Diarrhea Syndrome Research Articles

Acute gastrointestinal and post-acute COVID-19 gastrointestinal syndrome assessment on the Gastrointestinal Symptom Rating Scale scoring system: A questionnaire-based survey

ABSTRACT Background: Post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) is the persistence of sequel of acute SARS-COV-2 infection. Persistent/acquired gastrointestinal symptoms (GI-PACS) include loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility, dyspepsia, and irritable bowel syndrome. The study aimed to assess the short- and long-term GI-PACS syndrome on the GSRS scale. Methods: A cross-sectional, retrospective record analysis and telephonic questionnaire-based survey were conducted at a tertiary referral center in northern India. The data incorporated patients treated from April 2021 to March 2023. Exclusion criteria were neurological disorders, dementia, inability to understand Hindi/English languages, and psychiatric problems. All patients who met the inclusion criteria were telephonically called from November 2023 to January 2024. Results: The study population was 350 recovered patients from SARS-COVID-19 illness. Forty-three responses were removed during data cleaning and removal of duplication. The data analysis of 307 participants (ICU admissions=92, non-ICU admissions=123, and outdoor treatment =92) was done. The proportion of patients not having any GI symptoms, having at least one GI symptom, and having more than one GI symptom before SARS-COV-2 illness was 3%(3/307), 4.9% (15/307), and 3.6% (11/307), respectively. The four major GI symptoms analyzed in the study were vomiting, pain in the abdomen, diarrhea, and constipation. Overall, 13% (40/307) of the study population did not have any major GI symptoms before SARS-COV-2 diseases. During acute SARS-COV-2 illness, 86.97% (267/307) of patients develop new GI symptoms. Post SARS-COV-2 illness, the overall mean GSRS score for 15 items was 2.14 ± 0.829. The acquired GI-PACS was abdominal pain syndrome (mean score 2.5190 ± SD 0.86650), constipation syndrome (mean score 2.3844 ± 0.83840), reflux syndrome (mean score 2.2866 ± 1.31889), indigestion syndrome (mean score 1.8591 ± 0.93076), and diarrhea syndrome (mean score 1.8122 ± 0.90899). Overall, fever (95.1%, P = 0.007), anosmia (45.0%, P = 0.042), cough (80.1%, P = 0.032), and hospitalization (30.0%, P = 0.003) had a more significant association with one of the major four GI symptoms during the acute phase of SARS-COV-2 illness. Home-isolated patients having loss of appetite (95.4%, P = 0.0001) had a significant association with one of the major four GI symptoms during the acute phase of SARS-COV-2 illness. Hospitalized patients having fever (80.7%, P = 0.031), breathlessness (83.8%, P = 0.003), loss of smell (97.0%, P = 0.001), and cough (82.7%, P = 0.048) had a more significant association with one of the major four GI symptoms during the acute SARS-COV-2 illness. Abdominal pain, reflux, and constipation were considered severe GI symptoms (symptom GSRS score greater than total mean GSRS score). Diarrhea and indigestion were considered mild symptoms (symptom GSRS score was less than the total mean GSRS score). The GI symptoms during acute SARS-COV-2 illness recovered in 66.1% (203/307) patients within 3 months. The respondents taking medicines for more than 1 year following SARS-COV-2 illness were 19.2%. 12.0% (37/307) of respondents suffered from persistent GI symptoms on a mean follow-up of 20.1 ± 0.82 months. Conclusion: Long-term COVID-19 syndrome frequently manifested as GI symptoms, whereas most symptoms subsided with time.

Cross-sectional survey of 43,517 dogs in the Dog Aging Project identifies owner-reported lifetime prevalence and characteristics of gastrointestinal disease.

To evaluate the prevalence of and characteristics associated with owner-reported gastrointestinal (GI) disease in companion dogs within the US. Cross-sectional owner-reported survey study of 43,517 dogs enrolled in the DAP between December 26, 2019, and December 31, 2022. Dogs were grouped on the basis of having an owner-reported GI disorder (ORGID) versus not having that ORGID at any point in their history (control group). Multivariable logistic regression analysis was used to estimate the association between dog characteristics and ORGIDs with prevalence ORs (PORs). Of the 43,517 dogs in the DAP Pack, 30,677 (70%) had no history of ORGIDs and 12,840 (30%) had at least 1 ORGID. The most common ORGIDs included infectious diseases (7,580 of 43,517 [17%]), chronic diarrhea (1,316 [3%]), foreign bodies (1,086 [2%]), anal sac impactions (1,031 [2%]), pancreatitis (857 [2%]), inflammatory GI disease (615 [1%]), chronic vomiting (519 [1%]), and acute hemorrhagic diarrhea syndrome (388 [1%]). Compared to controls, dogs with noninfectious ORGIDs had greater odds of having a history of being castrated (POR, 2.55; 95% CI, 2.29 to 2.85), underweight (POR, 1.58; 95% CI, 1.47 to 1.70), or fed primarily canned food (POR, 2.51; 95% CI, 2.21 to 2.85) or receiving probiotics (POR, 1.69; 95% CI, 1.58 to 1.81) or nonprescription GI medications (POR, 4.06; 95% CI, 3.80 to 4.33). Dog owners in the US recruited from the general public reported a high prevalence of GI disorders in their dogs. Infectious and noninfectious ORGIDs were reported with approximately equal frequency. Dogs with ORGIDs were more likely to have a history of receiving probiotics or nonprescription GI medications, which may indicate that owners are changing lifestyle practices to accommodate these GI disorders, although future longitudinal research is needed.

Comparing treatment effects on dogs with acute hemorrhagic diarrhea syndrome: fecal microbiota transplantation, symptomatic therapy, or antibiotic treatment.

Dogs with acute hemorrhagic diarrhea syndrome (AHDS) present with similar clinical signs and histopathological findings as dogs with parvovirosis, in which fecal microbiota transplantation (FMT) has led to a significantly faster resolution of diarrhea and shorter hospitalization times. We investigated whether FMT results in faster clinical improvement and normalization of the intestinal microbiome compared to standard treatment. 32 client-owned dogs with AHDS. A prospective, double-anonymized clinical trial included 3 groups: symptomatic treatment (n = 12), FMT treatment (FMTT; 12), and antibiotic treatment (AT; 8). Clinical improvement was determined on the basis of AHDS index, changes in the microbiome based on the dysbiosis index, and PCR results for clostridial strains. Overall, no significant differences in clinical scores between the treatment groups over time were detected except on day 2 (higher AHDS index in the AT group compared to FMTT group; P = .046). The dysbiosis index increased and P hiranonis decreased on day 1 in some dogs, but these changes were transient in the symptomatic treatment and FMTT groups. In the AT group, the dysbiosis index was persistently elevated and 4 of 8 dogs showed a reduced abundance of P hiranonis on day 42. In 67% of the dogs on day 1, NetF-encoding Clostridium perfringens was detected and enterotoxin-encoding strains increased, but these changes were transient in all dogs, regardless of therapy. Overall, in dogs with AHDS, neither FMT nor AT resulted in faster clinical improvement. In addition, C perfringens strains are self-limiting and do not require antibiotic therapy.

A Clinical Case of a 10-Month-Old Child with Severe COVID-19 with Multisystem Inflammatory Syndrome Ended Fatally

Abstract At the beginning of the COVID-19 pandemic, it was assumed that children were at low risk of infection and that their infection was milder than adults. With an increase in the number of pediatric cases of SARS-CoV-2 infection associated with manifestations of hyperinflammation, the condition of multisystem inflammatory syndrome in children (MIS-C) was defined. We present a clinical case of a 10-month-old male child hospitalized in the Clinic of Infectious Diseases at University Hospital in Stara Zagora, Bulgaria, with a COVID-19. The patient had a number of co-morbidities, including protein-calorie malnutrition, chronic respiratory failure and bronchopulmonary dysplasia. During the hospital stay, he had an active diarrhea syndrome, with evidence of pneumonia and respiratory failure. In the clinical course, a progressive worsening of the condition with signs of multiple organ failure, increase in inflammatory markers and deterioration of coagulation indicators were observed. Placement in the ICU and the inclusion of artificial pulmonary ventilation were required, but after an 18-day hospital stay, the patient died. In conclusion, this was an acute case of COVID-19 in an infant that started with respiratory and gastrointestinal manifestations that progressed to MIS-C with multiple organ failure leading to death. We believe that the reason for this is the compromised immune status in connection with the highly damaged premorbid terrain and young age.

Genotyping <em> Escherichia coli </em> O157:H7 strains isolated from cattle and small ruminants in Fars province (Iran) using Enterobacterial Repetitive Intergenic Consensus PCR Analysis

Genotyping <em> Escherichia coli </em> O157:H7 strains isolated from cattle and small ruminants in Fars province (Iran) using Enterobacterial Repetitive Intergenic Consensus PCR Analysis

Rapid Enzymatic Detection of Shiga-Toxin-Producing E. coli Using Fluorescence-Labeled Oligonucleotide Substrates.

Shiga-toxin-producing Escherichia coli (STEC) are important human pathogens causing diarrhea, hemorrhagic colitis, and severe hemolytic uremic syndrome. Timely detection of the multifaceted STEC is of high importance but is challenging and labor-intensive. An easy-to-perform rapid test would be a tremendous advance. Here, the major STEC virulence factor Shiga toxins (Stx), RNA-N-glycosidases targeting the sarcin ricin loop (SRL) of 28S rRNA, was used for detection. We designed synthetic FRET-based ssDNA SRL substrates, which conferred a fluorescence signal after cleavage by Stx. Optimal results using bacterial culture supernatants or single colonies were achieved for substrate StxSense 4 following 30 to 60 min incubation. Stx1 and Stx2 subtypes, diverse STEC serotypes, and Shigella were detected. Within a proof-of-principle study, a total of 94 clinical strains were tested, comprising 65 STEC, 11 Shigella strains, and 18 strains of other enteropathogenic bacteria without Stx. In conclusion, the assay offers rapid and facile STEC detection based on a real-time readout for Stx activity. Therefore, it may improve STEC risk evaluation, therapy decisions, outbreak, and source detection and simplify research for antimicrobials.

Antibiotics and lectin C for diarrhea control intervention in piglets and influences

The study was conducted on 60 L of suckling piglets out of 775 piglets, of which 227 piglets had diarrhea litres of piglets, and out of 775 piglets, 227 piglets had diarrhoea syndrome. There were 3 interventions in separate trials as follows: 1 and 2 involved antibiotic use (Enrofloxacin and Gentamicin); Trial 3 used the supplement Lectin C (LvCLT3 and LvCLT4) for a treatment period of 3–7 days. Intervention results on 227 piglets with diarrhea showed the highest cure rate when supplemented with Lectin C, with no mortality rate, longer treatment time, and no reinfection rate. While the two antibiotic trials still had lower cure rates, mortality and reinfection rates were higher. After 05 days of recovery, piglets were tested for MCV, MCH, and MCHC, showing an apparent decrease in the group supplemented with Lectin C, while the two groups using antibiotics still had high rates, with a confidence level of P < 0.05; 0.01 and 0.001. Antibiotics treat piglets in their early stages, so there is a risk of immunodeficiency and low infection response. It is necessary to supplement substances derived from dietary supplements. Supplementing Lectin C increases resistance, enhances immune response, improves the effectiveness of treating diarrhoea syndrome in piglets, and ensures safe meat quality in the future. Lectin C supplementation will improve piglet health and breed quality efficiency. This heralds a promising future for the pig industry with improved meat quality and reduced environmental impact.

A novel neutralizing monoclonal antibody recognizes a linear antigenic epitope of the spike protein of swine acute diarrhoea syndrome coronavirus

Swine acute diarrhoea syndrome coronavirus (SADS-CoV) causes vomiting, severe diarrhoea and death in newborn piglets. The spike (S) protein plays a crucial role in promoting virus invasion and inducing neutralizing antibody production. In this study, the extracellular region of the S protein was used as an immunogen to immunize BALB/c mice. After immunization, B cells were collected, fused with SP2/0 myeloma cells, cultured and subcloned, and a cell line capable of secreting neutralizing antibodies was obtained and named as 5D6. Additionally, it was determined that the 5D6 mAb could be used as the primary antibody for western blotting and indirect immunofluorescence assay (IFA) to detect SADS-CoV. Further studies indicated that the 5D6 mAb binds to the 136STSHAAD142 motif, which located in the N-terminal domain (NTD) of the spike protein. This result suggested that the NTD of the S protein can induce the production of neutralizing antibodies. Amino acid sequence alignment revealed that the epitope of the 5D6 mAb was conserved among SADS-CoV strains. This study helps elucidate the S protein function of SADS-CoV, and the 5D6 mAb may be used to develop diagnostic and treatment tools for detecting SADS-CoV infection.

Study of the biochemical status of calves in the early postnatal period in connection with dyspepsia

Purpose: to study changes in the most important metabolic parameters in case of dyspepsia in calves.Materials and methods. Two groups of calves of 8 heads each, aged from 6 to 14 days, were formed. The first group included calves with signs of dyspepsia, who, in addition to diarrhea syndrome, had decreased appetite, weakness, and signs of abdominal pain. At the time of the study, the duration of the illness was 2-4 days. The second (control) group included clinically healthy animals of the same age. Blood was taken from the calves from the jugular vein in the morning before feeding. Blood serum was examined in a clinical biochemical laboratory using standard test systems to determine biochemical parameters.Results. In calves with dyspepsia, a significant decrease in the concentration of triglycerides by 1,8 times, cholesterol by 1,57 times, total protein by 5,5 % and albumin by 12,3 % was revealed. They also revealed a significant increase in the activity of transamination enzymes — ALT (2,6 times) and AST (1,6 times), which may indicate both damage to hepatocytes and the induction of enzymes to accelerate transamination reactions in order to meet energy needs calf body. The studies did not reveal significant changes in the concentrations of urea, creatinine and bilirubin.Conclusion. Studies have revealed metabolic changes that occur due to decreased absorption of nutrients in the intestines. Damage to the intestinal mucosa leads not only to a deterioration in the absorption of nutrients, but also to the penetration of proteins, primarily albumins, into the intestinal lumen and their removal from the body into the external environment. Redistribution of metabolic pathways to ensure homeostasis plays an adaptive role, but subsequently can have a negative role in the processes of growth and development of the calf’s body.

A novel multiplex and glycoprotein-based immunochromatographic serologic IgM test for the rapid diagnosis of Escherichia coli O157 and O145 causing bloody diarrhea and hemolytic uremic syndrome.

Shiga toxin-producing Escherichia coli (STEC) are the main etiological agents of hemolytic uremic syndrome (HUS). Good clinical management of STEC infections and HUS depends on early, rapid, and accurate diagnosis. Here, we have developed and evaluated the first multiplex and glycoprotein-based immunochromatographic test for the detection of IgM antibodies against the O-polysaccharide of the lipopolysaccharide of E. coli O157 and O145 in human serum samples. A retrospective study was carried out resulting in a diagnostic sensitivity of the E. coli O157/O145 LFIA (lateral flow immunoassay) of 97.1% and 98.9% for O157 and O145, respectively, and 97.9% for both serogroups. The diagnostic specificity was 98.7% for O157 and O145, and the overall specificity 97.4%. In samples obtained before 3 days after the onset of diarrhea, the detection percentage was 83%, increasing to 100% from 3 days onward. Finally, the association of bloody diarrhea (BD) or HUS cases to an STEC infection increased from 22.8% to 77.2% when stool culture and stx/Stx detection were combined with serology by LFIA. Our results demonstrate that the E. coli O157/O145 LFIA is a highly accurate and serospecific test for the early and rapid diagnosis of E. coli O157 and O145 infections in BD or HUS cases. This test allows the detection of specific IgM antibodies very early in the course of the infection, making it an ideal diagnostic tool to be implemented in pediatric emergencies and, thus, avoid delays in the application of the correct supportive or specific treatment and prevent complications associated with HUS.

Diversity of Campylobacter spp. circulating in a rhesus macaque (Macaca mulatta) breeding colony using culture and molecular methods.

Gastrointestinal disease is one of the most common reasons for hospitalization in non-human primate colonies and accounts for over one-third of non-research related euthanasia. In rhesus macaques, this manifests as both acute diarrhea and chronic enterocolitis (CE), a syndrome of chronic diarrhea resulting in poor weight gain or weight loss which is minimally responsive to treatment. Campylobacter spp. are major causes of acute enterocolitis in rhesus macaques and may predispose individuals to the development of CE, similar to post-infectious irritable bowel syndrome in humans. Despite these concerns, there are few studies characterizing Campylobacter in rhesus macaque colonies, in particular utilizing whole genome sequencing and assessing findings with respect to the health status of the host. Our findings provide insight into Campylobacter strains circulating in rhesus macaque colonies, which can improve clinical monitoring, assist in treatment decisions, and provide new avenues of investigation into campylobacteriosis as a catalyst for CE.

Association of adverse events and quality of life in patients with unresectable hepatocellular carcinoma

PurposeHepatocellular carcinoma (HCC) is the third-leading cause of cancer-related deaths globally. Patients are often diagnosed with advanced disease, in which systemic and locoregional therapies are commonly used as first-line treatment. Such treatments can cause adverse events (AEs) that negatively affect quality of life (QoL), which is particularly undesirable where prognosis is poor. The aim of the present study was to evaluate the impact of common AEs on QoL in patients with HCC.MethodsData from the SARAH randomized controlled trial (RCT) were analyzed. Given the large number of distinct AEs that occurred in the trial, AEs were grouped as in the SARAH trial and prioritized using principal component analysis (PCA). Linear mixed-effects models were then applied with age, ECOG status, and AEs as predictors of the QoL change as measured with the EORTC Core Quality of Life Questionnaire (QLQ-C30).ResultsThe PCA resulted in the selection of 28 AEs for inclusion in the linear mixed-effects models. Of the 28 AEs, diarrhea, decreased appetite, abdominal pain, and palmar-plantar erythrodysesthesia syndrome (hand-foot syndrome) were significant drivers of reductions in QoL as measured using the QLQ-C30 global health status scale. Diarrhea, abdominal pain, and hand-foot syndrome were also significant drivers of reduced QoL outcomes.ConclusionThe present analysis showed that diarrhea, decreased appetite, abdominal pain, and palmar-plantar erythrodysesthesia were significantly associated with reduced QoL in patients with unresectable HCC. Reducing the incidence and/or severity of these AEs should therefore be a key focus when selecting the optimal treatments for these patients.

Preferences of patients and physicians in the United States for relapsed/refractory follicular lymphoma treatments.

Patients with follicular lymphoma (FL) often relapse or become refractory to treatment (R/R). While the R/R FL treatment landscape evolves, little is known about the priorities of patients and physicians. This discrete-choice experiment (DCE) study assessed patients' and physicians' treatment preferences, and the trade-offs they would be willing to make between efficacy, tolerability, and administration. An online survey was conducted in US-based patients (≥18 years) with R/R FL and FL-treating physicians. The DCE was informed by a targeted literature review, clinical data, expert oncologist input, and pilot interviews. Participants completed eight experimental choice tasks where they chose between two hypothetical treatment profiles defined by six attributes: progression-free survival (PFS), administration/monitoring, risks of laboratory abnormalities requiring intervention, severe infections, diarrhea, and cytokine release syndrome (CRS). Relative attribute importance (RAI) and willingness to trade-off between PFS and other attributes were estimated. Two-hundred patients (mean age 63.5 years; median three prior lines of therapy) and 151 FL-treating physicians participated. Increasing PFS was most important for both groups, although it was relatively less important to patients than physicians (RAI 35.2% vs. 45.7%). Administration/monitoring was three times more important to patients than physicians (RAI 28.8% vs. 9.5%); patients preferred oral treatment and would be willing to tolerate a significant reduction in PFS for oral administration over weekly intravenous infusions. Avoiding CRS was less important to patients than to physicians (RAI 7.7% vs. 15.8%). Both groups would accept shorter PFS for reduced risks of side effects (especially of laboratory abnormalities for patients and of CRS for physicians). Although PFS was the most important attribute to patients and physicians, both would tolerate lower PFS for reduced side effects. Patients would also accept a substantial reduction in PFS for oral administration. Differences between the preferences/priorities of patients and physicians highlight the importance of shared decision-making.

The role of pharmaceutical care in the use of rifaximin for the treatment of diarrhea

the management of diarrhea represents a prevalent issue within the realm of healthcare. Rifaximin is recommended to treat traveler's diarrhea and irritable bowel syndrome. At the same time, it is important to rationally use an antimicrobial drug to prevent the development of antimicrobial resistance. Aim: to evaluate the role of pharmaceutical care in using rifaximin to treat diarrhea, based on a questionnaire. A questionnaire survey was done among 55 pharmacy professionals and 42 pharmacy visitors regarding the dispensing and use of rifaximin for diarrhea treatment. The survey of pharmacy visitors revealed that rifaximin was used for the treatment of small intestinal bacterial overgrowth syndrome (32 cases), traveler's diarrhea (7 cases), and irritable bowel syndrome with diarrhea (3 cases). Patients did not undergo stool culture before rifaximin prescription, which could have prevented antimicrobial resistance and ruled out other causes of diarrhea. It was found that 14% of respondents reported improvement the next day, while 83.3% reported improvement within three days. Pharmacists can educate visitors about the importance of completing the treatment course. Five percent of respondents reported nausea as an adverse reaction. Pharmacists dispensed rifaximin for the treatment of diarrhea in adults almost three times more often than in children. The tablet form of the drug was used in 94.5% of cases, while the oral suspension was used in 5.5% of cases. The majority of pharmacy visitors (89.0%) received rifaximin with a doctor's prescription, and 10.9% without a prescription, which emphasizes the importance of pharmaceutical care to prevent irrational use of the drug. The results of the study show that 92.7% of pharmacists provide recommendations on the safety of rifaximin use, and 78.2% recommend abstaining from alcohol during treatment. Only 21.8% of pharmacists warn about the possible staining of urine, which can cause concern for patients. The majority of pharmacists (89.1%) systematically ask women about possible pregnancy, which indicates their awareness of safe pharmacotherapy. Pharmacists also clarify the simultaneous use of rifaximin with other drugs: 32.7% ask about taking oral contraceptives, 7.3% – antiarrhythmic drugs, and 3.6% – warfarin. mailto:https://meshb.nlm.nih.gov/record/ui?ui=D002648Pharmacists can enhance the effectiveness of rifaximin treatment by preventing its uncontrolled use, emphasizing the importance of completing the treatment course and informing about possible adverse reactions. When providing pharmaceutical care to visitors taking rifaximin, pharmacists should educate them about potential changes in urine color. Additionally, pharmaceutical workers advise women taking oral contraceptives to use additional contraceptive methods while taking rifaximin.

Characteristics of Enterohaemorrhagic Escherichia coli in Jeju Province, Korea: a study of registry routes from 2017 to 2023

Enterohemorrhagic Escherichia coli (EHEC) produces Shiga toxin, which causes diarrhea, hemorrhagic colitis, and hemorrhagic uremic syndrome. The Korea Center for Disease Control and Prevention (KCDC) has designated EHEC as a legal infectious disease and has conducted laboratory surveillance. This study aimed to compare the demographic, epidemiological, clinical, and laboratory characteristics of EHEC cases in Jeju Province between August 2017 and November 2023, notified by two registry routes. The data were sourced from the integrated disease health and health management system managed by the KCDC. Cases reported due to experiencing gastrointestinal symptoms, or contacts of each case were defined as the “symptomatic” group. In contrast, cases with positive findings during a health checkup or laboratory surveillance were defined as the “screening” group. The symptomatic and screening groups had 35 and eight patients, respectively. There were significant differences in the age and seasonal distribution. The selection group was 20-59 years old in the main age distribution and registered evenly throughout the four seasons. In comparison, the symptomatic group was younger or older and not registered in the winter. These findings may be used to establish a more appropriate surveillance system for diarrheal outbreaks.

Clinical and immunological features of rotavirus infection in children infected with herpesviruses

The basis for conducting the study was the absence in the scientific literature of works devoted to the study of clinical and immunological features of rotavirus infection (RVI) in children against the background of the latent form of herpesvirus infection (lHVI) caused by cytomegalovirus (CMV) and human herpesvirus type 6 (HHV-6). The aim - to identify clinical and immunological features of RVI in children with lHVI caused by CMV and HHV-6 that will contribute to the early diagnosis of lHVI in patients. Materials and methods. A total of 81 children aged 12-36 months with RVI were examined. The Group 1 included 33 children who were not found to be infected with any of the herpesviruses. The Group 2 included 17 children who were suffering from RVI against the background of lHVI caused by CMV. The Group 3 included 31 children suffering from RVI against the background of lHVI caused by HHV-6 type. Statistical processing of the results was carried out using the IBM® SPSS® 25.0 program for Microsoft® Windows®. The results. The presence of lHVI caused by CMV in the acute period (AP) of RVI leads to lower indicators of temperature reaction, lower frequency of vomiting, a decrease in the immunoregulatory index (IRI) against the background of an increase in the level of CD8+ T-lymphocytes. In addition to lower numbers of the temperature reaction, the level of IgA was increased in children with lHVI caused by HHV-6. During the convalescent period (CP), CMV is associated with an increase in the duration of fever and diarrhea, an increased content of CD8+ T-cell counts, and lower IRI, CD16+, CD22+ T-cells, and IgM scores. In patients with lHVI caused by HHV-6, fever, diarrhea, and catarrhal syndrome persisted longer against the background of reduced levels of IRI, CD22+ T cells, and IgM. Conclusions. lHVI is caused by CMV and HHV-6, it has different effects on clinical and immune indicators in children with RVI. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution indicated in the work. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Experience of practical use of enterosorbents in the treatment of HIV-infected children with diarrhea syndrome

Despite advances in antiretroviral therapy (ART), diarrhea is common among people living with HIV (PLHIV) and negatively impacts quality of life. Although diarrheal diseases caused by opportunistic infections have decreased in the ART era, the overall prevalence of diarrhea remains unchanged, estimated at 28% to 60% of PLHIV.The aim of the study: to conduct a comparative assessment of the clinical efficacy of enterosorbents in the treatment of diarrheal syndrome in children with HIV infection.Materials and methods. The study material included 80 HIV-infected children who experienced acute infectious diarrhea aged 5 to 14 years. The main group included 40 children who received enterosgel, 2 times 1 tablespoon included in the traditional treatment regimen, and the control group included 40 children who received the drug lactofiltrum against the background of traditional therapy, 1 tablet 3 times a day. The duration of treatment was 10 days.Results and discussion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a significant decrease in the daily amount and in the duration of diarrhea was observed, which leads to a noticeable loss of signs of dehydration (P&lt;0.05). Elimination of acute diarrhea in children with HIV infection may also have eliminated the underlying intoxication syndrome due to the underlying and burning disease, which may lead to a reduction in health care costs and socioeconomic burden.Conclusion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a decrease in the daily amount and in the duration of diarrhea is reliably observed, which leads to a significant disappearance of signs of dehydration (р&lt;0.05).

Clinical and Epidemiological Characteristics of Leptospirosis in the Gomel Region

Relevance. Leptospirosis is a zoonotic ubiquitous natural focal infectious disease that has an adverse effect on human and pet health. The territory of the Republic of Belarus in terms of its natural-climatic and soil-geographical conditions is favorable for the existence of both natural and anthropurgical foci of leptospirosis. The purpose of the work is to study the long-term dynamics of the incidence of leptospirosis in the population of the Gomel region and the clinical and epidemiological features of leptospirosis. Materials and methods. The material for the study was the data of the state statistical reporting «Report on individual infectious, parasitic diseases and their carriers» for the period from 2002 to 2022. In this work, epidemiological diagnostic methods and statistical research methods were used. Descriptive retrospective continuous study of these case histories of patients diagnosed with Leptospirosis of the Gomel Regional Infectious Diseases Clinical Hospital institution was conducted to describe clinical data. Results. In the period from 2002 to 2022, 161 cases of leptospirosis were registered in the Gomel region with an average incidence rate of 0.52 per 100 thousand population. Over this period of time, the incidence of leptospirosis was characterized by an uneven distribution and was undulating. Periods with a low incidence of 0.14–0.42 cases per 100 thousand population lasting 5-6 years alternated with periods of rising incidence to 0.99 cases per 100 thousand population lasting 3 years. In 2022, a sharp rise in the incidence of leptospirosis in the Gomel region was registered, and therefore 15.8 times higher than the incidence in 2021, the incidence rate was 1.11 per 100 thousand of the population and exceeded the national average by 4.6 times. Adults predominated among the sick (93.3%). At the same time, 73.0% of the patients were urban residents. The source of infection in 81.2% of cases were rodents, in 7.52% of cases domestic animals. In 7.52% of cases, the disease appeared as a result of professional activity, only in 3.76% of cases the disease occurred after swimming in open water. Thus, the main route of transmission of leptospirosis at present is contact (88.72%), alimentary and water are less important, respectively 7.52% and 3.76%. Results of serological examination for leptospirosis by RMA showed that 5 serogroups of leptospir circulate among rodents: L. Pomona and L. Canicola, L. Grippotyphosa, L. Icterohaemorrhagiae, L. A. Ustralis. 36.4% of the samples showed a positive result at the same time to several serogroups. L. Grippotyphosa, L. Cterohaemorrhagiae and L. Pomona were detected more often, in total, these pathogens accounted for 46.5% of positive samples. The results of the survey of farm animals showed that 60.6% of the sera studied had positive results of RMA with leptospirs of several serogroups. L. Sejroe was also isolated – in 12.3% of samples, L. Hebdomad – in 1.3% of samples, L. Icterohaemorrhagiae – in 1.2%, L. Pomona – in 0.3%, others – 24.2%. In the period from 2002 to 2021, the following serogroups were isolated in patients with leptospirosis: L. Grippotyphosa – 36%, L. Pomona and L. Canicola – 16%, L. Australi – 13%, L. Wolffi – 9%, L. Icterohaemorrhagiae – 7% and L. Tarassovi – 3%. In 2022, there is a change in the polytypage of leptospir: L. Icterohaemorrhagiae (6.7%), L. Tarassovi (6.7%), L. Wolffi (6.7%), L. Pomona (13.3), L. Astralis (13.3), L. Canicola (6.7%), 6.7% – L. Sejroe, L. Grippotyphosa Moskva – 40%. For the period from 2005 to 2022, 49 people diagnosed with leptospirosis were treated at the Gomel Regional Infectious Diseases Hospital, of which men accounted for 69%, the average age of patients was 34.5 ± 3.8 years. Most patients are hospitalized on day 6 [4 – 8] of illness. All patients complained of fever, 86% of patients had muscle pain, headaches were recorded in 56.0%, yellowing of the skin and sclera – 34.0%, abdominal pain – 38%, 25% of patients reported nausea, vomiting, diarrhea syndrome. 28.6% of patients had an icteric form of leptospirosis, Weil's syndrome was diagnosed in 9.3% of patients, hemorrhagic syndrome was observed in 18.7% of patients. All patients had laboratory confirmation of the diagnosis. The duration of hospitalization was 15 [9 – 23] days. 1 case of the disease ended with a detailed outcome for the entire observation period. Conclusion. The incidence of leptospirosis in the Gomel region is undulating and is characterized by a change in periods of rising incidence lasting up to 3 years with periods of low incidence lasting up to 5 years. The results of the study suggest that the emergence and spread of the leptospira serotype in the territory led to a new increase in the incidence. Thus, continuous qualitative monitoring of leptospira serotypes among the population of sources of infection should be carried out.

Effects of fecal microbiota transplantation on clinical outcomes and fecal microbiota of foals with diarrhea.

Diarrhea in foals can be associated with disruption of the intestinal microbiota (dysbiosis). Effective management of intestinal dysbiosis in foals has not been demonstrated. Fecal microbiota transplantation (FMT) in foals with diarrhea influences the intestinal microbiota and improves clinical and clinicopathological outcomes. Twenty-five foals <6 months of age with diarrhea and systemic inflammatory response syndrome at 3 veterinary hospitals. A prospective randomized placebo-controlled cohort study. Foals in the FMT group (n = 19) or control group (n = 9) received FMT or electrolyte solution once daily for 3 days. Fecal samples were obtained on Day 0 (D0), D1, D2, D3, and D7. Within group and between group data analyses were performed for clinical, clinicopathological, and microbiota variables. Treatment had no effect on survival (FMT 79%; control 100%, P = .3) or resolution of diarrhea (FMT 68%; control 55%, P = .4). On D3, the white blood cell count of the FMT group was lower than the control group (D3 FMT group median 6.4 g/L [5-8.3 g/L]; D3 control group median 14.3 g/L [6.7-18.9 g/L] P = .04). Heart rate reduced over time in the FMT group (D0 median 80 bpm [60-150 bpm]; D2 median 70 bpm [52-110 bpm] [P = .005]; and D3 median 64, [54-102 bpm] [P < .001]). Phylum Verrucomicrobiota, genus Akkermansia, and family Prevotellaceae were enriched in the FMT group on D1 (linear discriminate analysis > 4). In foals with diarrhea, FMT appears safe and can be associated with some clinical and microbiota changes suggestive of beneficial effect.

Cabozantinib Plus Nivolumab in Adult Patients with Advanced or Metastatic Renal Cell Carcinoma: A Retrospective, Non-Interventional Study in a Real-World Cohort/GUARDIANS Project.

Combinations of immune-checkpoint inhibitors (ICIs) are the standard of care (SOC) for treatment-naive metastatic renal cell carcinoma (mRCC) patients. In this multicenter study, we evaluated the RW safety and efficacy of cabozantinib plus nivolumab in mRCC patients. Data were retrospectively collected from twelve cancer centers in Germany, Switzerland, and Austria. Patients with advanced or mRCC were eligible. The investigator-based objective response rate (ORR) and progression free survival (PFS) were calculated from the start of the treatment to progression or death. Descriptive statistics and Kaplan-Meier (KM) plots were utilized where appropriate. In total, 96 eligible patients (66.6% male) with a median age of 66.0 years were included. The most common histology was clear-cell RCC (ccRCC) in 63.4% (n = 61). A prior nephrectomy was performed in 60.4% (n = 58). ECOG 0-1 was 68.8% (n = 66). A partial response was documented in 43.8% of patients (n = 42), a stable disease in 32.3% (n = 31), and a progressive disease in 8.3% (n = 8) as the best overall response. Response data were not evaluable in 13.5% (n = 13). The median follow-up time was 12.7 months (95% CI, 10.0-15.3). The PFS rate at 6 months was 89.8% in the overall population (86.8% for ccRCC; 90.0% for non-ccRCC). Adverse events (AEs) were reported in 82.3% (n = 79) for all grades and 41.7% (n = 40) for grades 3-5. Elevated liver enzymes (34.4%), diarrhea (31.3%), and hand-foot syndrome (29.2%) were the three most frequent AEs of any grade and causality. In this real-world cohort of mRCC patients, the application of cabozantinib plus nivolumab was shown to be safe and feasible. Our data support the use of cabozantinib plus nivolumab as a first-line standard therapy in mRCC patients. Major limitations were the retrospective data capture and short follow-up time of our study.