Dysentery In Children Research Articles

Burden of diarrhea and antibiotic use among children in low-resource settings preventable by Shigella vaccination: A simulation study.

Shigella is a leading cause of diarrhea and dysentery in children in low-resource settings, which is frequently treated with antibiotics. The primary goal of a Shigella vaccine would be to reduce mortality and morbidity associated with Shigella diarrhea. However, ancillary benefits could include reducing antibiotic use and antibiotic exposures for bystander pathogens carried at the time of treatment, specifically for fluoroquinolones and macrolides (F/M), which are the recommended drug classes to treat dysentery. The aim of the study was to quantify the reduction in Shigella attributable diarrhea, all diarrhea, and antibiotic use in the first 2 years of life that could be prevented by a Shigella vaccine. We used data from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, a birth cohort study that followed 1,715 children with twice weekly surveillance for enteric infections, illnesses, and antibiotic use for the first 2 years of life from November 2009 to February 2014 at 8 sites. We estimated the impact of 2 one-dose (6 or 9 months) and 3 two-dose (6 and 9 months, 9 and 12 months, and 12 and 15 months) Shigella vaccines on diarrheal episodes, overall antibiotic use, and F/M use. Further, we considered additional protection through indirect and boosting effects. We used Monte Carlo simulations to estimate the absolute and relative reductions in the incidence of diarrhea and antibiotic use comparing each vaccination scenario to no vaccination. We analyzed 9,392 diarrhea episodes and 15,697 antibiotic courses among 1,715 children in the MAL-ED birth cohort study. There were 273.8 diarrhea episodes, 30.6 shigellosis episodes, and 457.6 antibiotic courses per 100 child-years. A Shigella vaccine with a mean vaccine efficacy of 60% against severe disease given at 9 and 12 months prevented 10.6 (95% CI [9.5, 11.5]) Shigella diarrhea episodes of any severity per 100 child-years (relative 34.5% reduction), 3.0 (95% CI [2.5, 3.5]) F/M courses for Shigella treatment per 100 child-years (relative 35.8% reduction), and 5.6 (95% CI [5.0, 6.3]) antibiotic courses of any drug class for Shigella treatment per 100 child-years (relative 34.5% reduction). This translated to a relative 3.8% reduction in all diarrhea, a relative 2.8% reduction in all F/M courses, a relative 3.1% reduction in F/M exposures to bystander pathogens, and a relative 0.9% reduction in all antibiotic courses. These results reflect Shigella incidence and antibiotic use patterns at the 8 MAL-ED sites and may not be generalizable to all low-resource settings. Our simulation results suggest that a Shigella vaccine meeting WHO targets for efficacy could prevent about a third of Shigella diarrhea episodes, antibiotic use to treat shigellosis, and bystander exposures due to shigellosis treatment. However, the reductions in overall diarrhea episodes and antibiotic use are expected to be modest (<5%).

Development of the Shigella flexneri 2a, 3a, 6, and S. sonnei artificial Invaplex (InvaplexAR) vaccines.

The Shigella artificial invasin complex (InvaplexAR) vaccine is a subunit approach that effectively induces robust immunogenicity directed to serotype-specific lipopolysaccharide and the broadly conserved IpaB and IpaC proteins. One advantage of the vaccine approach is the ability to adjust the constituents to address suboptimal immunogenicity and to change the Shigella serotype targeted by the vaccine. As the vaccine moves through the product development pipeline, substantial modifications have been made to address manufacturing feasibility, acceptability to regulatory authorities, and developing immunogenic and effective products for an expanded list of Shigella serotypes. Modifications of the recombinant clones used to express affinity tag-free proteins using well-established purification methods, changes to detergents utilized in the assembly process, and in vitro and in vivo evaluation of different Invaplex formulations have led to the establishment of a scalable, reproducible manufacturing process and enhanced immunogenicity of Invaplex products designed to protect against four of the most predominant Shigella serotypes responsible for global morbidity and mortality. These adjustments and improvements provide the pathway for the manufacture and clinical testing of a multivalent Invaplex vaccine. IMPORTANCE Shigella species are a major global health concern that cause severe diarrhea and dysentery in children and travelers to endemic areas of the world. Despite significant advancements in access to clean water, the increases in antimicrobial resistance and the risk of post-infection sequelae, including cognitive and physical stunting in children, highlight the urgent need for an efficacious vaccine. One promising vaccine approach, artificial Invaplex, delivers key antigens recognized by the immune system during infection, which results in increased resistance to re-infection. The work presented here describes novel modifications to a previously described vaccine approach resulting in improved methods for manufacturing and regulatory approvals, expansion of the breadth of coverage to all major Shigella serotypes, and an increase in the potency of artificial Invaplex.

Novel Coronavirus is the Only Virus Causing Childhood Invasive Diarrhea: A Case Series

Introduction: Typical manifestations of Coronavirus disease 2019 (COVID-19) include respiratory involvement. Gastrointestinal (GI) symptoms have also been reported as early clinical manifestations. The GI involvement can represent with diarrhea, vomiting, and abdominal pain. The present research aimed to identify dysentery as one of the signs of GI involvement in the novel coronavirus infection in children. Case Presentation: We report twelve patients with COVID-19 and dysentery. All these children had positive reverse transcription-polymerase chain reaction (RT-PCR) results. None had underlying illnesses or recent travel history. However, all children had contact with a first-degree relative affected by non-digestive COVID-19. In three patients, obvious dysentery was observed, and in the rest, red and white blood cells were evident in the stool exam. Stool exams were negative for bacterial infections, parasites, and the toxin of Clostridium difficile. Abdominal ultrasonography and echocardiographic evaluations to rule out multisystem inflammatory syndrome in children were normal. Supportive treatment, such as zinc supplementation and probiotics, was prescribed. They also received intravenous fluid therapy based on their dehydration percentage. In the end, they were discharged in good general condition without any complications. No GI complications were found in the follow-up series. Conclusions: Dysentery in children can be one of the GI manifestations of COVID-19, which is usually self-limiting. It does not require invasive diagnostic measures and antiviral treatments. This symptom is in contrast to other viral infections of the GI tract.

Comparison of the Effect of Azithromycin and Cefixime on Dysentery in Children Referred to Zahedan University Medical Centers

Aims Bloody diarrhea is mainly caused by infectious agents (bacterial and parasitic), especially Shigella or Entamoeba species, and causes high mortality, especially in children. This study was conducted to compare the effects of azithromycin and cefixime on the treatment of dysentery in children referred to Zahedan University Medical Centers. Methods &amp; Materials The participants of the present experimental study were 116 children aged 6 months to 5 years referred to Zahedan University Medical Centres diagnosed with dysentery by pediatricians with blood reported in their diarrhea stools. Dysentery was considered diarrhea with blood or diarrhea confirmed by stool tests. At the beginning of the study, patients’ names and contact numbers were obtained from patients’ families at the clinic. The blocking method with quadruple blocks was used for random allocation. The patients studied were in groups A and B. Group A received azithromycin for five days, with 12 mg/kg on the first day and 6 mg/kg over the next four days. Group B also received cefixime at 8 mg/kg daily for five days. Then, on the fifth day after the start of treatment, they were called to check the cases. Finally, the information was recorded and analysed. Findings In the present study, there was no significant difference between the two groups in terms of the average time of cessation of fever (P=0.887), the average time of cessation of blood excretion in feces (P=0.101), the average time of cessation of abdominal pain (P=0.133), and the average time of cessation of diarrhea (P=0.189). Conclusion In general, there was no clear clinical difference in the use of cefixime and azithromycin in the clinical recovery of children with dysentery. As a result, depending on the patient’s condition and the severity of the disease, it is recommended that the correct choice of these drugs be based on the physicians’ clinical experience and the patient’s condition.

Tinidazole versus Ornidazole in Amebic Dysentery in Children (a double blind trial)

Between January and June 1978, a double blind trial was conducted in 3.5 children, suffering from Amebic Dysentery in the OPD of the General Hospital Medan.&#x0D; The children were treated ambulatory, either with Tinidazole or Ornidazole, with a dose of 50 mg/kg body weight/day for 3 consecutive days, under close supervision. All the children, except on in the Tinidazole group (case no. 20), gave excellent responses.&#x0D; Disappearance of ameba's blood and mucus from the stools occurred in all of the patients after 2 days of treatment. There was no significant difference in the results of treatment with Tinidazole and Ornidazole (p&gt;0.05). Side effects were minimal. Marked vomiting occurred in one patirnt of the Ornidazole group.

Dysentery in Children.

The article's abstract is not available.

Human challenge study with a Shigella bioconjugate vaccine: Analyses of clinical efficacy and correlate of protection

BackgroundShigellosis is a major cause of moderate to severe diarrhoea and dysentery in children under 5 years of age in low and middle-income countries. The Flexyn2a vaccine conjugates the O-polysaccharide of Shigella flexneri 2a to Pseudomonas aeruginosa exotoxin A. We describe a Phase 2b proof-of-concept challenge study that evaluated safety, immunogenicity, and efficacy of the Flexyn2a vaccine to protect against shigellosis. MethodsIn this randomized, double blind, placebo-controlled trial, healthy adults were randomized 1:1 to receive Flexyn2a (10 µg) or placebo intramuscularly, twice, 4 weeks apart, followed by challenge 4 weeks later with 1500 colony forming units (CFUs) of S. flexneri 2a strain 2457T. The primary outcome was vaccine-induced protection. S. flexneri 2a lipopolysaccharide (LPS)-specific immune responses were assessed. FindingsSixty-seven subjects were enrolled, 34 received vaccine and 33 placebo. The vaccine was well tolerated; the majority of adverse events were mild in nature. Thirty vaccinees and 29 placebo recipients received the S. flexneri 2a challenge. Vaccination resulted in a 30.2% reduction in shigellosis compared with placebo (13/30 vs. 18/29; p = 0.11; 95% CI -15 to 62.6). Vaccine efficacy was more robust against severe disease, reaching 51.7% (p = 0.015, 95% CI 5.3 to 77.9) against moderate/severe diarrhoea or dysentery concurrent with fever or severe enteric symptoms and 72.4% (p = 0.07) against more severe diarrhoea (≥10 lose stools or ≥1000 g loose stools/24 h). Vaccinated subjects were less likely to need early antibiotic intervention following challenge (protective efficacy 51.7%, p = 0.01; 95% CI 9 to 76.8). In those who developed shigellosis, vaccinated subjects had a lower disease severity score (p = 0.002) than placebo-recipients. Additionally, LPS-specific serum IgG responses in Flexyn2a recipients were associated with protection against disease (p = 0.0016) and with a decreased shigellosis disease score (p = 0.002). InterpretationThe Flexyn2a bioconjugate vaccine was immunogenic, well tolerated and protected against severe illness after Shigella challenge and is a promising Shigella vaccine construct. We identified a strong association between anti-S. flexneri 2a serum IgG and a reduction in disease outcomes. (Clinicaltrials.gov, NCT02646371.) FundingFunding for this study was through a grant from the Wellcome Trust.

Clinical characteristics and treatment results of Shigella in Digestion department, National Children’s Hospital 2019

Objectives: 1. Describe some clinical epidemiological characteristics of Shigella dysentery in children in the Department of Gastroenterology of Central Children's Hospital in 2019; 2. Comment on treatment results in the above patients. Subjects: All patients under 15 years old are admitted to the Hospital of Gastroenterology, Vietnam National Children's Hospital.. Method of cross-sectional description. Results: More morbidity rates in men than in women. The male / female ratio is 1.8 / 1. In which, the highest incidence is from 1 to 3 years old. In comparison with other seasons, autumn has the highest proportion of hospital patients, accounting for 46.4%. The majority of patients admitted to hospital due to diarrhea and fever accompanied by blood in the stool accounted for 41.3%, some came to the hospital due to high fever with 15/184 patients accounting for 7.9%, high fever. Accompanied by seizures, accounting for 16.5%. The rate of treatment with Ciprofloxacin is 89.5%. The recovery rate is quite high, 93.3%, the percentage of patients who are also significantly better at 6.7% and there is no case of treatment failure.&#x0D;

Diagnosis and Management of Dysentery in Children Attending National Hepatology and Tropical Medicine Research Institute

Background: Dysentery is one of the main causes of morbidity and mortality among children especially in developing countries, several enteric pathogens are responsible. Diagnosis is made by taking personal history, clinical and laboratory examinations. Management is maintained by using rehydration therapy, ant parasitic, antiviral and antimicrobial therapy. Objective: The study was conducted to determine the prevalence of enteric pathogens causing dysentery in children and risk factors. Methodology: Stool samples were collected from children with dysentery, samples were examined by direct smear, formalin ether, modified ZN, copro antigens, culture /sensitivity and Rota virus antigen tests. Results: Pathogens were isolated from 77.8% samples with higher rate of parasites 35.6% than bacteria 21.7% or Rota virus 3.9%. Most common parasite was G. lamblia (22.2%). E.coli was the most frequent bacterial pathogens (42.0%). watery diarrhea was higher in children &gt; 5 years old (20.7%) than children &lt;5 years old (17.4%) specially in parasitic cases (25.7%), hepatomegaly was (7.2% ) in &gt; 5 years old , parasites and Rota virus were higher in boys (40.9%, 5.7%) than in girls (30.4%, 2.2%) while bacterial was higher in girls (28.3%) than in boys (14.9%) respectively. All sociodemographic data was insignificantly different except for insanitary water supply. Conclusion: This study provides update information about the prevalence of the enteric causative agents in children dysentery. We recommended awareness about prevention, improvement hygiene status and proper medications to reduce the disease. More strategies about risk factors are needed to develop recent controlling methods.

Subclinical Characteristics and Treatment Results of Shigella in Gastroeterology Department, Vietnam National Children’s Hospital 2019

Purpose: To describe some subclinical characteristics of Shigella dysentery in children of the Gastroenterology Department at the Vietnam National Children’s Hospital in 2019 and review the results of treatment in these patients.&#x0D; Methods: A cross-sectional descriptive study was conducted on patients under 15 years of age admitted to the Gastroenterology Department at Vietnam National Children's Hospital.&#x0D; Results: The CRP index increased to 81.8%, of which the increase was mainly in the S.sonnei group. The rate of the most common bacteria strain is S.sonnei accounting for 87.1%, followed by S.fexneri 11.8%, S.dysenteriae encountered a case of 1.1%. No cases of stool culture resulted in S.boydii. The cure rate with Ciprofloxacin is 89.5%. The recovery rate is quite high, 93.3%, the percentage of patients who are also significantly better at 6.7% and there is no case of treatment failure.&#x0D; Conclusions: The number of leukocytes and CRP in the peripheral blood is increased in most cases. The main antibiotic used is Ciprofloxacin, the treatment effectiveness with Ciprofloxacin antibiotic is 89.5%, the cure rate is high and there is no case of treatment failure.

A box-jenkins sarima analysis of dysentery cases in children aged below five at a provincial hospital in Zimbabwe

This piece of work uses monthly time series data on new dysentery cases at Gweru Provincial Hospital (GPH) from Janaury 2010 to December 2018, to predict dysentery cases over the period January 2019 to December 2020. As confirmed by unit root tests, the series under consideration is basically an I (1) variable. The study applied the Box-Jenkins “catch all” model. Residual analysis of this model indicates that the model is stable and thus suitable for predicting dysentery cases at GPH over the out-of-sample period. The results of the study reveal that dysentery cases will be on the rise at GPH over the out-of-sample period; characterized by seasonal repeats in December each year. The study offers a two-fold policy recommendation in order to help policy makers in the fight against dysentery in children under five years of age within the GPH catchment area.

A Novel Shigella Proteome Microarray Discriminates Targets of Human Antibody Reactivity following Oral Vaccination and Experimental Challenge.

Shigella spp. are a major cause of diarrhea and dysentery in children under 5years old in the developing world. The development of an effective vaccine remains a public health priority, necessitating improved understanding of immune responses to Shigella and identification of protective antigens. We report the development of a core Shigella proteome microarray consisting of 2,133 antigen targets common to all Shigella species. We evaluated the microarray with serum samples from volunteers immunized with either an inactivated whole-cell S.flexneri serotype 2a (Sf2aWC) vaccine or a live attenuated S.flexneri 2a vaccine strain (CVD 1204) or challenged with wild-type S.flexneri 2a (Sf2a challenge). Baseline reactivities to most antigens were detected postintervention in all three groups. Similar immune profiles were observed after CVD 1204 vaccination and Sf2a challenge. Antigens with the largest increases in mean reactivity postintervention were members of the type three secretion system (T3SS), some of which are regarded as promising vaccine targets: these are the invasion plasmid antigens (Ipas) IpaB, IpaC, and IpaD. In addition, new immunogenic targets (IpaA, IpaH, and SepA) were identified. Importantly, immunoreactivities to antigens in the microarray correlated well with antibody titers determined by enzyme-linked immunosorbent assay (ELISA), validating the use of the microarray platform. Finally, our analysis uncovered an immune signature consisting of three conserved proteins (IpaA, IpaB, and IpaC) that was predictive of protection against shigellosis. In conclusion, the Shigella proteome microarray is a robust platform for interrogating serological reactivity to multiple antigens at once and identifying novel targets for the development of broadly protective vaccines.IMPORTANCE Each year, more than 180 million cases of severe diarrhea caused by Shigella occur globally. Those affected (mostly children in poor regions) experience long-term sequelae that severely impair quality of life. Without a licensed vaccine, the burden of disease represents a daunting challenge. An improved understanding of immune responses to Shigella is necessary to support ongoing efforts to identify a safe and effective vaccine. We developed a microarray containing >2,000 proteins common to all Shigella species. Using sera from human adults who received a killed whole-cell or live attenuated vaccine or were experimentally challenged with virulent organisms, we identified new immune-reactive antigens and defined a T3SS protein signature associated with clinical protection.

The other Campylobacters: Not innocent bystanders in endemic diarrhea and dysentery in children in low-income settings.

BackgroundCampylobacter is one of the main causes of gastroenteritis worldwide. Most of the current knowledge about the epidemiology of this food-borne infection concerns two species, C. coli and C. jejuni. Recent studies conducted in developing countries and using novel diagnostic techniques have generated evidence of the increasing burden and importance of other Campylobacter species, i.e. non-C. coli/jejuni. We performed a nested case-control study to compare the prevalence of C. coli/jejuni and other Campylobacter in children with clinical dysentery and severe diarrhea as well as without diarrhea to better understand the clinical importance of infections with Campylobacter species other than C. coli/jejuni.Methodology/Principal findingsOur nested case-control study of 439 stool samples included dysenteric stools, stools collected during severe diarrhea episodes, and asymptomatic stools which were systematically selected to be representative of clinical phenotypes from 9,160 stools collected during a birth cohort study of 201 children followed until two years of age. Other Campylobacter accounted for 76.4% of the 216 Campylobacter detections by qPCR and were more prevalent than C. coli/jejuni across all clinical groups. Other Campylobacter were also more prevalent than C. coli/jejuni across all age groups, with older children bearing a higher burden of other Campylobacter. Biomarkers of intestinal inflammation and injury (methylene blue, fecal occult test, myeloperoxidase or MPO) showed a strong association with dysentery, but mixed results with infection. MPO levels were generally higher among children infected with C. coli/jejuni, but Shigella-infected children suffering from dysentery recorded the highest levels (26,224 ng/mL); the lowest levels (10,625 ng/mL) were among asymptomatic children infected with other Campylobacter. Adjusting for age, sex, and Shigella infection, dysentery was significantly associated with C. coli/jejuni but not with other Campylobacter, whereas severe diarrhea was significantly associated with both C. coli/jejuni and other Campylobacter. Compared to asymptomatic children, children suffering from dysentery had a 14.6 odds of C. coli/jejuni infection (p-value < 0.001, 95% CI 5.5–38.7) but were equally likely to have other Campylobacter infections–odds ratio of 1.3 (0.434, 0.7–2.4). Children suffering from severe diarrhea were more likely than asymptomatic children to test positive for both C. coli/jejuni and other Campylobacter–OR of 2.8 (0.034, 1.1–7.1) and 1.9 (0.018, 1.1–3.1), respectively. Compared to the Campylobacter-free group, the odds of all diarrhea given C. coli/jejuni infection and other Campylobacter infection were 8.8 (<0.001, 3.0–25.7) and 2.4 (0.002, 1.4–4.2), respectively. Eliminating other Campylobacter in this population would eliminate 24.9% of the diarrhea cases, which is almost twice the population attributable fraction of 15.1% due to C. coli/jejuni.Conclusions/SignificanceEighty-seven percent of the dysentery and 59.5% of the severe diarrhea samples were positive for Campylobacter, Shigella, or both, emphasizing the importance of targeting these pathogens to limit the impact of dysentery and severe diarrhea in children. Notably, the higher prevalence of other Campylobacter compared to C. coli/jejuni, their increasing burden during early childhood, and their association with severe diarrhea highlight the importance of these non-C. coli/jejuni Campylobacter species and suggest a need to clarify their importance in the etiology of clinical disease across different epidemiological contexts.

Prevalence of E. histolytica Associated Dysentery in Children in Satellite Town, Quetta

Amoebic dysentery is an infection of the gastrointestinal tract caused by the parasitic Entamoeba histolytica, the most invasive type of Entamoeba species. Tropical and sub-tropical developing countries like South Africa, West Africa, Central America, South America, India, Pakistan and Mexico have high rate of incidence where it is a serious health threat. Commonly it affects young to middle-aged adults but the most affected age groups are of infants. Among the infected ones 90% does not produce any symptoms and are therefore asymptomatic but the remaining 10% produces a spectrum varying from dysentery (inflammation of the intestine i.e. large intestine characterized by the presence of blood and mucus in their faeces) to amoebic liver abscess. This study was conducted in Satellite town (an area in Quetta city) and stool samples of 100 patients were collected from a nearby hospital (Saiban family hospital) in this particular area. The patients within age group between 2 to 6 years were examined for E. histolytica cysts presence using iodine solution as the basic diagnostic technique. Parameters like gender, haeme positive stool, blood group, BMI and age were determined for the examined patients. Besides that a questionnaire was also designed consisting of simple questions related to the disease to know more about its occurrence. The results obtained from this analytical study revealed that the incidence of childhood dysentery is relatively high in this area indicating that the parasite is more prevalent in male (77%) children within the age group of 2-5 as compared to in females. The high rate of incidence of this parasite could be due to low immunity level of the hosts caused as a result of malnourished status, poor personal hygiene and inadequate sanitary conditions. Contaminated water supply also contributes to this high rate.

A study on the antibiotic resistance of Shigella

Background The hospital morbidity caused by Shigella or dysen-tery ranges between 0.3 to 2.9%. Irrational use of antibiotics causesa persistent diarrhea and may lead to drug resistance.Objectives With various kinds of antibiotics available in Indone-sia at the moment, this study aimed to anticipate the kinds of anti-biotics appropriate for shigellosis and to evaluate the clinical spec-trum of dysentery in children in Indonesia.Method The study involved 50 children diagnosed with dysenteryor dysentery-like syndrome, aged 1 to 12 years, who came to fourdifferent hospitals in Jakarta, from November 2001 to April 2002.Parents were asked for their consent. Interviewers recorded de-tails of the children’s history of illness and the physical examina-tions. Stool culture and resistance tests were done.Results Fifty dysentery cases, comprising 30 males and 20 fe-males, 98% aged from 1 to 5 years, came to the four hospitalsduring the study period. Only 24 cases had positive Shigella cul-tures, of which 87% were Shigella flexneri and 17% were Shigellasonnei. The clinical manifestations of shigellosis were bloody stools(83%), mucus in the stool (75%), and watery diarrhea (96%). Fe-ver and tenesmus were absent in 67% and 92% of subjects, re-spectively. Almost 87% of shigellosis cases were resistant tocotrimoxazole; all were sensitive to colistin and most were sensi-tive to nalidixic acid.Conclusion This data suggests that colistin and nalidixic acid aredrugs of choice for dysentery syndrome. The clinical manifesta-tion of dysentery is not always accompanied by bloody stools butmostly incorporates watery diarrhea and mucus in the stool

Efficacy of Synbiotics for Treatment of Bacillary Dysentery in Children: A Double-Blind, Randomized, Placebo-Controlled Study.

Bacillary dysentery is a major cause of children's admission to hospitals. To assess the probiotic and prebiotic (synbiotics) effects in children with dysentery in a randomized clinical trial, 200 children with dysentery were studied in 2 groups: the synbiotic group received 1 tablet/day of synbiotic for 3–5 days and the placebo group received placebo tablets (identical tablet form like probiotics). The standard treatment was administered for all patients. Duration of hospitalization, dysentery, fever, and the weight loss were assessed in each group. It was concluded that there was no significant difference in both groups in the baseline characteristics. The mean duration of dysentery reduced (P < 0.05). The mean duration of fever has been significantly reduced in the synbiotic group (1.64 ± 0.87 days) in comparison to the placebo group (2.13 ± 0.94 days) (P < 0.001). Average amount of weight loss was significantly lower in the synbiotic group in comparison to that in the placebo group (129.5 ± 23.388 grams and 278 ± 28.385 grams, resp.; P < 0.001). There was no significant difference in the mean duration of hospitalization in both groups (P > 0.05). The use of synbiotics as an adjuvant therapy to the standard treatment of dysentery significantly reduces the duration of dysentery, fever, and rate of weight losses. The trial is registered with IRCT201109267647N1.

Upgrading a Piped Water Supply from Intermittent to Continuous Delivery and Association with Waterborne Illness: A Matched Cohort Study in Urban India

BackgroundIntermittent delivery of piped water can lead to waterborne illness through contamination in the pipelines or during household storage, use of unsafe water sources during intermittencies, and limited water availability for hygiene. We assessed the association between continuous versus intermittent water supply and waterborne diseases, child mortality, and weight for age in Hubli-Dharwad, India.Methods and FindingsWe conducted a matched cohort study with multivariate matching to identify intermittent and continuous supply areas with comparable characteristics in Hubli-Dharwad. We followed 3,922 households in 16 neighborhoods with children <5 y old, with four longitudinal visits over 15 mo (Nov 2010–Feb 2012) to record caregiver-reported health outcomes (diarrhea, highly credible gastrointestinal illness, bloody diarrhea, typhoid fever, cholera, hepatitis, and deaths of children <2 y old) and, at the final visit, to measure weight for age for children <5 y old. We also collected caregiver-reported data on negative control outcomes (cough/cold and scrapes/bruises) to assess potential bias from residual confounding or differential measurement error.Continuous supply had no significant overall association with diarrhea (prevalence ratio [PR] = 0.93, 95% confidence interval [CI]: 0.83–1.04, p = 0.19), bloody diarrhea (PR = 0.78, 95% CI: 0.60–1.01, p = 0.06), or weight-for-age z-scores (Δz = 0.01, 95% CI: −0.07–0.09, p = 0.79) in children <5 y old. In prespecified subgroup analyses by socioeconomic status, children <5 y old in lower-income continuous supply households had 37% lower prevalence of bloody diarrhea (PR = 0.63, 95% CI: 0.46–0.87, p-value for interaction = 0.03) than lower-income intermittent supply households; in higher-income households, there was no significant association between continuous versus intermittent supply and child diarrheal illnesses. Continuous supply areas also had 42% fewer households with ≥1 reported case of typhoid fever (cumulative incidence ratio [CIR] = 0.58, 95% CI: 0.41–0.78, p = 0.001) than intermittent supply areas. There was no significant association with hepatitis, cholera, or mortality of children <2 y old; however, our results were indicative of lower mortality of children <2 y old (CIR = 0.51, 95% CI: 0.22–1.07, p = 0.10) in continuous supply areas. The major limitations of our study were the potential for unmeasured confounding given the observational design and measurement bias from differential reporting of health symptoms given the nonblinded treatment. However, there was no significant difference in the prevalence of the negative control outcomes between study groups that would suggest undetected confounding or measurement bias.ConclusionsContinuous water supply had no significant overall association with diarrheal disease or ponderal growth in children <5 y old in Hubli-Dharwad; this might be due to point-of-use water contamination from continuing household storage and exposure to diarrheagenic pathogens through nonwaterborne routes. Continuous supply was associated with lower prevalence of dysentery in children in low-income households and lower typhoid fever incidence, suggesting that intermittently operated piped water systems are a significant transmission mechanism for Salmonella typhi and dysentery-causing pathogens in this urban population, despite centralized water treatment. Continuous supply was associated with reduced transmission, especially in the poorer higher-risk segments of the population.

Acute Bacterial Dysentery in Children

Acute Bacterial Dysentery in Children

Prevalence and antimicrobial susceptibility patterns of Shigella in stool samples in a tertiary healthcare hospital of Punjab

Background: Shigella is an important cause of invasive dysentery in children and others. The present study was done to study the prevalence, any seasonal variation, distribution among children and adults, and antimicrobial susceptibility pattern of Shigella isolates in stool. Materials and Methods: A retrospective study was conducted over a period of 1 year from June 2011 to June 2012 in the department of microbiology, in a tertiary care hospital in Punjab. Stool specimens from diarrhea/dysentery cases in different age-groups were processed. The specimens were processed by standard microbiological techniques. The suspected colonies of Shigella were identified by standard biochemical tests and serotyping was done by group specific antisera. The susceptibility of all the isolated Shigella species to different antibiotics were done by Kirby-Bauer's disk diffusion technique as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Shigella species were isolated from 30 (2.1%) of the total 1,402 stool samples received during the study period. Among these, Shigella flexneri was the predominant species accounting for 57% of isolates, followed by S. sonnei (36%) and S. boydii (7%). Over 70% of Shigella isolates were resistant to two or more drugs including ampicillin, trimethoprim-sulfamethoxazole, and norfloxacin; and 10% Shigella isolates were resistant to chloramphenicol and ceftriaxone during the study period. No resistance was observed to cefoperazone/sulbactam, piperacillin/tazobactam, and imipenem. Conclusions: The results of the study revealed the high prevalence of shigellosis with S. flexneri as the predominant species. The result also suggests that ampicillin, trimethoprim-sulfamethoxazole and norfloxacin should not be used empirically as the first line drugs in the treatment of shigellosis. Periodic analysis and reporting of antibiotic susceptibility is an important measure to check for antibiotic resistance and form appropriate treatment protocols.

Spectrum of dysentery in children presenting to a tertiary level teaching hospital in New Delhi

Dysentery accounts for significant morbidity in pediatric population with a high case fatality rate, if left untreated. Further, the easy availability of antibiotics has led to widespread emergence of resistant strains. The aims of this study were: (1) to study the clinical spectrum of dysentery in children, and (2) to determine various enteropathogens causing dysentery in children. 60 children in the age group 1 month to 12 years, presenting with dysentery (defined as loose stools with visible blood), were enrolled. The stool samples were cultured to determine various enteropathogens and their antibiotic sensitivity pattern. About 61.7% of children were in the age group of 6 months to 2 years. 71.7% had no dehydration at presentation. No complication was documented in our study. 80% of stool samples were grossly bloody and 58.3% were grossly mucoid. Enteropathogens were identified in 44 cases (73.3%). Leading isolates were Shigella in 23 cases (38.3%), Escherichia coli in 18 (30%). Salmonella were seen in 2 patients, accounting for 3.3% and Aeromonas in one patient. Among the Shigella, Shigella flexneri was the most frequent isolate (73.9%). Majority of Shigella were resistant to nalidixic acid (95.7%), norfloxacin (87%), and amoxicillin (56.5%). Most isolates were sensitive to cefotaxime, gentamycin and amikacin (95.6% each). Among the E. coli, EHEC were seen in 9 out of 18 (50%) cases, followed by ETEC and EPEC in 22.2% patients each. EIEC were seen in 5.6% of cases. Majority of E. coliwere resistant to amoxicillin (95%), nalidixic acid (88.9%), norfloxacin (66.7%), and cefotaxime (56%). However, most strains were sensitive to gentamycin (88.8%) and amikacin (100%). We conclude that enteropathogen resistance to commonly used antibiotics is rapidly rising however, resistance to extended spectrum cephalosporins is still rare. Thus, local susceptibility patterns should be assessed periodically to guide antimicrobial therapy. Key words: Dysentery, enteropathogens, antibiotic resistance.