Acute Infectious Diarrhea Research Articles

Efecto del zinc aminoquelado y el sulfato de zinc en la incidencia de la infección respiratoria y la diarrea en niños preescolares de centros infantiles

Introduction: Zinc deficiency is common in children among populations in developing areas. Zinc deficiency alters the immune system and the resistance to infections.Objective: To evaluate the effect of two zinc compounds in the prevention of acute respiratory infection and acute diarrhea.Materials and methods: Randomized triple-blind community trial with 301 children between 2-5 years of age from six child daycare centers in Medellin, Colombia. Children were distributed in three groups receiving zinc amino acid chelate, zinc sulfate and placebo five days a week for 16 weeks. Daily symptoms of respiratory infection, acute diarrhea and side effects were evaluated.Results: The incidence of respiratory infection was lower with zinc amino acid chelate (1.42 per 1,000 child-days) compared with placebo (3.3 per 1,000 child-days) (RR=0.43, 95% CI: 0.196 to 0.950, p=0.049) and with zinc sulfate (1.57 per 1,000 child-days) (RR=0.90, 95% CI 0.382 to 2.153, p=0.999). The incidence of acute diarrhea with zinc amino acid chelate (0.15 per 1,000 child-days) was lower than with placebo (0.49 per 1,000 child-days) (RR=0.32, 95% CI 0.006 to 3.990, p=0.346) and with zinc sulfate (0.78 per 1,000 child-days) (RR=0.20, 95% CI: 0.0043 to 1.662, p=0.361).Conclusions: Zinc amino acid chelate had a better effect in reducing the incidence of acute respiratory infection and acute diarrhea in preschool children when compared with the other groups.Identifier in clinicaltrials.gov: NCT01791608

Effect of zinc amino acid chelate and zinc sulfate in the incidence of respiratory infection and diarrhea among preschool children in child daycare centers

Zinc deficiency is common in children among populations in developing areas. Zinc deficiency alters the immune system and the resistance to infections. To evaluate the effect of two zinc compounds in the prevention of acute respiratory infection and acute diarrhea. Randomized triple-blind community trial with 301 children between 2-5 years of age from six child daycare centers in Medellin, Colombia. Children were distributed in three groups receiving zinc amino acid chelate, zinc sulfate and placebo five days a week for 16 weeks. Daily symptoms of respiratory infection, acute diarrhea and side effects were evaluated. The incidence of respiratory infection was lower with zinc amino acid chelate (1.42 per 1,000 child-days) compared with placebo (3.3 per 1,000 child-days) (RR=0.43, 95% CI: 0.196 to 0.950, p=0.049) and with zinc sulfate (1.57 per 1,000 child-days) (RR=0.90, 95% CI 0.382 to 2.153, p=0.999). The incidence of acute diarrhea with zinc amino acid chelate (0.15 per 1,000 child-days) was lower than with placebo (0.49 per 1,000 child-days) (RR=0.32, 95% CI 0.006 to 3.990, p=0.346) and with zinc sulfate (0.78 per 1,000 child-days) (RR=0.20, 95% CI: 0.0043 to 1.662, p=0.361). Zinc amino acid chelate had a better effect in reducing the incidence of acute respiratory infection and acute diarrhea in preschool children when compared with the other groups.

Medikamentöse Therapie der infektiösen Diarrhö

Diarrheal diseases are among the most common diseases worldwide. In this review the current treatment recommendations for acute (Part 1) and chronic (Part 2) infectious diarrhea are summarized and typical enteropathogens are discussed. The second part of the article describes chronic diarrhea, its related pathogens and treatment. In contrast to acute diarrhea which is mainly caused by viral and typical bacterial pathogens, chronic diarrhea has mainly non-infectious origins. Protozoal pathogens, such as Giardia lamblia and Entamoeba histolytica in particular are found and more rarely bacterial pathogens, such as Tropheryma whipplei. Opportunistic pathogens cause diarrhea in immunocompromised patients, such as in HIV patients. In these patients cytomegalovirus (CMV) colitis or infections with Cryptosporidium spp., Cyclospora cayetanensis, Isospora belli or microsporidia have to be considered. Besides targeted specific antimicrobial therapy, anti-retroviral drugs improving the underlying immunosuppression and thus the reconstitution of the adaptive immune response remain a cornerstone of the treatment in HIV-positive patients.

Crofelemer for the treatment of chronic diarrhea in patients living with HIV/AIDS

Diarrhea is a common comorbidity present in patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) who are treated with highly active antiretroviral therapy. With a multifactorial etiology, this diarrhea often becomes difficult to manage. In addition, some antiretrovirals are associated with chronic diarrhea, which potentially creates an adherence barrier to antiretrovirals and may ultimately affect treatment outcomes and future therapeutic options for HIV. A predominant type of diarrhea that develops in HIV patients has secretory characteristics, including increased secretion of chloride ions and water into the intestinal lumen. One proposed mechanism that may lead to this type of secretory diarrhea is explained by the activation of the cystic fibrosis transmembrane conductance regulator and calcium-activated chloride channels. Crofelemer is a novel antidiarrheal agent that works by inhibiting both of these channels. The efficacy and safety of crofelemer has been evaluated in clinical trials for various types of secretory diarrhea, including cholera-related and acute infectious diarrhea. More recently, crofelemer was approved by the US Food and Drug Administration for the symptomatic relief of noninfectious diarrhea in adult patients with HIV/AIDS on antiretroviral therapy. Results from the ADVENT trial showed that crofelemer reduced symptoms of secretory diarrhea in HIV/AIDS patients. Because crofelemer is not systemically absorbed, this agent is well tolerated by patients, and in clinical trials it has been associated with minimal adverse events. Crofelemer has a unique mechanism of action, which may offer a more reliable treatment option for HIV patients who experience chronic secretory diarrhea from antiretroviral therapy.

Probiotics and Prebiotics in Infants and Children

Probiotics and prebiotics have a major influence on gastrointestinal flora composition. This review analyses the relationship between this change in flora composition and health benefits in children. Literature databases were searched for relevant articles. Despite exhaustive research on the subject in different indications, such as prevention and treatment of acute gastroenteritis, antibiotic associated diarrhea (AAD), traveler's diarrhea, inflammatory bowel disease, irritable bowel syndrome, Helicobacter pylori, necrotizing enterocolitis, constipation, allergy and atopic dermatitis, colic and extraintestinal infections, reports of clear benefits for the use of prebiotics and probiotics in pediatric disorders remain scarce. The best evidence has been provided for the use of probiotics in acute gastroenteritis and in prevention of AAD. However, AAD in children is in general mild, and only seldom necessitates additional interventions. Overall, the duration of acute infectious diarrhea is reduced by approximately 24hours. Evidence for clinically relevant benefit in all other indications (inflammatory bowel disease, irritable bowel syndrome, constipation, allergy) is weak to nonexistent. Selected probiotic strains given during late pregnancy and early infancy decrease atopic dermatitis. Adverse effects have very seldom been reported. Since the risk seems minimal to nonexistent, prebiotics and probiotics may be helpful in the prevention and treatment of some disorders in children, although the evidence for benefit is limited. The best evidence has been accumulated for some lactobacilli strains and for Saccharomyces boulardii in the reduction of the duration of acute diarrhea due to gastroenteritis and prevention of AAD.

Clinical applications of the use of probiotics in pediatrics

The use of probiotics supposes a novel advance in the field of Pediatrics since they can be useful in the prevention and treatment of many gastrointestinal pathologies, constituting one more element in our therapeutic arsenal. This article presents an updated review of the scientific literature on the use of probiotics in paediatrics, mainly in gastrointestinal problems with alteration in the intestinal microbiota describing the main applications of the use of probiotics and prebiotics in childhood and reviewing the future lines of research. Although there enough scientific evidence in various pathologies, the use of probiotics is not entirely incorporated into the clinical practice of pediatricians. It is used in the context of the gastrointestinal diseases (acute infectious diarrhea, diarrhea associated with antibiotics, bacterial overcast) and, more recently, in chronic inflammatory processes such as inflammatory bowel disease or functional disorders as colic infant or constipation. Also have been assessed their beneficial effect in extraintestinal alterations, such as the allergies (atopic dermatitis) or the effects on respiratory or urogenital mucosae and, in recent years, in the prevention of pathology of the preterm newborn and in the H. pylori infection. In addition there are several lines of research open in nutritional supplementation with probiotics. and prebiotics. Each strain probiotics should be studied individually and extensively to determine its efficacy and safety in all situations in which their employment may be advisable.

Campylobacteriose-Ausbrüche in Hessen, 2005-2011 - und immer wieder Rohmilch

Campylobacter is the most frequently reported cause of acute infectious diarrhea in Germany. Campylobacter outbreaks are rare events. However, their investigation provides useful information on risks of infection and unused prevention potentials. We analyzed the Hessian database for notifiable diseases for cases of campylobacteriosis reported from 2005 through 2011. For campylobacter outbreaks including five or more cases we prospectively obtained additional information from local public health authorities. From 2005 through 2011, 29,473 cases of campylobacteriosis were reported in Hesse, Germany (approx. 6 million inhabitants), yielding an annual incidence ranging from 53.4 to 81.4 cases per 100,000 inhabitants. Only 236 cases were part of 16 outbreaks with five or more cases. Among these, six outbreaks occurred among groups traveling outside Germany, four were associated with the consumption of raw milk. For eight outbreaks consumption of poultry was considered a probable or - based on the frequent consumption of poultry during group travel - possible vehicle of infection. Two of the raw-milk associated outbreaks were reported among two groups who visited the same farm within 18 days. Five of 14 members of several families and 77 of 117 students fell sick. The local public health authority was only informed when both groups had visited the farm. The reported outbreaks can be attributed to known risk factors for campylobacteriosis - consumption of raw milk and poultry and international travel. This underlines that prevention possibilities are insufficiently used. These include avoiding the consumption of unpasteurized milk and milk products, the hygienically correct handling of raw poultry and timely identification and notification of outbreaks to public health authorities.

Acute diarrhea associated with Salmonella enterica in Belo Horizonte-MG: prevalence and characterization of isolates

Introduction: Acute infectious diarrhea is still regarded as a public health problem associated with a wide range of etiologic agents, from which Salmonella enterica is particularly worth mentioning inasmuch as it is a major cause of inflammatory diarrhea in both developed and developing countries. Objective: To assess the distribution of S. enterica among children with acute diarrhea in Belo Horizonte and to characterize bacterium isolates. Material and methods: The study group comprised a total of 157 children from low socioeconomic background. Stool samples were collected for leukocyte analysis and Salmonella bacterial culture. The isolates were serotyped and evaluated as to antimicrobial susceptibility profile, extended-spectrum β-lactamases (ESBL) production, and presence of virulence markers (invA, iroB, and spvC). RESULTS: A total of 5/3.2% children were infected by S. enterica, 3/60% by S. enterica Typhimurium, 1/20% by S. enterica Enteritidis and 1/20% S. enterica subsp. enterica serotype 8.20:z4,z23:-. Fecal leucocytes were detected in two out of five fecal specimens positive for S. enterica. Isolates from three children were resistant to nalidixic acid, nalidixic acid + chloramphenicol, and nalidixic acid + chloramphenicol + ampicillin. ESBL production was not detected. All samples presented invA and iroB genes. spvC marker was observed in isolates from two children infected by S. Typhimurium and S. Enteritidis. Conclusion: The results demonstrate that S. enterica infection is uncommon among children from our region. Furthermore, they indicate the need for periodic monitoring of bacterial antimicrobial susceptibility profile in order to establish suitable antimicrobial therapy when required.

Infectious Diarrhea and Dehydration in Childhood

Hulya Cakmur, Kafkas Universitesi Tip Fakultesi Aile Hekimligi Anabilim Dali Kars, Turkiye, Tel. 0532 5935058 Email. hulyacakmur@gmail.com Gelis Tarihi: 23.02.2012 • Kabul Tarihi: 31.08.2012 ABSTRACT Acute infectious diarrhea is still a major problem through the world, although its greatest impact is in the poor, lessdeveloped countries where more than four million pre-school children die each year. The median number of diarrheal episodea in children less than three years of age in under-developoed countries is between two and six per year.

Detection of 13 Enteric Bacteria and 5 Viruses Causing Acute Infectious Diarrhea Using Multiplex PCR from Direct Stool Specimens

Detection of 13 Enteric Bacteria and 5 Viruses Causing Acute Infectious Diarrhea Using Multiplex PCR from Direct Stool Specimens

Causes of Infectious Acute Diarrhea in Infants Treated at Pediatric Clinic

The aim of this work has been a presentation of causes of acute infectious diarrhea. The examinees have been the infants treated at the Pediatric Clinic. The diagnosis has been established on the basis ofanamnesis, physical examination and feces examination on bacteria, viruses, protozoa and fungi. During the period of seven years a number of patients that suffered from acute infectious diarrhea was 1050 (31.82%) out of a total number (3300) with diarrhea. The bacteriological examination proved positive on majority of them or in 655 (62.38%) cases, the viral examination proved positive in 375 (35.72%) cases, whereas fungi examination proved positive in only 3 cases (0.28%). The most frequent bacteria have been Salmonellae species in 255 (38.93%) cases and E. coli in 142 (21.69%) cases, the less frequent have been Yersinia enterocolitica in 16 (2.44%) cases and Bacillus cereus in 4 (0.61%) cases. The most frequent serotypes of Salmonella have been S. Wien in 92 (36.07%) and S. Gloucester in 42 (16.47%) cases. Enteropathogenic E. Coli (most frequent serotypes O111 and O55) has been found in 112 (78.88%) cases. From the group of Shigella the most frequent has been Sh. Flexneri (most frequent serotypes 6 and 4) in 35 (58.33%) cases. The same feces sample of the majority of examinees 501 (76.48%) cases contained only one bacteria (single bacteria), two bacteria (associated bacteria) have been found in 102 (15.17%) cases, three types of bacteria have been found in 17 (2.59%) cases. Rotavirus has been isolated in 271 (72.26%) cases in comparison to adenoviruses that have been isolated in 65 (17.33%) cases. Rotavirus and adenoviruses have been isolated in 39 (10.40%) cases. Infectious acute diarrhea appears frequently, and as causes of it usually appear to be pathogenic bacteria in comparison to viruses, protozoa and fungi.

Laboratory Diagnostic Challenges in Case/Control Studies of Diarrhea in Developing Countries

Case/control studies of acute infectious diarrhea require accurate and dependable laboratory tests to detect pathogens in samples from both symptomatic patients and healthy control subjects. The methods used to detect these pathogens have usually been evaluated on patient samples only, and their performance on samples from control subjects is mostly unknown. Because many pathogens occur at a high overall frequency in developing countries and thus may be present in a notable proportion of control subjects as well as patients, the relative ability of a diagnostic test to detect these pathogens in diarrheic and normal stools can have a profound effect on the interpretation of case/control data.

Acute Infectious Diarrhea Lessons Learned From the Past?

The Journal of Pediatric Gastroenterology and Nutrition (JPGN) has been at the forefront of many of the seminal advances into research on infectious diarrhea. In 1982, the first article of the JPGN was entitled “Oral Therapy for Dehydration in Diarrheal Diseases as a Global Problem” and has set the scene for several thousand subsequent articles. In his initial editorial, Finberg (1) posed several questions, which still have relevance 30 years later: 1. When is oral rehydration not appropriate, if ever? 2. What should be the composition of the oral solution and should there be more than one? 3. Should recommended practice be different in lesser-developed countries from those in developed countries? 4. Should the salts and glucose be prepackaged or should home supplies be used by instructed mothers? 5. When should standard feedings be resumed?

Understanding gut-immune interactions in management of acute infectious diarrhoea

This article discusses the role that immunity plays in the risk of diarrhoea and the potential role for probiotics in the management of acute infectious diarrhoea in older people, including antibiotic-associated diarrhoea and Clostridium difficile-associated diarrhoea.

The Effect of Lactobacillus GG on Acute Diarrheal Illness in the Pediatric Emergency Department

The purpose of this study was to evaluate the effectiveness of the probiotic Lactobacillus GG (LGG) in reducing the duration of acute infectious diarrhea in the pediatric emergency department. We conducted a double-blind, randomized controlled trial of children 6 months to 6 years presenting to the pediatric emergency department with a complaint of diarrhea. Patients were randomized to receive either placebo or LGG powder twice daily for 5 days. With each dose, parents recorded the stool history in a home diary and were followed up daily by a blinded researcher. Groups were compared in terms of time to normal stool and number of diarrheal stools. Of 155 patients enrolled, 129 completed the study: 63 in the LGG group and 66 in the placebo group. There was no significant difference in the median (interquartile range) time to normal stool (LGG: 60 hours [37-111] vs placebo: 74 hours [43-120]; P = 0.37) or the number of diarrheal stools (LGG: 5.0 [1-10] vs placebo: 6.5 [2-14]; P = 0.19). Among children who presented with more than 2 days of diarrhea, the LGG group returned to normal stool earlier (LGG: 51 hours [32-78] vs placebo: 74 hours [45-120]; P = 0.02), had fewer episodes of diarrheal stools (LGG: 3.5 [1.0-7.5] vs placebo: 7 [3.0-16.3]; P = 0.02), and were 2.2 times more likely to return to normal stool (95% confidence interval, 1.3-3.9; P = 0.01) compared with children in the placebo group. Lactobacillus GG may reduce the duration of acute diarrheal illness among children presenting with more than 2 days of symptoms.

Serum C-Reactive Protein (CRP) Levels in Young Adults Can Be Used to Discriminate Between Inflammatory and Non-inflammatory Diarrhea

To determine if the level of serum C-reactive protein (CRP) can be used to differentiate between inflammatory diarrhea and non-inflammatory diarrhea in patients with acute infectious diarrhea or acute gastrointestinal infection. This was a retrospective study based on medical records from a single military hospital located in Daejeon, Republic of Korea. The records of 1,085 patients who presented with abdominal pain, fever (≥ 37.8 °C), and diarrhea between May 2008 and May 2011 were reviewed, and 538 patients were selected. The eligible patients had undergone abdominal contrast tomography (CT) or colonoscopy within 3 days and blood sampling on the day of admission. The selected patients were divided into two groups on the basis of their abdominal CT or colonoscopy findings: group A, the inflammatory diarrhea group (n = 234), and group B, the non-inflammatory diarrhea group (n = 304). We then compared the clinical and laboratory characteristics of these two groups. Erythrocyte sedimentation rate and CRP levels were significantly higher in group A (inflammatory diarrhea) patients than group B (non-inflammatory diarrhea) patients (16.47 ± 5.46 vs. 15.29 ± 5.72 (P < 0.05), respectively, and 4.92 ± 2.49 vs. 1.79 ± 0.95 (P < 0.05), respectively). Multivariate analysis revealed that CRP level on admission was the most important predictor of inflammatory diarrhea (OR 7.39, P < 0.05). Receiver operating characteristic analysis results also showed that CRP had the highest area-under-the-curve value (0.91; 95 % confidence interval 0.88-0.93; P < 0.05) for distinguishing inflammatory diarrhea from non-inflammatory diarrhea. At a cut-off level of 3.08 mg/dL, CRP had a sensitivity of 82 % and a specificity of 85 %. CRP as a diagnostic marker of inflammatory diarrhea was superior to the other inflammatory markers and clinical characteristics we evaluated in this study. A patient's CRP level on admission may aid clinical decision-making, for example initiating empiric antibiotics therapy and/or performing additional clinical tests.

The Chronic Gastrointestinal Consequences Associated With Campylobacter

Campylobacteriosis is a leading cause of acute infectious diarrhea in the developing world, where it causes considerable mortality, and in developed countries, where it accounts for significant healthcare and other costs. Evidence has emerged from basic science, clinical, and epidemiological domains that suggests that Campylobacter infection is not limited to acute illness but is also involved in the development of well-described extraintestinal sequelae, such as the Guillain-Barré syndrome and reactive arthritis, and may also contribute to the pathogenesis of chronic gastrointestinal conditions. This review will focus on the role of Campylobacter infection as a risk factor for the development of chronic gastrointestinal sequelae, such as functional gastrointestinal disorders, with which irritable bowel syndrome has been most frequently associated, inflammatory bowel disease, and celiac disease.

Continuing Medical Education: July 2012

Chronic Gastrointestinal Consequences of Acute Infectious Diarrhea: Evolving Concepts in Epidemiology and Pathogenesis The American College of Gastroenterology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American College of Gastroenterology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Anti-infective bovine colostrum oligosaccharides: Campylobacter jejuni as a case study

Campylobacter jejuni is the leading cause of acute bacterial infectious diarrhea in humans. Unlike in humans, C. jejuni is a commensal within the avian host. Heavily colonized chickens often fail to display intestinal disease, and no cellular attachment or invasion has been demonstrated in-vivo. Recently, researchers have shown that the reason for the attenuation of C. jejuni virulence may be attributed to the presence of chicken intestinal mucus and more specifically chicken mucin. Since mucins are heavily glycosylated molecules this observation would suggest that glycan-based compounds may act as anti-infectives against C. jejuni. Considering this, we have investigated naturally sourced foods for potential anti-infective glycans. Bovine colostrum rich in neutral and acidic oligosaccharides has been identified as a potential source of anti-infective glycans. In this study, we tested oligosaccharides isolated and purified from the colostrum of Holstein Friesian cows for anti-infective activity against a highly invasive strain of C. jejuni. During our initial studies we structurally defined 37 bovine colostrum oligosaccharides (BCO) by HILIC-HPLC coupled with exoglycosidase digests and off-line mass spectroscopy, and demonstrated the ability of C. jejuni to bind to some of these structures, in-vitro. We also examined the effect of BCO on C. jejuni adhesion to, invasion of and translocation of HT-29 cells. BCO dramatically reduced the cellular invasion and translocation of C. jejuni, in a concentration dependent manner. Periodate treatment of the BCO prior to inhibition studies resulted in a loss of the anti-infective activity of the glycans suggesting a direct oligosaccharide-bacterial interaction. This was confirmed when the BCO completely prevented C. jejuni binding to chicken intestinal mucin, in-vitro. This study builds a strong case for the inclusion of oligosaccharides sourced from cow's milk in functional foods. However, it is only through further understanding the structure and function of milk oligosaccharides that such compounds can reach their potential as food ingredients.

A Comment on “Enteroendocrine and Neuronal Mechanisms in Pathophysiology of Acute Infectious Diarrhea” by Camilleri, Nullens and Nelsen

A Comment on “Enteroendocrine and Neuronal Mechanisms in Pathophysiology of Acute Infectious Diarrhea” by Camilleri, Nullens and Nelsen