Episodes Of Diarrhea Research Articles

The impact of vaccines for diarrhoea on antibiotic use among children in five low-resource settings: a comparative simulation study

Vaccines for diarrhoea could have the ancillary benefit of preventing antibiotic use. We aimed to quantify and compare the expected impact of enteric vaccines on antibiotic use via Monte Carlo simulations. We analysed data from a longitudinal birth cohort, which enrolled children from 2009 to 2012 from Bangladesh, India, Nepal, Pakistan, and Tanzania. We used Monte Carlo simulations to estimate hypothetical vaccine impact in nine vaccination scenarios (including six single vaccines and three combination vaccines) on antibiotic- treated diarrhoea, overall antibiotic courses, and antibiotic exposures to bystander pathogens. For each vaccine scenario, we randomly selected target pathogen-specific diarrhoea episodes to be prevented according to the specified vaccine efficacy and estimated the absolute and relative differences in incidence of antibiotic use outcomes between vaccine and no vaccine scenarios. Among 1119 children, there were 3029 (135·3 courses per 100 child-years) antibiotic-treated diarrhoea episodes. Based on simulated results, a Shigella vaccine would cause the greatest reductions compared with the other single pathogen vaccines in antibiotic courses for all-cause diarrhoea (6·1% relative reduction; -8·2 courses per 100 child-years [95% CI -9·4 to -7·2]), antibiotic courses overall (1·0% relative reduction; -8·2 courses per 100 child-years [-9·4 to -7·2]), and antibiotic exposures to bystander pathogens (1·2% relative reduction; -15·9 courses per 100 child-years [-18·5 to -13·8]). An adenovirus-norovirus-rotavirus vaccine would cause the greatest reductions in antibiotic use (12·2 courses per 100 child-years [-13·7 to -11·0]) compared with the other combination vaccines. However, projected vaccine effects on antibiotic use in 2021 were 45-74% smaller than those estimated in 2009-12 accounting for reductions in diarrhoea incidence in the past decade. Vaccines for enteric pathogens could result in up to 8-12 prevented courses of antibiotics per 100 vaccinated children per year. Combination vaccines will probably be necessary to achieve greater than 1% reductions in total antibiotic use among children in similar low-resource settings. Wellcome Trust and Bill & Melinda Gates Foundation.

Trends and Factors Related to Quality of Life in Patients with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) affects health-related quality of life (HRQoL). The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) score is strongly correlated with HRQoL in IBD patients. This study aimed to assess the factors influencing HRQoL in IBD patients. In this prospective study, all patients with ulcerative colitis (UC) and Crohn's disease (CD) completed the SIBDQ at enrollment; some patients also completed a second SIBDQ at follow-up. Multiple linear regression analysis was used to determine associations between SIBDQ scores and clinical factors. A total of 1,020 patients participated (UC, 67%; CD, 33%). The median SIBDQ score was 52 (interquartile range, 44 to 59). In UC patients, the stool frequency (β=-2.333, p<0.001), Physician Global Assessment score (β=-3.950, p<0.001), fecal calprotectin level (β=-4.014, p<0.001), and corticosteroid use (β=-4.809, p=0.006) were negatively correlated with the SIBDQ score. In CD patients, the number of diarrhea episodes per day (β=-1.467, p=0.024) and Crohn's Disease Activity Index score (β=-0.045, p<0.001) were negatively correlated with the SIBDQ score. A total of 202 patients completed the second SIBDQ within a mean of 3.4 years. The distributions of SIBDQ score changes were as follows: decrease >10%, 28%; -10%<change<10%, 29%; and increase >10%, 43%. In both the initial SIBDQ and follow-up SIBDQ, scores for items pertaining to systemic symptoms (tension and fatigue) were relatively low. Bowel movement-related problems significantly affect the HRQoL of both UC and CD patients. IBD patients scored lower on SIBDQ items related to general well-being. After 3 years of follow-up at the IBD clinic, 43% of patients showed a significant improvement in HRQoL.

A case of methotrexate toxicity in induced abortion

Background: Methotrexate is an anticancer drug from the antimetabolite class which is being used in cases of unruptured ectopic pregnancy and as an abortifacient as well. Giving correct dosage according to the body weight and body surface area is of utmost importance to avoid the complications.Case: A 29-year-old, G4P3L3 at 8+3 weeks of gestation with previous three cesarean sections, presented to our hospital with complaints of fever, abdominal pain, multiple episodes of diarrhea and vomiting and oral ulcers for two days. On enquiring, it was found that she received two doses of injection methotrexate (75 and 50 mg) as an abortifacient for an unwanted intrauterine pregnancy from a local doctor nearby. On presentation, her general condition was poor, she was dehydrated, temperature was 101.3°F, pulse rate was 130 beats/minute, blood pressure was 102/64mmHg, respiratory rate was 25/minute and SPO2 was 99% on room air. Her body weight was 55 kgs. Skin pigmentation and multiple oral ulcers were present. Per speculum and per vaginal examination was suggestive of minimal spotting and bulky uterus. Initial blood investigations revealed a hemoglobin level of 8.8 gm/dl, TLC of 1000/mm3, platelet count of 1.45L, INR of 1.37, and normal liver and renal function tests. A provisional diagnosis of methotrexate toxicity was made. Management of the patient was started in consultation with medical oncologist along with supportive treatment. She received IV fluids, antibiotics, and blood products (2-unit PCV and 12-RDP). She received oral leucoverin 15 mg QID and two doses of 300 mg granulocyte stimulating factor each. Gradually, her condition improved and thereafter tablet misoprostol was given for abortion. She was discharged after 13 days of hospital stay with contraceptive advice.Conclusion: The successful management of this case who presented with a constellation of symptoms and deteriorating hematological parameters exhibits the significance of a multidisciplinary approach and vigilant monitoring. Strategies to reduce the side effects and their early recognition include a safety checking procedure like SMART (safety of methotrexate therapy by assessing risks and toxicity) and determining plasma methotrexate concentrations.

International Trends in Zinc Treatment for Diarrhea.

Diarrhea is a leading cause of death among children <5 years of age and can have long-term adverse consequences for human development. The World Health Organization has recommended the therapeutic use of zinc for the treatment of diarrhea, along with oral rehydration solutions, since 2004. We studied recent trends in the use of zinc to treat diarrhea in 23 low- and middle-income countries. A repeated cross-sectional design of 46 Demographic and Health Surveys from 23 countries was used to estimate the average annual change in zinc treatment across recent years. The earlier surveys were conducted in different years from 2009 to 2014, and the latest surveys were conducted in different years from 2015 to 2023, with an average gap of 6 years between surveys. A diarrhea episode during the 2 weeks before the survey and the treatment of diarrhea using zinc and oral rehydration solutions among children <5 years old was identified using an interview with mothers. In the pooled sample, the treatment of diarrhea in children <5 years of age using zinc increased from 2% in the earlier surveys to 27% in the more recent surveys, or an average annual increase of 4 percentage points (pp). The prevalence of zinc treatment increased in all 23 countries, ranging from 9 pp per year on average in Sierra Leone to 1 pp in Cambodia. A large increase in the use of therapeutic zinc to treat diarrhea in children was observed in recent years. However, coverage remains incomplete.

Economic cost of a case of diarrhoea in Uvira, Democratic Republic of the Congo: A cost of illness study.

Diarrhoea is one of the leading causes of disability-adjusted life years (DALYs) among children below five years, though the proportion of the burden occurring amongst those aged over 70 is increasing. The cost of treating and managing diarrhoea can place a burden on individuals, their households, and society in general. The cost can be high but is often undocumented, and many studies focus on children or hospitalised patients only. This study aimed to estimate the economic cost per case of diarrhoea amongst individuals of any age in Uvira, Democratic Republic of the Congo. The study was cross-sectional and retrospective, and based on a household survey approximately representative of the city undertaken in September 2021. Data on quantities and prices of resources were collected in the survey, as well as from interviews with staff at the Cholera Treatment Centre in the Uvira general hospital and their records on resource use and patient numbers. Direct and indirect costs were measured from the societal perspective, and generalised linear regression used to identify factors associated with higher costs. Of 2,820 members of the 528 households surveyed, 175 people (6.2%) were reported to have had diarrhoea in the previous seven days. The majority sought care (91%) of which most (64%) visited a pharmacy. The average economic cost of illness (COI) for an episode of diarrhoea was 33,816 Congolese Francs (CDF) (US$ 17.0) in 2021 prices. The median was CDF 14,000 (US$ 7.0). The average out of pocket COI to patients was CDF 15,579 (US$ 7.8), representing 9% of the estimated average monthly income of households. On average caregivers and patients lost 4 days per episode. A concentration index suggested a lower economic COI among poorer households (p=0.099). A regression analysis identified that being older than 5 years (p=0.001) or being water insecure (p=0.032) were associated with higher COI. Households in Uvira experience many diarrhoeal episodes per year, and the COI is an important burden for them and society. These costs could be avoided if diarrhoea were prevented through public health interventions to reduce prevalence and care-seeking was better managed to avert this public health burden.

Knowledge, Attitude and Practice Regarding Use of ORS in Diarrhoea by Mothers in an Island of Bangladesh

Introduction: The second leading cause of death in under-five children is diarrhea. ORS is a simple and highly effective therapy for managing diarrhea. However inappropriate knowledge of preparation and lack of use of ORS leads to health hazards including increased rate of mortality and morbidity. So aim of this study to assess the knowledge, attitude, and Practice of mothers towards the use of oral rehydration solution in the treatment of acute diarrhea in children. Methods: A cross-sectional study was carried out over eight months (1st May to 30th December 2023) among 510 mothers who had children of six months to five years and had recent episodes of diarrhea. Data were collected by using a semi-structured questionnaire in face-to-face interview. Data were analyzed by using SPSS software program.Results: Among 510 mothers, 47.05% were 20-30 years old, 29.80% were below 20 years and 23.13% were over 30 years. One fourth of them had no institutional education and 36.27% had primary, 20.78% and 18.23% had secondary and tertiary level of education respectively. 40.39% were from lower socioeconomic condition, 31.97% were from middle and 27.64% from upper socioeconomic condition. 100% of family used sanitary latrine though 73.72% use safe drinking water as a preventive part of diarrhea.89.98% of mother was aware about ORS but only 75.88% used ORS in recent episode of diarrhea, among them 63.03% prepared ORS correctly and 60.98% used adequate amount. Age of mothers was not corresponds with the correct preparation and practice of ORS but socioeconomic condition and level of education carried statistically significant value. Conclusion: Knowledge and practice of ORS preparation and used of ORS in recent episode of diarrhea among the mother was unsatisfactory. Improve the Maternal education and socioeconomic status will improve ORS correct preparation and use. Mothers should be taught the importance of optimal use and correct preparation of ORS in diarrhea. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 43-49

Acute Manic Episode and Psychosis as Early Manifestations of Systemic Lupus Erythematosus with Lupus Nephritis: A Case Report

Background: Neurological and psychiatric conditions seen in SLE in the absence of other causes are broadly termed Neuropsychiatric SLE (NPSLE). Case Presentation: This case report was of a 37-year-old, separated female Banker who presented initially with symptoms of mania with psychosis at the Psychiatry Department. She was initially managed as such but represented again with similar symptoms in addition to fluffy brownish hair with hair loss, and hyper-pigmented patches along the bridge of her nose, glabella, and zygomatic regions, extending to the ears and retro auricular region. Annular hypo-pigmentation, atrophic patches were also observed on the extensor surface of both forearms. She developed fever, and epigastric tenderness with several episodes of vomiting and diarrhea which were initially non-bloody at 48hrs into admission on account of which she was placed on antibiotics. The patient improved significantly after which she discharged herself against medical advice however represented 2 days after with a worsened condition. Proactive management was ensured with some sessions of hemodialysis. An assessment of acute flare of systemic lupus erythematosus SLE, precipitated by sepsis was made and was managed as such. The patient recovered tremendously and was discharged to the clinic. Conclusion: The need for comprehensive examinations and investigations in this regard to exclude other differentials cannot be jettisoned. In this case, it could be said that the psychiatric symptoms came before the obvious signs of SLE, however, it is still possible to think of these symptoms as early signs of SLE or SLE aggravating an underlying mental disorder.

Clostridium spiroforme-induced diarrhea in a patient with acute myeloid leukemia: A case report

Clostridium spiroforme is a Gram-positive, obligate anaerobic bacillus. Previous studies have suggested that C. spiroforme mainly causes typhlocolitis and enterotoxemia in rabbits, with few documented cases of human infections. We present a rare case of acute diarrhea caused by C. spiroforme in a 78-year-old female patient with acute leukemia. In the early stages of infection, the patient experienced up to 10 episodes of diarrhea per day. She was subsequently treated with live Clostridium butyricum capsules to modulate the intestinal microflora, and her symptoms resolved after 7 days of treatment. This case report highlights an uncommon intestinal infection with C. spiroforme in a patient with a hematologic malignancy, contributing valuable clinical insights into this rare infection.

Efficacy of Bile Acid Sequestrants in the Treatment of Bile Acid Diarrhea: A Meta-Analysis of Randomized Controlled Trials.

Bile acid sequestrants (BASs) have often been used for bile acid diarrhea (BAD) but carry a high risk of adverse events. New generations of BASs show promising results; however, their efficacy remains unclear. This systematic review and meta-analysis was conducted using PubMed, Cochrane, and Embase to assess randomized controlled trials (RCTs) published up to November 2023 to retrieve studies that measured the parameters before and after the administration of BASs. The outcomes assessed were cessation or improvement in diarrhea, fecal consistency, abdominal cramping, frequency of diarrhea, and adverse events. Risk ratios (RRs) and mean differences with 95% confidence intervals (CIs) were pooled using a random-effects model. Statistical analyses were conducted using RStudio version 4.1.2. The protocol was prospectively registered with PROSPERO (CRD42023445444). Seven RCTs with a total of 311 patients were included, of which 168 (54%) were randomized to BASs. Among BAS-treated patients, 101 (60.1%) received colesevelam, 40 (23.8%) received chenodeoxycholate, 18 (10.7%) received cholestyramine, and 9 (5.3%) received colestid. BASs were associated with a significant improvement in the cessation of diarrhea (RR 3.27; 95% CI 2.08 to 5.15; P ≤ .05) and liquid stool to normal fecal consistency (RR 2.69; 95% CI 1.56 to 4.65; P ≤ .05), as well as an increase in abdominal cramps (RR 5.27; 95% CI 1.21 to 22.93; P ≤ .05). There were no differences in urgency, adverse events, or nausea between groups. These findings indicate that BASs are effective in the treatment of BAD, as indicated by the improvement or cessation of diarrhea episodes.

A 16-Year-Old Moroccan Child's Diffuse Bronchiectasis Exacerbation Revealed Deficient Expression of HLA Class II Molecules

Deficiency in HLA class II expression is an uncommon autosomal recessive immune deficiency associated with mutations in genes that regulate major histocompatibility complex class II (MHC II) expression. Despite being diagnosed during adolescence, our case is distinguished by a delayed diagnosis and a weak clinical presentation. We describe the medical history of a 16-year-old child who has been treated intermittently for constipation and meningitis since early childhood. The child also experienced alternating episodes of diarrhea and constipation. As a result of a bacterial exacerbation of diffuse bronchiectasis, the patient was hospitalized. Deficient expression of HLA class II molecules was confirmed by immune assessments. Favorable clinical development was achieved by starting antibiotic medication in conjunction with nutritional control. Bone marrow transplantation is the sole curative treatment available for this real-life Maghrebian illness.

8131 A Rare Case of Autoimmune Polyendocrine Syndrome; a Menopause Despite Replacement Therapy

Abstract Disclosure: M.E. Chacon Cruz: None. M. Sanchez Cordero: None. R.M. Roman Torres: None. G. Guerra Velazquez: None. Polyendocrinopathy is a heterogeneous group of disorders leading to dysfunction of multiple endocrine glands and other tissues. The syndromes can occur in patients from early infancy to old age and new components of a given syndrome can appear throughout life. APS can be classified into APS type 1 and APS2-4. APS-1 is a rare monogenic autosomal recessive autoimmune disorder consisting of the triad of chronic mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. APS2 require presence of Addison disease, autoimmune thyroid disorder and type 1 diabetes. APS 3 requires presence of Thyroid autoimmune disease associated with other autoimmune diseases. APS4 is a combination of organ specific autoimmune disease non included in a previous group. Autoimmune oophoritis is found in approximately 4 percent of females who presented with spontaneous primary ovarian insufficiency and may occur in type I and II syndromes of polyglandular autoimmune failure. This is the case of 44 year old female patient with history of hypertension, hypoparathyroidism diagnose at the age of 9 year old, vitiligo and premature ovarian failure diagnose at the age of 16 year old. Patient reported that started with multiple episodes of watery non bloody diarrhea and arthralgia. Patient went to her Pediatrician and they found hypocalcemia hyperphospathemia. Patient mineral was replaced with medication and then followed by pediatric endocrinologist. Patient continues with normal life, but menstrual periods had not started even at age 16th. Laboratory work up was done and premature ovarian failure was diagnosed after that, patient started with progesterone and estrogen to induce menstrual periods. Menstrual periods began regularly and monthly. Patient continues taking medication regularly, phoslo, calcitriol, progestin and estradiol without problem until this year that despite regular medication, started with signs and symptoms of menopause with irregular menstrual periods, palpitations hot flashes, sweating, anxiety and sleep problems. Patient met criteria for APS4 due to combination of organ specific autoimmune disease such premature ovarian failure, vitiligo and hypoparathryroidism. This case is extremely important since despite the fact that there is no family history of either endocrinological or autoimmune diseases, our patient debuts throughout her life with several autoimmune diseases, such as premature ovarian failure and vitiligo. Patient had Schedule appointment with gynecologist who increased the dose of progestin and estradiol. This case highlights the importance of being vigilant about new components of a syndrome developing at different times though a patient's life. As described, autoimmune diseases commonly are related to other diseases, but without a good clinical history and physical examination could be misdiagnosed affecting the quality of life of those patients. Presentation: 6/2/2024

Relation between Irritable Bowel Syndrome and Acute Infectious Gastroenteritis in Children

Abstract Background Post-infectious irritable bowel syndrome (PI-IBS) has been defined as a new onset of IBS following an episode of acute infectious diarrhea. Objective To determine the frequency of postinfectious irritable bowel syndrome (PI-IBS) among children who have an episode of acute infectious diarrhea. Subjects and Methods A case control longitudinal study was conducted on 93 children who fulfilled the criteria for diagnosis of acute infectious gastroenteritis. Patients were recruited from the Outpatient Clinic, Children’s Hospital, Ain Shams University, during a period of 6 months and were followed up for 3 months for the development of symptoms of IBS according to Rome IV criteria for diagnosis of IBS. They were compared to 100 age- and sex-matched controls who do not have history of acute infectious gastroenteritis during the last 3 months before enrollment. Result The age of studied cases ranged between (4-15) years old with a mean ±SD=9.26 ± 3.20 years. Females represented 61.3% of cases. PI-IBS occurred in 14%of cases with age ranged between (4-14) years old and females represented 61.5% of PI-IBS cases. Meanwhile, the incidence of IBS 3.2% of uninfected controls (relative risk, RR = 4.33). Most cases of PI-IBS were diarrhea prominent. There was no significant association with the causative organism identified among cases. Rota virus represented the most common organism among our patients with incidence of (32.3%) followed by campylobacter, salmonella, adeno virus, and giardia with incidence of (9.7%), (8.6%), (5.4%), (6.5%), respectively, while (37.6%) of patients have negative stool cultures for the mentioned organisms. Conclusion The frequency of PI-IBS is common among pediatrics but does not seem to be associated with the causative organism of the preceding episode of infectious diarrhea. Raising the awareness about this entity is of outmost importance as this will allow targeted treatment.

Frequency and genotyping of group A rotavirus among Egyptian children with acute gastroenteritis: a hospital-based cross-sectional study

BackgroundThis hospital-based cross-sectional study aims to investigate the epidemiologic and clinical characteristics of rotavirus group A (RVA) infection among children with acute gastroenteritis and to detect the most common G and P genotypes in Egypt.MethodsA total of 92 stool samples were collected from children under five who were diagnosed with acute gastroenteritis. RVA in stool samples was identified using ELISA and nested RT-PCR. Common G and P genotypes were identified utilizing multiplex nested RT-PCR assays.ResultsRVA was detected at a rate of 24% (22 /92) using ELISA and 26.1% (24 /92) using VP6 nested RT-PCR. The ELISA test demonstrated diagnostic sensitivity, specificity, and accuracy of 91.7%, 100%, and 97.8%, respectively. G3 was the most prevalent G type (37.5%), followed by G1 (12.5%), whereas the most commonly detected P type were P[8] (41.7%) and P[6] (8.2%). RVA-positive samples were significantly associated with younger aged children (p = 0.026), and bottle-fed (p = 0.033) children. In addition, RVA-positive samples were more common during cooler seasons (p = 0.0001). Children with rotaviral gastroenteritis had significantly more frequent episodes of diarrhea (10.87 ± 3.63 times/day) and vomiting (8.79 ± 3.57 times/day) per day (p = 0.013 and p = 0.011, respectively). Moreover, they had a more severe Vesikari clinical score (p = 0.049).ConclusionRVA is a prevalent cause of acute gastroenteritis among Egyptian children in our locality. The discovery of various RVA genotypes in the local population, as well as the identification of common G and P untypeable strains, highlights the significance of implementing the rotavirus vaccine in Egyptian national immunization programs accompanied by continuous monitoring of strains.

Observational Study of Rotavirus Related Gastrointestinal Tract Infection in Pediatric Age Group in Kut City Hospitals

In this study, the prevalence and impact of rotavirus infections on pediatric patients under six years old were investigated. Rotaviruses emerged as a predominant cause of severe diarrheal illness in newborns and young children globally. A comprehensive observational study in Al Kut city from May to September 2022 included 99 cases, revealing a 46.5 % positive rate for rotavirus. Statistical analysis indicated a significant association between rotavirus infection and increased frequency of diarrhea episodes (P=0.004) and severe dehydration (P=0.001). Moreover, rotavirus-positive cases were more likely to require intravenous fluid therapy (P=0.02). These findings underscore the substantial burden of rotavirus on both the healthcare system and society, emphasizing its role as a major contributor to infant gastroenteritis, often leading to severe complications and hospitalization

Assessing Fecal Microbial Diversity and Hormone Levels as Indicators of Gastrointestinal Health in Reintroduced Przewalski's Horses (Equus ferus przewalskii).

Diarrhea serves as a vital health indicator for assessing wildlife populations post-reintroduction. Upon release into the wild, wild animals undergo adaptation to diverse habitats and dietary patterns. While such changes prompt adaptive responses in the fecal microbiota, they also render these animals susceptible to gastrointestinal diseases, particularly diarrhea. This study investigates variations in fecal microorganisms and hormone levels between diarrhea-afflicted and healthy Przewalski's horses. The results demonstrate a significant reduction in the alpha diversity of the fecal bacterial community among diarrheal Przewalski's horses, accompanied by notable alterations in taxonomic composition. Firmicutes, Proteobacteria, and Bacteroidetes emerge as dominant phyla across all fecal samples, irrespective of health status. However, discernible differences in fecal bacterial abundance are observed between healthy and diarrhea-stricken individuals at the genus level, specifically, a diminished relative abundance of Pseudobutyrivibrio is observed. The majority of the bacteria that facilitate the synthesis of short-chain fatty acids, Christensenellaceae_R_7_group (Christensenellaceae), NK4A214_group (Ruminococcus), Lachnospiraceae_XPB1014_group (Lachnospiraceae), [Eubacterium]_coprostanoligenes_group (Eubacterium), Rikenellaceae_RC9_gut_group, Lachnospiraceae_AC2044_group (Lachnospiraceae), and Prevotellaceae_UcG_001 (Prevotella) are noted in diarrhea-affected Przewalski's horses, while Erysipelotrichaceae, Phoenicibacter, Candidatus_Saccharimonas (Salmonella), and Mogibacterium are present in significantly increased amounts. Moreover, levels of immunoglobulin IgA and cortisol are significantly elevated in the diarrhea group compared with the non-diarrhea group. Overall, this study underscores substantial shifts in fecal bacterial diversity, abundance, and hormone levels in Przewalski's horses during episodes of diarrhea.

Isolated pulmonary valve endocarditis in a pediatric patient with down syndrome

BackgroundIsolated pulmonary valve endocarditis (IPE) accounts for less than 2% of all infective endocarditis patients. It is commonly associated with several predisposing factors, including intravenous drug use (IVDU) and congenital heart disease. The most common causative pathogens of IPE are Staphylococcus aureus and Streptococcus viridans. We report a Down’s syndrome patient with IPE and with no standard risk factors caused by the rare pathogen Acinetobacter spp. This led to respiratory failure and systemic infection due to septic pulmonary emboli. Early elective surgery was decided upon as the patient was no longer responding to medical therapy, and his clinical condition was worsening over time.Case presentationA 15-year-old male with Down syndrome and no underlying heart defect presented with a 3-month history of episodic fever, nausea, vomiting, and diarrhea. Transthoracic echocardiography (TTE) revealed large vegetation on the pulmonary valve leaflet, another mobile mass at the pulmonary artery bifurcation, and severe pulmonary regurgitation. Serial blood cultures isolated Acinetobacter spp. Despite initial antibiotic therapy, the patient continued to have sepsis, unresolved vegetations, and developed life-threatening complications and respiratory distress, which convinced us to perform a pulmonary valve replacement surgery with a homograft. After surgery, the patient recovered and was discharged on the ninth postoperative day (POD).ConclusionThis report highlights IPE’s diagnostic and therapeutic challenges, alongside the importance of a comprehensive cardiopulmonary workup in patients with unexplained fever, sepsis, and pulmonary symptoms, even without typical risk factors. Based on the patient’s aggravating condition despite medical treatment, early surgical intervention and pulmonary valve replacement were deemed crucial. However, there still needs to be a definitive guideline on when and how surgery should be performed in patients with complicated IPE, especially in pediatric patients.

Diarrhoeagenic Escherichia coli and Salmonella spp. Contamination of Food and Water Consumed by Children with Diarrhoea in Maputo, Mozambique.

In Mozambique, about 500,000 cases of diarrhoea were caused by foodborne pathogens in 2018. A review of the epidemiology of diarrhoea in children under five showed a high disease burden. This study aimed to identify Diarrhoeagenic Escherichia coli (DEC) and Salmonella spp. contamination of food and water in urban and rural areas of Maputo consumed by children under five with diarrhoea. One hundred and eighty-six children with diarrhoea were selected from Primeiro de Maio and Marracuene Health Care Centres from the Kamaxakeni and Marracuene districts, respectively. Food (n = 167) and water (n = 100) samples were collected in children's households for diarrhoeagenic bacterial identification. Interviews were conducted using a semi-structured questionnaire to collect data about demographics and foods consumed a week before the children's diarrhoea episodes. The prevalence of both DEC and Salmonella spp. was 9.8% in food and 5.4% in water samples. DEC was most prevalent in cereals (urban = 2.8%; rural = 2.4%) and water samples (urban = 1.4%; rural = 3.3%). Salmonella spp. was mainly detected in cereals (urban = 0.7%; rural = 0.8%). Diarrhoeagenic pathogens were associated with the type of food frequently consumed by children under five years with diarrhoea (infant formula, fruit puree, ready-to-eat meals, and bottled water), while the association with demographics was absent. We found that the infant foods consumed by children with diarrhoea are associated with DEC and Salmonella spp., and the prevalence of these contaminants is higher in the rural (8.9%) than in the urban area (6.3%), showing the need for caregiver education on food handling practices.

Feeding a Saccharomyces cerevisiae Fermentation Product to Mares in Late Gestation Alters the Biological Activity of Colostrum.

The quality of equine colostrum is typically defined by refractometry or the concentration of maternal antibodies. However, the activity of other equine colostral bioactive molecules has not yet been investigated. This study analyzed whether the administration of a Saccharomyces cerevisiae fermentation product (SCFP) influences the biological activity of mare colostrum and whether the biological activity of colostrum has a lasting immunomodulating effect for foals. A total of fourteen pregnant mares received 20 g/day of a SCFP for a period of twelve weeks prior to the calculated date of birth (SCFP-group). Twelve pregnant mares without supplementation served as controls (CON). Colostral Brix values were determined within three hours after parturition. The concentration of IgG in blood sera and colostrum samples was determined with an ELISA. The biological activity was determined in a cell growth assay with a porcine epithelial cell line (IPEC-J2). Mares (at three weeks before the calculated date of birth) and foals (at the age of 5-8 months) received a parenteral active vaccination against influenza and tetanus. The administration of SCFP did not alter the mare's serum and colostrum IgG concentrations and did not exert a significant influence on the mares' early response to the vaccination. Growth and diarrhea episodes were comparable between foals of supplemented mares (SCFP) and foals of mares without supplementation (CON). Colostrum samples from SCFP-supplemented mares exhibited heightened biological activity. While SFCP and CON foals did not differ in their early response to vaccination, the vaccination-induced alterations in circulating neutrophilic granulocyte numbers were significantly correlated with the biological colostrum activity. These findings suggest that the supplementation of mares in late gestation with SCFP can enhance the biological activity of colostrum, which subsequently influences the innate immune responses of their offspring in later life.

Dietary Fiber Deficiency Accelerates Colitis in Mice in the Short Term Independent of Short-Chain Fatty Acids

It is believed that short-chain fatty acids (SCFAs)—the bacterial metabolites produced by the digestion of dietary fiber—potentially contribute to the prevention of colitis. However, this beneficial effect has not been conclusively proven. We thus attempted to verify this beneficial effect by examining whether colitis can be caused or worsened by the deficiency in dietary fiber in mice. We found that dextran sodium sulfate (DSS)-induced colitis was accelerated under a fiber-deficient condition, but the fiber deficiency itself did not provoke colitis. Moreover, episodes of diarrhea and epithelium damage in the large intestine were found upon analysis 24 h after the intervention. Unfortunately, these symptoms and tissue damage could not be ameliorated by administering SCFAs. On the other hand, a fiber-deficient condition increased the population of Desulfovibrio spp. and decreased the population of Lactobaccillus spp. regardless of the presence or absence of DSS upon analysis 24 h after the intervention. These results suggest that a deficiency in dietary fiber makes the intestinal environment irritable to colitis-inducing stimuli within the short term. This change does not appear to be related to the presence of SCFAs, but to the alteration of microbiota. Hence, a regular intake of dietary fiber is strongly recommended to avoid colitis and preserve intestinal health.

Acute flaccid paralysis on 11 years old child in Bali: a case report

Introduction: As medical professionals, we need to be aware of cases of acute flaccid paralysis, known as the current outbreak of polio infections in Indonesia. Polio is a highly contagious illness that primarily affects children under five. It can result in death (2-10% of those who were paralyzed) or lifelong paralysis (about 1 in 200 infections). The virus spreads from person to person mostly by the fecal-oral pathway. Contaminated foods and water are also less common routes of transmission. After the virus grows in the gut, it can enter the nerve system and paralyze people. Though it may vary from 4 to 35 days, the duration of incubation is typically 7 to 10 days. Approximately ninety percent of infected individuals either show no symptoms at all or have minor ones, hence the illness is typically not diagnosed. The purpose of this case report is to describe a case of acute flaccid paralysis and increase our awareness about the current polio outbreak. The Case: Eleven-year-old Korean child weighing 41 kg arrived to the clinic complaint of weakness in both limbs for the past five days. It happened throughout the day, particularly during the morning, and was felt abruptly. He also had instability when walking and trembling in both legs. He also experienced three episodes of watery diarrhea that day. In addition, he reported having puked twice in the two days before his clinic appointment. His calves had a motoric grade of 3 and a grade of 5 on his soles, indicating that his calves were weaker than his soles. It was discovered that the muscular tone was weak. No evidence of muscular atrophy was present. Positive tripod indication was seen. There were no abnormalities in sensibility. He was diagnosed with acute flaccid paralysis et causa suspected poliomyelitis dd Guillain Barre Syndrome dd hypokalemia paralysis et causa diarrhea and vomiting. Conclusion: Facing the polio outbreak in Indonesia, this case would serve as an example to raise awareness of acute flaccid paralysis cases, enabling early detection, differential diagnosis exclusion, and effective surveillance.