Infectious Diarrhea In Children Research Articles

Influence of zinc supply on the course of infectious diarrhea in children of early age

Aim. Give a comparative characteristic of the course of infectious diarrhea in young children, residents of the Zaporizhzhia region (Ukraine), depending on their provision of zinc (Zn). Materials and methods. The study included 99 children aged 1 to 36 months with manifestations of infectious diarrhea. On the day of hospitalization, immunochromatographic and bacteriological examination of feces was performed. Also, on the first, third and fifth days of hospitalization, a general blood test and the level of Zn in the blood were determined for each patient. Results. It was found that among the examined patients with infectious diarrhea at the onset of the disease, 22 children (22.2 %) had a reduced concentration of Zn in blood serum. In these children, the zinc level ranged from 7.63 to 9.17 μmol/l. It was also noted that the level of Zn in these patients on the 5th day of inpatient treatment rose to the norm of reference indicators. After studying the anamnesis, it was found that 40.9% of children with low Zn content had episodes of acute intestinal infection before this disease. During a comparative analysis of the clinical and laboratory data of patients, it was found that the tendency to more frequent vomiting occurred in patients with Zn deficiency (p = 0.05), that Zn availability had the most significant effect on the expressiveness of the diarrheal syndrome at the onset of the disease and more than a third (n = 8, 36.4 %) of children with Zn deficiency had more than 5 episodes of diarrhea per day, among which every second had more than 10. We did not determine significant differences between the frequency of viral and bacterial causes of diarrhea in the comparison groups. As for complete blood count, patients with Zn deficiency more often had a tendency to blood neutrophilia with a reliably frequent shift of the leukocyte formula to the left (p = 0.003). At the same time, children with a reduced content of Zn in blood serum significantly more often had lymphopenia at the onset of diarrheal disease (p = 0.006). When investigating the effect of Zn deficiency on the course of the disease, we found that in children with reduced Zn, the duration of diarrhea was almost twice as long (8 [6; 9] days vs. 5 [4; 6] in children with normal Zn indicators; p = 0.0001 according to the Mann–Whitney test) and in patients with infectious diarrhea who had Zn deficiency at the onset of the disease, on the seventh day of treatment diarrhea persisted significantly more often (p = 0.03). Such symptoms were accompanied by the persistence of signs of anemia (p = 0.06 on the 5th day) and a shift of the leukocyte formula to the left (p = 0.007) without leukocytosis. Conclusions. Almost 25 % of young children with infectious diarrhea in the Zaporizhzhia region had Zn deficiency. Most likely, Zn deficiency is caused by the peculiarities of its supply with food and its metabolism. In the debut of a diarrheal disease, insufficient supply of Zn is associated with lymphopenia and a shift of the leukocyte formula to the left. Zn deficiency in infectious diarrhea leads to a long (more than 5 days) course of the disease due to prolongation of the diarrheal syndrome.

Age characteristics and possibilities of laboratory diagnosis of infectious diarrhea in children in the tashkent city

Objective: to study the age characteristics of pathogens of infectious diarrhea in children and evaluate the possibilities of laboratory diagnosis of intestinal infections in the Tashkent city. Material and methods. The study included 360 children aged 6 months to 18 years, hospitalized in Tashkent with a diagnosis of “Acute diarrhea”. Diagnosis of intestinal infection was carried out by bacteriological, immunochromatographic and PCR methods using RIDA®QUICK tests (R - BIOPHARM AG, Germany) and kits from Inter Lab Service “AmpliSens® OKI screen-FL”. Results. Analysis showed that the majority (56.7%) of children with diarrhea belonged to the age group of 3-7 and 7-14 years. In the etiological structure of diarrhea, the main share was occupied by viral and bacterial agents (30% and 45.8%, respectively). In 3.6% of cases parasitic diarrhea was observed and in 20.6% of patients the etiology of diarrhea remained unclear. A comparative evaluation of laboratory methods demonstrated the high efficiency of immunochromatographic and PCR methods compared with bacteriological examination in terms of early diagnosis of the etiological agent of diarrhea and the identification of viral pathogens. Conclusions. In children in the younger age group, diarrhea of viral etiology is more often observed, in contrast to older age groups, where bacterial ones are more common. Immunochromatographic and PCR methods enable earlier diagnosis of the causative agent of diarrhea and, consequently, the start of etiotropic treatment.

Effects of <i>Lactobacillus delbrueckii</i> TS1-06 probiotic strain on the size of myocardial infarction in Wistar rats with systemic inflammatory response syndrome

Experimental medicine provides the scientific community with a plethora of information on therapeutic efficacy of probiotic strains. However, from the point of view of evidence-based medicine, the list of disorders controlled by probiotics is limited to antibiotic-associated diarrhea in adults and children, Clostridium difficile-associated diarrhea, acute infectious diarrhea in children and adults, eradication therapy, ulcerative colitis and irritable bowel syndrome. Recently, these indications are also amended by well-validated clinical guidelines for the usage of probiotic preparations, in order to modulate immunity. Given the permeability of gastrointestinal and immune system barriers for pathogenic and opportunistic microbiota, it seems logical to assume the effectiveness of probiotics as potential symbiotic regulators of nervous and cardiovascular systems. It should also be taken into account that metabolic disorders, e.g., obesity, with a low-intensity inflammatory response and characteristic cytokine pattern, are acquired as a gain of human civilization. In this regard, we propose a scientific hypothesis about the effectiveness of probiotic microbial strains in increasing myocardial resistance to ischemic-reperfusion injury, due to their ability to block individual links of the cytokine cascade during the development of inflammatory response, for its subsequent translation into clinical practice.The development and validation of a new experimental model of systemic inflammatory response syndrome (SIRS) in male Wistar rats, including obesity, acute inflammatory process of the colon, and antibiotic-induced dysbiosis, became basic to the study of efficacy of probiotic drugs in terms of myocardial resistance to ischemicreperfusion injury (IRI). Rats with SIRS showed a significantly increased size of the infarction area (+28%) upon experiments with isolated perfused heart under global ischemia-reperfusion conditions. Significant changes in the leukocyte formula and immunological parameters associated with SIRS were corrected by introduction of a mixture of probiotic strains L. acidophilus (LA-5) and B. animalis subsp. lactis (BB-12), and the isolated strain L. delbrueckii TS1-06. In both groups with probiotic correction, there was a decrease in the infarction area compared to the SIRS group. General and specific changes in IL-2, transforming growth factor-b (TGF-b) and tumor necrosis factor-a (TNFa) were noted. The reduction of myocardial infarction by probiotics may be related to the blocking of first-order cytokines, which leads to a «break» of proinflammatory cascade. A need for in-depth study of cardioprotective mechanisms mediated by probiotics was confirmed due to their potential usage as a symbiotic alternative to biological drugs which block the main pro-inflammatory cytokines.

Сучасні уявлення про значущість забезпечення цинком при інфекційній патології в дітей

Zinc (Zn) is an essential trace element that is critical for growth, development and maintenance of immune function. Zn is an indispensable trace element for humans, which is part of more than 20 metalloenzymes, including DNA and RNA polymerase, phosphatase, carbonic anhydrase and some others. The cycle of cell development requires this trace element. The permeability of cell membranes is also related to Zn. It has antioxidant properties and delays the apoptosis of peripheral cells. The formation of immunity depends on the body’s supply of Zn, and its deficiency causes atrophy of the thymic-lymphatic system. Zn is part of insulin, accelerates the regeneration of the mucous layer of the intestines, increases the activity of enzymes of the brush border of enterocytes, increases the level of secretory antibodies and the intensity of cellular immunity. The provision of this element cannot but affect the course of various infectious pathologies. Purpose - by analyzing modern literature data, to find out the importance of Zn provision in infectious pathologies in children. It is analyzed a review of the literature on the pathogenetic role of Zn in the diagnosis, pathogenesis and treatment of infectious diseases, based on a search for articles in the Science, Medline and PubMed databases published from January 2017 to June 2021. An analysis of current literature has shown that Zn is an important micronutrient involved in the regulation of innate and adaptive immune responses. Zn is necessary to ensure the barrier function of membranes. It is involved in the modulation of the pro-inflammatory response. Zn homeostasis is essential for many aspects of the immune system, including hematopoiesis, cell maturation and differentiation, cell cycle progression, and proper immune cell function. Consequently, Zn deficiency leads to cell-mediated immune dysfunctions. Such dysfunctions lead to deterioration of the body's response to bacterial infection. Zn is known to modulate antiviral immunity. Due to zinc, the production of interferon-α is activated and its antiviral activity is increased. Studies show that during the infectious process there is a decrease in the concentration of zinc in the blood plasma. Such changes, on the one hand, provide the needs of immune protection factors, and on the other hand, reduce the availability of the trace element for pathogens. Conclusions. Zn is one of the important trace elements that plays a leading role in maintaining homeostasis and is an integral component of the pathogenesis of various pathological conditions of infectious origin. The most studied is Zn deficiency in infectious diarrhea in children, but studies have been conducted in developing countries with limited resources. No works studying the prevalence of Zn deficiency in Ukraine were found. No conflict of interests was declared by the authors.

Stool Examination and Antibiotic Prescriptions Related to Infectious Diarrhea in Children: A Literature Review

Based on the duration and type of symptoms, diarrhea is categorized into acute or chronic and infectious or non-infectious. Infectious diarrhea is most commonly caused by parasites and enteric bacterial infections in developing nations. The identification of the etiological agent is crucial to the diagnosis and management of diarrhea. Stool examination and stool culture are two non-invasive tests that can be used to determine the etiology of infectious diarrhea. Stool analyses can provide crucial details regarding conditions that affect the gastrointestinal system. Stool can be examined both macroscopically and microscopically. It is necessary to create general guidelines for the use of antibiotics in hospitals and healthcare facilities in order to optimize its wise usage. Stool examination is important for antibiotic prescription because identifying the exact pathogens that caused the diarrhea lead to more effective usage of antibiotic.

Clostridium butyricum powders combined with zinc gluconate on inflammatory factors and intestinal microecology in children with infectious diarrhea

Objective: To investigate the clinical value of Clostridium butyricum powders combined with zinc gluconate in the treatment of infectious diarrhea in children, clinical data of 86 children with infectious diarrhea were retrospectively analyzed. Methods: Both groups received routine treatments to reduce symptoms, among which the control group ( n = 40) was given Clostridium butyricum powders, and the experiment group ( n = 46) was given Clostridium butyricum powders and zinc gluconate. Patients in both groups were treated for 5 days. The clinical efficacy, recovery time, safety, serum levels of inflammatory markers (interleukin-6, interleukin-17, C-reactive protein), indicators of the intestinal mucosal function (diamine oxidase, D-lactate) and indicators to intestinal microecology (bifidobacteria, lactobacillus) before and after treatment were compared between the two groups. Results: The clinical efficacy in the experiment group (95.65%) was higher than that in the control group (77.50%, p < 0.05). The time of recovery from symptoms including diarrhea, abdominal pain and vomiting, and to normal body temperature in the experiment group were shorter than those in the control group (all p < .001). After treatment, the serum IL-6, IL-17, CRP levels and DAO, D-lactate levels in both groups were lower than those before treatment, and were lower in the experiment group than in the control group (all p < .001). After treatment, the intestinal bifidobacteria and lactobacillus levels in both groups were higher than those before treatment, and were higher in the experiment group than in the control group (all p < .01). There was no significant difference in the incidence of adverse reactions between the experiment group (8.70%) and the control group (2.50%). Conclusion: In this open-label study, Clostridium butyricum powders combined with zinc gluconate are significantly effective in treating children with infectious diarrhea, which is conducive to relieving early symptoms, downregulating serum inflammatory factor levels, improving intestinal mucosal function, regulating intestinal microecology, and ensuring the safety of patients.

Curcumin inhibits the replication of rotavirus in vitro.

Rotavirus is the most important etiological agent of infectious diarrhea in children under 5 years of age with more than 125,000 deaths occurring annually worldwide. The present study aims to determine the effect of curcumin, anatural polyphenol compound, on rotavirus in acell culture model. The anti-viral activity of curcumin was evaluated by reverse-transcriptase quantitative PCR (RT-qPCR), TCID50, and western blot techniques to assess CC50 in curcumin-treated MA104 cells as well as EC50 and SI within the infected MA104 cell line. Our findings supported that curcumin exerted an inhibitory influence against rotavirus in adose-dependent manner and decreased the viral titer and VP6 expression by ~99% at aconcentration of 30 μM (p Keywords: curcumin; rotavirus; RT-qPCR; in vitro; anti-rotavirus agent.

Inter- and intra-observer reliability of BITSS scale in the diagnosis and early follow-up of infectious diarrhea in children under 3 years of age

The BITSS scale (Brussels Infant and Toddler Stool Scale) is an instrument used in the diagnosis and follow-up of infants and young children with infectious diarrhea. It consists of 7 pictures of diapers with different types of stools. To determine intra and interobserver reliability of the BITSS scale in infants and children using diapers. Reliability study. Three pediatri cians with experience in treating childhood infectious diarrhea were selected and, after training in applying the BITSS scale, they evaluated 70 pictures of stools obtained from pediatric patients, repre senting the 7 different types of stools categorized by the scale (10 images for each item). Two pediatri cians participated in the interobserver reliability study and performed a blind evaluation of the same pictures, assigning a value to each one, and the third pediatrician participated in the intra-observer analysis, evaluating 70 images on two different occasions, 15 days apart. Interobserver agreement and kappa statistics were determined for the scale and each scale item. 280 measurements were made, 140 for the inter-observer reliability study and 140 for the intra-observer one. The degree of inter-observer agreement for the scale was 85.7%; with a kappa of 0.817 (95% CI 0.72; 0.92), and standard error of 0.05; and the intra-observer kappa for the scale was 0.883 (95% CI 0.80; 0.96), with a standard error of 0.04. The BITSS scale has good intra- and interobserver reliability.

Trends in healthcare visits and antimicrobial prescriptions for acute infectious diarrhea in individuals aged 65\xa0years or younger in Japan from 2013 to 2018 based on administrative claims database: a retrospective observational study

BackgroundThe inappropriate use of antimicrobials for acute infectious diarrhea is widespread and leads to the problem of antimicrobial resistance. To improve the use of antimicrobials, it is first necessary to understand the actual situation of diarrheal disease and to identify potential targets for intervention. This study aimed to investigate the recent epidemiological characteristics of and antimicrobial prescriptions for acute infectious diarrhea in Japan.MethodsThis was a retrospective observational study of outpatients aged 0–65 years, separated into children (age 0–17 years) and adults (age 18–65 years), diagnosed with acute infectious diarrhea, using the administrative claims database of the Japan Medical Data Center from 2013 to 2018. We evaluated the number of eligible visits/number of database registrants (defined as the visit rate). The analysis of the antimicrobial prescription rate was restricted to otherwise healthy individuals diagnosed with acute infectious diarrhea alone by excluding patients with multiple disease diagnoses and with medical backgrounds of chronic bowel diseases or immunocompromised conditions. We further classified them by diagnosis of bacterial or nonbacterial acute infectious diarrhea.ResultsThe total number of eligible visits for acute infectious diarrhea was 2,600,065. The visit rate, calculated based on the number of eligible visits by database registrants, was higher in children (boys, 0.264; girls, 0.229) than in adults (men, 0.070; women, 0.079), with peaks in early summer and winter. The peaks for visits in adults lagged those of children. In total, 482,484 visits were analyzed to determine the antimicrobial prescription rate; 456,655 (94.6%) were diagnosed with nonbacterial acute infectious diarrhea. Compared with children (boys, 0.305; girls, 0.304), the antimicrobial prescription rate was higher in adults, and there were differences between sexes in adults (men, 0.465; women, 0.408). Fosfomycin and fluoroquinolone were most frequently used for nonbacterial acute infectious diarrhea in children (44.1%) and adults (50.3%), respectively.ConclusionsThese results revealed overprescription of antimicrobials for acute infectious diarrhea in this administrative claims database in Japan and contribute to the development of antimicrobial stewardship strategies and the identification of targets for efficiently reducing inappropriate antimicrobial use.

Effectiveness of probiotics and synbiotics in reducing duration of acute infectious diarrhea in pediatric patients in developed countries: a systematic review and meta-analysis.

Acute diarrhea is one of the most frequent causes of doctor visits and hospital admissions for children. Our objective was to evaluate the association between probiotics administration and reduction of acute infectious diarrhea duration in children dwelling in developed countries. Bibliographic databases, gray literature, and reference lists were searched up to September 29, 2019. Double-blind, randomized controlled trials that examined probiotics efficacy in children with acute infectious diarrhea residing in developed countries were included. Data were synthesized by generic inverse variance method using fixed- and random-effects model. Twenty trials met the eligibility criteria (n = 3469 patients) and were included in the qualitative synthesis, and 19 studies in meta-analysis. Twelve trials (n = 840) were assessed as high/unclear risk of bias and eight (n = 2629) as low risk of bias. Comparisons revealed a moderate effectiveness of probiotics in low risk of bias studies (MD = - 13.45 h; 95% CI - 24.26, - 2.62; p = 0.02, Bayesian meta-analysis pooled effect MD = - 0.38, 95% CrI - 2.3, 1.58) and a notable effect in studies with high/unclear risk for bias (MD = - 19.70 h; 95% CI - 28.09, - 11.31; p = 0.0004). In trials of optimal methodological quality (n = 1989), probiotics effect was absent (MD = - 3.32 h; 95% CI - 8.78, 2.13, p = 0.23).Conclusion: Outcomes suggest that probiotics do not demonstrate sufficient clinical impact in reducing diarrhea duration in children in the developed countries.Systematic Review Registration: This review is registered at PROSPERO (ID: CRD42020152966). What is Known: • Probiotics, due to the conflicting study results, are administered without adequate evidence as an adjuvant therapeutic agent for eliminating duration of acute infectious diarrhea in pediatric patients. What is New: • In developed countries, probiotics are demonstrated as ineffective in reducing the duration of acute infectious diarrhea in children.

Predisposing factors contributing to the development of renal dysfunction in acute infectious diarrhea associated with hemocolitis (AIDH)

Outcomes of severe variants of acute infectious diarrhea in children with acute renal injury/failure (ARI/ARF) remain unsatisfactory, and mortality reaches 70% and more. ARI/ ARF therapy requires high material costs, which represent significant burden on health financing systems. It makes us consider AFR as one of the most important medical and social problems.The aim of our studywas to investigate predisposing factors contributing to the development of renal dysfunction in acute infectious diarrhea associated with hemocolitis (AIDH), as well as to study the relationship of the developed renal dysfunction with the severity of endogenous intoxication, damage of vascular endothelium and hemostasis system.We examined 60 sick children with AIDH, divided into two groups: with ARF and without kidney pathology.Susceptibility to ARI/ARF in severe forms of AIDH is mediated by early childhood (up to 3 years in 89,5% of patients), artificial and mixed feeding (in 52,6% and 36,8% of children respectively), pathology of pregnancy in the first trimester, mother diseases during pregnancy (84,2%) and the late admission to hospital (89,5%) on the 4,9±0,2 day of the disease, i/m administration of furosemide without volume circulating blood restoration, i/m administration of nephrotoxic antibacterial medicines. Shigella spp. and Escherichia coli as etiologic factors of diarrhea in 42,1% and 47,4% of cases respectively. Thus due these parameters we can predict the loss of kidneys adaptation ability in diseases with severe course including acute infectious diarrheas.Interrelationships between elevation of the number of antigen binding lymphocytes to tissue antigens of vascular endothelium up to 8,1±0,6% in children with ARF and development of hemorrhagic syndrome (decrease of PTI to 72,5%) and intensity of endogenic intoxication (average molecular peptides up to 9,7±0,6 g/l) and worsening of AFR signs were established.Thus, it was found that AKI most often develops when rehydration therapy is started late or inferiorly performed, when nephrotoxic antibiotics and loop diuretics are prescribed without circulating blood volume (CBV) compensation and is accompanied by an increase in the degree of endogenous intoxication and vascular endothelial damage.

Effectiveness of pathogenetic therapy for infectious diarrhea in children with COVID-19

Introduction . The article presents basic information on approaches to pathogenetic therapy of acute intestinal infections. Data from our own research on the diagnosis and treatment of gastrointestinal manifestations of COVID-19 in children aged 3 months to 18 years are presented. The aim of the study was to evaluate the effectiveness of complex rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea of various etiologies, including those developing with a new coronavirus infection. Materials and methods . We analyzed data from our own observations of patients aged 3 months to 18 years with diarrhea against the background of acute intestinal infections of various etiologies (120 children), as well as with a new coronavirus infection caused by the SARS-CoV-2 virus (32 children). The children were treated in accordance with current standards and treatment recommendations. Clinical examples are presented. Results and discussion. Diarrhea was observed in 64% of patients with a new coronavirus infection. Clinical cases confirm the effectiveness of rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea, regardless of the etiology, including COVID-19. Conclusions . Diarrhoea and other symptoms of gastrointestinal disorders in COVID-19 are stopped when pathogenetic therapy is recommended for patients with acute intestinal infections.

Effectiveness of pathogenetic therapy for infectious diarrhea in children with COVID-19

Introduction. The article presents basic information on approaches to pathogenetic therapy of acute intestinal infections. Data from our own research on the diagnosis and treatment of gastrointestinal manifestations of COVID-19 in children aged 3 months to 18 years are presented. The aim of the study was to evaluate the effectiveness of complex rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea of various etiologies, including those developing with a new coronavirus infection.Materials and methods. We analyzed data from our own observations of patients aged 3 months to 18 years with diarrhea against the background of acute intestinal infections of various etiologies (120 children)), as well as with a new coronavirus infection caused by the SARS-CoV-2 virus (32 children). The children were treated in accordance with current standards and treatment recommendations. Clinical examples are presented.Results and discussion. Diarrhea was observed in 64% of patients with a new coronavirus infection. Clinical cases confirm the effectiveness of rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea, regardless of the etiology, including COVID-19.Conclusions. Diarrhoea and other symptoms of gastrointestinal disorders in COVID-19 are stopped when pathogenetic therapy is recommended for patients with acute intestinal infections.

COVID-19 and Autism Research: Perspectives from Around the Globe.

COVID-19 and Autism Research: Perspectives from Around the Globe.

Гемолітико-уремічний синдром як ускладнення інфекційної діареї у дітей: клінічні випадки

Гемолітико-уремічний синдром як ускладнення інфекційної діареї у дітей: клінічні випадки

Intestinal Protozoan Parasitic Infections in Immunocompromised Child Patients with Diarrhea.

Intestinal protozoan parasites are common causes of infectious diarrhea in children receiving anticancer therapy or undergoing transplantation. Additionally, immunosuppression therapy in such patients may exacerbate the symptoms related to these parasitic infections. The aim of this study was to evaluate the prevalence and diagnostic importance of parasitic protozoan infections in children treated for malignancies or undergoing transplantation, and to highlight the control of intestinal parasitic infections for immunosuppressed patients at a hospital in İzmir, Turkey. In total, 82 stool samples from 62 patients were analyzed by microscopic examination and polymerase chain reaction (PCR) for the presence of coccidian parasites. Our results showed that Cryptosporidium, Cyclospora, and Cystoisospora were present in 22.5% (14/62), 9.6% (6/62), and 3.2% (2/62) of the cases using either method, respectively. The prevalence of these coccidian parasites identified with both methods was 35.4% (20/62). Other intestinal parasites (Blastocystis, Giardia, and Entamoeba coli) were detected in 10 patients. PCR analysis showed the presence of all coccidian parasites in the same stool sample for one patient. Finally, both PCR and microscopic examination of the stools revealed that there is a higher prevalence of Cryptosporidium, Cyclospora, and Cystoisospora in immunocompromised children. These examinations allowed an early start of appropriate antibiotic treatments and led to an increased percentage of correctly treated patients.

Control of Diarrhoeal Diseases in Children in Kericho West Sub-County, Kenya

Acute diarrheal disease among children aged less than five years remains a significant cause of morbidity and mortality worldwide. Severe infectious diarrhoea in children occurs most frequently under circumstances of poor environmental sanitation and hygiene, inadequate water supplies and poverty. In Kenya, the control of diarrhoea disease including the promotion of breastfeeding, oral rehydration therapy and specific health education is a part of national strategies aimed to improve the quality of life and reduce the burdens caused by diseases. In Kericho West Sub-County, diseases associated with contaminated water, sanitation and poor hygiene tend to affect more in rural households. Nearly half of the children under five years suffer from related diarrhoeal diseases, thereby causing major concern to the entire local population. Therefore, this study aimed to determine the factors that lead to diarrhoeal diseases, to investigate the hygienic condition and source of water supply in the area, to examine the practices of the breastfeeding mothers and to determine the measures the county government has put in place to improve the health situation of the children. The study was grounded on two theories proposed by self-efficacy theory by Bandura. The study was carried out using a structured questionnaire as a quantitative tool while the interview guide was the qualitative tool for data collection. The location of the study was in Kericho West sub-county. The study concluded that there was a relationship between childhood diarrhoea, water, sanitation and hygiene in the study area. The study also found that there was a substantial positive association between breastfeeding and diarrhoea in children aged less than five years. From the findings, 83% used water with soap, while 41.3% obtained food from street vendors. The study recommends that the government facilities and private facilities should start sensitizing the Kericho West sub-county residents on the importance of maintaining hygiene through the use of clean and treated water as well as washing their utensils with hot water and soap. The government health care workers at the government facilities should counsel all the mothers and educate them on all the waterborne diseases as this would be the best option to control the communicable diseases in the County.

Нарушение микробиоты кишечника в остром периоде инфекционной диареи у детей и сравнительная оценка влияния последующей терапии нифуроксазидом и препаратами группы цефалоспоринов

The intestinal microbiota (IM) plays an important role in maintaining homeostasis in the human organism. Changes in the IM are associated with many diseases, for example, IM is involved in the pathogenesis of inflammation during acute intestinal infections (AIIs). Medications have different effects on the quantitative and qualitative composition of the microbial community and can therefore indirectly affect the course of recovery. Objective. To evaluate the IM composition in the acute period of infectious diarrhea in children and to assess the effect of therapy with nifuroxazide and cephalosporins on it. Patients and methods. This study included 21 children with invasive AIIs. Twelve patients received nifuroxazide (IN group), whereas 9 patients were treated with third-generation cephalosporins (IC group). There was also a control group comprised of 10 healthy children (group C). The duration of the course of antibacterial therapy was 5–7 days. We analyzed the microbial composition of fecal specimens from all study participants using 16S rRNA gene high-throughput sequencing. Data analysis was performed using the Knomics-Biota platform and the R Programming Environment. Results. We observed reduced alpha diversity (an integral characteristic of a microbial community which estimates the number of species in it and their proportion) already in the early period of invasive AII in children. We also found an increased total proportion of opportunistic bacteria in children with AIIs compared to controls, particularly species of Fusobacteriacea. Restoration of alpha diversity was achieved only in patients receiving nifuroxazide. Differences in the dynamics of the proportion of opportunistic microflora in the intervention groups were associated with the initial differences in the microbiome composition between the groups due to small number of patients in them. In the IN group, the proportion of Fusobacteriaceae species before treatment was higher than that in healthy controls; however, immediately after treatment completion and one month later, there were no differences in the IM composition between the IN group and controls. Patients from the IC group had higher proportion of opportunistic bacteria than healthy children; by the end of the treatment course, this parameter was normalized and was similar to that in the control group. Conclusion. The use of nifuroxazide in children with invasive AIIs was associated with restoration of alpha diversity and the reduction in the proportion of opportunistic species (in particular, Fusobacteriaceae). Children receiving cephalosporins also demonstrated the reduction in this proportion, but their alpha diversity was not restored. Keywords: acute intestinal infections, children, antibacterial therapy, nifuroxazide, cephalosporins, intestinal microbiota, 16S rRNA gene sequencing

Intradermal or Sublingual Delivery and Heat-Labile Enterotoxin Proteins Shape Immunologic Responses to a CFA/I Fimbria-Derived Subunit Antigen Vaccine against Enterotoxigenic Escherichia coli.

Enterotoxigenic Escherichia coli (ETEC) is a major cause of infectious diarrhea in children, travelers, and deployed military personnel. As such, development of a vaccine would be advantageous for public health. One strategy is to use subunits of colonization factors combined with antigen/adjuvant toxoids as an ETEC vaccine. Here, we investigated the intradermal (i.d.) or sublingual (s.l.) delivery of CFA/I fimbrial antigens, including CfaEB and a CfaE-heat-labile toxin B subunit (LTB) chimera admixed with double mutant heat-labile toxin (LT) LT-R192G/L211A (dmLT). In addition, we compared dmLT with other LT proteins to better understand the generation of adjuvanted fimbrial and toxoid immunity as well as the influence on any local skin reactogenicity. We demonstrate that immunization with dmLT admixed with CfaEB induces robust serum and fecal antibody responses to CFA/I fimbriae and LT but that i.d. formulations are not optimal for s.l. delivery. Improved s.l. vaccination outcomes were observed when higher doses of dmLT (1 to 5 μg) were admixed with CfaEB or, even better, when a CfaE-LTB chimera antigen was used instead. Serum anti-CFA/I total antibodies, detected by enzyme-linked immunosorbent assay, were the best predictor of functional antibodies, based on the inhibition of red blood cell agglutination by ETEC. Immunization with other LT proteins or formulations with altered B-subunit binding during i.d. immunization (e.g., by addition of 5% lactose, LTA1, or LT-G33D) minimally altered the development of antibody responses and cytokine recall responses but reduced skin reactogenicity at the injection site. These results reveal how formulations and delivery parameters shape the adaptive immune responses to a toxoid and fimbria-derived subunit vaccine against ETEC.

Zusanli (ST36) acupoint injection for acute diarrhea in children under 5 years old: A protocol of systematic review and meta-analysis of randomized clinical trials.

Background:Acute diarrhea is the 2nd highest prevalence disease among children under 5 years of age. It can cause malnutrition and even death in children, especially in developing country. Traditional Chinese medicine therapy has been applied and already in the guidelines for clinical practice of acute infectious diarrhea in children in China, but there is no specific methods or recommendations due to lacking of evidence. Zusanli acupoint injection as a form of acupuncture therapy, which is proved to be effective in randomised controlled trials (RCTs) and very suitable for children, has been used in acute diarrhea in children for a long time; therefore, a systematic review is necessary to provide available evidence for further study.Methods:Different studies from various databases will be involved in this study. Only RCTs of children under 5 years of age diagnosed with acute diarrhea using any recognized diagnostic criteria will be included. We will search manually the literature in the databases from China Conference Paper Database. Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, WanFang, Chongqing VIP, and China Biomedical Literature CDROM Database. Primary outcomes: clinical cure rate (clinical cure is defined as the frequency, timing and character of stool back to normal status, as well as disappearance of diarrhea symptoms), diarrhea duration (from admission to the cessation of diarrhea). Secondary outcomes: stool frequency within 24 hours, rate of adverse effect. Data will be extracted by 2 researchers independently; risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0.Results:This study will synthesize and provide evidence based on the data of the currently published zusanli (ST36) acupoint injection for acute diarrhea in children under 5 years old, especially in terms of clinical efficacy and safety.Conclusion:This systematic review aims to evaluate the benefits and harms of zusanli acupoint injection for acute diarrhea in children under 5 years old reported in RCTs, and provide evidence reference in TCM field for Chinese guidelines on the treatment of acute diarrhea in children.Ethics and dissemination:This study is a systematic review; the outcomes are based on the published evidence, and hence examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations.PROSPERO registration number:PROSPERO 2019 CRD42019135275.