Cause Of Diarrhea Research Articles

Shigella sonnei: epidemiology, evolution, pathogenesis, resistance and host interactions.

Shigella sonnei is a major cause of diarrhoea globally and is increasing in prevalence relative to other Shigella because of multiple demographic and environmental influences. This single-serotype species has traditionally received less attention in comparison to Shigella flexneri and Shigella dysenteriae, which were more common in low-income countries and more tractable in the laboratory. In recent years, we have learned that Shigella are highly complex and highly susceptible to environmental change, as exemplified by epidemiological trends and increasing relevance of S. sonnei. Ultimately, methods, tools and data generated from decades of detailed research into S. flexneri have been used to gain new insights into the epidemiology, microbiology and pathogenesis of S. sonnei. In parallel, widespread adoption of genomic surveillance has yielded insights into antimicrobial resistance, evolution and organism transmission. In this Review, we provide an overview of current knowledge of S. sonnei, highlighting recent insights into this globally disseminated antimicrobial-resistant pathogen and assessing how novel data may impact future vaccine development and implementation.

Lactiplantibacillus plantarum L47 and inulin affect colon and liver inflammation in piglets challenged by enterotoxigenic Escherichia coli through regulating gut microbiota

IntroductionInfection by pathogenic bacteria during weaning is a common cause of diarrhea and intestinal inflammation in piglets. Supplementing the diet with synbiotics is beneficial for animal health. The strain of Lactiplantibacillus plantarum L47 (L47) isolated in our lab exhibited good probiotic properties when combined with inulin. Here, the effectiveness of combining L47 and inulin (CLN) in protecting against enterotoxigenic Escherichia coli (ETEC) induced colon and liver inflammation in weaned piglets was evaluated.MethodsTwenty-eight piglets aged 21 days were randomly assigned into 4 groups: CON (control), LI47 (oral CLN culture fluid, 1010 CFU/d of L47 and 1 g/d of inulin), ECON (oral ETEC culture fluid, 1010 CFU/d), and ELI47 (oral CLN and ETEC culture fluid). After 24 days, the colon and liver samples were collected for further analysis.Results and discussionCLN alleviated colon damage caused by ETEC challenge, as evidenced by an increase of colonic crypt depth, mRNA expression of tight junction Claudin-1 and Occludin, GPX activity, the concentration of IL-10 and sIgA (p < 0.05). Moreover, there was a decrease in MDA activity, the load of E. coli, the concentration of LPS, gene expression of TLR4, and the concentration of TNF-α and IL-6 (p < 0.05) in colonic mucosa. Additionally, CLN counteracted liver damage caused by ETEC challenge by modulating pathways associated with immunity and disease occurrence (p < 0.05).ConclusionSupplementing with CLN alleviated colon inflammation induced by ETEC challenge by decreasing the E. coli/LPS/TLR4 pathway and regulating hepatic immune response and disease-related pathways, suggesting that CLN could protect intestinal and liver health in animals.

Escherichia coli diarrhoea among the adults – prospective research

Introduction: Eschrichia coli is common diarrhea causing agent. This study aimed to identify the bacterial pathogens responsible for diarrhea and abdominal pain in adults. Foodborne illnesses remain a significant public health concern, with Escherichia coli. Methods: The study, conducted from January to May 2021 at GSL Medical College, included adults with diarrhea and abdominal pain. Stool samples were collected, processed, and cultured on selective media to identify bacterial pathogens. Statistical analysis was performed to assess pathogen prevalence and its association with symptoms, using descriptive statistics for findings interpretation. Results: Among 100 adults with diarrhea and abdominal pain, 52% were male, and the majority (40%) were aged 31–45 years. Abdominal pain (80%) and diarrhea (75%) were the most common symptoms. Escherichia coli was the leading isolate (30%), followed by Salmonella spp. (25%) and Staphylococcus aureus (20%). Conclusion: In conclusion, this study highlights Escherichia coli as the primary bacterial cause of diarrhea among adults, followed by Salmonella spp. and Staphylococcus aureus. These findings underscore the importance of targeted food safety measures and public health interventions to address foodborne pathogens and prevent related illnesses in communities. Key words: Escherichia coli, Diarrhea, Foodborne pathogens, Abdominal pain, Bacterial isolation

Application of Reverse Vaccinology and Immunoinformatics to Design a Multitope Vaccine against Gastrointestinal Cancer-inducing Cryptosporidium Parvum

Cryptosporidium parvum (C. parvum) is an apicomplexan protozoan known as a frequent cause of diarrhea. Because of its severe outbreaks and the association with different types of gastrointestinal cancers, it became an urgent need to develop effective solutions against that parasite. In the current study, the complete proteome of C. parvum was analyzed, and after applying several filtration steps, two proteins, namely Glycoprotein 60 (gp40/15) and thrombospondin-related adhesive protein (TRAP C-1), were selected as the protein candidates for epitope prediction. Next, CTL, HTL and BCL epitopes of each protein candidate were defined, and the best epitopes of each category were assembled alongside suitable linkers and adjuvants to initiate a potential multitope vaccine construct finally. That construct was evaluated for several properties, including its antigenicity, allergenicity, stability, secondary and tertiary structure, and the ability of that 3D predicted model to bind to TLR4. Furthermore, the stability of the constructed vaccine ligand in the TLR4 receptor was deeply investigated through a molecular dynamics simulation. The current study describes the stages of the multitope construct design. It demonstrates the results of that construct computational evaluation where the generated scores support the nomination of that potential vaccine as a solution for C. parvum infection, and further wet lab experiments are required to validate our current findings.

Comparative analysis of the epidemiological characteristics of adenovirus, rotavirus A, and coinfection in children during 2014–2023 in Guangzhou, China

BackgroundInfection is the cause of diarrhoea, and rotaviruses and adenoviruses are important pathogens in children.MethodsA retrospective study was conducted on 144,067 children with diarrhoea between 2014 and 2023 in China. We used the colloidal gold method to detect intestinal adenovirus and rotavirus A antigens in faeces. The epidemiological characteristics of these viruses and the impact of meteorological factors on them were analysed before and after coronavirus disease 2019 (COVID-19) pandemic.ResultsDuring this decade, the positive rate of adenovirus infection was 6.41%, while the positive rate of rotavirus A infection was 11.81%, higher than that of adenovirus infection. The positive rate of adenovirus and rotavirus A coinfection was 1.92%. The positive rates of adenovirus, rotavirus A and coinfection showed a fluctuating trend, and suddenly decreased in 2020. There was an apparent decrease of positive rate of rotavirus A, with a decrease of 57.27%, during 2020–2023. Surprisingly, the positive rate of adenovirus infection exceeded that of rotavirus A infection in 2021 and 2023. During the COVID-19 pandemic, the proportion of female patients and children over two years of age infected with adenovirus or rotavirus A increased, while the proportion of cases in winter decreased. In addition, we found that the positive rate of rotavirus A infection was related to average temperature and sunshine, and the positive rate of adenovirus and rotavirus A coinfection was only related to sunshine. However, these correlations disappeared during the COVID-19 pandemic.ConclusionsThis study revealed the recent prevalence of adenovirus and rotavirus A infections in children with diarrhoea in south-central China and provided a theoretical basis for the prevention and control of viral diarrhoea.

Isoleucine Enhanced the Function of the Small Intestinal Mucosal Barrier in Weaned Piglets to Alleviate Rotavirus Infection.

Rotavirus (RV) is a major cause of diarrhea in young children and animals, especially piglets, leading to substantial economic losses in the global pig industry. Isoleucine (Ile), a branched-chain amino acid, plays an important role in regulating nutrient metabolism and has been shown to improve diarrhea. This study aimed to evaluate the effects of Ile supplementation on the mucosal immune barrier of the small intestine in RV-infected weaned piglets. Forty-eight 21-day-old weaned piglets were randomly divided into three dietary treatments (each treatment was subdivided into two groups, eight replicates per group), with 0%, 0.5%, or 1% Ile added for 15 days, and then, one group from each treatment was challenged with RV. The results showed that 1% Ile added to the diet promoted the healthy development of the intestinal mucosa. Ile could restore the reduced villus height in the ileum and the goblet cell number in the duodenum and ileum to normal levels, improving the intestinal epithelial tight junctions in RV-infected piglets. Additionally, Ile increased the activity of lipase, amylase, and sucrase, as well as superoxide dismutase (SOD) and glutathione (GSH), along with the expression of SIgA, DEFβ1, and DEFβ2 in parts of the small intestine. The addition of Ile to the diet mitigated the effects of RV infection on intestinal morphology and mucosal barrier function, as well as the physiological functions of weaned piglets, and improved the antioxidant and immune functions of the piglets to some extent. These findings offer valuable insights, contributing to a deeper understanding of the role of Ile in supporting intestinal health.

Epidemiology of Clostridioides difficile PCR ribotype 181 after the COVID-19 pandemic in Northern Greece.

Clostridioides difficile infection (CDI) is one of the most significant causes of diarrhea in hospitalized patients. The aim of this study was to investigate the incidence and epidemiology of CDI after the COVID-19 pandemic in hospitalized patients in a rehabilitation center in Thessaloniki, Greece. Αretrospective observational cohort study was performed in inpatients diagnosed with diarrhea of all ages (January 2023 - December 2023) who were initially screened for CDI. From the total cohort of patients with proven CDI, some patients were randomly selected based on their monthly isolation incidence throughout the study period, to investigate their epidemiological data and clinical characteristics. Laboratory diagnosis of CDI was performed by enzyme immunoassay, followed by specific anaerobic culture and molecular testing for detection of toxigenic C. difficile. The isolated C. difficile strains were further characterized by PCR ribotyping. The annual incidence of CDI during the studyperiod was 27.1% (130/480). The linear trend of CDI incidence decreased from 32.5% to 18.2% (P= 0.024). The all-cause mortality rate was 5.0% (3/60). A positive correlation was observed between the length of hospital stay and the number of recurrences (r = 0.546, P < 0.001), while 28 patients (46.7%) experienced recurrence of the infection. Seven different PCR ribotypes were identified in thisstudy. C. difficile tcdA+, tcdB+, cdtA+, cdtB+ PCR ribotype 181 (RT181) was the predominant (76.6%, 46/60), followed by toxin A-negative PCR RT017 (11.6%, 7/60). The annual incidence of CDIdecreased after the COVID-19 pandemic. Our study demonstrates predominance of C. difficile RT181 with tcdA+, tcdB+, cdtA+, cdtB+ toxin gene profile after COVID-19 pandemic in Northern Greece.

Prevalence of Parasitic Disease Burden in the Adult Population Presenting With Persistent or Chronic Diarrhea.

Introduction Parasitic infection is an overlooked cause of diarrhea in adults. It can cause persistent or chronic diarrhea that contributes to a significant burden on the overall morbidity of the population. Stool sampling would aid in the diagnosis of parasitic infection in adults presenting with diarrhea. Methods A cross-sectional study was conducted from January to June 2024 at Medical Teaching Institution (MTI)-Hayatabad Medical Complex, Peshawar, Pakistan. A total of 500 stool samples were collected using non-probability consecutive sampling. All the patients presenting with complaints of persistent or chronic diarrhea to the medical outpatient department or admitted to the medical units were included in the study. Patients with bloody diarrhea and those less than 13 years of age were excluded from the study. Verbal and written informed consent was obtained from all the patients included in the study. The stool samples of all the patients were collected, reported, and verified by the microbiology department. Results Out of 500 stool samples of the patients with persistent or chronic diarrhea, 174 (34.8%) were found to be infected with cysts or trophozoites of parasites.Gender distribution of parasitic infections showed that 89 out of 245 females (36.3%) and 85 out of 255 males (33.3%) were affected. The comparison between genders yielded a p-value of 0.482. All the patients showed mono parasitism. The most common isolate was Giardia lamblia in 90 (51.72%) cases, followed by H-Nana in 49 (28.17%) isolates, Entamoeba histolytica in 16 (9.20%), Ascaris lumbricoides in 14 (8.04%), Trichuris trichura in two (1.15%), Taenia saginata in two (1.15%), and Cryptosporidium in one (0.6%) infected patient. Conclusion Parasitic intestinal infections, particularly Giardia and H-Nana, are prevalent yet overlooked causes of persistent and chronic diarrhea in adults. These findings underscore the importance of routine stool examination as a cost-effective diagnostic tool, potentially improving patient outcomes and reducing unnecessary medical interventions.​​​​​​​​​.

Intestinal Epithelial Cell Brush Border Membrane Cl:HCO3 Exchanger Regulation by Mast Cells in Chronic Ileitis.

Malabsorption of NaCl is the primary cause of diarrhea in inflammatory bowel disease (IBD). Coupled NaCl absorption occurs via the dual operation of Na:H and Cl:HCO3 exchange in the brush border membrane (BBM) of villus cells. Cl:HCO3 exchange is mediated by BBM transporters DRA (downregulated in adenoma) and PAT1 (putative anion transporter 1) in the mammalian small intestine. DRA/PAT1-mediated Cl:HCO3 exchange was significantly downregulated in the BBM of villus cells in a rabbit model of chronic ileitis, while Na:H exchange was unaffected. The inhibition of Cl:HCO3 exchange was restored in the rabbits when treated with a broad-spectrum immunomodulator, i.e. a glucocorticoid, indicating that the downregulation of DRA/PAT1 is likely to be immune-mediated during chronic enteritis. Mucosal mast cells are one type of key immune cells that are known to proliferate and release immune inflammatory mediators, thus playing a significant role in the pathogenesis of IBD. However, how mast cells may regulate DRA- and PAT1-mediated Cl:HCO3 exchange in a rabbit model of chronic ileitis is unknown. In this study, treatment of rabbits with chronic intestinal inflammation with the mast cell stabilizer ketotifen did not affect the mucosal architecture of the inflamed intestine. However, ketotifen treatment reversed the inhibition of Cl:HCO3 activity in the BBM of villus cells. This restoration of Cl:HCO3 activity to normal levels by ketotifen was found to be secondary to restoring the affinity of the exchangers for its substrate chloride. This observation was consistent with molecular studies, where the mRNA and BBM protein expressions of DRA and PAT1 remained unaffected in the villus cells under all experimental conditions. Thus, this study indicates that mast cells mediated the inhibition of coupled NaCl absorption by inhibiting Cl:HCO3 exchange in a rabbit model of chronic enteritis.

Spray-dried plasma protects against rotavirus-induced gastroenteritis via regulating macrophage and T cells divergence in weanling pigs.

Infectious gastroenteritis is the major cause for diarrhea in piglets. The protection of spray-dried plasma (SDP) on viral gastroenteritis during the progression of rotavirus (RV) infection remain unclear. In this study, 64 weanling piglets were randomly assigned to control diets (n = 40) and SDP diets (n = 24) for 14 days, and then pigs were challenged with RV on day 15. Pigs were sacrificed on day 14 (normal condition), day 18 (manifestation stage), and day 21 (convalescent stage) of the trial. Prior to RV infection, SDP increased ADG, M1 macrophages and CD4+ T cells in different organs without increasing proinflammatory cytokines, indicating a more robust immunity with less inflammation. During the manifestation of infection, SDP enhanced mucosal immunity by increasing M1 macrophages, M1/M2 ratio and cytokines in mucosa and increasing intraepithelial CD8+ T cells for RV clearance. During the convalescence, SDP promoted M2 macrophage polarization and reduced pro-inflammatory cytokines to facilitate intestinal repair and prevent prolonged inflammation. Collectively, SDP enhanced mucosal immunity to promote viral clearance and maintained immune homeostasis to prevent long-lasting inflammation as a therapeutically approach for infectious gastroenteritis.

Molecular detection of Cryptosporidium parvum in sheep and goats in rural areas of Al-Muthanna Province, Iraq

Background: Cryptosporidium species are widespread protozoa and are considered an important cause of diarrhea in humans and animals. Aim: The aim of this study was to identify the occurrence of Cryptosporidium parvum in diarrheic sheep and goats from the rural areas of the Al-Muthanna Province, southern Iraq, based on molecular screening using PCR. The outcomes would help in determining the distribution of C. parvum in sheep and goats in the area, as well as the risk factors for the infection. Methodology: Sixty fecal samples were collected from clinically ill sheep and goats. The samples were submitted to PCR and sequencing that targeted the 18S rRNA gene in the protozoan. Results: The PCR revealed a 60% (18 samples) and 76.67% (23 samples) positive identification of C. parvum in sheep and goats, respectively. The sequencing demonstrated nucleotide similarities with isolates deriving from Iraq (MG878399.1) and India (JN836324.1) for the sheep isolates, and with isolates deriving from South Korea (DQ054819.1) and the USA (AF159112.1) for the goat isolates. Conclusion: C. parvum is the dominant species in the sheep and goats of Al-Muthanna Province, in southern Iraq. Moreover, the phylogenetic analysis demonstrates that the current study’s isolates may share the same ancestor with local and global isolates.

Frequency of Bacteria Causing Exudative Diarrhea in Children Less Than Five Years Old in a Tertiary Hospital, Iran

Background: Exudative diarrhea is a significant global public health issue, particularly affecting children under the age of 5. Identifying the cause of diarrhea is crucial for epidemiological surveillance and, in some cases, for ensuring appropriate treatment for patients. Objectives: The aim of this study was to investigate the frequency of bacteria responsible for exudative diarrhea in samples from children under five years old in a tertiary hospital in Iran. Methods: In this multicenter cross-sectional descriptive study, 104 children with exudative diarrhea who were referred to Mofid Children's Hospital in Tehran, as well as hospitals in Hamedan, Ardebil, and Bandar Abbas, from December 2020 to March 2022 were enrolled. DNA extraction was performed using a commercial kit, and the identification of various causative bacteria was conducted through conventional and real-time PCR. Descriptive and inferential statistics were analyzed using SPSS version 22 software. Results: Most of the children with exudative diarrhea were under 12 months old (31%) or between 12 and 24 months old (22%). Boys made up 66% of the participants. Additionally, 70% of the children had a fever, and 58% experienced vomiting. Furthermore, 56% of the patients were dehydrated. The most prevalent bacterial causes of exudative diarrhea were Shigella spp., followed by Salmonella spp., Campylobacter spp., Clostridium difficile, E. coli-Stx1, and E. coli-Stx2. Conclusions: The findings indicated that *Shigella* spp. was the leading cause of diarrhea in children under five years old. The most common signs and symptoms associated with exudative diarrhea were fever and vomiting, which physicians should consider in their diagnostic and treatment processes.

Silver and Copper Nanoparticles Hosted by Carboxymethyl Cellulose Reduce the Infective Effects of Enterotoxigenic Escherichia coli:F4 on Porcine Intestinal Enterocyte IPEC-J2.

Zero-valent copper and silver metals (Ms) nanoparticles (NPs) supported on carboxymethylcellulose (CMC) were synthesized for treating Enterotoxigenic Escherichia coli fimbriae 4 (ETEC:F4), a major cause of diarrhea in post-weaned pigs. The antibacterial properties of Cu0/CMC and Ag0/CMC were assessed on infected porcine intestinal enterocyte IPEC-J2, an in vitro model mimicking the small intestine. The lower average particle size (218 nm) and polydispersity index [PDI]: 0.25) for Ag0/CMC, when compared with those of Cu0/CMC (367 nm and PDI 0.96), were explained by stronger Ag0/CMC interactions. The minimal inhibitory concentration (MIC) and half inhibitory concentration (IC50) of Ag0/CMC were lower in both bacteria and IPEC-J2 cells than those of Cu0/CMC, confirming that silver nanoparticles are more bactericidal than copper counterparts. IPEC-J2, less sensitive in MNP/CMC treatment, was used to further investigate the infective process by ETEC:F4. The IC50 of MNP/CMC increased significantly when infected IPEC-J2 cells and ETEC were co-treated, showing an inhibition of the cytotoxicity effect of ETEC:F4 infection and protection of treated IPEC-J2. Thus, it appears that metal insertion in CMC induces an inhibiting effect on ETEC:F4 growth and that MNP/CMC dispersion governs the enhancement of this effect. These results open promising prospects for metal-loaded biopolymers for preventing and treating swine diarrhea.

Enhancing diagnostic accuracy: Direct immunofluorescence assay as the gold standard for detecting Giardia duodenalis and Cryptosporidium spp. in canine and feline fecal samples

The enteric protozoan parasites Giardia duodenalis and Cryptosporidium spp. are common cause of diarrhea in pet dogs and cats, affecting primarily young animals. This comparative study evaluates the diagnostic performance of conventional and molecular methods for the detection of G. duodenalis and Cryptosporidium spp. infection in dogs and cats.The compared diagnostic assays included merthiolate-iodine-formalin (MIF) method, lateral flow immunochromatography rapid test (ICT) and real-time PCR; using direct immunofluorescence assay (DFA) as golden standard. The study included the analysis of 328 fecal samples from different dog (n = 225) and cat (n = 103) populations.According to DFA, the overall prevalence of G. duodenalis was 24.4% (80/328, 95% CI: 19.8–29.4), varying from 11.6% (12/103, 95% CI: 6.2–19.5) in cats to 30.2% (68/225, 95% CI: 24.3–36.7) in dogs. The overall prevalence of Cryptosporidium spp. was 4.0% (13/328, 95% CI: 2.1–6.7), varying from 2.9% (3/103, 95% CI: 0.6–8.3) in cats to 4.4% (10/225, 95% CI: 2.1–8.0) in dogs. MIF was only used for the detection of G. duodenalis, which was identified by this method in 22.7% of dogs and 7.8% of cats, respectively. DFA was the most sensitive technique for detecting G. duodenalis in samples from dogs and cats (p-value: < 0.001), followed by real-time PCR. Identification of Cryptosporidium infections was most effectively accomplished by the combination of DFA and PCR technique (p-value: < 0.001). In addition, epidemiological (sex, age, origin) and clinical (fecal consistency) variables were collected to assess their potential associations with an increased likelihood of infection by G. duodenalis and/or Cryptosporidium spp. Breeder dogs were more likely to harbor G. duodenalis infection (p-value: 0.004), whereas female cats were significantly more infected with Cryptosporidium (p-value: 0.003).In conclusion, DFA (alone or in combination with PCR) has been identified as the most accurate and cost-effective method for detecting G. duodenalis and Cryptosporidium spp. in fecal samples from pet dogs and cats. This highlights their importance in both veterinary and clinical settings for enabling prompt treatment and preventing potential transmission to humans.

Function of the alternative electron transport chain in the Cryptosporidium parvum mitosome.

Cryptosporidiosis is the leading cause of diarrhea in young children and immunocompromised individuals, particularly AIDS/HIV patients. The only FDA approved drug against cryptosporidiosis, nitazoxanide, has limited effectivity in immunocompromised patients and is not approved for usage in children under 1 year old. Genomic analysis and previous studies proposed an alternative respiration pathway involving alternative oxidase (AOX) and type II NAD(P)H dehydrogenase (NDH2), which are thought to generate the mitosome membrane potential in C. parvum. Additionally, AOX and NDH2 were nominated as potential drug targets, based on their absence in mammalian hosts and sensitivity of parasite growth to known inhibitors of AOX. However, our study demonstrated that NDH2 is not localized in mitosome, AOX non-essential for parasite growth, and knockout lines lacking this enzyme are equally sensitive to AOX inhibitors. These findings indicate that AOX and NDH2 are not ideal candidates for future drug development against cryptosporidiosis and force a re-evaluation for models of how the mitosome generate its membrane potential.

Prevalence and molecular characterization of Cryptosporidium spp. in pre-weaned diarrheic dairy calves and their bedding materials in northern China.

Cryptosporidiosis, primarily caused by Cryptosporidium parvum, is a significant cause of diarrhea in pre-weaned dairy calves. To investigate the prevalence of Cryptosporidium among pre-weaned diarrheic dairy calves and identify potential sources of infection in northern China, 234 fecal samples from 18 farms in six regions were analyzed for Cryptosporidium. Furthermore, 217 bedding samples from both occupied and unoccupied calf hutches, heating lamp pens, and individual calving pens in eight farms in Beijing were also examined for the presence of the parasite. All samples were screened for Cryptosporidium spp. using nested PCR targeting the SSU rRNA gene fragment, and C. parvum was subtyped with nested PCR targeting the 60kDa glycoprotein gene. The prevalence of Cryptosporidium was 33.3%, with C. parvum and C. bovis constituting 29.9% and 3.4% of cases, respectively. The positive rate of Cryptosporidium in 1- to 4-week-old calves ranged from 9.6 to 63.6%. Analysis of the gp60 fragment of C. parvum revealed four subtypes: IIdA15G1, IIdA17G1, IIdA19G1, and IIdA20G1. Besides the bedding samples in heating lamp pens, both C. parvum and C. bovis were detected in bedding samples throughout the other regions. A significant positive correlation between the detection rate of Cryptosporidium in fecal samples and that in the bedding materials of occupied calf hutches (R = 0.93, P = 0.002). These findings suggest that C. parvum is the predominant species among pre-weaned diarrheic dairy calves in northern China. Contaminated bedding materials may act as sources of infection for newborn calves.

The role of pharmaceutical care in the use of rifaximin for the treatment of diarrhea

the management of diarrhea represents a prevalent issue within the realm of healthcare. Rifaximin is recommended to treat traveler's diarrhea and irritable bowel syndrome. At the same time, it is important to rationally use an antimicrobial drug to prevent the development of antimicrobial resistance. Aim: to evaluate the role of pharmaceutical care in using rifaximin to treat diarrhea, based on a questionnaire. A questionnaire survey was done among 55 pharmacy professionals and 42 pharmacy visitors regarding the dispensing and use of rifaximin for diarrhea treatment. The survey of pharmacy visitors revealed that rifaximin was used for the treatment of small intestinal bacterial overgrowth syndrome (32 cases), traveler's diarrhea (7 cases), and irritable bowel syndrome with diarrhea (3 cases). Patients did not undergo stool culture before rifaximin prescription, which could have prevented antimicrobial resistance and ruled out other causes of diarrhea. It was found that 14% of respondents reported improvement the next day, while 83.3% reported improvement within three days. Pharmacists can educate visitors about the importance of completing the treatment course. Five percent of respondents reported nausea as an adverse reaction. Pharmacists dispensed rifaximin for the treatment of diarrhea in adults almost three times more often than in children. The tablet form of the drug was used in 94.5% of cases, while the oral suspension was used in 5.5% of cases. The majority of pharmacy visitors (89.0%) received rifaximin with a doctor's prescription, and 10.9% without a prescription, which emphasizes the importance of pharmaceutical care to prevent irrational use of the drug. The results of the study show that 92.7% of pharmacists provide recommendations on the safety of rifaximin use, and 78.2% recommend abstaining from alcohol during treatment. Only 21.8% of pharmacists warn about the possible staining of urine, which can cause concern for patients. The majority of pharmacists (89.1%) systematically ask women about possible pregnancy, which indicates their awareness of safe pharmacotherapy. Pharmacists also clarify the simultaneous use of rifaximin with other drugs: 32.7% ask about taking oral contraceptives, 7.3% – antiarrhythmic drugs, and 3.6% – warfarin. mailto:https://meshb.nlm.nih.gov/record/ui?ui=D002648Pharmacists can enhance the effectiveness of rifaximin treatment by preventing its uncontrolled use, emphasizing the importance of completing the treatment course and informing about possible adverse reactions. When providing pharmaceutical care to visitors taking rifaximin, pharmacists should educate them about potential changes in urine color. Additionally, pharmaceutical workers advise women taking oral contraceptives to use additional contraceptive methods while taking rifaximin.

Molecular detection of bacteria causing diarrhea in human

This study aimed to detect bacteria causing diarrhea in human by molecular method. During 2021 and 2022, around 150 patients (both sexes) with chronic diarrhoea or similar symptoms were registered at a private clinic. After collecting all of the necessary patient data, a sterile cotton swab was used to collect faecal samples, which were then put in a peptone water broth and sent off to the lab within an hour, then cultured on different media. Multiple biochemical assays and serotyping led to positive identifications of the bacterial isolates. The molecular study includes three primers uidA, invA, 16s rRNA. The current study showed that female 55% was highly infected than male 45% and the total percentage of infection was 40%. The present study exhibited that the age group of 1-5 years had higher infectivity than other age groups. In comparison to other bacteria, this research found that E. coli was the most common cause of diarrhoea in patients.

Shigella and Enterotoxigenic Escherichia coli Have Replaced Rotavirus as Main Causes of Childhood Diarrhea in Rwanda After 10 Years of Rotavirus Vaccination.

The causes of diarrhea after 10 years of rotavirus vaccination in Rwanda were investigated with real-time polymerase chain reaction in 496 children with diarrhea and 298 without. Rotavirus was detected in 11% of children with diarrhea (odds ratio, 2.48; P = .002). Comparison of population attributable fractions (PAFs) shows that Shigella (PAF, 11%) and enterotoxigenic Escherichia coli producing labile toxin (PAF, 12%) have replaced rotavirus as the main causative agents. The PAF for rotavirus had declined from 41% prevaccination to 6.5% postvaccination, indicating that rotavirus has become one among several similarly important causes of childhood diarrhea in Rwanda. A rotavirus genotype shift to G3P[8] points at the importance of continued genotype surveillance.

EP492 - Fulminant Clostridium difficile infection post reversal of ileostomy

Abstract Aims Clostridium difficile infection (CDI) is an important cause of diarrhoea in hospitalized patients, varying from mild to fulminant forms. Fulminant CDI subsequent to the reversal of ileostomy, despite negative C. difficile toxin, is rare. Results We present the case of a 75-year-old male with a history of atrial fibrillation, chronic obstructive pulmonary disease and hypertension, who underwent elective ileostomy reversal following an emergency laparotomy and end ileostomy for acute diverticular bleed two years prior. Initially uncomplicated, the patient developed mild CDI on postoperative day 4 with white cell count of 18.6×109/L, evolving rapidly to severe CDI by day 6, characterized by worsening abdominal pain, worsening leukocytosis (30×109/L), and acute kidney injury stage 1. Patient was started on Vancomycin and Metronidazole, Computed Tomography (CT) scan showed uncomplicated sigmoid colitis. Despite aggressive antibiotic therapy and fluid resuscitation, the patient deteriorated on day 8, presenting with fulminant CDI, hypotension, elevated lactate of 2.6 and leukocytes of 46×109/L. Subsequent CT Imaging revealed pneumatosis coli. At that point, the patient's NELA score was 53.4%. The patient was stabilised by the critical care team prior to emergency subtotal colectomy and end ileostomy due to suspected colonic perforation. Surgical finding showed transverse colon inflammation with a hepatic flexure abscess. Patient required 14-day intensive care unit stay and 13 days of ward management before he is fit for rehab. Conclusion This case highlights the potential for fulminant CDI post-ileostomy reversal and highlights the challenges in managing such complications, necessitating prompt recognition and interventions to mitigate adverse outcomes.