Etiology Of Diarrhea Research Articles

The aetiology of diarrhoea, pneumonia and respiratory colonization of HIV-exposed infants randomized to breast- or formula-feeding

Background:Diarrhoea and pneumonia are common causes of childhood death in sub-Saharan Africa but there are few studies describing specific pathogens.Objectives:The study aimed to describe the pathogens associated with diarrhoea, pneumonia and oropharyngeal colonization in children born to HIV-infected women (HIV-exposed infants).Methods:The Mashi Study randomized 1200 HIV-infected women and their infants to breastfeed for 6 months with ZDV prophylaxis or formula-feed with 4 weeks of ZDV. Children were tested for HIV by PCR at 1, 4, 7, 9 and 12 months and by ELISA at 18 months. Pre-defined subsets of children were sampled during episodes of diarrhoea (n = 300) and pneumonia (n = 85). Stool was tested for bacterial pathogens, rotavirus and parasites. Children with pneumonia underwent bacterial blood culture, and testing of nasopharyngeal aspirates for viral pathogens by PCR. Oropharyngeal swabs were collected from a consecutive subset of 561 infants at the routine 3-month visit for bacterial culture.Results:The median age (range) at sampling was 181 days for diarrhoea (0–730) and 140 days for pneumonia (2–551). Pathogens were identified in 55 (18%) children with diarrhoea and 32 (38%) with pneumonia. No differences in pathogens by child HIV status (HIV-infected vs HIV-uninfected) or feeding strategy were identified. Campylobacter was the most common diarrhoeal pathogen (7%). Adenovirus (22%) and other viruses (19%) were the primary pathogens isolated during pneumonias. More formula-fed infants had oropharyngeal colonization by pathogenic Gram-negative bacteria (16.8% vs 6.2%, P = 0.003), which was associated with a non-significant increased risk of pneumonia (OR 2.2, 95% CI 0.8–5.7).Conclusion:A trend toward oropharyngeal bacterial colonization was observed in formula-fed infants. Although viruses were most commonly detected during pneumonia, respiratory colonization by Gram-negative bacteria may have contributed to pneumonia in formula-fed infants.

Persistent Diarrhea: A Clinical Review.

Diarrheal disease is commonly encountered in clinical practice. Persistent diarrhea (≥14 days) can be caused by pathogens that differ from those commonly seen in acute illness; proper etiologic diagnosis is important for appropriate therapeutic management. This review provides an overview of the epidemiology, etiology, diagnosis, and management of persistent diarrhea caused by infectious agents in immunocompetent individuals worldwide. Much of the data on persistent diarrhea comes from studies of residents in or expatriates of developing countries and travelers to these regions where follow-up studies have been performed. Persistent diarrhea occurs in approximately 3% of individuals traveling to developing countries. Schistosoma mansoni (and rarely Schistosoma haematobium) intestinal infection is also not very common and is found only in endemic areas. The microbiologic causes of protracted diarrhea include detectable parasitic (eg, Giardia, Cryptosporidium) and bacterial (eg, enteroaggregative Escherichia coli, Shigella) pathogens. Available diagnostic tests include culture-dependent for bacterial pathogens and culture-independent methods for bacterial, viral, and protozoal infections (eg, polymerase chain reaction [PCR]), including multiplex PCR, as well as and microscopy for protozoal infections. Antimicrobial therapy can be given empirically to patients returning from the undeveloped to the developed world. Otherwise, antibiotics should be given based on the results of laboratory testing. Persistent diarrhea is a poorly recognized syndrome in all populations that requires proper assessment and diagnosis to ensure that affected individuals receive the treatment needed to experience improvement of clinical symptoms.

Correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with Clostridium difficile infection.

BackgroundClostridium difficile is the most common infectious etiology of nosocomial diarrhea. Fecal calprotectin (fc) is a sensitive marker of intestinal inflammation, found to be associated with enteric bacterial infections and inflammatory bowel disease.MethodsWe evaluated fc levels using a Chemiluminescent immunoassay method, in hospitalized patients with C. difficile infection (CDI) diagnosed by molecular stool examination and assessed correlation with virulent ribotype 027 strain infection, antibiotic susceptibility by gradient Etest strip performed on C. difficile colonies and clinical and laboratory measures of disease severity. Statistical analysis was performed for correlation of fc levels with clinical and laboratory parameters, disease severity and patient outcomes.ResultsOverall 29 patients with CDI were admitted at the Poria medical center in northern Israel, during June 2014-May 2015. Resistance to metronidazole was found in 3 (10.3 %) isolates and to vancomycin in 5 (17.2 %) isolates. Regarding patient outcomes, within 30 days of CDI diagnosis, recurrence of disease occurred in 10 (34.5 %) patients and 2 patients (6.9 %) died. Seven (24.1 %) isolates were C. difficile ribotype 027. Mean fc level was 331.4 μg/g (21–932). Higher fc levels were found in patients with C. difficile ribotype 027 (p < 0.0005). Fc levels were also correlated with elevated peripheral blood white cell count (p = 0.0007). A trend for higher fc levels was found in patients with a higher clostridium severity score index (p = 0.0633). No correlation was found between fecal calprotectin levels and age, sex, functional status, community versus hospital acquired CDI, antibiotic susceptibility, fever, and creatinine levels.ConclusionsOur study highlights the fact that fc has a potential role as a biomarker of disease severity and binary toxin producing ribotype associated disease.

Calf health and antimicrobial use in Swiss dairy herds: Management, prevalence and treatment of calf diseases

Fifty-two dairy herds in the canton Fribourg were included during one winter in a study on calf management, prevalence and treatments of calf diseases. Colostrum management was optimal in 46.2% of the herds only, and 51.3% of the calves had been sick at least once during the observation period. The most commonly observed diseases included respiratory disease (57.5%), diarrhea (32.8%) and umbilical disease (5.7%). Cases of pneumonia were treated with antimicrobials first by the farmers in 65.4% of the herds. Calf diarrhea was treated with antimicrobial drugs by 57.7% of the farmers. Fluorochinolones were used in 47% of all parenteral treatments and oral antimicrobial drugs included macrolides in 11% of the cases. These results provide information on calf management, calf health and treatment strategies in an area where dairying is the most important sector of the farming industry. They show clearly that the farmers are not sufficiently informed about the use of critically important antimicrobial drugs and about the etiology of calf diarrhea. Improvements in colostrum management and treatment strategies are urgently needed.

Prevalence of Intestinal Protozoans among Schoolchildren in Suburban Areas near Yangon, Myanmar

Although intestinal protozoans are common etiologies of diarrhea, few studies have been conducted in Myanmar. This study planned to investigate the prevalence of Giardia lamblia, Entamoeba coli, Entamoeba histolytica, and Endolimax nana among schoolchildren and their guardians in suburban areas near Yangon, Myanmar. We performed a cross-sectional survey among schoolchildren and their guardians from 7 primary schools in South Dagon and Hlaing Thar Yar districts, Yangon, Myanmar. Stool samples were observed with a microscope after concentration technique and iodine staining. Total 821 stool samples, including 556 from schoolchildren and 265 from guardians, were examined. The median age was 6 years old for schoolchildren and 36 years old for guardians. A 53.1% of the school children and 14.6 % of the guardians were males. The overall prevalence of each intestinal protozoan species was as follows: 3.4% (28/821) for G. lamblia; 3.5% (29/821) for E. coli; 1.2% (10/821) for E. histoytica, and 3.0% for E. nana. This study showed that intestinal protozoans are common in primary schoolchildren and their guardians in suburban areas near Yangon, Myanmar. Health interventions, such as hand washing education, improvement of sanitation, and establishment of water purification systems are urgently needed in this area.

Role of Enterotoxigenic Bacteroides fragilis in Children Less Than 5 Years of Age With Diarrhea in Tabriz, Iran.

BackgroundDiarrhea is the most frequent health problem among children in developing countries. Defining the etiology of acute diarrhea is critical to disease therapy and prevention. Some anaerobic bacteria such as Enterotoxigenic Bacteroides fragilis (ETBF) strains cause diarrheal disease by production of enterotoxin in children less than 5 years old.ObjectivesThis study aimed to evaluate the prevalence of ETBF among common bacteria and viruses causing diarrhea in children aged less than five years.Materials and MethodsOne hundred diarrheal stools were cultured for detection of aerobic and anaerobic pathogen bacteria by direct plating on selective media and antibiotic susceptibility tests were performed according to clinical and laboratory standards institute (CLSI) guidelines on isolates of ETBF. The enterotoxigenic gene among B. fragilis isolates was also investigated using the polymerase chain reaction (PCR) method. Detection of viral pathogens was carried out using the latex agglutination test.ResultsTen B. fragilis were isolated from 100 diarrheal fecal specimens. All isolates were susceptible to metronidazole, while 10% were susceptible to clindamycin. Four (40%) ETBF were isolated. Rotaviruses (57.2%) and adenoviruses (18.6%) were the most frequently detected etiological agents.ConclusionsETBF is one of the etiological agents that may cause diarrhea in children but it is not the commonest of them. Metronidazole is still an effective antibiotic against B. fragilis. Viruses are the most important etiological agents of diarrhea in children less than 5 years of age.

Detection of 23 Gastrointestinal Pathogens Among Children Who Present With Diarrhea.

Diarrheal diseases are a major cause of ambulatory care visits and hospitalizations among children. Because of overlapping signs and symptoms and expensive and inefficient testing methods, the etiology of pediatric diarrhea is rarely established. We identified children <18 years of age who were evaluated for diarrhea at Primary Children's Hospital in Salt Lake City, Utah, between October 2010 and September 2012. Stool specimens submitted for testing were evaluated by using the FilmArray gastrointestinal diagnostic system, which is a rapid multiplex polymerase chain reaction platform that can simultaneously detect 23 bacterial, viral, and protozoal agents. A pathogen was detected in 561 (52%) of 1089 diarrheal episodes. The most commonly detected pathogens included toxigenic Clostridium difficile (16%), diarrheagenic Escherichia coli (15%), norovirus GI/GII (11%), and adenovirus F 40/41 (7%). Shiga toxin-producing E coli were detected in 43 (4%) specimens. Multiple pathogens were identified in 160 (15%) specimens. Viral pathogens (norovirus, adenovirus, rotavirus, and sapovirus) were more common among children <5 years old than among those 5 to 17 years old (38% vs 16%, respectively; P < .001). Bacterial pathogens were identified most commonly in children 2 to 4 years of age. Children with 1 or more underlying chronic medical conditions were less likely to have a pathogen identified than those without a chronic medical condition (45% vs 60%, respectively; P < .01). Viral pathogens were detected more commonly in the winter, whereas bacterial pathogens were detected more commonly in the summer. Toxigenic C difficile, diarrheagenic E coli, and norovirus were the leading organisms detected among these children with diarrhea. Viral pathogens are identified frequently among young children with acute gastroenteritis.

Travel Diarrhea in Childhood, “Part Two; what is the Problem?”

In the first part, we briefly reviewed literature about the characteristics, etiology, pathology, and management of pediatric travel diarrhea (TD) [ 1 ]. Ultimately, we concluded that more studies are needed on its pathogenesis, pathogen frequency, prevention, and management, especially in specific conditions such as children with immunodeficiency. In this section, the future aspects of pediatric TD will be discussed. The pathogens and etiology of TD in children are assessed in different areas and countries, but information about the less important pathogens and even some main ones in some countries is lacking. Therefore, providing a management plan for prevention and treatment for travelers to these locations is impossible. At first, it is necessary to prepare a comprehensive diagram of the main and accessory pathogens of pediatric TD. Next, an agenda for determining all remaining and ambiguous etiologies throughout the world should be proposed. Although the majority of etiology of TD remains bacterial, parasites, viruses, etc. are emerging as new pathogens [ 2 ]. Therefore, it is important to follow the frequency, incidence, and outbreak of each atypical pathogen to make an annual guideline so as to provide travelers with a safer trip. Moreover, travel agencies could play a more important and effective role in controlling TD. In a study in Australia, 56% of travel agencies and consultants thought that there was not enough readily accessible travel health information; 52% said they would like to be more involved in providing health information to their clients. Thus, a guideline and periodic training course for updating their health information can help travelers travel more safely. Furthermore, more academic and classified education is needed for general healthcare practitioners. Balaban et al. reported that almost half of public health professionals who travel internationally reported exposure to unanticipated health risks; one-quarter of travelers to malarious areas reported inconsistent or no use of malaria chemoprophylaxis [ 3 ]. Although many studies are conducted in these fields yearly and many innovations emerge, a large number of unsolved problems remain, especially in the field of treatment and prophylaxis methods. If developing countries focus their research on eliminating and managing their native and endemic infectious diseases that cause travel diseases instead of on costly and, at the same time, undervalued and perfunctory studies on diseases of the developed world [ 4 ], their economy will profit more.

Molecular diagnostics and the aetiology of diarrhea in low-income countries

Abstract: Studies of childhood diarrhea in developing countries have traditionally employed a wide range of diagnostic modalities including culture, microscopy, and enzyme immunoassay. Molecular diagnostics offer a substantial increase in sensitivity, however they also increase the background rate of pathogen detection. A quantitative analytic approach can help identify the subset of clinically significant molecular detections. In this symposium talk, we will present estimates of of pathogen-specific attributable fractions of diarrhea from ongoing re-analyses of two multisite studies of childhood diarrhea (GEMS and MAL-ED). Compared to prior burden estimates from these studies, this approach reveals a substantial increase in the burden of diarrhea due to pathogens for which conventional diagnostics were not sufficiently sensitive, in particular Shigella, ST-ETEC, and adenovirus 40/41. Burden estimates for other pathogens, including rotavirus and Cryptosporidium, were not significantly changed. After rotavirus, Shigella was associated with the highest burden of moderate-to-severe non-bloody diarrhea, which suggests that current guidelines limiting the role of antibiotics to bloody diarrhea in children in these settings need to be re-evaluated. These findings also have significant implications for the prioritization of pathogen-specific interventions aimed at reducing the burden of diarrheal disease in children in these settings.

Effects of Bolus and Continuous Nasogastric Feeding on Gastric Emptying, Small Bowel Water Content, Superior Mesenteric Artery Blood Flow, and Plasma Hormone Concentrations in Healthy Adults

Objective:We aimed to demonstrate the effect of continuous or bolus nasogastric feeding on gastric emptying, small bowel water content, and splanchnic blood flow measured by magnetic resonance imaging (MRI) in the context of changes in plasma gastrointestinal hormone secretion.Background:Nasogastric/nasoenteral tube feeding is often complicated by diarrhea but the contribution of feeding strategy to the etiology is unclear.Methods:Twelve healthy adult male participants who underwent nasogastric intubation before a baseline MRI scan, received 400 mL of Resource Energy (Nestle) as a bolus over 5 minutes or continuously over 4 hours via pump in this randomized crossover study. Changes in gastric volume, small bowel water content, and superior mesenteric artery blood flow and velocity were measured over 4 hours using MRI and blood glucose and plasma concentrations of insulin, peptide YY, and ghrelin were assayed every 30 minutes.Results:Bolus nasogastric feeding led to significant elevations in gastric volume (P < 0.0001), superior mesenteric artery blood flow (P < 0.0001), and velocity (P = 0.0011) compared with continuous feeding. Both types of feeding reduced small bowel water content, although there was an increase in small bowel water content with bolus feeding after 90 minutes (P < 0.0068). Similarly, both types of feeding led to a fall in plasma ghrelin concentration although this fall was greater with bolus feeding (P < 0.0001). Bolus feeding also led to an increase in concentrations of insulin (P = 0.0024) and peptide YY (P < 0.0001), not seen with continuous feeding.Conclusion:Continuous nasogastric feeding does not increase small bowel water content, thus fluid flux within the small bowel is not a major contributor to the etiology of tube feeding-related diarrhea.

Etiology of Diarrhea in Children Younger Than 5 Years Attending the Bengo General Hospital in Angola.

Diarrheal disease is among the leading causes of death in children younger than 5 years, especially in developing countries. The aim of this study was to investigate the most frequent etiological agents of diarrhea and its associated factors in children younger than 5 years attending the Bengo General Hospital in Angola. From September 2012 through December 2013, stool samples were collected from 344 children presenting with diarrhea to investigate the presence of viral, bacterial and parasitic agents. Relevant sociodemographic and clinical data were obtained from parents and caregivers. An enteric pathogen was detected in 66.6% of stool samples: Cryptosporidium spp. (30.0%), rotavirus (25.1%), Giardia lamblia (21.6%), diarrheagenic Escherichia coli (6.3%), Ascaris lumbricoides (4.1%), adenovirus (3.8%), Strongyloides stercoralis (3.5%), astrovirus (2.6%), Hymenolepis nana (1.7%), Entamoeba histolytica/dispar (0.9%), Taenia spp. (0.6%), Trichuris trichiura (0.3%) and Entamoeba histolytica (0.3%). Children younger than 12 months were more frequently infected with Cryptosporidium spp. compared with older children (age: 12-59 months), independently of sex, season, lethargy and wasting [odds ratio (OR): 3.5, 95% confidence interval (95% CI): 2.0-6.2]. Age (OR: 5.0, 95% CI: 2.6-9.3), vomiting (OR: 2.7, 95% CI: 1.5-4.8) and type of admission (inpatients, OR: 0.5, 95% CI: 0.3-0.9) were significantly associated with rotavirus infection. This study demonstrates high rates of infection with an enteric pathogen, particularly in children younger than 12 months, emphasizing the need to address diarrheal disease in this age group.

The aetiology of diarrhoea, pneumonia and respiratory colonization of HIV-exposed infants randomized to breast- or formula-feeding

The aetiology of diarrhoea, pneumonia and respiratory colonization of HIV-exposed infants randomized to breast- or formula-feeding

Surveillance of enteric pathogens in outpatient children with acute diarrhea

Objective To monitor the clinical epidemiology and etiology of acute diarrhea in children in the outpatient setting in Shanghai. Methods An active surveillance study in Children's Hospital of Fudan University between August 2013 and July 2014 was conducted. Outpatient children with acute diarrhea were enrolled in this study and stool samples were collected. Pathogens including norovirus, diarrheagenic Escherichia coli (DEC), nontyphoidal Salmonella spp. (NTS), Campylobacter, Shigella, pathogenic vibrio and Yersinia enterocolitica were identified and typed. The χ2 test was used for statistical analysis. Results Of the 881 stool samples from enrolled children, the pathogens included into the target detection were identified in 246 (27.92%) cases. Norovirus, DEC, NTS, Campylobacter and Shigella were detected in 98 (11.12%) cases, 74 (8.40%) cases, 61 (6.92%) cases, 34 (3.86%) cases and 2 (0.23%) cases, respectively. Neither pathogenic vibrio nor Yersinia enterocolitica was identified. Children younger than 36 months old (3.27%, 26/794) had a lower risk (χ2=7.41, P=0.006) of Campylobacter infection compared with older children (9.20%, 8/87). Vomiting (37.76%) and watery diarrhea (21.34%) were more commonly seen in children with norovirus infection; fever and mucous stool were commonly seen in diarrheal children with NTS infection (40.98% and 21.31%, respectively) and Campylobacter infection (29.41% and 26.47%, respectively). Conclusion Enteric pathogens play a major role in childhood acute diarrhea in Shanghai. Continuous monitoring of enteric pathogens will be helpful for reasonable treatment and prevention of acute diarrhea in children. Key words: Acute diarrhea; Child; Enteric pathogens

Norovirus: new developments and implications for travelers' diarrhea.

Noroviruses are the leading cause of acute gastroenteritis in the United States and are responsible for at least 50 % of acute gastroenteritis outbreaks occurring worldwide each year. In addition, noroviruses have caused outbreaks on cruise ships, in nursing homes and hospitals, and in deployed military personnel, but its role in the etiology of travelers’ diarrhea is not well defined. The aim of this review is to describe the role of noroviruses in travelers’ diarrhea in terms of epidemiology, current diagnostics, treatment and vaccine development efforts. Studies have shown prevalence rates of noroviruses in travelers’ diarrhea cases ranging from 10–65 %. It is likely that norovirus prevalence rates are highly underestimated in travelers’ diarrhea due to rapid onset, short duration of the illness, limited availability of laboratory facilities, and the fact that most clinical laboratories lack the diagnostic capability to detect noroviruses in stool. Further, additional studies are needed to accurately determine the true prevalence rates of norovirus as an etiologic agent of diarrhea among travelers to different regions around the world. With the rapid progress in the development of a norovirus vaccine, travelers could serve as an ideal population for future norovirus clinical trials.

Etiology of bacterial and parasitological pediatric diarrhoea in a tertiary care hospital

Background : Before starting to discuss about Diarrhoea, we have to remember diarrhoea is one of the main causes of morbidity and mortality in children. Aims and Objectives : The aim of this study was to determine the prevalence of intestinal parasitic and bacterial infections as cause of childhood diarrhoea. Materials and Methods : During the study period, a total of 116 stool samples were collected and processed. Examined grossly and microscopically for presence of ova/cyst. They were also cultured on MacConkey agar and E. coli isolated were identified by standard biochemical tests.Results : Out of 116 stools samples, Entamoeba histolytica (63.33%) and Giardia lamblia (23.33%) were more common parasitic cause diarrhoea among children by either ova or cyst. E.coli (74.13%) was common bacterial cause of diarrhoea among children. E. coli isolated in pure culture and sent for sero typing to Central Research Institute (CRI), Kasauli. Maximum percent were found to be pathogenic Escherichia coli i.e. EPEC 22.5%. Conclusion : According to the result, the most common cause of bacterial diarrhoea is E.coli. EPEC were more prevalent followed by EHEC. Thus, macroscopic and microscopic stool examinations as well as culture were important for finding out the course of diarrhoea in childhood.Asian Journal of Medical Sciences Vol. 7(3) 2016 54-57

Etiology and Epidemiology of Diarrhea in Hospitalized Children from Low Income Country: A Matched Case-Control Study in Central African Republic.

BackgroundIn Sub-Saharan Africa, infectious diarrhea is a major cause of morbidity and mortality. A case-control study was conducted to identify the etiology of diarrhea and to describe its main epidemiologic risk factors among hospitalized children under five years old in Bangui, Central African Republic.MethodsAll consecutive children under five years old hospitalized for diarrhea in the Pediatric Complex of Bangui for whom a parent’s written consent was provided were included. Controls matched by age, sex and neighborhood of residence of each case were included. For both cases and controls, demographic, socio-economic and anthropometric data were recorded. Stool samples were collected to identify enteropathogens at enrollment. Clinical examination data and blood samples were collected only for cases.ResultsA total of 333 cases and 333 controls was recruited between December 2011 and November 2013. The mean age of cases was 12.9 months, and 56% were male. The mean delay between the onset of first symptoms and hospital admission was 3.7 days. Blood was detected in 5% of stool samples from cases. Cases were significantly more severely or moderately malnourished than controls. One of the sought-for pathogens was identified in 78% and 40% of cases and controls, respectively. Most attributable cases of hospitalized diarrhea were due to rotavirus, with an attributable fraction of 39%. Four other pathogens were associated with hospitalized diarrhea: Shigella/EIEC, Cryptosporidium parvum/hominis, astrovirus and norovirus with attributable fraction of 9%, 10%, 7% and 7% respectively. Giardia intestinalis was found in more controls than cases, with a protective fraction of 6%.ConclusionsRotavirus, norovirus, astrovirus, Shigella/EIEC, Cryptosporidium parvum/hominis were found to be positively associated with severe diarrhea: while Giardia intestinalis was found negatively associated. Most attributable episodes of severe diarrhea were associated with rotavirus, highlighting the urgent need to introduce the rotavirus vaccine within the CAR’s Expanded Program on Immunization. The development of new medicines, vaccines and rapid diagnostic tests that can be conducted at the bedside should be high priority for low-resource countries.

Newly Identified Viruses in Human Gastroenteritis: Pathogens or Not?

Infectious diarrheal diseases remain a common cause of morbidity and mortality especially in children younger than 5 years in low-income and middle-income countries.1 The most common viral pathogens known to cause acute gastroenteritis in humans are rotavirus A, norovirus, sapovirus, enteric adenoviruses and astrovirus. In addition to these well-established etiologies, a large number of moderate to severe diarrhea cases go without etiological diagnosis and many unanswered questions surrounding the burden and etiology of diarrhea, and the factors determining clinical expression of infection remain. [...]

Persistent Infectious Diarrhea as a Risk Factor for Deterioration of Renal Function in Kidney Transplant Recipients

Background: Gastrointestinal complications are common in kidney transplant recipients. Severe diarrhea might result in graft dysfunction or rejection if being ignored. The study aim was to describe the relationship between kidney allograft function and diarrhea, and to determine how diarrhea is influenced by various immunosuppressive regimens at a single center in Taiwan.Methods: This was a retrospective and comparative study. We included kidney transplant recipients who suffered from persistent diarrhea between January 2009 and August 2015. Survival and regression analyses and sub-analyses of creatinine levels over different diarrhea periods were performed.Results: We eventually collected 62 patients for analyses, including 16 with infectious diarrhea and 46 with non-infectious diarrhea. At 3rd year post transplantation, patients with infectious diarrhea demonstrated a significantly lower cumulative renal function rate (56.3% vs. 84.7%, p&lt;0.05). No significant differences were found between recipients receiving different immunosuppressive regimens in terms of renal function. However, recipients receiving mammalian target of rapamycin (mTOR) inhibitor and mycophenolate mofetil (MMF) tended to show a slower rate for deterioration of renal function.Conclusion: In this study, infectious diarrhea, especially when persisting for more than 10.5 days, does significant damages to renal function and predicts for deterioration of renal function. Besides, regimen of mTOR inhibitor and MMF showed a trend toward reducing incidence of deterioration of renal function. Better understanding of the diarrhea etiologies to provide timely treatment for this illness and appropriate choice of immunosuppressive regimen might help maintain renal function for kidney transplant recipients.

Aetiology of diarrhoeal disease and evaluation of viral–bacterial coinfection in children under 5 years old in China: a matched case–control study

Globally, diarrhoeal diseases are the second leading cause of death among children under 5 years old. Few case–control studies on the aetiology of diarrhoea have been conducted in China. A case–control study on 922 children under 5 years old who presented with diarrhoea and individually matched controls was conducted in China between May 2011 and January 2013. Quantitative PCR was used to analyze stool samples for 10 diarrhoeal pathogens. Potential enteric pathogens were detected in 377 (81.8%) of 461 children with diarrhoea and 215 controls (46.6%, p <0.001). Rotavirus, norovirus GII, Shigella and adenovirus were qualitatively associated with diarrhoea. Using receiver operating characteristic curves, the optimal cutoff threshold for defining a symptomatic individual was 72, 5840, and 104 copies per reaction for rotavirus (odds ratio 259), norovirus GII (odds ratio 10.6) and Shigella (odds ratio 5.1). The attributable fractions were 0.18 for rotavirus, 0.08 for norovirus GII, 0.01 for Shigella and 0.04 for adenovirus. Coinfections between pathogens were common. Two pairs, rotavirus and adenovirus, and norovirus GII and Salmonella were positively associated. The co-occurrence of rotavirus and sapovirus, astrovirus, enterotoxigenic Escherichia coli or Campylobacter jejuni only occurred in children with disease. Coinfection was not correlated with clinical symptoms. Quantitative data are critical. Our results indicate that increased pathogen loads increase the OR between diarrhoea and rotavirus, norovirus GII and Shigella. Coinfections with rotavirus and norovirus GII are common and occur in a nonrandom distribution. Despite testing for ten diarrhoeal pathogens, over two-thirds of cases do not have a recognized attributable cause.

Follow-Up Trends of Bacterial Etiology of Diarrhoea and Antimicrobial Resistance in Urban Areas of Bangladesh

Background: Diarrhoea is considered as the most widespread illness occurring in Bangladesh. In addition, the growing antimicrobial resistance of diarrhoeal pathogens in this developing country hardens physicians to supervise patients effectively. Objectives: In our study, we retrospectively analysed the data of a diarrhoeal pathogens and their antimicrobial resistant patterns isolated from diarrhoeal patients attending Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka and domiciliary patients of Dhaka city of Bangladesh. Patients and Methods: During a six-year period (2009 - 2014), a total of 90207 diarrhoeal specimens were collected from patients to screen bacterial etiology by standard culture methods. Antimicrobial susceptibility testing was performed for culture-positive selected diarrhoeal pathogens using disk diffusion method. Results: One or more potential pathogens were identified in 20467 (23%) patients, more often from under-five children. The most predominant etiological agent was Vibrio spp. (33.23%), followed by Campylobacter spp. (26.04%), Shigella spp. (19.12%), Aeromonas spp. (12.21%), Salmonella spp. (6.74%) and Plesiomonas shigelloides (2.66%). Among children under the age of five, Campylobacter spp., Vibrio spp. and Shigella spp. were more common. V. cholerae O1 El Tor biotype was the predominant pathogen (90.75%) among all the Vibrio spp. isolated. High prevalence of multiple antibiotic resistances towards ampicillin (AM), ciprofloxacin (CIP) and co-trimoxazole (SXT) was common among Vibrio spp., Shigella spp. and Campylobacter spp. Beside, correlation with previous data from 2005 - 2008 showed that resistant percentages of Shigella spp., Campylobacter spp., Salmonella spp. to these antibiotics are increasing with time (P < 0.001). Conclusions: These findings underscored the importance of monitoring and developing guidelines for better management of infectious diarrhoea in Bangladesh and elsewhere.