Acute Diarrheal Infections Research Articles

Reducing Stool Ova and Parasite Testing in Patients Admitted to the Hospital with Acute Diarrhea

Introduction & Background: A significant number of patients are either admitted to the hospital for acute diarrhea or develop diarrhea during their admission. Frequently stool O&P testing is ordered as part of the workup for acute diarrhea when it is not clinically indicated, leading to an increased financial burden on both the patient and the hospital. Aim & Significance: To reduce the overuse of inpatient stool O&P testing by instructing residents on the appropriate criteria for ordering this test in patients with acute diarrhea. Methods & Design: Infectious Disease Society of America and American College of Gastroenterology guidelines for acute diarrheal infections in adults were reviewed and a simplified flowsheet was created based upon their recommendations for indications for Stool O&P testing. The flowsheets were then placed in easy to view locations in the resident work rooms. Baseline data was collected by pulling the number of stool O&P tests ordered by the resident teaching service for the 3 months leading up to the intervention. Data from the same teaching services were pulled once again 3 months after the intervention had been performed. Results: After the intervention, there was an 18% decrease in stool O&P orders placed by the resident teaching services. Discussion: Overutilization of stool O&P testing and the associated financial burden can be reduced by providing education regarding the appropriate indications for ordering this test in patients with acute diarrhea.

The 2018-2019 FoodNet Population Survey: a tool to estimate risks and behaviors associated with enteric infections.

The FoodNet Population Survey is a periodic survey of randomly selected residents at 10US sites on exposures and behaviors that may be associated with acute diarrheal infections and the health care sought for those infections. This survey is used to estimate the true disease burden of enteric illness in the United States and to estimate rates of exposure to potential sources of illness. Unlike previous FoodNet Population Surveys, this cycle used multiple sampling frames and administration modes, including cell phone and web-based questionnaires, that allowed for additional question topics and a larger sample size. It also oversampled children to increase representation of this population. Analytic modeling adjusted for mode effects when estimating the prevalence estimates of exposures and behaviors. This report describes the design, methodology, challenges, and descriptive results from the 2018-2019 FoodNet Population Survey.

Cholera outbreak trends in Nigeria: policy recommendations and innovative approaches to prevention and treatment.

Cholera, an acute diarrheal infection from ingesting contaminated food or water, remains a significant public health threat in Nigeria, especially in areas lacking safe water and sanitation. Characterized by severe watery diarrhea, cholera can cause dehydration and death if untreated. Historical data shows cholera's endemic nature in Nigeria, with notable outbreaks since 1970, including major ones in 1991, 1999, 2010, 2018, and 2024. According to a descriptive study in Nigeria, the 1991 outbreak reported 59,478 cases and 7,654 deaths, with a Case Fatality Ratio (CFR) of 12.9%. In 2010, there were 41,787 cases and 1,716 deaths, with a CFR of 4.1% across 18 states, mainly affecting impoverished communities and children. The 2018 outbreak had 43,996 cases and 836 deaths, with a CFR of 2% in 20 states, a 240% increase from 2017. By mid-2024, there were 1,579 suspected cases and 54 deaths (CFR 3.4%) in 32 states. This paper evaluates cholera trends in Nigeria and proposes effective preventive and treatment strategies. Policy recommendations highlight the need for improved WASH infrastructure, enhanced surveillance, and rapid response mechanisms. Innovative approaches like case-area targeted interventions (CATI) and increased public health education are crucial for mitigating future outbreaks and achieving the goal of reducing cholera deaths by 90% by 2030.

Do asymptomatic STEC-long-term carriers need to be isolated or decolonized? New evidence from a community case study and concepts in favor of an individualized strategy.

Asymptomatic long-term carriers of Shigatoxin producing Escherichia coli (STEC) are regarded as potential source of STEC-transmission. The prevention of outbreaks via onward spread of STEC is a public health priority. Accordingly, health authorities are imposing far-reaching restrictions on asymptomatic STEC carriers in many countries. Various STEC strains may cause severe hemorrhagic colitis complicated by life-threatening hemolytic uremic syndrome (HUS), while many endemic strains have never been associated with HUS. Even though antibiotics are generally discouraged in acute diarrheal STEC infection, decolonization with short-course azithromycin appears effective and safe in long-term shedders of various pathogenic strains. However, most endemic STEC-strains have a low pathogenicity and would most likely neither warrant antibiotic decolonization therapy nor justify social exclusion policies. A risk-adapted individualized strategy might strongly attenuate the socio-economic burden and has recently been proposed by national health authorities in some European countries. This, however, mandates clarification of strain-specific pathogenicity, of the risk of human-to-human infection as well as scientific evidence of social restrictions. Moreover, placebo-controlled prospective interventions on efficacy and safety of, e.g., azithromycin for decolonization in asymptomatic long-term STEC-carriers are reasonable. In the present community case study, we report new observations in long-term shedding of various STEC strains and review the current evidence in favor of risk-adjusted concepts.

In Vitro Sensitivity Test of Escherichia coli ATCC 25922 to Various Antibiotics with Well Diffusion Method

In Vitro Sensitivity Test of Escherichia coli ATCC 25922 to Various Antibiotics with Well Diffusion Method

Selection of G-rich ssDNA aptamers for the detection of enterotoxins of the cholera toxin family

Cholera and milder diarrheal disease are caused by Vibrio cholerae and enterotoxigenic Escherichia coli and are still a prominent public health concern. Evaluation of suspicious isolates is essential for the rapid containment of acute diarrhea outbreaks or prevention of epidemic cholera. Existing detection techniques require expensive equipment, trained personnel and are time-consuming. Antibody-based methods are also available, but cost and stability issues can limit their applications for point-of-care testing. This study focused on the selection of single stranded DNA aptamers as simpler, more stable and more cost-effective alternatives to antibodies for the co-detection of AB5 toxins secreted by enterobacteria causing acute diarrheal infections. Cholera toxin and Escherichia coli heat-labile enterotoxin, the key toxigenicity biomarkers of these bacteria, were immobilized on magnetic beads and were used in a SELEX-based selection strategy. This led to the enrichment of sequences with a high % GC content and a dominant G-rich motif as revealed by Next Generation Sequencing. Enriched sequences were confirmed to fold into G-quadruplex structures and the binding of one of the most abundant candidates to the two enterotoxins was confirmed. Ongoing work is focused on the development of monitoring tools for potential environmental surveillance of epidemic cholera and milder diarrheal disease.

Bioinformatics analysis of structural protein to approach a vaccine candidate against Vibrio cholerae infection.

The bacteria Vibrio cholerae causes cholera, an acute diarrheal infection that can lead to dehydration and even death. Over 100,000 people die each year as a result of epidemic diseases; vaccination has emerged as a successful strategy for combating cholera. This study uses bioinformatics tools to create a multi-epitope vaccine against cholera infection using five structural polyproteins from the V. cholerae (CTB, TCPA, TCPF, OMPU, and OMPW). The antigenic retrieved protein sequence were analyzed usingBCPred and IEDB bioinformatics tools to predict B cell and T cell epitopes, respectively, which were then linked with flexible linkers together with an adjuvant to boost it immunogenicity. The construct has a theoretical PI of 6.09, a molecular weight of 53.85kDa, and an estimated half-life for mammalian reticulocytes in vitro of 4.4h. These resultsdemonstrate the construct's longevity. The vaccine design was docked against the human toll-like receptor (TLR) to evaluate compatibility and effectiveness; also otheradditional post-vaccination assessments were carried out on the designed vaccine. Through in silico cloning, its expression was determined. The results show that it has a CAI value of 0.1 and GC contents of 58.97% whichestablished theadequate expression and downstream processing of the vaccine construct, and our research demonstrated that the multi-epitope subunit vaccine exhibits antigenic characteristics. Additionally, we carried out an in silico immunological simulation to examine the immune reaction to an injection. Our results strongly suggest that the vaccine candidate on further validation would induce immune response against the V. cholerae infection.

A Clinical and Bacteriological Study on Patients Presented with Acute Diarrhea Admitted in Silchar Medical College and Hospital, Cachar District, Assam

Background: Acute diarrheal infection is a leading cause of outpatient visits, hospitalizations, and lost quality of life. It is defined as the passage of three or more loose or liquid stools per day. The Centers for Disease Control and Prevention (CDC) has estimated 47.8 million cases occurring annually in the United States. According to NFHS-5, the prevalence of diarrhea among under-five children in Assam is 5.5%. Aims and Objective: The aim of this work was to study the clinical and bacteriological spectrum in the recent outbreak of acute gastroenteritis in Silchar Medical College and Hospital. Materials and Methods: A cross-sectional study was conducted on patients with diarrhea admitted in the Medicine Department of Silchar Medical College and Hospital for the time period of January 2016 to March 2016. Result: In our study, a total of 327 patients were enrolled. The median age of patients was 36 years with the majority being female and belong to Hindu religion. All were presented with loose stool, followed by vomiting (85%). The most common pathogen isolated from stool was Escherichia coli (71.2%) followed by Klebsiella (16.2%). More than 50% of cases with E. coli infection are resistant to Piperacillin, Doxycycline, while in cases with Klebsiella infection, more than 50% are resistant to Doxycycline followed by Azithromycin. Conclusion: This study may provide valuable information about the clinical features and microbiology of patients with diarrheal diseases to the Medical practitioners which might help in diagnosis and management.

Oral Cholera Vaccine Efficacy and Effectiveness.

Although measuring vaccine efficacy through the conventional phase III study design, randomized, double-blinded controlled trial serves as the “gold standard”, effectiveness studies, conducted in the context of a public health program, seek to broaden the understanding of the impact of a vaccine in a real world setting including both individual and population level impacts. Cholera is an acute diarrheal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae. Since the 1980s, either killed or live oral cholera vaccines (OCVs) have been developed and efficacy and effectiveness studies have been conducted on OCV. Although the results of OCV effectiveness studies sometimes showed outliers, the tendency seen is for effectiveness of the vaccine used in public health settings to be somewhat higher than estimated in randomized controlled trials due to the influence of indirect herd protection. Efficacy and Effectiveness studies both generate important information about the vaccine performance characteristics and its impact when used in real world populations at risk for the disease.

Indirect effects of the SARS CoV-2 pandemic on the prevalence of breastfeeding: Modeling its impact.

:Introduction: Breastfeeding has a protective effect against acute respiratory and diarrheal infections. There are psychological and social effects due to physical isolation in the population in the mother-child group.Objective: To assess the impact on infant mortality due to a decrease in the prevalence of breastfeeding during 2020 due to the physical isolation against the SARS CoV-2 (COVID-19) pandemic in Colombia.Materials and methods: We used the population attributable risk approach taking into account the prevalence of breastfeeding and its potential decrease associated with the measures of physical isolation and the relative risk (RR) of the association between exclusive breastfeeding and the occurrence of acute infection consequences in the growth (weight for height) of children under the age of five through a mathematical modeling program.Results: We found an increase of 11.39% in the number of cases of growth arrest in the age group of 6 to 11 months with a 50% decrease in breastfeeding prevalence, as well as an increase in the number of diarrhea cases in children between 1 and 5 months of age from 5% (5.67%) on, and an increased number of deaths in children under 5 years (9.04%) with a 50% decrease in the prevalence of exclusive breastfeeding.Conclusions: A lower prevalence of breastfeeding has an impact on infant morbidity and mortality in the short and medium-term. As a public health policy, current maternal and childcare strategies must be kept in order to reduce risks in the pediatric population.

Catch me if you can: Under-detection of Trypanosoma cruzi (Kinetoplastea: Trypanosomatida) infections in Triatoma dimidiata s.l. (Hemiptera: Reduviidae) from Central America

Assays for parasite detection in insect vectors provide important information for disease control. American Trypanosomiasis (Chagas disease) is the most devastating vector-borne illness and the fourth most common in Central America behind HIV/AIDS and acute respiratory and diarrheal infections (Peterson et al., 2019). Under-detection of parasites is a general problem which may be influenced by parasite genetic variation; however, little is known about the genetic variation of the Chagas parasite, especially in this region. In this study we compared six assays for detecting the Chagas parasite, Trypanosoma cruzi: genomic reduced representation sequencing (here referred to as genotype-by-sequencing or GBS), two with conventional PCR (i.e., agarose gel detection), two with qPCR, and microscopy. Our results show that, compared to GBS genomic analysis, microscopy and PCR under-detected T. cruzi in vectors from Central America. Of 94 samples, 44% (50/94) were positive based on genomic analysis. The lowest detection, 9% (3/32) was in a subset assayed with microscopy. Four PCR assays, two with conventional PCR and two with qPCR showed intermediate levels of detection. Both qPCR tests and one conventional PCR test targeted the 195 bp repeat of satellite DNA while the fourth test targeted the 18S gene. Statistical analyses of the genomic and PCR results indicate that the PCR assays significantly under detect infections of Central American T. cruzi genotypes.

Diversity of enteric and non-enteric human adenovirus strains in Brazil, 2006-2011.

During 2006-2011, 5035 fecal samples were tested by PCR for human adenovirus (HAdV) and sequenced. HAdV was detected in 198 cases (3.9%), with the highest rate in children ≤5 years. Enteric HAdVs were the most prevalent genotypes (78%; 146/187): HAdV-F41 (63.6%; 119/187), HAdV-F40 (12.3%; 23/187), HAdV-A12 (1.6%; 3/187) and HAdV-A31 (0.5%; 1/187). Non-enteric HAdVs were detected in 22% (41/187): HAdV-C1 (8.0%; 15/187), HAdV-C2 (6.9%; 13/187), HAdV-C5 (4.3%; 8/187), HAdV-D8 (1.3%; 2/187), HAdV-B21 (0.5%; 1/187), HAdV-B3 (0.5%; 1/187) and HAdV-C6 (0.5%; 1/187). This 6-year retrospective study points out a high diversity of HAdV types circulating in Brazil and highlights the need to carry out molecular epidemiological studies of HAdV among patients with acute diarrheal infection on a regular basis.

S1231 Utility of Stool Real-Time Polymerase Chain (PCR) Testing in Management of Patients With Acute Diarrhea

INTRODUCTION: Acute diarrheal infection is one of the leading causes of hospitalizations with an estimated 47.8 million cases occurring annually in the United States leading to 128,000 hospitalizations at an estimated cost of $150 million. Physicians commonly order the stool real-time polymerase chain (PCR) bacterial and viral panel for patients presenting with acute diarrhea. This test has significant turnaround times, costs and presents challenges in sample collection. Per the American College of Gastroenterology (ACG), unless an immunocompetent patients present with bloody diarrhea, high fevers great than 101F, recent history of travel, or persistent diarrhea lasting 14-30 days, there is no indication for further stool microbiologic assessment to guide management. METHODS: A retrospective study was done on electronic medical records of adult patients that were hospitalized at Community Regional Medical Center (CRMC) from April to September 2018 and had stool PCR tests ordered for diarrhea. The number of stool PCR tests ordered and their outcomes were assessed, followed by analysis of changes in patient care and management. Patient records were reviewed to assess for appropriate ordering of stool testing based on ACG criteria. Based on test results, post study intervention completed in electronic health record to restrict testing to appropriate indications and to increase education among healthcare providers. RESULTS: 192 patients in April 2018 to September 2018 had stool PCR tests ordered during hospitalization. 19.8% of these patients fulfilled one or more criteria for stool microscopic assessment for acute diarrhea. Out of these 19.8%, only 15.8% had changes in management, while the other 84.2% did not. 66.7% had the changes made after the release of stool PCR results, while 33.3% had changes made before test results. 72 (38%) of these 192 stool PCR orders was canceled due to inadequate sample collection. 15% tests were positive, 43% of which were viral etiology with only supportive care available as treatment. CONCLUSION: Our study demonstrates the limited efficacy of stool microbiologic assessment outside the aforementioned criteria. The majority of the stool PCR tests ordered, regardless of their results, did not alter patient care or management, thus placing an unnecessary cost and burden on our patients and healthcare system. Post-study quality improvement was completed to limit stool PCR testing to qualified criteria where test results may affect patient care and management.Figure 1.: Stool PCR Test Results.Figure 2.: Positive Stool PCR Test Etiology.

Draft genome sequence of Escherichia coli M51-3: a multidrug-resistant strain assigned as ST131-H30 recovered from infant diarrheal infection in Mexico.

In this study, we report the draft genome sequence of a multidrug-resistant (MDR)Escherichia coli strain recovered from stool sample of an outpatient infant girl with acute diarrheal infection in Mexico. Antimicrobial susceptibility testing and PCR-based detection of diarrheagenic E. coli (DEC) were performed. In addition, genomic DNA from E. coli strain M51-3 was sequenced using Ion Torrent PGM platform with 200-bp chemistry and generated reads were de novo assembled using SPAdes v3.11. The draft genome was annotated and analyzed regarding multilocus sequence typing (MLST), serotyping, fimH typing, plasmid replicons, acquired antimicrobial resistance and virulence genes using web tools available at the Center for Genomic Epidemiology. A draft genome comprising 5 088 545 bp in length and 5308 protein-coding sequences was generated. In silico typification revealed that E. coli strain M51-3 belongs to ST131-O25:H4-H30 pandemic subclone. Several genes associated with resistance to β-lactams [blaTEM-1B], aminoglycosides [aph(3'')-Ib, aadA5, aph(6)-Id and aac(3)-IId], sulfonamides [sul1 and sul2], trimethoprim [dfrA17], and tetracycline [tet(A)] were identified. Besides, point mutations in gyrA, parC, and parE genes were detected. Interestingly, the enterotoxin-coding virulence gene senB was evidenced. To our knowledge, this is the first draft genome of an E. coli ST131-O25:H4-H30 strain recovered from infant diarrheal stool sample in Mexico. The genome sequence of E. coli M51-3 presented here will be helpful to understand the genomic diversity of this highly virulent and MDR successfully pandemic bacterial pathogen.

Incidence, predisposing risk factors for the development and spreading of acute intestinal infections in the north-eastern region of Ukraine

Using data of the branch statistical reporting of the State Sanitary and Epidemiological Service in Sumy region and Sumy Regional State Laboratory of Veterinary Medicine, the incidence rate, modern risk factors for the development and spreading of acute infectious diarrheas were determined in the North-Eastern region of Ukraine. Under the current conditions incidence rate indices of acute intestinal infections and food toxicoinfections are within the range of 159.8-193.6 per 100 thousands. pop. Seasonal and epidemical rises are associated with a species of the agent. In the etiological structure of acute diarrheal infections there are dominated viruses, of food toxicoinfections--Klebsiellae pneumoniae, Staphylococcus aureus and Enterobacter cloacae (p < 0.05). Predictors of the complication of epidemiological situation of Shigella infections are the gain in the detection of bacterially contaminated samples of milk and dairy products (r = 0.75), for food toxicoinfections caused by Klebsiellae pneumoniae and Enterobacter cloacae--pastry with cream and cooking meat products (r = 0.64; r = 0.75). Epizootic situation in the region affects on the salmonellosis incidence rate of the population (r = 0.89). There were revealed correlations between the selection of E. coli bacteria from swabs taken from the enterprises of catering, in child care centers and the levels of incidence rates of salmonellosis, acute intestinal infections of unknown etiology (r = 0.59; r = 0.60). Timely detection and sanitation of Shigella carriers are a powerful instrument to reduce the incidence rate of shigellosis (r = 0.83).

Correction: Current management of acute diarrheal infections in adults.

Correction: Current management of acute diarrheal infections in adults.

The prevalence of Vibrio Cholera Infection among Patients with Diarrheal Infections in flood affected population of Pol-e Dokhtar County: 2019

Backgrounds: Cholera is an acute diarrheal intestinal infection caused by infection of intestine with vibrio cholera. Cholera is defined as endemic in Iran, thus rapid detection in the early stage of infection is crucial, especially during the disease outbreaks. Materials and Methods: We collected 172 rectal swab samples from patients with diarrheal infections, and sterile beakers were used to collect water samples from some regions of Pol-e Dokhtar city. The collected specimens were transported to the laboratory using Cary-Blair transport medium and were then grown and incubated on alkaline peptone water (APW) and thiosulfate citrate bile salts sucrose (TCBS) agar. Then, all colonies that grew in Kligler Iron Agar (KIA) were cultured. Results: In this study, colonies were grown on APW and TCBS media, and were then transferred to the KIA. None of the colonies were shown to be belonged to V. cholerae strains. Thus, all collected samples were negative for V. cholerae in all patients as well as the drinking water in most regions of the city. Conclusion: The findings of this study suggest that V. cholerae was not the major cause of severe diarrheal infections in a flood-hit population of Pol-e Dokhtar city, and therefore other bacterial and viral agents should be responsible for severe diarrheal illnesses in this population.

Current management of acute diarrheal infections in adults.

New guidelines on the management of acute diarrhea in adults were promulgated in 2016. The aim of this review was to provide an overview of the context of acute diarrhea and how to generally approach a patient; to present some new areas in the field concerning diagnostics, particularly culture-independent testing, as well as some of the risks and benefits of treatment; and to discuss prevention, particularly in the traveler's diarrhea setting.

Cholera, Migration, and Global Health – A Critical Review

Cholera is an acute diarrheal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae. The causative agent of this disease was originally described by Filippo Pacini in 1854, and afterwards further analyzed by Robert Koch in 1884. It is estimated that each year there are 1.3 million to 4 million cases of cholera, and 21000 to 143000 deaths worldwide from the disease. Cholera remains a global threat to public health and an indicator of inequity and lack of social development. A global strategy on cholera control with a target to reduce cholera deaths by 90% was launched in 2017. Before 1817, cholera was confined to India’s Bay of Bengal. However, primarily following trade and migration between India and Europe, by the 1830s, cholera had spread internationally. The global spread of cholera was the driving force behind the first International Sanitary Conference in Paris, in 1851. The global health significance of cholera is underscored by its inclusion as one of four priority diseases in the 1969 and 2005 International Health Regulations. This article reviews the evolution of seven cholera pandemics and their reciprocal impacts on migration and global health. Also discussed are global efforts to address cholera, particularly the International Health Regulations, the 1969 and 2005 version of which stipulated that cholera epidemics require mandatory reporting to the IHR. This article concludes with a brief case study of Yemen’s unprecedented cholera epidemic.

Norovirus interactions with the commensal microbiota.

Human norovirus (HNoV) is the leading cause of epidemic nonbacterial gastroenteritis worldwide, causing an acute diarrheal infection and occasionally chronic infection in immunocompromised individuals. Mouse and tissue culture models utilizing murine norovirus (MNoV) have allowed for interrogation of viral mechanisms of infection and pathogenesis. Here, we outline the interactions between the commensal microbiota of the intestine and norovirus and their implications (Fig 1). Open in a separate window Fig 1 Norovirus pathogenesis is affected by many factors in the enteric environment. a) The presence of commensal bacteria allows for efficient MNoV infection, with tuft cells being one rare cell population infected. b) Absence of commensal bacteria reduces MNoV titers by depleting tuft cell populations and potentially altering innate immune responses during persistent MNoV infection. c) Binding of HNoV to HBGA-positive enteric bacteria has been found to facilitate infection of B cells. d) Sialic acid moieties on the cell surface have been found to act as coreceptors for MNoV infection of macrophages, while bile acids have been found to be important for the establishment of HNoV infection of enterocytes. e) MNoV infection has been found to trigger the expression of IFN-λ in infected cells, up-regulating interferon simulated genes that restrict viral replication and subsequent spread of infection—the mechanism of this process has yet to be characterized, but commensals are believed to play a major regulatory role. HBGA, histo-blood group antigen; HNoV, human norovirus; IFN-λ, interferon lambda; MNoV, murine norovirus.