Diarrhea Patients Research Articles

Association Between the Duration of Diarrhea and the Length of Hospitalization Among Clostridioides difficile Patients in Northern Nigeria

The United States Centers for Disease Control and Prevention (CDC) has categorized Clostridioides difficile infection (CDI) as a significant concern in extended-care facilities, hospitals, and outpatient clinics. However, little is known about CDI in low- and middle-income countries. This study determined CDI prevalence and impact in outpatient adults presenting with diarrhea in Nigeria. Toxigenic culture and PCR were used to detect and validate C. difficile. Prior antibiotic use, medical history, and demographic data were also obtained. Descriptive and inferential statistics were used for data analysis. The patient demographics were 35.48% (22/62) for the 18–24 years age group and 32.26% (20/62) for both the 25–30 years age group and the 31+ years group, with an average age of 29.7 years. Forty-eight percent of the patients (30/62) tested positive for CDI, and the prevalence increased with age. Most patients (86.67%, 52/60) reported moderate/severe cases of diarrhea and 67.7% had no knowledge of antibiotics. The results showed that 62.30% of the cases were hospitalized with the duration of diarrhea being significantly associated (r = 0.98, p ˂ 0.001) with the length of hospitalization. These results suggest that C. difficile is common among diarrhea patients in this population and that Nigerian hospitals’ infection prevention and control measures must include this pathogen.

Occurrence and antimicrobial resistance of Campylobacter jejuni isolated from poultry and hospitalized diarrheal patients in Pakistan

The leading human enteropathogen Campylobacter jejuni (C. jejuni) is recognized as a major public-health concern, due to emerging multidrug resistant (MDR) strains, and associated post-infectious complications. Therefore, the present study determined the occurrence of C. jejuni in diarrheal cases and poultry, in Khyber Pakhtunkhwa Province, Pakistan, and associated antimicrobial resistance patterns. In total, 840 samples were collected from clinical and different poultry sources between May 2019 to April 2020, to determine the occurrence, seasonal variations, bacterial loads in diverse poultry samples, age-related variations in human infections as well as associated antimicrobial resistance patterns of C. jejuni, highlighting its “One Health significance” at the human-food interface. Clinical samples (n = 240) from five age-groups of hospitalized diarrhoea patients, showed occurrence rate of 39 %, which peaked in the summer and was highest in children under 5. In poultry samples, 57 % (342/600) were positive for C. jejuni, varied from 45 % (109/240) in chicken meat to 65 % (233/360) in farm samples. Except frozen meat, C. jejuni-positive poultry samples showed seasonal contamination levels, with summer having the highest bacterial loads. In chicken meat, 2 % of positive samples (2/109) had bacterial loads <1 logCFU/g, while 20 % (22/109) exceeding 3log CFU/g. Grocery store samples showed lower bacterial contamination. All human and poultry isolates (n = 436) were resistant to nalidixic acid (100 %) and none to amikacin (0 %). Of these, 66 % showed multidrug resistance, with 9 % (38/436) resistant to panel of seven out of eight antibiotics tested. This study highlights the high occurrence of and concerns about MDR C. jejuni in Khyber Pakhtunkhwa, Pakistan, particularly in young children.

Etiology, clinical features, and epidemiological analysis of diarrhea patients visiting a gastrointestinal clinic in a comprehensive hospital in Beijing, China, in 2023

AbstractObjectiveTo investigate the clinical features and epidemiology of diarrhea patients and analyze the current distribution of enteropathogens causing diarrhea in a comprehensive hospital in Beijing, China, in 2023.Materials and MethodsFrom April to October 2023, we enrolled patients with diarrheal diseases who visited the gastrointestinal clinic in our hospital. The patients' demographic, epidemiological, and clinical features were obtained via a questionnaire. Stool samples were examined for 20 enteropathogens by multiplex polymerase chain reaction testing.ResultsWe enrolled 260 patients; men and adults accounted for 55.77% and 95.77% of the patients, respectively. The median age was 37 years. Eighty‐four enteropathogens, 72 bacteria and 12 viruses, were identified in 74 patients. Enteroaggregative Escherichia coli was the predominant agent. Patients with and without pathogens detected in stool samples showed no significant differences in age, sex, gastrointestinal symptoms, and stool characteristics. Possible food‐related events were recorded in 57.31% of the patients. Leukocyte counts in patients with bacterial infections were higher than those of patients with viral infections and those with no detected pathogens (p &lt; 0.05). Seasonality of bacterial distribution was observed (p &lt; 0.05).ConclusionBacteria were predominant pathogens among the diarrhea patients. The incidence of diarrhea was related to hot weather and foodborne illness. Bacterial diarrhea may cause systemic infection. The clinical symptoms of infectious diarrhea were usually non‐specific and unrelated to the type of infection. Timely and comprehensive multi‐pathogen surveillance might be helpful to detect suspected pathogens and promote epidemic prevention and control.

Diarrhea and cholera surveillance for early warning and preparedness to prevent epidemics among Rohingya Myanmar nationals in Cox's Bazar, Bangladesh

Diarrheal diseases, especially cholera, can be a serious threat to Rohingya refugees in Cox's Bazar due to overcrowding and inadequate hygiene infrastructure. Assessing the risk, cholera surveillance network was established with the aim to identify the outbreak of diarrhea and cholera and help to take appropriate preventive measures including a vaccination campaign. The surveillance network has been ongoing for 6 years (2017–2023) in 17 health facilities. Diarrhea patients from Rohingya Myanmar nationals matched with case definition were enrolled and stool samples were tested by Rapid diagnostic test (RDT) for early cholera detection Multiple Logistic regression models were fitted to examine the associations of risk factors among cholera cases. A total of 17,252 stool samples were collected through surveillance. Among the tested samples, 588 (3.5 %) were detected positive by RDT, and 239 (1.4 %) Vibrio cholerae were isolated by microbiological culture. Between 2021 and 2023, the number of culture-confirmed cases exceeded that in the period from 2017 to 2020. In addition to V. cholerae; high positivity was identified for ETEC (11.8 %) followed by Salmonella (3.9 %) and Shigella (2.7 %). Most of the cholera cases were presented with vomiting, dehydration and loose watery and rice watery nature of stool (p value = <0.001). Major risk factors for cholera were 2–4 years age group (OR = 5.72; 95 % CI, 3.84–8.53.14; P = .001), process of water treatment (OR = 1.54; 95 % CI, 1.01–2.37; P = .046) and hand washing with soap before taking meals (OR = 0.6; 95 % CI, 0.39–0.92; P = .020. This study highlights the epidemiology of cholera among the Rohingya population and underscores the effectiveness of integrating surveillance data with early warning, alert, and response systems (EWARS) system, along with oral cholera vaccine (OCV) campaigns, in preventing major cholera outbreak.

Clinical Thoughts and Cases of Jianpi Yishen Sechang Decoction Combined with Acupuncture in the Treatment of Functional Diarrhea

Functional diarrhea (FDr) accounts for a relatively high proportion of digestive diseases. It is an infection that is not accompanied by abdominal pain and shows negative results in laboratory tests for bacteria and viruses. The main symptoms are persistent or recurrent discharge of watery and soft stools. The course of the disease is prolonged and recurring, and the treatment cost is higher and greatly affects the patient’s daily life. The incidence rate has a gradual increase in the trend. Its pathogenesis is complex where Western medicine is mostly used in symptomatic drug treatment. The treatment can be fast-acting and effective in relieving diarrhea. However, the long-term use of Western medicine poses a high risk in terms of side effects and a high chance of recurring upon stopping medication. At the same time, some diarrhea patients show the existence of drug-resistant strains of bacteria, and the overall efficacy of the drug is limited. Chinese medicine is mild and able to provide excellent treatment of diarrhea. With its lower price and cost, most families can afford it. Fengliang Tian, director of traditional Chinese medicine, implemented the “needle and medicine” method, which combines medicine and acupuncture, involving the usage of Jianpi Yishen Sechang Decoction and acupuncture in the treatment of functional diarrhea. The method has a low price, fewer side effects, is easy to accept, and can significantly reduce the recurrence rate with high efficacy. The study would like to share the clinical thinking and cases as follows to provide ideas and methods for the treatment of functional diarrhea by traditional Chinese medicine.

Epidemiological characteristics and drug resistance of diarrheagenic Escherichia coli infection in diarrhea patients in Shanghai, 2016-2022

Objective: To understand the infection status, epidemiological characteristics and drug resistance of Diarrheagenic Escherichia coli (DEC) in Shanghai and provide evidence for the disease surveillance. Methods: The epidemiological data of diarrhea cases in Shanghai from 2016 to 2022 were collected from Shanghai Diarrhea Comprehensive Surveillance System, and stool samples were collected from the cases for DEC detection. The drug resistance data was obtained from Chinese Pathogen Identification Network. Statistical analysis was conducted by using χ2 and fisher test. Results: In 24 883 diarrhea cases detected during 2016-2022, the DEC positive rate was 9.13% (2 271/24 883), the single DEC positive rate was 8.83% (2 197/24 883) and the mixed DEC positive rate was 0.30% (74/24 883). The main type of DEC was Enterotoxigenic Escherichia coli (ETEC) [4.33% (1 077/24 883)]. The DEC positive rate was highest in people aged ≤5 years 18.48% (22/119). The annual peak of DEC positive rate was observed during July - September [5.91% (1 470/24 883)]. The DEC positive rate were 9.47% (554/5 847) and 9.02% (1 717/19 036) in urban area and in suburbs, respectively, Enteroaggregative Escherichia coli (EAEC) [3.98% (233/5 847)] and ETEC [4.56% (868/19 036)] were mainly detected. From 2016 to 2019, the DEC positive rate was 9.42% (1 821/19 330), while it was 8.10% (450/5 553) from 2020 to 2022, the main DEC types were ETEC (4.87%, 941/19 330) and EAEC (4.70%, 261/5 553). The multi-drug resistance rate was 40.21% (618/1 537). The top three antibiotics with high drug resistance rates were ampicillin [64.74% (995/1 537)], nalidixic acid [58.49% (899/1 537)] and tetracycline [45.09% (693/1 537)]. Conclusions: Compared with 2016- 2019, a decrease in DEC detection rate was observed during 2020-2022, and the main type of DEC detected shifted from ETEC to EAEC. The prevalence of multi-drug resistance was severe. Therefore, it is necessary to further strengthen the surveillance for DEC drug resistance and standardize the use of clinical antibiotics.

Determination of the Activity of Antibiotic Resistance in Bacterial Causative Agents of Diarrhea among Children Under the Age of 5 Years

Abstract Background: Escherichia coli is one of the most important bacterial agents that cause diarrhea in children. Objectives: The present study was carried out to investigate the bacterial causative agents of diarrhea in children, as well as the genes that encoded for antibiotic resistance to beta-lactams in E. coli isolated from the feces of children under the age of 5 years with symptoms of diarrhea and its relationship to antibiotic resistance. Materials and Methods: One hundred stool samples were collected from the diarrhea patients. Individually 15 samples of stool were planted on several culture media, and then the bacterial isolates were diagnosed using the Vitek 2 technique. After that an antibiotic sensitivity test was conducted. Forty isolates of E. coli were subjected to molecular detection by polymerase chain reaction. Results: The results of the sensitivity test showed that most of bacterial isolates were resistant to the all tested types of antibiotic. In contrast three (7.5%) bacterial isolates were resistant to the antibiotic Amikacin, which is the lowest percentage of resistance. The results of molecular identification showed that 12 (66%) isolates were carried the blaCTX-M gene, which was significantly higher (P ≤ 0.05) compared to the isolates carrying the blaTEM gene 6 (33%) isolates. Conclusion: It can be concluded that E. coli isolated from diarrhea children under of 5 years old conferred of antibiotics resistances against a wide range of antibiotics tested could be due to genes (such as TEM and CTX-M) which encoded to this resistance activity.

Watery diarrhea between Vibrio cholera and Aeromonas hydrophila during Iraqi cholera outbreaks

Cholera remains a significant health challenge globally, especially in regions with poor infrastructure and healthcare. This study aimed to detect Aeromonas hydrophila in clinical samples from diarrhea patients during the 2022-2023 outbreaks in Iraq. Archived samples from Baquba General Teaching Hospital were analyzed using culture media, biochemical tests, and the VITEK 2 system. Both Vibrio cholerae and A. hydrophila isolates produced virulence factors such as hemolysin, protease, lipase, phospholipase, and biofilm. Antibiotic susceptibility testing showed A. hydrophila was susceptible to cefepime, ceftazidime, amikacin, imipenem, meropenem, and piperacillin-tazobactam but resistant to aztreonam, levofloxacin, and ciprofloxacin. V. cholerae was susceptible to amikacin, imipenem, meropenem, piperacillin-tazobactam, doxycycline, and chloramphenicol but resistant to trimethoprim-sulfamethoxazole and ampicillin. The findings highlight the need for better recognition of Aeromonas as a gastrointestinal pathogen and emphasize the importance of improved diagnostics and public health initiatives to reduce diarrheal diseases. Highlight: Detection Methods: Culture media, biochemical tests, VITEK 2 system used. Virulence Factors: Hemolysin, protease, lipase, phospholipase, biofilm production identified. Antibiotic Resistance: Specific resistance observed in A. hydrophila and V. cholerae. Keyword: Cholera, Aeromonas hydrophila, Antibiotic Susceptibility, Diarrhea, Iraq Outbreak

Disturbance of bile acids profile aggravates the diarrhea induced by capecitabine through inhibiting the Wnt/β-catenin pathway

IntroductionDiarrhea is the primary dose-limiting side effect of capecitabine(Cap) hindering its clinical application, but the mechanism is unclear. Clarifying this mechanism may enhance the patient compliance and improve the treatment outcome. ObjectivesTo assess if the endogenous metabolic profile could prodict the diarrhea induced by Cap and explore and validate underlying mechanisms. MethodsUntargeted and targeted bile acids(BAs) metabolomics were performed to analyzed the metabolic profile of baseline samples from colorectal cancer(CRC) patients and the association with the diarrhea induced by Cap was assessed. The toxicity of BAs and Cap and its metabolites alone or their combinations to the human normal intestinal epithelial cell(HIEC) was assessed, and the key genes that mediated the BAs-enhanced toxicity of Cap were discovered by RNA-seq and then validated. A mouse model with high exposure levels of BAs was constructed and then treated with Cap to verify the Cap-induced diarrhea enhanced by BAs. ResultsThe baseline endogenous metabolic profile showed obviously difference between diarrhea and non-diarrhea CRC patients, and the differential metabolites mainly enriched in BAs metabolism; the deoxycholic acid(DCA) and lithocholic acid(LCA) were selected to be the key BAs that enhanced the toxicity of Cap metabolite 5-FU to the HIEC cell; the DCA and LCA could inhibit the Wnt/β-catenin signaling pathway, which then suppressed the P-glycoprotein and increased the exposure level of 5-FU in the HIEC cell. The results of animal experiment verified that the excessive DCA and LCA could aggravate the Cap-induced diarrhea through inhibiting Wnt/β-catenin-P-glycoprotein pathway. ConclusionsThe disordered BAs metabolic profile showed close relationship with diarrhea induced by Cap, and excessive DCA and LCA were proved to be the key BAs, which could aggravate the Cap-induced diarrhea through inhibiting Wnt/β-catenin-P-glycoprotein pathway.

Estimation of IL-8 and TNF-α Levels in Pediatric Diarrhea Patients Infected with Enterohemorrhagic E. coli O157:H7

Abstract Background: Verotoxins are bacterial virulence factors produced by E. coli O157:H7, transmitted by the fecal-oral route. Objectives: The aim of this article was to diagnose E. coli O157:H7 which causes diarrhea and sometimes develops into HUS, which considers pig health problems and estimates the levels of interleukin (IL)-8 and tumor necrosis factor (TNF)-α in the sera of pediatric patients infected with Enterohemorrhagic E. coli compared to the control group. Materials and Methods: Stool and blood samples were collected from 421 pediatric patients with diarrhea, ranging in age from birth to 13 years old, from March to October 2022. Samples were collected from Al Noor Teaching Hospital, Babylon Hospital for Pediatric and Gynecology, Hilla, Iraq. E. coli O157:H7 was cultured on eosin methylene blue (EMB) and Sorbitol MacConkey agar (SMA), confirmed by biochemical test and cultured on HiCrome E. coli O157:H7 selective medium which was an agar base supplemented with cefixime tellurite agar. Serum from 30 pediatric diarrhea patients infected with E. coli O157:H7 compared with 30 healthy children as control group used to determine serum levels of IL-8 and TNF-α by sandwich ELISA. Results: The results revealed that out of the total 421 samples used in this study, E. coli O157H:7, represented 7% (30 of 421) stool samples. This 30serum samples of infected children as well as 30 samples from healthy children subjected to the estimate serum level of IL-8 and TNF-α which record significant differences P ≤ 0.01 and P ≤ 0.05 to this cytokines in different age group; the mean of IL-8 level was 283.62 ± 17.8 pg/mL (7–9 years), and the mean of TNF-α was 208.62 ± 28.7 pg/mL (10–13 years) comparative with the control group of 80.58 ± 15.4pg/mL and 32.50 ± 7.5 pg/mL, respectively, and also result showed an increased mean level of IL-8 than TNF-α in the male comparative with female 195.19 ± 10.4 pg/mL and 159.05 ± 12.4 pg/mL, respectively, comparative with the control group. The result showed no significant differences in IL-8 and TNF-α between watery diarrhea (192.43 ± 24.3 pg/mL and 136.05 ± 20.4 pg/mL) and bloody diarrhea (189.02 ± 22.5 pg/mL and 123.80 ± 13.5 pg/mL), and also result showed significant increase of mean sera level of IL-8 than TNF-α in formula feeding children comparative with breastfeeding children (187.87 ± 19.5 pg/mL and 119.93 ± 17.4 pg/mL, respectively). Conclusion: The finding of this study suggested that increased levels of IL-8 and TNF-α are present in all age groups, in male comparative with female, and also in pediatric diarrhea feeding by formula than breastfeeding and no differences of this cytokine according to consistency of diarrhea. These results contribute to using the immune profile as a serological marker for diagnosing diarrhea caused by E. coli O157:H7 in comparison with the control group.

Earthworm Infusion as an Antimicrobial Against Bacteria Causing Diarrhea

Diarrhea is the second most common disease worldwide after Acute Respiratory Infection (ARI). One of the causes of diarrhea is the gastrointestinal infection caused by disease bacteria (microbe) such as Salmonella sp., Escherichia coli, Shigella sp., and Vibrio cholerae. The earthworm species Lubricus sp can be used as an alternative medication believed to be able to cure digestive diseases such as typhus, dysentery, and other indigestion like gastritis. This research is laboratory experimental research. The antibacterial activity is measured by determining the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of earthworm infusion (Lumbricus rubellus) using the tube dilution test. The bacteria used in this research are Escherichia coli, Shigella dysentriae, and Vibrio cholerae, isolated from the feces of diarrhea patients. This research aims to examine the earthworm infusion antibacterial (Lumbricus rubellus) activity to several bacteria that commonly cause diarrhea. The research results show that the average MIC value of earthworm infusion (Lumbricus rubellus) against Escherichia coli is &gt;50%, Shigella dysentriae 0,098%, and Vibrio cholerae &gt;50%. The average MBC value of earthworm infusion against Shigella dysentriae is 50%. .

Prevalence and antimicrobial resistance patterns of diarrheagenic and uropathogenic Escherichia coli in Odisha, India

Objective: The aim of this study was to determine the prevalence and antibiotic susceptibility patterns of pathogenic Escherichia (E.) coli causing diarrhea and urinary tract infection (UTI) in patients admitted for treatment in selected health care facilities in Odisha, an eastern Indian State. Methods: A total of 189 rectal swabs from patients with diarrhea and 297 urine samples from patients with UTI were collected from selected health care facilities. E. coli isolates were phenotypically confirmed using MacConkey agar, MacConkey sorbitol agar and blood agar along with biochemical tests. These phenotypically confirmed E. coli isolates were investigated genotypically for known pathogenic E. coli via multiplex PCR. Finally, the pathogenic E. coli was subjected to antibiotic sensitivity test. Results: Culture of 189 rectal swabs and 297 urine samples revealed 46 (24.3%) diarrheagenic E. coli (DEC) and 36 (12.1%) uropathogenic E. coli (UPEC). PCR analysis of DEC identified 27 (14.3%) enterotoxigenic E. coli (ETEC), 8 (4.2%) enteropathogenic E. coli, 10 (5.3%) enteroaggregative E. coli and 1 (0.5%) Enterohemorrhagic E. coli (EHEC) in diarrhea patients and 5 (1.7%) ETEC, 7 (2.4%) enteroaggregative E. coli, 11 (3.7%) EHEC O157:H7 and 1 (0.3%) EHEC non-O157:H7 in UTI patients. DEC and UPEC exhibited multidrug resistance with a high rate of resistance to commonly prescribed antibiotics. A high frequency of ETEC causing diarrhea, atypical enteropathogenic E. coli harboring the eae gene was found among children with acute diarrhea, and ETEC (est+ ) and EHEC O157:H7 were detected in UTI patients along with high antibiotic resistance among DEC and UPEC were important findings. Conclusions: To the best of our knowledge, this is the first study to report the prevalence of DEC and UPEC in patients admitted to hospital in Odisha, India, revealing a high rate of antimicrobial resistance.

A Rapid and Robust DNA Extraction Method for PCR-Based Diagnosis of V. cholerae

Cholera, caused by _V. cholerae_, needs rapid diagnosis because of its threat for rapid spread. Recent molecular diagnosis by PCR assay is more advantageous than the conventional methods. The bottleneck in PCR diagnosis lies in the delay in template DNA extraction of _V. cholerae_, which is the basic requirement. This study describes a simple, less expensive, and rapid template DNA extraction method to lessen the total time for PCR diagnosis of _V. cholerae._ To obtain template DNA, our method involves boiling of _V. cholerae_ suspension in distilled water (takes 18-24 hours) instead of boiling the suspension in broth medium, which is a lengthy process (takes 72 hours). The validation of our template DNA was conducted using 40 _V. cholerae_ O1 strains that were confirmed previously, and its usefulness was checked on 20 clinical strains of _V. cholerae_ O1 isolated from acute diarrhea patients; results were compared with those of conventional template DNA. The analysis of our template DNA in simplex and quadruplex PCR assays revealed the presence of _ctxA_, _tcpA _(El Tor), _rfb _(O1), _ToxR_, _ctxB_, _zot_, _ace,rst _, and _OmpW _genes in _V. cholerae _O1. The comparison of the results of PCR assays using the template DNA from both sources showed equal results and matched correctly. The sensitivity of our template DNA was 1.5x103 CFU per assay. Our template DNA extraction method is simple, less expensive, and rapid, and it can be employed for early diagnosis of _V. cholerae_ during outbreaks, in research laboratories, and in hospital setups where infrastructures are available.

Effect of a Water, Sanitation, and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo: A Randomized Pilot of the PICHA7 Program.

Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC.

Evaluation of a rapid diagnostic test for detection of Vibrio cholerae O1 in the Democratic Republic of the Congo: Preventative intervention for cholera for 7 days (PICHA7 program).

Globally, there are estimated to be 2.9 million cholera cases annually. Early detection of cholera outbreaks is crucial for resource allocation for case management and for targeted interventions to be delivered to stop the spread of cholera. In resource limited settings such as Eastern Democratic Republic of the Congo (DRC), there is often limited laboratory capacity for analysing stool samples for cholera by bacterial culture. Therefore, rapid diagnostic tests (RDTs) for cholera present a promising tool to rapidly test stool samples in a health facility setting for cholera. Our objective is to evaluate the Crystal VC O1 RDT for cholera detection compared with bacterial culture and polymerase chain reaction (PCR) for Vibrio cholerae. From March 2020 to December 2022, stool samples were collected from 644 diarrhoea patients admitted to 94 health facilities in Bukavu in Eastern DRC. Patient stool samples were analysed by Crystal VC O1 RDT for cholera and by bacterial culture and PCR for V. cholerae O1. Twenty six percent of diarrhoea patients (166/644) had stool samples positive for cholera by RDT, and 24% (152/644) had stool samples positive for V. cholerae O1 by bacterial culture or PCR. The overall specificity and sensitivity of the Crystal VC O1 RDT by direct testing was 94% (95% confidence interval [CI]: 92%-96%) and 90% (95% CI, 84%-94%), respectively, when compared with either a positive result by bacterial culture or PCR. Our findings suggest that the Crystal VC O1 RDT presents a promising tool for cholera surveillance in this cholera endemic setting in sub-Saharan Africa.

Characteristics of Acute Diarrhea Patients in Toddlers at Ibnu Sina YW-UMI Hospital Makassar in 2021-2022

Acute diarrhea is defined as passing stool more than 3 times a day with a change in consistency to liquid, with or without mucus and blood, and lasting less than one week. Diarrhea remains an endemic disease and a significant contributor to mortality in Indonesia, especially among toddlers.The purpose of this research is to determine the characteristics of acute diarrhea patients in toddlers at Ibnu Sina Hospital Makassar in 2021-2022. The results showed the highest incidence of acute diarrhea found in the age group of 1 - &lt;3 years (53.1%), predominantly in males (53.1%), with good nutritional status (60.5%), experiencing vomiting symptoms (41.5%), experiencing dehydration (75.3%), and receiving exclusive breastfeeding (51.9%). The findings of this research lead to the conclusion that acute diarrhea in toddlers is most prevalent in the age group under three years old, predominantly in males, with good nutritional status, experiencing vomiting symptoms, suffering from dehydration, and receiving exclusive breastfeeding.

Traditional Chinese medicine (Xielikang) reduces diarrhea symptoms in acquired immune deficiency syndrome (AIDS) patients by regulating the intestinal microbiota.

Diarrheal acquired immune deficiency syndrome (AIDS) seriously affects the quality of life of patients. In this study, we analyzed the differences in the intestinal microbiota among healthy individuals, AIDS patients without diarrhea and AIDS patients with diarrhea through high-throughput sequencing. The microbial diversity in the intestines of patients in the AIDS diarrhea group was significantly increased, and after treatment with Xielikang, the intestinal microbial diversity returned to the baseline level. At the phylum level, compared those in to the healthy (ZC) and AIDS non diarrhea (FN) groups, the relative abundances of Bacteroidetes and Verrucomirobia in the AIDS diarrhea (FA) group before treatment were significantly increased, while the relative abundance of Firmicutes was significantly decreased. Similarly, compared with those in the FA group, the relative abundances of Bacteroidea and Firmicutes in the AIDS diarrhea (FB) group after treatment were significantly increased, while the relative abundance of Firmicutes was significantly decreased after treatment. Additionally, there was no significant difference between the ZC and FN groups. At the genus level, compared with those in the ZC group, the relative abundance of Prevotella and Escherichia_Shigella in the FA group was significantly increased, while the relative abundances of Megamonas and Bifidobacterium was significantly decreased compared to that in the ZC group. After treatment with Xielikang, the relative abundance of Prevotella and Escherichia_Shigella in the FB group were significantly decreased, while the relative abundances of Megamonas and Bifidobacteria were significantly increased than those in the FA group; moreover, there was no significant difference between the ZC and FN groups. The functional prediction results showed that the ketodeoxyoctonate (Kdo) transfer to lipid IVA III and the superpathway of N-acetylglucosamine pathways in the AIDS diarrhea group were significantly altered. The correlation analysis results showed that Dorea was positively correlated with inflammatory factors, while Streptococcus and Lactobacillus were negatively correlated with inflammatory factors. The composition and function of the intestinal microbiota changed significantly in AIDS diarrhea patients, which affected the immune function of the host. The Xielikang capsule modulated the composition of the intestinal microbiota in AIDS diarrhea patients and thus improved immune function and reduced diarrheal symptoms.

The Effect of Infection on Some Intestinal Parasite on Some Hematological Parameters for Diarrhea Patients in Zakho City, Kurdistan Region, Iraq

This study was carried out in Emergency hospital of Zakho / Duhok, Iraq from january2019 to december2019. A total of 515 Patients of both sexes from all ages were eligible for this study. The chosen patients had single infection either with Entamoeba histolytica or Giardia lamblia. Entamoeba histolytica was diagnosed in 122(23.6%) stool samples from the total number examined No significant differences were appeared between males (23.8%) and females (23.5%) infected with E. histolytica. Age group 16-25 years had significantly higher rate of infection (28.8%) followed by 1-15 years with rate of (24.6%). The lower rate was for 36-45(14.2%). High rates of the E. histolytica positive samples contained trophozoite and cyst (50%), followed by trophozoite stage (26.3%), while cyst stage was found in (23.7%). G. lamblia prevalence was significantly lower compared with E. histolytica. It was diagnosed in 96 (18.6%) stool samples of 515 samples examined. significant differences were recorded between the females (16.9%) and males (20.1%). Age group 1-15 years had significantly higher rate of infection (21.5%). The lower rate was for 36-45(12.3%). G. lamblia was more prevalent as trophozoite (47.9%), trophozoite and cystic (35.5%) than cystic stage alone (16.6%). The samples containing trophozoite and cystic stages of E. histolytica had the most apparent significant effect on all hematological parameters, and the highest rate of abnormality was seen in HB levels and WBC levels, as well as for G. lamblia was seen the highest rate of abnormality in HB levels and WBC levels of The samples containing trophozoite and cystic stages.

Etiologies of Mild and Moderate Diarrheal Illness among Children in Consuelo, Dominican Republic.

Since the rotavirus vaccine was included in the Dominican Republic's national immunization schedule in 2012, the microbiologic etiologies of acute gastroenteritis have not been described. This study aimed to determine the contribution of rotavirus as an etiology of acute gastroenteritis over a 12-month period in children under 5 years of age in both an inpatient and an outpatient setting in Consuelo, Dominican Republic. All children who were seen at Niños Primeros en Salud clinic or admitted to Hospital Municipal Dr. Angel Ponce Pinedo for acute gastroenteritis during January 2021-April 2022 were enrolled in the study. Stools were evaluated for rotavirus, enteric parasites, and pathogenic bacteria. Pathogen detection was compared between outpatients and inpatients and on the basis of child's vaccination status. From 181 children enrolled, 170 stool samples were collected, 28 (16.5%) from inpatients and 142 (83.5%) from outpatients. Rotavirus was the most commonly detected pathogen and was proportionately more common among hospitalized children, with nine (32.1%) cases among hospitalized children and 16 (11.3%) among outpatient children. (Pearson χ2 = 8.1, P = 0.004). Among patients with a positive rotavirus result, vaccination rate was lower among moderate (hospitalized) (three of six; 50%) compared with mild (outpatient) diarrhea patients (12 of 15; 80%). Giardia lamblia (10%) was the next most prevalent pathogen detected in both inpatients and outpatients using standard laboratory measures. Despite the availability of rotavirus vaccination, rotavirus remains a common cause of gastrointestinal illness among children under 5 years of age in our cohort. Incomplete vaccination status was associated with hospitalization for gastrointestinal illness.

Prevalence and dissemination of mcr-9.1-producing non-typhoidal Salmonella strains from diarrhea patients throughout China during 2010–2020

The emergence of mobilized colistin resistance (mcr) genes has raised significant concerns as they pose a public health issue. The prevalence of mcr genes, particularly the newly discovered mcr-9 gene, in non-typhoidal Salmonella (NTS) isolates remains unclear. We characterized mcr-9.1-producing NTS isolates from China. Among 7,106 NTS isolates from diarrhea cases in 32 provinces during 2010–2020, 11 mcr-9.1-producing isolates were identified and were all not resistant to colistin. Five isolates belonged to Salmonella Thompson and sequence type (ST) 26, two belonged to Salmonella Typhimurium and ST34, two belonged to Salmonella Typhimurium and ST36, and two belonged to Salmonella 1,4,[5],12:i:- and ST34. Plasmids harboring mcr-9.1 tended to possess the IncHI2 backbone and were ~ 300 kb long. All mcr-9.1 genes shared the same flanking sequence, rcnR-rcnA-pcoS-IS903-mcr-9.1-wbuC. According to the NCBI data, we found that NTS serves as the primary host of mcr-9.1, although the prevalence of specific serotypes differed between domestic and international settings. Notably, most data came from developed countries, such as the USA. mcr-9.1 tended to be transferred as a gene cassette or to be mobilized by a conjugational plasmid in multiple bacteria across humans, animals, and the environment. Furthermore, mcr-9.1 frequently co-existed and was co-transferred with various genes encoding resistance to first-line drugs, reducing the effectiveness of available therapeutic options. In summary, although mcr-9 does not mediate colistin resistance, it can silently spread with some genes encoding resistance to first-line drugs, and therefore warrants research attention.