Diarrhea Patients Research Articles

Variants of ctxB alleles of Vibrio cholerae O1 caused sequential cholera outbreaks in the tribal areas of Odisha, India.

Cholera localized outbreaks/epidemics accounting for high morbidity and mortality have been reported in different years both from the coastal and tribal districts of Odisha. In the present study, the emergence and spread of two sequential cholera outbreaks reported in July to October 2012 from Rayagada and Kalahandi districts of Odisha was investigated. Environmental water samples from different sources and rectal swabs from diarrhoea patients were analysed for identification, antibiogram profiles and molecular studies using DMAMA-PCR assays. The pulsed field gel electrophoresis (PFGE) was done on some selected Vibrio cholerae O1 strains isolated from these cholera outbreak areas. Results showed 42% of rectal swabs and 2.3% of water samples collected from both the districts were positive for Vibrio cholerae O1 Ogawa biotype El Tor carrying both ctxB1 and ctxB7 genotypes. The common resistance profile of V. cholerae O1 strains was ampicillin, nalidixic acid, furazolidone and co-trimoxazole. The PFGE analysis on selected V. cholerae O1 strains of ctxB1 and ctxB7 genotypes showed three pulsotypes with 96% similarity matrix exhibiting the relationship with their respective water sources. Hence, continuous surveillance is highly essential to monitor the antibiogram profile and changing pattern of ctxB genotypes of V. cholerae O1 in this region.

Hematocrit Value in Diarrhea Patients

Diarrhea is the discharge of stool that is not normal or the form of watery stools with more frequency than usual. Diarrhea can be caused by various things, namely infectious and non-infectious. In acute diarrhea, complications can occur, including dehydration. On hematological.examination. of. diarrhea. patients,.there can be an increase in several blood tests such as an increase in hematocrit and hemoglobin in a state of severe dehydration. The. purpose. of. this. study. was. to. determine. the. hematocrit value in inpatient diarrhea patients at the Tonjong Public Health Center, Brebes Regency. This is a descriptive study using a non-probability sampling technique that relies on medical record data for 30 respondents at the Tonjong Public Health Center, Brebes Regency. The results showed that there were 3 men who had decreased hematocrit levels and 8 people who had normal hematocrit levels. Whereas in women, the hematocrit levels decreased as many as 17 people and those who had normal hematocrit levels were 2 people. Based on the age category, the most are the late elderly as many as 8 people and the final adults as much as 2 people. Meanwhile, based on the status of dehydration, all diarrhea patients who came for treatment at the Tonjong Health Center, Brebes Regency, 100% did not experience diarrhea with dehydration. The hematocrit levels in diarrhea patients at the Tonjong Public Health Center, Brebes Regency were 30 samples, on average they had low hematocrit levels.

EVALUASI PENGGUNAAN OBAT GASTRITIS PADA PASIEN RAWAT INAP DI RS GRANDMED LUBUK PAKAM TAHUN 2020

Gastritis is a disease caused by the bacterium Helicobacter phylory, this first gastritis drug, namely Antacids, Omeprazole, and Ranitidine. The increasing number of Gastritis patients from 2019 to 2020 at Grandmed Lubuk Pakam Hospital is encouraging researchers to conduct this study. The purpose of this study was to determine the description of the use of Gastritis drugs and the rationality of the use of Gastritis medications in Gastritis patients at Grandmed Lubuk Pakam Hospital in 2019. This study was a descriptive (non-experimental) study with retrospective data collection taken from patient medical records. Gastritis at Grandmed Lubuk Pakam Hospital. Data were collected using a purposive sampling technique in accordance with the inclusion criteria and exclusion criteria using the Data Collection Sheet. The number of samples used in this study were 64 medical records of patients diagnosed with gastritis. Data analysis was performed using Univariat with the help of SPSS. Results of distribution of duration of treatment data for which most patients undergo treatment. And the number of Chronic Diseases suffered by Diarrhea patients is 20 patients (31.2%). All three have a significant relationship with patient care outcomes. While in the age range 31-60 years, 45 people (70.3%) affected by gastritis. and The results of evaluating the rationality of treatment for gastritis are the right indications (96.9%), (62 patients), 100% correct patients (64 patients), the right medication by (96.9%) (62 patients), and the correct dosage 100% correct (64).

Drug resistance characteristics of Diarrheagenic Escherichia coli isolated from patients with diarrhea in Shunyi district of Beijing, 2013–2019

Objective To study the drug resistance characteristics of Diarrheagenic Escherichia coli (DEC) isolated from patients with diarrhea in two sentinel hospitals in Shunyi district of Beijing during 2013—2019. Method Stool samples of diarrhea patients were collected in the two sentinel hospitals during this period. Isolation, bacterial identification and PCR typing were conducted for DEC strains. Antimicrobial susceptibility tests were carried out using micro broth method to analyze the drug resistance characteristics of the isolated strains, including resistance rate, non-sensitive rate, multi-drug resistance rate and drug resistance spectrum. Result The detection rate of DEC in diarrhea patients was 9.53% (232/2434). The proportions of Enterotoxic Escherichia coli (ETEC), Enteropathogenic Escherichia coli (EPEC), and Enteroaggregative Escherichia coli (EAEC) were 56.47% (131/232), 27.16% (63/232) and 16.38% (38/232), respectively. The multi-drug resistance rates of DEC with 90 drug resistance spectrum, ETEC with 36 drug resistance spectrum, EPEC with 42 drug resistance spectrum, and EAEC with 23 drug resistance spectrum were 33.19% (77/232), 17.56% (23/131), 58.73% (37/63), 44.74% (17/38), respectively. Antibacterial drugs with resistance rate ≥30% included nudicacid (NAL) and ampicillin (AMP) for ETEC; AMP, tetracycline (TET), sulfamethoxazole tablets (SXT), sulfamethoxazole (Sul), NAL for EPEC; NAL, AMP, SXT, Sul, TET for EAEC. A comparison of the differences in the antimicrobial susceptibility tests during 2013—2016 and during 2017—2019 found that the resistance of ETEC to AMP, cefazolin (CFZ), TET, cefepime (FEP), aztreonam (AZM), and ampicillin/sulbactam (AMS) increased, while the resistance to Sul decreased; the resistance of EPEC to gentamicin (GEN) decreased; the resistance of EAEC to cefotaxime (CTX), GEN, and doxycycline (DOX) decreased. Conclusion Among the diarrhea cases in Shunyi, the intensity of DEC spread was high, and the spread and the drug resistances of ETEC, EPEC and EAEC had unique characteristics. The drug resistance was serious, to which close attention should be paid.

Lactobacillus plantarum CCFM1143 Alleviates Chronic Diarrhea via Inflammation Regulation and Gut Microbiota Modulation: A Double-Blind, Randomized, Placebo-Controlled Study.

Irritable bowel syndrome with diarrhea and functional diarrhea are both functional bowel disorders that cause chronic diarrhea. Chronic diarrhea is closely related to daily life and the psychological condition of diarrhea in patients, and probiotics can play a significant role in alleviating chronic diarrhea in some research. Lactobaccilus plantarum CCFM1143 can relieve diarrhea in mice caused by enterotoxigenic Escherichia coli (ETEC); however, its clinical effects remain unclear. This study aimed to assess the effects of CCFM1143 as a therapy for chronic diarrhea patients. Fifty-five patients with chronic diarrhea were randomly assigned into the probiotic group (n = 28) and the placebo group (n = 27), receiving the routine regimen with or without probiotics for 4 weeks, respectively. CCFM1143 can mitigate the apparent clinical symptoms and improve the health status and quality of life of patients. In addition, it could inhibit the increase in interleukin 6 (IL-6) and the decrease in motilin; modulate the short-chain fatty acids, especially acetic and propionic acids; and regulate the gut microbiota, particularly reducing the abundance of Bacteroides and Eggerthella and enriching the abundance of Akkermansia, Anaerostipes, and Terrisporobacter. In addition, treatment with probiotics showed clinical effectiveness in managing chronic diarrhea when compared with the placebo group. The findings could help to develop and further the application of probiotics for chronic diarrhea.

Bowel Histology of CVID Patients Reveals Distinct Patterns of Mucosal Inflammation

Diarrhea is the commonest gastrointestinal symptom in patients with common variable immunodeficiency (CVID). Different pathologies in patients’ bowel biopsies have been described and links with infections have been demonstrated. The aim of this study was to analyze the bowel histology of CVID patients in the Royal-Free-Hospital (RFH) London CVID cohort. Ninety-five bowel histology samples from 44 adult CVID patients were reviewed and grouped by histological patterns. Reasons for endoscopy and possible causative infections were recorded. Lymphocyte phenotyping results were compared between patients with different histological features. There was no distinctive feature that occurred in most diarrhea patients. Out of 44 patients (95 biopsies), 38 lacked plasma cells. In 14 of 21 patients with nodular lymphoid hyperplasia (NLH), this was the only visible pathology. In two patients, an infection with Giardia lamblia was associated with NLH. An IBD-like picture was seen in two patients. A coeliac-like picture was found in six patients, four of these had norovirus. NLH as well as inflammation often occurred as single features. There was no difference in blood lymphocyte phenotyping results comparing groups of histological features. We suggest that bowel histology in CVID patients with abdominal symptoms falls into three major histological patterns: (i) a coeliac-like histology, (ii) IBD-like changes, and (iii) NLH. Most patients, but remarkably not all, lacked plasma cells. CVID patients with diarrhea may have an altered bowel histology due to poorly understood and likely diverse immune-mediated mechanisms, occasionally driven by infections.

S1361 Small Bowel Bacterial Overgrowth in Patients of Chronic Diarrhea in South India

S1361 Small Bowel Bacterial Overgrowth in Patients of Chronic Diarrhea in South India

Viral Etiology of Acute Gastroenteritis Among Forcibly Displaced Myanmar Nationals and Adjacent Host Population in Bangladesh.

BackgroundSince August 2017, Myanmar nationals from Rakhine state have crossed the border into Bangladesh and settled in Cox’s Bazar, the World’s largest refugee camp. Due to overcrowding, poor sanitation, and hygienic practices they have been under significant health risks including diarrheal diseases. The objective of this study is to determine the viral etiology of acute gastroenteritis (AGE) among forcibly displaced Myanmar nationals (FDMN) and adjacent Bangladeshi local host population (AHP).MethodsFrom April 2018 to April 2019, we collected stool specimens from 764 FDMN and 1159 AHP of all ages. We tested 100 randomly selected specimens from each group for the most common AGE viruses.ResultsAmong 200 diarrhea patients, 55% and 64% of FDMN and AHP patients, respectively, had viral infections; the most common viruses were rotavirus (29% vs 44%), adenovirus (24% vs 31%), and norovirus (14% vs 10%). In both populations, viral infections were significantly higher in children less than 5 years of age, compared with bacterial infections that were higher in patients older than 5 years of age (P ≤ .05).ConclusionsDisparities in viral and bacterial prevalence among various age groups warrant careful antibiotic usage, especially in children less than 5 years of age.

The changing pattern of enteric pathogen infections in China during the COVID-19 pandemic: a nation-wide observational study.

BackgroundNon pharmaceutical interventions (NPI) including hand washing directives were implemented in China and worldwide to combat the COVID-19 pandemic, which are likely to have had impacted a broad spectrum of enteric pathogen infections.MethodsEtiologically diagnostic data from 45 937 and 67 395 patients with acute diarrhea between 2012 and 2020, who were tested for seven viral pathogens and 13 bacteria respectively, were analyzed to assess the changes of enteric pathogen infections in China during the first COVID-19 pandemic year compared to pre-pandemic years.FindingsTest positive rates of all enteric viruses decreased during 2020, compared to the average levels during 2012−2019, with a relative decrease of 71•75% for adenovirus, 58•76% for norovirus, 53•50% for rotavirus A, and 72•07% for the combination of other four uncommon viruses. In general, a larger reduction of positive rate in viruses was seen among adults than pediatric patients. A rebound of rotavirus A was seen after September 2020 in North China rather than South China. Test positive rates of bacteria decreased during 2020, compared to the average levels during 2012−2019, excepting for nontyphoidal Salmonella and Campylobacter coli with 66•53% and 90•48% increase respectively. This increase was larger for pediatric patients than for adult patients.InterpretationThe activity of enteric pathogens changed profoundly alongside the NPIs implemented during the COVID-19 pandemic in China. Greater reductions of the test positive rates were found for almost all enteric viruses than for bacteria among acute diarrhea patients, with further large differences by age and geography. Lifting of NPIs will lead to resurgence of enteric pathogen infections, particularly in children whose immunity may not have been developed and/or waned.FundingChina Mega-Project on Infectious Disease Prevention; National Natural Science Funds.

Collagenous colitis: a rare cause of chronic diarrhea

Abstract Introduction: Collagenous colitis is a chronic inflammatory disease of the colon with a peak incidence in middle-aged adults. It is characterized by chronic diarrhea and pain from abdominal cramping, with near normal mucosa morphology under gross colonic examination by colonoscopy. Currently, the pathogenesis remains unclear but there is speculation of an association with abnormal collagen metabolism, contributing to prominent sub-epithelial matrix deposition. Patient concerns: A 51-year-old male patient without any underlying disease presented after experiencing watery light brown diarrhea 4–5 times per day for the past 2 months. Diagnosis: The diagnosis of collagenous colitis was confirmed by the pathological examination of the second colonic biopsy, which reported positive Masson's trichrome staining. Intervention: The patient was initially diagnosed with unspecified functional bowel disorder, but showed no clinical improvement after treatment with oral medication. Mesalamine therapy was administered after collagenous colitis was diagnosed by follow-up colonoscopy. Outcome: Normal bowel movement was restored in the patient after 2 weeks of mesalamine therapy. Conclusion: Collagenous colitis is a rare etiology of chronic diarrhea, which can only be diagnosed by pathology of colonic mucosa. Consequently, repeat colonoscopy with multiple stepwise random colonic biopsies at suspicious lesion sites or even normal-appearing mucosa should be considered in refractory chronic diarrhea patients without established diagnoses.

THE CORRELATION BETWEEN HEALTHY HOUSES AND ACCESS TO SAFE DRINKING WATER WITH THE INCIDENCE OF DIARRHEA IN EAST JAVA IN 2016

ABSTRACTDiarrhea is a common endemic disease in Indonesia. In developing countries, the high prevalence of diarrhea can be attributed to the lack of clean water and proper sanitation. This study determined a correlation between access to safe drinking water and healthy houses with the incidence of diarrhea in East Java in 2016. The study applied a correlation study design. The population consisted of all diarrhea patients treated in East Java in 2016; thus, the population was used also as a sample. The data were obtained from secondary data, namely the 2016 East Java Provincial Health Profile. Pearson correlation test was used in analyzing the data. There was a correlation between healthy homes (p = 0.000) and sustainable access to safe drinking water (p = 0.000) with the incidence of diarrhea. Pearson correlation coefficient for the healthy house variable was 0.798, while the Pearson correlation coefficient for sustainable access to safe drinking water was 0.722. It can be concluded that the relationship between healthy homes and access to safe drinking water with the incidence of diarrhea in the Province of East Java in 2016 was strong enough.Keywords: diarrhea, healthy houses, access to safe drinking water.

Evaluation of nested PCR for diagnosis of Cyclospora cayetanensis in a sample of immunosuppressed and diarrheic patients in Turkey

Background: Cyclospora cayetanensis is a food-borne coccidian parasite that causes cyclosporiasis inhumans and possibly in other animals. It presents with watery diarrhea and other related symptoms.Since detection of oocysts may be difficult with histological stains, a negative result should not exclude thepossibility of C. cayetanensis. PCR methods can achieve more sensitive detection of the parasite.Objective: The presence of C. cayetanensis was investigated in an immunosuppressed patient group,diarrhea patient group, and in both immunosuppressed and diarrhea patient group using the modifiedacid-fast staining and nested polymerase chain reaction (nPCR) methods.Subjects and Methods: Included in the study were 80 patients with immune suppression, 50 patientswith diarrhea, and 70 patients with both immune suppression and diarrhea. The clinical findings of thesepatients were recorded, stool samples were collected and examined using both the modified acid-fast (AF)staining and nPCR methods.Results: The overall detection rate of C. cayetanensis was 8% and 12% using the modified AF and nPCR,respectively. C. cayetanensis was detected in 5% of immunosuppressed patients, 12%, in patients withdiarrhea and 20% in patients with both immune suppression and diarrhea. Statistically significantrelationships were identified between the frequency of C. cayetanensis and abdominal pain (P<0.01),nausea (P<0.01), fatigue (P<0.01), diarrhea (P<0.05), and weight loss (P<0.01).Conclusion: nPCR gave a higher rate of cyclosporiasis, and it is more appropriate especially in cases withrecurrent prolonged symptoms.

Characterization of Human Origin Salmonella Serovar 1,4,[5],12:i:- in Eastern China, 2014 to 2018.

The prevalence of Salmonella serovar 1,4,[5],12:i:- among diarrhea patients has increased considerably in many countries around the world, including China. However, the characterization of this serovar of human origin has been less reported from China. We characterized 76 isolates of Salmonella 1,4,[5],12:i:- gained from diarrhea patients from 2014 to 2018 in the Jiangsu Province of eastern China. These isolates fell into a single-sequence type (ST34) determined by multilocus sequence typing (MLST), and into 44 pulsed-field gel electrophoresis band patterns, with 1 pattern (JSSMM015) comprising 12 isolates (15.9%). By means of PCR-based assays, the seven prophage located virulence genes were detected in our Salmonella 1,4,[5],12:i:- isolates with a high rate of gipA, gtgB, sspH1, sspH2, sodC1, and gtgE (93.4-97.4%), and with a moderate rate of sopE (42.1%). In contrast, none of the five plasmid-borne virulence genes (spvC, pefA, mig5, rck, and srgA) was identified. We tested the isolates' susceptibility to 18 antibiotics of 9 categories using the VITEK 2 system. A high proportion (89.5%) of the isolates were multidrug resistant (MDR) strains with full resistance to cefazolin, cefotetan, amikacin, gentamycin, and tobramycin, followed by resistance to ampicillin (88.2%) and ampicillin/sulbactam (80.3%). The resistance to piperacillin/tazobactam, ceftazidime, cefepime, and levofloxacin was scarce (2.6-9.2%). Notably, an isolate from 2018 was resistant to carbapenems. blaTEM-1B and aac(6')-Ib-cr were the most common drug resistance genes presented in cephalosporin- and fluoroquinolone-resistant strains. All Salmonella 1,4,[5],12:i:- isolates were capable of forming biofilm, with 13.2% of them having strong ability. However, no association was indicated between the scale of biofilm formation ability and MDR. Our results indicate that the combination of these characteristics may together provide a selective and competitive advantage to those Salmonella 1,4,[5],12:i:- isolates, contributing to their increasing prevalence observed worldwide.

Analysis of pathogen monitoring results of infectious diarrhea in Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from 2016 to 2019

Objective: to analyze the distribution characteristics of major enteropathogens in infectious diarrhea cases attending the intestinal outpatient clinic of Beijing Traditional Chinese medicine hospital, Capital Medical University. Methods: From 2016 to 2019, 588 fecal samples of patients with infectious diarrhea in Beijing Hospital of traditional Chinese Medicine Affiliated to Capital Medical University were collected for microbial isolation, culture, identification and pathogen gene detection. Using VITEK 2 compact full-automatic microbial identification/drug sensitivity analysis system to identify the bacteria isolated from the culture; using serum agglutination test to classify the pure colonies; using multiple fluorescence quantitative PCR amplification technology to detect the gene amplification of the samples. Results: In 2016-2019, the total physical examination rate of pathogen was 39.796%. The top three pathogen were diarrhea Escherichia coli (21.769%, n=128), Salmonella (5.782%, n=34), Vibrio (4.762%, n=28). The difference of positive rates of different pathogens in four years was statistically significant (P=0.021), and the peak of incidence was from July to September. The positive rate of norovirus was 5.612% (n=33), and the highest incidence occurred in May. Conclusion: The pathogen of infectious diarrhea patients in Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from April to October 2016-2019 is mainly diarrhea Escherichia coli, and the pathogen type of norovirus is GⅡ genome.

Molecular analysis on Vibrio parahaemolyticus strains isolated from patients in Nanjing, Jiangsu, 2016–2019

Objective To understand the molecular characteristics of Vibrio parahaemolyticus strains in Nanjing, Jiangsu, and provide evidence for the prevention and control of human infection with V. parahaemolyticus. Methods Clinical isolates from diarrhea and food poisoning patients were collected from 2016 to 2019. Virulence genes of tlh, tdh, trh, toxRS/new and ORF8 were detected by polymerase chain reaction (PCR). Molecular types were analyzed by multilocus sequence typing (MLST). Results A total of 93 V. parahaemolyticus strains were collected. O3∶K6 was the predominant serotype (65 strains, 69.9%). Virulence genes screening revealed that all isolates carried tlh gene. 73 strains with tdh+trh-toxRS/new+ were classified as pandemic strains, and 5 non-pandemic strains with tdh-trh- were non-pathogenic strains. A total of 13 STs were detected, of which ST3 was predominant (68/93, 73.1%). Conclusion Molecular analysis on V. parahaemolyticus revealed that ST3 was predominant, and both the pandemic and non-pandemic strains were distributed in Nanjing.

Epidemiological characteristics and fingerprinting polymorphism of Salmonella in human, Heilongjiang

Objective To understand the serotypes and molecular characteristics of Salmonella in human in Heilongjiang province. Methods Serotyping and pulsed-field gel electrophoresis (PFGE) polymorphism analysis on Salmonella isolated from diarrhea cases were carried out in Heilongjiang from 2016 to 2019. Results A total of 303 strains of human Salmonella were detected in 9 977 cases of diarrhea patients during this period. The detection rates of Salmonella were higher in Daqing, Harbin and Qiqihar, and the annual detection rate was higher in the second quarter than in other quarters. The detection rates of Salmonella in age groups 16–20 years and 56–60 years were higher than those in other age groups. Salmonella in Heilongjiang had 46 serotypes. The proportion of S. enteritidis, the main serotype causing human infection, was as high as 40.59%. There were 67 different PFGE patterns of S. enteritidis, which can be divided into three band clusters. 54.10% of the predominant strains were from infants under 5 years old. Conclusion People aged 16–20 years and 56–60 years were at high risk for human Salmonella infection, and S. enteritidis was the main serotype causing human infection. The fingerprints of human Salmonella in Heilongjiang showed polymorphism distribution.

Serum Levels of Fibroblast Growth Factor 19 Correlate with the Severity of Diarrhea and Independently from Intestinal Inflammation in Patients with Inflammatory Bowel Disease or Microscopic Colitis.

In chronic diarrhea patients, massive over-reporting symptom-based criteria for functional bowel disorders are pitfalls. There is currently no objective biomarker that may provide a correct correlation with the severity of chronic diarrhea. To clarify the role of fibroblast growth factor-19 (FGF-19) as a biomarker of objective measurements of the severity of diarrhea in comparison with a patientreported outcome, based on the Bristol Stool Form (BSF) Scale. Consecutive 100 patients with chronic diarrhea underwent standard investigations with laboratory tests, fecal calprotectin (FC), endoscopy with biopsies, and serum FGF-19. All patients and 14 healthy controls completed a diary recording, BSF, and stool frequency. We found that irritable bowel syndrome with diarrhea (IBS-D) n = 21/23 (91%) reported a high number on BSF ≥6, compared to patients with inflammatory bowel diseases (IBD) 56/77 (72%) with BSF ≥ 6 (P = .011). FGF-19 median serum levels were significantly lower in Microscopic colitis (0.010 pg/mL) and IBD patients (0.009 pg/mL) compare to IBS-D (266.9 pg/mL) and high levels in healthy subjects (463 pg/mL) (P < .001). Strong inverse correlation of FGF-19 with the stool frequency/day and stool index was found (r = -0.800, P < .001; r = -0.739, P < .001), independently from disease activity (r = -0.718, P = .001; r = -0.792, P = .001). Serum FGF-19 can become a new biomarker for evaluating the severity of diarrhea with objectively and independently from intestinal inflammation. FC and FGF-19 are predictive biomarkers for the organic cause of diarrhea.

Diarrhoea Management using Over-the-counter Nutraceuticals in Daily practice (DIAMOND): a feasibility RCT on alternative therapy to reduce antibiotic use

BackgroundAlthough rarely indicated, antibiotics are commonly used for acute diarrhoea in China. We conducted a randomised, double blind exploratory clinical trial of loperamide, berberine and turmeric for treatment of acute diarrhoea.MethodsAdults with acute uncomplicated diarrhoea aged 18 to 70 were randomised to 4 groups: (A) loperamide; (B) loperamide and berberine; (C) loperamide and turmeric; (D) loperamide, berberine and turmeric. All participants were given rescue ciprofloxacin for use after 48 h if symptoms worsened or were unimproved. Primary endpoints were feasibility and ciprofloxacin use during the 2-week follow-up period. Semi-structured interviews were conducted following recruitment and were analysed thematically. Recruiting doctors, delivery pharmacists and research assistants were blinded to treatment allocation.ResultsOnly 21.5% (278/1295) of patients screened were deemed eligible, and 49% (136/278) of these consented and were entered into the final analysis. Most participants had mild symptoms, because most patients with moderate or severe symptoms wanted to be given antibiotics. Follow-up was good (94% at 2 weeks). Only three participants used rescue antibiotics compared to 67% of acute diarrhoea patients in the hospital during the recruitment period. The median symptom duration was 14 h in group B (interquartile range (IQR) 10-22), 16 h in group D (IQR 10-22), 18 h in group A (IQR 10-33) and 20 h in group C (IQR 16-54). Re-consultation rates were low. There were no serious treatment-related adverse events. Most interviewed participants said that although they had believed antibiotics to be effective for diarrhoea, they were surprised by their quick recovery without antibiotics in this trial.ConclusionAlthough recruitment was challenging because of widespread expectations for antibiotics, patients with mild diarrhoea accepted trying an alternative. The three nutraceuticals therapy require further evaluation in a fully powered, randomised controlled trial among a broader sample.Trial registrationChiCTR-IPR-17014107

Rapid testing of gut permeability using oral fluorescein and confocal laser endomicroscopy in Zambian adults.

Dual sugar testing for gut permeability is time-consuming and complex. We explored the utility of fluorescein as a simple and inexpensive alternative method. We used a confocal laser endomicroscopy probe placed at the fingertip of participants who had ingested sodium fluorescein to measure the fluorescence at various time points. In 10 patients with diarrhoea, but not in 10 controls, fluorescence was detected quickly. By 6min fluorescence was detected in all diarrhoea patients but only 1 control (p=0.0004). After 15min there was no difference between the groups. This simple oral fluorescein test may be useful to study gut permeability in low-resource settings.

Epidemiology and genetic characterization of human sapovirus among hospitalized acute diarrhea patients in Bangladesh, 2012-2015.

Human sapovirus, which causes acute gastroenteritis, is not well studied and poorly understood. This study aims to investigate the contribution of sapovirus in diarrhea, their clinical association, and genotypic diversity. Fecal specimens (n = 871) were randomly selected from diarrheal patients who attended International Centre for Diarrhoeal Disease Research, Bangladesh hospital in Dhaka, Bangladesh during January 2012-December 2015 and tested for the presence of sapovirus RNA using real-time polymerase chain reaction. Sapovirus RNA was identified in 2.3% (n = 20) of the samples. Seventy-five percent of the sapovirus positive cases were coinfected with other pathogens, such as rotavirus, norovirus, enterotoxigenicEscherichia coli, adenovirus, Shigella spp., and Vibrio cholerae. A vast genetic diversity was observed among sapovirus with at least seven common genotypes (GI.1, GI.2, GI.7, GII.1, GII.4, GII.6, and GIV), and a new genotype GII.NA1. Some of the GI.1 strains detected were similar to GI.4 in the polymerase region sequence and were confirmed as recombinant strains. Our findings suggest that the overall contribution of sapovirus in hospitalized diarrheal illness is low but highlight enormous genetic diversity.