Diarrhea In Young Children Research Articles

Rotavirus A Infection Prevalence and Spatio-Temporal Genotype Shift among Under-Five Children in Amhara National Regional State, Ethiopia: A Multi-Center Cross-Sectional Study.

Background: Globally, rotavirus (RV) A (RVA) is the most common cause of severe and sometimes fatal diarrhea in young children. It is also the major cause of acute gastroenteritis among children in Ethiopia. Currently, the WHO has prequalified four RVA vaccines for universal childhood immunization. Ethiopia introduced the monovalent Rotarix vaccine into its national immunization program in 2013. Since then, only a few studies on the burden and genotype distribution of RVA infection post-vaccine introduction have been conducted (mostly at sentinel surveillance sites). Therefore, this study aimed to assess RVA prevalence and genotype distribution among children under five years in Ethiopia (February 2021-December 2022). Methods: This multi-center hospital-based cross-sectional study involved 537 diarrheic children under-five years old. Rotavirus A detection was conducted using a one-step reverse-transcriptase polymerase chain reaction (RT-PCR). Genotyping was conducted by Sanger sequencing of the VP7 (complete) and VP4 (partial) genes. Descriptive analysis and Pearson's chi-squared test were carried out using SPSS version 29. Phylogenetic analysis with 1000 bootstrap replicates was performed using MEGA version 11 software. Statistical significance was set at p < 0.05 for all analyses. Results: The prevalence of RVA infection among diarrheic children was 17.5%. The most prevalent G-types identified were G3 (37%), the previously uncommon G12 (28%), and G1 (20%). The predominant P-types were P[8] (51%), P[6] (29%), and P[4] (14%). The three major G/P combinations observed were G3P[8] (32.8%), G12P[6] (28.4%), and G1P[8] (19.4%). Phylogenetic analysis revealed clustering of Ethiopian strains with the globally reported strains. Many strains exhibited amino acid differences in the VP4 (VP8* domain) and VP7 proteins compared to vaccine strains, potentially affecting virus neutralization. Conclusions: Despite the high RVA vaccination rate, the prevalence of RVA infection remains significant among diarrheic children in Ethiopia. There is an observable shift in circulating RVA genotypes from G1 to G3, alongside the emergence of unusual G/P genotype combinations such as G9P[4]. Many of these circulating RVA strains have shown amino acid substitutions that may allow for neutralization escape. Therefore, further studies are warranted to comprehend the emergence of these unusual RVA strains and the diverse factors influencing the vaccine's diminished effectiveness in developing countries.

LncRNA Nostrill promotes interferon-γ-stimulated gene transcription and facilitates intestinal epithelial cell-intrinsic anti-Cryptosporidium defense.

Intestinal epithelial cells possess the requisite molecular machinery to initiate cell-intrinsic defensive responses against intracellular pathogens, including intracellular parasites. Interferons(IFNs) have been identified as cornerstones of epithelial cell-intrinsic defense against such pathogens in the gastrointestinal tract. Long non-coding RNAs (lncRNAs) are RNA transcripts (>200 nt) not translated into protein and represent a critical regulatory component of mucosal defense. We report here that lncRNA Nostrill facilitates IFN-γ-stimulated intestinal epithelial cell-intrinsic defense against infection by Cryptosporidium, an important opportunistic pathogen in AIDS patients and a common cause of diarrhea in young children. Nostrill promotes transcription of a panel of genes controlled by IFN-γ through facilitating Stat1 chromatin recruitment and thus, enhances expression of several genes associated with cell-intrinsic defense in intestinal epithelial cells in response to IFN-γ stimulation, including Igtp, iNos, and Gadd45g. Induction of Nostrill enhances IFN-γ-stimulated intestinal epithelial defense against Cryptosporidium infection, which is associated with an enhanced autophagy in intestinal epithelial cells. Our findings reveal that Nostrill enhances the transcription of a set of genes regulated by IFN-γ in intestinal epithelial cells. Moreover, induction of Nostrill facilitates the IFN-γ-mediated epithelial cell-intrinsic defense against cryptosporidial infections.

Budidaya Tanaman Buah Jambu Demi Masyarakat yang Lebih Baik

Red guava leaves are a type of medicinal plant that has many health benefits, including treating diarrhea in young children, reducing bad cholesterol (LDL) levels, preventing cancer, healthy skin, treating hair loss, treating gum disease, and a natural cure for diabetes. . The purpose of this community service is to provide information on how to increase the potential of natural resources located in Pamulang, which is an area that has quite high potential in the guava plant business in general, but currently it has not been utilized optimally by the local community at this time. Most of the guava plants that are produced are immediately sold individually without knowing the harvest that is consumed. This is due to a lack of innovation from the local community. Therefore, guava cultivation is one way that can be done by harvesting quite small or large areas of land that can be put to good use, maintain nutritional value, and increase economic value. With this cultivation empowerment, it is hoped that it can help improve the economy of the Pamulang community and take advantage of the harvest of guava plants for social welfare which is more durable to give rise to various innovations in guava processing itself in a sustainable manner.

Assessing safety and efficacy of a novel glucose-free amino acid oral rehydration solution for watery diarrhea management in children: a randomized, controlled, phase III trial

Diarrhoeal disease poses a significant global health challenge, especially in children under three years old. Despite the effectiveness of oral rehydration therapy (ORT), its adoption remains low. Glucose-based ORS (GORS) is the standard, but novel formulations like glucose-free amino acid-based VS002A have emerged as potential alternatives. This study aimed to compare the safety and efficacy of VS002A against the standard WHO-ORS in treating non-cholera acute watery diarrhoea in children. A triple-blind, randomized trial enrolled 310 male infants and children aged 6-36 months, who were assigned to receive WHO-ORS or VS002A over a 16-month period, from June 2021 to September 2022. Both groups received standard of care, including zinc supplementation. The Primary study outcome measured was the duration of diarrhoea. Secondary outcomes included stool output, treatment failure and adverse events. Exploratory endpoints included urinary output, body weight changes, blood biochemistry, stool microbiology and gut health biomarkers. Both VS002A and WHO-ORS were well-tolerated with a low adverse event rate. While not different statistically (p=0.10), duration of diarrhoea was shorter in children treated with VS002A vs. WHO-ORS (65.4h vs. 72.6h). Similarly, stool output was also lower vs. WHO-ORS in children treated with VS002A, though not statistically different (p=0.40). Serum citrulline levels, an indicator of gut health, were higher in the VS002A group at 24h suggesting a potential protective effect (p=0.06). The findings of this study support the non-inferiority of VS002A, a glucose-free amino acid-based ORS compared to the WHO-ORS standard of care. VS002A was shown to be safe and effective in treating non-cholera acute watery diarrhoea in young children. VS002A may offer advantages in pathogen-driven diarrhoea, supported by trends toward a lower duration of diarrhoea and stool output within the per protocol group. Furthermore, individuals with prolonged diarrhoea, severe malnutrition, environmental enteric dysfunction or have issues with obesity or insulin resistance, could benefit from a glucose-free ORS. This research contributes to addressing the persistent challenge of childhood diarrhoea by presenting an alternative glucose-free ORS formulation with potential advantages in select scenarios, offering a promising avenue for improving paediatric diarrhoea management worldwide. The study was funded by Entrinsic Bioscience, LLC., Norwood, MA, USA.

Influence of zinc supply on the course of infectious diarrhea in children of early age

Aim. Give a comparative characteristic of the course of infectious diarrhea in young children, residents of the Zaporizhzhia region (Ukraine), depending on their provision of zinc (Zn). Materials and methods. The study included 99 children aged 1 to 36 months with manifestations of infectious diarrhea. On the day of hospitalization, immunochromatographic and bacteriological examination of feces was performed. Also, on the first, third and fifth days of hospitalization, a general blood test and the level of Zn in the blood were determined for each patient. Results. It was found that among the examined patients with infectious diarrhea at the onset of the disease, 22 children (22.2 %) had a reduced concentration of Zn in blood serum. In these children, the zinc level ranged from 7.63 to 9.17 μmol/l. It was also noted that the level of Zn in these patients on the 5th day of inpatient treatment rose to the norm of reference indicators. After studying the anamnesis, it was found that 40.9% of children with low Zn content had episodes of acute intestinal infection before this disease. During a comparative analysis of the clinical and laboratory data of patients, it was found that the tendency to more frequent vomiting occurred in patients with Zn deficiency (p = 0.05), that Zn availability had the most significant effect on the expressiveness of the diarrheal syndrome at the onset of the disease and more than a third (n = 8, 36.4 %) of children with Zn deficiency had more than 5 episodes of diarrhea per day, among which every second had more than 10. We did not determine significant differences between the frequency of viral and bacterial causes of diarrhea in the comparison groups. As for complete blood count, patients with Zn deficiency more often had a tendency to blood neutrophilia with a reliably frequent shift of the leukocyte formula to the left (p = 0.003). At the same time, children with a reduced content of Zn in blood serum significantly more often had lymphopenia at the onset of diarrheal disease (p = 0.006). When investigating the effect of Zn deficiency on the course of the disease, we found that in children with reduced Zn, the duration of diarrhea was almost twice as long (8 [6; 9] days vs. 5 [4; 6] in children with normal Zn indicators; p = 0.0001 according to the Mann–Whitney test) and in patients with infectious diarrhea who had Zn deficiency at the onset of the disease, on the seventh day of treatment diarrhea persisted significantly more often (p = 0.03). Such symptoms were accompanied by the persistence of signs of anemia (p = 0.06 on the 5th day) and a shift of the leukocyte formula to the left (p = 0.007) without leukocytosis. Conclusions. Almost 25 % of young children with infectious diarrhea in the Zaporizhzhia region had Zn deficiency. Most likely, Zn deficiency is caused by the peculiarities of its supply with food and its metabolism. In the debut of a diarrheal disease, insufficient supply of Zn is associated with lymphopenia and a shift of the leukocyte formula to the left. Zn deficiency in infectious diarrhea leads to a long (more than 5 days) course of the disease due to prolongation of the diarrheal syndrome.

Sanitation risk factors contributing to diarrhea in children below five years in Igembe South Sub-County, Meru County, Kenya.

Introduction: Lack of safe water, poor hygiene, and poor sanitation account for about 90% of the diarrheal diseases in the world. Globally, half a million people lack adequate sanitation, leading to fatalities for over five million people annually. In Kenya, diarrhea still remains one of the top five causes of morbidity and mortality in children below 5 years.&#x0D; Aim: To identify the household sanitation risk factors contributing to diarrhea in under-five-year-old children in Igembe South Sub County in Meru County, Kenya.&#x0D; Study Design: A retrospective and cross-sectional study.&#x0D; Place and Duration of the study: Nyambene Sub-County Hospital, Igembe South Sub-County in Meru County, Kenya between December 2022 and March 2023.&#x0D; Methodology: The sample size was 196 children calculated from a population of 3,332 children who had diarrhea in Igembe South Sub County out of 22412 children who had diarrhea in Meru County for the last year. Data was analyzed by use of SPSS (2022) and ANOVA.&#x0D; Results: The study found a strong link (p=0.0034) between diarrhea cases in children under five and the absence of household latrines, as well as sanitation-related factors. It noted that many households lacked proper latrines, and many caregivers did not practice hand washing after handling child feces.&#x0D; Conclusion: The study identified access to safe drinking water as a key factor in reducing diarrhea in young children. The study recommends close monitoring of sanitation facilities and ongoing assessments of water source safety by the County Government of Meru and other stakeholders to improve overall hygiene and reduce diarrhea cases in the region.

Structure and immunogenicity of the murine astrovirus capsid spike.

Human astroviruses (HAstVs) are small, non-enveloped icosahedral RNA viruses that are a significant cause of diarrhoea in young children. Despite their worldwide prevalence, HAstV pathogenesis studies and vaccine development remain challenging due to the lack of an animal model for HAstV infection. The recent development of a murine astrovirus (MuAstV) infection model in mice provides the opportunity to test proof-of-concept vaccines based on MuAstV antigens. To help establish a system in which an astrovirus capsid spike-based vaccine could be tested in vivo, we designed and produced a recombinant MuAstV capsid spike protein based on predicted secondary structure homology to HAstV spike proteins. The recombinant MuAstV spike can be expressed with high efficiency in Escherichia coli and retains antigenicity to polyclonal antibodies elicited by MuAstV infection. We determined the crystal structure of the MuAstV spike to 1.75 Å and assessed its structural conservation with HAstV capsid spike. Despite low sequence identity between the MuAstV and HAstV spikes and differences in their overall shapes, they share related structural folds. Additionally, we found that vaccination with MuAstV spike induced anti-MuAstV-spike antibodies, highlighting that the recombinant spike is immunogenic. These studies lay a foundation for future in vivo MuAstV challenge studies to test whether MuAstV spike can be the basis of an effective vaccine.

Corrected and republished from: "VP4 Is a Determinant of Alpha-Defensin Modulation of Rotaviral Infection".

Rotavirus is a leading cause of severe diarrhea in young children. Like other fecal-oral pathogens, rotaviruses encounter abundant, constitutively expressed defensins in the small intestine. These peptides are a vital part of the vertebrate innate immune system. By investigating the impact that defensins from multiple species have on the infectivity of different strains of rotavirus, we show that some rotaviral infections can be inhibited by defensins. We also found that rotaviruses may have evolved resistance to defensins in the intestine of their host species, and some even appropriate defensins to increase their infectivity. Because rotaviruses infect a broad range of animals and rotaviral infections are highly prevalent in children, identifying immune defenses against infection and how they vary across species and among viral genotypes is important for our understanding of the evolution, transmission, and zoonotic potential of these viruses as well as the improvement of vaccines.

Prevalence and risk factors associated with the occurrence of Campylobacter sp. in children aged 6-24 months in peri-urban Nairobi, Kenya.

Campylobacter bacteria is a major cause of foodborne-related bacterial gastroenteritis in humans worldwide. It is known to cause diarrhea in young children which has been shown to directly affect their weight and height as a result of malnutrition. Severe cases of diarrhea can also lead to death. Most of the burden is experienced in resource-limited countries in Africa and Southeast Asia where the disease is linked to poor hygiene and sanitation. The objective of this study was to determine the prevalence of Campylobacter in children aged between 6 and 24 months in Nairobi, Kenya and identify potential risk factors associated with their occurrence. A cross-sectional study was carried out between May to December 2021. A total of 585 randomly selected households were visited in two wards (Uthiru/Ruthimitu and Riruta) in Dagoretti South sub-county, Nairobi. A questionnaire regarding how children's food is handled, the major foods consumed, sanitation and hygiene, and animal ownership was conducted among caregivers to identify associated risk factors. Stool samples were collected from 540/585 children and screened for the presence of Campylobacter using culture-based methods and confirmed through PCR. Of the 540 children's stool samples processed, Campylobacter isolates were detected in 4.8% (26/540). Campylobacter jejuni (C. jejuni) was the most common species in 80.8% of positive samples compared to Campylobacter coli (C. coli) in 26.9% of samples. In six samples, both C. jejuni and C. coli were isolated, while in four samples, it was not possible to speciate the Campylobacter. Drinking cow's milk (OR 4.2, 95% CI 1.4 - 12.6) and the presence of animal feces in the compound (OR 3.4, 95% CI 1.1 - 10.3) were found to be statistically associated with Campylobacter carriage in children. The carriage of Campylobacter in children in this community indicates a need for further investigation on source attribution to understand transmission dynamics and inform where to target interventions. Awareness creation among caregivers on good personal and food hygiene is needed, including boiling milk before consumption. Implementation of biosecurity measures at the household level is highly recommended to reduce contact between animals and humans.

Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach

BackgroundThe climate of southern Africa is expected to become hotter and drier with more frequent severe droughts and the incidence of diarrhoea to increase. From 2015 to 2018, Cape Town, South Africa, experienced a severe drought which resulted in extreme water conservation efforts. We aimed to gain a more holistic understanding of the relationship between diarrhoea in young children and climate variability in a system stressed by water scarcity.MethodsUsing a mixed-methods approach, we explored diarrhoeal disease incidence in children under 5 years between 2010 to 2019 in Cape Town, primarily in the public health system through routinely collected diarrhoeal incidence and weather station data. We developed a negative binomial regression model to understand the relationship between temperature, precipitation, and relative humidity on incidence of diarrhoea with dehydration. We conducted in-depth interviews with stakeholders in the fields of health, environment, and human development on perceptions around diarrhoea and health-related interventions both prior to and over the drought, and analysed them through the framework method.ResultsFrom diarrhoeal incidence data, the diarrhoea with dehydration incidence decreased over the decade studied, e.g. reduction of 64.7% in 2019 [95% confidence interval (CI): 5.5–7.2%] compared to 2010, with no increase during the severe drought period. Over the hot dry diarrhoeal season (November to May), the monthly diarrhoea with dehydration incidence increased by 7.4% (95% CI: 4.5–10.3%) per 1 °C increase in temperature and 2.6% (95% CI: 1.7–3.5%) per 1% increase in relative humidity in the unlagged model. Stakeholder interviews found that extensive and sustained diarrhoeal interventions were perceived to be responsible for the overall reduction in diarrhoeal incidence and mortality over the prior decade. During the drought, as diarrhoeal interventions were maintained, the expected increase in incidence in the public health sector did not occur.ConclusionsWe found that that diarrhoeal incidence has decreased over the last decade and that incidence is strongly influenced by local temperature and humidity, particularly over the hot dry season. While climate change and extreme weather events especially stress systems supporting vulnerable populations such as young children, maintaining strong and consistent public health interventions helps to reduce negative health impacts.

Assessing the Knowledge, Attitude and Practices among Health Workers on Rotavirus Diarrhoea Prevention in Rukiga District

Purpose: Rotavirus has been identified as the most common pathogen associated with severe diarrhoea. Rotavirus infection is the leading cause of diarrhea in children under five and it is highly contagious. It poses an exception to typical diarrheal disease management rules. While improved access to clean water and better sanitation and hygiene practices are vital to preventing most diarrheal diseases, they have done little to disrupt infection. The virus may cause severe, dehydrating diarrhea in young children and, in untreated cases, lead to death. The aim of this study is to determine the knowledge, attitude and practices regarding Rotavirus Prevention and its vaccination among medical workers in Rukiga district&#x0D; Methodology: A total of 263 health workers were selected through random sampling. A structured and validated questionnaire was used. Questions about knowledge, attitude and practices were collected and verified on scale. Descriptive statistics were presented; multivariable regression analysis was done to determine the correlation of knowledge, attitude level, and practices with socio demographic variables such as age, sex and education. The p value≤0.05 considered was statistically significant.&#x0D; Findings: 118(47.14%) had adequate knowledge, 164(66.138%) positive attitude and 102(41.1%) appropriate practices on the Rotavirus diarrhoea prevention. Knowledge, attitude level and practices were increased significantly with increasing age, sex and education. After controlling for variables in the multivariable regression model, age, sex and education were the significant factors in determining the scores on knowledge, attitude and practices. About the knowledge. Age (β=4.15, p&lt;0.001), sex (β=3.012, p=0.001) and education level (β=14.04, p&lt;0.038), then attitude, age (β=4.32, p&lt;0.001), sex (β=0.015, p=0.003) and education level (β=0.021, p&lt;0.001) while for practices, age (β=0.021, p&lt;0.001). Similarly, sex (β=0.022, p&lt;0.001), education level (β=0.136, p=0.006). Generally, there was inadequate knowledge, positive attitude and inappropriate practices amongst the respondents on Rotavirus diarrhoea prevention in Rukiga District.&#x0D; Recommendations: Rukiga District needs to train, mentor and coach the health workers on prevention of Rotavirus including vaccination in order to have increased knowledge level, positive attitude and appropriate actions.

Microbiota-produced indole metabolites disrupt mitochondrial function and inhibit Cryptosporidium parvum growth

Cryptosporidiosis is a leading cause of life-threatening diarrhea in young children in resource-poor settings. To explore microbial influences on susceptibility, we screened 85 microbiota-associated metabolites for their effects on Cryptosporidium parvum growth invitro. We identify eight inhibitory metabolites in three main classes: secondary bile salts/acids, a vitamin B6 precursor, and indoles. Growth restriction of C.parvum by indoles does not depend on the host aryl hydrocarbon receptor (AhR) pathway. Instead, treatment impairs host mitochondrial function and reduces total cellular ATP, as well as directly reducing the membrane potential in the parasite mitosome, a degenerate mitochondria. Oral administration of indoles, or reconstitution of the gut microbiota with indole-producing bacteria, delays life cycle progression of the parasite invitro and reduces the severity of C.parvum infection in mice. Collectively, these findings indicate that microbiota metabolites impair mitochondrial function and contribute to colonization resistance to Cryptosporidium infection.

Classification of group A rotavirus VP7 and VP4 genotypes using random forest.

Introduction: Group A rotaviruses are major pathogens in causing severe diarrhea in young children and neonates of many different species of animals worldwide and group A rotavirus sequence data are becoming increasingly available over time. Different methods exist that allow for rotavirus genotyping, but machine learning methods have yet to be explored. Usage of machine learning algorithms such as random forest alongside alignment-based methodology may allow for both efficient and accurate classification of circulating rotavirus genotypes through the dual classification system. Methods: Random forest models were trained on positional features obtained from pairwise and multiple sequence alignment and cross-validated using methods of repeated 10-fold cross-validation thrice and leave one- out cross validation. Models were then validated on unseen data from the testing datasets to observe real-world performance. Results: All models were found to perform strongly in classification of VP7 and VP4 genotypes with high overall accuracy and kappa values during model training (0.975-0.992, 0.970-0.989) and during model testing (0.972-0.996, 0.969-0.996), respectively. Models trained on multiple sequence alignment generally had slightly higher overall accuracy and kappa values than models trained on pairwise sequence alignment method. In contrast, pairwise sequence alignment models were found to be generally faster than multiple sequence alignment models in computational speed when models do not need to be retrained. Models that used repeated 10-fold cross-validation thrice were also found to be much faster in model computational speed than models that used leave-one-out cross validation, with no noticeable difference in overall accuracy and kappa values between the cross-validation methods. Discussion: Overall, random forest models showed strong performance in the classification of both group A rotavirus VP7 and VP4 genotypes. Application of these models as classifiers will allow for rapid and accurate classification of the increasing amounts of rotavirus sequence data that are becoming available.

Open-label, randomised controlled trial found that a green banana mixed rice suji diet was most effective for persistent diarrhoea in children in Bangladesh.

Persistent diarrhoea continues for at least 14 days and kills more children than acute diarrhoea. We assessed whether rice suji, green banana mixed rice suji or 75% rice suji improved persistent diarrhoea compared in young children. This open-labelled randomised controlled trial was carried out between December 2017 and August 2019 at the Dhaka Hospital of icddr,b, Bangladesh, with 135 children aged 6-35 months with persistent diarrhoea. The children were randomly assigned to green banana mixed rice suji, rice suji, or 75% rice suji, with 45 in each group. The primary outcome was the percentage who recovered from diarrhoea by day five using an intention to treat analysis. The children's median age was eight months (interquartile range 7-10 months). By day five the recovery rate was 58%, 31% and 58% children in the green banana mixed rice suji, rice suji and 75% rice suji groups, respectively. The green banana mixed rice suji group had fewer relapses (7%) than the 75% rice suji group (24%). Enteroaggregative Escherichia coli, rotavirus, norovirus, Enteropathogenic Escherichia coli, astrovirus and Campylobacter were the major pathogens for persistent diarrhoea. Green banana mixed rice suji was the most effective option for managing persistent diarrhoea in young children.

Management of Diarrhea in Young Children in Sub-Saharan Africa: Adherence to World Health Organization Recommendations During the Global Enteric Multisite Study (2007-2011) and the Vaccine Impact of Diarrhea in Africa (VIDA) Study (2015-2018).

Reducing diarrhea-related morbidity and mortality is a global priority, particularly in low-resource settings. We assessed adherence to diarrhea case management indicators in the Global Enteric Multisite Study (GEMS) and Vaccine Impact of Diarrhea in Africa (VIDA) study. GEMS (2007-2010) and VIDA (2015-2018) were age-stratified case-control studies of moderate-to-severe diarrhea (MSD) in children aged <5 years. In this case-only analysis, we included children enrolled in The Gambia, Kenya, and Mali. A case with no dehydration received adherent care at home if they were offered more than usual fluids and at least the same as usual to eat. Children with diarrhea and some dehydration are to receive oral rehydration salts (ORS) in the facility. The recommendation for severe dehydration is to receive ORS and intravenous fluids in the facility. Adherent care in the facility included a zinc prescription independent of dehydration severity. For home-based management of children with MSD and no signs of dehydration, 16.6% in GEMS and 15.6% in VIDA were adherent to guidelines. Adherence to guidelines in the facility was likewise low during GEMS (some dehydration, 18.5%; severe dehydration, 5.5%). The adherence to facility-based rehydration and zinc guidelines improved during VIDA to 37.9% of those with some dehydration and 8.0% of children with severe dehydration. At research sites in The Gambia, Kenya, and Mali, suboptimal adherence to diarrhea case management guidelines for children aged <5 years was observed. Opportunities exist for improvement in case management for children with diarrhea in low-resource settings.

Genome-Wide Association Studies of Diarrhea Frequency and Duration in the First Year of Life in Bangladeshi Infants.

Diarrhea is the second leading cause of death in children under 5 years old worldwide. Known diarrhea risk factors include sanitation, water sources, and pathogens but do not fully explain the heterogeneity in frequency and duration of diarrhea in young children. We evaluated the role of host genetics in diarrhea. Using 3 well-characterized birth cohorts from an impoverished area of Dhaka, Bangladesh, we compared infants with no diarrhea in the first year of life to those with an abundance, measured by either frequency or duration. We performed a genome-wide association analysis for each cohort under an additive model and then meta-analyzed across the studies. For diarrhea frequency, we identified 2 genome-wide significant loci associated with not having any diarrhea, on chromosome 21 within the noncoding RNA AP000959 (C allele odds ratio [OR] = 0.31, P = 4.01 × 10-8), and on chromosome 8 within SAMD12 (T allele OR = 0.35, P = 4.74 × 10-7). For duration of diarrhea, we identified 2 loci associated with no diarrhea, including the same locus on chromosome 21 (C allele OR = 0.31, P = 1.59 × 10-8) and another locus on chromosome 17 near WSCD1 (C allele OR = 0.35, P = 1.09 × 10-7). These loci are in or near genes involved in enteric nervous system development and intestinal inflammation and may be potential targets for diarrhea therapeutics.

Evaluation of fecal occult blood testing for rapid diagnosis of invasive diarrhea in young children.

Antimicrobials are only indicated in acute childhood diarrhea if it is invasive or persistent. Rapid screening for invasive diarrhea can therefore inform treatment decisions but pathogen identification by culture is slow, expensive and cumbersome. This study aimed to assess the diagnostic utility of stool microscopy and immunochromatographic fecal occult blood test (FOBT) kits for identifying invasive or potentially invasive diarrhea in Ibadan, Nigeria. Fecal specimens from 46 children under 5 years old with diarrhea, collected as part of ongoing case-control studies, were subjected to stool microscopy for erythrocytes and leucocytes, and FOBT using the innovator's product and four locally procurable generic immunochromatographic kits, each according to manufacturers' instructions. Stool specimens were cultured for enteric bacterial pathogens using standard procedures. Presumptive pathogen isolates were identified biochemically and by PCR, and then confirmed by whole genome sequencing. Shigella, enteroinvasive Escherichia coli and Yersinia, pathogens that invariably cause invasive diarrhea, were detected in five of 46 specimens. Occult blood detection by microscopy was 55.6% sensitive and 78.4% specific, while the innovator's FOBT product was respectively 62.5% and 81.6% sensitive and specific compared to strict invasive pathogen recovery. Microscopy and FOBT testing were less sensitive in identifying specimens that contained pathogens that do not always elicit invasive diarrhea. Generic FOBT tests compared well with the innovator's product. Microscopy and FOBT testing have some value for delineating likely invasive diarrheas. They could inform treatment and serve as early warning indicators for dysentery outbreaks in resource limited settings. Inexpensive, generic FOBT kits that are locally procurable in Nigeria performed as well as the innovator's product.

Intestinal disorders after acute diarrhea in young children and their coprological predictors

Background. After acute diarrhea in young children, intestinal disturbances and even chronic functional intestinal diseases may occur. To date, no pathogenetically based criteria have been found that would indicate the probability of chronic intestinal disorders, just as the mechanisms of their occurrence after acute diarrhea have not been fully elucidated. The objective: to evaluate the frequency and nature of bowel disorders in children of the younger age group within 6 months after a stay in hospital for acute diarrhea and to establish their relationship with coprological indicators — fecal calprotectin (FCР), the content of carbohydrates (reducing substances, RS), lactic acid (LA) and short-chain fatty acids (SCFA) — acetic, propionic and fatty (butyric). Materials and methods. The study involved 47 children aged 6–24 months who were hospitalized for acute diarrhea. Acute enterocolitis (group I) was diagnosed in 18 patients and was caused by Campylobacter jejuni in 12 cases, Escherichia coli O-18 and Escherichia coli O-44 in 3, Salmonella enteritidis in 2 and Yersinia enterocolitica in one case. Rotaviral gastroenteritis (group II) was diagnosed in 11 patients. Another 11 children had acute symptomatic (parenteral) diarrhea (group III) against the background of intestinal infection — acute otitis, pneumonia, pyelonephritis. In 7 children, diarrhea was classified as functional digestive disorder (group IV). Routine clinical tests were supplemented with an examination of feces for the presence of intestinal parasites, Clostridium difficile A/B toxins, adenoviruses, human hemoglobin, RS, FCP, SCFA and LA. Results. Six-month follow-up established that 14 of 18 children in group I had permanent or temporary loose stools. These complaints in 13 cases were combined with episodes of abdominal pain similar to intestinal colic. The same complaints were much less frequent in children of group II (6 and 3 of 11, respectively), group III (4 and 2 of 11) and group IV (only in 2 of 7 children). The rank correlation analysis did not reveal any significant relationships between the intensity and duration of complaints and FCP, RS, LA, and SCFA in patients of groups I and II. On the contrary, in group III, there were multiple correlations of complaints with FCP, RS, LA, and SCFA. In group IV, the association of loose stools with an increase in LA and acetic acid has been found. Conclusions. According to the 6-month follow-up, 57 % of young children with acute diarrhea complained of loose stools and/or recurrent abdominal pain after discharge from the hospital. Most often, intestinal disorders were detected in children who had acute bacterial enterocolitis. There were no correlations between the intensity of post-infectious (bacterial or viral) disorders with FCP, RS, LA and SCFA during hospitalization. In contrast, such associations were numerous in children with symptomatic (parenteral) and functional diarrhea. It was suggested that the studied coprological parameters can be used to predict the state of the intestine after acute diarrhea.

The electrolyte abnormalities and duration of hospitalisation in children with gastroenteritis

Background: Diarrhoea remains one of the major causes of death among infants significantly in Asia, Africa and Latin America. The major contributing factors for higher incidence and mortality rates are improper sanitation, unsafe drinking water, physiological conditions like malnutrition, weak immune system.Rotavirus is the major causative agent of diarrhoea in young children in developed and undeveloped countries. Electrolyte abnormalities is the leading causes of morbidity and mortality in younger children with acute gastroenteritis and increased mortality is seen in malnourished children. The common abnormalities associated with acute gastroenteritis are hyponatremia and hypokalaemia. The average duration of hospital stay is 2.5 days.Methods: This is a descriptive cross-sectional study which studied 173 patients of acute gastroenteritis which have been admitted to the CMC, Tehran in 1 year. (June 2021-May2022).Results: In this study 173 patients were studied. 101 patients (58.4%) were infants, 55 patients (31.8%) were preschool children and 17 patients (9.8%) were older children. 70 patients (40.5%) were females and 103 patients (59.5%) were males. The most common electrolyte abnormality that was encountered in this study is hyponatremia (51.4%) &gt;hypokalaemia (11.6%) &gt;hypernatremia (6.9%) &gt;hyperkalaemia (1.2%).Conclusions: The order of electrolyte abnormalities seen: Hyponatremia (51.4%), hypokalaemia (11.6%), hypernatremia (6.9%), hyperkalaemia (1.2%). Duration of hospitalisation is 1 day for majority of the patients and is high for patients with hyponatremia.

Epidemiology of Human Adenovirus in Pakistani Children Hospitalized with Community-Acquired Gastroenteritis under the Age of Five Years.

Acute gastroenteritis is the major cause of morbidity and mortality among infants and children around the globe. Along with other enteropathogens, human adenovirus (HadV) is a major etiological agent associated with diarrhea in young children. However, information about the epidemiology of Adenoviruses in Pakistan is limited or has not been reported. A total of 1082 stool samples were collected from patients with acute gastroenteritis under the age of five years with symptoms of diarrhea, vomiting, nausea, and abdominal cramps who visited Benazir Bhutto Hospital Rawalpindi and Children’s hospital in Lahore of Punjab Province in Pakistan. Of this, 384 cases with no blood in their stool, negative for Rotavirus, and under the age of five years were recruited in this study. Human Adenoviruses were isolated in the human epithelial HEp-2 cell line. Furthermore, adenovirus antigen detection was carried out by an enzyme-linked immunosorbent assay (ELISA), and then all positive and negative samples were confirmed by nested PCR. After inoculating a clear stool supernatant on HEp-2 cell lines, we observed a positive cytopathic effect in 65 (16%) cases. Using an enzyme-linked immunosorbent assay, HAdV antigens were detected in 54 (14.06%) of the clear supernatant from gastroenteritis cases. However, HAdV hexon coding regions were amplified in 57 (14.80%) fecal samples, mainly from patients ≤24 months of age. The findings of this study suggest that adenovirus circulates significantly in the children population under the age of five years and may be the potential etiological factor of acute gastroenteritis in the mentioned cities. This study provides baseline data about the possible role of adenovirus in causing viral diarrhea in children. Further large-scale epidemiological surveys are recommended to better understand disease burden, etiological agents, and its clinical impact across the country.