Diagnosis Of Infectious Diarrhea Research Articles

A relationship between causative agents of infectious diarrhea and fatal outcomes in pre-school children

Infectious diarrhea is one of the leading causes of fatal outcomes in young children. Differential diagnostics of such infections within the first hours of illness poses significant objective obstacles. Data from laboratory studies of autopsy material and pathological studies provide valuable information for understanding the spectrum of differential diagnostics and etiological structure of infectious diarrhea with fatal outcomes in young children. Materials and methods. There were analyzed 100 cases of fatal outcomes in children under the age of six years registered in Russia from November 2011 to December 2019, who was diagnosed with infectious diarrhea at different levels of the healthcare system. The data were assessed based on available medical case reports and the laboratory testing of autopsy samples performed by using nucleic acid amplification methods. Results. The diagnosis of infectious diarrhea was revised in 24 patients, based on the data of a set of intravital and post-mortem studies. In patients with unconfirmed diagnosis of acute intestinal infections, pneumonia was the most often detected — in 45.8% (11/24), sepsis — in 29.2% (7/24), meningitis/meningoencephalitis, acute surgical pathology and asphyxiation associated with vomit aspiration — in 16.7 % (4/24) cases. The causative agents of infectious diarrhea were identified in 71 of 76 patients with confirmed diagnosis of acute intestinal infections. Most prevalent were group A rotaviruses — 52.6% (40/76), group F adenoviruses — 17.1% (13/76), and noroviruses — 13.2% (10/76). Combination of pathogens was detected in 29 cases (38.2%). Prehospital lethal outcomes in patients with infectious diarrhea were observed in 17 cases (22.4%). In total, rate of neonatal deaths due to acute intestinal infections accounted for 62.2% and 2-year-old toddlers — 20.3%. 64 of 76 (84%) children had no unfavorable premorbid background. The most common pathologies associated with infectious diarrhea with developing fatal outcomes were pneumonia (including aspiration pneumonia) in 22.4% (17/76) and aspiration asphyxia in 6.6% (5/76). Hemolytic-uremic syndrome associated with diarrhea was diagnosed in 7.9% (6/76) of children. Conclusions. Within the first years of life children comprise a risk group for developing fatal outcomes during infectious diarrhea. Lack of unfavorable premorbid background should not be considered as a reliable positive prognostic criterion. Diagnostics of pneumonia should be included in the mandatory examination plan for children with severe infectious diar rhea. Based on study of clinical and autopsy material, group A rotaviruses were the lead causative agents among those resulting in infectious diarrhea with fatal outcomes in young children. Special attention should be paid to preventing vomit aspiration within the first days after disease onset.

Analysis of relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults

Objective To investigate the relationship between clinical parameters related to acute bacterial dysentery and other infectious diarrhea in adults. Methods From April to October 2018, 70 patients with clinical diagnosis of acute bacterial dysentery, 180 patients with clinical diagnosis of infectious diarrhea and 399 patients with diarrhea to be examined were investigated retrospectively. The collected data included gender, age, time from onset to treatment, maximum body temperature, main symptoms, epidemiological history, blood routine, C-reactive protein and stool routine. Analysis of these clinical factors related to acute bacterial dysentery and other infectious diarrhea. Results A total of 70 patients with acute bacterial dysentery, 180 patients with other infectious diarrhea and 399 patients with diarrhea of unknown origin were investigated. The positive rate of epidemiology in the three groups was statistically significant (P<0.05); the age of onset of bacterial dysentery was younger than that in patients with diarrhea of unknown origin (P<0.05). Compared with the other two groups of patients, the onset to visit time was earlier, the number of vomiting was higher, the incidence of fever and tenesmus was higher, and the levels of white blood cells, neutrophils and C-reactive protein were significantly increased (P<0.05). Conclusions Patients with acute bacterial dysentery, other infectious diarrhea, and diarrhea of unknown origin have some differences in epidemiological history, age at onset, clinical manifestations, and laboratory tests. Key words: Adult; Bacterial dysentery; Infectious diarrhea

Multiplex Molecular Panels for Diagnosis of Gastrointestinal Infection: Performance, Result Interpretation, and Cost-Effectiveness.

Gastrointestinal disease is a major cause of morbidity and mortality worldwide, especially among young children and immunocompromised patients. Diarrhea may result from infection with a variety of microbial pathogens, including bacteria, viruses, or parasites. Historically, the diagnosis of infectious diarrhea has been made using microscopy, antigen tests, culture, and real-time PCR. A combination of these traditional tests is often required due to the inability to distinguish between infectious etiologies based on the clinical presentation alone. Recently, several multiplex molecular assays have been developed for the detection of gastrointestinal pathogens directly from clinical stool samples. These panels allow for the detection and identification of up to 20 pathogens in as little as 1 h. This review will focus on the multiplex molecular panels that have received clearance from the FDA for the diagnosis of diarrheal disease and will highlight issues related to test performance, result interpretation, and cost-effectiveness of these new molecular diagnostic tools.

The application and epidemiological research of xTAG GPP multiplex PCR in the diagnosis of infectious diarrhea

To investigate the application value of xTAG (®) gastrointestinal pathogen panel (xTAG9(®) GPP) multiplex PCR in the early diagnosis of infectious diarrhea, and understand the epidemiology of intestinal diarrhea pathogens. Five hundred and ninety two specimens were collected in outpatient of Tongren Hospital, Capital Medical University, from 1st Oct 2013 to 30th Sep 2014, comparing the xTAG(®) GPP multiplex PCR assay with the traditional methods (culture, rapid enzyme immunoassay chromatography, microscopic examination, Real-time PCR) and mading the statistical analysis. The positive rate of 592 patients with diarrhea specimens was 47.8% (283/592), the proportion of male and female was 1: 1.02, the average age was 31years. The virus detection rate was 18.1%, Rotavirus A was the most common organism detected (8.8%), concentrated in winter, popular in children.Secondly,Norovirus GI/GII (8.4%),Adenovirus 40/41 was five cases. The positive rate of bacteria was 35.5%, Enterotoxigenic E.coli (8.4%, 50/592) was most frequently detected in summer, common in young adults. The other pathogens were Campylobacter 7.7%, Salmonella 7.0%, Clostridium difficile toxinA/B 3.5%, Shigella 3.3%,E.coli O157 3.3% and Shiga toxin-producing E.coli LT/ST 1.7%.None of Yersinia enterocolitica and Vibrio cholerae was detected. There were ten samples with parasitic (1.7%), five samples were positive for Cryptosporidium, three for Entamoeba histolytica and two for Giardia. All of them did not have obvious distribution followed by season and population. Totally 242(40.8%) infected specimens with single pathogen were detected. There were 41 (6.9%) co-infections samples, including two pathogens 36 cases (6.1%), three pathogens in 5 cases (0.8%). xTAG(®) GPP multiplex PCR is simple, sensitive, specific and can be used as a quick way to diagnose the infectious diarrhea. Diarrhea pathogen has significant characteristics with the season and crowd.

Treatment strategies for infectious diarrhea in HIV-infected patients

While highly active antiretroviral therapy has led to substantial decreases in morbidity and mortality, diarrhea remains a common problem in HIV-infected individuals. Patients with low CD4 cell counts (less than 200/ mL) have a higher risk of developing chronic, infectious diarrhea. The diagnosis of infectious diarrhea is usually made by obtaining the appropriate tests. Therapy should be pathogen directed if the offending agent is identified, or aimed at symptomatic improvement if a specific pathogen is not detected.

MODERN DIAGNOSIS (WITH MOLECULAR TESTS) OF ACUTE INFECTIOUS DIARRHEA

There have been three significant technical developments in the molecular genetic diagnosis of infectious diarrhea. The first was the replacement of polynucleotide probes with more specific synthetic oligonucleotide probes. The second was the replacement of radiolabeled markers with nonradiolabeled markers, and the third was PCR amplification. In the PCR procedure, it is possible to increase the quantity of target nucleotide sequences to quantities easily detectable with nonradioactive oligonucleotide probes. It is now possible to amplify nucleotide sequences of more than one enteric pathogen with different primers simultaneously and to detect these amplified nucleotide sequences with nonradiolabeled oligonucleotide probes. With a scanning laser system, the results of enteric PCRs will be used to identify enteric pathogens on a routine basis in clinical and public health laboratories. Computers need to be used to analyze these results and transfer this information rapidly to clinicians and public health officials.