of acute diarrheal diseases among children below 2 years of age.

Quality of water for human consumption and its association with morbimortality in Colombia, 2008-2012

The quality of water for human consumption has been correlated with the occurrence of different diseases. Studying the relationship between these parameters would allow determining the impact of water quality on human health, and to direct preventative measures and promote environmental health. To analyze the quality of water intended for human consumption and its association with morbimortality in Colombia, 2008-2012. The database for surveillance of water quality was analyzed by means of descriptive statistics of the principal indicators (total coliforms, Escherichia coli , turbidity, color, pH, free residual chlorine and water quality risk index). The results were correlated with infant mortality and morbidity due to acute diarrheal diseases, foodborne diseases and hepatitis A. A risk map was prepared to identify those municipalities with the highest risk of water contamination and infant mortality. A high percentage of municipalities did not conform to existing standards for water potability values. Problems were identified that were related to presence of E. coli and total coliforms, as well as absence of free residual chlorine, a situation that was exacerbated in rural areas. Water quality showed a high correlation with infant mortality, highlighting its importance for children's health. Water quality was found to have an important impact on infant mortality. Improving water quality in Colombia will require policies that strengthen water supply systems in this country. Strengthening of environmental health surveillance programs is essential to guide actions aimed at improving water quality and exert a positive impact on health.

Calidad del agua para consumo humano y su asociación con la morbimortalidad en Colombia, 2008-2012

Introduction: The quality of water for human consumption has been correlated with the occurrence of different diseases. Studying the relationship between these parameters would allow determining the impact of water quality on human health, and to direct preventative measures and promote environmental health.Objective: To analyze the quality of water intended for human consumption and its association with morbimortality in Colombia, 2008-2012.Materials and methods: The database for surveillance of water quality was analyzed by means of descriptive statistics of the principal indicators (total coliforms, Escherichia coli, turbidity, color, pH, free residual chlorine and water quality risk index). The results were correlated with infant mortality and morbidity due to acute diarrheal diseases, foodborne diseases and hepatitis A. A risk map was prepared to identify those municipalities with the highest risk of water contamination and infant mortality.Results: A high percentage of municipalities did not conform to existing standards for water potability values. Problems were identified that were related to presence of E. coli and total coliforms, as well as absence of free residual chlorine, a situation that was exacerbated in rural areas. Water quality showed a high correlation with infant mortality, highlighting its importance for children’s health.Conclusion: Water quality was found to have an important impact on infant mortality. Improving water quality in Colombia will require policies that strengthen water supply systems in this country. Strengthening of environmental health surveillance programs is essential to guide actions aimed at improving water quality and exert a positive impact on health.

Antimicrobial susceptibility pattern of Enteropathogenic Escherichia coli (EPEC) in paediatric diarrhoeal patients

Enteropathogenic Escherichia coli (EPEC) mediated infantile diarrhoea among children is an important cause of morbidity and mortality in developing countries. The antimicrobial susceptibility pattern of EPEC strains isolated from children under 5 years of age was studied. Stool samples from 272 patients with diarrhoea were collected from two tertiary care hospitals. Out of 272 stool samples, 20 (7.35%) isolates were identified as EPEC on the basis of presence of bfpA gene detected by polymerase chain reaction and antibiotic susceptibility testing was performed on these EPEC strains by Kirby-Bauer disc diffusion method. The antimicrobial susceptibility test revealed that the EPEC isolates were highly resistant to ampicillin (100%), nalidixic acid (95%) and tetracycline (95%) and were sensitive to ceftazidime (95%), cefotaxime (90%), ceftriaxone (95%), imipenem (100%) and levofloxacin (85%). Isolation of EPEC is of great importance since they are responsible for acute diarrhoeal diseases in large number of children under the age of five years. The high antimicrobial resistance observed in our study indicates indiscriminate or improper use of antimicrobials, besides the risks of self-medication.Ibrahim Med. Coll. J. 2014; 8(1): 12-16

Knowledge and Practices on Diarrhea Prevention among Mothers

Acute diarrheal diseases are very rampant among children under 5 years old worldwide. The objective of this study is to determine mother’s level of knowledge and extent of practice on prevention of diarrhea in Lobatse, Botswana. A cross-sectional survey was conducted online on mothers with children less than five years. A standardized questionnaire was posted through a link on Lobatse groups in Facebook. The tool assessed the socio-demographic variables, knowledge on diarrhea on signs and symptoms, causes and mode of transmission and practices regarding water, sanitation and hygiene and other domestic practices. A total of 80 respondents answered the questionnaire. The findings revealed that mothers have high knowledge on diarrhea but poor practices on prevention of diarrhea. Thus, there is a wide gap in the knowledge and practices of mothers regarding the prevention of diarrhea. From this, interventions are needed to enhance the mothers’ practices to promote the prevention of diarrhea. Keywords: Knowledge, practices, diarrhea prevention, mothers, Botswana

Surveillance of communicable disease from a tertiary care teaching hospital of central Kerala, India

Background: Surveillance is the back bone of any disease control program. Communicable disease is a major cause of morbidity. Precise data on the pattern of communicable disease will enable us to identify the epidemic early so that timely response will be possible. Aims: (1) To find out the morbidity and mortality pattern of communicable diseases. (2) To study the disease trend and seasonality of acute respiratory infections (ARIs) and acute diarrheal diseases (ADD). Materials and Methods: Retrospective record-based descriptive study was done to find out the morbidity and mortality pattern of communicable disease and trend of seasonality. Five years surveillance data from 2009 to 2013 were collected and analyzed. Results: Maximum morbidity (47.6%) was observed in air borne diseases. ARI accounted for 53%, and pulmonary tuberculosis 27% of morbidity among air borne diseases. Admissions from water borne diseases were mainly done for ADD (47%), followed by hepatitis (34%). 90% of the morbidity from vector borne disease was due to dengue fever. ADD showed a rise during the summer season, and ARI showed peak during the rainy season. The difference in incidence observed between seasons for ADD and ARI were statistically significant (P = 0.001). Leptospirosis and chickenpox were present throughout the years. Increase in mortality from all communicable diseases was observed from the year 2011 onwards. 48% of mortality was due to air borne diseases such as pulmonary tuberculosis, pneumonia, and chickenpox. Conclusion: Maximum morbidity and mortality were due to airborne diseases. Incidence of ADD was more during the summer while ARI was more during the rainy season.

Evaluation of Disease Surveillance System for early detection of Acute Diarrhoeal Disease in Karnataka-India

Background: Evaluation of integrated disease surveillance system in Acute Diarrhoeal Diseases (ADD) in Karnataka was carried out during (Please mention duration). The specific objectives of the evaluation were to describe the structure and to evaluate the attributes of system for surveillance of ADD.