Diarrheal Illness Research Articles

Factors Associated with Medical Care-Seeking and Stool Sample Submission for Diarrheal Illness, FoodNet, United States, 2018-2019.

Laboratory-based surveillance for enteric pathogens causing diarrhea is foundational for monitoring foodborne diseases in the United States. However, diarrheal illnesses are not always confirmed by laboratory testing, so estimates of the true number of illnesses must adjust for underdiagnosis, including underdiagnosis due to ill persons not seeking medical care or submitting a stool sample for laboratory testing. We assessed these factors among persons with an acute diarrheal illness who responded to the most recent Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey (2018-2019). Multiple modes of administration (telephone, web-based) and multiple sampling frames were used to ask survey respondents in English or Spanish about diarrhea and other symptoms experienced in the 30 days before the interview and to ask if they had sought medical care or submitted a stool sample. Of 1018 respondents with an acute diarrheal illness, 22.0% had sought medical care and 4.7% submitted a stool sample. On multivariable analysis, older adults (aged 65 years and over), male respondents, and persons with a household income of ≥$40,000 per annum were significantly more likely to seek medical care, as were respondents reporting cough, fever, vomiting, recent international travel, or duration of diarrhea for ≥3 days. Older adults and persons with five or more loose stools in 24 h who sought medical care were significantly more likely to submit a stool sample. Ill respondents with a concurrent cough were less likely to submit a stool sample. Sociodemographic characteristics, symptoms, and international travel influence whether a patient with an acute diarrheal illness will seek care or submit a stool specimen. Accounting for these factors when analyzing surveillance data will likely produce more precise estimates of the true number of foodborne illnesses.

IMPLEMENTING AND EVALUATING A PAEDIATRIC EMERGENCY MANAGEMENT TRAINING PROGRAM FOR PRIMARY HEALTHCARE WORKERS IN ZARIA

Nigeria continues to grapple with alarmingly high under-five mortality rates, with approximately 2,300 children dying daily due to preventable and treatable diseases such as pneumonia, malaria, and diarrheal illnesses. This crisis is particularly pronounced in rural areas, where childhood mortality rates are significantly higher than in urban centres. For many rural communities, primary healthcare (PHC) centres serve as the sole access point to medical services, making these centres critical to addressing this public health challenge. Despite their importance, PHC centres often face significant challenges, including inadequate infrastructure, limited access to essential medications, and a shortage of adequately trained health personnel. This study aimed to implement and evaluate a Paediatric Emergency Management Training Program for healthcare workers at PHC centres in Zaria, Kaduna State. The primary objective was to assess the effectiveness of the training in improving the competency of health workers in managing common paediatric emergencies, thereby enhancing the overall quality of care provided at these centres. A cross-sectional descriptive study was conducted involving 139 healthcare workers from selected PHC centres in Sabon Gari and Zaria Local Government Areas, utilizing a multi-stage random sampling technique. Data collection was performed using a pre-tested, semi-structured, self-administered questionnaire designed to evaluate the participants' baseline knowledge, followed by an assessment after the training intervention. The data were analysed using SPSS version 21, with chi-square tests employed to examine the associations between variables. Results were presented using tables and charts for clarity. The findings revealed a generally low baseline competency in managing common paediatric emergencies among the healthcare workers. Specifically, 66 (48.5%) of the respondents demonstrated very poor knowledge regarding the causes of common paediatric emergencies, 32 (23.5%) had poor knowledge, 34 (25.0%) had good knowledge, and only 4 (2.9%) of the respondents exhibited excellent knowledge. Similarly, knowledge regarding the treatment of these emergencies was also lacking, with 46.7% of respondents showing very poor understanding, 34.1% having poor knowledge, 16.3% demonstrating good knowledge, and only 3.0% showing excellent knowledge. A statistically significant relationship was observed between academic qualifications and knowledge levels in both causes (p = 0.004) and treatment (p = 0.000) of paediatric emergencies. The low baseline knowledge underscores the critical need for targeted training interventions. The study highlights the importance of establishing a sustained partnership between the Department of Paediatrics at Ahmadu Bello University Teaching Hospital and the Departments of Primary Health Care in Zaria and Sabon Gari Local Governments. Regular training workshops, held quarterly, are recommended to continuously equip PHC workers with the necessary skills to effectively manage paediatric emergencies, ultimately contributing to a reduction in childhood mortality rates in the region.

Characteristics of Diseases in Developing Countries

In the urgent realm of global health, it is imperative to acknowledge and promptly address the distinct characteristics of diseases that afflict developing countries. These nations face a unique set of challenges that contribute to the burden of illness and significantly impact the quality of life for their populations. By promptly exploring the key features of diseases in developing countries, we can better understand the complex interplay between socioeconomic factors and health outcomes [1]. One of the primary characteristics of diseases in developing countries is their disproportionate impact on vulnerable populations. Socio-economic disparities, limited access to healthcare, inadequate sanitation infrastructure, and poor nutrition contribute to the heightened susceptibility of marginalized communities to preventable infectious diseases such as hydatid cysts, malaria, tuberculosis, and diarrheal illnesses. The lack of resources and infrastructure further exacerbates the spread of these diseases, creating a cycle of sickness and poverty [2,3]. Furthermore, the prevalence of neglected tropical diseases (NTDs) is a defining feature of the disease landscape in developing countries. These illnesses, which include dengue fever, Chagas disease, and schistosomiasis, predominantly affect populations in low-resource settings and often go unnoticed on the global health agenda. The burden of NTDs is compounded by limited funding for research and treatment, leaving affected communities without adequate support and interventions [4]. In addition to infectious diseases, non-communicable diseases (NCDs) are on the rise in developing countries, posing a dual burden of illness alongside contagious diseases. Factors such as urbanization, lifestyle changes, and an aging population contribute to the increasing prevalence of conditions like cardiovascular diseases, diabetes, and cancer. The inadequate healthcare infrastructure in many developing countries further hinders NCDs' prevention, diagnosis, and management, leading to poorer health outcomes for those affected [5]. Addressing the characteristics of diseases in developing countries requires a multi-faceted approach that encompasses strengthening the healthcare system, investing in public health infrastructure, and, most importantly, providing equitable access to essential medicines. By ensuring fair access to these medicines, we can work towards achieving health equity and reducing the burden of disease in developing countries.

Travel-associated illness in children in pre-pandemic Western Sydney, 2018-2020.

Observational cohort study. In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service. We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded. Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness.

Hygiene practice and diarrhea prevalence among underfive children in Myanmar: a cross-sectional study

BackgroundOver 1.7 billion instances of diarrheal illness in children are reported worldwide yearly. Diarrhea was a major cause of death in children, accounting for 9% of all global under-five child deaths in 2021. The objective of this study was to identify the association between hygiene practices and childhood diarrhea among under-five children in Myanmar.MethodThis cross-sectional study was conducted in 16 townships from 8 states and regions of Myanmar. 1207 children between the ages of 6 and 59 months were recruited by multistage random sampling. Data were collected with a preformed questionnaire after participants provided consent. Multiple logistic regressions were administered to determine the factors associated with childhood diarrhea.ResultThis study found that 86 (7.13%) under-five children experienced diarrhea disease. This study identified that children receiving limited hygiene services were 2.85 times (AOR = 2.85, 95% CI: 1.31 to 6.21; p value 0.01) and children without hygiene services were 2.63 times (AOR = 2.63, 95% CI: 1.42 to 4.89; p value 0.01) more likely to have diarrhea disease than those with basic hygiene services. Other factors associated with diarrhea included: fathers who washed their hands less than four steps (AOR = 2.20, 95% CI: 1.29 to 3.74; p value 0.01), families taking more than 15 min to collect water (AOR = 1.77, 95% CI: 1.06 to 2.97; p value 0.03), families sharing toilet usage (AOR = 2.00, 95% CI: 1.15 to 3.48; p value 0.01), mother’s inadequate and problematic hygiene promotion health literacy (AOR = 2.20, 95% CI: 1.24 to 3.90; p value 0.01), houses made of bamboo or lacking floors (AOR = 2.31, 95% CI: 1.38 to 3.89; p value 0.01), families with three or more children (AOR = 1.68, 95% CI: 1.01 to 2.79; p value 0.05) and breastmilk being the primary food after 6 months of age (AOR = 2.07, 95% CI: 1.09 to 3.93; p value 0.03).ConclusionsEnsuring access to basic hygiene services, getting water at home 24 h per day, seven days per week, using private toilets, promoting hygiene health literacy, improving house flooring, family planning and introducing a variety of foods after age 6 months could significantly prevent diarrhea among under-five children in Myanmar. This study underscores the critical role of handwashing facilities in reducing the diarrhea incidence in children.

Utility of syndromic surveillance for the surveillance of healthcare-associated infections in resource-limited settings: a narrative review.

Globally, Healthcare-associated infections (HCAIs) pose a significant threat to patient safety and healthcare systems. In low- and middle-income countries (LMICs), the lack of adequate resources to manage HCAIs, as well as the weak healthcare system, further exacerbate the burden of these infections. Traditional surveillance methods that rely on laboratory tests are cost-intensive and impractical in these settings, leading to ineffective monitoring and delayed management of HCAIs. The rates of HCAIs in resource-limited settings have not been well established for most LMICs, despite their negative consequences. This is partly due to costs associated with surveillance systems. Syndromic surveillance, a part of active surveillance, focuses on clinical observations and symptoms rather than laboratory confirmation for HCAI detection. Its cost-effectiveness and efficiency make it a beneficial approach for monitoring HCAIs in LMICs. It provides for early warning capabilities, enabling timely identification and response to potential HCAI outbreaks. Syndromic surveillance is highly sensitive and this helps balance the challenge of low sensitivity of laboratory-based surveillance systems. If syndromic surveillance is used hand-in-hand with laboratory-based surveillance systems, it will greatly contribute to establishing the true burden of HAIs in resource-limited settings. Additionally, its flexibility allows for adaptation to different healthcare settings and integration into existing health information systems, facilitating data-driven decision-making and resource allocation. Such a system would augment the event-based surveillance system that is based on alerts and rumours for early detection of events of outbreak potential. If well streamlined and targeted, to monitor priority HCAIs such as surgical site infections, hospital-acquired pneumonia, diarrheal illnesses, the cost and burden of the effects from these infections could be reduced. This approach would offer early detection capabilities and could be expanded into nationwide HCAI surveillance networks with standardised data collection, healthcare worker training, real-time reporting mechanisms, stakeholder collaboration, and continuous monitoring and evaluation. Syndromic surveillance offers a promising strategy for combating HCAIs in LMICs. It provides early warning capabilities, conserves resources, and enhances patient safety. Effective implementation depends on strategic interventions, stakeholder collaboration, and ongoing monitoring and evaluation to ensure sustained effectiveness in HCAI detection and response.

Insights into human norovirus cultivation in human intestinal enteroids.

Human noroviruses (HuNoVs) are a significant cause of epidemic and sporadic acute gastroenteritis worldwide. The lack of a reproducible culture system hindered the study of HuNoV replication and pathogenesis for almost a half-century. This barrier was overcome with our successful cultivation of multiple HuNoV strains in human intestinal enteroids (HIEs), which has significantly advanced HuNoV research. We optimized culture media conditions and generated genetically modified HIE cultures to enhance HuNoV replication in HIEs. Building upon these achievements, we now present new insights into this culture system, which involve testing different media, unique HIE lines, and additional virus strains. HuNoV infectivity was evaluated and compared in new HIE models, including HIEs generated from different intestinal segments of individual adult organ donors, HIEs from human intestinal organoids produced from directed differentiation of human embryonic stem cells that were then transplanted and matured in mice before making enteroids (H9tHIEs), genetically engineered (J4FUT2 knock-in [KI], J2STAT1 knockout [KO]) HIEs, as well as HIEs derived from a patient with common variable immunodeficiency (CVID) and from infants. Our findings reveal that small intestinal HIEs, but not colonoids, from adults, H9tHIEs, HIEs from a CVID patient, and HIEs from infants support HuNoV replication with segment and strain-specific differences in viral infection. J4FUT2-KI HIEs exhibit the highest susceptibility to HuNoV infection, allowing the cultivation of a broader range of genogroup I and II HuNoV strains than previously reported. Overall, these results contribute to a deeper understanding of HuNoVs and highlight the transformative potential of HIE cultures in HuNoV research.IMPORTANCEHuman noroviruses (HuNoVs) cause global diarrheal illness and chronic infections in immunocompromised patients. This paper reports approaches for cultivating HuNoVs in secretor positive human intestinal enteroids (HIEs). HuNoV infectivity was compared in new HIE models, including ones from (i) different intestinal segments of single donors, (ii) human embryonic stem cell-derived organoids transplanted into mice, (iii) genetically modified lines, and (iv) a patient with common variable immunodeficiency disease. HIEs from small intestine, but not colon, support HuNoV replication with donor, segment, and strain-specific variations. Unexpectedly, HIEs from one donor are resistant to GII.3 infection. The genetically modified J4FUT2 knock-in (KI) HIEs enable cultivation of a broad range of GI and GII genotypes. New insights into strain-specific differences in HuNoV replication in HIEs support this platform for advancing understanding of HuNoV biology and developing potential therapeutics.

Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries.

Severe dehydration due to acute infectious diarrhea remains a leading cause of death among young children worldwide. Diarrhea with severe dehydration is a clinical syndrome with distinct management per the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and the WHO Global Task Force on Cholera Control (GTFCC) guidelines. We sought to characterize the pathogens causing severe dehydration using data from the Global Enteric Multicenter Study. We used the IMCI and GTFCC guidelines to define severe dehydration and quantitative polymerase chain reaction-based attribution models to assign the etiology of diarrhea associated with severe dehydration. The IMCI or GTFCC guidelines classified 2284 of the 5304 (43%) cases with moderate-to-severe diarrhea as having severe dehydration. In one-third of the cases with severe dehydration, no pathogens were attributed. The top pathogens attributed to children with guidelines-classified severe dehydration varied by age and were similar among those requiring intravenous hydration and hospitalization. Rotavirus (30.9%), Cryptosporidium (12.0%), and heat-stable (ST) enterotoxigenic Escherichia coli (ETEC) (10.3%) were the most common pathogens for ages 0-11 months, while Shigella/enteroinvasive E coli (EIEC) (25.8%), rotavirus (19.3%), and ST-ETEC (10.9%) were the most common for ages 12-23 months. Shigella/EIEC (25.9%), Vibrio cholerae (10.4%), and rotavirus (9.2%) were the most common among ages 24-59 months. The findings inform prioritization of pathogens, in addition to V cholerae, that cause severe dehydration for future preventive and treatment efforts. The schema for prioritization is driven primarily by age stratifications.

Knowledge, Attitude, and Practices regarding Prevention and Management of Under-five Diarrhea among mothers of Worawora Community

Background: Diarrheal illness continues to be the second greatest cause of under-five mortality worldwide. Diarrhea is responsible for roughly 1.5 million infant fatalities per year, or close to one in five. Aim: This current study was to assess knowledge, attitude, and practices regarding prevention and management of under-five diarrhea among mothers of Worawora Community. Methodology: A cross-sectional descriptive study was carried out using a total of 207 mothers with children less than 5 years. SPSS version 20 software was used for data analysis. Means, frequencies, and percentages were used for descriptive analysis and Pearson correlation for association with a set P value of 0.05. Results: The ages of the mothers ranged from 13 to 50 years, with a mean age of 27.70 ± 7.15 years. About 68.1% had good knowledge of diarrhea definition, causes, and prevention. The majority (74.4%) of the mothers had a good attitude. The majority had moderate food hygiene practices. About half (51.2%) had good hand-washing practices. About 34.3% had good home management of child diarrhea. Mothers' diarrhea prevention and management knowledge positively correlated with attitude, r(207) =.301, p < .001, hand hygiene practice, r(207) =.417, p < .001 and diarrhea management score, r(207) =.339, p < .001. Also, the attitude of respondents positively correlated with their practice scores for hand hygiene r(207) =.246, p < .001, and food hygiene r(207) =.299, p < .001. Finally, there was a significant correlation between mothers' hand hygiene practice and diarrhea management practice r(207) =.459, p < .001. Conclusion: Most of the respondents exhibited good knowledge and attitude toward under-five diarrhea management and prevention. However, the good knowledge and attitude did not translate to good practice and management in all of the respondents.

A rapid economical multiplex PCR-RFLP method for molecular detection and genotyping of Giardia duodenalis clinical isolates

Giardia duodenalis is a common cause of diarrheal illness in regions with limited resources. The demand for rapid and cost-effective detection and genotyping methods in large-scale epidemiological studies and clinical diagnostics is imperative. Hence, we developed a multiplex PCR-RFLP technique targeting the tpi gene of G. duodenalis. The assay successfully screened G. duodenalis positive clinical samples (6.33 %; 36/565). It was also able to categorize the isolates into assemblages A (41.66 %; 13/36) and B (58.33 %; 23/36), as well as into subassemblages: AI (13.8 %; 5/36), AII (27.77 %; 10/36), BIII (36.11 %; 15/36) and BIV (22.22 %; 8/36). High diagnostic sensitivity (94.2 %), specificity (100 %) and accuracy (97.1 %) of the PCR assay were obtained, indicating its reliability for diagnosing giardiasis. Notably, the assay demonstrated close concordance with microscopy (κ=0.85) and reference PCR (κ=0.98) results. The optimized method offers a cost-effective and rapid approach for G. duodenalis detection and genotyping, convenient for epidemiological studies and clinical diagnostics.

A Longitudinal Study of Escherichia coli Clinical Isolates from the Tracheal Aspirates of a Paediatric Patient-Strain Type Similar to Pandemic ST131.

Escherichia coli is a Gram-negative bacterium and part of the intestinal microbiota. However, it can cause various diarrhoeal illnesses, i.e., traveller's diarrhoea, dysentery, and extraintestinal infections when the bacteria are translocated from the intestine to other organs, such as urinary tract infections, abdominal and pelvic infections, pneumonia, bacteraemia, and meningitis. It is also an important pathogen in intensive care units where cross-infection may cause intrahospital spread with serious consequences. Within this study, four E. coli isolates from the tracheal aspirates of a tracheotomised paediatric patient on chronic respiratory support were analysed and compared for antibiotic resistance and virulence potential. Genomes of all four isolates (5381a, 5381b, 5681, 5848) were sequenced using Oxford Nanopore Technology. According to PFGE analysis, the clones of isolates 5681 and 5848 were highly similar, and differ from 5381a and 5381b which were isolated first chronologically. All four E. coli isolates belonged to an unknown sequence type, related to the E. coli ST131, a pandemic clone that is evolving rapidly with increasing levels of antimicrobial resistance. All four E. coli isolates in this study exhibited a multidrug-resistant phenotype as, according to MIC data, they were resistant to ceftriaxone, ciprofloxacin, doxycycline, minocycline, and tetracycline. In addition, principal component analyses revealed that isolates 5681 and 5848, which were recovered later than 5381a and 5381b (two weeks and three weeks, respectively) possessed more complex antibiotic resistance genes and virulence profiles, which is concerning considering the short time period during which the strains were isolated.

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

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

SARS-CoV-2 Infection and Other Communicable Diseases Identified Among Evacuees From Afghanistan Arriving in Virginia and Pennsylvania, August to September 2021.

In 2021, the US government undertook Operation Allies Welcome, in which evacuees from Afghanistan arrived at 2 US ports of entry in Virginia and Pennsylvania. Because of the rapid evacuation process, the US government granted evacuees an exemption to a Centers for Disease Control and Prevention (CDC) requirement in place at that time-namely, that air passengers present a negative SARS-CoV-2 viral test result or documentation of recovery from COVID-19 before they boarded international flights bound for the United States. This study describes cases of SARS-CoV-2 infection detected among 65 068 evacuees who arrived at the 2 ports of entry in August and September 2021. Because evacuees were a population at increased risk for infection with diseases of public health concern, CDC staff helped coordinate on-site and on-arrival testing, visually observed evacuees for signs and symptoms of communicable disease, and referred evacuees for further evaluation and treatment as needed. CDC staff used antigen or nucleic acid amplification tests at the ports of entry to evaluate evacuees aged ≥2 years without documentation of recent SARS-CoV-2 infection. CDC staff isolated evacuees with confirmed SARS-CoV-2 infection and quarantined their close contacts, consistent with CDC guidance at the time, before evacuees rejoined the repatriation process. Of 65 068 evacuees, 214 (0.3%) were confirmed as having SARS-CoV-2 infection after port-of-entry testing. Cases of measles, varicella, pertussis, tuberculosis, hepatitis A, malaria, leishmaniasis, and diarrheal illness were also identified. Although the percentage of SARS-CoV-2 infection was low in this evacuated population, communicable disease detection at US ports of entry, along with vaccination efforts, was an important part of a multilayered approach to mitigate the transmission of disease in congregate housing facilities and into US communities.

Insights into Human Norovirus Cultivation in Human Intestinal Enteroids.

HuNoVs cause global diarrheal illness and chronic infections in immunocompromised patients. This manuscript reports approaches for cultivating HuNoVs in secretor positive human intestinal enteroids (HIEs). HuNoV infectivity was compared in new HIE models, including ones from i) different intestinal segments of single donors, ii) human embryonic stem cell-derived organoids transplanted into mice, iii) genetically-modified lines, and iv) a patient with chronic variable immunodeficiency disease. HIEs from small intestine, but not colon, support HuNoV replication with donor, segment and strain-specific variations. Unexpectedly, HIEs from one donor are resistant to GII.3 infection. The genetically-modified J4 FUT2-KI HIEs enable cultivation of a broad range of GI and GII genotypes. New insights into strain-specific differences in HuNoV replication in HIEs support this platform for advancing understanding of HuNoV biology and developing potential therapeutics.

Enumerating genotypic diversity and host specificity of Giardia in wild rodents around a New York watershed

Giardia is a genus of flagellated protozoans that parasitize the gastrointestinal tract of humans and wildlife worldwide. While G. duodenalis is well-studied due to its potential to cause outbreaks of diarrheal illness in humans, other Giardia species from wildlife have been largely understudied. This study examines the occurrence, host specificity, and genotypic diversity of Giardia in wild rodents living within the New York City water supply watershed. A novel nested PCR assay targeting the 18S ssu-rDNA gene is introduced, which captures nearly the entire gene for improved species-level determination versus existing molecular typing methods. Molecular characterization of 55 Giardia specimens reveals at least seven novel lineages. Phylogenetic analysis indicates a close relationship between the newly characterized Giardia lineages and rodent hosts, suggesting rodents as important reservoirs of Giardia and its close relatives. These findings provide insights into the diversity of Giardia species and their public health potential in localities with human-wildlife interaction and further emphasizes the need for continued efforts to improve the molecular tools used to study microbial eukaryotes, especially those with zoonotic potential.

Enterotoxigenic Escherichia coli heat labile enterotoxin affects neutrophil effector functions via cAMP/PKA/ERK signaling

ABSTRACT Enterotoxigenic Escherichia coli (ETEC) are a major cause of diarrheal illness in humans and animals, induced by enterotoxins produced by these pathogens. Despite the crucial role of neutrophils in combatting bacterial infections, our understanding of how enterotoxins impact neutrophil function is limited. To address this knowledge gap, we used heat-labile enterotoxin (LT) and heat-stable enterotoxin a (STa) to investigate their impact on the effector functions of neutrophils. Our study reveals that pSTa does not exert any discernible effect on the function of neutrophils. In contrast, LT altered the migration and phagocytosis of neutrophils and induced the production of inflammatory factors via activation of cAMP/PKA and ERK1/2 signaling. LT also attenuated the release of neutrophil extracellular traps by neutrophils via the PKA signaling pathway. Our findings provide novel insights into the impact of LT on neutrophil function, shedding light on the underlying mechanisms that govern its immunoregulatory effects. This might help ETEC in subverting the immune system and establishing infection.

Faecal microbiota and cytokine profiles of rural Cambodian infants linked to diet and diarrhoeal episodes

The gut microbiota of infants in low- to middle-income countries is underrepresented in microbiome research. This study explored the faecal microbiota composition and faecal cytokine profiles in a cohort of infants in a rural province of Cambodia and investigated the impact of sample storage conditions and infant environment on microbiota composition. Faecal samples collected at three time points from 32 infants were analysed for microbiota composition using 16S rRNA amplicon sequencing and concentrations of faecal cytokines. Faecal bacterial isolates were subjected to whole genome sequencing and genomic analysis. We compared the effects of two sample collection methods due to the challenges of faecal sample collection in a rural location. Storage of faecal samples in a DNA preservation solution preserved Bacteroides abundance. Microbiota analysis of preserved samples showed that Bifidobacterium was the most abundant genus with Bifidobacterium longum the most abundant species, with higher abundance in breast-fed infants. Most infants had detectable pathogenic taxa, with Shigella and Klebsiella more abundant in infants with recent diarrhoeal illness. Neither antibiotics nor infant growth were associated with gut microbiota composition. Genomic analysis of isolates showed gene clusters encoding the ability to digest human milk oligosaccharides in B. longum and B. breve isolates. Antibiotic-resistant genes were present in both potentially pathogenic species and in Bifidobacterium. Faecal concentrations of Interlukin-1alpha and vascular endothelial growth factor were higher in breast-fed infants. This study provides insights into an underrepresented population of rural Cambodian infants, showing pathogen exposure and breastfeeding impact gut microbiota composition and faecal immune profiles.

Delhi Belly during Deadly Summers: A Study of Acute Diarrhea Due to Vibrio cholerae Infection

Abstract Background: Cholera is an acute, watery diarrheal disease caused by Vibrio cholerae, and a major public health problem in developing nations with poor sanitary conditions. Summers of 2024 in Delhi witnessed extremes of temperature, and water scarcity, sparking rise in diarrhoeal illnesses. Aims and Objective: The primary objective of this study is to investigate aetiology of diarrheal diseases during summer using a rapid molecular method, ‘gastrointestinal syndromic panel testing by multiplex polymerase chain reaction (PCR)’ on stool specimen, with special attention to Vibrio Cholerae. Material and Methods: This study was carried out between April to June of 2024, at a tertiary care hospital of Delhi Cantonment. Stool samples were collected from cases of acute watery diarrhoea and processed in parallel for conventional culture and commercially available multiplex PCR, BioFire Film Array. Results: BioFire Gastro-intestinal (GI) panel identified a total of 55 pathogens in 35 stool samples (63.63%) with multiple organisms detected in 15 (42.85%) samples. Conventional microbiological culture revealed Vibrio cholerae O1 biotype El Tor serotype Ogawa as the causative agent in six cases, whereas BioFire GI panel detected Vibrio cholera in seven. Conclusion: Multiplex PCR assay on stool sample offers a shorter turnaround time and the ability to detect a wide array of pathogens. BioFire GI panel is recommended as a screening tool for prompt diagnosis of acute gastroenteritis in a setting of an outbreak.

Host-derived CEACAM-laden vesicles engage enterotoxigenic Escherichia coli for elimination and toxin neutralization

Enterotoxigenic Escherichia coli (ETEC) cause hundreds of millions of diarrheal illnesses annually ranging from mildly symptomatic cases to severe, life-threatening cholera-like diarrhea. Although ETEC are associated with long-term sequelae including malnutrition, the acute diarrheal illness is largely self-limited. Recent studies indicate that in addition to causing diarrhea, the ETEC heat-labile toxin (LT) modulates the expression of many genes in intestinal epithelia, including carcinoembryonic cell adhesion molecules (CEACAMs) which ETEC exploit as receptors, enabling toxin delivery. Here, however, we demonstrate that LT also enhances the expression of CEACAMs on extracellular vesicles (EV) shed by intestinal epithelia and that CEACAM-laden EV increase in abundance during human infections, mitigate pathogen-host interactions, scavenge free ETEC toxins, and accelerate ETEC clearance from the gastrointestinal tract. Collectively, these findings indicate that CEACAMs play a multifaceted role in ETEC pathogen-host interactions, transiently favoring the pathogen, but ultimately contributing to innate responses that extinguish these common infections.

Campylobacter spp. in men who have sex with men: A systematic review.

Campylobacter spp. has been reported to be a sexually transmissible enteric infection in men who have sex with men (MSM) since the 1980s causing an acute severe diarrhoeal illness and rarely an acute demyelinating polyneuropathy (Guillain-Barré syndrome). The aim of this review was to explore the factors seen in MSM with Campylobacter spp. We conducted a systematic review following PRISMA guidelines by searching 7 bibliographical databases in August 2024 for manuscripts in English. Initial screening was conducted by a primary author and then two authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts which explored factors seen in MSM with Campylobacter spp.. Two authors independently used the Joanna Briggs Institute critical appraisal tools to assess risk for bias. This review was registered with PROSPERO (CRD42023464803). 25 manuscripts met the inclusion criteria that included 265 MSM with Campylobacter spp.. This review has highlighted demographic factors (living with HIV, living in urban MSM districts, HIV negative MSM using HIV-PrEP), biological factors (antimicrobial resistant Campylobacter spp., having a concurrent or previous sexually transmitted infection [Neisseria gonorrhoeae, Chlamydia trachomatis, Herpes simplex virus, Hepatitis C, Mpox] current/previous enteric infection including non-pathogenic parasites [Shigella spp., Giardia duodenalis, Cryptosporidium, Entamoeba histolytica, Salmonella spp., Entamoeba hartmanii, Entamoeba coli, Endolimax nana, Iodamoeba butchlii]) and behavioural factors (condomless receptive anal sex, oral-anal sex, oral genital sex, multiple/new sexual partners, using sex on premises venues and the internet to meet sexual partners) seen in MSM with Campylobacter spp. This review has highlighted some important demographic, biological and behavioural risk factors seen in MSM with Campylobacter spp.. These data can be used to inform future public health interventions and clinical guidelines.