Onset Of Diarrhea Research Articles

Early behavioral indicators of aberrant feces in newly-weaned piglets.

Post-weaning diarrhea (PWD) is a frequently occurring health and welfare issue in weaned piglets. Behavioral changes indicating impaired health may be detectable before the onset of signs and could be useful to detect the development of PWD early, enabling targeted and timely interventions. Current algorithms enable automated behavioral classification on the group level, while PWD may not affect all piglets in one pen and individual level analysis may be required. Therefore, this study aimed to assess whether changes in pen activity or individual piglet behavior can be early indicators of the occurrence of PWD. During 3 replicated rounds, 72 piglets (Sus scrofa domestica, Landrace x Large White) weaned at 27days of age, were housed in 4 pens with 6 piglets each. Individual fecal color and consistency were scored (0-5; ≥ 3 considered as aberrant feces) six times during the first two weeks post-weaning using rectal swabs. Additionally, using a similar scoring scale, feces on the pen floor were assessed daily. Two methods were applied for behavioral scoring. Individual behaviors (eating, drinking, standing, walking; n = 48) were scored manually and instantaneously with a five-minute interval from videos of the first two rounds, while pen activity (eating, drinking, moving; n = 12) was analyzed automatically and continuously using a commercially available algorithm from videos of all three rounds. Piglets showing a relatively higher proportion of standing behavior one day before fecal scoring had increased odds of an aberrant fecal color score (odds ratio (OR): 4.8; 95% confidence interval (CI): 1.5-15.3). Furthermore, odds of aberrant colored feces increased in pens where piglets showed more moving activity two days before (OR: 6.14; 1.26 < 95%CI < 29.84), which was also found for fecal consistency (OR: 4.77; 95%CI: 1.1-21.6). Our results indicate that increased standing in individual piglets and an increased moving activity on the pen level may be important behavioral indicators of PWD before the onset of diarrhea. Further development of current algorithms that can identify behavioral abnormalities in groups, from the pen to the individual level, may therefore be a promising avenue for improved and targeted health and welfare monitoring.

Efficacy and safety assessment of probiotic Bacillus coagulans (Heyndrickxia coagulans) BCP92 for treatment of diarrhea.

Probiotics offer a potentially new therapeutic approach for the treatment of diarrhea. This study aimed to determine the anti-diarrheal activity of Bacillus coagulans BCP92 (MTCC 25460) and its safety assessment (acute and sub-acute toxicity studies) in animal models and cell lines. The antidiarrheal activity was studied in mice using a castor oil-induced diarrhea model. In the acute toxicity study, the rats were orally fed 2000 mg/kg (4 × 1011 CFU/g) of B. coagulans BCP92 (MTCC 25460) as a single dose, and for sub-acute toxicity study rats received 250, 500, and 1,000 mg/kg/day for 28 days. At the end of the treatment, body weight, organ weight, food intake, biochemical parameters, hematological parameters, and histopathology were studied. B. coagulans BCP92 is effective against diarrhea by reducing the onset of diarrhea (latency), frequency of defecation, total fecal weight, and percentage of defecation. In-vitro MTT assay was performed on Vero cell lines. In-vitro MTT assay showed a cytoprotective effect. In acute toxicity study, 2000 mg/kg dose did not cause any alteration in clinical signs, morbidity, or mortality. The findings of the subacute toxicity study showed no alterations in physical appearance and behavioral patterns. Moreover, no significant variations were found in organ weights and hematological and biochemical parameters of the treated groups in the control group. Furthermore, no visible histological changes were observed in the heart, lung, liver, and kidney of the high-dose treatment groups. Thus, the results of the present study conclude that B. coagulans BCP92 is safe for human use in the treatment of diarrhea.

Whole genome sequencing assisted outbreak investigation of Salmonella enteritidis, at a hospital in South Africa, September 2022.

Health authorities were notified of a suspected outbreak of foodborne disease in a hospital in South Africa, where staff and patients reported acute onset of abdominal cramps, diarrhoea, fever and rigours after eating a chicken pasta meal. The aim of this report is to discuss the use of whole genome sequencing (WGS) analysis of bacterial isolates to support an epidemiological investigation. An epidemiological investigation led by the Infection Control Manager of the hospital and supported by an outbreak response team was conducted. Standard microbiological procedures were used to process stool samples and culture/identify diarrhoeal pathogens. Bacterial cultures were investigated using WGS performed using Illumina NextSeq technology, and WGS data were analysed using multiple bioinformatics tools, including those available at the Center for Genomic Epidemiology and EnteroBase. Core genome multilocus sequence typing (cgMLST) was used to investigate the phylogeny of isolates. Forty-nine cases were identified, with stool samples collected from 21 cases, and nontyphoidal Salmonella isolated from 19 out of 21 (90%) of the samples. All isolates were identified as Salmonella enterica serovar Enteritidis and differed from each other by ≤2 allele differences on cgMLST, indicating that isolates are highly genetically related. Delays in testing of food retention samples rendered the negative test results of limited value. A case-control study was conducted; eating chicken pasta was strongly associated with developing gastroenteritis (Odds Ration (OR) = 15.4, Chi-Square test with Yates correction p value = 0.02). The epidemiological evidence suggests that the chicken pasta was the likely vehicle of transmission in this outbreak, although the source of S. enterica serovar Enteritidis remains unknown.

A novel multiplex and glycoprotein-based immunochromatographic serologic IgM test for the rapid diagnosis of Escherichia coli O157 and O145 causing bloody diarrhea and hemolytic uremic syndrome.

Shiga toxin-producing Escherichia coli (STEC) are the main etiological agents of hemolytic uremic syndrome (HUS). Good clinical management of STEC infections and HUS depends on early, rapid, and accurate diagnosis. Here, we have developed and evaluated the first multiplex and glycoprotein-based immunochromatographic test for the detection of IgM antibodies against the O-polysaccharide of the lipopolysaccharide of E. coli O157 and O145 in human serum samples. A retrospective study was carried out resulting in a diagnostic sensitivity of the E. coli O157/O145 LFIA (lateral flow immunoassay) of 97.1% and 98.9% for O157 and O145, respectively, and 97.9% for both serogroups. The diagnostic specificity was 98.7% for O157 and O145, and the overall specificity 97.4%. In samples obtained before 3 days after the onset of diarrhea, the detection percentage was 83%, increasing to 100% from 3 days onward. Finally, the association of bloody diarrhea (BD) or HUS cases to an STEC infection increased from 22.8% to 77.2% when stool culture and stx/Stx detection were combined with serology by LFIA. Our results demonstrate that the E. coli O157/O145 LFIA is a highly accurate and serospecific test for the early and rapid diagnosis of E. coli O157 and O145 infections in BD or HUS cases. This test allows the detection of specific IgM antibodies very early in the course of the infection, making it an ideal diagnostic tool to be implemented in pediatric emergencies and, thus, avoid delays in the application of the correct supportive or specific treatment and prevent complications associated with HUS.

CASE REPORT: HEMICHOREA-HEMIBALLISMUS IN NONKETOTIC HYPERGLYCEMIC FEMALE PATIENT: PUTAMINAL HIGH INTENSITY LESION ON MRI T1-WEIGHTED IMAGES

A 65-year-old female known case of diabetes mellitus type 2, hypertension, chronic heart failure and chronic renal failure was admitted to our hospital with fever, diarrhea, and sudden onset of hemichorea-hemiballismus in right upper limb and lower limb. On admission blood glucose level was 175mg/dl, hemoglobin A1c was 11% and the serum osmolality was 292 mOsm/l. Urine analysis was negative for glucose and ketone bodies. After correction of blood glucose to normal level choreiform and ballistic movements disappeared. MRI showed high intensity on T1-weighted images in the left putamen, which disappeared 4 months after onset. The putaminal abnormality was the cause of her involuntary movements. The cause of high intensity in the putamen might be the multiple petechial hemorrhages which can occur in association with nonketotic hyperglycemia. We report an occurrence of hemichorea-hemiballismus in a female patient with diabetes mellitus type 2.

In vivo evaluation of anti-diarrheal activity of hydroalcoholic extract and solvent fractions of the leaf of Leucas deflexa Hook.f (Lamiaceae) in rodents

The emergence of antibiotic-resistant bacteria has intensified the search for novel antidiarrheal drug. Plant-derived extracts offer promising alternatives due to their ability to modulate gut motility and enhance water absorption. The leaves of Leucas deflexa Hook.f., a plant native to Ethiopia, have been traditionally utilized in the treatment of diarrheal diseases. Nonetheless, its traditional application has yet to be scientifically confirmed. Hence, the aim of the present study was to evaluate antidiarrheal activity of the crude extract and fractions of the leaf of Leucas deflexa Hook.f (Lamiaceae). Healthy Swiss albino mice were randomly divided into five groups per experimental model: castor oil-induced diarrhea, gastrointestinal motility, and anti-enteropooling assays. The control group received distilled water (10ml/kg), while the positive control was treated with loperamide (3mg/kg). The remaining groups were administered various dosages (LD100, LD200, and LD400 mg/kg) of a hydroalcoholic extract or its fractions from Leucas deflexa Hook.f. The crude extract and chloroform fraction substantially (P<0.001) delayed the onset of diarrhea, reduced fecal frequency, and decreased total fecal weight at all administered doses compared to the negative control. The butanol and aqueous fractions exhibited a substantial antidiarrheal effect at doses of 200mg/kg and 400mg/kg, respectively. All treatments, including the crude extract, chloroform, butanol, and aqueous fractions, substantially (P<0.001) reduced the volume and weight of intestinal contents at various doses. Additionally, the chloroform, aqueous fraction, and crude extract at doses of 100, 200, and 400mg/kg substantially inhibited gastrointestinal motility compared to the negative control. The results of this study corroborate the traditional use of Leucas deflexa leaves in the treatment of diarrhea. These findings give a scientific justification for further exploration of the underlying mechanisms and potential therapeutic applications of this plant extract.

Birth Traits Associated with Pre-Adulthood Disease Manifestations in Calves.

The objective of this study was to explore the relationship between calf birth traits and their susceptibility to diseases before reaching adulthood. A total of 5253 birth traits of Chinese Holstein calves were examined, including gestation length (GL), calf weight at birth (CW), and calving ease score (CES), which ranges from 1 (easy) to 5 (very difficult). Furthermore, monthly medical records were scrutinized for pneumonia and diarrhea in these calves. The study assessed five aspects of disease manifestation in calves: age at first onset, frequency of illness, longest duration of treatment, and total duration of treatment. The link between age at onset and disease manifestation prior to adulthood was analyzed using general linear models and regression models. The GL of calves significantly correlated with the risk of pneumonia, with the risk decreasing as the GL increases. A higher CES was associated with a later onset of diarrhea in calves. Furthermore, the CES was significantly negatively correlated with the duration of diarrhea treatment in calves. These results suggest that implementing different preventive measures for calves with different birth traits and modifying treatment protocols for affected calves could enhance the productivity of dairy cows and reduce losses on farms.

A-282 Purpura fulminans caused by Haemophilus influenzae: case report of unusual etiology

Abstract Background Fulminant purpura is a clinical syndrome characterized by a purplish, ischemic-looking skin rash, commonly accompanied by systemic symptoms ranging from acute febrile syndrome to septic shock. Due to high lethality of possible infectious etiologies, immediate recognition and early initiation of empirical antimicrobial therapy are crucial to ensure better outcomes. Interdisciplinary collaboration among healthcare teams, infectious disease specialists and microbiologists is essential to ensure accurate and early microbiological diagnosis. Methods This work aims to report a case of Haemophilus influenzae-induced purpura fulminans that occurred in Fortaleza-CE, a coastal city in northeastern Brazil, highlighting clinical recognition and microbiological identification, based on review of medical records. Results Case report A 59-year-old man, originally from Germany, was on vacation in Brazil. He presented to emergency medical service with an acute onset of fever, abdominal pain and diarrhea, progressing to decreased level of consciousness and purplish ischemic skin lesions with hemorrhagic bullae on trunk and extremities (Figure 1), with no history of trauma. Upon admission, the blood exams showed bicytopenia - 1900 leukocytes/µL (86% segmented) and 51,000 platelets/µL - and very high C-reactive protein (41.58 mg/dL). Although empirical antimicrobial therapy with vancomycin and piperacillin-tazobactam was initiated, patient progressed to septic shock, hepatic dysfunction, requiring mechanical ventilation, vasopressor support, and renal replacement therapy. Blood cultures from hospital admission were positive after about 14 hours and allowed isolation of small and translucent colonies in Chocolate PVX plate Agar (BioMerieux™). Maldi tof analysis by Vitek MS identified H. influenzae (99.9 % accuracy). Despite prolonged hospitalization due to multiple organ dysfunctions, patient had a positive outcome. Conclusions This case illustrates the importance of immediate recognition of the syndrome coupled with assertive empirical treatment and early microbiological diagnosis for a positive clinical outcome, even in a severe presentation. Multiprofessional approach is essential for accurate and early diagnosis.

Antidiarheal Activity of Methanol Seed Extract of Cola Acuminata Schott &amp; Endl (Malvaceae) In Mice

Cola acuminata nut extract has been shown to relax smooth muscles of the intestine in vitro, and this has made the plant popular as a potential antidiarrheal agent. This study aimed at evaluating the antidiarrheal activity of methanolic seed extract of Cola acuminata in mice. The extract was subjected to phytochemical analysis. The acute toxicity (LD50) study was conducted according to Lorke's method. The antidiarrheal activity was evaluated using castor oil-induced diarrhea and charcoal meal method in mice. Groups of mice were orally administered water (10 ml/kg), charcoal, Cola acuminata nut extract (150, 300 and 600 mg/kg), loperamide 2mg/kg, and atropine 1 mg/kg before castor oil. Phytochemical screening revealed the presence of alkaloids, cardiac glycosides, tannins, triterpenes, and saponins. The oral LD50 of the extract was estimated to be 2154 mg/kg. The extract produced a significant p &lt; 0.05 increase in time of onset of diarrhea compared to the distilled water group. The extract produced dose dependent inhibition of the number of wet faeces. Extract at 600 mg/kg had more protection against diarrhea than the Loperamide. The extract did not significantly (p &gt; 0.05) affect the intestinal movement of charcoal meal.

Frequency of Microscopic Colitis among Patients with Diarrhea Predominant Irritable Bowel Syndrome

Abstract Background Microscopic colitis is a chronic inflammatory disease of the colon that frequently causes chronic watery diarrhoea that might be accompanied by abdominal pain, nocturnal diarrhoea, urgency, and faecal incontinence. These symptoms lead to poor quality of life and increased health-care costs. Diagnosis relies on histological examination of multiple biopsy samples from the colonic mucosa, which often show no or only few abnormalities on endoscopy. Two major histological subtypes can be distinguished-collagenous colitis and lymphocytic colitis-but incomplete and variant forms with fewer characteristic features have been reported. Here we summarise the latest evidence on epidemiology, pathogenesis, and risk factors, and discuss established and novel therapeutic options for clinical remission. Finally, we propose an updated treatment algorithm. Further prospective studies are needed to clarify the natural history of microscopic colitis, supported by validated criteria for the assessment of disease activity. Aim of the Work The aim of this study is to assess the frequency of collagenous colitis and lymphocytic colitis among patients diagnosed with diarrhea predominant -IBS according to Rome III criteria in a scale of Egyptian population and its relation to bilharziasis. Patients and Methods Type of Study: Cross-sectional study of 50 patients with IBS-D who will undergo medical history and clinical examination. Results The present study showed significant elevation of ESR levels in MC patients with range (5-15mg/dl) than other patients levels which showed range (3-13 mg/dl), as ESR is acute phase reactant. Our study showed significant decrease in the level of Hb in patients with MC with range (10-12gm/dl) than patients with normal biopsy which showed range (12-15.7gm/dl) which may be due to chronic illness in patients with MC. Conclusion The present study showed significant decrease of albumin levels in MC patients with range (3- 4.5gm/dl) than other patients levels which showed range (3.4- 5.4 gm/dl), which may be due to severe attacks of diarrhea in patients with MC.

Unveiling the anti-giardial properties of Andrographis paniculata leaf extract through in vitro studies.

Giardiasis, caused by the parasite Giardia lamblia, is a prevalent and serious public health concern, particularly affecting children worldwide. The primary mode of transmission for the parasite is through contaminated food and water sources and often leads to the onset of diarrhoea in infected individuals. However, the present medications for Giardiasis treatment often come with numerous side effects, while the growing problem of drug resistance adds a significant complication. Therefore, there is an urgent need for alternative treatments. In this study, we explored the in-vitro potential of Andrographis paniculata leaf extract as a possible alternative treatment for Giardiasis. Our investigation involved assessing the impact of the ethanolic extract on Giardia trophozoites through the analysis of parameters such as cell death, morphological alterations, adherence, ROS generation, and cell cycle dynamics. A. paniculata leaf extracts demonstrated significant inhibitory activity against the growth of Giardia trophozoites. After being incubated for 24 hours, the test results revealed an IC50 value of 51.26µg/ml (95% CI 37.17- 65.35) for inducing cell death in Giardia trophozoites. We observed a substantial degradation of DNA, alteration in morphology, inhibition in adherence, ROS generation and inhibition of the cell cycle in Giardia trophozoites. The findings indicate that A. paniculata extract has the potential to be used as a therapeutic treatment for giardiasis. This approach aims to offer a natural therapeutic solution for giardiasis, minimizing side effects and reducing the risk of drug resistance.

Fecal microbiota of diarrheic calves: Before, during, and after recovering from disease.

It is unknown if gastrointestinal dysbiosis in diarrheic calves causes disease or is a consequence of the disease. Describe the fecal microbiota of calves before, during, and after recovering from diarrhea. Fifteen female Holstein calves of 0 to 21 days old from a single farm. Seven calves remained healthy throughout the study, and 8 developed diarrhea on Day 14. Longitudinal cohort study. Microbiota composition was characterized by amplifying the V4 region of the 16S rRNA gene. Diversity (Shannon index) increased with age in healthy and diarrheic calves from Day 3 to 21, but diarrheic calves had a lower diversity on the day diarrhea was first observed (Day 14). By Day 21, diversity increased in calves that recovered from diarrhea and was not significantly different from that of their healthy counterparts (P > .05). Weighted UniFrac distance showed significant differences in the fecal microbiota between diarrheic and healthy calves at Day 14 of age (PERMANOVA, P < .05), but not before or after diarrhea (PERMANOVA, P > .05). Lactobacillus, Clostridium Sensu Stricto 1, and Collinsella were differentially abundant on Day 10 in calves that developed diarrhea on Day 14 (P < .05). The fecal microbiota of healthy and diarrheic calves evolved similarly during the first 10 days of age but differed significantly on the day of onset of diarrhea. Enriching Lactobacillus, Clostridium Sensu Stricto 1, and Collinsella before diarrhea onset could have been contributed to the development of diarrhea.

A very early Presentation of Wilson disease

Male patient, aged 13 years, developed recurrent monthly attacks of fever, abdominal pain, vomiting, diarrhea, and occasional oligo-arthritis. Each attack persisted for 5-7 days that resolved spontaneously.

Development of the Intestinal Microbiota of Dairy Calves and Changes Associated with Cryptosporidium spp. Infection in Brazil.

Cryptosporidium spp. is one of the most important pathogens infecting nursing calves worldwide. This study aimed to investigate the intestinal microbiota of dairy calves during the first month of life and the impact of diarrhea caused by Cryptosporidium on a Brazilian farm. Fecal samples from 30 calves were collected during the first month of life, and fecal scores were recorded. Samples from the second, third, and fourth days of life were analyzed by DNA sequencing of the 16S rRNA gene. In addition, samples of sixteen calves positive for Cryptosporidium spp. were retrospectively chosen according to the development of diarrhea: four and two days before diarrhea, at the onset of diarrhea, after four days of diarrhea, at the end of diarrhea, and after six days of diarrhea resolution. Diarrhea was observed in all calves (100%), starting at day 5 of life, and all calves tested positive for Cryptosporidium in at least one sample. The microbiota richness increased with age but was retarded by diarrhea. Compositional changes associated with Cryptosporidium infection included increases in Fusobacterium, Prevotella, and Peptostreptococcus, as well as decreases in Collinsella and Lachnospiraceae. In conclusion, Cryptosporidium infection has the potential to decrease richness and change the composition of the intestinal microbiota of dairy calves.

Probiotics in miRNA-Mediated Regulation of Intestinal Immune Homeostasis in Pigs: A Physiological Narrative.

The microbiota plays a crucial role in maintaining the host's intestinal homeostasis, influencing numerous physiological functions. Various factors, including diet, stress, and antibiotic use, can lead to such imbalances. Probiotics have been shown to restore the microbiota, contributing to maintaining this balance. For instance, the weaning stage in piglets is crucial; this transition can cause unfavorable changes that may contribute to the onset of diarrhea. Probiotic supplementation has increased due to its benefits. However, its mechanism of action is still controversial; one involves the regulation of intestinal immunity. When recognized by immune system cells through membrane receptors, probiotics activate intracellular signaling pathways that lead to changes in gene expression, resulting in an anti-inflammatory response. This complex regulatory system involves transcriptional and post-transcriptional mechanisms, including the modulation of various molecules, emphasizing microRNAs. They have emerged as important regulators of innate and adaptive immune responses. Analyzing these mechanisms can enhance our understanding of probiotic-host microbiota interactions, providing insights into their molecular functions. This knowledge can be applied not only in the swine industry, but also in studying microbiota-related disorders. Moreover, these studies serve as animal models, helping to understand better conditions such as inflammatory bowel disease and other related disorders.

Norovirus Management and Outcomes in a Multicenter Pediatric Kidney Transplant Population.

Norovirus is the most common cause of viral gastroenteritis. Studies in adult kidney recipients have documented significant morbidity associated with norovirus infection, but there are few studies in pediatric recipients. Multicenter retrospective cohort study of pediatric kidney transplant recipients with norovirus, confirmed by stool PCR, between January 1, 2008, and December 31, 2018. Outcomes of interest included duration of diarrhea, incidence of chronic diarrhea, management strategies, and graft function. Forty pediatric kidney transplant recipients from four centers were identified for inclusion. Median age at transplant was 5.4 years (IQR 2.2-11.2 years), and median time post-transplant was 1.9 years (IQR 0.8-3.8 years). Median diarrheal duration was 16 days (IQR 6.0-41.5 days); 15 patients (43%) had acute diarrhea, 8 (23%) had persistent, and 12 (30%) had chronic diarrhea. Twenty-one (53%) patients developed acute kidney injury. Thirty-five (88%) patients required supplemental fluids, 8 (20%) patients underwent immunosuppression reduction for a median of 22 days, 5 (13%) were treated with nitazoxanide, and 5 (13%) received oral immunoglobulin. Acute rejection was diagnosed in 3 (8%) patients within 6 months of norovirus diagnosis. We observed no sustained decline in eGFR at 12 months after diarrhea resolution (median eGFR difference: 2.8 mL/min/1.73 m2 [IQR: -17.1, 7.4]). Of the patients in the cohort, two lost their graft at 6.8 and 30.0 months after the onset of diarrhea. Norovirus is associated with significant morbidity in pediatric kidney transplant recipients. Various treatment interventions are being employed for norovirus infection. Larger studies, both observational and interventional, are needed to determine the optimal treatment.

A novel MALT1 variant in an Egyptian patient presenting with exfoliative dermatitis: a case-based review.

Inborn errors of the CARD11-BCL10-MALT1 (CBM) signalosome have recently been shown to underlie severe combined immunodeficiency (SCID) and combined immunodeficiency (CID) with variable immunological and clinical phenotypes, and patients usually present with recurrent bacterial, viral, and fungal infections, periodontal disease, enteropathy, dermatitis, and failure to thrive. In the present study, we describe the clinical and immunological characteristics of an Egyptian patient with a mutation in the MALT1 gene. The patient suffered from an itchy exfoliative skin rash and eczematous lesions over his face and flexural surface of the limbs. He also had dental enamel erosion, repeated attacks of diarrhea, and pneumonia. He had elevated serum IgE and normal B- and T-lymphocyte subset counts, but there was an arrest in the B-cell maturation. DOCK8 expression on the lymphocytes by flow cytometry was normal. Next-generation sequencing revealed a novel homozygous variant in the MALT1 gene (c.762dup in exon 5 of 17; p.Ile255TyrfsTer10); this variant is likely pathogenic, thus supporting the genetic diagnosis of immunodeficiency-12 (IMD12). Although the presence of eczema, recurrent sinopulmonary, and staphylococcal infections are suggestive of DOCK8 deficiency, they are also a finding in CARD11 and MALT1 deficiency. Thus, whenever DOCK 8 has been excluded, the molecular diagnosis is mandatory as this could lead to discovering more patients hence better understanding and reporting of the phenotype and natural history of the disease especially since there are very few documented cases. Early diagnosis will also enable the proper patient management by hematopoietic stem cell transplantation (HSCT) prior to the establishment of infections and pulmonary damage leading to a better outcome.

Trichohepatoenteric syndrome type 1: expanding the clinical spectrum of THES type 1 due to a homozygous variant in the SKIC3 gene

Trichohepatoenteric syndrome (THES), also known as phenotypic diarrhea or syndromic diarrhea, is a rare autosomal recessive genetic disorder caused by mutations in SKIC2 (THES-type 2) or SKIC3 (THES-type 1) and is characterized by early onset diarrhea, woolly brittle hair, facial dysmorphic features and liver disease. We report the case of a 24-month-old girl who presented with chronic diarrhea since the neonatal period along with intrauterine growth restriction (IUGR), developmental delay, dysmorphic features, congenital heart defects, liver disease, and recurrent infections. The diagnosis was made through whole-exome sequencing analysis, which detected a homozygous variant (c.4070del, p.Pro1357Leufs*10) in the SKIC3 gene. The patient required parenteral nutrition and was hospitalized for the first 10 months of life and then discharged on PN after showing improvement. She remained stable on PN after discharge despite a few admissions for central line infections. Recent follow-up at the age of 2 years revealed that she was stable on long-term parenteral nutrition and that she had advanced chronic liver disease.

Time to treatment-seeking by caretakers of children under-five with diarrhea and associated factors in Uganda: a multilevel proportional hazards analysis

BackgroundDiarrhea is considered to be one of the major public health concerns in developing countries. It has a detrimental impact, reflecting one of the highest child mortality rates globally, especially in Sub-Saharan Africa, where 2 out of every 10 children in Uganda under the age of five die. The objective of this study was to investigate the factors associated with time to treatment seeking by caretakers of children under-five with Diarrhea in Uganda.MethodDOVE dataset of 745 caretakers in a prospective and retrospective incidence-based study using multi-stage sampling design was used in the assessment. The analysis was done using a time-to-event approach using life tables, Kaplan Meier survival analysis and multilevel proportional hazards model.ResultsKaplan-Meier survival analysis indicated the median time to seeking treatment among 745 caretakers of children under-Five after onset of diarrhea was 2 days. The multi-level proportional hazards model of a Weibull distribution showed that the estimated frailty variance was 0.13, indicating heterogeneity of treatment seeking time by caretakers of under-five children with diarrhea across regions in Uganda. Significant factors found to influence time to treatment-seeking by caretakers of children under-five with diarrhea were, male children (HR = 0.82; 95% CI = 0.71–0.95, p = 0.010), belonging to richest wealth quintile (HR = 1.37; 95% CI = 1.05–1.78, p = 0.022), and residing more than 5 km away from a health facility (HR = 0.68; 95% CI = 0.56–0.84, p = 0.000).ConclusionsThere are delays in seeking diarrhea treatment in Uganda because two days are enough to claim a life after dehydration.The policymakers should pay attention to formulate effective intervention to sensitize caregivers on the importance of early treatment-seeking behavior to avoid severe malnutrition caused by diarrhea. Community awareness program should also be encouraged particularly in areas of more than 5 km from the health facility to make people aware of the necessity to take prompt action to seek care in the early stage.

Multiplex Gastrointestinal Panel Testing in Hospitalized Patients With Acute Diarrhea in Thailand.

Multiplex gastrointestinal (GI) panel testing is widely used for outpatient diagnosis of diarrhea. However, the clinical practicality of multiplex testing in hospitalized diarrheal subjects has not yet been thoroughly elucidated. We enrolled hospitalized subjects with acute diarrhea. The subjects' stool samples were collected in triplicate; 1 sample was tested using traditional diagnoses, and the other 2 were tested using Allplex (AP) and FilmArray (FA) GI panel testing. Clinical data were reviewed and analyzed. Of the 199 subjects, 92 (46.5%) were male, and the mean age was 66.3 years. The median (interquartile range) onset of diarrhea was 6 (2--14) days after hospitalization. One hundred fifty-one patients (75.9%) had sepsis, and 166 (83.4%) had received prior or were receiving current antimicrobial therapy. Positive stool cultures were obtained from 4/89 (4.5%), and Clostridioides difficile toxin gene tests were positive in 14/188 (7.4%) patients. AP and FA multiplex tests were positive for GI pathogens in 49/199 (24.6%) and 40/199 (20.1%), respectively. The target most frequently detected by AP was Aeromonas spp. Both assays commonly detected enteropathogenic E. coli (EPEC), C. difficile toxin gene, and Salmonella spp.; neither assay detected pathogens in 75.4% and 79.9%. Fever (odds ratio [OR], 2.05; 95% CI, 1.08-3.88; P = .028), watery diarrhea (OR, 2.69; 95% CI, 1.25-5.80; P = .011), and antimicrobial therapy (OR, 2.60; 95% CI, 1.18-5.71; P = .018) were independent factors associated with the negative multiplex test result. Multiplex GI panel testing effectively detects enteric pathogens associated with diarrhea in hospitalized subjects. The etiology remains undiagnosed in >75% of cases. Factors contributing to negative test results should be considered before implementing the tests.