Diarrheal Stool Research Articles

Evaluation of Phytochemical and Antibacterial Potential of Vernonia amygdalina and Elaeis guineensis on Some Bacteria Associated with Diarrhea

Background: Bitter leaf and palm oil combination in treating diarrhoea is common in Africa. The aim of this study is to determine the synergistic and antimicrobial potential of Vernonia amygdalina and Elaeis guineensis on bacteria isolates from diarrheic stool.
 Methodology: One hundred and fifty (150) diarrheic stool samples from the Diagnostic Laboratory in Rivers State University Teaching Hospital (RSUTH), Port Harcourt, were inoculated in Selenite F broth, MacConkey, Nutrient and Salmonella-Shigella agar plates using standard methods. Fresh and dry bitter leaf extracts were prepared by mashing, weighing and dissolving 100 grams(g) and 150 g concentrations of each in 100 milliliters(mls) of ethanol and sterile distilled water respectively. Undiluted mixture of bitter leaf and palm oil were prepared by mixing 2 mls of each in a sterile beaker. Zero-point one milliliter (0.1ml) of each undiluted extract, their mixture, ethanol and palm oil were separately dispensed into appropriately labeled wells using sterile pipette for sensitivity test on the isolated bacteria. The pH, temperatures and the phytochemical contents of the bitter extracts and palm oil were determined using pH meter, thermometer and spectrophotometric method.
 Results: Escherichia coli, Staphylococcus aureus and Salmonella sp. were isolated. The pH and temperature of bitter leaf extract and palm oil were 7.2 and 26⁰C and 6.7 and 26⁰C respectively while the pH and temperature for bitter leaf and the palm oil mixture was 6.9 and 26⁰C. The bitter leaf and palm oil extracts, their combination, ethanol and distilled water used on the isolates as antibiotics did not show any sensitivity. The phytochemicals identified in the bitter leaf were saponins, alkaloids and tannins while carotene was detected in the palm oil.
 Conclusion: It can be concluded that the bitter leaf extract, palm oil and their combination did not inhibit the growth of bacteria as a result of lack of bioactive components from the bitter leaf. The nature of the diluents used for the extraction may not have been the right one as it would have caused the low concentration, dilution and disfiguring of the molecules of the bioactive compounds that prevented the proper reaction between the bacteria and the extracts used.

Severe congenital diarrhea secondary to tufting enteropathy. Case report

Introduction: Tufting enteropathy is a rare cause of congenital diarrhea in neonates. It is characterized by the abnormal distribution of epithelial adhesion molecules, which causes enterocytes to shed into the lumen, forming the characteristic tufts. Case presentation: A 15-day-old female neonate was taken by her parents to the emergency department of a tertiary care hospital due to diarrheal stools she had been experiencing since birth. The patient presented with dehydration, abnormal weight loss, metabolic acidosis, and acute kidney failure. She received treatment with alizapride, loperamide, zinc sulfate, and probiotics, but after 75 days of treatment she was still symptomatic. An upper tract endoscopy and colonoscopy were performed, finding flattening of the villi and lymphoid cells in the lamina propria. However, the symptoms persisted, and she died at the age of ten months. A post-mortem exome sequencing reported tufting enteropathy. Conclusions. When congenital diarrhea is present, tufting enteropathy should be considered. An early molecular study would allow to evaluate the possibility of performing an intestinal transplant or modifying the treatment to meet the patient’s palliative care needs.

Pentraxin 3 and Shigella LPS and IpaB Antibodies Interplay to Defeat Shigellosis.

Shigella causes moderate to severe diarrhea or dysentery after invading the colon mucosa. Long Pentraxin 3 (PTX3) is recognized as the humoral component of the innate immune response to bacterial pathogens. We examined the interplay between levels of PTX3 and levels of anti-Shigella lipopolysaccharide (LPS) and anti-Shigella type 3 secretion system protein-IpaB antibodies in children during acute shigellosis and after recovery. PTX3 concentrations in serum and stool extracts were determined by sandwich ELISA using commercial anti-PTX3 antibodies. Serum IgG, IgM, and IgA anti-S. sonnei LPS or anti-S. sonnei IpaB were measured using in house ELISA. Children with acute shigellosis (n = 60) had elevated PTX3 levels in serum and stools as compared with recovered subjects (9.6 ng/mL versus 4.7 ng/mL, p < 0.009 in serum and 16.3 ng/g versus 1.1 ng/g in stool, p = 0.011). Very low levels of PTX3 were detected in stools of healthy children (0.3 ng/g). Increased serum levels of PTX3 correlated with high fever accompanied by bloody or numerous diarrheal stools characteristic of more severe shigellosis while short pentraxin; C-Reactive Protein (CRP) did not show such a correlation. PTX3 decreased in convalescence while anti-Shigella antibodies increased, switching the response from innate to adaptive toward the eradication of the invasive organism. These data can inform the development of Shigella vaccines and treatment options.

The Epidemiology of Sapovirus in the Etiology, Risk Factors, and Interactions of Enteric Infection and Malnutrition and the Consequences for Child Health and Development Study: Evidence of Protection Following Natural Infection.

BackgroundSapovirus is one of the principal agents of acute viral enteritis in children. Because it has not been routinely included in diagnostic evaluations, the epidemiology and natural history remain poorly described.MethodsA birth cohort of 1715 children from 8 countries contributed surveillance samples (n = 35 620) and diarrheal specimens (n = 6868) from 0 to 24 months of age. Sapovirus was detected by quantitative polymerase chain reaction concurrently to other enteropathogens using multiarray cards. Logistic regression was used to identify risk factors, and longitudinal models were employed to estimate incidence rates and evaluate evidence of protective immunity.ResultsSapovirus was detected in 24.7% (n = 1665) of diarrheal stools and 12.8% (n = 4429) of monthly surveillance samples. More than 90% of children were infected and 60% experienced sapovirus diarrhea in the first 2 years of life. Breastfeeding and higher socioeconomic status were associated with reduced incidence of infection and illness. Specimens with sapovirus detected had an increased odds of coinfection with rotavirus (odds ratio [OR], 1.6 [95% confidence interval {CI}, 1.3–2.0]), astrovirus (OR, 1.5 [95% CI, 1.3–1.7]), adenovirus (OR, 1.3 [95% CI, 1.1–1.5]), and Shigella (OR, 1.4 [95% CI, 1.3–1.6]). Prior infection with sapovirus conferred a risk reduction of 22% for subsequent infection (hazard ratio [HR], 0.78 [95% CI, .74–.85]) and 24% for subsequent diarrhea (95% CI, 11.0%–35.0%; HR, 0.76).ConclusionsSapovirus is a common cause of early childhood diarrhea. Further research on coinfections is warranted. Evidence of acquired immunity was observed even in the absence of genotype-specific analysis for this pathogen of known genetic diversity.

Characterization of NDM-5 Carbapenemase-Encoding Gene (bla NDM-5) - Positive Multidrug Resistant Commensal Escherichia coli from Diarrheal Patients.

PurposeThe multidrug resistance Enterobacteriaceae cause many serious infections resulting in prolonged hospitalization, increased treatment charges and mortality rate. In this study, we characterized blaNDM-5-positive multidrug resistance commensal Escherichia coli (CE) isolated from diarrheal patients in Kolkata, India.MethodsThree CE strains were isolated from diarrheal stools, which were negative for different pathogroups of diarrheagenic E. coli (DEC). The presence of carbapenemases encoding genes and other antimicrobial resistance genes (ARGs) was detected using PCR. The genetic arrangement adjoining blaNDM-5 was investigated by plasmid genome sequencing. The genetic relatedness of the strains was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) methods.ResultsIn addition to colistin, the blaNDM-5-positive CE strains showed resistance to most of the antibiotics. Higher MICs were detected for ciprofloxacin (>32 mg/L) and imipenem (8 mg/L). Molecular typing revealed that three CE strains belonged to two different STs (ST 101 and ST 648) but they were 95% similar in the PFGE analysis. Screening for ARGs revealed that CE strains harbored Int-1, blaTEM, blaCTX-M3, blaOXA-1, blaOXA-7, blaOXA-9, tetA, strA, aadA1, aadB, sul2, floR, mph(A), and aac(6´)-Ib-cr. In conjugation experiment, transfer frequencies ranged from 2.5×10−3 to 8.4x10−5. The blaNDM-5 gene was located on a 94-kb pNDM-TC-CE-89 type plasmid, which is highly similar to the IncFII plasmid harboring an IS26-IS30-blaNDM-5-bleMBL-trpF-dsbd-IS91-dhps structure.ConclusionTo the best of our knowledge, this is the first report on carbapenem resistance involving the blaNDM-5 gene in CE from diarrheal patients. The circulation of blaNDM-5 gene in CE is worrisome, since it has the potential to transfer blaNDM-5 gene to other enteric pathogens.

Diarrhea-Causing Bacteria and Their Antibiotic Resistance Patterns Among Diarrhea Patients From Ghana.

Diarrheal disease remains a major global health problem particularly in children under 5 years and the emergence of antibiotic-resistant strains of causative pathogens could slow control efforts, particularly in settings where treatment options are limited. This surveillance study conducted in Ghana aimed to determine the prevalence and antimicrobial susceptibility profile of diarrhea-causing bacteria. This was a cross-sectional study carried out in five health facilities in the Ga West Municipality of Ghana between 2017 and 2021. Diarrheic stool samples from patients were collected and cultured on standard differential/selective media and isolates identified by standard biochemical tests, MALDI-TOF assay, and serological analysis. The antibiogram was determined using Kirby-Bauer disk diffusion and Microscan autoScan4 MIC panels which were used for extended-spectrum beta-lactamase (ESBL) detection. Bacteria were isolated from 97.5% (772/792) of stool samples, and 167 of the isolates were diarrheagenic and met our inclusion criteria for antimicrobial resistance (AMR) analysis. These included Escherichia coli (49.1%, 82/167), Salmonella species (23.9%, 40/167), Vibrio species (16.8%, 28/167), and Shigella species (10.2%, 17/167). Among 24 Vibrio species, we observed resistances to cefotaxime (21/24, 87.5%), ceftriaxone (20/24, 83.3%), and ciprofloxacin (6/24, 25%), including four multi-drug resistant isolates. All 13 Vibrio parahaemolyticus isolates were resistant to cefazolin. All 17 Shigella isolates were resistant to tetracycline with resistance to shigellosis drugs such as norfloxacin and ciprofloxacin. Salmonella isolates were highly susceptible to norfloxacin (40/40, 100%) and tetracycline (12/34, 35%). Two ESBL-producing E. coli were also identified with marked susceptibility to gentamicin (66/72, 91.7%) and amikacin (57/72, 79.2%) prescribed in the treatment of E. coli infections. This study showed the different bacteria implicated in diarrhea cases in Ghana and the need for differential diagnoses for better treatment outcomes. Escherichia coli, Shigella, Salmonella, and Vibrio have all been implicated in diarrhea cases in Ghana. The highest prevalence was E. coli and Salmonella with Shigella the least prevalent. Resistance to commonly used drugs found in these isolates may render bacteria infection treatment in the near future nearly impossible. Routine antimicrobial susceptibility testing, effective monitoring, and nationwide surveillance of AMR pathogens should be implemented to curb the increase of antimicrobial resistance in Ghana.

Effects of Isoniazid on the Acquisition and Expression of Morphine Dependence in Male Mice

Background:GABAergic drugs have extensive interference with morphine’s pharmacological effects, including dependence.&#x0D; Objectives:The present study was conducted to evaluate the effects of isoniazid, a GABAergic agent, on the acquisition and expression of morphine-induced dependence in male mice.&#x0D; Methods: Sixty-four male mice were used. The mice became dependent on morphine by administrating ten doses of morphine in four days. For the precipitation of the morphine withdrawal signs (jumping, diarrhea, and weight loss), two hours after the last dose of morphine, the mice received naloxone (4 mg/kg, IP). In the expression experiment, four groups of mice received saline or isoniazid (25, 50, and 75 mg/kg, IP) one hour before naloxone. In the acquisition experiment, the other four groups, one hour before the first six doses of morphine, received saline or isoniazid (25, 50, and 75 mg/kg, IP).&#x0D; Results: In the expression experiment, all doses of isoniazid decreased the number of jumping in mice, but only the lowest dose influenced diarrhea (increased weight of diarrheal stool) significantly. The higher doses of isoniazid (50 and 75 mg/kg, IP) caused a significant reduction in the percentage of weight loss, but its lowest dose (25 mg/kg, IP) significantly increased the sign. In the acquisition experiment, isoniazid (25, 50 mg/kg IP) decreased the number of jumping and the percentage of weight loss, but not the weight of diarrheal stool.&#x0D; Conclusion: Isoniazid may be a good candidate to prevent morphine withdrawal signs.

Epidemiology of Campylobacter infections among children of 0\u201324\xa0months of age in South Africa

BackgroundCampylobacter spp. are one of the most frequent causes of diarrhoeal disease in humans throughout the world. This study aimed at determining the prevalence and the genotypic distribution of Campylobacter spp. and their association with diarrhoea and child growth in children of less than the age of two in the Limpopo Province of South Africa.MethodsA total of 4280 diarrheal and non-diarrheal stool samples were collected on a monthly basis from children recruited at birth and followed up to 24 months. All stool samples were screened for the presence Campylobacter antigen using ELISA technique after which CAH 16S primer was used on the positive samples to confirm the presence of Campylobacter. Subsequently, the PCR positive samples were further characterised using species specific primers for Campylobacter jejuni and Campylobacter coli.ResultsCampylobacter antigen was detected in 564/4280 (13.2%). Campylobacter was more commonly found in diarrheal stools (20.4%) compared to non-diarrheal stools (12.4%) with a statistically significant difference (χ2 = 7.345; p = 0.006). Throughout the year there were two main peaks of Campylobacter infection one in December- January and the second peak in June. The prevalence of Campylobacter increased with the age of the children up to 11 months after which the prevalence decreased. Out of 564 positive ELISA samples, 257 (45.6%) were confirmed to have 16S rRNA gene for Campylobacter spp. Furthermore, C. jejuni was found to be more prevalent (232/257) than C. coli (25/257) with a prevalence of 90.3% and 9.7%, respectively. Both C. jejuni and C. coli were significantly associated with diarrhea with statistical values of (χ2 = 22.224; p < 0.001) and (χ2 = 81.682; p < 0.001) respectively. Sequences generated from the analysis of hip gene confirmed the PCR positives samples were C. jejuni positive.ConclusionsThis study has delineated a high prevalence of Campylobacter spp. in the study cohort. Moreover, C. jejuni was found to be more prevalent than C. coli both of which were associated with diarrhea. These findings are of clinical and epidemiological significance.

Isolation, Extraction, and Characterization of Verotoxin-producing Escherichia coli O157:H7 from Diarrheal Stool Samples

Background: Escherichia coli O157:H7 infection causes hemorrhagic colitis and is diagnosed based on symptoms such as cramps, stomach pain, and watery diarrhea. Shiga-like toxins (Verotoxin) produced by Escherichia coli O157:H7 damages endothelial cells of both kidney and brain, causing renal dysfunction and neurological problems.&#x0D; Methods: The present study focuses on identifying the prevalence of Verotoxin-producing Escherichia coli O157:H7 among diarrheal inpatients at Erode Government Hospital, India, and its antibiogram. Further, the Verotoxins were characterized by using SDS-PAGE analysis. A total of 123 samples were collected both from diarrheal stools, and strains from 37 samples (43.02 %) were found to have the presence of E. coli. The organisms were identified based on their colony morphology on various media, cell morphology, and biochemical tests. The Shiga-like toxin production was identified by non-fermentation of sorbitol on SMAC agar plates. Confirmation of Shiga-like toxin was performed using agglutination assay.&#x0D; Results: In total, 12 isolates showed agglutination and these isolates were confirmed to be E. coli O157:H7. The molecular weight of the Verotoxin was found to be between 20 and 29 kD. The antibiogram profile of the four isolated strains against 10 standard antibiotics was determined.&#x0D; Conclusion: The results of this study show the occurrence of drug resistance on hemorrhagic colitis causing E. coli O157:H7.

Clostridioides (Clostridium) difficile in children with diarrhoea in Vietnam

BackgroundClostridioides (Clostridium) difficile commonly causes hospital-acquired infection which can range from mild diarrhoea to life-threatening toxic megacolon and even death. Reports on C. difficile infection (CDI) in Vietnam are limited, so this study was designed to evaluate the prevalence, molecular epidemiology and antimicrobial susceptibility of C. difficile isolated from children with diarrhoea in Vietnam. Infants are often colonised with C. difficile and it was hypothesised that those colonising strains would represent strains of C. difficile circulating in the hospital/region at the time, however, this was not an attempt to determine if C. difficile was the cause of the diarrhoea. MethodsDiarrhoeal stool samples collected at two children's hospitals in northern Vietnam from October 1, 2020 to February 28, 2021 were transported to Perth, Western Australia, for culture of C. difficile and further investigations on isolates; PCR ribotyping, toxin gene profiling and antimicrobial susceptibility testing. ResultsFrom these hospitals, 370 diarrhoeal stool samples were collected, most from children aged 1–15 months (71.9%; 266/370). The overall prevalence of C. difficile in stool samples from children aged ≤16 years was 37.8% (140/370) and the highest prevalence was in the 2–12 months age group (52.9%; 74/140). In total, 151 isolates of C. difficile were recovered; the proportion of toxigenic isolates was 16.6% (25/151). Of the 25 toxigenic C. difficile isolates, the toxin gene profiles A+B+CDT− and A−B+CDT− comprised 72% and 28%, respectively. The four most prevalent C. difficile ribotypes (RTs) were QX 011 (25/151), RT 010 (25/151), QX 107 (12/151) and RT 012 (11/151). All isolates were susceptible to vancomycin, metronidazole and fidaxomicin, while there was significant resistance to clindamycin (90.1%), and some to moxifloxacin (6.6%) and rifaximin (3.3%). ConclusionThe prevalence of C. difficile in children with diarrhoea was high (37.8%) although the proportion of toxigenic strains was comparatively low. The clinical significance of any isolate needs to be determined.

Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae Family of Bacteria from Diarrheal Stool Samples in Northwest Ethiopia.

Background Resistance among the commensal flora is a serious threat because they are highly populated ecosystems like the gut, maybe a source of extraintestinal infections. Infections due to extended-spectrum beta-lactamase (ESBL)- and carbapenemase (CPM)-producing Enterobacteriaceae family of bacteria impose a major global issue because they are usually resistant to multiple antimicrobial agents. Data on the fecal ESBL- and CPM-producing group of bacteria in developing countries including Ethiopia are limited mainly due to resource constraints. Thus, this study aimed to determine the prevalence of multidrug-resistant (MDR)-, ESBL-, and CPM-producing Enterobacteriaceae family of bacteria from diarrheal stool samples at the University Hospital, Northwest Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted involving a total of 384 study participants having gastrointestinal complaints from January to April 2019. A diarrheal stool sample was aseptically collected and inoculated on a MacConkey agar plate. After getting pure colonies, biochemical and antimicrobial susceptibility testing was done following standard microbiological techniques. ESBL production was screened using ceftazidime and cefotaxime and confirmed using a combined disk diffusion test. Carbapenemases were screened by meropenem disk and confirmed by the modified carbapenem inactivation method. Data were checked, cleaned, and entered using Epi Info version 7.1 and transferred to SPSS version 20 for analysis. Result A total of 404 Enterobacteriaceae groups of bacteria were isolated from 384 diarrheal stool samples. The overall prevalence of fecal MDR-, ESBL-, and CPM-producing group of Enterobacteriaceae was 196 (48.5%), 66 (16.3%), and 4 (1%), respectively. Of the total ESBL-producing Enterobacteriaceae, E. coli (41/66 (62.1%)) and K. pneumoniae (18/66 (27.3%)) were the most predominant isolates. One half of CPE has been observed in Citrobacter species and the rest in E. coli (25%) and P. vulgaris (25%). Conclusion and Recommendation. Finding the high rate of ESBL-producing Enterobacteriaceae and CPE requires strict infection control measures and careful selection of empirical therapy in the study area. Therefore, active surveillance with large sample size and better infection prevention control is needed.

Prevalence of Bacterial Species in Skin, Urine, Diarrheal Stool, and Respiratory Samples in Cats.

Bacterial infections are a significant cause of illness and death in different animals. However, these bacterial infections could be a source of human disease or illness if these pathogenic bacteria are present in companion animals. This study aimed to investigate the prevalence of pathogenic bacteria associated with different site infections in cats in the Republic of Korea. For this purpose, samples were collected from the skin/ear, urine, respiratory, and diarrheal stool origins of cats obtained between 2018 and 2019 from seven different laboratories and centers participating in the Korean Veterinary Antimicrobial Resistance Monitoring System. These samples were subjected to analysis for the identification and isolation of associated bacterial species using a bacterial culture approach. A total of 609 isolates were identified in four different cat samples. Among them, 267, 184, 57, and 101 were extracted from diarrheal stool, skin, urine, and respiratory samples, respectively. The findings of this study showed that Escherichia coli was the most prevalent species among isolated bacterial species of diarrheal stool and urine origin. Staphylococcus felis and Pasteurella multocida were most prevalent in the skin and respiratory tract, respectively. However, there was no significant difference in bacterial distribution among the different age groups in all samples. This is the first nationwide surveillance report that associates bacterial prevalence with their site of origin and helps in the prevention of bacterial infections in cats. Moreover, the pattern of bacterial prevalence could provide sufficient guidance for the selection of empirical antimicrobial therapy against infections in cats.

Evaluation of the antibacterial properties of the extracts and fractions of Ipomoea triloba l. (Convolvulaceae) on selected enteric diarrheagenic bacteria

Diarrhoea is a leading killer of young children accounting for approximately 8% of all deaths among children ˂ 5 years worldwide and causes neonatal mortality and hospitalization in geriatrics. Ipomoea triloba L. has been claimed to have antidiarrheal properties. This study evaluated antibacterial properties of the ethanol / aqueous extracts and fractions of I. triloba on diarrheagenic bacteria to validate its use in trado-medical treatment of diarrhoea. Aqueous and ethanol extracts of pulverized I. triloba were prepared by cold maceration and phytochemical screening was performed using standard procedures. Diarrheagenic bacteria were isolated from twenty (20) composite diarrhoeal stool samples by community bioprospecting using appropriate selective and differential media. In vitro antibacterial activity of extracts and fractions of I. triloba was determined by the modified agar-well diffusion technique, while minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) was determined by reference standard agar-dilution technique (ADT) after re-incubation of MIC samples at 37o C for 24 h. A total of 74 isolates, belonging to six genera, were identified with their numbers and percentages of occurrence as follows: Escherichia coli, 26 (35.1%), Staphylococcus aureus, 4 (5.4 %), Pseudomonas aeruginosa, 9 (12.2%), Shigella dysenteriae, 18 (24.3%), Salmonella typhi, 8 (10.8%) and Vibrio cholera, 9 (12.2%). Flavonoids, saponins, terpenes, carbohydrates and steroids were detected in both extracts. Ethanol extracts (≥30 mm) showed more potent broad-spectrum antibacterial activity than aqueous extract (≥18 mm). The MIC and MBC values ranged from 250 to 500 mg/mL and 500 to 1000 mg/mL respectively, thus establishing a time-dependent bactericidal mode of antibacterial activity. The best antibacterial activity was elicited by dichloromethane fraction. From the study, I. triloba possesses antibacterial potentials and may be exploited in the chemotherapy of bacterial diarrhoea.

Clostridioides difficile colonization among very young children in resource-limited settings

ObjectivesTo describe the epidemiology and risk factors for Clostridioides difficile (C. difficile) colonization among young children in eight low-resource settings. MethodsWe tested 41 354 monthly non-diarrhoeal and diarrhoeal stools for C. difficile toxin genes (TcdA and TcdB) using quantitative PCR (qPCR) in 1715 children from birth to age two years in a multisite birth cohort study. We estimated the prevalence, cumulative incidence, and seasonality of C. difficile colonization and investigated the associations of C. difficile detection with risk factors of infection, markers of enteropathy, and growth. ResultsThe prevalence of C. difficile detection was lower in diarrhoeal (2.2%; n = 151/6731) compared to non-diarrhoeal stools (6.1%; n = 2106/34 623). By 24 months of age, the cumulative incidence of C. difficile varied widely by site, with 17.9% (n = 44; Pakistan) to 76.3% (n = 148; Peru) of children having at least one positive stool. Only Bangladesh and Pakistan had seasonal differences in C. difficile detection. Female sex (adjusted risk ratio (aRR): 1.18; 95% CI: 1.02–1.35), cephalosporin use in the past 15 days (aRR: 1.73; 95% CI: 1.39–2.16), and treated water (aRR: 1.24; 95% CI: 1.02–1.50) were risk factors for C. difficile positivity. The presence of C. difficile was significantly associated with elevated faecal myeloperoxidase, neopterin, and α-1-antitrypsin, but no associations were found between C. difficile and child growth at 24 months of age. DiscussionC. difficile colonization among children ages 0–2 years was variable across low-resource settings. Significant elevation of intestinal inflammation and barrier disruption markers associated with C. difficile detection suggests a subclinical impact of colonization.

Details Regarding the Medical Treatment of Children with Clostridium Difficile Infection - Clinical Case

Abstract The diarrheal disease produced by Clostridium difficile has a clinical picture that can vary from mild forms to life-threatening forms with a high risk of recurrence. The classic clinical picture described at that time was post-antibiotic, nosocomial diarrhea, which especially affects the elderly. It is the case of a male child of 5 years and 10 months, who presented himself in the morning with vomiting, diarrheal stools and flatulence. He underwent antibiotic treatment for 5 days for acute erythematous angina. From a biological point of view, the blood count is within normal limits, minimal inflammatory tests, examination of coproculture is normal. Clostridium Difficile infection or viral infection with Rotavirus, Norovirus or Adenovirus is suspected. A digestive multiplex panel is performed with a positive Clostridium difficile test and positive rotavirus, norovirus and adenovirus antigens. The treatment instituted was antibiotic, hydroelectrolytic balance, simpatomatic, accompanied by a hygienic-dietary regimen, with a favorable evolution. Acute gastroenteritis with Clostridium difficile is a disease with severe complications in children. Its typical nosocomial character begins to be less and less specific, with the increase in the rate of community infections, which should make clinicians aware and make them more responsible in terms of recommending antibiotic therapy in outpatient settings.

Evaluation of the antidiarrheal activity of 80% methanol extract and solvent fractions of the leaf of Bersama abyssinica fresen (Melianthaceae) in mice

IntroductionThe use of traditional medicinal plants in the management of diarrhea has long been practiced in Ethiopia. B. abyssinica fresen is one of the plants traditionally used to treat diarrhea whereas an in vivo study had not yet been conducted. Thus, this study aimed to evaluate the antidiarrheal activity of crude extract and solvent fractions of the leaf of B. abyssinica in mice.MethodsCold maceration within 80% methanol was used to extract the leaf powder and extract of the leaf was fractionated using n-hexane, chloroform, and distilled water. The in vivo antidiarrheal activity of crude extracts and solvent fractions were tested in experimental models of castor oil-induced diarrhea, enteropooling, and antimotility test. Five groups each with 6 mice were used under the three antidiarrheal models. Positive controls were treated with loperamide 3 mg/kg and atropine 5 mg/kg and 2% tween 80 was used in the treatment of negative controls. The extract and solvent fractions were administered at doses of 100, 200, and 400 mg/kg. Time of onset of diarrhea, number and weight of total and wet feces, the percent reduction in the number of wet feces, weight and volume of intestinal contents, and percent inhibition of intestinal motility were recorded. Data were analyzed using SPSS version 20.ResultDefecation of castor oil-induced diarrheal or loose stools was inhibited (p < 0.01 to p < 0.001) at 200 mg/kg and 400 mg/kg of crude extract and aqueous fraction. The crude extract and the aqueous fraction at three doses (p < 0.01 to p < 0.001), the chloroform fraction at 200 mg/kg and 400 mg/kg (p < 0.01 to p < 0.001), and the n-hexane fraction at 400 mg/kg (p < 0.05) reduced intraluminal fluid accumulation compared with the negative control. Castor oil-induced intestinal motility was significantly suppressed with the three-doses of aqueous fraction (p < 0.05 to p < 0.001), 200 mg/kg and 400 mg/kg of crude extract (p < 0.05 to p < 0.01), 400 mg/kg of chloroform and n-hexane (p < 0.01 to p < 0.001) compared with negative control.ConclusionThe crude extract, aqueous, and chloroform fractions of B. abyyssinica leaves have promising anti-diarrheal effects, supporting the plant's traditional use to treat diarrhea.

Development and performance evaluation of an In-House ELISA for the detection of group A rotavirus in diarrheal stool samples from children and domestic South American camelids

Group A rotavirus (RVA) is a prevalent pathogen causing acute gastroenteritis (AGE) in young children and animals. We developed an in-house ELISA (ROTA-GeFeK) for RVA detection, based on the expression of native recombinant VP6 protein in E. coli. To detect the RVA antigen, rabbit polyclonal IgG antibodies, produced against rVP6,were used as capture and detector antibodies in a sandwich ELISA. To validate the ROTA-GeFeK, 252 stool samples from children with AGE, were evaluated by conventional RT-PCR and commercial ELISA. Compared to RT-PCR, the ROTAGeFeK had a sensitivity of 88.2 % and a specificity of 94.4 %. Total detection rates with the ROTA-GeFeK, commercial ELISA and RT-PCR were 58 %, 58 % and 64 % respectively. The limit of detection was equal to 2.1 × 10 4 CCID 50 of the RVA strain RIX4414. No cross-reactivity with other enteric pathogens was observed. The RVApositive samples detected by the assay belonged to a diversity of G and [P] genotypes.This assay displayed reactivity and was proved to be useful for the detection of RVA in diarrheal samples of domestic South American Camelids. We suggest that the ROTAGeFeK can be used as an epidemiologic tool for rotavirus surveillance and for RVA detection in other animal species.

Treatment of Diarrhoea in Humans Using &amp;lt;i&amp;gt;Lactobacillus salivarius&amp;lt;/i&amp;gt; PROBIOTIC Isolated from Human Saliva

In this study, Lactobacillus salivarius was isolated from human saliva by culture technique using MRS medium, identified through relevant biochemical protocols, and compared to a known control of Lactobacillus acidophilus sourced from Puritan Pride Inc., Qadelade, New York, USA. Primary isolation of microorganisms of interest was carried out at Cheznik Diagnostic and Research laboratories while animal preparation and treatment were carried out at Animal Farm, Mgbakwu Awka. Twenty wistar rats were used as the test animals and another twenty for positive control. The animals in the test group were induced to diarrhea using 1 ml of castor oil following 12-hour fasting while the control group was fed with daily feed and distilled water. The test animals upon production of diarrhoeic stool were fed with 1 × 109 cfu/ml (410 mg/dl w/v) of the Lactobacillus sp isolate in distilled water. The diarrhoea was resolved within 24 hours of treatment. The average weights of the animals taken just after preparation and early treatment (Tx) showed appreciable loss in weight among the test animals possibly due to stress compared to initial weight at T0. However, upon continued treatment with the isolate, obvious weight gain (Tf) compared to Tx was observed. The results of the haematological data at the final analysis showed proximal values and consistency to that of the control group following administration of the Lactobacillus sp isolate. The routine general health data of the test animals showed marked improvement upon treatment with the isolate. A test of significance at 0.05 showed a positive agreement (p Lactobacillus sp showed marked sensitivity to erythromycin, ceftazidine, and chloromphenicol antimicrobial drugs just like other known probiotic strains. No known health hazard or death was recorded. From the study, it was observed that saliva can also proffer a good site in addition to the gut and ileum for the isolation of probiotic microorganisms. It has also shown that the presumptive Lactobacillus salivarius, though strain-specific, possesses probiotic properties effective in resolving most gut issues but especially in diarrhoeic cases.

PRIMARY BILIARY CHOLANGITIS COMPLICATED WITH ULCERATIVE COLITIS: A CASE REPORT

Liver involvement is not unusual in patients with inflammatory bowel disease (IBD), where one third of patients have abnormal liver biochemical tests, becoming a diagnostic challenge. Primary biliary cholangitis (CPB) is an autoimmune liver disease that presents with chronic cholestasis, the presence of specific antibodies and histological findings of destructive non-suppurative cholangitis. Genetic, immunological, and environmental factors that contribute to the pathogenesis of IBD may also contribute to associated hepatobiliary disorders. Objective: Present the case of a 67-year-old woman who consulted for cholestatic symptoms. Medical record of smoking for 25 years was suspended 15 years ago with a smoking index of 5. She reported a history of weakness, asthenia, self-limited palmar and plantar pruritus of 2 years of evolution, associated with abnormal liver function tests (total bilirubin 1.8 mg / dl, INR 1.40, albumin 3.2 g / dL). The initial physical examination revealed jaundice in the sclera, palmar erythema, evidence of telangiectasia in the abdomen, collateral circulation with medusa caput, positive ascitic wave, and splenomegaly. R factor is cholestatic, with alkaline phosphatase of 416 U / L, gamma glutamyl transpeptidase 660 U / L, alanine transferase 59 U / L, for which possible viral and autoimmune causes are addressed as the first possibility, reflecting antimitochondrial antibodies with high titers (278 U / L), associated with immunoglobulin G of 2490 mg / dl and immunoglobulin M of 734 mg / dl. During her one-year follow-up, she reported the onset of diarrheal stools Bristol 6, 2 to 3 episodes per day, with occasional urgency and with inflammatory characteristics, due to the presence of mucus and blood. Infectious causes are ruled out, elevated acute phase reactants are reported, followed up with a colonoscopy and biopsy samples, reporting the presence of nonspecific proctitis, chronic colitis with focal ulceration, lymphoid aggregates, focal atrophy, and glandular distortion compatible with ulcerative colitis (UC). (Panel A) Due to the unusual association between UC and PBC, magnetic resonance cholangiography was requested, ruling out the overlap syndrome between primary biliary cholangitis and primary sclerosing cholangitis. (Panel B) A diverse heterogeneous group of hepatobiliary manifestations is reported in both UC and CD, and approximately 5% of adults with IBD have developed chronic liver disease. PBC is not usually associated with IBD, and concomitant reported cases are anecdotal. The presentations are different than the typical CBP without UC. PBC usually affects middle-aged women. The sex ratio is 10: 1 (female to male) and the mean age at diagnosis is 57.5 years. While the disease tends to affect men more often, with a female / male sex ratio of 2: 1 when associated with IBD. The distribution of ulcerative colitis in PBC patients is usually mild with limited bowel involvement. In a review by Tasa et al., eleven of 15 patients described left side colitis and proctitis. The association between PBC and UC remains rare, as there are still few reported cases regarding the combined presentation of these diseases. Although PSC is the most specific hepatobiliary manifestation among UC patients with cholestasis, PBC should be considered in those with unexplained intrahepatic cholestasis. The use of a reliable test such as AMAs is of utmost importance to avoid misdiagnosis and/or under diagnosis. The authors declare that there is no conflict of interest.

Evaluation of Anticolitis and Antioxidant Properties of Bixa orellana (Bixaceae) Leaf Hydroethanolic Extract on Acetic Acid-Induced Ulcerative Colitis in Rats

BackgroundUlcerative colitis is an idiopathic inflammatory bowel disease characterized by tissue damage, diarrhea, anemia, and loss of body weight. Tissue damage occurs as a result of uncontrolled activation of the immune response and an increase in free radicals, which have a strong effect on the pathogenesis of inflammatory bowel disease. The incidence and prevalence of this inflammatory disease continue to increase worldwide. Maceration of Bixa orellana leaves in palm wine is used in traditional medicine to treat diarrhea, dysentery, and hemorrhoids in the Adamaoua region of Cameroon.ObjectiveThe present work evaluated the preclinical effects (ie, antioxidant, hematological, and histological activities) of the hydroethanolic extract of Bixa orellana leaves in an in vivo, rat acetic acid-induced ulcerative colitis model.MethodsThirty-six female rats weighing between 165 and 180 g were fasted for 18 hours and then anesthetized with ether. A dose of 1 mL acetic acid (5%) was administered rectally through a catheter in all rats except the normal control group, which received distilled water (1 mL) instead. Treatments began 48 hours after rectal administrations of acetic acid or water, and all animals were treated twice daily for 7 days. The normal control group and the colitis control group received PO distilled water (10 mL/kg), the positive control received orally loperamide (5 mg/kg, and the 3 test groups received orally the hydroethanolic extract of Bixa orellana at 100, 200, and 400 mg/kg, respectively. During treatment, the number of diarrheal stools and weight change were assessed. At the end of the treatment, the animals were put to death under ether anesthesia. Blood was collected postmortem for evaluation of hematological and antioxidant parameters. The abdomen was opened via a midline incision and the colon was removed and emptied of all contents to assess histological and antioxidant parameters.ResultsDuring treatment, the number of diarrheal stools was significantly decreased from day 3 in animals treated with 100 (P < 0.05), 200 (P < 0.05), and 400 (P < 0.01) mg/kg extract compared with the colitis control group. The change in body weight of all extract-treated rats decreased significantly from day 3 (–5.55%; P < 0.05) to day 8 (–13.80%; P < 0.01) compared with the normal control. In the colitis control, this change ranges from –6.15% on day 2 to –15.13% on day 8. Extract treatment with 100, 200, and 400 mg/kg significantly reduced (P < 0.05) the number of lesions and the relative weight of the colon. The levels of red blood cells, neutrophils, and total white blood cells decreased in the colitis control group, whereas treatment with the extract at doses of 100, 200, and 400 mg/kg was associated with a significant increase in these hematological parameters. Catalase and superoxide dismutase activity and glutathione concentrations all increased significantly (P < 0.01) in blood and colon in all extract-treated animals, whereas levels of malondialdehyde and nitric oxide were significantly decreased (P < 0.01) compared with the colitis control animals.ConclusionsThe hydroethanolic extract of Bixa orellana leaves had protective effects against acetic acid-induced ulcerative colitis in rats that was associated with inhibited production of free radicals believed to be responsible for oxidative stress, hematological disorders, and tissue damage in this animal model.