Diarrheal Illness In Children Research Articles

Acute infectious diarrhoea in children: new insights in antisecretory treatment with racecadotril

In developing countries acute infectious diarrhoea remains one of the leading causes of death among young children, especially those under 1 year of age. In contrast, in industrialized nations the death rate is very low, although the disease is an important cause of morbidity and consumes substantial healthcare costs. A variety of viral, bacterial and parasitic organisms have been implicated in the pathogenesis of acute diarrhoea. The primary objectives of treatment of acute infectious diarrhoea are correction of dehydration with oral replacement therapy (ORT) and maintenance of good nutritional status via food intake. With regards drug therapy antimicrobial agents are not usually recommended since the disease is generally self‐limiting. Racecadotril is powerful and selective enkephalinase inhibitor and has emerged as a promising drug in the antisecretory therapy of acute infectious diarrhoea in children.Conclusion: There is encouraging evidence that treatment with racecadotril can provide clinically relevant symptomatic relief by reducing the severity and duration of diarrhoeal episodes. The drug is well tolerated and has a favourable safety profile. However, further comparative studies and cost‐effectiveness analyses are needed to define the position of the drug in the management of diarrhoeal illness in children.

NITAZOXANIDE IN THE TREATMENT OF DIARRHEA IN CHILDREN

Background: Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide. Diagnosis of the various etiological causes of diarrhea is often problematic in terms of cost, time and sensitivity, potentially delaying appropriate treatment. Methods: A double blind, placebo-controlled clinical trial of nitazoxanide in children with diarrheal illness lasting >3 days and <30 days was conducted at the Regional Hospital of Cajamarca, Peru. Fecal samples collected at baseline were subjected to ova and parasite examination, enzyme immunoassay for enteric viruses and coproculture. Patients were randomized to receive the standard 3-day course of nitazoxanide suspension or placebo suspension. Daily follow-up was performed for 7 days. The primary efficacy endpoint was time from first dose to resolution of all symptoms analyzed by Kaplan-Meier survival analysis and Prentice modified Wilcoxon test. Results: One-hundred children (median age: 30 months, IQR, 20-47) were enrolled in the study. The median time to resolution of symptoms for nitazoxanide-treated patients was 1 day vs. 3 days for the placebo group (P < 0.0001). The most common enteropathogens were Giardia lamblia (32%), rotavirus (12%), Escherichia coli (7%), adenovirus (4%), Blastocystis hominis (2%) and Shigella sonnei (2%). 38% had no identifed enteropathogen. The effect of nitazoxanide was observed in subsets of patients with G. lamblia (P = 0.0008), rotavirus (P = 0.0143) and with no identifed enteropathogen (P = 0.0028). The medication was well tolerated. Conclusions: Nitazoxanide reduced the duration of diarrheal illness of multiple etiologies. These results suggest that nitazoxanide may be a good therapeutic option for diarrheal illness in children where the etiology is unknown or presumed to be of infectious origin.

Antimicrobial sensitivity pattern of &lt;i&gt;Campylobacter&lt;/i&gt; species among children in Jimma University Specialized Hospital, Southwest Ethiopia

Abstract Background: Compylobacter species are the major causes of diarrhoeal illness in children in Ethiopia. Thus, updated local information is very crucial in order to take effective control measures on this pathogen. Objectives: To determine the prevalence and antibiotic susceptibility patterns of Campylobacter species in children younger than 15 years of age. Method: A cross sectional study was conducted whereby stool specimens were collected from 430 children who had diarrhoea and were investigated for presence of common enteric bacterial pathogens and intestinal parasites. Stool specimens were inoculated on Salmonella-Shigella agar and Campylo agar plates, and then isolation, biochemical characterization, and antibiotic sensitivity testing were done in accordance with the standard methodology. Parasites were detected by direct stool microscopy. Result: Campylobacter species were isolated from 11.6% of the total patients. The isolation rates of Salmonella and Shigella species were 5.8% and 4.9% respectively. Sixty five percent (283/430) of the children were found to be infected by one or more parasites. Close contact with cats or dogs, duration and consistency of diarrhoea were associated with the isolation of Campylobacter species. The antimicrobial sensitivity study findings showed that all tested isolates were sensitive to chloramphenicol, gentamicin and kanamycin. A majority of the strains of Campylobacter species were sensitive to tetracycline and erythromycin. The majority and half of the isolates were resistant for trimethoprim-sulfamethoxazole and ampicillin, respectively. Conclusion: The findings of this research indicate that Campylobacter species is an important etiological agent of childhood diarrhoea and therefore, it should be properly diagnosed in routine investigation and physicians should prescribe the appropriate drugs either after sensitivity testing or, in areas where there are no facilities for culturing, they have to refer updated information on local sensitivity pattern. [Ethiop.J.Health Dev. 2004;18(3):185-189]

Pathogen-specific risk factors and protective factors for acute diarrheal illness in children aged 12-59 months in São Paulo, Brazil.

Diarrheal diseases are a leading cause of childhood morbidity and mortality in Latin America. Most studies have focused on infants but not on older children. We enrolled 505 children (age, 12-59 months) with diarrhea and age-matched controls in a case-control study in Sao Paulo, Brazil. Independent risk factors for diarrhea included another household member with diarrhea (matched odds ratio [mOR], 8.1; attributable fraction [AF], 0.17; P<.001) and consumption of homemade juice (mOR, 1.8; AF, 0.10; P=.01); protective factors included boiling of the baby bottle or nipple (mOR, 0.60; AF, 0.19; P=.026), childcare at home (mOR, 0.58; AF, 0.12; P=.004), and piped sewage (mOR, 0.58; AF, 0.05; P=.047). Hand washing by the caretaker after helping the child defecate protected against Shigella infection (mOR, 0.35; P<.05). Preparation of rice, beans, or soup in the morning and serving it to children after noon were associated with enterotoxigenic Escherichia coli infection (mOR, 8.0; P<.05). In these poor households, 28% of cases of diarrhea in 1-4-year-old children was attributable to easily modifiable exposures.

New rotavirus vaccine could be licensed this year

Rotaviruses are common protozoan parasites that cause potentially fatal diarrhoeal illness in children. A new generation of rotavirus vaccines could receive approval from the Mexican authorities this year.

Septic system density and infectious diarrhea in a defined population of children.

One-quarter of U.S. households use a septic system for wastewater disposal. In this study we investigated whether septic system density was associated with endemic diarrheal illness in children. Cases--children 1 to < 19 years old seeking medical care for acute diarrhea--and controls resided in the Marshfield Epidemiologic Study Area, a population-based cohort in central Wisconsin. Enrollment was from February 1997 through September 1998. Study participants completed a structured interview, and septic system density was determined from county sanitary permits. Household wells were sampled for bacterial pathogens and indicators of water sanitary quality. Risk factors were assessed for cases grouped by diarrhea etiology. In multivariate analyses, viral diarrhea was associated with the number of holding tank septic systems in the 640-acre section surrounding the case residence [adjusted odds ratio (AOR), 1.08; 95% confidence interval (CI), 1.02-1.15; p = 0.008], and bacterial diarrhea was associated with the number of holding tanks per 40-acre quarter-quarter section (AOR, 1.22; 95% CI, 1.02-1.46; p = 0.026). Diarrhea of unknown etiology was independently associated with drinking from a household well contaminated with fecal enterococci (AOR, 6.18; 95% CI, 1.22-31.46; p = 0.028). Septic system densities were associated with endemic diarrheal illness in central Wisconsin. The association should be investigated in other regions, and standards for septic systems should be evaluated to ensure that the public health is protected.

Epidemiological features of rotavirus infection in Goiânia, Goiás, Brazil, from 1986 to 2000.

A total of 2,605 faecal specimens from children up to 10 years old with or without diarrhoea were collected. Samples were obtained from 1986 to 2000 in hospitals, outpatient clinics and day-care centers in Goiânia, Goiás. Two methodologies for viral detection were utilized: a combined enzyme immunoassay for rotavirus and adenovirus and polyacrylamide gel electrophoresis. Results showed 374 (14.4%) faecal specimens positive for Rotavirus A, most of them collected from hospitalized children. A significant detection rate of rotavirus during the period from April to August, dry season in Goiânia, and different frequencies of viral detection throughout the years of study were also observed. Rotavirus was significantly related to hospitalization and to diarrhoeal illness in children up to 24 months old. This study reinforces the importance of rotavirus as a cause of diarrhoea in children and may be important in regards to the implementation of rotavirus vaccination strategies in our country.

Rotavirus and enteric pathogens in infantile diarrhoea in Manipal, South India.

The etiology of Rotavirus in acute diarrhoeal illness in children 0-5 years of age, admitted to the pediatric wards of Kasturba Medical College Hospital, Manipal was studied over a period of 5 years. Rotavirus in the faeces detected by Latex agglutination test accounted for 19.56% of the diarrhoea with maximum incidence (65%) in the 7-12 months of age group. Bacterial aetiological agents continued to play a significant role (69.6%) in diarrhoeal diseases. Enteroaggregative E. coli was common in the age group between 25-36 months, Shigellosis in 37-60 months and Salmonella typhimurium enteritis in 7-12 months of age. The other pathogens isolated were vibrio cholerae (4.98%), species of aeromonas (15.92%), along with cryptosporidium (6.47%) and candida albicans (3.98%). In a control group consisting of 100 children without history of diarrhoea, 2 were positive for rotavirus, 3 for cryptosporidium and 12 for Escherichia coli.

Efficacy of probiotic use in acute diarrhea in children: a meta-analysis.

Our objective was to determine the efficacy of probiotic use in reducing the duration of increased stool output in children with acute diarrheal illness. Eligible studies were limited to trials of probiotic therapy in otherwise healthy children <5 years old with acute-onset diarrhea. The main outcome variable was difference in diarrhea duration between treatment and control groups. Our meta-analysis of 18 eligible studies suggests that coadministration of probiotics with standard rehydration therapy reduces the duration of acute diarrhea by approximately 1 day [random-effects pooled estimate = -0.8 days (-1.1, -0.6), P < 0.001]. Differences in treatment effect between studies was assessed by calculating the Q statistic (Q = 204. 1, P < 0.001). In subsequent analyses limited to studies of hospitalized children, to double-blinded trials, and to studies evaluating lactobacilli, the pooled estimates were similar (-0.6 to -1.2 days, P < 0.001). In conclusion, bacterial probiotic therapy shortens the duration of acute diarrheal illness in children by approximately one day.

Management of Uncomplicated Diarrheal Illness in Children

Management of Uncomplicated Diarrheal Illness in Children

Prospective study of diarrhoeal outbreaks in child long-daycare centres in western Sydney.

To investigate outbreaks of diarrhoeal illness in children attending long-daycare centres (LDCs), to characterise parasitic, bacterial and viral isolates from the children's faeces and to identify individual and LDC risk factors for diarrhoea. Eleven-month prospective case-control study of diarrhoeal outbreaks among children in LDCs. 2368 children attending 35 LDCs in the western Sydney area. Frequency of diarrhoeal outbreaks, rate of attack and spread to family members; pathogens isolated from stools; and individual and LDC risk factors. The overall incidence of diarrhoeal disease was low (0.28 outbreaks per centre per year and 0.056 outbreak-associated cases per child-year). Attack rates during outbreaks varied widely (4%-55%; mean, 15%), as did secondary spread rates to family members (1%-15%; mean, 9%). Pathogens were isolated from 7% of symptomatic children and 7% of controls; no outbreak was shown to be caused by a recognised pathogen. Children with outbreak-associated diarrhoeal illness were more likely to have suffered vomiting, poor appetite, lack of energy, fever and to have taken antibiotics in the previous week than other children. Hygiene practices varied widely among centres. We found low incidence and morbidity from diarrhoeal illness in Australian urban LDCs. Diarrhoea in children in LDCs may be caused predominantly by non-infectious factors such as diet and antibiotic exposure. Current hygiene measures in LDCs seem adequate to prevent and contain outbreaks of infectious diarrhoea.

Association of Bacteroides fragilis with Childhood Diarrhea

Enterotoxigenic strains of Bacteriodes fragilis (ETBF) have recently been found to be associated with diarrheal illness in Apache and Bangladeshi children. This study was conducted to define the role of ETBF in diarrhea of children in an urban setting. Fecal specimens from 991 children with diarrhea and 581 asymptomatic age-matched controls were cultured for B. fragilis (BF). The isolates were tested for enterotoxin production using a human colonic epithelial cell line. BF was isolated from 318 (32.1%) of the patients and 123 (21.2%) of the controls (p < 0.001). In children < 1 year old which comprised about 50% of both patients and controls, the BF isolation rates were comparable (26.5% vs 25.7%; p = 0.812), contrasting with the significant difference in isolation rates for children > or = 1 year (37.6% vs 16.5%; p = < 0.001). Overall, ETBF were identified in 4.4% of patients and 3.1% of controls (p = 0.2). However, ETBF were significantly associated with diarrheal disease in children 1-5 years (5.4% vs 1.8%; p = 0.033) and 1-10 years (4.8% vs 1.5%; p = 0.021) in age. ETBF were isolated the year round and comprised 14.4% and 15% of the BF isolated from the patients and controls, respectively, suggesting that part of the indigenous BF are inherently enterotoxin producers. In this study, BF and ETBF were associated with diarrheal illness in children 1-10 years old.

Infectious diarrhoea in children: controlling transmission in the child care setting.

An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.

Management of gastroenteritis in early childhood.

The most important aspect of modern management of acute diarrhoeal illness in children is that of oral rehydration therapy, and drug therapy is very rarely indicated. Despite the dramatic decline in mortality and morbidity in recent years, there is still the need for continuing education in the appropriate use of oral rehydration solutions. The constitution of oral rehydration solutions and policies of feeding practices during illness continue to be controversial, mainly because of wide variation in the aetiology of the diarrhoea, the nutrition of the child, and the economic and public health factors involved in any particular community. The priority of all healthcare workers is to provide simple guidelines in the use of a safe oral rehydration solution while discouraging unsafe treatments.

Rotavirus and bacterial enteropathogens causing acute diarrhea

The etiology of rotavirus in acute diarrhoeal illness in children 0-5 years of age, admitted to the Pediatric wards of Kasturba Medical College Hospital, Manipal was studied, over a period of one year. Rotavirus in the faecal samples detected by the slide latex agglutination test accounted for 14.9% of the diarrheas with maximum incidence in the 7-12 months of age group (57.5%). Bacterial enteropathogens continued to play a significant role in diarrheal diseases. Salmonella enteritis was found more in the age group 0-6 months and shigellosis in 37-60 months. In a control study of 100 children who had no diarrhea, 2 were found positive for rotaviruses.

Estimates of morbidity and mortality rates for diarrheal diseases in American children

Although the importance of diarrhea as a prime cause of morbidity and death in developing countries is well recognized, the disease burden in the United States has never been thoroughly examined. We have prepared national estimates of the annual number of cases of diarrhea in children less than 5 years of age and of the outcome, measured in terms of visits to a physician, hospitalizations, and deaths. The annual number of diarrheal episodes was estimated by reviewing longitudinal studies of childhood diarrhea conducted in the United States and extrapolating these data to the nation. Estimates of physician visits, hospitalizations, and deaths were prepared from a variety of national data sources. We estimate that 16.5 million children less than 5 years of age have between 21 and 37 million episodes of diarrhea annually. Of these, 2.1 to 3.7 million episodes lead to a physician visit, a total of 220,000 patients are hospitalized, and 325 to 425 children die. The major cost of diarrhea lies in the high numbers and cost of hospitalizations, because approximately 10.6% of hospitalizations in this age group are for diarrhea. Diarrheal deaths occur in relatively small numbers, are more common in the South and among black persons, are potentially avoidable, and could represent as much as 10% of the preventable postneonatal infant death in the United States. These estimates underscore the extensive burden of diarrheal illness in children in the United States and suggest that interventions to prevent disease or decrease its severity could be cost-effective.

Serotype, antimicrobial resistance, and adherence properties of Escherichia coli strains associated with outbreaks of diarrheal illness in children in the United States.

Since most recorded outbreaks of diarrhea in U.S. infants attributed to Escherichia coli occurred before currently available pathogenicity assays existed, we examined the characteristics of nonenterotoxigenic E. coli strains isolated from 50 outbreaks of diarrheal disease in U.S. infants between 1934 and 1987. We assayed the strains for enteropathogenic E. coli (EPEC) serotype, localized adherence (LA) and diffuse adherence to tissue cultures, the presence of EPEC adherence factor genes, Shiga-like (Vero) toxin production, and antimicrobial resistance. EPEC serotypes were identified in 28 outbreaks (56%). LA to HeLa cells was found in 23 outbreak strains and correlated 100% with the EPEC adherence factor probe. LA was observed in 21 of 28 EPEC and 2 of 22 non-EPEC strains; however, 5 of 23 strains that were LA positive for HeLa cells did not adhere to HEp-2 or HL cells. One strain was diffuse adherence positive, and none was Shiga-like toxin positive. Multiple resistance was common in EPEC (64%), LA-positive (74%), and LA-positive EPEC (76%) strains but not in others (10%). EPEC serotypes or LA was found in 60% (n = 30) of the outbreak strains. The remaining E. coli strains may represent nonpathogenic normal flora, as-yet-undefined pathogens, or pathogens that have lost virulence-associated traits during storage or subculturing.

Burden of Enteropathogens Associated Diarrheal Diseases in Children Hospital, Nepal

Diarrheal disease caused by bacteria, parasites or viruses continues to be an important cause of morbidity and mortality among young children in developing countries. Methods currently used in public health laboratories do not allow for the identification of rotavirus, Cyclospora and pathogenic E.coli infection though they represent as an etiology in large proportion of patients with diarrhea, the possibility exists that a portion of the undiagnosed illness may be attributable to one or more of the above enteropathogens. In a view to determine the causative agents of diarrhoea, the current study described the various enteropathogens associated with diarrhoea in hospitalized children. Stool samples were collected from children under 11 years of age who developed diarrhoea and were admitted to Kanti Children's Hospital between May to October 2007 and investigated in Tribhuvan University, Institute of Medicine, Health Research Laboratory; by using both the combination of microbiological and immunological tools ( EIA for rotavirus detection, standard parasitological procedure for Cyclospora and other intestinal parasites, and selective culture method and serotyping were used to differentiate the species of bacteria). A total of 440 diarrhoeal stool samples were collected and 285 (64.8%) enteropathogens were identified. The highest infection was due to intestinal parasites 104/285 (36.5%) followed by rotavirus 92/285 (32.3%); pathogenic bacteria 57/285 (20%) and Cyclospora 32/285 (11.2%). Among the pathogenic bacteria (20%) isolated, the predominant bacteria were Shigella species (36.8%); Vibrio species (26.3%); Escherichia coli (22.8%) and Salmonella species (14.03%) respectively. Various enteropthogens responsible for diarrhoea especially rotavirus, different pathogenic bacteria and Cyclospora infection, which are not examined routinely in public health laboratories, were found in significant proportion as a cause of diarrhoeal illness in children. The infection was peak in children under 2 years of age and was highest in rainy season. Key words: Burden; Diarrhea; Enteropathogens; Children; Nepal. DOI: 10.3126/sw.v7i7.3830Scientific World Vol.7(7) 2009 pp.71-75