Gastroenteritis Disease Research Articles

Preparation of Bacterial Ghosts from Campylobacter jejuni Strain PP3894181

In the industrialized world, campylobacter jejuni is a prevalent foodborne bacterial infection. And is zoontic disease and causing gastroenteritis and others disease in the study using this bacteria as vaccine by preparing of bacterial ghost from C. jejuni This is the aim of the study for vaccine was prepared by determining the MIC, MGC of the bacteria that were grown on N.B medium after that a group of chemicals compound SDS, NaOH, CaCO3 and H2O2 were added at specific concentration and according to the Sponglike Protocol and using Plackett-Burman Experiment design and conducting a viability test for the bacteria, the concentration of MIC and MGC were determined.

First Specific Detection of Mammalian Orthoreovirus from Goats Using TaqMan Real-Time RT-PCR Technology.

Mammalian orthoreovirus (MRV) infections are ubiquitous in multiple mammalian species including humans, and mainly causes gastroenteritis and respiratory disease. In this study, we developed a rapid and sensitive TaqMan qRT-PCR method for MRV detection based on the primers and probe designed within the conserved L1 gene. The qRT-PCR assay was evaluated for its sensitivity, specificity, efficiency and reproducibility. It was found that the detection sensitivity was equivalent to 10 DNA copies/μL, and the standard curves had a linear correlation of R2 = 0.998 with an amplification efficiency of 99.6%. The inter- and intra-assay coefficients of variation (CV%) were in the range of 0.29% to 2.16% and 1.60% to 3.60%, respectively. The primer sets specifically amplified their respective MRV segments and had the highest detection sensitivities of 100.25 TCID50/mL with amplification efficiencies of 99.5% (R2 = 0.999). qRT-PCR was used for MRV detection from samples of sheep, goats, and calves from four regions in China, and the overall MRV prevalence was 8.2% (35/429), whereas 17/429 (4.0%) were detected by RT-PCR and 14/429 (3.3%) by virus isolation. The qRT-PCR assay showed significantly higher sensitivity than RT-PCR and virus isolation. Results from an epidemiological survey indicated that the positive rate of MRV in rectal swabs from sheep and goats tested in Shaanxi, Jiangsu, and Xinjiang were 9/80 (11.3%), 12/93 (12.9%) and 14/128 (10.9%), respectively. In goats and sheep, MRV prevalence was obviously associated with season and age, with a high positive rate of more than 8% during September to April and approximately 13% in small ruminant animals under two months of age. This is the first instance of MRV infection in sheep and goats in China, thus broadening our knowledge of MRV hosts. Consequently, primer optimization for qRT-PCR should not only prioritize amplification efficiency and specificity, but also sensitivity. This assay will contribute to more accurate and rapid MRV monitoring by epidemiological investigation, viral load, and vaccination efficacy.

Bidirectional association between infectious gastroenteritis and inflammatory bowel disease: a population-based study

BackgroundIntertwined association between infectious gastroenteritis (IGE) and inflammatory bowel disease (IBD) has not been investigated clearly. We aimed to examine the bidirectional association between IGE and IBD.MethodsA bidirectional study using the Taiwan National Health Insurance Research Database was designed. Through a case-control design, we identified 2899 new IBD cases during 2006–2017 and matched to 28,990 non-IBD controls. We used conditional logistic regression model to estimate odds ratios (OR) of IBD for previous IGE in different exposure time-windows within 5-years before IBD diagnosis and Poisson regression model to estimate incidence rate ratio (IRR) of subsequent IGE for IBD group to non-IBD group.ResultsThe mean age at the initial IBD diagnosis was 41 years. More IBD patients (21.49%) than controls (12.60%) had been exposed to IGE during > 6 months to 5 years before IBD diagnosis, the OR of IBD for IGE was 1.89 [95% confidence interval: 1.69–2.11]. Excess OR decreased as IGE exposure time before the index date increased. More IGE episodes were associated with additional increase in IBD risk (OR: 1.64, 2.19, 2.57, 3.50, and 4.57 in patients with 1, 2, 3, 4, and ≥ 5 IGE episodes, respectively). The IRR of having IGE for IBD group to non-IBD group was 2.42 before IBD diagnosis and increased to 5.74 after IBD diagnosis.ConclusionsThese findings suggested an IGE-IBD bidirectional association. More attention is needed for physicians to develop preventive strategies and be aware of the higher risk of subsequent IGE in IBD patients.

Gastrointestinal Infection in South African Children under the Age of 5 years: A Mini Review.

To estimate gastroenteritis disease and its etiological agents in children under the age of 5 years living in South Africa. A mini literature review of pertinent articles published in ScienceDirect, PubMed, GoogleScholar, and Scopus was conducted using search terms: "Gastroenteritis in children," "Gastroenteritis in the world," Gastroenteritis in South Africa," "Prevalence of gastroenteritis," "Epidemiological surveillance of gastroenteritis in the world," and "Causes of gastroenteritis". A total of 174 published articles were included in this mini review. In the last 20 years, the mortality rate resulting from diarrhea in children under the age of 5 years has declined and this is influenced by improved hygiene practices, awareness programs, an improved water and sanitation supply, and the availability of vaccines. More modern genomic amplification techniques were used to re-analyze stool specimens collected from children in eight low-resource settings in Asia, South America, and Africa reported improved sensitivity of pathogen detection to about 65%, that viruses were the main etiological agents in patients with diarrhea aged from 0 to 11 months but that Shigella, followed by sapovirus and enterotoxigenic Escherichia coli had a high incidence in children aged 12-24 months. In addition, co-infections were noted in nearly 10% of diarrhea cases, with rotavirus and Shigella being the main co-infecting agents together with adenovirus, enteropathogenic E. coli, Clostridium jejuni, or Clostridium coli. This mini review outlines the epidemiology and trends relating to parasitic, viral, and bacterial agents responsible for gastroenteritis in children in South Africa. An increase in sequence-independent diagnostic approaches will improve the identification of pathogens to resolve undiagnosed cases of gastroenteritis. Emerging state and national surveillance systems should focus on improving the identification of gastrointestinal pathogens in children and the development of further vaccines against gastrointestinal pathogens.

The Combined Effect of Infant and Mother Secretor Status on Infant Susceptibility to Viral Gastroenteritis and Celiac Disease

Celiac disease is a prevalent autoimmune disorder with a rising incidence of 7.5% annually during the second half of the 20<sup>th</sup> century and the 21<sup>st</sup> century. Not all genetically susceptible individuals that carry the risk alleles HLA DQ2 and DQ8 go on to develop celiac disease, suggesting that there may be other environmental triggers that contribute to the development of celiac disease in genetically susceptible individuals. Gastroenteritis during infancy has been shown to be associated with increased risk of celiac disease. Secretor status, per the FUT2 genotype, and subsequent alterations in the microbiota, is associated with risk of gastroenteritis in infants. This review investigates the literature from January 2010 to June 2022 to determine the combined effect of secretor status and viral gastroenteritis on the development of celiac disease.<strong> </strong>Mothers with the secretor phenotype and infants with the non-secretor phenotype provided the most protection against particular strains of gastroenteritis and celiac disease. Both the maternal and infant secretor status, as well as the infant’s Lewis status and ABO blood group can influence the infant’s susceptibility to different viral strains, which cause gastroenteritis. Gastroenteritis caused by viral infections can damage intestinal epithelial cells, cause dysbiosis, and affect pro-inflammatory cytokines, which exacerbate celiac disease onset. Understanding the effect of secretor status and gastroenteritis on celiac disease may provide a novel approach to early screening and preventative strategies to reduce risk factors that contribute to the onset of celiac disease.

Class 1 integrons in clinical and swine industry isolates of Salmonella Typhimurium from Colombia, dating 1997 to 2017.

Background. Salmonella enterica subsp. enterica serovar Typhimurium (S. Typhimurium) has been linked to outbreaks of foodborne gastroenteritis disease, and the emergence of antimicrobial-resistant clones. In Colombia, laboratory surveillance of Salmonella spp. between 1997-2018 revealed that S. Typhimurium was the most ubiquitous serovar (27.6 % of all Salmonella isolates), with increasing levels of resistance to several families of antibiotics.Hypothesis. Resistant isolates of S. Typhimurium recovered from human clinical, food and swine samples carry class 1 integrons that are linked to antimicrobial resistance genes.Aim. Identify class 1 integrons, and investigate their association with other mobile genetic elements, and their relationship to the antimicrobial resistance of Colombian S. Typhimurium isolates.Methods. In this study, 442 isolates of S. Typhimurium were analysed, of which 237 were obtained from blood culture, 151 from other clinical sources, 4 from non-clinical sources and 50 from swine samples. Class 1 integrons and plasmid incompatibility groups were analysed by PCR and whole-genome sequencing (WGS), and regions flanking integrons were identified by WGS. The phylogenetic relationship was established by multilocus sequence typing (MLST) and single-nucleotide polymorphism (SNP) distances for 30 clinical isolates.Results . Overall, 39 % (153/392) of the human clinical isolates and 22 % (11/50) of the swine S. Typhimurium isolates carried complete class 1 integrons. Twelve types of gene cassette arrays were identified, including dfr7-aac-bla OXA-2 (Int1-Col1), which was the most common one in human clinical isolates (75.2 %, 115/153). Human clinical and swine isolates that carried class 1 integrons were resistant to up to five and up to three antimicrobial families, respectively. The Int1-Col1 integron was most prevalent in stool isolates and was associated with Tn21. The most common plasmid incompatibility group was IncA/C.Conclusions. The widespread presence of the IntI1-Col1 integron in Colombia since 1997 was striking. A possible relationship between integrons, source and mobile elements that favour the spread of antimicrobial resistance determinants in Colombian S. Typhimurium was identified.

Gastrointestinal Manifestations of SARS-CoV-2: Transmission, Pathogenesis, Immunomodulation, Microflora Dysbiosis, and Clinical Implications.

The clinical manifestation of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the respiratory system of humans is widely recognized. There is increasing evidence suggesting that SARS-CoV-2 possesses the capability to invade the gastrointestinal (GI) system, leading to the manifestation of symptoms such as vomiting, diarrhea, abdominal pain, and GI lesions. These symptoms subsequently contribute to the development of gastroenteritis and inflammatory bowel disease (IBD). Nevertheless, the pathophysiological mechanisms linking these GI symptoms to SARS-CoV-2 infection remain unelucidated. During infection, SARS-CoV-2 binds to angiotensin-converting enzyme 2 and other host proteases in the GI tract during the infection, possibly causing GI symptoms by damaging the intestinal barrier and stimulating inflammatory factor production, respectively. The symptoms of COVID-19-induced GI infection and IBD include intestinal inflammation, mucosal hyperpermeability, bacterial overgrowth, dysbiosis, and changes in blood and fecal metabolomics. Deciphering the pathogenesis of COVID-19 and understanding its exacerbation may provide insights into disease prognosis and pave the way for the discovery of potential novel targets for disease prevention or treatment. Besides the usual transmission routes, SARS-CoV-2 can also be transmitted via the feces of an infected person. Hence, it is crucial to implement preventive and control measures in order to mitigate the fecal-to-oral transmission of SARS-CoV-2. Within this context, the identification and diagnosis of GI tract symptoms during these infections assume significance as they facilitate early detection of the disease and the development of targeted therapeutics. The present review discusses the receptors, pathogenesis, and transmission of SARS-CoV-2, with a particular focus on the induction of gut immune responses, the influence of gut microbes, and potential therapeutic targets against COVID-19-induced GI infection and IBD.

Exposing new taxonomic variation with inflammation — a murine model-specific genome database for gut microbiome researchers

BackgroundThe murine CBA/J mouse model widely supports immunology and enteric pathogen research. This model has illuminated Salmonella interactions with the gut microbiome since pathogen proliferation does not require disruptive pretreatment of the native microbiota, nor does it become systemic, thereby representing an analog to gastroenteritis disease progression in humans. Despite the value to broad research communities, microbiota in CBA/J mice are not represented in current murine microbiome genome catalogs.ResultsHere we present the first microbial and viral genomic catalog of the CBA/J murine gut microbiome. Using fecal microbial communities from untreated and Salmonella-infected, highly inflamed mice, we performed genomic reconstruction to determine the impacts on gut microbiome membership and functional potential. From high depth whole community sequencing (~ 42.4 Gbps/sample), we reconstructed 2281 bacterial and 4516 viral draft genomes. Salmonella challenge significantly altered gut membership in CBA/J mice, revealing 30 genera and 98 species that were conditionally rare and unsampled in non-inflamed mice. Additionally, inflamed communities were depleted in microbial genes that modulate host anti-inflammatory pathways and enriched in genes for respiratory energy generation. Our findings suggest decreases in butyrate concentrations during Salmonella infection corresponded to reductions in the relative abundance in members of the Alistipes. Strain-level comparison of CBA/J microbial genomes to prominent murine gut microbiome databases identified newly sampled lineages in this resource, while comparisons to human gut microbiomes extended the host relevance of dominant CBA/J inflammation-resistant strains.ConclusionsThis CBA/J microbiome database provides the first genomic sampling of relevant, uncultivated microorganisms within the gut from this widely used laboratory model. Using this resource, we curated a functional, strain-resolved view on how Salmonella remodels intact murine gut communities, advancing pathobiome understanding beyond inferences from prior amplicon-based approaches. Salmonella-induced inflammation suppressed Alistipes and other dominant members, while rarer commensals like Lactobacillus and Enterococcus endure. The rare and novel species sampled across this inflammation gradient advance the utility of this microbiome resource to benefit the broad research needs of the CBA/J scientific community, and those using murine models for understanding the impact of inflammation on the gut microbiome more generally.8oDwaJeBPqYs8E78ifbGCvVideo

Factors Associated with Gastroenteritis Disease among Children Age 2-5 Years in Qaladze and Ranya City

Acute gastroenteritis is a major cause of pediatric morbidity and death worldwide, with high healthcare utilization, ongoing practice variation, and significant family burden, especially in developing countries, and young children under the age of five are the most vulnerable. The objectives of the study are to: To assess the factors associated with gastroenteritis in children 2-5 years of age and also to investigate if there is a correlation between socio-demographic data with some of the factors of gastroenteritis A quantitative /descriptive study was conducted, with A non-probability /convenience sampling, The sample size was (111) children who had gastroenteritis and were admitted in Ranya maternity and pediatric teaching hospital and pediatric ward in Shahidan Qaladze Teaching Hospital. The data was collected by modifying the questionnaire that was asked from the patient’s parents by interview (face to face) method. The results of the study indicate that most of the cases were between the age (of 24-28) months 22%, (29-33) months 14%, (32-38) months14% and (59and more) months 28% with the (Mean =42) months. The male was more affected (58%) than the female (42%). Most of the patients were from urban areas (67%). According to the findings, there is a correlation between BMI (body mass index) with gastroenteritis because the P-value is less than 0.05, (P-value =0.04566), there is a significant correlation between Type of feeding and eating Type with Gastroenteritis because the p-value for both of these correlations is less than (0.05), the p-value of correlation between Feeding type and Gastroenteritis is (0.0374). There is a correlation between making the water safer to drink with gastroenteritis because the P-value less than 0.05, and the P-value is (0.0423). Children under 5 years of age are vulnerable to suffering gastroenteritis, the factors, including BMI (body mass index) ،methods that are used to clean water safer, feeding type, and eating type; are those factors that make clients vulnerable to suffer gastroenteritis.

Pediatric Shigellosis Encephalopathy with Atypical Brain Imaging (P6-10.007)

<h3>Objective:</h3> We present a comprehensive case report of a previously healthy 5-years-old girl who suffered from shigellosis encephalopathy and was found to have diffuse cortex sparing pattern of abnormal diffusion restriction not commonly associated with shigellosis. <h3>Background:</h3> Shigellosis is a gastroenteritis disease caused by a class of bacteria known as Shigella. In addition to the typical gastrointestinal symptoms, shigellosis can be associated with neurological extraintestinal manifestations such as encephalopathy and seizures. In this case report, we present a case of a previously healthy five-year old girl who was brought to the hospital for seizures and persistent encephalopathy, after having two days of fever, nausea, vomiting, and non-bloody diarrhea from shigellosis. Our magnetic resonance imaging of the brain revealed a diffuse cortex sparing pattern of abnormal diffusion restriction not commonly associated with shigellosis. <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> We provide a comprehensive report of her clinical course during hospitalization including her neurologic examination findings, brain imaging, electroencephalogram, relevant laboratory results, management, and her post-hospitalization course. <b>Disclosure:</b> Dr. Huang has received personal compensation for serving as an employee of Kaiser Permanente Los Angeles. Dr. Iordanova has nothing to disclose. Dr. Lam has nothing to disclose.

Salmonella Enteritidis clades in South Africa: why we should be paying more attention

Salmonella Enteritidis is the most reported non-typhoidal Salmonella serovar and is implicated in both gastroenteritis and invasive non-typhoidal disease. Whole-genome sequence comparison of Salmonella Enteritidis isolates from across the world identified four definitive clades: Outlier, Global Epidemic, East African and West African. Three of these clades were implicated in epidemics: the Global Epidemic clade was linked to poultry-associated gastroenteritis, while the two African clades were related to invasive disease. Despite the recognition of different Salmonella Enteritidis clades, the distribution and epidemiology of these clades across Africa is poorly understood. In our proof-of-concept study, we classified 618 Salmonella Enteritidis isolates originating from four South African provinces over a period of two years (2012 – 2013) into clades using a clade-typing real-time PCR assay. Associations between clades and province of collection, antimicrobial resistance and HIV status were explored using statistical analysis. Majority of the South African isolates were classified within the Outlier clade (61.00%), with fewer classified within the Global Epidemic clade (38.83%) and only one isolate classified within the West African Clade (0.16%). Of note, were the isolates within the Global clade, which were strongly associated with ciprofloxacin resistance (15.42%, OR: 7.45, CI: 3.526 – 15.751) and invasive disease (58.33%, OR: 1.57, CI: 1.13 – 2.17) in humans. The increase in poultry consumption and importation in South Africa has placed the country at risk of a Salmonella Enteritidis epidemic. Thus, there is a necessity for routine monitoring of S. Enteritidis along the farm-to-fork continuum to implement preventative measures.

Epidemiology and antifungal susceptibilities of clinically isolated Aspergillus species in South China.

Aspergillosis is a rising concern worldwide; however, its prevalence is not well documented in China. This retrospective study determined Aspergillus's epidemiology and antifungal susceptibilities at Meizhou People's Hospital, South China. From 2017 to 2022, the demographic, clinical, and laboratory data about aspergillosis were collected from the hospital's records and analysed using descriptive statistics, chi-square test, and ANOVA. Of 474 aspergillosis cases, A. fumigatus (75.32%) was the most common, followed by A. niger (9.92%), A. flavus (8.86%), and A. terreus (5.91%). A 5.94-fold increase in aspergillosis occurred during the study duration, with the highest cases reported from the intensive care unit (52.74%) - chronic pulmonary aspergillosis (79.1%) and isolated from sputum (62.93%). Only 38 (8.02%) patients used immunosuppressant drugs, while gastroenteritis (5.7%), haematologic malignancy (4.22%), and cardiovascular disease (4.22%) were the most prevalent underlying illnesses. In A. fumigatus, the wild-type (WT) isolates against amphotericin B (99.1%) were higher than triazoles (97-98%), whereas, in non-fumigatus Aspergillus species, the triazole (95-100%) WT proportion was greater than amphotericin B (91-95%). Additionally, there were significantly fewer WT A. fumigatus isolates for itraconazole and posaconazole in outpatients than inpatients. These findings may aid in better understanding and management of aspergillosis in the region.

Investigation of genotype diversity of 7,804 norovirus sequences in humans and animals of China.

Norovirus is a prominent enteric virus responsible for severe acute gastroenteritis disease burden worldwide. In our current study, we analyzed 7,804 norovirus sequences of human and animals in China which were detected from 1980 to 2020 from GenBank. The GenBank database was searched up to May 2021 with the following search terms: "norovirus" or "norwalk virus" and "China." The 7,804 norovirus sequences were collected and evaluated by phylogenetic analysis using MEGA X software package. The online typing tool (https://www.rivm.nl/mpf/typingtool/norovirus/) was used to confirm the genotypes. There were 36 norovirus genotypes prevailing in China. GII.4 was the most prevalent genotype, and GII.2, GII.3 and GII.17 also emerged during different time periods. Most sequences were detected in East China (41.72%, 3,256/7,804), but different norovirus genotypes were distributed widely across the country. A variety of norovirus genotypes, including GI, GII, GIII, GIV, GV, GVI, GVII and GX, were reported in different animals. Furthermore, a GI.3 sequence detected from animal had high identity with norovirus detected in human from the same region, indicating the potential norovirus zoonotic transmission in China. In conclusion, these results indicated that norovirus sequences with considerable genetic diversity distributed widely in China, with potential reverse zoonotic transmission from human to animals.

Frequency of SARS-CoV-2 Positivity Among Children Presenting With Gastroenteritis in Emergency Department.

To the Editors: SARS-CoV-2 infection typically presents with respiratory symptoms, such as rhinitis, cough and dyspnea.1 Although children affected by SARS-CoV-2 might also present uniquely with vomiting or diarrhea,2 the frequency of SARS-CoV-2 positivity among children presenting with an acute gastroenteritis is currently unknown.3,4 The primary aim of this study was to investigate the frequency of SARS-CoV-2 positivity among children with gastroenteritis. The secondary aims were to compare the frequency of SARS-CoV-2 positivity among children with gastroenteritis, with an acute respiratory disease or without any symptom of infection. At the emergency department (ED) of the Fondazione Ca’ Granda Policlinico, Milan, Italy, children presenting with gastroenteritis or a respiratory disease undergo a nasopharyngeal swab for the detection of SARS-CoV-2 by a molecular test. Children requiring an immediate hospitalization are also tested, regardless of their symptoms.5 For this study, we included all children <18 years of age visiting the ED from December 21, 2020, to March 20, 2022, with gastroenteritis (ie, >3 episodes of vomiting or diarrhea in 24 hours). For each child with gastroenteritis, one child with a respiratory disease (rhinitis, cough or dyspnea) and one child requiring hospitalization for conditions without any symptom of infection (eg, trauma) during the same period were included. These children were matched for age (±6 months) and encounter date (±10 days) with those presenting with gastroenteritis. Subjects with both gastrointestinal and respiratory symptoms or without a SARS-CoV-2 swab test were excluded. Children reporting a close contact with a subject with SARS-CoV-2 in the previous 7 days were also excluded. Information on age, sex, date of encounter and the presence of fever (≥37.5 °C) was retrospectively extracted. Data are given as median and interquartile range or frequency, percentage and 95% confidence interval (CI). The χ2-test was used to compare the frequency of SARS-CoV-2 positivity among the 3 study groups. In the study period, 423 children presented to the ED with acute gastroenteritis. The molecular test for SARS-CoV-2 was not available in 13 children. Therefore, 410 children [3.7 (1.4–8.2) years] with gastroenteritis, 410 with a respiratory disease and 410 hospitalized without any infectious symptom were included (Table 1). Fever was more frequent (P < 0.001) in children with respiratory disease than in those with gastroenteritis. The prevalence of SARS-CoV-2 positivity was similar in children with gastroenteritis and with a respiratory disease [8.0% (5.6%–11%) vs. 6.6% (4.4%–9.4%), respectively; P = 0.5], and lower in those without any infectious symptom [3.2% (1.7%–5.4%); P = 0.004]. Among children with fever, those with gastroenteritis and those with a respiratory disease had a similar frequency of SARS-CoV-2 positivity [8.8% (5.3%–14%) vs. 6.0% (3.5%–9.6); P = 0.3]. TABLE 1. - Characteristics of Children With Acute Gastroenteritis, Respiratory Disease or Without Any Symptom of Infection Admitted to the ED Between December 21, 2020, and March 20, 2022 Gastroenteritis Respiratory Disease No Symptom N 410 410 410 Age, y 3.9 [1.5–8.3] 3.4 [1.4–6.8] 3.9 [1.2–8.7] Male 239 (58) 231 (56) 243 (59) Fever 205 (50) 265 (65)* 0 SARS-CoV-2 positivity 33 (8.0)§ 27 (6.6)‡ 13 (3.2)† Children of the 3 groups are matched for age and encounter date. Data are presented as median and interquartile range or frequency and percentage (%).*P < 0.001 gastroenteritis vs. respiratory disease.‡P = 0.5 gastroenteritis vs. respiratory disease.§P = 0.004 gastroenteritis vs. no symptom.†P = 0.034 respiratory disease vs. no symptom. These data suggest that the frequency of SARS-CoV-2 is similar in cases with acute gastroenteritis and with a respiratory disease. Furthermore, both children with respiratory disease and gastroenteritis are more frequently SARS-CoV-2 positive than children without any symptom of infection. Although data were retrospectively collected in a single center, this study has potential implications for clinicians and health policymakers and helps assessing the pretest probability of SARS-CoV-2 positivity among children in ED.

Viral Gastroenteritis Prevalence in Iranian Pediatric Population: A Systematic Review

Background: Viral gastroenteritis infection, a prevalent condition in adolescents and children, is still a rigid and serious problem among humans. This disease is responsible for up to three million fatalities nationwide. noroviruses, rotaviruses, astroviruses, adenoviruses, and sapoviruses are the most common and well-known pathogens associated with viral gastroenteritis agents. In this systematic review, we extracted all original articles and data on viral gastroenteritis that were performed on the Iranian pediatric population. Methods: To investigate the viral agent pathogens of gastroenteritis in Iran, 48 articles on the identification of viral gastroenteritis were gathered from the existing data. Viral gastroenteritis was detected in fourteen provinces, including the southern and northern parts of Iran. The seasonal distribution in Iran was analyzed as well. Finally, all the data from 1978-2021, along with their detailed information, were summarized, including the number of patients, the number of positive cases, applied technics, and the region of the studied cases in Iran. Results: Based on the results, most of the viral detection was associated with Rotavirus, the major pathogen responsible for gastroenteritis disease, followed by Adenovirus, Norovirus, Parechovirus, Bocavirus, Astrovirus, Aichivirus, Sapovirus, and three case reports of SARS-CoV-2 that were associated with viral gastroenteritis. Conclusion: Different studies conducted over Iran, including the northern, southern, and central regions, were obtained based on the data. Most studies had been merely dedicated to rotavirus, which had the highest prevalence of all other viral gastroenteritis. Our review clearly demonstrated that Rotavirus genotype G1P [8] is the dominating sereotype among the other studied gastroenteritis viral agents in Iran in which the most frequency rate was during the winter (44.26%), while the least frequency rate was observed during summer (8.96%).

The Efficacy of Commercial Surface Sanitizers against Norovirus on Formica Surfaces with and without Inclusion of a Wiping Step.

ABSTRACTCommonly used surface sanitizers often lack activity against human noroviruses (hNoVs). The impact of inactivation versus removal when these products are applied via wiping is poorly characterized. The purpose of this work was to assess the anti-hNoV efficacy of various surface sanitizer chemistries, as applied to a laminate material commonly used for restaurant tabletops, using standard surface assays (ASTM E1053-11) and a newly developed wiping protocol. Four commercially available products with different active ingredient(s) (i.e., ethanol [EtOH], acid + anionic surfactant [AAS], quaternary ammonium compound [QAC], and sodium hypochlorite [NaOCl]) and a water control were evaluated against hNoV GII.4 Sydney, hNoV GI.6, and the cultivable surrogate Tulane virus (TuV). Virus concentration was evaluated using RNase-reverse transcriptase (RT)-quantitative PCR (qPCR) (hNoV) and infectivity assay (TuV). Only the EtOH-based product significantly reduced virus concentration (>3.5 log10 reduction [LR]) by surface assay, with all other products producing ≤0.5 LR. The inclusion of a wiping step enhanced the efficacy of all products, producing complete virus elimination for the EtOH-based product and 1.6 to 3.8 LR for the other chemistries. For hNoVs, no detectable residual virus could be recovered from paper towels used to wipe the EtOH-based product, while high concentrations of virus could be recovered from the used paper towel and the wiped coupon (1.5 to 2.5 log10 lower genome equivalent copies [GEC] compared to control) for the QAC- and AAS-based products and for water. These results illustrate the variability in anti-hNoV activity of representative surface sanitizers and highlights the value of wiping, the efficacy of which appears to be driven by a combination of virus inactivation and removal.IMPORTANCE Human noroviruses (hNoVs) are the leading cause of acute gastroenteritis and food-borne disease worldwide. Noroviruses are difficult to inactivate, being recalcitrant to sanitizers and disinfectants commonly used by the retail food sector. This comparative study demonstrates the variability in anti-hNoV activity of representative surface sanitizers, even those allowed to make label claims based on the cultivable surrogate, feline calicivirus (FCV). It also highlights the importance of wiping in the process of sanitization, which significantly improves product efficacy through the action of physical removal of surface microbes. There is a need for more and better product formulations with demonstrated efficacy against hNoVs, which will likely necessitate the use of alternative cultivable surrogates, such as Tulane virus (TuV). These findings help food safety professionals make informed decisions on sanitizing product selection and application methods in order to reduce the risk of hNoV contamination and transmission in their facilities.

A Rare Case of Synchronous Severe Duodenal Ulcers and Acute Colitis in Sartan-Induced Enteropathy: A Case Report and Review of Literature

Sartan induced sprue-like enteropathy (SIE) was initially reported as a side effect of chronic Olmesartan use in 2012 and is characterized by chronic diarrhoea and weight loss. The diagnosis is often difficult and requires ruling out of other causes of enteropathy including infectious gastroenteritis, autoimmune enteropathy and celiac disease. A 51 – year – old Caucasian male was admitted to our hospital because of chronic non-bloody diarrhoea associated with severe acute renal failure and electrolyte imbalances. His medical history was only positive for hypertension for which he was on Olmesartan Medoxomil and Lacidipine, both of which were discontinued due to hypotension at admittance. Stool cultures and search for C. Difficile toxin resulted negative, whilst a Colonscopy showed endoscopic and histological signs of aspecific acute colitis. After having responded to i.v. hydration with normalization of the renal function the patient was discharged home with the same medications he was on before admittance. His diarrhoea relapsed and he was readmitted shortly afterwards with acute renal failure and electrolyte imbalances; the anti-hypertensive medications were again discontinued. After having excluded all other causes of diarrohea, including celiac disease and HIV, Sartan – induced enteropathy (SIE) was suspected and then confirmed with an esophagogastroduodenoscopy which revealed a severe erosive duodenitis with multiple duodenal ulcers. The patient again responded to i.v. hydration with normalization of the renal function and Olmesartan was held also at discharge without further relapse of the symptoms. SIE is a rare cause of chronic diarrhoea, weight loss and possible severe renal failure. It could affect the whole gastrointestinal tract and in cases of unexplained non-bloody diarrhea, suspecting SIE is fundamental and should be considered in the differential diagnosis. Discontinuation of the drug is generally sufficient for symptom resolution: in suspected cases with a positive medical history for chronic angiotensin receptor blocker (ARB) use, stopping the drug ex-juvantibus should be undertaken. Further research on the immunopathological mechanisms and how to recognize patients at higher risk of developing this condition is deemed necessary.

Epidemiology of Diseases and Mortality in a Pediatric Intensive Care Unit in Qazvin, Iran

Background: Depending on the level of care and the availability of pediatric intensive care unit (PICU) facilities, the mortality rate of acutely ill children varies in PICUs. Referral of patients from other medical centers, admission during working or off-work hours, and nosocomial infections are the most important risk factors for the high mortality rates in PICUs. Objectives: The present study aimed to investigate the characteristics and factors related to the risk of mortality in pediatric patients admitted to the PICU of a pediatric hospital in Qazvin, Iran. Methods: This cross-sectional study was performed on children admitted to the PICU of a pediatric hospital in Qazvin, Iran, between June 2017 and June 2020. During this period, a total of 1504 children, aged one month to 13 years, were admitted to the PICU, and 106 cases expired. The patients’ clinical data (ie, demographic characteristics, underlying disease, cause of death, and length of hospital stay) was extracted from their medical records. A prolonged length of stay was defined as more than 28 days of PICU admission. Results: A total of 106 children, with a mean age of 3.89 ± 3.23 years, expired during the study, with 41 (38.7%) cases being male. Among the investigated cases, 61 (57%) were &lt; 2 years, 18 (17%) were 2 - 5 years old, and 27 (26%) were ≥ 6 years. In these patients, sepsis (13/82, 15.85%) and pneumonia (10/82, 12.19%) were the main causes of death. Other mortalities (14/106) were due to infectious diseases (gastroenteritis, influenza, and coronavirus disease) and non-infectious diseases (aspiration, anaphylaxis, and electrocution). The majority of children with a prolonged length of stay were &lt; 2 years (17/23, 74%). The length of PICU stay was shorter in children with a lower weight percentile (P = 0.016). Conclusions: Following infectious diseases, congenital abnormalities and genetic disorders were the most common causes of pediatric mortality. Chronically ill children were more likely to be underweight and develop nutritional disorders, leading to the deterioration of their condition.

Lack of Association of Household Income and Acute Gastroenteritis Disease Severity in Young Children: A Cohort Study.

To determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE). We conducted a secondary analysis employing data collected in 10 US-based tertiary-care, pediatric EDs between 2014 and 2017. Participants were aged 3 to 48 months and presented for care due to AGE. Income status was defined based on 1) home ZIP Code median annual home income and 2) percentage of home ZIP Code households below the poverty threshold. The primary outcome was moderate-to-severe AGE, defined by a post-ED visit Modified Vesikari Scale (MVS) score ≥9. Secondary outcomes included in-person revisits, revisits with intravenous rehydration, hospitalization, and etiologic pathogens. About 943 (97%) participants with a median age of 17 months (interquartile range 10, 28) completed follow-up. Post-ED visit MVS scores were lower for the lowest household income group (adjusted: -0.60; 95% confidence interval [CI]: -1.13, -0.07). Odds of experiencing an MVS score ≥9 did not differ between groups (adjusted odds ratio: 0.91; 95% CI: 0.54, 1.52). No difference in the post-ED visit MVS score or the proportion of participants with scores ≥9 was observed using the national poverty threshold definition. For both income definitions, there were no differences in terms of revisits following discharge, hospitalizations, and intravenous rehydration. Bacterial enteropathogens were more commonly identified in the lowest socioeconomic group using both definitions. Lower household income was not associated with increased disease severity or resource use. Economic disparities do not appear to result in differences in the disease course of children with AGE seeking ED care.

Quantifying risk factors for microscopic colitis: A nationwide, retrospective cohort study.

Microscopic colitis (MC) is associated with several risk factors; however, their relative risk has been variable and not thoroughly evaluated. We aimed to quantify the risk of medical comorbidities and medications associated with MCand treatment offered to these patients. A population-based retrospective analysis in International Business Machines (IBM) Explorys (1999-2018), a pooled, de-identified database of 63 million patients in the USA, was performed. Odds ratios (OR) were calculated between MC and other diseases/medications. MC patients were also stratified by age to assess trends of MC in different age groups. A total of 1130 patients had MC in the database. Among medications, non-steroidal anti-inflammatory agents (OR, 20.2) and proton pump inhibitors (OR, 12.1) were associated with highest odds of MC. Among medical comorbidities, infectious gastroenteritis (OR, 26.6) and celiac disease (OR, 22.5) had the highest odds of being associated with MC. Tobacco smoking, psoriasis, Sjogren's syndrome, Clostridium difficile infection, and malabsorption syndromes all conferred odds greater than 10. Early identification of MC is critical for minimizing morbidity and mortality. Epidemiologic information can be integrated with current clinical algorithms to more rapidly identify patients at risk.