Diarrhea In Adults Research Articles

Impact of subinhibitory concentrations of metronidazole on proteome of Clostridioides difficile strains with different levels of susceptibility.

Clostridioides difficile is responsible for various intestinal symptoms from mild diarrhea to severe pseudomembranous colitis and is the primary cause of antibiotic-associated diarrhea in adults. Metronidazole was the first-line treatment for mild to moderate C. difficile infections for 30 years. However, clinical failure and recurrence rates of metronidazole is superior to oral vancomycin and metronidazole is now recommended only as an alternative to vancomycin or fidaxomicin, for an initial non-severe infection. The mechanisms of treatment failure and infection recurrence remain unclear. Given the poor fecal concentrations of metronidazole, the bacteria may be exposed to subinhibitory concentrations of metronidazole and develop adaptation strategy, which is likely to be the origin of an increase in treatment failures. In this study, a proteomic approach was used to analyze changes in the proteome of two strains with different levels of susceptibility to metronidazole in the presence of subinhibitory concentrations of this antibiotic. The two strains were grown to stationary phase: CD17-146, a clinical C. difficile isolate with reduced susceptibility to metronidazole, and VPI 10463, a metronidazole susceptible strain. Our study revealed that, whatever the strain, subinhibitory concentrations of metronidazole modified the amount of proteins involved in protein biosynthesis, glycolysis, and protection against stress induced by metronidazole, as well as in DNA repair. Several proteins involved in stress response are known to be synthesized under the control of Sigma factor B, which suggests a close link between Sigma factor B and metronidazole. Interestingly, impact of metronidazole on protein production for VPI 10463 strain differed from CD17-146 strain, for which the amount of two proteins involved in biofilm formation of CD17-146 were modified by metronidazole.

Association Between Selenium Intake with Chronic Constipation and Chronic Diarrhea in Adults: Findings from the National Health and Nutrition Examination Survey.

The effects of dietary selenium intake on specific bowel habits (i.e., constipation or diarrhea) in the general population are not well understood. This study aims to evaluate the associations of selenium intake with the risk of chronic constipation and chronic diarrhea in adults aged ≥ 20years using data from the 2007-2008 and 2009-2010 continuous National Health and Nutritional Examination Surveys (NHANES) (N = 9585). Chronic constipation and chronic diarrhea were defined by Bristol Stool Form Scale (BSFS) types 1 and 2 and BSFS types 6 and 7 as the "usual or most common stool type," respectively, and frequent laxative users were also defined as having chronic constipation. Dietary selenium intake was obtained from 24-h dietary recall. Multivariable logistic regression models were performed controlling for confounding factors (dietary, lifestyle, psychological, and health conditions). No significant associations between selenium intake and chronic diarrhea were found. However, selenium intake was inversely associated with the risk of chronic constipation. Compared with quartile 1, the multivariate-adjusted ORs (95% CI) of chronic constipation across quartiles 2 to 4 of selenium intake were 0.81 (0.64-1.03), 0.74 (0.58-0.95), and 0.54 (0.33-0.89), respectively. This association was significant among men, but not significant among women in subgroup analyses. Generally, there was an inverse association between selenium intake and chronic constipation in adults that modified by sex.

Disturbed gut microbiota and bile homeostasis in Giardia-infected mice contributes to metabolic dysregulation and growth impairment.

Although infection with the human enteropathogen Giardia lamblia causes self-limited diarrhea in adults, infant populations in endemic areas experience persistent pathogen carriage in the absence of diarrhea. The persistence of this protozoan parasite in infants has been associated with reduced weight gain and linear growth (height-for-age). The mechanisms that support persistent infection and determine the different disease outcomes in the infant host are incompletely understood. Using a neonatal mouse model of persistent G. lamblia infection, we demonstrate that G. lamblia induced bile secretion and used the bile constituent phosphatidylcholine as a substrate for parasite growth. In addition, we show that G. lamblia infection altered the enteric microbiota composition, leading to enhanced bile acid deconjugation and increased expression of fibroblast growth factor 15. This resulted in elevated energy expenditure and dysregulated lipid metabolism with reduced adipose tissue, body weight gain, and growth in the infected mice. Our results indicate that this enteropathogen's modulation of bile acid metabolism and lipid metabolism in the neonatal mouse host led to an altered body composition, suggesting how G. lamblia infection could contribute to growth restriction in infants in endemic areas.

Molecular Characterization of Norovirus Circulating in Northwest Mexico During 2013-2014.

Norovirus (NoV) is an important etiological agent of diarrhea in children and adults. In Mexico, NoV screening is not routinely performed. NoV is highly infectious and is responsible for massive outbreaks due to the consumption of contaminated food. The study was a cross-sectional design. Samples of diarrheal stools were collected from (62) children and (38) adults with acute gastroenteritis during 2013-2014. The circulating genogroups of NoV were detected by amplifying the RdRp gene fragment, and for the genotyping, the capsid and polymerase fragments were sequenced. Seventy-seven percent of the analyzed samples were positive for NoV. Genotyping was possible for 51 samples; for polymerase GII.P2, GII.P31, GII.P4, GII.P7, GII.P40, and GI.P14 were identified, whereas for capsid, genotypes GI.3, GII.2, GII.4, GII.5, GII.14, and GII.17. In conclusion, there is a high prevalence of gastroenteritis due to NoV in the northwest of Mexico, including genotypes that have not been reported previously in Mexico.

Surveillance of Human Rotavirus in Wuhan, China (2011-2019): Predominance of G9P[8] and Emergence of G12.

Rotaviruses are a major etiologic agent of gastroenteritis in infants and young children worldwide. To learn the shift of genotypes and genetic characteristics of Rotavirus A (RVA) causing diarrhea in children and adults, a hospital-based surveillance of rotavirus was conducted in Wuhan, China from June 2011 through May 2019, and representative virus strains were phylogenetically analyzed. Among a total of 6733 stool specimens collected from both children and adults with acute gastroenteritis, RVA was detected in 25.5% (1125/4409) and 12.3% (285/2324) of specimens, respectively. G9P[8] was the most common genotype (74.5%), followed by G1P[8] (8.7%), G2P[4] (8.4%), and G3P[8] (7.3%), with G9P[8] increasing rapidly during the study period. The predominant genotype shifted from G1P[8] to G9P[8] in 2012–2013 epidemic season. G12P[6] strain RVA/Human-wt/CHN/Z2761/2019/G12P[6] was detected in April 2019 and assigned to G12-P[6]-I1-R1-C1-M1-A1-N1-T2-E1-H1 genotypes. Phylogenetic analysis revealed that VP7, VP4, VP6, VP3, NSP1, NSP2, and NSP5 genes of Z2761 clustered closely with those of Korean G12P[6] strain CAU_214, showing high nucleotide identities (98.0–98.8%). The NSP3 gene of Z2761 was closely related to those of G2P[4] and G12P[6] rotaviruses in Asia. All the eleven gene segments of Z2761 kept distance from those of cocirculating G9P[8], G1P[8], and G3P[8] strains detected in Wuhan during this study period. This is the first identification of G12 rotavirus in China. It is deduced that Z2761 is a reassortant having DS-1-like NSP3 gene in the background of G12P[6] rotavirus genetically close to CAU_214.

Acute and chronic diarrhea: a roadmap to differential diagnosis and therapy

Diarrhea is among the most frequently reported symptoms in clinical practice. Acute diarrhea is usually caused by infectious agents with a self-limited disease course. In contrast, differential diagnosis of chronic diarrhea may be challenging. The aim of this review is to provide the reader with an overview on the causes, pathomechanisms, differential diagnosis and clinical management of acute and chronic diarrhea in adults.

Random colonic biopsies in macroscopically normal colonoscopies: is there any benefit? A two-centre audit of current practice.

Recent guidelines from the British Society of Gastroenterology published in April 2018, recommended performing random colonic biopsies (RCB) in endoscopically normal colonic mucosa when investigating chronic diarrhoea in adults to rule out microscopic colitis; however, cost effectiveness was not accounted for due to poor evidence base. There is now more evidence that RCBs are of low yield and of significant cost. A two-centre audit of current practice was conducted at Rockingham General Hospital and Fremantle Hospital in Western Australia, aiming to determine the yield of RCB in macroscopically normal mucosa for microscopic colitis, from 1 January 2009 to 30 June 2018, with comparisons of practice and results between gastroenterologists and general surgeons. Variability in the indications (diarrhoea and non-diarrhoea indications) for RCBs was determined and the cost of consumables, additional endoscopy time and histopathology analysis were calculated. A total of 872 normal colonoscopies with RCBs were included; 48.7% of colonoscopies with RCB were for diarrhoea. Only 1.5% of RCBs were positive for microscopic colitis; 3.1% of patients with diarrhoea had microscopic colitis. Only one patient received pharmacologial treatment as a result of the test. The calculated cost per positive diagnosis of microscopic colitis was $10 862.42. RCBs from normal colonic mucosa have poor yield and are costly. Local guidelines should be updated, so RCBs are performed only in patients with a high degree of suspicion of an organic cause of chronic diarrhoea.

Characterization of Highly Mucus-Adherent Non-GMO Derivatives of Lacticaseibacillus rhamnosus GG.

Lacticaseibacillus rhamnosus GG is one of the best studied lactic acid bacteria in the context of probiotic effects. L. rhamnosus GG has been shown to prevent diarrhea in children and adults and has been implicated to have mitigating or preventive effects in several disorders connected to microbiota dysbiosis. The probiotic effects are largely attributed to its adhesive heterotrimeric sortase-dependent pili, encoded by the spaCBA-srtC1 gene cluster. Indeed, the strain-specific SpaCBA pili have been shown to contribute to adherence, biofilm formation and host signaling. In this work we set out to generate non-GMO derivatives of L. rhamnosus GG that adhere stronger to mucus compared to the wild-type strain using chemical mutagenesis. We selected 13 derivatives that showed an increased mucus-adherent phenotype. Deep shotgun resequencing of the strains enabled division of the strains into three classes, two of which revealed SNPs (single nucleotide polymorphisms) in the spaA and spaC genes encoding the shaft and tip adhesive pilins, respectively. Strikingly, the other class derivatives demonstrated less clear genotype – phenotype relationships, illustrating that pili biogenesis and structure is also affected by other processes. Further characterization of the different classes of derivatives was performed by PacBio SMRT sequencing and RNAseq analysis, which resulted in the identification of molecular candidates driving pilin biosynthesis and functionality. In conclusion, we report on the generation and characterization of three classes of strongly adherent L. rhamnosus GG derivatives that show an increase in adhesion to mucus. These are of special interest as they provide a window on processes and genes driving piliation and its control in L. rhamnosus GG and offer a variety of non-GMO derivatives of this key probiotic strain that are applicable in food products.

A new plasmid carrying mphA causes prevalence of azithromycin resistance in enterotoxigenic Escherichia coli serogroup O6

BackgroundAt present, azithromycin has become an effective treatment for severe diarrhea caused by Enterotoxigenic Escherichia coli (ETEC) infection. However, enterobacteria have begun to develop resistance to azithromycin and have attracted attention in recent years. This study conducted to described the emergence of a high proportion of azithromycin-resistant ETEC serogroup O6 strains in Shanghai and to analyzed the mechanisms of azithromycin resistance.ResultsStrains from adult diarrhea patients with ETEC serogroup O6 infections were collected by Shanghai Diarrhea Surveillance Network and the Foodborne Surveillance Network from 2016 to 2018. We tested 30 isolates of ETEC O6 serogroup, 26 of which were resistant to azithromycin. Phylogenetic analysis revealed that these ETEC serogroup O6 strains have formed an independent dominant clone. S1-PFGE and southern blotting revealed the presence of the mphA gene on the 103 kb plasmid. Illumina and Nanopore sequencing and plasmid coverage analysis further confirmed that azithromycin-resistant strains carried a novel IncFII plasmid harboring mphA and blaTEM-1 resistance genes.ConclusionsThis is the first study to report a high proportion of azithromycin resistance in a particular ETEC serogroup due to a specific plasmid carrying mphA. Our findings indicate the rapid spread of azithromycin resistance, highlighting the urgency of stringent surveillance and control measure.

Diarrhea in adults. Clinical guidelines. Project

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Diarrhea when COVID-19 in adults

This review provides a systematization of literature on the problem of chronic diarrhea in adults, issues of differential diagnosis and diagnosis at the stage of primary health care Chronic diarrhea is a persistent deviation from the norm with the consistency of stool between types 5 and 7 on the Bristol stool scale and an increase in frequency of more than 4 weeks. The classification of diarrhea in terms of frequency (the most common causes, infrequent and rare), a brief description of clinical and laboratory signs of the most common causes of diarrhea in the practice of a General practitioner and gastroenterologist, a review of the literature on the features of diarrhea in COVID-19, and the stages of diagnostic search.

Comparative clinical and epidemiological characteristics and cytokine profile of viral diarrhea in adults

The aim of the work is to determine the clinical and pidemiological features and indicators of the cytokine profile in patients with viral diarrhea in the adult population, to establish the influence of inflammatory mediators on the course of the disease. Materials and methods -we analyzed the patient’s hospital records, as well as the blood serum of patients diagnosed with viral diarrhea. The experimental group consisted of 29 patients aged 23,2 ±8,4, with an equal distribution among men and women. The 1 experimental group included 22 patients with norovirus infection, the 2 comparison group consisted of 7 people with rotavirus gastroenteritis. The control group consisted of 20 somatically healthy people of the appropriate age (23,3±1,4). The concentration of proinflammatory and anti-inflammatory cytokines in blood serum was determined by ELISA using reagents from Vector-best LLC (Novosibirsk). Statistical processing of the obtained data was carried out using electronic programs Microsoft Excel 2010, Statistica 6.0, with the determination of the statistical significance of differences at the achieved significance level p ≤ 0.05 using the Mann – Whitney test (U-test). When calculating correlations, we used Spearman’s coefficient, r = -1+1 (r=0-0, 3 – weak connection, r= 0,3–0,7 – medium strength connection, r= 0,7–1 – strong connection; «+» – direct connection, «–» – feedback). The distribution of features was evaluated using the Shapiro – Wilkes W test. Results : in the course of work, the prevalence of norovirus infection among adult patients with viral diarrhea was established. Among the ways of infection, the food and water routes predominated, contact and household was noted, mainly, when caring for children with intestinal infection. In the clinical picture, all patients had a moderate intoxication syndrome. With rotavirus infection, catarrhal and pronounced gastroenteritis syndromes were determined, while for norovirus gastroenteritis, catarrhal syndrome was not characteristic, and patients also had a tendency to constipation. When assessing the cytokine status, an increase in the concentration of IL-2, IL-6, TNF- α , IL-10 was found, regardless of the etiological factor, at normal levels of IL-1 β and low IL-4, as well as a strong direct dependence of the severity of feverish intoxication syndrome on the level of IL-2, IL-1 β and IL-4. The effect of Pro-inflammatory and anti-inflammatory cytokine production on the duration of individual syndromes and on the duration of the disease as a whole has not been established. Conclusion – norovirus infection, in contrast to rotavirus infection, occurs without an obvious respiratory catarrhal syndrome, with the predominance of intoxication over gastroenteritis, while in rotavirus infection, the syndrome of intoxication and gastroenteritis are expressed equally. In viral diarrhea, there is an increase in IL-2, IL-6, TNF-a, and IL-10, which play an important role in the development of feverintoxication syndrome and the formation of antiviral protection.

Survival and Germination of Bacillus clausii UBBC07 Spores in in vitro Human Gastrointestinal Tract Simulation Model and Evaluation of Clausin Production.

Bacillus clausii UBBC07 is a commercial spore probiotic known to reduce diarrhea in children and adults. In the present study, survival and germination of UBBC07 spores were investigated under fed and fasted conditions in Simulator of Human Intestinal Microbial Ecosystem. Besides this, lantibiotic production, purification, and characterization were performed. The agar plate analysis showed that spores were 100% tolerant to fed and fasted gastrointestinal tract (GIT) conditions. Simultaneously, flow cytometry revealed that at the end of small intestinal incubation, 120% (fed) and 133% (fasted) spores were in viable germinating state. The transformation of viable germinating spores into viable vegetative cells was observed at 3 h of incubation under fasted GIT conditions. In antimicrobial evaluation, UBBC07 produced low-molecular-weight (2107.94 Da) class I lantibiotic clausin. The presence of lanB, lanC, and lanD genes confirms the clausin production. Clausin is stable at proteases (pepsin, proteinase K, and trypsin), temperature (up to 100°C), and pH (up to 11). Furthermore, the antimicrobial activity toward Gram-positive bacteria including Clostridium difficile is advantageous. In conclusion, B. clausii UBBC07 spore probiotic is capable of surviving and germinating under in vitro upper GIT conditions. The clausin production justifies strain applicability in diarrhea.

Immunogenicity and protective efficacy of a live, oral cholera vaccine formulation stored outside-the-cold-chain for 140\u2009days

BackgroundCholera, an acute watery diarrhoeal disease caused by Vibrio cholerae serogroup O1 and O139 across the continents. Replacing the existing WHO licensed killed multiple-dose oral cholera vaccines that demand ‘cold chain supply’ at 2–8 °C with a live, single-dose and cold chain-free vaccine would relieve the significant bottlenecks and cost determinants in cholera vaccination campaigns. In this direction, a prototype cold chain-free live attenuated cholera vaccine formulation (LACV) was developed against the toxigenic wild-type (WT) V. cholerae O139 serogroup. LACV was found stable and retained its viability (5 × 106 CFU/mL), purity and potency at room temperature (25 °C ± 2 °C, and 60% ± 5% relative humidity) for 140 days in contrast to all the existing WHO licensed cold-chain supply (2–8 °C) dependent killed oral cholera vaccines.ResultsThe LACV was evaluated for its colonization potential, reactogenicity, immunogenicity and protective efficacy in animal models after its storage at room temperature for 140 days. In suckling mice colonization assay, the LACV recorded the highest recovery of (7.2 × 107 CFU/mL) compared to those of unformulated VCUSM14P (5.6 × 107 CFU/mL) and the WT O139 strain (3.5 × 107 CFU/mL). The LACV showed no reactogenicity even at an inoculation dose of 104–106 CFU/mL in a rabbit ileal loop model. The rabbits vaccinated with the LACV or unformulated VCUSM14P survived a challenge with WT O139 and showed no signs of diarrhoea or death in the reversible intestinal tie adult rabbit diarrhoea (RITARD) model. Vaccinated rabbits recorded a 275-fold increase in anti-CT IgG and a 15-fold increase in anti-CT IgA antibodies compared to those of rabbits vaccinated with unformulated VCUSM14P. Vibriocidal antibodies were increased by 31-fold with the LACV and 14-fold with unformulated VCUSM14P.ConclusionThe vaccine formulation mimics a natural infection, is non-reactogenic and highly immunogenic in vivo and protects animals from lethal wild-type V. cholerae O139 challenge. The single dose LACV formulation was found to be stable at room temperature (25 ± 2 °C) for 140 days and it would result in significant cost savings during mass cholera vaccination campaigns.

Development of enteric polymer-based microspheres by spray-drying for colonic delivery of Lactobacillus rhamnosus GG.

Antibiotics are well-known disruptive elements of the intestinal microbiota and antibiotic-associated diarrhea appeared as the most common complication related with post-antibiotic dysbiosis. Lactobacillus rhamnosus GG (LGG) strain is very effective in preventing antibiotic-associated diarrhea in children and adults. However, as any probiotics, it is concerned by the loss of viability during storage and gastrointestinal transit. The aim of this study was to develop an encapsulation system suitable for the specific colonic delivery of LGG strain after oral administration. For this purpose, spray-dried Eudragit® S100 microparticles encapsulating LGG bacteria were developed by using an aqueous based spray-drying approach, avoiding the use of organic solvents. Carbohydrates were added to the formulation since they are widely used as protective agents of bacteria against the harmful effect of dehydration stress. Here, both Surface Enhanced Raman Scattering (SERS) and conventional plate count methods showed that carbohydrates increased the survival ratio of bacteria after spray-drying from 3 to more than 50%. Moreover, these protective agents ensured low residual moisture content thus providing great stability of the cells in the spray-dried powder during storage. Significant improvement of the cell viability in simulated gastro intestinal fluid (SGIF) was observed for encapsulated cells as compared with free LGG bacteria for which no viable cell was detectable after 1h incubation in gastric fluid only. As a consequence, 4.5×107 CFU/g of encapsulated LGG were found viable after incubation of microparticles 1h in Simulated Gastric Fluid followed by 6h in Simulated Intestinal Fluid, corresponding to less than 3 log reduction of viable cells during the 7h incubation in Simulated Gastro Intestinal Fluid. These results attested that the developed encapsulation system is suitable for its use as a bacteria carrier for specific colonic delivery.

Differential regulation of claudin-2 and claudin-15 expression in children and adults with malabsorptive disease

Intestinal Na+-nutrient cotransport depends on claudin-2 and claudin-15 mediated Na+ recycling. Expression of these proteins is coordinately regulated during postnatal development. While expression of claudin-2 and claudin-15 has been studied in inflammatory bowel disease (IBD) and celiac disease (CD), it has not been assessed in other malabsorptive diseases, and no reports have compared expression in children and adults. We used quantitative immunofluorescence microscopy to assess claudin-2 and claudin-15 expression in duodenal biopsies from children and adults with malabsorptive disease and healthy controls. Consistent with previous work in rodents, claudin-2 expression in healthy children was markedly greater, and claudin-15 expression was less, than that in adults. Claudin-2 expression was increased in adults with CD and downregulated in children with graft-versus-host disease (GVHD). In contrast, claudin-15 expression was reduced in adults with GVHD and common variable immunodeficiency (CVID). These data show that one of the two Na+/water pore-forming claudins is upregulated in CD and downregulated in GVHD and CVID. The specific claudin whose expression changes, however, reflects the age of the patient (child or adult). We conclude that contributions of claudin-2 and claudin-15 to pathophysiology of and responses to diarrhea in children and adults with GVHD and CVID differ from those in CD and IBD.

Randomised, double-blind, placebo controlled multi-centre study to assess the efficacy, tolerability and safety of Enterosgel\xae in the treatment of irritable bowel syndrome with diarrhoea (IBS-D) in adults

BackgroundIrritable bowel syndrome (IBS) with diarrhoea (IBS-D) is a common and chronic condition that can significantly impair quality of life. The emergence of new drugs for IBS-D has been slow and there is a need for new treatments, including drug-free treatments, which are easy to use and suitable for different patient groups. Currently available drug-free treatments include Enterosgel®, an intestinal adsorbent approved for use in IBS-D and acute diarrhoea and available over-the-counter in the UK and 30 countries worldwide. The aim of this randomised, double-blind, placebo-controlled, multi-centre study is to test the efficacy and safety of Enterosgel® compared to placebo in symptomatic treatment in IBS-D.Methods/designWe will recruit 430 participants with IBS-D from approximately 30 primary and secondary care sites in England. Participants meeting the required abdominal pain and stool consistency criteria over a 2-week screening period will be randomly allocated to receive blinded treatment (Enterosgel® or placebo) for 8 weeks. This will be followed by an 8-week open-label treatment phase with Enterosgel®. Participants will be allowed to adjust their daily dosage during both phases based on their symptoms. Participants will then return to standard care and those who responded to treatment will receive a follow-up call 8 weeks later. Co-medication with loperamide will be permitted and use recorded. The primary outcome measure is the percentage of participants defined as responders for abdominal pain and stool consistency during at least 4 weeks in the 8-week blinded phase. Secondary outcome measures include stool frequency, stool consistency, abdominal pain, bloating, urgency, adequate relief, questionnaire scores and rescue medication use. Exploratory outcomes will be assessed in subsets of participants including qualitative and quantitative data on faecal microorganisms and biomarkers and gut-related measurements from magnetic resonance imaging data.DiscussionThis is the first large scale randomised controlled trial investigating Enterosgel® in IBS-D. A study design with blinded phase followed by an open-label phase was chosen to encourage participation and study completion. Demonstrating that Enterosgel® is effective and safe in IBS-D could encourage adoption by patients and healthcare professionals and foster future clinical trials assessing its use in related conditions.Trial registrationISRCTN17149988. Prospectively registered on 14 November 2017.

Potential of Silver Nano Particles Synthesized from <i>Ficus sycomorus</i> <i>Linn</i> Against Multidrug Resistant <i>Shigella species</i> Isolated from Clinical Specimens

Ficus sycomorus Plant was known traditionally for its medicinal properties, Shigella species as a bacterial was also known for their resistance to orthodox medicine. Hence the synthesis of silver nanoparticles from Ficus sycomorus. This study was carried out to investigate the anti-shigellosis potential of silver nanoparticles synthesized from Ficus sycomorus Linn stem bark aqueous extract against Multi-drug Resistant (MDR) Shigella species isolated from clinical specimen collected from patients attending Yobe State Specialist Hospital Damaturu, Nigeria. A total of 400 diarrhoeagenic stools were screened for isolation of Shigella species and determined their antibiotic susceptibility pattern using standard methods. Phytochemical constituents of Ficus sycomorus extract were used to synthesize silver nanoparticles using green synthesis approach. The nanoparticles was analyzed for transmittance, functional groups, sizes and shapes using Uv-vis, FTIR and Scanning Electron Microscopy (SEM), and was tested for antibacterial activities on MDR Shigella isolates. There is no significant difference in Shigella recovery relation to patients gender (P 30 years (21). Shigella were also found to be sensitive to Ciprofloxacin (92%), Augmentin (87%), Cefuroxime (85%), Streptomycin (83.5%) while the most frequent resistance was showcased against Nalidixic Acid (48%), and Tetracycline (27%). Phytochemicals detected include saponins, flavonoids, alkaloids, cardiac glycoside and tannin. Uv-vis showed broad peaks around 460nm, the FTIR showed C-H stretch of hydroxyl group of alkanes and the SEM showed nanoparticles with wide range of shapes and sizes. Anti-Shigella activities of silver nanoparticles is higher at zones of inhibition between 10mm and 30mm higher compared to the activities of crude aqueous extract and AgNO3 solution against the MDR Shigella species which showed an enhanced activities. The high prevalence of shigellosis among children in this study, indicated that improved hygiene is needed for children in the area and detailed examination is required for the treatment of diarrhoea in adults. Ciprofloxacin and Amoxicillin Clavulanate, Nalidixic acid could be used only where culture and sensitivity results prevailed. Enhanced traditional medicine should be given priority because of its potentials. This study have demonstrated feasibility of the green synthesis of F. sycomorus as a potent anti-shigellosis to combat the global burden of the disease. This is the first study On Stem bark aqueous extracts of F. sycomorus against Shigella species in the area.

Opportunistic parasitic infections in patients with human immunodeficiency virus/acquired immunodeficiency syndrome: A review.

The number of human immunodeficiency virus (HIV) cases increases annually, and Indonesia has become the country with the fastest HIV/acquired immunodeficiency syndrome (AIDS) epidemic spread among the five Southeast Asian countries. Indonesia entered the critical phase of HIV/AIDS infections after 5 out of the 33 provinces, namely, Papua, Jakarta, Bali, West Java, and East Java, reported HIV/AIDS epidemic since 2004. In AIDS pathophysiology and immune-suppression are severe, thus, opportunistic intestinal parasitic infections that cause diarrhea in HIV infection may be fatal. Several studies have suggested that Cryptosporidium parvum, Isospora belli, and Blastocystis hominis are the most common intestinal protozoan parasites categorized as AIDS associated illness. Diarrhea caused by parasites is considerably suspected in the cases of chronic and persistent diarrhea in adults, in an era of increasing HIV/AIDS cases nowadays. The present review highlights the current advances in etiologic agents of HIV/AIDS opportunistic infections among countries, epidemiology and prevalence, lifecycle, risk factors, examination methods, and treatment.

Berberine for diarrhea in children and adults: a systematic review and meta-analysis.

Background:Diarrhea is a ubiquitous digestive system disease, leading to loss of fluid and electrolytes, and may be life-threatening, especially in children and adults who are immunosuppressed or malnourished. Berberine has a broad-spectrum antibiotic activity and is very widely used to treat diarrhea in China. No systematic review has been carried out to evaluate the evidence presented in clinical trials. The aim of this study was to assess the effectiveness and safety of berberine in diarrhea treatment among children and adults.Methods:Seven databases and two clinical trial registries were searched on 1 September 2019. Randomized controlled trials were included, where participants were diagnosed (first diagnosed) as having diarrhea according to clear diagnostic criteria. Berberine alone or in combination with Western medication as intervention were included. Subgroup analyses were conducted based on children or adults, acute or persistent diarrhea, infectious or noninfectious and treatment courses. Primary outcomes were clinical cure rate and duration of diarrhea. The GRADE tool was used to assess the quality of evidence.Results:A total of 38 randomized controlled trials were included involving 3948 participants (including 27 trials on 2702 children) were included. Compared with antibiotics, berberine plus antibiotics showed better results in both adults and in children in general, especially when given for 7 days or 3 days in acute infectious diarrhea of children. Compared with the control groups, using berberine alone or in combination with montmorillonite, probiotics, and vitamin B increased the clinical cure rate of diarrhea. The use of berberine alone or berberine combined with montmorillonite reduced the duration of hospitalization. Using berberine had significantly better laboratory indicators (isoenzyme, inflammatory factors, myocardial enzyme, and fecal trait) and fewer systemic symptoms than the no berberine groups. Overall, 22 of 27 trials on children used berberine as an enema. No deaths and serious adverse events were reported. The quality of evidence of included trials was moderate to low or very low. The impact of different dosages, frequencies and treatment durations on the outcomes was not evaluated due to insufficient number of trials.Conclusion:This review demonstrated that berberine was generally effective in improving clinical cure rates and shortening the duration of diarrhea compared with control groups. No severe adverse event was reported. However, there is still a lack of high-quality evidence for evaluating the efficacy and safety of berberine.Trial registration:PROSPERO CRD42020151001 (available from http://www.crd.york.ac.uk/PROSPERO/).