Acute Infectious Diarrhea Research Articles

Enteric pathogens implicated in acute infectious diarrhea among young children in resource-limited region with rapidly growing population: a hospital-based cross-sectional study.

Acute infectious diarrhea is among the leading causes of morbidity and mortality worldwide, particularly in developing countries and among children younger than 5 years of age. To determine the causative microorganisms in diarrhea and elucidate their epidemiological trajectory among children younger than 5 years of age to establish successful preventive measures. This cross-sectional study was conducted in Al-Musayyib District, Babil Governorate, Iraq, using data from January 2023 to January 2024 provided by the information system of Ibn Saif Children's Hospital and Al-Musayyib General Hospital. Data from 300 children under 5 years of age with infectious diarrhea were collected to determine the causative pathogens. Patient data including sex, age, treatment, and post-treatment clinical condition, were collected from the hospital archive and analyzed. Overall, 56% of males and 44% of females had diarrhea. The 1-2-year age group was the most susceptible to diarrhea (33.3%). This rate gradually decreased with age, reaching 9.9% in the 4-5-year age group. Furthermore, bacteria were the causative organisms in 43% of cases, followed by viruses, parasites, and fungi at 24.7%, 12%, and 7.7%, respectively. Mixed infections were detected in 12.6%. Post-treatment, 89.7% of patients completely recovered, 8% experienced physiological disorders, and 2.3% died. Bacteria were the most common causative organisms of infectious diarrhea among children younger than 5 years of age. Children in the 1-2-year age group were the most commonly affected. This study highlights that diarrhea continues to threaten the lives and well-being of children.

Epidemiology of Acute Infectious Diarrhea-Associated Viruses in Children in Hangzhou, China, 2023

Abstract Objective To investigate the epidemiological characteristics of children infected with diarrheal virus in Hangzhou, China, 2023. Methods From January 2023 to December 2023, 20,939 stool samples from children with acute infectious diarrhea were collected for the detection of rotavirus A and human adenovirus (HAdV), using latex agglutination detection kits; 7,584 stool samples were collected for the detection of norovirus, using real-time polymerase chain reaction reagent. Results A total of 639 (3.0%, 639/20,939) tested positive for rotavirus A, and 1,201 (5.7%, 1,201/20,939) positive samples were detected by colloidal gold method. The positive rates of norovirus were 42.2% (3,203/7,585). Among all age groups, the rotavirus A positive detection rate was the highest in participants aged 3 to 6 years (6.46%, 260/4,024). The monthly distribution of patients with rotavirus A showed that the number of cases was the lowest in October (0.45%, 8/1,779) and reached the peak in April (7.97%, 144/1,806). The highest and lowest positive rates among all age groups for HAdV were found in children aged 3 to 6 years(8.27%, 333/4,024) and in those aged 0 to 6 months (2.21%, 60/2,717). The monthly positivity rates of HAdV spanning from January to November 2023 were 1.38, 1.44, 2.34, 3.65, 6.64, 7.71, 7.54, 7.13, 6.82, 4.15, and 6.50%, and reached the peak in December (8.17%). For norovirus, children aged 1 to 3 years had the highest positive detection rate (57.95%, 1,349/2,328), while infants aged 0 to 6 months had the lowest positive detection rate (19.60%, 205/1,046). The results show that January had the lowest number of cases (14.63%, 6/41), while September had the highest (50.51%, 545/1,079). Conclusion The detection rate of rotavirus A and HAdV was highest among participants aged 3 to 6 years, whereas the detection rate of norovirus was highest among those aged 1 to 3 years. The monthly distribution peaks for the three enteric viruses varied significantly.

Zinc as a treatment modality for acute infectious diarrhea in children.

Zinc as a treatment modality for acute infectious diarrhea in children.

Acute Toxicity and In vivo Antidiarrhoeal Activity of Ethanol Extract and Fractions of Ipomoea triloba by Model Infection and Protection Tests in Mice against Selected Clinical Diarrhoeagenic Bacterial Isolates

Aim: This research work was aimed at investigating the acute toxicity and in vivo antidiarrhoeal activity of the extracts and fractions of Ipomoea triloba, a plant used locally for the treatment of acute infectious diarrhoea in order to investigate its safety profile. Study Design: 20 diarrhoeaic Clinical stool samples were collected and implicating organisms were isolated. Place and Duration of Study: Department of Pharmaceutical Microbiology and Biotechnology, University of Uyo AkwaIbom State, South-South Nigeria between May 2021-December, 2022. Methodology: Antibiogram, Plasmid curing and Intraperitoneal assay of acute toxicity and mouse protection test of the ethanol extract of plant were carried out on the bacterial-diarrhoeaic isolates. Results: Antibiogram by the agar-diffusion technique indicated a predominant resistance by the isolates. Plasmid curing assessment for antidiarrhoeal activity indicated a predominantly plasmid-borne resistance. Combined antidiarrhoeal activity of the ethanol extract and fractions of Ipomoea triloba with standard antibiotic (tetracycline), assessed by the activity index profile (AIP), showed a reduction in the in antagonistic activity and an increase in protective efficacy after plasmid curing. Acute toxicity (LD50) assay in albino mice (15.0-18-0 g body weight) indicated that the ethanol extract of Ipomoea triloba showed relative non-toxicity with an estimated value of 946.68 mg/kg body weight. In vivo antidiarrhoeal activity and protection efficacy of the ethanol extract assayed by mouse protection test (MPT) infection model offered appreciable (50.0 - 83.3%) protection to the bacterial-diarrhoeaic isolates challenged mice, compared with the relatively moderate (33.3 - 50.0%) protection by the control. Conclusion: There is need for further studies to elucidate the active principles responsible for the antidiarrhoeal activity of Ipomoea triloba in order to establish its structure activity relationship, this then can be introduced into the treatment regimen as a plausible remedy against acute hypersecretory infectious diarrhoea because of its safety profile which has been established in this work.

Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries.

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. We used the IMCI and GTFCC guidelines to define severe dehydration and quantitative polymerase chain reaction-based attribution models to assign the etiology of diarrhea associated with severe dehydration. The IMCI or GTFCC guidelines classified 2284 of the 5304 (43%) cases with moderate-to-severe diarrhea 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 intravenous hydration and hospitalization. Rotavirus (30.9%), Cryptosporidium (12.0%), and heat-stable (ST) enterotoxigenic Escherichia coli (ETEC) (10.3%) were the most common pathogens for ages 0-11 months, while Shigella/enteroinvasive E coli (EIEC) (25.8%), rotavirus (19.3%), and ST-ETEC (10.9%) were the most common for ages 12-23 months. Shigella/EIEC (25.9%), Vibrio cholerae (10.4%), and rotavirus (9.2%) were the most common among ages 24-59 months. 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.

Relation between Irritable Bowel Syndrome and Acute Infectious Gastroenteritis in Children

Abstract Background Post-infectious irritable bowel syndrome (PI-IBS) has been defined as a new onset of IBS following an episode of acute infectious diarrhea. Objective To determine the frequency of postinfectious irritable bowel syndrome (PI-IBS) among children who have an episode of acute infectious diarrhea. Subjects and Methods A case control longitudinal study was conducted on 93 children who fulfilled the criteria for diagnosis of acute infectious gastroenteritis. Patients were recruited from the Outpatient Clinic, Children’s Hospital, Ain Shams University, during a period of 6 months and were followed up for 3 months for the development of symptoms of IBS according to Rome IV criteria for diagnosis of IBS. They were compared to 100 age- and sex-matched controls who do not have history of acute infectious gastroenteritis during the last 3 months before enrollment. Result The age of studied cases ranged between (4-15) years old with a mean ±SD=9.26 ± 3.20 years. Females represented 61.3% of cases. PI-IBS occurred in 14%of cases with age ranged between (4-14) years old and females represented 61.5% of PI-IBS cases. Meanwhile, the incidence of IBS 3.2% of uninfected controls (relative risk, RR = 4.33). Most cases of PI-IBS were diarrhea prominent. There was no significant association with the causative organism identified among cases. Rota virus represented the most common organism among our patients with incidence of (32.3%) followed by campylobacter, salmonella, adeno virus, and giardia with incidence of (9.7%), (8.6%), (5.4%), (6.5%), respectively, while (37.6%) of patients have negative stool cultures for the mentioned organisms. Conclusion The frequency of PI-IBS is common among pediatrics but does not seem to be associated with the causative organism of the preceding episode of infectious diarrhea. Raising the awareness about this entity is of outmost importance as this will allow targeted treatment.

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.

Molecular Study of Viral Causes of Childhood Diarrhea in Western Maharashtra

ABSTRACT Introduction: Although diarrheal diseases are highly preventable, they remain one of the leading causes of mortality and morbidity in the pediatric population in developing countries. Knowledge of etiological agents is essential to implement public health programs. Viral infections are the most common cause of acute infectious diarrhea among children. There is a paucity of information regarding viral enteropathogens responsible for diarrhea in India, as many hospitals do not routinely carry out diagnostic tests for viral detection. Aim and Objectives: To estimate the prevalence of viral enteropathogens in children under five years of age presenting with acute diarrhea using real-time multiplex polymerase chain reaction (PCR) and its correlation with clinico-demographic features. Methodology: A cross-sectional study was carried out in a tertiary care center in Maharashtra from January 2016 to June 2019. Our study included 300 children who were under five years old with acute diarrhea. Standard protocols were advocated for the collection and transportation of stool samples. All samples were subjected to real-time multiplex PCR (Light cycler 480 Roche) using Fast Track Diagnostic kits for viral gastroenteritis. Data analysis was done using descriptive and analytical methods. Results: In our study, 57% of samples were positive for viral enteropathogens. Rotavirus (32%) was the most common isolate, followed by Norovirus Genogroup II (GII) (17%). The majority of pathogens were isolated from children less than 2 years of age. Conclusion: There is a need to test stool specimens of clinically confirmed diarrheal patients for enteric virus. This will avoid blind antibiotic treatment.

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

Antidiarrheal effect of Psidium guajava L. extract in acute diarrhea: a systematic review.

Acute diarrheal diseases are a leading cause of childhood mortality and morbidity worldwide. Psidium guajava has been globally used for its antidiarrheal potential. We conducted a systematic review of scientific articles published up to the year 2021, which included in vivo pre-clinical tests and clinical trials involving patients with acute infectious diarrhea to verify the antidiarrheal, antibacterial and antispasmodic effects of galenic preparations or phytopharmaceuticals from P. guajava. PRISMA and Rayyan were used as tools for the selection of studies collected in four databases (Pubmed, Scopus, Web of Science and Science Direct). The keywords used to carry out the search were: 'Psidium guajava', 'guava', 'antidiarrhe*' and 'diarrhe*', joined by Boolean operators 'OR' or 'AND'. The characteristics of studies in animal models of acute diarrhea induction, as well as in vivo and in vitro motility and microbiological tests linked with its main pathophysiological mechanisms, were collected. Twenty-three articles were included. Twenty (87%) of these reported heterogenic preclinical studies, predominating pharmacological studies of efficacy against conventional antidiarrheal agents, which utilized relevant outcomes and models of infectious diarrhea from the top pathogens in the clinic along with classical castor oil-induced diarrhea associated with motility tests. Only three articles (13%) corresponded to clinical trials investigating the efficacy, dose and safety of these preparations. Most studies reported positive results and significant mechanistic evidence from antibacterial, anti-motility, anti-secretory and protective/anti-inflammatory perspectives. However, further studies are needed to define the clinical significance and safety treatment with P. guajava extracts. © 2024 Society of Chemical Industry.

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.