Infectious Diarrhea In Adults Research Articles

Seasonality and etiological characteristics of infectious diarrhea in outpatients of 18 or above-year-old in Shanghai, 2014-2017

Objective: To understand the seasonality and etiological characteristics of infectious diarrhea in adults from Shanghai. Methods: Adult patients with diarrhea who had visited the enteric disease clinics in 22 hospitals that carrying on the Diarrhea Comprehensive Surveillance sentinel programs in Shanghai during 2014-2017, were surveyed. Stool specimens were collected according to the different intervals of sampling and detected for 12 bacteria and 5 viruses. Concentration ratio and circular distribution method were used for data analysis. Results: From 2014 to 2017, a total of 9 573 stool specimens were collected from the targeted diarrhea patients ≥18 years old (n=96 067), through the Shanghai Diarrhea Comprehensive Surveillance program. The positive rate of detection was 46.44%. Seasonal peaks of infectious diarrhea were both seen in summer (bacteria peak, diarrheagenic Escherichia coli and Vibrio parahaemolyticus, etc.) and in winter (virus peak, Norovirus, etc.). Both bacterial and viral infections presented seasonal concentration (Raleigh's test P<0.001) but more obvious with bacterial infection. Viral infection accounted for 60.19% of the cause of infectious diarrhea. The top five predominant pathogens appeared as Norovirus, Rotavirus, diarrheagenic Escherichia coli, Vibrio parahaemolyticus, and Salmonella spp.. Conclusions: Among the adult outpatients with infectious diarrhea in Shanghai, obvious seasonality was seen, with peaks in both summer and winter. Viral infection with Norovirus in particular, appeared as the predominant source of infection. Active, continuous and comprehensive diarrhea-related surveillance programs would be able to monitor the changing dynamic of pathogen spectrum, and lead to the adoption of targeted preventive measures.

JAID/JSC Guidelines for Infection Treatment 2015-Intestinal infections.

JAID/JSC Guidelines for Infection Treatment 2015-Intestinal infections.

The Efficacy of Probiotic in Adults with Acute Infectious Diarrhea

Diarrhea is a global health problem with high morbidity and mortality. In developing countries, acute diarrhea is most commonly caused by infectious pathogens. Regardless of the cause, diarrhea is primarily treated by fluid replacement therapy to decrease the risk of dehydration and death, although it does not affect the duration of diarrhea. Probiotics are able to shorten the duration of diarrhea in children, but its efficacy in adults is unclear. This study aimed to evaluate the benefit of probiotic in reducing the duration of acute diarrhea in adults as compared to placebo. Systematic search was done using four databases: PubMed, Scopus, ProQuest, and Embase, without limit on the year of publication. Randomized clinical trials were selected as the appropriate study design to answer the clinical question and two studies were considered relevant for appraisal. In conclusion, probiotics could improve the recovery of acute infectious diarrhea in adults (level of evidence 1b) however more studies should be carried out since only very few strains of probiotics have been investigated. Normal 0 false false false IN X-NONE X-NONE

Fecal microbiota transplantation: Literature review

Objective: Despite the advancement of antimicrobial treatments, Clostridium difficile infection (CDI) remains the most commoncause of nosocomial infectious diarrhea in adults, and is increasing in frequency and severity in the United States. The reducedefficacy of antimicrobial treatment therapies is a real concern among practitioners and has fuelled the search for alternativetreatment options. Fecal Microbiota Transplantation (FMT) has been reported as a safe and effective treatment for CDI for more than 50 years, but has failed to make its way into common practice. The aim is to assess current literature pertaining to the efficacyof FMT as a treatment option for CDI using the Stetler model. Method: An electronic search using CINHAL Complete, MEDLINE, and Cochrane databases, limited only to articles from academic journals that had full text access and that were published within the last five years. Selection criteria were systematic reviews, and original research studies that used FMT, regardless of delivery modality, for the treatment of recurring and/orrefractory CDI (rCDI) and that had laboratory confirmed results and that reported follow-up. Conclusion: While there is an abundance of literature reporting FMT as a safe and durable practice, most of the publishedliterature consists of case studies and retrospective reviews. The analysis of the selected articles suggests FMT has a substantial effect for the treatment of recurrent CDI. Only three RCTs appear to have been published and majority of the systematic reviews predate the RCTs. More controlled studies with adequate sample sizes are needed before establishing FMT as best practice.

Loperamide therapy for voluminous diarrhea in Ebola virus disease.

Loperamide therapy for voluminous diarrhea in Ebola virus disease.

The diagnosis and treatment of acute infectious diarrhea in adults: an expert concensus

The diagnosis and treatment of acute infectious diarrhea in adults: an expert concensus

Abordaje multidisciplinario de la infección por Clostridium difficile

Clostridium difficile is the most common cause of infectious diarrhea in adults healthcare institutions. Recent studies have shown an increase in the incidence, severity and recurrence of C. difficile infection (CDI). Factors associated with the patient and medical care provided contribute to establishing colonization and, in some cases, subsequent progression to symptomatic disease. The availability of new microbiological techniques has contributed greatly to improving care for these patients. A diagnostic algorithm is provided for cases in which CDI is suspected based on current evidence regarding the effectiveness of microbiological and radiological methods. In cases in which CDI is confirmed, the first and most effective measure is the withdrawal of any antibiotic treatment the patient is receiving, if possible. The antimicrobial treatment of CDI is based on three classic agents: metronidazole, vancomycin and teicoplanin, along with the recent addition of fidaxomicin. Patients presenting serious symptoms, in addition to appropriate support and monitoring measures, may require surgical treatment. Infection prevention and control strategies can interrupt the transmission mechanism. This manuscript reviews current evidence on the approach of this entity from a multidisciplinary point of view.

Recommendations for Probiotic Use-2008 Cited Data Do Not Support “A” Recommendation for Infectious Diarrhea in Adults

Recommendations for Probiotic Use-2008 Cited Data Do Not Support “A” Recommendation for Infectious Diarrhea in Adults

Loperamide Use for Acute Infectious Diarrhea in Children: Safe and Sound?

Loperamide Use for Acute Infectious Diarrhea in Children: Safe and Sound?

Fulminant Clostridium difficile colitis

Clostridium difficile is the most common cause of nosocomial infectious diarrhea in adults. The purpose of this review is to increase awareness that infection from C. difficile is not always indolent, but with fulminant colitis, it can be lethal. The epidemiology, pathogenesis and treatment of C. difficile infection are discussed, with special emphasis on management of fulminant colitis. Clostridium difficile causes fulminant colitis in 3-8% of patients. Early predictors of disease include immunosuppression, hypotension, hypoalbuminemia, and a pronounced leukocytosis. In patients with fulminant colitis, early colectomy before vasopressor therapy is required and may improve survival. The incidence and virulence of C. difficile infection are increasing. Antibiotic use and length of hospital stay correlate strongly with infection. Oral or intravenous metronidazole is the recommended first-line therapy, with discontinuation of systemic antibiotics if possible. Forty percent of patients may have a prolonged course and 20% will relapse despite adequate therapy. Fulminant colitis develops in 3-8% of patients; diagnosis can be difficult with diarrhea absent in 20% of the subgroup. Once diagnosed, subtotal colectomy with ileostomy is usually required. In patients with a marked leukocytosis or bandemia, surgery is advisable because the leukocytosis frequently precedes hypotension and the requirement for vasopressor therapy, which carries a poor prognosis.

Epidemiology of Clostridium difficile-associated infections

Clostridium difficile is responsible for 15–25% of cases of antibiotic-associated diarrhea (AAD) and for virtually all cases of antibiotic-associated pseudomembranous colitis (PMC). This anaerobic bacterium has been identified as the leading cause of nosocomial infectious diarrhea in adults and can be responsible for large outbreaks. Nosocomial C. difficile infection results in an increased length of stay in hospital ranging from 8 to 21 days. Risk factors for C. difficile-associated diarrhea include antimicrobial therapy, older age (>65 years), antineoplastic chemotherapy and length of hospital stay. Other interventions with high risk associations are enemas, nasogastric tubes, gastrointestinal surgery and antiperistaltic drugs. Prospective studies have shown that nosocomial transmission of C. difficile is frequent but often remains asymptomatic. Patients can be contaminated from environnemental surfaces, shared instrumentation, hospital personnel hands and infected roommates. Once an outbreak starts, C. difficile may be spread rapidly throughout the hospital environment where spores may persist for months. Measures that are effective in reducing incidence of C. difficile infections and cross-infection include: (i) an accurate and rapid diagnosis, (ii) appropriate treatment, (iii) implementation of enteric precautions for symptomatic patients, (iv) reinforcement of hand-washing, (v) daily environmental disinfection, and (vi) a restrictive antibiotic policy. C. difficile is a common cause of infectious diarrhea and should be therefore systematically investigated in patients with nosocomial diarrhea.

Therapy for acute infectious diarrhea in children

This article reviews current recommendations of therapy with antidiarrheal compounds and antimicrobial agents for acute infectious diarrhea in children. In most infants and children with acute infectious diarrhea, treatment with antidiarrheal compounds is not indicated. Many of these compounds interfere with identification of enteropathogens in stool specimens, and the antimotility class has an overdose potential. Antimicrobial therapy is given to reduce symptoms and to prevent the spread of infection by decreasing fecal shedding of organisms. Although effective therapy is not available for patients with enteric viruses, Cryptosporidium, and Microsporidium, therapy is useful for children with amebiasis, antimicrobial-associated colitis, cholera, giardiasis, various forms of Escherichia coli diarrhea and Salmonella disease, isosporiasis, shigellosis, and strongyloidiasis. For several other conditions, antimicrobial therapy is of questionable benefit (infection with Campylobacter jejuni or Yersinia enterocolitica, intestinal salmonellosis and enterohemorrhagic E. coli infection). Compounds such as the fluoroquinolones, which are effective in the treatment of acute infectious diarrhea in adults, are not approved for use in children because of potential side effects. Many bacterial, viral, and parasitic organisms cause acute infectious diarrhea; appropriate antimicrobial therapy requires the accurate, rapid identification of the offending enteropathogen. In children with an underlying illness such as acquired immunodeficiency syndrome, manifestations may be prolonged, severe, and recurrent despite appropriate therapy.

The effects of acute clostridium difficile diarrhea on fecal nitrogen content in adult hospitalized patients.

Clostridium difficile diarrhea (CDD) is a frequent cause of hospital-associated infectious diarrhea and a common reason for nutritional consultation. Limited data are available on fecal nitrogen losses during infectious diarrhea in adults. Eleven patients with acute CDD were studied for stool volume and fecal nitrogen. The mean stool output was 630 +/- 110 g/day and fecal nitrogen 2.5 +/- 0.3 g per 24 hour period (mean +/- SEM). Fecal nitrogen loss was increased from the predicted 12.0 mg/kg BW/day to 38.0 +/- 5.9 mg/kg BW/day. Fecal nitrogen loss in CDD can be an important source of nitrogen loss and should be measured in nitrogen balance studies in such patients.