Diarrhea Research Articles

Overexpressed Palladin Rescues Enteropathogenic E. coli (EPEC) Pedestal Lengths in ArpC2 Depleted Cells.

Enteropathogenic Escherichia coli (EPEC) causes diarrheal disease. Once ingested, these extracellular pathogens attach to the intestinal epithelial cells of their host, collapse the localized microvilli, and generate actin-rich structures within the host cells that are located beneath the attached bacteria, called "pedestals." Palladin is an actin-associated protein that cross-links and stabilizes actin filaments. This protein also acts as a scaffolding protein for other actin-binding proteins. Here, we examine the role of Palladin during EPEC infections and show that Palladin is co-opted by EPEC. Depletion of Palladin resulted in shorter pedestals, and when Palladin containing mutations in either its actin- or VASP-binding domains were overexpressed in cells, pedestals decreased in length. Importantly, we show that the overexpression of Palladin in ArpC2-/- (Arp2/3 complex-depleted) cells rescued pedestal length. Together, our results demonstrate that Palladin has the ability to rescue pedestal length during EPEC infections when the function of the Arp2/3 complex is diminished.

Systemic sclerosis-related fecal incontinence: a scoping review focusing on a neglected manifestation.

This scoping-review sought to summarize the current knowledge on the epidemiology, pathogenesis, clinical presentation, and the investigations that may help characterize faecal incontinence (FI) in patients with systemic sclerosis (SSc). The planned scoping review was based on the methodological framework proposed by Arksey & O'Malley.Two databases were screened: PubMed (Medline), (webofSciences), data extraction was performed using a predefined template. 454 abstracts were screened and 61 articles were finally included, comprising 32 original articles. The prevalence of FI was 0,4% to 77% in original articles that did not use FI among the mandatory inclusion criteria. Internal anal sphincter was reported as more impacted than external sphincter and vasculopathy of arterioles and extra-cellular matrix deposition with fibrous replacement of the internal sphincter were the key underlaying pathogenic events. The most represented PRO in original articles was the Wexner FI score (22% of original articles) followed by the UCLA SCTC-GIT 2.0 (16% of original articles). Although there is no validated diagnostic approach for FI in SSc, 47% of original articles used anorectal manometry to assess rectal physiology in SSc patients. Conservative measures to treat either liquid or hard stool including anti-diarrheal medications and dietary adjustments were the first step of proposed FI management in included narrative reviews and guidelines. This is the first scoping review exploring FI in SSc. We propose a new research agenda which may help improve treatment strategies and foster research focusing on a neglected manifestation of SSc.

Unveiling Balantidium coli : A rare protozoan causing a series of cases of dysentery in Rajasthan and review of literature.

Balantidium coli is the largest, uncommon, and only ciliate parasite that infects humans and is more common in tropics and subtropical regions. It is mostly asymptomatic, but can cause diarrhea and abdominal pain and sometimes leads to perforation of the colon. It is harbored in animals, particularly among pigs in hotter environments and monkeys in the jungles. If not treated on time, it may lead to perforation of the large intestine, peritonitis, appendicle involvement, etc. It is more common in immune-compromised individuals, particularly in those living in poor hygienic conditions. Retrieval of rare parasites was possible only because of prompt stool transport and its early processing. There are only few previous reports regarding the pediatric cases of balantidiasis, and there is a little information about its clinical signs and treatment. Here, we report a case series of B. coli infection presenting as an acute diarrheal disease from Rajasthan.

PERILAKU IBU TERHADAP PENCEGAHAN DAN PENGOBATAN PENYAKIT DIARE PADA BALITA DI KELURAHAN KARANG PULE KECAMATAN SEKARBELA KOTA MATARAM TAHUN 2024

Diarrhea is defecated in a liquid form more than three times a day and usually lasts for two or more days. The most prone to diarrhea groups are 2-3 years, although many have also found relatively young sufferers between 6 months and 12 months. The purpose of this study is to know how mothers behave in the prevention and diarrhea treatment of toddlers in the pule coral region mataram city.The method of research used is descriptive research. The population and samples on this study are mothers who have children with diarrhea, the sample collection technique used is proposive sempling with as many as 81 respondents.Studies have shown that sufficient behaviors of respondents (mothers) (87.65%), diarrheal prevention measures are said to be sufficient with a percentage (85.55%) and diarrhea treatment is said to be less than a percentage (62.96%).Conclusion, the vast majority of infant respondents (mothers) who suffer from adequate adverse diarrhea while in the treatment of diarrheal diseases in toddlers are less. It is expected that health-care workers will be able to educate about treatment and prevention of disease in the area.

Diarrhoeagenic Escherichia Coli Isolated from Children with Acute Diarrhoea by Culture and Multiplex PCR in Tertiary Care Hospitals of Dhaka, Bangladesh

Background: Diarrhoeal diseases are a major childhood health problem and an important cause of morbidity and mortality, especially in developing countries. Objective: This study aimed to detect Diarrhoeagenic Escherichia coli (DEC) by detecting virulence genes (lt, st, bfp, and aat) and to determine the antimicrobial susceptibility pattern of all identified DEC isolates in fecal samples. Methodology: This cross-sectional study was carried out in the Department of Microbiology at Dhaka Medical College Hospital, Dhaka, Bangladesh and Dhaka Shishu Hospital, Dhaka, Bangladesh from July, 2012 to June, 2013 for around one year. Identification of Diarrhoeagenic Escherichia coli (DEC) in fecal samples from children under 5 years old was done by culture and standard biochemical tests. Virulence factor genes for DEC were detected by Polymerase Chain Reaction (PCR). Susceptibility to antimicrobial agents of all identified DEC isolates was observed by disc diffusion method. Results: Out of total 200 stool samples, E. coli was isolated in 130(65.0%). The prevalence of DEC was 52(40.0%) and the most common was enterotoxigenic Escherichia coli (55.8%) followed by enteropathogenic Escherichia coli (34.6%) and enteroaggregative Escherichia coli (26.9%). Among 52 DEC, 12(23.1%) contained more than one pathogenic genes of DEC in various combinations. Colistin, imipenem and amikacin were found to be the most effective against isolated DEC. Most of the strains were resistant to ampicillin, erythromycin, tetracycline and nalidixic acid. Conclusion: Differentiation between the Diarrhoeagenic Escherichia coli pathotypes is of great importance since they are involved in acute diarrhoeal diseases and may require specific antimicrobial chemotherapy. Bangladesh Journal of Medical Microbiology, January 2024;18(1):17-21

High prevalence of CTX-M-15 producing Shigella spp. isolated from patients with gastroenteritis in Northeast Iran.

Shigellosis, a diarrheal disease caused by Shigella species, is a significant public health concern, particularly in developing countries with inadequate sanitation systems. This study aimed to investigate the patterns of antibiotic resistance, ESBL and AmpC genes, integrons, and enterotoxin genes in Shigella species isolated from patients with gastroenteritis in Northeast Iran. This cross-sectional study was conducted between January 2017 and December 2019 at a tertiary care hospital in Northeast Iran. Atotal of 110 Shigella isolates were collected from stool samples of patients with gastroenteritis. The isolates were identified using conventional biochemical tests and confirmed by PCR. The highest resistance rates were detected for ampicillin (88.2%) and cotrimoxazole (84.5%). Altogether 64.5% of isolates exhibited multidrug resistance however, ESBL and AmpC phenotypes were detected in 34.54% and 1.81% of isolates, respectively. Interestingly, blaCTX-M-15 and blaTEM were detected in all ESBL-positive isolates but integron class 1, 2, and 3 were identified in 97.3%, 76.4%, and 59.1% of isolates, respectively. The sen gene was present in 72.7% of the isolates. In this study CTX-M-15 production was detected in 31 strains of Shigella sonnei and in 7 strains of Shigella flexneri. The high prevalence of multidrug-resistant Shigella isolates is concerning and shows the need for continuous monitoring and rational use of antibiotics.

Geography, Antimicrobial Resistance, and Genomics of Salmonella enterica (Serotypes Newport and Anatum) from Meat in Mexico (2021–2023)

Salmonella enterica non-typhoidal is a major contributor to diarrheal diseases, with over 2600 serovars identified across diverse environments. In Mexico, serovars Newport and Anatum have shown a marked increase, especially in foodborne disease, posing a public health problem. We conducted a cross-sectional study from 2021 to 2023 using active epidemiological surveillance to assess contamination in ground beef and pork at butcher shops nationwide. It involved isolation, phenotypic antimicrobial resistance, comparative genomics, spatial distribution, antimicrobial-resistance genes, and pangenome analysis. A total of 402 non-typhoidal S. enterica strains were isolated, including 59 Newport and 50 Anatum. After curating for redundancy, 45 Newport and 32 Anatum strains remained. We found that 75% of Newport strains exhibited multidrug resistance (MDR), compared to 25% of Anatum strains. Salmonella Newport also showed a broader distribution and stronger antibiotic-resistance capacity, particularly due to genes such as mphA and ramA. Our pangenome analysis showed a predominance of cell maintenance and survival-process genes in the accessory genome of both serotypes. Considering unique genes, Salmonella Anatum and Newport showed a notorious abundance of genes with functions related to replication, recombination, and repair. The substantial rise of Anatum and Newport strains in meat samples for human consumption presents an epidemiological alert, highlighting the critical need for stringent surveillance programs to mitigate human and ecosystem health risks.

Anti-CdtB and anti-vinculin antibodies to diagnose irritable bowel syndrome in inflammatory bowel disease patients

BackgroundDespite adequate treatment, a subgroup of patients with inflammatory bowel disease (IBD), including Crohn`s disease and ulcerative colitis, have persistent gastrointestinal symptoms that are not always related to mucosal damage. Recently, two autoantibodies, anti-CdtB and anti-vinculin, were validated as post-infectious IBS (PI-IBS) markers, however there is limited evidence of its diagnostic role in IBD population.MethodsPatients with more than 3 bowel movements/day and indication of colonoscopy were enrolled. Samples were collected at the time of colonoscopy for assessment of serum levels of anti-CdtB and anti-vinculin antibodies.ResultsA total of 160 subjects were included in 4 groups: active IBD (n = 44); quiescent IBD and chronic diarrhea IBD-IBS (n = 25); predominant-diarrhea IBS (n = 45) and controls (n = 46). The mean value of the optical density for anti-CdtB was 1.2 ± 0.65 in group 1, 1.27 ± 0.64 in group 2, 1.49 ± 0.47 in the group 3 and 1.6 ± 0.68 in group 4, p = 0.012. For anti-vinculin, optical densities were: 1.34 ± 0.78 in group 1, 1.46 ± 0.92 in group 2, 1.31 ± 0.79 in group 3 and 1.41 ± 0.86 for controls (p = 0.875). Using a cut-off of 1.56 for anti-CdtB, the positivity between groups was n = 10 (22.7%) in group 1, n = 9 (34.6%) in group 2, 19 (43.2%) in group 3, 21 (45.7%) in group 4 (p = 0.106). The positivity of anti-vinculin using a cut-off of 1.6 was n = 18 (40.9%) in group 1, n = 11 (42.3%), n = 15 (34.1%), n = 22 (47.8%) (p = 0.622).ConclusionsOur findings show that anti-CdtB and anti-vinculin could not identify IBD-IBS patients or discriminate IBS-D from healthy controls.

Infantile nephrocalcinosis with chronic diarrhea.

A 3-month-old girl presented with symptoms indicative of dysuria, gross hematuria, chronic diarrhea, and nephrocalcinosis. She was born to fourth-degree consanguineous parents. The infant exhibited hypercalciuria and hyperoxaluria, and her stool tested positive for reducing sugars. She responded positively to dietary lactose restriction, and her hyperoxaluria improved over the course of 3months. This suggests an enteric hyperoxaluria phenotype, although her hypercalciuria persisted. Whole exome sequencing identified a homozygous variant in the LCT gene, which is associated with congenital lactase deficiency, as well as a heterozygous variant in the ADCY10 gene, which is linked to absorptive hypercalciuria.

Epidemiology of Rome IV Fecal Incontinence in Japan: An Internet Survey of 9995 Individuals.

Fecal incontinence (FI) is a debilitating condition defined as recurrent uncontrolled passage of fecal material according to Rome IV. Although FI greatly impacts patients' health-related quality of life (HRQOL), there have been few studies about the prevalence of FI in the Japanese general population. The aim of this study was to investigate the epidemiology of FI using Rome IV criteria in Japan. This was a cross-sectional internet survey for Japanese individuals aged 18 to 79 years using a questionnaire about demographics, comorbidities, lifestyle, abdominal symptoms, bowel habits, HRQOL, and disorders of gut-brain interaction according to Rome IV diagnostic criteria. Multivariate linear regression analysis identified factors associated with FI fulfilling Rome IV criteria (Rome IV FI). Overall, 9995 subjects were analyzed. Of which, 9.5% of the participants had at least one episode of FI in the last 3 months, and the prevalence of Rome IV FI was 1.2%. HRQOL was significantly impaired in patients with Rome IV FI compared to continent individuals. Major functional bowel disorders overlapped with 39.5% of Rome IV FI where functional diarrhea (25.8%) was the most predominant. The overlap further impaired HRQOL in Rome IV FI patients. Alcohol consumption (odds ratio 1.82, 95% CI 1.24-2.66, p = 0.002) was independently related to Rome IV FI apart from gastroesophageal reflux disease, irritable bowel syndrome, functional abdominal bloating/distension, and functional diarrhea. The prevalence of Rome IV FI was 1.2% in Japan. Further study is warranted to investigate the effect of lifestyle modification on the management of FI.

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

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

A perspective on the 2021 GBD study of diarrhoeal diseases

A perspective on the 2021 GBD study of diarrhoeal diseases

Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

Coinfection and Clinical Impact of Enterotoxigenic Escherichia coli Harboring Diverse Toxin Variants and Colonization Factors: 2017-2022.

The severity of the diarrhea disease is exacerbated by co-infections that involve Enterotoxigenic Escherichia coli (ETEC) and other enteric pathogens, which complicate the diagnosis and treatment. This study explores the prevalence, clinical manifestations, and risk factors of ETEC and its co-infections in Dhaka, Bangladesh. The study used data from the Diarrheal Disease Surveillance System at Dhaka Hospital, involving 16,276 patients from 2017-2022. We identified 1404 ETEC-positive patients from the 16,276 data points to investigate the association between ETEC infections, co-infections, and clinical outcomes. ETEC was identified in 1404 (8.6%) of cases, representing the most common infection among adults (56.6%). ETEC co-infection occurred combined with Vibrio cholerae (23%), Aeromonas (14.6%), rotavirus (11.8%), Campylobacter (6.5%), and Shigella spp. (1.7%), respectively. Adults were more likely to develop co-infections with ETEC and Vibrio cholerae, while children under five were more likely to develop ETEC co-infections with rotavirus. Co-infections with V. cholerae, rotavirus, and Salmonella spp. increased the likelihood of fever, while ETEC co-infections with V. cholerae increased risks of vomiting, dehydration, and intravenous fluids. ETEC and co-infections exacerbate illness severity and overburden healthcare systems. Policymakers should prioritize resilient healthcare strategies for ETEC and co-infections.

A perspective on nanomaterials against Campylobacter jejuni biofilm - new control strategies.

Campylobacter jejuni - a Gram-negative bacterium - is considered the fourth cause of diarrheic diseases that can form biofilms (mono and multi-species) or colonize pre-existing biofilms adhering to both, inert or biotic surfaces; its biofilms contribute to transmission through the food chain and survival under harsh environmental conditions. Thus, developing alternatives against this pathogen is compulsory. Nanomaterials have revolutionized the way of fighting infections related to biofilms due to their unique properties compared to traditional antibiotics. Nanomaterials have also been used against C. jejuni based on zinc, titanium, silver, molybdenum, magnesium, cobalt, erbium, lithium, nickel, hydroxide, polyethylene, graphene, lipids, chitosan, and poly(lactic-co-glycolic acid) (PLGA). Those organic and inorganic materials have synthesized nanoparticles, nanofillers, nanowires, nanoferrites, double layers, nanocomposites, and films that have encapsulated, entrapped, coated or doped molecules. Additionally, bare metal nanoparticles have been tested by their antimicrobial activity on planktonic and sessile forms. Therefore, the present review aimed to describe general biology virulence factors, host-pathogen relationships and biofilm formation, as well as nanomaterials and nanoparticles fighting against C. jejuni biofilms. Considerations are presented and placed in perspective.

Acute diarrhoeal disease among under-five children presenting at a paediatric referral Facility in Lagos, Nigeria

Background: The morbidity and mortality from acute diarrhoeal disease remain significantly high especially in low and middle income countries. Aim: This study was carried out to determine the prevalence of acute diarrhoea, and the associated risk factors among under-five children seen at a paediatric referral facility in Lagos, Nigeria. Methods: This was a cross-sectional descriptive study of under-five children who presented with acute diarrhoeal disease at the Children Emergency Room and General Out-Patient Clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, South-Western Nigeria. Information was obtained on socio-demographic characteristics, environmental/ hygienic practices, feeding practices and immunization status. Results: The prevalence of acute diarrhoea was 400 of 4836(8.3%) under-five children. Three hundred and ninety-five (73.7%) of these children were aged less than two years. The identified associated risk factors for acute diarrhoea among children aged less than two years were use of feeding bottles (OR 12.4; 95% CI 1.8-7.2; p= 0.000), failure to complete immunization(OR 13.0; 95% CI 3.1-43.3; p= 0.000), attendance of crèches (OR 47.1; 95% CI 15.6-141.1; p= 0.000), failure to exclusively breastfeed (OR 6.7; 95% CI 1.3-6.7; p= 0.010) and malnutrition (OR 3.9; 95% CI 1.0-20.3; p= 0.049). Conclusions: Acute diarrhoea remain a significant public health burden affecting majorly children aged less than two years. Efforts at prevention of diarrhoeal disease burden should focus on improvement of hygienic and feeding practices.

Addition of hydrogen peroxide to natural ferruginous water improves the efficacy of SODIS method against the waterborne pathogen Cryptosporidium

The enhancement of SODIS method against the waterborne pathogen Cryptosporidium by incorporating H2O2 in natural ferruginous water (NFW) was evaluated. Polyethylene terephthalate bottles containing distilled water or different NFW with added different concentrations of H2O2 (0–100 mg L−1) were spiked with Cryptosporidium parvum oocysts and exposed to simulated and natural solar radiation. Oocyst viability was evaluated by induced excystation and inclusion/exclusion of the vital dye propidium iodide (PI). The experiments performed under sunlight showed better C. parvum inactivation rates than those under simulated solar radiation. Oocyst viability rates of 2.26±1.91% and 16.52±3.83% were determined by induced excystation and inclusion/exclusion of PI, respectively, after exposure to natural sunlight during 6 h in NFW with 100 mg L−1 of H2O2. This study proves the enhancement in the effectiveness of conventional SODIS by the addition of H2O2 to natural ferruginous waters, speeding up the C. parvum oocyst inactivation. Since surface waters in countries where the SODIS method can be used often contain dissolved iron salts, the addition of small amounts of H2O2 will increase the microbiological quality of drinking waters and consequently would decrease the risk of diarrhoeal diseases in the population, having a positive impact in terms of development and poverty reduction.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses, including incision and drainage alone or combined concurrent fistulotomy, remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula. AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures. METHODS In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included. A new classification for anorectal abscesses based on their propensity to develop into fistulas, considering 18 other potential risk factors, was established. These factors, from electronic medical records, were screened for significance using the χ ² test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses. RESULTS One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively. Univariate χ ² analysis showed significant differences in recurrence rates based on anatomical classifications and pus culture results (P < 0.05). Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective (P < 0.05). Moreover, fistula-prone abscess [odds ratio (OR) = 7.651, 95%CI: 4.049–14.458, P < 0.001], ≥ 7 days from symptom onset to surgery (OR = 2.137, 95%CI: 1.090–4.190, P = 0.027), chronic diarrhea (OR = 2.508, 95%CI: 1.216–5.173, P = 0.013), and local anesthesia (OR = 2.308, 95%CI: 1.313–4.059, P = 0.004) were independent risk factors for postoperative anorectal abscess recurrence using multivariate logistic regression. Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203–7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess. CONCLUSION The choice of surgical procedure for treating anorectal abscesses should follow this new classification. Prompt and thorough incision and drainage can significantly reduce postoperative recurrence.

Recombinant Saccharomyces cerevisiae EBY100/pYD1-FaeG: a candidate for an oral subunit vaccine against F4+ ETEC infection.

Diarrheal diseases attributable to multidrug-resistant F4+ enterotoxigenic Escherichia coli (ETEC) are escalating in severity, posing significant risks to the health and safety of both humans and animals. This study used Saccharomyces cerevisiae EBY100 to display the FaeG subunit of F4 colonizing factor as an oral vaccine against F4+ ETEC infection. Mice were orally immunized twice with 108 CFU of EBY100/pYD1-FaeG, followed by a challenge with F4+ ETEC EC6 on day 7 post-immunization. The results showed that the recombinant strain EBY100/pYD1-FaeG orally enhanced the growth of the small intestine villi, significantly boosted the expression of tight junction proteins (ZO-1, Occludin, MUC2, and Claudin) (P < 0.05), and modulated the gut microbiota composition. Additionally, immunization with EBY100/pYD1-FaeG also upregulated the levels of IL-2, IL-4, and IFN-γ in the intestines of mice (P < 0.01), while serum IgG and fecal sIgA titer significantly increased (P < 0.05). These immune responses enhanced the capacity to fight against ETEC, leading to an increased survival rate of mice and relieved damage to tissues and organs of mice infection. In summary, the study suggested that the recombinant Saccharomyces cerevisiae EBY100/pYD1-FaeG could effectively stimulate the immune response and generate specific antibodies against F4+ ETEC, showing its potential to serve as a subunit oral vaccine candidate for preventing F4+ ETEC infection.IMPORTANCEThe multidrug-resistant F4+ enterotoxigenic Escherichia coli (ETEC) strains are the primary clinical pathogens responsible for post-weaning diarrhea in piglets, resulting in substantial economic losses in the pig farming industry. In the study, we developed an oral vaccine candidate, Saccharomyces cerevisiae EBY100/pYD1-FaeG, to prevent diarrhea caused by multidrug-resistant F4+ ETEC. Oral administration of EBY100/pYD1-FaeG significantly enhanced immune responses, improved intestinal health, and provided protection against F4+ ETEC infection in mice. This approach offers a potential application prospect for preventing F4+ ETEC infections that lead to post-weaning diarrhea in clinical settings and provides a promising solution for addressing the growing threat of antibiotic resistance in bacterial pathogens.

Antibiotic use prior to attending a large diarrheal disease hospital among preschool children suffering from bloody or non-bloody diarrhea: A cross-sectional study conducted in Bangladesh.

Among diarrheal children, injudicious use of antibiotics is a major public health concern particularly in low- and middle-income countries. There are evidence-based guidelines by the World Health Organization (WHO) to prescribe antibiotics for bloody diarrhea in children. There is a scarcity of published data regarding the judicious use of antibiotics for bloody diarrhea in children. So, we aimed to evaluate the presenting features of bloody diarrhea at hospital with prior antibiotic use at home and the prevalence of injudicious antibiotic use for bloody diarrhea in children. We screened 7,289 children aged 24-59 months with diarrhea (≥3 loose stools in the last 24 h) at Dhaka Hospital, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), from December 5, 2021 to February 16, 2023. Antibiotic intake at home due to current diarrheal illness was evaluated and confirmed by direct observation of a prescription, the bottle of antibiotics, or asking the caregiver about the name of antibiotics. Out of 7,289 children presented with diarrhea, 3,823 (52.45%) children consumed antibiotics before visiting hospital. 254 (3.48%) children presented with bloody diarrhea, among which 162 ingested antibiotics. Among 162 children, 88 (54.32%) received inappropriate antibiotics due to bloody diarrhea, according to the WHO guidelines. The most prevalent single antibiotic consumed in bloody diarrhea was metronidazole (n = 45, 27.78%), followed by ciprofloxacin (n = 39, 24.07%) and azithromycin (n = 32, 19.75%). After adjusting for relevant covariates like age, sex, presence of straining/tenesmus, fever during admission, history of cough, stunting, wasting, and underweight; children suffering from bloody diarrhea had 1.55 times higher odds of using metronidazole alone or in combination with other antibiotics (aOR:1.55, 95% CI: 1.10-2.19, p-value = 0.012) and 1.93 times higher odds of using multiple antibiotics (aOR:1.93, 95% CI: 1.23-3.02, p-value = 0.004) compared to children with non-bloody diarrhea. The study underscores the excessive use of antimicrobials among children with diarrheal illnesses. It is also evident that metronidazole use and multiple antibiotic use are increasing among children due to bloody diarrhea, which is alarming and calls for antibiotic stewardship by regulating bodies in the country.