Diarrhea In Adults Research Articles

Acupuncture and Moxibustion in the Treatment of Adult Diarrhea Irritable Bowel Syndrome: A Network Meta-analysis.

Objective This study was aimed at comparing the clinical efficacy of acupuncture and moxibustion on irritable bowel syndrome complicated with diarrhea (IBS-D) in adults and providing guidance for clinical treatment. Methods PubMed, The Cochrane Library, Embase, CBM, CNKI, and VIP and Wanfang databases were searched to obtain clinical randomized controlled trials (RCTs) on acupuncture and moxibustion in the treatment of IBS-D published from establishment of the database to August 5, 2021. Relevant data were extracted to assess the risk of bias in the included studies, and statistical software Stata 16.0 was used for meta-analysis. Results Twenty-one studies were eventually included in the network meta-analysis (NMA), including 1626 patients with IBS-D and 8 therapeutic measures. NMA showed that acupuncture [OR = 0.35, 95%CI (0.25, 0.49), P < 0.05], warming needle moxibustion [OR = 6.34, 95%CI (2.83, 14.21), P < 0.05], acupuncture+sandwiched moxibustion [OR = 12.83, 95%CI (4.49, 36.64), P < 0.05], acupuncture+heat-sensitive moxibustion [OR = 9.86, 95%CI (1.77, 55.00), P < 0.05] were more effective than pinaverium bromide in the treatment of IBS-D. Cumulative ranking probability (SUCRA) showed that the comprehensive efficacy of acupuncture and moxibustion (86.8%) and quality of life (QOL) (70.4%) was the best, while the comprehensive efficacy of pinaverium bromide (2.1%) and QOL (16.3%) was the worst. GV20, GV29, ST 25, ST37, ST36, SP6, LR3, and CV12 were used frequently. Conclusion Acupuncture+sandwiched moxibustion has the best effect on improving the efficacy and QOL of IBS-D patients. Limited by the number and quality of studies, we still need a large sample, multicenter, and high-quality clinical trials to confirm our findings.

Association Between Clostridium innocuum and Antibiotic-Associated Diarrhea in Adults and Children: A Cross-sectional Study and Comparative Genomics Analysis.

A recent study from Taiwan suggested that Clostridium innocuum may be an unrecognized cause of antibiotic-associated diarrhea (AAD) and clinically indistinguishable from Clostridioides difficile infection. Our objective was to compare C. innocuum prevalence and strain between those with AAD and asymptomatic controls. In this cross-sectional study, we collected stool from 200 individuals with AAD and 100 asymptomatic controls. We evaluated the association between AAD and C. innocuum in stool using anaerobic culture and quantitative polymerase chain reaction (qPCR). To identify strain-specific associations with AAD, we performed whole-genome sequencing of C. innocuum isolates using Illumina MiSeq and constructed comparative genomics analyses. C. innocuum was isolated from stool of 126/300 (42%) subjects and more frequently from asymptomatic controls than AAD subjects (50/100 [50%] vs 76/200 [38%], respectively; P = .047). C. innocuum isolation frequency was not associated with AAD in either the adult or pediatric subgroups. C. innocuum and C. difficile were frequently co-prevalent in individuals with and without diarrhea. There were no phylogenetic differences or accessory genome associations between C. innocuum isolates from AAD subjects and asymptomatic controls. C. innocuum was frequently isolated and at a greater frequency in asymptomatic controls than those with AAD. We did not identify strain lineages or accessory genomic elements associated with AAD. These data highlight that differentiating C. innocuum-associated diarrhea from asymptomatic colonization, and differentiating diarrhea caused by C. difficile from C. innocuum, are clinical microbiology challenges that require additional investigation to identify host-specific factors and/or biomarkers that distinguish these conditions.

ANTIBACTERIAL ACTIVITIES OF CIHERANG RICE (Oryza sativa L. Var. Ciherang) ETHANOL EXTRACT AGAINST Enterotoxigenic Escherichia coli (ETEC)

Enterotoxigenic Escherichia coli (ETEC) is one of the most common bacteria that cause a large number of diarrhea in infants, children and adults living in developing countries. Potential activity of Ciherang rice’s (Oryza sativa L. var. Ci-herang) leaves’ extract as antibacterial agent against the ETEC was investigated in this research. The secondary metabolite was extracted, its antibacterial activity, and its minimum inhibitory concentration (MIC) against the ETEC were determined. This study indicated the leaf extract of Ciherang rice in the ethanol fraction contained tannins, saponins, flavonoids, alkaloids, and terpenoids. It showed strong antibacterial activity against ETEC (at concentration of 100%); the extract activity test had diameter of inhibition zone around 11.12 mm with MIC value of 11.12 mm. This study suggested the ethanol leaf extract at various concentrations showed significant effect (p&lt;0.05) toward the diameter of the inhibition zone. The Ethanol leaves extract of Ciherang rice at 100% of concentration has a MIC value of 11.37 mm.

Diarrhoeal outcomes in young children depend on diarrhoeal cases of other household members: a cross-sectional study of 16,025 people in rural Uganda

BackgroundThere is a limited understanding of how diarrhoeal cases across other household members influence the likelihood of diarrhoea in young children (aged 1–4 years).MethodsWe surveyed 16,025 individuals from 3421 households in 17 villages in Uganda. Using logistic regressions with standard errors clustered by household, diarrhoeal cases within households were used to predict diarrhoeal outcomes in young children. Regressions were adjusted for socio-demographic, water, sanitation, and hygiene (WASH), and ecological covariates. Selection bias for households with (1632/3421) and without (1789/3421) young children was examined.ResultsDiarrhoeal prevalence was 13.7% (2118/16,025) across all study participants and 18.5% (439/2368) in young children. Young children in households with any other diarrhoeal cases were 5.71 times more likely to have diarrhoea than young children in households without any other diarrhoeal cases (95% CI: 4.48–7.26), increasing to over 29 times more likely when the other diarrhoeal case was in another young child (95% CI: 16.29–54.80). Diarrhoeal cases in older household members (aged ≥ 5 years) and their influence on the likelihood of diarrhoea in young children attenuated with age. School-aged children (5–14 years) had a greater influence on diarrhoeal cases in young children (Odds Ratio 2.70, 95% CI: 2.03–3.56) than adults of reproductive age (15–49 years; Odds Ratio 1.96, 95% CI: 1.47–2.59). Diarrhoeal cases in individuals aged ≥ 50 years were not significantly associated with diarrhoeal outcomes in young children (P > 0.05). These age-related differences in diarrhoeal exposures were not driven by sex. The magnitude and significance of the odds ratios remained similar when odds ratios were compared by sex within each age group. WASH factors did not influence the likelihood of diarrhoea in young children, despite influencing the likelihood of diarrhoea in school-aged children and adults. Households with young children differed from households without young children by diarrhoeal prevalence, household size, and village WASH infrastructure and ecology.ConclusionsOther diarrhoeal cases within households strongly influence the likelihood of diarrhoea in young children, and when controlled, removed the influence of WASH factors. Future research on childhood diarrhoea should consider effects of diarrhoeal cases within households and explore pathogen transmission between household members.

Clostridioides difficile infection (CDI) treatment outcomes and recurrence factor at a pediatric hospital

Background: CDI is the single most common cause of nosocomial diarrhea in both adults and children. Available data regarding treatment outcomes in hospitalized children remain limited. CDI recurrence in children has been reported in 20%–30% of cases. Consensus regarding the best testing method for CDI is lacking. The 2018 IDSA guideline recommends a multistep algorithm with detection of glutamate dehydrogenase antigen plus toxin, followed by detection of toxigenic C. difficle with nucleic acid amplification test (NAAT) if results are discordant. Methods: We included patients aged 1–26 years admitted from July 2020 through June 2021 with CDI symptoms and positive toxin or NAAT. Healthcare facility-onset CDI (HO-CDI) was defined as positive specimen collected &gt;3 days after admission. Community-onset CDI (CO-CDI) was defined as positive specimen collected ≤3 days after admission. Community-onset healthcare facility-associated CDI (CO-HCFA-CDI) was defined as positive specimen from a patient who was discharged from the facility ≤4 weeks prior. Recurrence was defined as an episode of CDI occurring within 60 days after onset of a previous infection. Results: Mean age of the 63 patients meeting inclusion criteria was 11.2 years (range, 1–21 years). Most patients (n = 37; 58.7%) were male, tested negative for C. difficile toxins (n = 39; 61.9%), and had mild-to-moderate disease (n = 61; 96.8%). Patients with immunocompromising conditions were common, including malignancy (n = 38; 60.3%), inflammatory bowel disorder (n = 8; 12.7%), and history of solid organ transplant (n = 5; 7.9%). Previously healthy without chronic medical conditions were uncommon (n = 4; 6.3%). CO-CDI was most common (n = 26; 41.3%) followed by HO-CDI (n = 23; 36.5%). Also, 34 patients (53.9%) were exposed to antibiotics within the previous 30 days, 16 (47.0%) of whom received 2 or more antibiotics. Sulfamethoxazole–trimethoprim was the most prescribed agent (13; 38%), most (12; 92.3%) as prophylaxis for Pneumocystis jirovecii pneumonia. Furthermore, 42 patients (66.7%) were receiving gastric acid suppressant agents. Laxatives were given to 14 patients (22.2%) within 72 hours of testing, despite electronic reminders. Most were treated with oral vancomycin (n = 46; 73.0%). In addition, 5 patients (7.9%) did not receive CDI treatment at the discretion of the treating physician; all were toxin negative. CDI was cured in 58 patients (92.1%) with only 5 (7.9%) experiencing recurrence infection. Patients testing positive for C. difficile toxin were more likely to experience infection recurrence compared to those with a negative toxin screen: 4 of 24 (16.7%) versus 1 of 39 (2.6%) (P = .044). Conclusions: Most patients with CDI were treated with oral vancomycin at our institution. We observed significantly lower rate of recurrence than previously reported. Toxin-positive patients experienced higher recurrence rate. Prospective studies are needed to confirm our findings.Funding: NoneDisclosures: None

Diagnosis and Management of Microscopic Colitis in Pediatric Patients.

Microscopic colitis (MC) is an inflammatory disease of the colon, characterized by chronic watery diarrhea with distinguishing histologic findings despite normal endoscopic appearance of the colonic mucosa. MC is a common cause of diarrhea in older adults, though it has been infrequently reported in children and adolescents. As MC is rare in the pediatric population, and the clinical presentation is non-specific, increased awareness of this disease amongst pediatric clinicians and pathologists is essential for timely diagnosis, which requires performing colonoscopy with biopsy. The etiology of MC is incompletely understood, but current theories in pathogenesis inform management strategies. The goals of management in pediatric MC should be to achieve symptomatic improvement while minimizing adverse effects of treatment. Many patients who achieve clinical response have symptomatic recurrence after discontinuation of initial therapy, and may require maintenance medication therapy to sustain remission. This review aims to summarize the epidemiology and risk factors, clinical features, diagnosis, theories regarding pathogenesis, and suggested management approaches for MC in the pediatric population.

Rekomendasi Apoteker Komunitas Saat Menghadapi Permintaan Swamedikasi Diare yang Disertai Alarm Symptoms

Appropriate recommendations given by pharmacists play a critical role in determining the efficacy and safety of self-medication practices in pharmacies, including in the case of diarrhea with alarm symptoms. This observational study with a cross-sectional design aims to determine the profile and appropriateness of recommendations given by pharmacists in Surabaya when they faced self-medication requests for diarrhea with alarm symptoms. Data were collected using a questionnaire consisting of two parts, i.e., participants’ characteristics and one case of adult diarrhea with alarm symptoms. The case used was newly developed and the content had been validated. The content validation and the determination of appropriate recommendations given by pharmacists involved experts in clinical pharmacy, community pharmacy, and public health. The final data were analyzed and presented descriptively. A total of 160 pharmacists were involved in this study, the majority of whom were managing pharmacists (82.50%), female (85.50%), and have been working as pharmacists for 1 to 7 years (48.75%). Most pharmacists (56.87%) gave more than one type of recommendation, the majority of whom recommended dispensing of pharmaceutical products accompanied by a referral to physicians (21.88%). Only 42 pharmacists (26.25%) gave appropriate recommendations including referral to physicians (18.13%) or referral accompanied by pharmaceutical product (6.88%) and non-pharmacology recommendations (1.25%). Need assessment is required to identify interventions preferred by pharmacists to optimize their role in promoting responsible self-medication practices.

Positive Effects of a Lecithin-Based Delivery Form of Boswellia serrata Extract in Acute Diarrhea of Adult Subjects.

Acute diarrhea is a frequent problem worldwide, mostly due to gastrointestinal infections or food poisoning. Boswellia serrata could be active in the treatment of acute diarrhea due to its anti-inflammatory, antispasmodic, and antimicrobial activity. In this randomized, double-blind, placebo-controlled clinical study, 49 adults with acute diarrhea were randomly allocated to receive 250 mg of a lecithin-based delivery form of Boswellia serrata (CASP) or placebo for 5 days. The time it took to become healthy with stoppage of diarrhea (primary end point) was significantly shorter in the intervention group (3.08 vs. 4.44 days: p-value < 0.0001). The probability of subjects treated with CASP to recover sooner was equal to 80.2%. A significantly lower number of stools was observed in the CASP group over time (β = −0.17, p-value < 0.0001). A significant difference was observed between the two groups for abdominal pain, nausea, and GAE (global assessment of efficacy). In conclusion, the lecithin-based delivery form of Boswellia serrata extract could be a useful addition to the treatment of acute diarrhea in adults. CASP is safe and reduces the time it takes to become healthy, the frequency of stools, the abdominal pain and nausea of subjects with acute diarrhea. Further studies are needed to confirm these promising results.

On-chip-based electrochemical biosensor for the sensitive and label-free detection of Cryptosporidium

Cryptosporidium, an intestinal protozoan pathogen, is one of the leading causes of death in children and diarrhea in healthy adults. Detection of Cryptosporidium has become a high priority to prevent potential outbreaks. In this paper, a simple, easy to fabricate, and cost-effective on-chip-based electrochemical biosensor has been developed for the sensitive and label-free detection of Cryptosporidium oocysts in water samples. The sensor was fabricated using standard lithography using a mask with a 3-electrode design and modified by self-assembling a hybrid of a thiolated protein/G and the specific anti-Cryptosporidium monoclonal antibodies (IgG3). The electrochemical impedance spectroscopy (EIS) was employed to quantitate C. parvum in the range of 0 to 300 oocysts, with a detection limit of approximately 20 oocysts/5 µL. The high sensitivity and specificity of the developed label-free electrochemical biosensor suggest that this novel platform is a significant step towards the development of fast, real-time, inexpensive and label-free sensing tool for early warning and immediate on-site detection of C. parvum oocysts in water samples, as compared to the traditional methods (such as PCR and microscopy). Furthermore, under optimized conditions, this label-free biosensor can be extended to detect other analytes and biomarkers for environmental and biomedical analyses.

Obesity is associated with decreased risk of microscopic colitis in women.

BACKGROUNDMicroscopic colitis is a leading cause of diarrhea in the older adults. There is limited information about risk factors. We hypothesized that obesity would be associated with microscopic colitis.AIMTo examine the association between obesity and microscopic colitis in men and women undergoing colonoscopy.METHODSWe conducted a case-control study at the University of North Carolina Hospitals. We identified and enrolled men and women referred for elective, outpatient colonoscopy for chronic diarrhea. We excluded patients with a past diagnosis of Crohn’s disease or ulcerative colitis. A research pathologist reviewed biopsies on every patient and classified them as microscopic colitis cases or non-microscopic colitis controls. Patients provided information on body weight, height and exposure to medications via structured interviews or Internet based forms. The analysis included 110 patients with microscopic colitis (cases) and 252 non-microscopic colitis controls. Multivariable analyses were performed using logistic regression to estimate odds ratios and 95% confidence intervals.RESULTSCases were older and more likely than controls to be white race. Study subjects were well educated, but cases were better educated than controls. Cases with microscopic colitis had lower body mass index than controls and reported more weight loss after the onset of diarrhea. Compared to patients who were normal or under-weight, obese (BMI > 30 kg/m2) patients were substantially less likely to have microscopic colitis after adjusting for age and education, adjusted OR (aOR) 0.35, 95% confidence interval (CI) 0.18-0.66). When stratified by sex, the association was limited to obese women, aOR 0.21, 95%CI: 0.10-0.45. Patients with microscopic colitis were more likely to report weight loss after the onset of diarrhea. After stratifying by weight loss, there remained a strong inverse association between obesity and microscopic colitis, aOR 0.33, 95%CI: 0.10 – 1.11 among the patients who did not lose weight. Ever use of birth control pills was associated with lower risk of microscopic colitis after adjusting for age, education and BMI, aOR 0.38, 95%CI: 0.17-0.84.CONCLUSIONCompared to controls also seen for diarrhea, microscopic colitis cases were less likely to be obese. Mechanisms are unknown but could involve hormonal effects of obesity or the gut microbiome.

Impact of Concurrent Use of Probiotics on Risk of Antibiotic Associated Diarrhoea in Adults

Antibiotics are one of the most prescribed medications worldwide. It is given to treat a wide range of infections and diseases. However, usage of antibiotics is associated with several side effects. The most frequently reported side effect is diarrhoea since antibiotics affect the gastrointestinal microbial environment. Antibiotic associated diarrhoea refers to the diarrhoea that develops at the initiation of the antibiotic therapy and can extend even up to six or more weeks after termination of the therapy. The prevalence of antibiotic associated diarrhoea ranges from 5% to 39% and is associated with significant morbidity and mortality. Antibiotic associated diarrhoea can be caused by any antibiotic used although the risk is higher for broad-spectrum antibiotics since they primarily target anaerobes and are poorly absorbed. Probiotics aid in reducing the risk of antibiotic associated diarrhoea. The purpose of this research is to review the available information about the impact of concurrent use of probiotics on risk of antibiotic-associated diarrhoea in adults. Various studies in the literature suggest of concurrent use of probiotics in treatment and prevention of antibiotic associated diarrhoea. Probiotics have been widely recommended as a robust and reliable strategy to lessen the negative effects of antibiotics on gastrointestinal function. Probiotics have a beneficial role in improving the gut health thus lowering the incidence of antibiotic associated diarrhoea if administered concurrently. Probiotics are generally well-tolerated and have minimum side effects. However more clinical research is needed to establish the guidelines for their concurrent use with antibiotic therapy to prevent antibiotic associated diarrhoea.

Herbal Formula Shenling Baizhu San for Chronic Diarrhea in Adults: A Systematic Review and Meta-analysis.

Background:Shenling Baizhu San (SBS), a well-known Chinese medicine herbal formula, has been widely used for treating chronic diarrhea for thousands of years. However, the efficacy and safety of SBS in treating chronic diarrhea have not been fully assessed.Objective:This study evaluates the efficacy and safety of the herbal formula SBS in symptomatic relief of chronic diarrhea.Methods:English and Chinese language databases (PubMed, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Data, and SinoMed electronic databases) were searched through April 2020 for relevant randomized controlled trials (RCTs). The outcomes in these RCTs included stool frequency, stool consistency, patient-reported satisfaction of chronic diarrhea treatment, quality of life and adverse events. Paired reviewers independently extracted data and conducted qualitative and quantitative analyses. The Cochrane revised risk of bias RoB-2 tool was applied to assess the risk of bias for each trial whereas the RevMan 5.3 software was used for outcomes data synthesis and meta-analysis. Mean difference (MD) and the 95% confidence interval (CI) were used to measure continuous data. The dichotomous data were analyzed via the relative risk (RR) with 95% CIs.Results:Fourteen RCTs including 1158 participants (54% males) with chronic diarrhea were included. Shenling Baizhu San combined with or without conventional medicine (CM) was associated with greater patient-reported satisfaction than CM alone. There was no increased risk of adverse events (AEs) during treatment.Conclusion:Treatment with SBS was associated with significant improvement in patient-reported satisfaction, irrespective of conventional medicine use. Rigorous and powered RCTs with objective outcome measures are needed to confirm the effects of SBS in specific gastrointestinal disease populations with chronic diarrhea symptoms.Systematic review registration number (PROSPERO):CRD42020178073

Rekomendasi Apoteker Komunitas Saat Menghadapi Permintaan Swamedikasi Diare yang Disertai Darah: Sebuah Survei di Wilayah Perkotaan Indonesia

Diarrhea is one of the medical problems frequently found in the community. Pharmacists should determine the conditions treatable with over-the-counter medications and those that need urgent referral to a doctor, such as bloody diarrhea. Therefore, this study aimed to determine the appropriateness of the pharmacists' recommendations when responding to self-medication requests in the case of adult bloody diarrhea. This cross-sectional study was conducted from October to December 2019 using a questionnaire consisting of participants' characteristics and newly developed acute bloody diarrhea scenarios in adults. The quality and content of the questionnaire was validated by the experts in clinical pharmacy, public health, and pharmacists. The data obtained from 84 pharmacists with the response rate of 38.71% were analyzed descriptively. About 89.29 % of the pharmacists were female between 24 to 34 years. Referral to a doctor was the most suitable recommendation; however, only 23 pharmacists (34.52%) recommended this method. Some recommended antibiotics, such as metronidazole, cotrimoxazole, or thiamphenicol. Most pharmacists have not provided appropriate recommendations for a scenario related to bloody diarrhea in adults. Therefore, further research should be conducted to identify the required variables by the community pharmacists to make an appropriate recommendation as a response towards minor ailments in the community, especially medical referrals.

Standardisation and validation of an in-house quantitative real-time polymerase chain reaction (qPCR) assay for the diagnosis of Clostridioides difficile infection

ObjectivesClostridioides difficile is an emerging enteric pathogen that causes nosocomial diarrhoea in adults. The excessive cost of commercial molecular tests restricts the access of developing countries to its diagnosis. This study aimed to develop and validate in-house quantitative polymerase chain reaction (qPCR) targeting the C. difficile toxin B gene (tcdB) using two detection methodologies—SYBR Green and hydrolysis probes—for the diagnosis of C. difficile infection (CDI). MethodsGlutamate dehydrogenase (GDH) plus toxigenic culture was the standard reference diagnostic method. The SYBR Green method and hydrolysis probes were used to study 392 samples simultaneously to assess the diagnostic value of these real-time PCR assays in detecting CDI from clinical samples. ResultsThe SYBR Green and hydrolysis probe assays showed 97.9% and 87.5% sensitivity; 99.1% and 100.0% specificity; 94.0% and 100.0% positive predictive value; 99.7% and 98.3% negative predictive value; and 99.0% and 98.5% accuracy, respectively. ConclusionsThe two qPCR methodologies evaluated could offer an adequate tool as part of an algorithm in the laboratory diagnosis of CDI.

Spectrum of Diarrheagenic Escherichia coli in Drinking and Wastewater in Rafha City of Saudi Arabia

Introduction: E coli is one of the most important etiologic agent of diarrhea in children and adults. Based on the clinical features and virulence determinants, there are five major E. coli strains which cause diarrhea; Enterohemorrhagic E. coli (EHEC), Enteropathogenic E. coli (EPEC), Enterotoxigenic E. coli (ETEC), Enteroinvasive E. coli (EIEC) and Enteroaggregative E. coli (EAEC). The PCR based identification proves to be a better choice as it can differentiate between different strains on the basis of genetic difference.&#x0D; Aim: The purpose of the current study was to isolate diarrheagenic E. coli from the drinking and wastewater from Rafha city of Saudi Arabia.&#x0D; Methodology: One 100 drinking and wastewater samples (50 each) were included in the study. The samples were cultured on MacConkey agar plates at 37 oC for 24 hours. Pink colonies were carefully picked and subjected to DNA isolation and PCR detection and identification of E. coli and Diarrheagenic E. coli. The detected PCR products were sequenced for the confirmation.&#x0D; Results: We identified 5 isolates out of 50 wastewater samples (10%) which were further categorized into 3 different DEC pathotypes. They included ETEC (2 out of 5), atypical EPEC (1 out of 5), and EAEC (1 out of 5); EIEC and EHEC were not detected.&#x0D; Discussion and Conclusion: The prevalence of DEC strains is different across different studies which depends on different factors such as geographical location, number of samples taken, and the number and type of the target genes selected. The prevalence of DEC in the current study was much lower than other reported studies. Although the percentage of DEC strains in the wastewater samples from WWTP of Rafha was moderate to low, it can be a considerable risk factor for the people using ground water for drinking.

Study on the genetic characteristics of enteric viral pathogens of sporadic adult diarrhea in Chaoyang district, Beijing in 2019

Objective: To analyze the distribution and genetic characteristics of sporadic adult diarrhea virus in Chaoyang District, Beijing. Methods: Fecal samples from 177 adult patients with sporadic diarrhea were collected from 4 enteric outpatient clinics in Chaoyang District, Beijing from May to December 2019. Nucleic acid detection of Norovirus, Sappovirus, Rotavirus, Enteric Adenovirus and Astrovirus in the samples was performed by real-time quantitative PCR. The positive samples were amplified by RT-PCR/PCR and sequenced. The phylogenetic analysis was performed by neighbor-Joining (NJ) methods of Mega 6.0 software. Results: There were 60 of 177 (33.90%) adult sporadic diarrhea samples positive for enteric viral pathogens. Among them, 47 cases were infected with single virus, including 29 cases of Norovirus, 9 cases of Sappovirus, 8 cases of Astrovirus and 1 case of Enteric Adenovirus, in addition with 13 cases of multiple infections. None of rotavirus was detected. Partial sequences were successfully obtained for analysis, including 16 cases of GI Norovirus (7 subtypes and GI.3[P13] predominant), 10 cases of GII Norovirus (5 subtypes and GII.6[P7] predominant), 12 cases of Sappovirus (4 subtypes and GI.2 predominant), and 7 cases of Astrovirus (2 subtypes and AST-1 predominant). Conclusion: Norovirus, Astrovirus and Sappovirus are main pathogens among sporadic adult diarrhea in Beijing in 2019, and and different pathogenic gene subtypes show diverse characteristics.

Bile Acid Diarrhea in Adults and Adolescents.

Bile acids are central to enterohepatic signaling pathways activated through natural receptors, farnesoid X receptor [FXR mediates synthesis of fibroblast growth factor-19 (FGF-19)], and G protein-coupled bile acid receptor 1 (GPBAR1, also known as TGR5). Although bile acid diarrhea (BAD) is more commonly encountered in ileal resection or disease, there is evidence documenting "idiopathic" BAD in about 20% of adolescents and 30% of adults presenting with chronic, non-bloody diarrhea often attributed to irritable bowel syndrome. Mechanism(s) leading to increased hepatic synthesis and colonic bile acid levels in "idiopathic" BAD include reduced synthesis of FGF-19 by the ileal mucosa, or genetic variation in hepatocyte proteins klotho β and FGF receptor 4 (FGFR4) that mediate negative feedback of bile acid synthesis. The objective of this review is to summarize the diagnosis of BAD in adults and adolescents. In addition to 75 SeHCAT retention for diagnosis of BAD, studies have validated fasting serum 7αC4 and FGF-19, respectively, by-product and inhibitor of hepatic bile acid synthesis, as well as fecal bile acid measurements. These assays are widely available through reference laboratories, and they are being simplified (eg, measurement of primary fecal bile acids in a random stool sample). BAD has also been identified as a co-factor contributing to persistent diarrhea in other diseases in remission including inflammatory bowel disease, microscopic colitis, celiac disease, and neuroendocrine tumors. In summary, advances in diagnosis of BAD provide opportunities for generalists and pediatric and adult gastroenterologists to provide targeted treatment for BAD presenting as chronic non-bloody diarrhea.

Review on Emerging Waterborne Pathogens in Africa: The Case of Cryptosporidium

Water-related diseases, particularly waterborne diseases, remain significant sources of morbidity and mortality worldwide but especially in developing countries. Emerging waterborne pathogens represent a major health risk. Cryptosporidium is one such pathogen which is globally recognized as a major cause of diarrhea in children and adults. The objective of this paper is not only to review published studies on the impact of these emerging waterborne pathogens but also to identify the various risk factors that favor their transmission. A number of envisaged and needed actions to tackle the challenge of these pathogens in Africa have also been discussed. We have searched the web of ScienceDirect, PubMed, Scopus. ISI Web of Science, SpringerLink, and Google Scholar. The first database search yielded 3099 articles. As a result, 141 studies were submitted for abstract review. A total of 68 articles were selected for full text analysis. After evaluating a considerable number of articles on this topic, the following results were obtained. A number of pathogens are likely to present public health risks, including Cryptosporidium. The contaminating potential of these pathogens is associated with a multitude of factors, such as the effects of climate change, social and behavioral aspects of local populations, water issues, geographical locations that may cause isolation, and inequalities due to lack of transparency of governments in the distribution of financial resources. We stress the need to maintain and strengthen real-time surveillance and rapid epidemiological responses to outbreaks and the emergence of new waterborne pathogens in all countries. African governments, for their part, should be aware of future risks of waterborne protozoan diseases. They must provide immediate and effective responses by establishing technical and financial mechanisms to ensure sufficient quantities of safe drinking water, sewage disposal, and hygiene for all.

Пробіотики при антибіотик-асоційованiй діареї в дітей: обґрунтований вибір

Призначення пробіотичних штамів для профілактики антибіотик-асоційованої діареї (ААД) у дорослих і дітей на сьогодні є стандартною схемою як віт­чизняних, так і європейських протоколів лікування. Сахароміцети Saccharomyces boulardii належать до дріжджових пробіотиків. Їх принциповою відмінністю від бактеріальних пробіотиків (Lactobacіllus та ін.) є стійкість до дії антибіотиків. У зв’язку з цим Saccharomyces boulardii можуть застосовуватися одночасно з антибіотиками для профілактики виникнення побічних явищ з боку травного тракту, викликаних антибіотикотерапією (перш за все ААД). Вибір у цій ситуації бактеріального пробіотика менш вдалий, оскільки антибіотики можуть пригнічувати активність введених бактерій. Важливо зазначити, що Saccharomyces boulardii не здатні передавати стійкість до дії антибіотиків патогенним бактеріям, у той час як у бактеріальних пробіотиків такий потенціал існує. Результати виконаних клінічних досліджень свідчать про високу ефективність та безпечність Saccharomyces boulardii в профілактиці та лікуванні антибіотик-асоційованої діареї в дітей. В Україні цей пробіотик представлений лікарським засобом Ентерол®.

Trends in healthcare visits and antimicrobial prescriptions for acute infectious diarrhea in individuals aged 65\xa0years or younger in Japan from 2013 to 2018 based on administrative claims database: a retrospective observational study

BackgroundThe inappropriate use of antimicrobials for acute infectious diarrhea is widespread and leads to the problem of antimicrobial resistance. To improve the use of antimicrobials, it is first necessary to understand the actual situation of diarrheal disease and to identify potential targets for intervention. This study aimed to investigate the recent epidemiological characteristics of and antimicrobial prescriptions for acute infectious diarrhea in Japan.MethodsThis was a retrospective observational study of outpatients aged 0–65 years, separated into children (age 0–17 years) and adults (age 18–65 years), diagnosed with acute infectious diarrhea, using the administrative claims database of the Japan Medical Data Center from 2013 to 2018. We evaluated the number of eligible visits/number of database registrants (defined as the visit rate). The analysis of the antimicrobial prescription rate was restricted to otherwise healthy individuals diagnosed with acute infectious diarrhea alone by excluding patients with multiple disease diagnoses and with medical backgrounds of chronic bowel diseases or immunocompromised conditions. We further classified them by diagnosis of bacterial or nonbacterial acute infectious diarrhea.ResultsThe total number of eligible visits for acute infectious diarrhea was 2,600,065. The visit rate, calculated based on the number of eligible visits by database registrants, was higher in children (boys, 0.264; girls, 0.229) than in adults (men, 0.070; women, 0.079), with peaks in early summer and winter. The peaks for visits in adults lagged those of children. In total, 482,484 visits were analyzed to determine the antimicrobial prescription rate; 456,655 (94.6%) were diagnosed with nonbacterial acute infectious diarrhea. Compared with children (boys, 0.305; girls, 0.304), the antimicrobial prescription rate was higher in adults, and there were differences between sexes in adults (men, 0.465; women, 0.408). Fosfomycin and fluoroquinolone were most frequently used for nonbacterial acute infectious diarrhea in children (44.1%) and adults (50.3%), respectively.ConclusionsThese results revealed overprescription of antimicrobials for acute infectious diarrhea in this administrative claims database in Japan and contribute to the development of antimicrobial stewardship strategies and the identification of targets for efficiently reducing inappropriate antimicrobial use.