Acute Infectious Gastroenteritis Research Articles

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.

S2k Leitlinie akute infektiöse Gastroenteritis im Säuglings-, Kindes- und Jugendalter – Update 2024

The aim of the interdisciplinary S2k guideline "Acute infectious gastroenteritis in infants, children and adolescents" is to summarise the current state of knowledge on the clinical presentation, diagnosis, treatment, prevention and hygiene of acute infectious gastroenteritis, including nosocomial gastrointestinal infections, in infants, children and adolescents on the basis of scientific evidence, to evaluate it by expert consensus and to derive practice-relevant recommendations from it. The guideline provides a corridor for action for frequent decisions. It also serves the purpose of evidence-based further education and training and is thus intended to improve the medical care of children with acute gastroenteritis. In particular, the guideline aims to avoid unnecessary hospitalisation of children with AGE and to take preventive measures to avoid and spread infection.

Experience of using a probiotic containing <i>Lactobacillus reuteri</i> B-9448 in children with acute infectious gastroenteritis

The article presents literature data on the relationship of disorders of the gastrointestinal tract with its microbiota in acute intestinal infections, as well as information on various beneficial properties of the probiotic microorganism Lactobacillus reuteri, including antagonistic effects on pathogenic and opportunistic pathogens, anti-inflammatory and immunomodulatory effects. The clinical and laboratory effectiveness of the use of a probiotic containing the Lactobacillus reuteri B-9448 strain in children with acute infectious gastroenteritis hospitalized. It was found that patients who received this probiotic in complex therapy spent significantly fewer bed days in the hospital compared to children who were not prescribed probiotic. At the same time, no undesirable side effects were registered in the group of patients treated with Lactobacillus reuteri B-9448, which indicates its safety.

Effects of probiotics in children with acute gastroenteritis: A systematic review and meta-analysis focusing on probiotics utilized in Japan

BackgroundMany randomized controlled trials and systematic reviews have evaluated the use of probiotics to treat acute infectious gastroenteritis. However, most probiotic species evaluated in previous large randomized controlled trials are unavailable in Japan. Our objective was to investigate the efficacy of probiotics utilized in Japan for acute gastroenteritis. MethodsThe inclusion criterion was a randomized controlled study that compared probiotics with a placebo to treat children younger than 18 years with acute infectious gastroenteritis. We excluded studies that did not contain the following species available in Japan: Bifidobacterium spp., Lactobacillus acidophilus, Enterococcus faecium, Clostridium butyricum, and Bacillus subtilis and studies in low- or lower-middle-income countries.We searched PubMed, CENTRAL, and Igaku Chuo Zasshi from their inception to November 27, 2022.After the risk of bias assessment, data on diarrhea duration, number of hospitalizations, length of hospital stay, and adverse effects were extracted. ResultsFourteen studies were included in this meta-analysis. Diarrhea lasting longer than 48 h (7 articles, n = 878) was significantly lower in the probiotic group (risk ratio (RR) 0.70, 95 % confidence interval (CI) 0.59–0.83). The duration of diarrhea (14 articles; n = 1761) was 23.45 h (95 % CI 18.22–26.69) shorter in the probiotic group. Duration of hospitalization (6 articles; n = 971) was 17.73 h (95 % CI 6.9–28.56) shorter in the probiotic group. ConclusionsAlthough the certainty of evidence is very low, the use of probiotics for acute gastroenteritis in children may improve diarrhea approximately one day earlier.This study was registered with PROSPERO (CRD 42023405559).

Tinjauan Ketepatan Kode Diagnosa Gastroenteritis pada Pasien Rawat Inap di Rumah Sakit Umum Daerah Budhi Asih

The results of early observations at the Budhi Asih Hospital, on the medical record files of inpatients with a diagnosis of gastroenteritis, found that there were still coding errors. The Gastroenteric Code is divided into two, namely infectious gastroenteritis and non-infectious gastroenteritis. Infectious gastroenteritis can be coded A09.0 (acute infectious gastroenteritis) or A09.9 (unspecified infectious gastroenteritis). Meanwhile, non-infectious gastroenteritis can be coded K52.- and non-infectious gastroenteritis in neonates is coded P78.3.
 The completeness and accuracy of gastroenteritis coding comes from doctors and nurses who record information on the patient's condition, as well as coding officers providing coding. The purpose of this study was to determine the completeness and accuracy of coding in cases of gastroenteritis in hospitalized patients based on ICD-10.
 Keywords: Diagnostic code accuracy, Gastroenteritis, Discharge Summary.

All Vomit Is Not Viral

Duplication cysts are congenital malformations of the gastrointestinal tract. They are rare, occurring in 1 in 4,500 births.1 Although the age of symptomatic onset is typically 2 years, current literature shows reports of presentation from newborn to adulthood. Presentation of duplication cysts may vary widely and can occur during outbreaks of acute infectious gastroenteritis cases. Thus, it is important to consider these cysts in the differential diagnosis of the vomiting child. We report the case of a 7-year-old boy with persistent bilious vomiting who was found to have a bilobed duplication cyst. [ Pediatr Ann . 2023;52(7):e273–e276.]

An unusual outbreak of acute infectious gastroenteritis

An unusual outbreak of acute infectious gastroenteritis

Yersinia enterocolitica in Crohn's disease.

Increasing attention is being paid to the unique roles gut microbes play in both physiological and pathological processes. Crohn's disease (CD) is a chronic, relapsing, inflammatory disease of the gastrointestinal tract with unknown etiology. Currently, gastrointestinal infection has been proposed as one initiating factor of CD. Yersinia enterocolitica, a zoonotic pathogen that exists widely in nature, is one of the most common bacteria causing acute infectious gastroenteritis, which displays clinical manifestations similar to CD. However, the specific role of Y. enterocolitica in CD is controversial. In this Review, we discuss the current knowledge on how Y. enterocolitica and derived microbial compounds may link to the pathogenesis of CD. We highlight examples of Y. enterocolitica-targeted interventions in the diagnosis and treatment of CD, and provide perspectives for future basic and translational investigations on this topic.

Epidemiology and Economic Burden of Acute Infectious Gastroenteritis Among Adults Treated in Outpatient Settings in US Health Systems.

Acute infectious gastroenteritis (AGE) is a common reason for outpatient visits and hospitalizations in the United States. This study aimed to understand the demographic and clinical characteristics, common pathogens detected, health care resource utilization (HRU), and cost among adult outpatients with AGE visiting US health systems. A retrospective cohort study was conducted using one of the largest hospital discharge databases (PINC AI Healthcare Database) in the United States. Adult patients (aged ≥18 years) with a principal diagnosis of AGE during an outpatient visit between January 1, 2016, and June 30, 2021, were included. Pathogen detection analysis was performed in those with microbiology data available. Among 248,896 patients, the mean age was 44.3 years (range 18-89+ years), 62.9% were female, and 68.5% were White. More than half (62.0%) of the patients did not have any preexisting comorbidity, and only 18.3% underwent stool workup at the hospital. Most patients (84.7%) were seen in the emergency department, and most (96.4%) were discharged home. Within 30 days of discharge, 1.0% were hospitalized, and 2.8% had another outpatient visit due to AGE. The mean cost of the index visit plus 30-day AGE-related follow-up was $1,338 per patient, amounting to $333,060,182 for the total study population. Among patients with microbiology data available (n = 12,469), common pathogens detected were Clostridioides difficile (32.2%), norovirus (6.3%), and Campylobacter spp. (4.0%). AGE is a common and costly disease affecting adults of all ages and more females than males, including individuals with or without baseline conditions in a hospital-based outpatient setting. C. difficile was the most common pathogen detected.

Persistent Norovirus infection in a young patient with renal transplant: The challenging cost of immunosuppression and the negative impact on patient’s quality of life

Norovirus (NoV) is one of the most common causes of acute infectious gastroenteritis in the United States (US). The infection is typically short-lasting and self-limiting in immunocompetent hosts. Renal transplant recipients on immunosuppressive therapy are more prone to infectious gastroenteritis that can be caused by various common and opportunistic organisms. NoV infection in renal transplant patients presents as an acute diarrheal illness that may progress to a chronic infection with frequent relapses leading to adverse short-term complications (acute renal injury (AKI) and acute graft rejection from the reduction of the dose of immunosuppressive medications) and possibly long-term morbidities (malabsorption syndrome, and a decline in graft survival). The management of chronic NoV infections in renal transplant patients may be quite challenging, as no specific antiviral treatment is presently approved, and frequent adjustments of immunosuppressive therapy may be required in the setting of reduced renal clearance and the attempts to decrease immunosuppressive effects to enhance the viral clearance.Herein, the authors present a case of persistent NoV in a young female patient with a renal transplant that was associated with recurrent admissions with AKI, gross electrolyte disturbances, and significant weight loss. The relapsing NoV infection has negatively impacted the patient's quality of life and socioeconomic performance.

1997. Epidemiology and Burden of Acute Infectious Gastroenteritis Among Adult Outpatient Treated in United States Hospitals

Abstract Background Little is known about the epidemiology and burden of acute infectious gastroenteritis (AIG) among adult outpatients treated in United States (US) hospitals. We assessed the demographic and clinical characteristics, common pathogens detected, healthcare resource use (HRU), and cost among adult outpatients in US hospitals. Methods Using large geographically diverse PINC AI Healthcare Database data during January 1, 2016–June 30, 2021, we analyzed adult patients (≥ 18-year-old) with a principal diagnosis of AIG during an outpatient visit. Patients with a history of AIG within 30 days prior to the index visit and visits for diagnostic testing or surgery were excluded. Pathogen analysis was performed among those with microbiology data available. Results Among 248,896 eligible patients, the mean age was 44.3 years (range 18-89+), 62.9% were female, and 68.5% were White (Table 1). Most patients visited small (48.7%, 1-299 beds), non-teaching (60.4%), and urban (77.9%) hospitals. Common comorbid conditions included hypertension (27.5%), chronic pulmonary disease (19.4%), diabetes (16.1%), and obesity (7.6%). However, 62.0% of the patients did not have any pre-existing comorbidity. Among all patients with an AIG diagnosis, only 15.3% underwent stool work-up at the hospital. The majority of patients (84.7%) were seen in the emergency room, and most (96.4%) were discharged home (Table 2). Within 30 days of discharge, < 1.0% underwent ancillary abdominal/gastrointestinal diagnostic testing, 1.0% were hospitalized and 2.8% had another outpatient visit due to AIG at the same hospital. Mean cost of the index visit plus 30-day follow-up was $1,338 per patient, amounting to $333,060,182 for the total study population. Among the subgroup of patients with microbiology data available (n=12,469), common pathogens detected were Clostridium difficile (32.2%), Norovirus (6.3%), and Campylobacter spp. (4.0%). No pathogen was detected in 47.5%. Table 1.Patient, clinical, and hospital characteristics of hospital-based infectious gastroenteritis outpatients during January 1, 2016 - June 30, 2021Table 2.Outcomes of hospital-based infectious gastroenteritis outpatients during January 1, 2016 - June 30, 2021 Conclusion Acute infectious gastroenteritis is a common and costly disease affecting adults of all ages and more females than males, including individuals either with or without baseline conditions in a hospital-based outpatient setting. Clostridium difficile was the most common pathogen detected. Disclosures Rena Moon, MD, MPH, Premier Inc: Employee Tammy C. Bleak, PharmD, MSc, bioMerieux: Employee of bioMerieux Ning Rosenthal, MD, PhD, MPH, Premier Inc: Employee|Premier Inc: Stocks/Bonds Brianne Couturier, PhD, bioMerieux: Employee of bioMerieux Rachael Hemmert, MSPH, bioMerieux: Employee of bioMerieux Tristan T. Timbrook, PharmD, bioMerieux: Employee of bioMerieux Harold Brown, MBA, MHA, Premier Inc: Employee Ferric C. Fang, MD, bioMerieux: Advisor/Consultant.

1996. Association between Multiplex Polymerase Chain Reaction Stool Diagnostic Testing and Pathogen Detection, Healthcare Resource Use, and Cost Among Adult Outpatients Treated in United States Hospitals for Acute Infectious Gastroenteritis

Abstract Background Multiplex polymerase chain reaction (PCR) gastroenteritis testing panels simultaneously detect multiple pathogens with rapid turnaround, allowing more accurate and timely diagnosis and treatment. This retrospective observational study assessed the association between stool test type (i.e., multiplex PCR panel with < 12 target pathogens [PCR< 12], multiplex PCR panel with ≥ 12 target pathogens [PCR12], traditional work-up [TW]) and healthcare resource use (HRU), cost, and diagnostic yield in adult outpatients treated in U.S. hospitals for acute infectious gastroenteritis (AIG). Methods Using large geographically diverse PINC AI Healthcare Database data from January 1, 2016–June 30, 2021, we analyzed adults (≥ 18-years) with an AIG diagnosis and stool test performed during an outpatient visit. Pathogen analysis was performed in those with microbiology data available. Results Among 36,787 patients, TW was most often performed (57.0%), followed by PCR12 (30.2%) and PCR< 12 (12.8%). Patients with PCR12 were more likely younger, Hispanic/Latino, and uninsured, and less likely socially vulnerable compared to TW (all p< 0.01, Table 1). PCR12 was more common in patients from large (500+ beds), teaching, urban hospitals in the Midwest, compared to patients with TW (all p< 0.01, Table 2). Patients with PCR12 were more likely to have a history of transplantation or HIV/AIDS (both p< 0.01). PCR12 was associated with a higher mean index visit cost (by $101) but lower mean 30-day follow-up cost (by $130) than TW (Table 3). Patients with PCR12 had lower 30-day AIG-related admission risk than TW (1.7% vs. 2.7% p< 0.01). Among 8,451 patients with microbiology data, PCR12 was associated with fewer stool tests per patient (mean:1.61 vs. 1.26), faster turnaround time (mean: 6.3 vs. 25.7 hours) and less likelihood of receiving in-hospital antibiotics (39.4% vs. 47.1%, all p< 0.01) than TW. A higher percentage of patients with PCR12 had a target pathogen detected (73.1%) compared to PCR< 12 (63.6%) or TW (45.4%, p< 0.01). Table 1.Patient characteristics of hospital-based infectious gastroenteritis outpatients during January 1, 2016 - June 30, 2021, stratified by type of stool testTable 2.Clinical and hospital characteristics of hospital-based infectious gastroenteritis outpatients during January 1, 2016 - June 30, 2021, stratified by type of stool testTable 3.Outcomes of hospital-based infectious gastroenteritis outpatients during January 1, 2016 - June 30, 2021, stratified by the type of stool test Conclusion PCR12 multiplex panels were associated with lower 30-day follow-up cost and risk of IG-related hospitalization. PCR12 was also associated with less secondary testing, reduced in-hospital antibiotic use, faster turnaround, and increased diagnostic yield compared to TW. Disclosures Rena Moon, MD, MPH, Premier Inc: Employee Tammy C. Bleak, PharmD, MSc, bioMerieux: Employee of bioMerieux Ning Rosenthal, MD, PhD, MPH, Premier Inc: Employee|Premier Inc: Stocks/Bonds Brianne Couturier, PhD, bioMerieux: Employee of bioMerieux Rachael Hemmert, MSPH, bioMerieux: Employee of bioMerieux Tristan T. Timbrook, PharmD, bioMerieux: Employee of bioMerieux Harold Brown, MBA, MHA, Premier Inc: Employee Ferric C. Fang, MD, bioMerieux: Advisor/Consultant.

Fecal microbiota transplantation in patients with post-infectious irritable bowel syndrome: A randomized, clinical trial

Research in recent years has shown the potential benefits of fecal microbiota transplantation (FMT) for irritable bowel syndrome (IBS). Acute infectious gastroenteritis is a well-established risk factor for developing such forms of IBS as post-infectious IBS (PI-IBS). However, the effective use of FMT in patients with IP-IBS has not yet been clarified. The study aimed to conduct a single-center, randomized clinical trial (RCT) to assess FMT's safety, clinical and microbiological efficacy in patients with PI-IBS. Patients with PI-IBS were randomized into two groups: I (standard-care, n = 29) were prescribed basic therapy, namely a low FODMAP diet, as well as Otilonium Bromide (1 tablet TID) and a multi-strain probiotic (1 capsule BID) for 1 month; II (FMT group, n = 30), each patient with PI-IBS underwent a single FMT procedure with fresh material by colonoscopy. All patients underwent bacteriological examination of feces for quantitative and qualitative microbiota composition changes. The clinical efficacy of treatment was evaluated according to the dynamics of abdominal symptoms, measured using the IBS-SSS scale, fatigue reduction (FAS scale), and a change in the quality of life (IBS-QoL scale). FMT was associated with rapid onset of the effect, manifested in a significant difference between IBS-SSS points after 2 weeks of intervention (p < 0.001). In other time points (after 4 and 12 weeks) IBS-SSS did not differ significantly across both groups. Only after 3 months of treatment did their QoL exceed its initial level, as well value for 2 and 4 weeks, to a significant extent. The change in the ratio of the main microbial phenotypes in the form of an increase in the relative abundance of Firmicutes and Bacteroidetes was recorded in all patients after 4 weeks. It should be noted that these changes were significant but eventually normalized only in the group of PI-IBS patients who underwent FMT. No serious adverse reactions were noted. This comparative study of the results of FMT use in patients with PI-IBS demonstrated its effectiveness compared to traditional pharmacotherapy, as well as a high degree of safety and good tolerability.

BD MAX Enteric Bacterial, Bacterial Plus, and Virus Panels for Diagnosis of Acute Infectious Gastroenteritis: a Cost-Benefit Analysis.

ABSTRACTEconomic assessment is required to gauge the value of implementing PCR syndromic platforms in the microbiology laboratory for the diagnosis of community-acquired acute gastroenteritis (AGE) in pediatric and adult in- and outpatients. A cost-benefit analysis was conducted from a health care system perspective using BD MAX Enteric Bacterial, Bacterial Plus, and Virus panels. Two 6-month periods were selected, in which either conventional procedures (in 2017) or BD MAX PCR multiplex panels (in 2018) were used. We retrospectively reviewed medical records of all patients with positive results and a representative sample of negative ones. A Markov model was used to represent transition probabilities between different health care states from time of stool microbiological study until completion of AGE-episode-associated health care. A total of 1,336 medical records were reviewed (829 in 2018 and 507 in 2017), showing overall a significantly higher positivity rate in 2018 than in 2017 (26% versus 6%, P < 0.001). The total cost per individual associated with health care for AGE was €314 in 2018 and €341 in 2017; when we only considered the pediatric cohort, the figures were €271 and €456, respectively. Using Tornado sensitivity analyses, we found that the three variables that most influenced the model in descending order of weight were the probability of longer hospital stays, the probability of returning to the emergency room (ER), and the probability of hospitalization from the ER. Use of BD MAX enteric PCR platforms for the diagnosis of community-acquired AGE instead of a non-PCR-based conventional approach results in an incremental benefit from a health care perspective in the general population, particularly children.IMPORTANCE The implementation of multiplex molecular panels allows microbiological laboratories to quickly, sensitively, and accurately diagnose acute infectious gastroenteritis. This methodology therefore allows faster decisions regarding treatment and infection control measures. Economic evaluations are required to gauge the value of implementing these syndromic PCR platforms in a community-based acute gastroenteritis setting. We studied the potential clinical and cost benefits, in terms of both their impact on laboratory costs and the subsequent costs of managing patients.

Use of Drotaverine 80mg with Paracetamol 500mg in Patients with Acute Bacterial Gastroenteristis

Objective: This study's goal is to see whether drotaverine 80 mg and paracetamol 500 mg are as effective and safe as each other in treating individuals with acute gastroenteritis. Study Design: Randomized control trial Place and Duration: The study was conducted at the medicine department of Lahore General Hospital and Ittefaq Hospital Trust, Lahore for the period of five months from April 2021 to August 2021. Methods: Total one hundred and eighty patients of both genders with ages 17-60 years were presented. Patients had acute infectious gastroenteritis with abdominal pain from last 24 hours were included. To obtain comprehensive demographic information, including age, gender, height/weight, and BMI (body mass index), informed written permission was obtained from each patient. A total of two groups of patients were created: I and II. It took two days to provide 80mg drotaverine, together with 500 mg paracetamol, to patients in group I, while it took two days to administer 500 mg paracetamol, along with the same number of patients, in group II. A visual analogue scale (VAS) was used to measure the severity of pain in both groups after treatment to determine efficacy and safety. SPSS 24.0 was used to analyze the data. For categorical data, frequency and percentage were employed. Results: Mean age of the patients in group I was 30.07±4.28 years with mean BMI 23.07±4.32 kg/m2 and in group II 28.17±9.88 years was the mean age with mean BMI 22.44±8.21 kg/m2. Majority of the patients were males 59 (65.6%) in group I and 54 (60%) in group II. Intensity of pain was significantly decreases after 8hrs in group I 1.01±2.17 as compared to group II 4.09±11.34. Post treatment effectiveness among patients in group I was 84 (93.3%) greater than that of group II 54 (60%). The most prevalent side effects in both groups were nausea, vomiting, and dizziness, however the frequency was considerably lower in group I than in group II with a p value of 0.005.Frequency of satisfaction in group I was 88 (97.8%) higher than that of group II 60 (66.7%). Conclusion: In this study we concluded that the combination of 80mg drotaverine with 500mg paracetamol was effective and safe in terms of pain control and control of infection as compared to the paracetamol alone in the treatment of patients with acute gastroenteritis. Keywords: Acute Gastroenteritis, Drotaverine, Paracetamol, Efficacy

Streptococcal toxic shock syndrome in an adolescent

A special form of streptococcal infection is streptococcal toxic shock syndrome (STS), characterized by rapid development of symptoms and high mortality. Patient O., 14 years old, was taken to the infectious diseases department of OGAUZ DBNo. 1 by the SMP team with complaints of shortness of breath, vomiting, loose stools in a state of moderate severity due to intoxication syndrome. Diagnosis upon admission: Acute infectious gastroenteritis of moderate severity. Acute respiratory infections rhinopharyngitis, acute bronchitis, pneumonia (?), DN1. During examination in the UAC, anemia, leukocytosis, acceleration of ESR, in the biochemical blood analysis – an increase in CRP, in the coagulogram — increased INR, APTT, RFMC, decreased PTI, in urine tests – protein, erythrocytes, on the X–ray — bilateral pleural effusion, in the tank. sputum culture — Streptoccocus oralis 10/3 KOE/ml, PCR SARS-CoV-2: negative, blood test for antistreptolysin-O (ASL-O): 800 IU/ml (norm up to 200 IU/ml), blood for sterility 19.05.20: no bacterial microflora growth was detected. After receiving laboratory data, the diagnosis was made: Acute glomerulonephritis?, Аcute intestinal infection. Double-sided hydrothorax. Internal combustion engine. Anemia of the 1st degree. The final diagnosis: Acute post-streptococcal glomerulonephritis with a debut in the form of streptococcal toxic shock syndrome, a period of extensive clinical and laboratory changes, with a decrease in the debut of kidney function in the form of acute renal failure, recovery period. Against the background of the treatment (2 courses of antibiotic therapy (cefotaxime, amoxicillin), infusion therapy, pulse therapy with metipred (5 pulses), double transfusion of freshly frozen plasma, prednisone, lasix, veroshpiron, enap, curantil, heparin, and other accompanying therapy), pronounced positive clinical and laboratory dynamics was noted. She was hospitalized for 43 days, of which 9 days were in the intensive care unit (5 days on a ventilator). On the 44th day, the child was discharged in a satisfactory condition with recommendations under the supervision of a pediatrician, a pediatric nephrologist at the place of residence

Determination and Genotype Distribution of Rotavirus Gastroenteritis in Pediatric Patients Admitted to a Tertiary Care Hospital

Acute infectious gastroenteritis is a prevalent disease worldwide, and most of the cases are caused by viral pathogens. Many different viruses, including Rotavirus (RV), Norovirus, Adenovirus, and Astroviruses, are responsible for most acute viral gastroenteritis cases. According to the Centers for Disease Control and Prevention (CDC), viral gastroenteritis infections cause more than 200 000 child mortalities each year worldwide. One of the best strategies to reduce the global burden of RV gastroenteritis is the development and administration of effective vaccines. However, since there are differences in the coverage of the vaccines, the choice of appropriate vaccine for localized genotypes based on regions is important. The aim of this study was to detect the RV infections in our region and to perform genotyping using real time polymerase chain reaction (Rt-PCR) and high resolution melting (HRM) analysis. A total of 341 stool samples collected from pediatric patients were tested. Lateral flow immunochromatographic assay principle based assay was used for antigen detection. RT-PCR and HRM were applied for genotype analysis. Similar to the data from our country and Eastern Mediterranean region, RV positivity in stool samples was 23.1%. The majority of the patients (51%) were aged 0-2 years and the vast majority of the patients, with a rate of 77%, were between the ages of 0-5. Most of the cases were detected in the winter months, especially in February. The distribution of 40 samples, whose G genotype could be detected, was as follows: G2, 21 (52.5%); G1, 11 (27.5%); G9, 5 (12.5%); G3, 2 (5%); G4, 1 (2.5%). The distribution of 53 samples, whose P genotype could be detected, was as follows: P4, 44 (83.0%); P9, 8 (15.1%); P10, 1 (1.9%). Among those whose genotype could be detected, the most prevalent genotypes were G2 with 52.5% and P4 with 83%. When the distribution of 25 samples was evaluated, in which RV G and P genotypes were detected simultaneously, G1P [4] 11 (44%), G2P[9] 5 (20%), G9P[4] 5 (20%), G2P[4] 2 (8%), G3P[10] 1 (4%), and G4P[4] 1 (4%) genotypes were determined, respectively. The most commonly observed genotype was G1P[4]. In the HRM analysis, it was observed that the melting curve peaks were at different temperatures in nine of the G2 genotype samples and 16 of the P4 and P9 genotype samples. Thus, genotyping with HRM analysis could not be fully finalized, especially for G2 and P. Of the Rota Teq® and RotarixTM vaccines administered on demand in our country, Rota Teq® is considered the vaccine that has the widest coverage for the genotypes observed in our country and region. ROTASIIL® vaccine, which covers all the genotypes in our region (G1, G2, G3, G4, G9) is not available in our country. The emergence of the strains with the potential to increase the current burden of RV disease should be continuously monitored, as different results are obtained by region and year, even within the same country. Thus, the emergence of vaccine-resistant strains can be followed up, especially in countries with higher viral diversity.

Postinfectious Irritable Bowel Syndrome: Polemic and Open Issues

Aim. An analysis of polemic and open topics in epidemiology, pathogenesis, clinic, diagnosis and treatment of postinfectious irritable bowel syndrome (IBS).Key points. The incidence of postinfectious IBS links to aetiological factors underlying the development of acute infectious gastroenteritis (bacteria, viruses or protozoans). The risk factors of postinfectious IBS have been identified: female gender, excessive anxiety, depression and somatisation, a severe sequence of acute infectious gastroenteritis, etc. The diagnosis of postinfectious IBS implies exclusion of organic diseases with similar clinical presentations. A specific postinfectious IBS treatment is currently lacking and adheres to non-postinfectious IBS strategies.Conclusion. The postinfectious IBS problematic is poorly understood and requires further research.

Dose-Response of a Norovirus GII.2 Controlled Human Challenge Model Inoculum.

Genogroup II noroviruses are the most common cause of acute infectious gastroenteritis. We evaluated the use of a new GII.2 inoculum in a human challenge. Forty-four healthy adults (36 secretor-positive and 8 secretor-negative for histo-blood group antigens) were challenged with ascending doses of a new safety-tested Snow Mountain virus (SMV) GII.2 norovirus inoculum (1.2 × 104 to 1.2 × 107 genome equivalent copies [GEC]; n = 38) or placebo (n = 6). Illness was defined as diarrhea and/or vomiting postchallenge in subjects with evidence of infection (defined as GII.2 norovirus RNA detection in stool and/or anti-SMV immunoglobulin G [IgG] seroconversion). The highest dose was associated with SMV infection in 90%, and illness in 70% of subjects with 10 of 12 secretor-positive (83%) and 4 of 8 secretor-negative (50%) becoming ill. There was no association between prechallenge anti-SMV serum IgG concentration, carbohydrate-binding blockade antibody, or salivary immunoglobulin A and infection. The median infectious dose (ID50) was 5.1 × 105 GEC. High rates of infection and illness were observed in both secretor-positive and secretor-negative subjects in this challenge study. However, a high dose will be required to achieve the target of 75% illness to make this an efficient model for evaluating potential norovirus vaccines and therapeutics. NCT02473224.