Epidemiology Of Diarrheal Disease Research Articles

Occurrence of intestinal parasitic infections in HIV-positive patients

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are among the leading causes of infectious disease morbidity and mortality worldwide. Diarrhea is one of the most common AIDS-related illnesses causing a significant morbidity and mortality in HIV infected patients. The opportunistic enteric parasites most commonly implicated in HIV-positive patients are Cryptosporidium parvum, Isospora belli, Cyclospora, Microsporidium spp, Giardia intestinalis, Entamoeba histolytica and Strongyloides stercoralis. Despite the spread of HIV infection in India, and the high prevalence of diarrheal disease, there is little information available on the epidemiology of diarrheal disease among people with HIV infection. The present study was aimed to determine the prevalence of intestinal parasites in HIV infected patients. HIV infection was prevalent in the age group 36 40 years, followed by age group of 31 -35 years, with males outnumbering females. Cryptosporidium parvum followed by Isospora belli and Giardia intestinalis were the most common intestinal parasites isolated. Our study highlights the importance of early diagnosis and treatment of intestinal parasites, so as to reduce morbidity and mortality in HIV/AIDS patients due to diarrhea. K e y w o r d s Cryptosporidium parvum, Giardia intestinalis, Isospora belli, Human Immunodeficiency Virus, Intestinal parasites, Diarrhea

The role of HIV infection in the etiology and epidemiology of diarrheal disease among children aged 0–59 months in Manhiça District, Rural Mozambique

BackgroundDiarrhea is an important health problem among HIV-infected patients. This study evaluated the role of HIV in the epidemiology, etiology, and severity of diarrheal disease among children. MethodsThe Global Enteric Multicenter Study enrolled children with moderate-to-severe diarrhea (MSD) and less-severe diarrhea (LSD) between December 2007 and November 2012. One to three controls for MSD cases and one per LSD case were enrolled and matched by age, sex, and neighborhood. All children were tested for HIV. Clinical data, anthropometric data, and stool samples were collected. Follow-up was performed at 60 days. ResultsTwo hundred and fourteen MSD cases and 418 controls, together with 349 LSD cases and 214 controls were tested. HIV prevalence was 25% among MSD cases (4% for matched controls) and 6% among LSD cases (6% among matched controls). HIV-infected children were more likely to have MSD (odds ratio 5.6, p<0.0001).Mortality rates were higher among HIV-infected children than among the uninfected (34 vs. 5 per 1000 child-weeks at risk; p=0.0039). Cryptosporidium, Giardia, and enteroaggregative Escherichia coli (aatA only) were more prevalent among HIV-infected MSD cases than among uninfected ones. ConclusionHIV is an important risk factor for MSD. The high mortality rate implies that children with MSD should be screened for HIV and managed accordingly.

Detection and Characterization of Enteropathogenic and Shiga Toxin-Producing Escherichia coli Strains in Rattus spp. from Buenos Aires.

Enteropathogenic Escherichia coli (EPEC) and Shiga toxin-producing E. coli (STEC) are pathovars of E. coli that impact human health by causing childhood diseases. In this work, 118 synanthropic rodents of the genus Rattus from Buenos Aires, Argentina were evaluated as EPEC and STEC carriers. Rectal swab samples from captured animals were evaluated by conventional PCR to detect the presence of the eae, stx1, stx2, and rfbO157 genes. Twenty-one isolates were obtained (17 EPEC isolates from seven animals and four STEC isolates from the same animal). All EPEC isolates tested negative for the presence of the bfpA gene. One EPEC isolate carried the iha gene, and five EPEC isolates carried the toxB gene. STEC isolates exhibited two different virulence profiles: stx1a/stx2a/stx2c/stx2d/saa/ehxA/subA (3/4) and stx1a/stx2a/saa/ehxA/subA (1/4). EPEC isolate serotypes included O109:H46 (7), O71:H40 (4), O71:NM (2), O138:H40 (1), O108:H21 (1), O88:H25 (1), and O76:NM (1), and STEC isolates belonged to the O108:H11 (4) serotype. Antimicrobial susceptibility testing was carried out, and resistance to tetracycline was observed in one EPEC strain. Our results demonstrate that Rattus spp. may act as carriers of EPEC and STEC strains and may be involved in the epidemiology of diarrheal disease in infancy.

Epidemiology Of Diarrheal Diseases in Children Below 5 Years in Wassit Province

Diarrheal diseases are major causes of morbidity and mortality among children in developing countries. We have analyzed distribution of diarrhea in children under five years of age who resided in rural or urban environments but attended Al_Karama hospital in Al_Kut city in Wassit. In this study we have found that diarrheal disease is more common in family that their parents illiterate, there is a peak incidence at1-2 years old. The disease more in infant who use bottle feeding than in those who feed on breast of their mothers and those with mixed type of feeding.The incidence of the disease is greater in children whose mothers use tap water for feeding. As for the Residence of the parents of these children, the occurrence of the condition is nearly equal between urban and rural regions.There is no significant difference between male and female.Conclusion: During this study, important environmental risk factors were recognized. Endangered groups and mothers with children under 5 years old should be aware of these risk factors in order to prevent their children's diseases. Prevention of acute diarrhea in children can reduce massive detriments to health system.

Group A rotavirus gastroenteritis: post-vaccine era, genotypes and zoonotic transmission.

ABSTRACTThis article provides a review of immunity, diagnosis, and clinical aspects of rotavirus disease. It also informs about the changes in epidemiology of diarrheal disease and genetic diversity of circulating group A rotavirus strains following the introduction of vaccines. Group A rotavirus is the major pathogen causing gastroenteritis in animals. Its segmented RNA genome can lead to the emergence of new or unusual strains in human populations via interspecies transmission and/or reassortment events.

Acute diarrheal disease caused by enteropathogenic Escherichia coli in Colombia

Intestinal Escherichia coli pathogens are leading causes of acute diarrheal disease in children less than 5 years in Latin America, Africa and Asia and a leading cause of death in children living in poorest communities in Africa and South East Asia. Studies on the role of E. coli pathogens in childhood diarrhea in Colombia and other countries in Latin America are limited due to the lack of detection assays in clinical laboratories at the main urban medical centers. Recent studies report that enterotoxigenic E. coli is the most common E. coli pathogens associated with diarrhea in children less than 5 years of age. Other E. coli pathotypes have been detected in children with diarrhea including enteropathogenic, enteroaggregative, shiga-toxin producing and diffusely adherent E. coli. It was also found that meat and vegetables at retail stores are contaminated with Shiga-toxin producing E. coli and enteroaggregative E. coli, suggesting that food products are involved in transmission and infection of the susceptible host. More studies are necessary to evaluate the mechanisms of transmission, the impact on the epidemiology of diarrheal disease, and management strategies and prevention of these pathogens affecting the pediatric population in Colombia.

An Epidemiologic Review of Enteropathogens in Gaborone, Botswana: Shifting Patterns of Resistance in an HIV Endemic Region

BackgroundThe epidemiology of diarrheal disease in Botswana, an HIV endemic region, is largely unknown. Our primary objective was to characterize the prevalent bacterial and parasitic enteropathogens in Gaborone, Botswana. Secondary objectives included determining corresponding antimicrobial resistance patterns and the value of stool white and red blood cells for predicting bacterial and parasitic enteropathogens.Methodology/Principal FindingsA retrospective cross-sectional study examined laboratory records of stool specimens analyzed by the Botswana National Health Laboratory in Gaborone, Botswana from February 2003 through July 2008. In 4485 specimens the median subject age was 23 [interquartile range 1.6–34] years. Overall, 14.4% (644 of 4485) of samples yielded a pathogen. Bacteria alone were isolated in 8.2% (367 of 4485), parasites alone in 5.6% (253 of 4485) and both in 0.5% (24 of 4485) of samples. The most common bacterial pathogens were Shigella spp. and Salmonella spp., isolated from 4.0% (180 of 4485) and 3.9% (175 of 4485) of specimens, respectively. Escherichia coli (22 of 4485) and Campylobacter spp. (22 of 4485) each accounted for 0.5% of pathogens. Comparing antimicrobial resistance among Shigella spp. and Salmonella spp. between two periods, February 2003 to February 2004 and July 2006 to July 2008, revealed an increase in ampicillin resistance among Shigella spp. from 43% to 83% (p<0.001). Among Salmonella spp., resistance to chloramphenicol decreased from 56% to 6% (p<0.001). The absence of stool white and red blood cells correlated with a high specificity and negative predictive value.Conclusions/SignificanceMost gastroenteritis stools were culture and microscopy negative suggesting that viral pathogens were the majority etiologic agents in this Botswana cohort. Shigella spp. and Salmonella spp. were the most common bacteria; Isospora spp. and Cryptosporidium spp. were the most common parasites. Resistance to commonly used antimicrobials is high and should be closely monitored.

Supplementation with vitamin A reduces watery diarrhoea and respiratory infections in Mexican children

Previous clinical vitamin A trials have found no consistent effect on diarrhoeal disease and respiratory tract infection. These inconsistent results may be due to the distinct effects vitamin A supplementation has among children stratified by factors related to socio-economic status, nutritional status and season. We evaluated the effect of supplementation on the overall incidence of diarrhoeal disease and respiratory tract infections and on the incidence among children stratified by these factors. A total of 188 children, aged 6-15 months, from periurban, marginalized communities of Mexico City were assigned to receive vitamin A ( < 12 months of age, 20,000 IU retinol; >or= 12 months, 45,000 IU retinol) or a placebo every 2 months, and were followed for up to 15 months. Project personnel visited households twice a week to determine the onset and duration of diarrhoeal disease and respiratory tract infections. Vitamin A supplementation had no significant effect on risk of overall diarrhoeal disease but reduced mild watery diarrhoea (incidence rate ratio (RR) 0.69; 95 % CI 0.50, 0.93) and cough with fever (RR 0.69; 95 % CI 0.48, 0.98). Vitamin A supplementation decreased diarrhoeal disease during the summer (RR 0.74; 95 % CI 0.57, 0.94), among non-stunted children (RR 0.69; 95 % CI 0.52, 0.93) and among children from households with better socio-economic measures. Heterogeneity in the response to vitamin A supplementation may reflect heterogeneity in the aetiology and epidemiology of diarrhoeal disease and respiratory tract infections and the impact that supplementation has on the immune response.

Epidemiology of diarrheal disease among children enrolled in four West Coast health maintenance organizations. Vaccine Safety Datalink Team.

We used information from the Vaccine Safety Datalink (VSD) about approximately 1 million children enrolled in four health maintenance organizations to assess the morbidity from diarrhea and estimate the disease burden of rotavirus. We examined trends of diarrhea-associated hospitalizations and emergency room (ER) visits among VSD children ages 1 month through 4 years during October, 1992, through September, 1994 (two rotavirus seasons) and estimated the morbidity from rotavirus on the basis of characteristic patterns of age and seasonality. Overall diarrhea was associated with 6.3% of hospitalizations and 4% of ER visits. During a child's first 5 years of life, we estimated that 1 in 57 was hospitalized and 1 in 21 required an ER visit because of diarrhea. Each year the number of diarrhea-associated hospitalizations and ER visits was greatest in winter among children ages 4 to 23 months and peaked in November in California and during February in Oregon and Washington. The winter seasonality of diarrhea-associated hospitalizations reflected the trends for diarrhea of presumed noninfectious and viral etiologies, which together accounted for most (92.9%) hospitalizations. Diarrhea is an important cause of morbidity among VSD children. The epidemiologic patterns of diarrhea-associated hospitalizations and ER visits resembled those reported previously for rotavirus diarrhea, suggesting that rotavirus may be a major contributor to the overall morbidity from diarrhea. Enhanced surveillance by screening for rotavirus in a sample of children with diarrhea will permit a more accurate assessment of the disease burden of this pathogen and the cost effectiveness of a rotavirus immunization program.

Epidemiology of diarrhoeal disease: implications for control by vaccines

Vaccines present perhaps the most attractive solution to the worldwide problem of diarrhoeal disease. Epidemiological evidence has important implications for the development and use of such vaccines, and results of studies on diarrhoeal diseases in developing and developed countries, in particular among children, and travellers' diarrhoea are reviewed. The virulence and pathogenicity of various enteropathogens are discussed, and the extent to which immunity may be acquired. It is concluded that the development of appropriate vaccines may be a complex task.

Epidemiology of diarrheal diseases: implications for control by vaccines

Epidemiology of diarrheal diseases: implications for control by vaccines

The Epidemiology of Diarrheal Disease in the United States

Diarrheal disease remains an important health problem in the United States. The magnitude of this problem and the relative importance of bacterial, viral, and parasitic pathogens are examined. The often unique epidemiologic associations with specific organisms can be helpful not only in suggesting diagnoses in individual patients but also in the direction of public health action.

Etiology and epidemiology of diarrheal diseases in the United States

Accurate data on the frequency of acute diarrheal illness and the distribution of pathogens are not available for several reasons, including the facts that only a small fraction of cases come to the attention of physicians and that available diagnostic tests establish an etiology in only about half of these. In a survey of three groups of patients in a community (upper-middle class and lower class outpatients and hospitalized Infants), a possible cause was found in fewer than 20 percent of outpatients, and rotavirus accounted for the majority. However, asymptomatic colonization with rbtavirus is very common in early infancy, and demonstration of the antigen correlates with a causative role in diarrhea in only about one half of cases. Data on cases of shigellosis over a 15-year period in Dallas compared with the Centers for Disease Control national data demonstrate that epidemiologic patterns in any given community can differ substantially from the national data. Day-care centers are important sources of Glardia and Shigella infections in the community. The epidemiologic roles of newly reported causes of diarrhea (Campylobacter laridis, Blastocystis hominis, Cryptosporidium species, and Aeromonas hydrophila) are being explored. Generalizations about etiology and epidemiology of pathogens in diarrheal disease are Invalid unless the population group is defined socloeconomically and geographically.