Acute Infectious Diarrhea Research Articles

Etiology of severely dehydrating diarrheal illness in infants and young children residing in low- and middle-income countries

Abstract Background Severe dehydration due to acute infectious diarrhea remains a leading cause of death among young children worldwide. Diarrhea with severe dehydration is a clinical syndrome with distinct management per the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and the WHO Global Task Force on Cholera Control (GTFCC) guidelines. We sought to characterize the pathogens causing severe dehydration using data from the Global Enteric Multicenter Study. Methods We used the IMCI and GTFCC guidelines to define severe dehydration and quantitative PCR-based (qPCR) attribution models to assign the etiology of diarrhea associated with severe dehydration. Results The IMCI or GTFCC guidelines classified 2,284 (43%) of the 5304 cases with moderate-to-severe diarrhea (MSD) as having severe dehydration. In one third of the cases with severe dehydration no pathogens were attributed. The top pathogens attributed to children with guidelines-classified severe dehydration varied by age and were similar among those requiring IV hydration and hospitalization. Rotavirus (30.9%), Cryptosporidium (12.0%), and ST-ETEC (10.3%) were the most common pathogen for ages 0-11 months, while Shigella/EIEC (25.8%), rotavirus (19.3%), and ST-ETEC (10.9%) were the most common for ages 12-23 months. Shigella/EIEC (25.9%), V. cholerae (10.4%), and rotavirus (9.2%) were the most common among 2–5-year-olds. Conclusions The findings inform prioritization of pathogens, in addition to V. cholerae, that cause severe dehydration for future preventive and treatment efforts. The schema for prioritization is driven primarily by age stratifications.

Adherence to Clinical Practice Guidelines on the Management of Acute Infectious Gastroenteritis in Children as a Measure of Quality of Care Delivered by a Primary Care Facility in Rural Philippines: A Descriptive Retrospective Study.

This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH). A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low. There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%. Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.

Experience of practical use of enterosorbents in the treatment of HIV-infected children with diarrhea syndrome

Despite advances in antiretroviral therapy (ART), diarrhea is common among people living with HIV (PLHIV) and negatively impacts quality of life. Although diarrheal diseases caused by opportunistic infections have decreased in the ART era, the overall prevalence of diarrhea remains unchanged, estimated at 28% to 60% of PLHIV.The aim of the study: to conduct a comparative assessment of the clinical efficacy of enterosorbents in the treatment of diarrheal syndrome in children with HIV infection.Materials and methods. The study material included 80 HIV-infected children who experienced acute infectious diarrhea aged 5 to 14 years. The main group included 40 children who received enterosgel, 2 times 1 tablespoon included in the traditional treatment regimen, and the control group included 40 children who received the drug lactofiltrum against the background of traditional therapy, 1 tablet 3 times a day. The duration of treatment was 10 days.Results and discussion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a significant decrease in the daily amount and in the duration of diarrhea was observed, which leads to a noticeable loss of signs of dehydration (P<0.05). Elimination of acute diarrhea in children with HIV infection may also have eliminated the underlying intoxication syndrome due to the underlying and burning disease, which may lead to a reduction in health care costs and socioeconomic burden.Conclusion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a decrease in the daily amount and in the duration of diarrhea is reliably observed, which leads to a significant disappearance of signs of dehydration (р<0.05).

Prevalence of Enteric Pathogens and Antibiotic Resistance: Results of a Six-Year Active Surveillance Study on Patients Admitted to a Teaching Hospital.

Acute Infectious Diarrhea (AID) and the short- and long-term complications associated with it are major causes of hospitalization worldwide. In Italy, due to a lack of robust surveillance programs, only limited data has been collected on their prevalence and circulation. This study aims to evaluate the resistance pattern of enteric pathogens and their epidemiological trends over a six-year period. This cross-sectional retrospective study was conducted from January 2018 to December 2023. Stool samples were analyzed during routine diagnosis with culture methods, syndromic molecular tests, and enzyme immunoassay. Bacteria were the most isolated enteric pathogens (62.2%), followed by fungi (29.0%), viruses (8.2%), and parasites (0.6%). Most bacteria were isolated from outpatients (29.5%) and from patients in the Oncology ward (26.2%). The most prevalent target was EPEC (11.1%), followed by C. difficile toxin A/B-producing strains (8.3%), C. jejuni (2.5%), and S. enterica, (1%.). Norovirus and Candida spp. were the most prevalent in pediatric patients (6.5% and 39.6%, respectively). In the last years, enteric pathogens have been a frequent cause of infections characterized by a problematic resistance to common antimicrobials. In our study, S. enterica showed resistance to amikacin, gentamicin, ampicillin, levofloxacin, and ciprofloxacin. C. jejuni was susceptible to all tested drugs. Timely notification of gastroenteric infections is crucial in identifying potential outbreak sources and ensuring strict adherence to food safety and hygiene practices, so as to protect the most vulnerable populations. The present study offers insights into the epidemiological characteristics and the antibiotic susceptibility of the main enteric AID pathogens in order to implement infection control measures in health care settings.

Comparison of two different serological methods in the diagnosis of Rotavirus and Adenovirus in stool samples

Objective: Rotaviruses are the most common cause of acute infectious diarrhea in children under 5 years of age worldwide. This study aims to compare the immunochromatographic and ELISA methods, determine the sensitivity and specificity of the methods used, and shed light on humanity to diagnose the disease correctly. Method: Stool samples of 1000 patients sent to Diyarbakır Pediatrics Hospital for rapid antigen testing of Rotavirus were studied. Single-stage Rotavirus and Adenovirus Co-immunochromatographic and ELISA methods were used in the examination of the samples. Samples with positive rapid test results were taken into 1.5 ml microcentrifuge tubes, and positive antigen samples collected for the ELISA test were stored at -80°C until the time to be studied. Results: Of 1000 stool samples analyzed, 40 (11.59%) of 345 girls and 60 (9.16%) of 655 boys had Rotavirus antigen in a total of 100 (10%) and 20 (2%) had Adenovirus antigen (P> 0.05). Viral antigen-positive cases were seen most frequently in winter months (December, January, February). There was no statistically significant difference between the data in terms of age and gender (P

PROBIOTICS FOR THE PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA

Ventilator-associated pneumonia is associated with a high rate of all-cause mortality and a prolonged duration of mechanical ventilation and intensive care unit stay. Ventilator associated pneumonia accounts for about half of all antibiotics given in the intensive care unit. Plenty of studies have assessed various kinds of prevention strategies, including pharmacological and non-pharmacological interventions, to prevent ventilator-associated pneumonia over the years. An emerging number of studies has assessed the non-antibiotic approaches for the prevention of ventilator-associated pneumonia in the last few years. One of the frequently used strategy is addition of probiotics in the preventive measures list. Regular consumption of probiotics can modulate immune responses and metabolic processes as well as antioxidant and anti-inflammatory effects. The strongest evidence in favor of probiotics lies in the prevention or treatment of necrotizing enterocolitis, acute infectious diarrhea, acute respiratory tract infections, antibiotic-associated diarrhea, and infant colic. The beneficial effects of probiotics in the prevention of ventilator-associated pneumonia were not yet entirely clarified. Multiple pieces of evidence indicate that the bacteria that populate the gut efficiently modulate the immune response. Treatment with probiotics have shown promising preliminary results to attenuate systemic inflammation, especially in postoperative infections and ventilation performance. This review aims to summarize latest data on the use probiotics to prevent ventilator-associated pneumonia in critical care unit.

Досвід застосування пробіотика Bacillus clausii UBBC-07 при гострій водянистій діареї в дітей раннього віку в умовах стаціонарного відділення

Acute watery diarrhea in children remains an urgent problem in pediatrics due to its high prevalence and high mortality rates at an early age. Modern treatment protocols provide for a comprehensive approach to the treatment of patients. However, the main method of treatment of diarrhea - oral rehydration, does not allow for the stoppage of the progression of gastroenteritis, of the elimination of the imbalance of microflora and intestinal dysfunction. Such tasks can be solved thanks to the use of probiotics, which are recommended as a component of auxiliary therapy for children with acute infectious diarrhea. Purpose - to conduct a comprehensive clinical and epidemiological analysis of the results of the use of the spore-forming probiotic Bacillus clausii (B. clausii) strain UBBC-07 (Lactiale Germina) in the complex treatment of hospitalized young children with acute infectious watery diarrhea syndrome. Materials and methods. 85 children with acute infectious non-inflammatory diarrhea were comprehensively examined. 2 clinical groups were formed. The Group I - 50 hospitalized children (average age 3.1±0.4 years, the proportion of boys - 64.0%), who received 1 bottle of Lactiale Germina 1 time/day in complex treatment (5 ml=2×109 CFU B. clausii endospores). The Group II included 35 patients (average age 2.4±0.4 years (p>0.05), the share of boys - 54.3% (p>0.05)); who received standard treatment according to existing standards. According to the main clinical characteristics, the comparison groups can be considered comparable. Results. The analysis of the conducted studies established that the use of Lactial Germin increased the chances of a three-fold reduction in the frequency of bowel movements on the 4th day (absolute risk increase (ARI) - 27.0%, relative risk increase (RRI) - 34.6 (95% CI: 25.4-44.8) with the minimum number of patients who need to be treated to obtain a positive result (MNP) - 2.9 (95% CI: 0.5-8.6), led to the absence of the symptom of vomiting already for the 3rd day of inpatient treatment (ARI - 9.0%, RRI - 37.5 (95% CI: 28.0-47.7) with MNP - 2.7 (95% CI: 0.4-8.1), increased the chances of a lower need for long-term (≥3 days) parenteral rehydration (ARI - 12.9%, RRI - 13.7% (95% CI: 7.6-22.1) with MNP - 7.3 (95% CI: 2.9-14.3) and reduced the risk of needing to use antidiarrheal agents (relative risk - 3.2 (95% CI: 2.6-3.9) with an odds ratio - 7.1 (95% CI: 3,4-14,7)). Conclusions. Food supplement Lactiale Germina (probiotic strain B. clausii strain UBBC-07) in the complex treatment of children with acute watery diarrhea is effective and safe with good tolerability and rapid rates of clinical recovery. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Effect of probiotics plus zinc supplementation on clinical outcomes of infants and children with acute infectious diarrhea: a randomized controlled trial.

Findings are conflicting regarding the effect of zinc supplementation on disease severity in children with acute gastroenteritis. To examine the effects of probiotics and zinc on the clinical outcomes of infants and children with acute infectious diarrhea. In this randomized controlled trial, children with mild or moderate to severe acute gastroenteritis in the Kurdistan Region from November 2021 to June 2022 were diagnosed clinically and randomly assigned to the experimental or control group. The experimental group (n=50) received probiotics and zinc, whereas the control group (n=51) received probiotics alone for 1 week. The product contained live Bifidobacterium infantis, Lactobacillus paracasei, and Lactobacillus rhamnosus (10×106 colony-forming units/day for 7 days). Zinc syrup was administered to the probiotic plus zinc group. Each 5 mL of syrup contained 15 mg of zinc sulfate. Dehydration and disease severity in both groups were measured using the Clinical Dehydration Scale and the Modified Vesikari Scale, respectively. An illness episode was defined as an episode of gastroenteritis with a total score of ≥9 on the Modified Vesikari Scale (range, 0-20). The probiotic and probiotic plus zinc groups were similar in age (1.79 years vs. 1.69 years, respectively; P= 0.645), sex (male/female ratio: 1.43 and 1.0, respectively; P=0.373), and medical characteristics. The groups had similar mean dehydration and disease severity scores and a similar incidence of dehydration recovery (some dehydration, 3.92% and 4.00%, respectively; P=1.000), and recovery from mild gastroenteritis (0.0% and 2.0%, respectively; P=0.495) at 2 weeks. Significant decreases in mean dehydration severity and disease severity score (1.80 to 0 and 6.66 to 0, respectively; P<0.001) and the development of dehydration (some dehydration, from 94.0% to 4.0%; P<0.001) from baseline to 2 weeks were noted in the probiotics plus zinc group. The probiotics group responded similarly. The development of mild gastroenteritis was significantly reduced from baseline to 2 weeks (90.2% to 0% and 78.0% to 2.0% in the probiotics and probiotics plus zinc groups, respectively; P<0.0001). The probiotics plus zinc group had a shorter mean recovery time (1.34 days vs. 2.00 days, respectively; P<0.001). Taking probiotics plus zinc did not significantly affect disease severity in children with gastroenteritis at 2 weeks. However, the probiotics plus zinc group recovered more quickly than the probiotics group.

Presentations of Children with Suspected Sepsis Caused by Acute Infectious Diarrhea in the Pediatric Emergency Department.

Acute infectious diarrhea is a common cause of hospitalization in children. Hence, early identification of acute bacterial gastroenteritis with suspected sepsis in pediatric emergency departments (EDs) is important. This study aimed to describe the clinical spectrum and initial characteristics of children who were presented to a pediatric ED with acute infectious diarrhea and suspected sepsis. Between April 2020 to March 2021, children with clinical diagnoses of acute bacterial colitis and suspected sepsis who were admitted to the pediatric ED were prospectively enrolled. The following data were obtained and compared between different age groups of children: including demographics, presentation, laboratory tests, culture results, treatment modalities, complications, and short-term outcomes. A total of 105 patients (70 males and 35 females; mean age: 3.75 ± 3.52 years) were enrolled in this study. Of them, 89 (84.8%) patients were <6 years of age, and 80 (76.2%) patients required hospitalization for a duration of 4.7 ± 2.08 days. C-reactive protein (CRP) and procalcitonin (PCT) levels were significantly higher in the admission (both p < 0.001) and anti-biotic treatment groups (both p < 0.001). Salmonella enteritidis was the most common organism cultured from the stool and blood samples (39 of 91 (38.5%) and 2 of 105 (1.9%), respectively). The primary causative organism of acute infectious diarrhea identified in this study was S. enteritidis. Age and elevated serum CRP or PCT levels could be important factors in the decisions of emergency physicians regarding hospitalization and antibiotic therapies for pediatric acute infectious diarrhea.

The role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department

PurposeThis study aimed to investigate the role of rapid syndromic diagnostic testing of gastrointestinal pathogens as a clinical decision support tool in a pediatric emergency department (ED) by comparing clinical decision and patient outcome parameters pre- and post-implementation.MethodsThis was a big data analytical study of children < 18 years old without any underlying diseases, that visited the ED with acute moderate to severe diarrhea during a 34-month period from 2018 to 2022 using Seoul St. Mary’s hospital’s healthcare corporate data warehouse to retrieve demographic, clinical, and laboratory parameters. Outcome measures pre- and post-implementation of a rapid syndromic multiplex gastrointestinal panel (GI panel) were compared.ResultsA total of 4,184 patients’ data were included in the analyses. Broad spectrum antibiotics were prescribed at a significantly lower rate to patients presenting with acute infectious diarrhea at discharge from the ED (9.9% vs 15.8%, P < 0.001) as well as upon admission (52.2% vs 66.0%, P < 0.001) during the post-implementation period compared to the pre-implementation period. Although the duration of ED stay was found to be significantly longer (6.5 vs 5.5 h, P < 0.0001), the rate of ED revisit due to persistent or aggravated symptoms was significantly lower (Δ in intercept, β = -0.027; SE = 0.013; P = 0.041), and the admission rate at follow up after being discharged from the ED shown to be significantly lower during the post-implementation period compared to the pre-implementation period (0.8% vs. 2.1%, P = 0.001, respectively). No significant difference in disease progression was observed (P = 1.000).ConclusionUsing the GI panel in the ED was shown to decrease broad spectrum antibiotic prescribing practices and reduce revisits or admission at follow up by aiding clinical decisions and improving patient outcome.

Acute Infectious Diarrhea.

Acute infectious diarrhea (AID) is one of the most common diseases in pediatric age with relevant burden both in high and in low-income countries. Thanks to their direct action on enterocyte functions and indirect actions on the mucosal and systemic immune system and on intestinal microbiome, probiotics are an ideal intervention to treat AID in childhood. However, their efficacy is strictly related to strains and indications, and practitioners should take this information into account in clinical practice. This chapter summarizes the main mechanisms of action of probiotics in AID, with a focus on proof of efficacy supporting their use in prevention and treatment of childhood AID. The use of selected strains in appropriate doses is strongly recommended by guidelines of AID, based on compelling proofs of efficacy and safety. At present, therapy with probiotics of AID is probably the strongest indication for probiotic use in medicine. Their role in prevention of AID is however questionable in healthy population, whereas it should be considered in at-risk population. Evidence for prevention of diarrhea in day-care centers and communities is lacking, but consistent evidence supports efficacy in prevention of hospital acquired diarrhea. Finally, this chapter presents novelties on this topic, in particular the role of rotavirus immunization on probiotics effectiveness and the effect of probiotics and postbiotics on Covid-associated diarrhea.Overall: AID is the most convincing area for probiotic use in children with gastrointestinal disorders, and effective strains should be used early on after onset of symptoms.

Effect of treatment with probiotics in the reduction of altered levels of the lipid profile in humans and rats: a systematic review

Introduction: Evidence suggests that the use of probiotics can prevent or help in the treatment of diseases such as obesity, acute infectious diarrhea, irritable bowel syndrome, liver problems, and the correction of hyperlipidemia, whether of total cholesterol, c-HDL, c-LDL or triglycerides. Probiotic strains have been studied that with various mechanisms can decrease lipid levels in children, adults and rats. Objective: To demonstrate the lipid-lowering effect of some probiotic strains tested in humans and rats, compiling research that supports it. Methods: A search was carried out for articles with a year of publication between 2013 and 2023, experimental, observational and cohort studies published in English, full text available and analysis of the decrease in some lipid profile marker due to the use of probiotics. The MESH terms and the Boolean operators used for the search were “probiotics, lipid-lowering, children; Adults; rats and lipid profile”. Data sources: the databases used were PubMed, Google Scholar, Elsevier, Clinical Key, and ScienceDirect. Results: Of 2150 articles, 30 were included. After the analysis of the selected articles, the results reveal that probiotics have a beneficial effect on the lipid profile by 25,01%. Total cholesterol level was reduced by 16,65%, c-LDL 32,02% and c-HDL was raised by 21,71%. Conclusion: Supplementation with specific strains of probiotics has a lipid-lowering effect, especially it reduces hypercholesterolemia through various mechanisms, but more studies are required to determine the dosage and treatment time.

Probiotics and Its Therapeutic Effects: A Review

Mankind has been exploiting microorganisms involuntarily from the very beginning until Louis Pasteur proposed the role of microorganisms in fermentation. However, the ability of these microorganisms to reshape the human life came into frame through the pioneering studies by ‘The father of Probiotics’, Ellie Metchnikoff in the beginning of 20th century. Replacement of putrefactive bacteria in the gut micro biome by probiotics microorganisms has shown to restore and maintain the gastrointestinal health. Probiotics by definition is “live microorganisms which when administered in adequate amounts confer a health benefit on the host”. Though the most common strains of probiotics employed are Lactobacillus and Bifidobacterium sp., the prospect of other microorganisms are still being explored. This review mainly focuses on the potential therapeutic effects of probiotics on different classes of diarrhea such as acute infectious diarrhea, traveler’s diarrhea, Antibiotic associated diarrhea, inflammatory Bowel Syndrome, Necrotizing Enterocolitis as well as the its effects on various skin diseases such as Atopic dermatitis, Psoriasis, Acne, Rosacea along with some miscellaneous effects Hypercholestremia, wounds, urogenital tract infections, etc.

Effects of &lt;i&gt;Lactobacillus delbrueckii&lt;/i&gt; TS1-06 probiotic strain on the size of myocardial infarction in Wistar rats with systemic inflammatory response syndrome

Experimental medicine provides the scientific community with a plethora of information on therapeutic efficacy of probiotic strains. However, from the point of view of evidence-based medicine, the list of disorders controlled by probiotics is limited to antibiotic-associated diarrhea in adults and children, Clostridium difficile-associated diarrhea, acute infectious diarrhea in children and adults, eradication therapy, ulcerative colitis and irritable bowel syndrome. Recently, these indications are also amended by well-validated clinical guidelines for the usage of probiotic preparations, in order to modulate immunity. Given the permeability of gastrointestinal and immune system barriers for pathogenic and opportunistic microbiota, it seems logical to assume the effectiveness of probiotics as potential symbiotic regulators of nervous and cardiovascular systems. It should also be taken into account that metabolic disorders, e.g., obesity, with a low-intensity inflammatory response and characteristic cytokine pattern, are acquired as a gain of human civilization. In this regard, we propose a scientific hypothesis about the effectiveness of probiotic microbial strains in increasing myocardial resistance to ischemic-reperfusion injury, due to their ability to block individual links of the cytokine cascade during the development of inflammatory response, for its subsequent translation into clinical practice.The development and validation of a new experimental model of systemic inflammatory response syndrome (SIRS) in male Wistar rats, including obesity, acute inflammatory process of the colon, and antibiotic-induced dysbiosis, became basic to the study of efficacy of probiotic drugs in terms of myocardial resistance to ischemicreperfusion injury (IRI). Rats with SIRS showed a significantly increased size of the infarction area (+28%) upon experiments with isolated perfused heart under global ischemia-reperfusion conditions. Significant changes in the leukocyte formula and immunological parameters associated with SIRS were corrected by introduction of a mixture of probiotic strains L. acidophilus (LA-5) and B. animalis subsp. lactis (BB-12), and the isolated strain L. delbrueckii TS1-06. In both groups with probiotic correction, there was a decrease in the infarction area compared to the SIRS group. General and specific changes in IL-2, transforming growth factor-b (TGF-b) and tumor necrosis factor-a (TNFa) were noted. The reduction of myocardial infarction by probiotics may be related to the blocking of first-order cytokines, which leads to a «break» of proinflammatory cascade. A need for in-depth study of cardioprotective mechanisms mediated by probiotics was confirmed due to their potential usage as a symbiotic alternative to biological drugs which block the main pro-inflammatory cytokines.

Chlorogenic Acid Ameliorates Post-Infectious Irritable Bowel Syndrome by Regulating Extracellular Vesicles of Gut Microbes.

Post-infectious irritable bowel syndrome (PI-IBS) occurs after acute infectious diarrhea, and dysbiosis can be involved in its pathogenesis. Here, the role of chlorogenic acid (CGA) is investigated, a natural compound with several pharmacological properties, in alleviating PI-IBS in rats. It is elucidated that the gut microbiota plays a key role in PI-IBS pathogenesis and that rectal administration of CGA alleviated PI-IBS by modulating the gut microbiota and its metabolites. CGA supplementation significantly increased fecal Bacteroides acidifaciens abundance and glycine levels. Glycine structurally altered B. acidifaciens extracellular vesicles (EVs) and enriched functional proteins in the EVs; glycine-induced EVs alleviated PI-IBS by reducing inflammation and hypersensitivity of the intestinal viscera and maintaining mucosal barrier function. Moreover, B. acidifaciens EVs are enriched in the brain tissue. Thus, CGA mediates the mitigation of PI-IBS through the gut microbiota and its metabolites. This study proposes a novel mechanism of signal exchange between the gut microenvironment and the host.

Effectiveness of Saccharomyces Boulardii CNCM I-745 probiotic in acute inflammatory viral diarrhoea in adults: results from a single-centre randomized trial

BackgroundProbiotics are effective for treating acute infectious diarrhoea caused by bacteria, but there are inconsistent results for the effectiveness of probiotics for diarrhoea caused by viruses. In this article we want to determine whether Sb supplementation has an effect on acute inflammatory viral diarrhoea diagnosed with the multiplex panel PCR test. The aim of this study was to evaluate the efficacy of Saccharomyces boulardii (Sb) as a treatment in patients diagnosed with viral acute diarrhoea.MethodsFrom February 2021 to December 2021, 46 patients with a confirmed diagnosis of viral acute diarrhoea diagnosed with the polymerase chain reaction multiplex assay were enrolled in a double-blind, randomized placebo-controlled trial. Patients received paracetamol 500 mg as a standard analgesic and 200 mg of Trimebutine as an antispasmodic treatment plus 600 mg of Sb (n = 23, 1 × 109/100 mL Colony forming unit) or a placebo (n = 23) orally once daily for eight days. The improvement in and severity of symptoms were measured using a symptom diary, the Patient Global Impression and the Patient Global Impression of Change scales (days 4 and 8), both answered and recorded by the patient.ResultsOf the 46 patients who completed treatment, 24 (52%) were men and 22 (48%) were women. The average age was 35.6 ± 12.28 years (range 18 to 61 years). The average duration of the evolution of illness at the time of diagnosis was 0.85 ± 0.73 days (maximum 2 days). On day 4 after the diagnosis, 20% reported pain and 2% reported fever, but on day 8, no patient reported pain or fever. On day 4, 70% of patients in the Sb group and 26% in the placebo group reported improvement (P = 0.03), based on the Patients’ Global Impression of Change scale, which assesses patient’s rating of overall improvement. These findings suggest that 3 to 4 days of treatment with Sb helped to improve symptoms of diarrhoea caused by a virus.ConclusionTreatment with Sb on acute inflammatory diarrhoea of viral aetiology shows no changes regarding the severity of the symptoms; nevertheless, it seems to impact improvement positively.Trial registration22CEI00320171130 dated on 16/12/2020, NCT05226052 dated on 07/02/2022.

Characteristics of acute diarrhea in adult cases with &lt;i&gt;Campylobacter&lt;/i&gt; spp. positive fecal samples

Recently, cases caused by Campylobacter spp. in Russia similar to other countries tended to clearly rise, partly due to the widely implemented biomolecular PCR-based laboratory analysis that substantially facilitated Campylobacter spp. detection in patients samples. The problem of being infected by Campylobacter spp. is so far worth studying because of campilbacteriosis signs in a form of a variety of clinical patterns including local and general forms, possible trigger role in forming the consequent chronic digestive tract pathology as well as general systemic pathology. Development of colitis or heamocolitis as the pattern part of acute diarrhea caused by Campylobacter spp. is usually considered as associated with the disease burden. So far as adult patients have acute diarrhea with positive Campylobacter spp. samples it might be of interest to compare and analyze their clinical and laboratory data to find some possible associations as particular features of different disease patterns. Objective to analyze clinical features and laboratory data of hospitalized AD adult cases with feces samples positive for Campylobacter spp. When carrying out the retrospective cohort study the analyzed were clinical and laboratory data of 111 hospitalized adult patients suffering from moderate acute diarrhea with clinical samples (feces) positive for Campylobacter spp. To verify acute infectious diarrhea all patients went through complex specific laboratory examination that included PCR based methods (feces) with use of Amplisense AD screen-FL in addition to routine standard culture (feces), serologic (specific antibody detection) and ELISA laboratory methods. The analysis results have shown that more than 1/2 part of patients developed colitis syndrome with blood in feces in practically every forth case. In patients (predominantly males) without chronic digestive tract problems relative risks to develop colitis and haemocolitis are respectively 1.6 and 2.6 times higher given they are hospitalized on day 4 after the onset and later versus those hospitalized earlier.

PROBIOTICS FOR INFANTILE COLIC : A SYSTEMATIC REVIEW

Colic in infants is a self-limiting ailment; nonetheless, it can be unpleasant for parents and tough for doctors to treat. Approximately 20% of infants suffer from infantile colic, which typically reaches its peak between 5 and 6 weeks of age. The challenge for the medical staff is in making an accurate diagnosis and coming up with a treatment plan for the ailment. In order to give doctors with a full grasp of the problem, current advancements, and future possibilities, the purpose of this review article is to outline the pathophysiology of infantile colic, as well as the treatment choices and prognosis for the condition. There are a few potential treatments for infantile colic, the most prominent of which is the use of probiotics, specifically lactobacillus. The most compelling evidence in support of probiotics comes from the prevention or treatment of these five conditions: necrotizing enterocolitis, acute infectious diarrhea, acute respiratory tract infections, antibiotic-associated diarrhea, and newborn colic. Inhibition of bacterial adhesion, improvement of mucosal barrier function, manipulation of both the innate and adaptive immune systems, release of bioactive metabolites, and control of the enteric and central nervous systems are some of the mechanisms of action that probiotics exhibit.

THE STATE OF INTESTINAL MICROBIOCENOSIS IN DIARRHEA IN CHILDREN WITH HIV INFECTION

to study the state of intestinal microbiocenosis in diarrhea in HIV-infected children. During the study, 876 children under the age of 18 were examined. Healthy children - 130 people, group 1 - 261 children with HIV infection with diarrhea, group 2 - 247 children with only diarrhea without HIV infection and group 3 - 238 children with HIV infection without diarrhea. In HIV-infected children with acute diarrhea, there was a sharp decrease in obligate (Bacteroides spp., Bifidobacterium spp., Lactobacillus spp., E. coli lac+) and an increase in facultative intestinal microflora (E. coli lac-, Enterobacter spp., Enterococcus spp. ., Staphylococcus spp.). High values of Candida spp., Salmonella, Shigella, Cambilobacter, Yersinia were also recorded (P&gt;0.05). This probably indicates the development of invasive diarrhea. High dysbiotic changes in acute infectious diarrhea in HIV-positive children require the introduction of drugs that restore intestinal microbiocenosis into their treatment regimen.

Shigellosis attended in the emergency department of a regional hospital in southeastern Spain: from their presence to multiresistance

In the bacterial etiology of severe acute infectious diarrhea, except that caused by Clostridioides difficile, most of them have an invasive character and antibiotic treatment will be necessary in specific situations. Shigella is a classic pathogen, in which it is crucial to know the sensitivity to different classic and alternative antimicrobials. The objective of this work was to analyze the presence of shigellosis and the rate of antibiotic resistance. A descriptive-retrospective study of the reports of shigellosis of stool cultures issued between January 2016 and April 2022 was conducted. A total of 34 episodes (16 -47.1%- by Shigella sonnei) were observed, as of 2018. There were only 2 pediatric cases. The overall resistance rate to azithromycin, trimethoprim-sulfamethoxazole and ciprofloxacin was 52.9%, 64.7% and 44.1%, respectively. 26.5% were resistant to the 3 groups of antibiotics. There was a higher rate of resistance for S. sonnei. The emergence of resistance to cephalosporins in recent years stands out. Episodes of multidrug-resistant shigellosis were detected between 2020 (1 by S. flexneri) and 2022 (4 by S. sonnei). The episodes of shigellosis are emerging in our environment with a higher rate of multi-resistance. In this context, current empirical treatments for acute enteroinvasive enteritis are at risk of failure, if necessary.