Infectious Diarrhea Research Articles

Draft Whole-Genome Sequencing and Phenotypic Analysis of Salmonella from Retail Aquatic Products in Weifang.

Salmonella is one of the most common causative agents of infectious diarrhea in humans, but in China, there are very limited data on the presence of Salmonella in aquatic products. This study describes the isolation of Salmonella from aquatic products in Weifang, China, from April 2022 to April 2023. Seven out of 160 (4.38%) retail aquatic product samples were positive for Salmonella. Two distinct serotypes were identified: Salmonella enterica subsp. enterica serovar Senftenberg (n = 4) and S. enterica subsp. diarizonae serovar IIIb 59:z10:z57 (n = 3). The results of molecular typing of isolates with the same serotype were consistent. Only one of the isolates was resistant to ampicillin, while the other isolates were not resistant to the tested antibiotics, suggesting that Salmonella in aquatic products in this region are relatively susceptible to antibiotics. There were 17 resistance genes in the 7 strains, 13 of which were shared. golS, MdtK, mdsA, and mdtG were unique to S. Senftenberg. A total of 155 virulence genes were annotated in the S. Senftenberg isolates, and 136 virulence genes were annotated in the S. IIIb 59:z10:z57 isolates. The S. Senftenberg isolates harbored more adhesion-related genes than the S. IIIb 59:z10:z57 isolates. Multilocus sequence typing analysis revealed that ST34 has been the most prevalent type of Salmonella in China since 2020, followed by ST11. The predominant type of Salmonella in aquaculture is ST14. This study provided additional genetic information about Salmonella in aquatic sources, providing a basis for subsequent research related to risk assessment, antibiotic resistance mechanisms, and so forth.

Cryptosporidium parvum infection alters the intestinal mucosa transcriptome in neonatal calves: impacts on epithelial barriers and transcellular transport systems

IntroductionCryptosporidium parvum (C. parvum) is the most prevalent enteric protozoan parasite causing infectious diarrhea in neonatal calves worldwide with a direct negative impact on their health and welfare. This study utilized next-generation sequencing (NGS) to deepen our understanding of intestinal epithelial barriers and transport mechanisms in the pathophysiology of infectious diarrhea in neonatal calves, which could potentially unveil novel solutions for treatment.MethodsAt day 1 of life, male Holstein-Friesian calves were either orally infected (n = 5) or not (control group, n = 5) with C. parvum oocysts (in-house strain LE-01-Cp-15). On day 8 after infection, calves were slaughtered and jejunum mucosa samples were taken. The RNA was extracted from collected samples and subjected to sequencing. Differentially expressed genes (DEG) between the infected and CTRL groups were assessed using DESeq2 at a false discovery rate < 0.05 and used for gene ontology (GO) and pathway enrichment analysis in Cytoscape (v3.9.1).Results and discussionTo study the pathophysiology of infectious diarrhea on intestinal permeability, 459 genes related to epithelial cell barrier integrity and paracellular and transmembrane transport systems were selected from 12,908 identified genes in mucus. Among, there were 61 increased and 109 decreased gene transcripts belonged to adhesion molecules (e.g. ADGRD1 and VCAM1), ATP-binding cassette (ABC, e.g. ABCC2 and ABCD1) and solute carrier (SLC, e.g. SLC28A2 and SLC38A3) transporters, and ion channels (e.g. KCNJ15). Our results suggest deregulation of cellular junctions and thus a possibly increased intestinal permeability, whereas deregulation of ABC and SLC transporters and ion channels may influence the absorption/secretion of amino acids, carbohydrates, fats, and organic compounds, as well as acid-based balance and osmotic hemostasis. Besides pathogen-induced gene expression alterations, part of the DEG may have been triggered or consequently affected by inflammatory mechanisms. The study provided a deeper understanding of the pathophysiology of infectious diarrhea in neonatal calves and the host-pathogen interactions at the transcript level. For further studies with a particular focus on the transport system, these results could lead to a new approach to elucidating pathophysiological regulatory mechanisms.

The N-terminus of the Clostridioides difficile transferase A component directs toxin activity and potency.

Clostridioides difficile infection is the leading cause of antibiotic-associated, hospital-acquired diarrhea in the USA; the pathology of which is mediated by toxins. The presence of a toxin known as the C. difficile Transferase (CDT) in some clinical isolates is linked to severe symptoms including increased incidence of reinfection and higher rates of mortality. Despite its apparent importance to C. difficile pathology, a mechanistic model of how CDT intoxicates cells remains incomplete. Here, we describe a motif composed of acidic and basic residues (the KDKEK motif) that is essential for toxin function. Using Cryogenic Electron Microscopy (Cryo-EM), we highlight an orientation of the KDKEK motif wherein the acidic residues engage structures thought to play an important role during toxin delivery. We thus present a model wherein these interactions prime CDT for entry into host cells. We expect that this model can be extrapolated to other bacterial toxins to understand how they enter cells.IMPORTANCEClostridioides difficile is the leading cause of hospital-acquired infectious diarrhea in the USA. The pathology that accompanies infection is triggered by toxins produced by the bacterium. One of these, the C. difficile Transferase (CDT), has been associated with poorer patient outcomes, although a direct connection to CDT activity has remained elusive. Herein, we present new insight into the mechanism of CDT intoxication and define two regions of the toxin as important for its activity. Moreover, we have generated mutants of CDT that retain the ability to assemble but can no longer intoxicate host cells. In the future, we expect these mutants will serve as valuable tools to help elucidate the role of CDT during infection.

Assessing Community Pharmacists' Management of Acute Diarrhea in Saudi Arabia: A Simulated Patient Study.

Antimicrobial resistance poses a significant threat to global health, and community pharmacists are positioned to play a crucial role in mitigating this issue. The present study aimed to evaluate the extent of compliance among community pharmacists in Saudi Arabia with relevant regulations and clinical guidelines in the management of suspected infectious diarrhea. This cross-sectional study employed simulated patients presenting with diarrhea to assess the management practices within 200 community pharmacies in two major cities across Saudi Arabia. Trained pharmacy students presented pharmacists with three case scenarios involving adult patients with diarrhea. Statistical analysis included descriptive statistics and chi-square tests to examine the relationships between pharmacist characteristics and practice categories. The findings of this study indicate that the performance of community pharmacists in managing diarrhea is suboptimal. Notably, less adequate practice emerged as the predominant outcome at 63% (n = 126). Only 14% (n = 28) of pharmacists demonstrated adequate practice, while 23% (n = 46) exhibited poor investigative practice. Metronidazole dispensing increased across scenarios, from 16.92% (n = 11) in Scenario 1 to 30.3% (n = 20) in Scenario 3. Most pharmacists inquired about the patient's age (72%; n = 144); however, only a limited number probed for symptoms of dehydration (5.5%, n = 11) and medication history (3%, n = 6). A significant association was found between geographical location and practice performance (p = 0.015). This study reveals significant deficiencies in the management of infection-related diarrhea, underscoring the urgent need for enhanced training and regulatory measures within community pharmacy settings in Saudi Arabia to improve patient care and effectively address antimicrobial resistance (AMR).

Epidemiology of Acute Infectious Diarrhea-Associated Viruses in Children in Hangzhou, China, 2023

Abstract Objective To investigate the epidemiological characteristics of children infected with diarrheal virus in Hangzhou, China, 2023. Methods From January 2023 to December 2023, 20,939 stool samples from children with acute infectious diarrhea were collected for the detection of rotavirus A and human adenovirus (HAdV), using latex agglutination detection kits; 7,584 stool samples were collected for the detection of norovirus, using real-time polymerase chain reaction reagent. Results A total of 639 (3.0%, 639/20,939) tested positive for rotavirus A, and 1,201 (5.7%, 1,201/20,939) positive samples were detected by colloidal gold method. The positive rates of norovirus were 42.2% (3,203/7,585). Among all age groups, the rotavirus A positive detection rate was the highest in participants aged 3 to 6 years (6.46%, 260/4,024). The monthly distribution of patients with rotavirus A showed that the number of cases was the lowest in October (0.45%, 8/1,779) and reached the peak in April (7.97%, 144/1,806). The highest and lowest positive rates among all age groups for HAdV were found in children aged 3 to 6 years(8.27%, 333/4,024) and in those aged 0 to 6 months (2.21%, 60/2,717). The monthly positivity rates of HAdV spanning from January to November 2023 were 1.38, 1.44, 2.34, 3.65, 6.64, 7.71, 7.54, 7.13, 6.82, 4.15, and 6.50%, and reached the peak in December (8.17%). For norovirus, children aged 1 to 3 years had the highest positive detection rate (57.95%, 1,349/2,328), while infants aged 0 to 6 months had the lowest positive detection rate (19.60%, 205/1,046). The results show that January had the lowest number of cases (14.63%, 6/41), while September had the highest (50.51%, 545/1,079). Conclusion The detection rate of rotavirus A and HAdV was highest among participants aged 3 to 6 years, whereas the detection rate of norovirus was highest among those aged 1 to 3 years. The monthly distribution peaks for the three enteric viruses varied significantly.

Spatio-temporal pattern and associate factors study on intestinal infectious diseases based on panel model in Zhejiang Province

BackgroundIntestinal infectious diseases (IIDs) can impact the growth and development of children and weaken adults. This study aimed to establish a spatial panel model to analyze the relationship between factors such as population, economy and health resources, and the incidence of common IIDs. The objective was to provide a scientific basis for the formulation diseases prevention measures.MethodsData on monthly reported cases of IIDs in each district and county of Zhejiang Province were collected from 2011 to 2021. The spatial distribution trend was plotted, and nine factors related to population, economy and health resources were selected for analysis. A spatial panel model was developed to identify statistically significant spatial patterns of influencing factors (P < 0.05).ResultsThe results revealed that each type of IIDs exhibited a certain level of clustering. Each IIDs had a significant radiation effect, HEV (b = 0.28, P < 0.05), bacillary dysentery (b = 0.38, P < 0.05), typhoid (b = 0.36, P < 0.05), other infectious diarrheas (OIDs) (b = 0.28, P < 0.05) and hand, foot and mouth disease (HFMD) (b = 0.39, P < 0.05), indicating that regions with high morbidity rates spread to neighboring areas. Among the population characteristics, density of population acted as a protective factor for bacillary dysentery (b=-1.81, P < 0.05), sex ratio acted as a protective factor for HFMD (b=-0.07, P < 0.05), and aging rate increased the risk of OIDs (b = 2.39, P < 0.05). Urbanization ratio posed a hazard factor for bacillary dysentery (b = 5.17, P < 0.05) and OIDs (b = 0.64, P < 0.05) while serving as a protective factor for typhoid (b=-1.61, P < 0.05) and HFMD (b=-0.39, P < 0.05). Per capita GDP was a risk factor for typhoid (b = 0.54, P < 0.05), but acted as a protective factor for OIDs (b=-0.45, P < 0.05) and HFMD (b=-0.27, P < 0.05). Additionally, the subsistence allowances ratio was a risk factor for HEV (b = 0.24, P < 0.05).ConclusionThe incidence of IIDs in Zhejiang Province exhibited a certain degree of clustering, with major hotspots identified in Hangzhou, Shaoxing, and Jinhua. It would be essential to consider the spillover effects from neighboring regions and implement targeted measures to enhance disease prevention based on regional development.

Correlation between notifiable infectious diseases and transportation passenger traffic from 2013 to 2019 in mainland China

PurposePopulation mobility significantly contributes to the spread and prevalence of infectious diseases, posing a serious threat to public health safety and sustainable development across the globe. Understanding the impact of population mobility on the prevention and control of infectious diseases holds profound significance.MethodsIn this study, we collected the data on the incidence of notifiable infectious diseases in mainland China from 2013 to 2019, and analyzed the characteristics of notifiable infectious diseases, as well as their correlation with transportation passenger traffic.ResultsAmong 29 common notifiable infectious diseases, the incidence rate of intestinal diseases per 100,000 people was the highest (256.35 cases), while the mortality rate was the lowest (0.017 cases). The mortality rate per 100,000 people due to sexually transmitted and bloodborne diseases was the highest (1.154 cases). A significant linear correlation was noted between commercial passenger traffic and the number of cases of tuberculosis (r = 0.83, P = 0.022), hepatitis A (r = 0.87, P = 0.012), bacillary and amebic dysentery (r = 0.90, P = 0.006), typhoid/paratyphoid (r = 0.94, P = 0.002), leptospirosis (r = 0.90, P = 0.005), AIDS(r=-0.90, P = 0.006), gonorrhea (r=-0.79, P = 0.035) and scarlet fever (r=-0.85, P = 0.016). A significant linear correlation was noted between public transportation passenger traffic and the number of cases of measles (r = 0.94, P = 0.002), hepatitis A (r = 0.96, P = 0.001), parasitic and vector-borne diseases (r = 0.96, P = 0.001), brucellosis (r = 0.95, P = 0.001), leptospirosis (r = 0.88, P = 0.008), other infectious diarrhea (r = 0.86, P = 0.013) and gonorrhea (r = 0.84, P = 0.018).ConclusionThe results of this study indicated that transportation passenger traffic significantly affected the incidence of infectious diseases, and reasonable management of passenger traffic was a potentially important means of prevention and control of infectious diseases.

Zinc as a treatment modality for acute infectious diarrhea in children.

Zinc as a treatment modality for acute infectious diarrhea in children.

Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries.

Severe dehydration due to acute infectious diarrhea remains a leading cause of death among young children worldwide. Diarrhea with severe dehydration is a clinical syndrome with distinct management per the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and the WHO Global Task Force on Cholera Control (GTFCC) guidelines. We sought to characterize the pathogens causing severe dehydration using data from the Global Enteric Multicenter Study. We used the IMCI and GTFCC guidelines to define severe dehydration and quantitative polymerase chain reaction-based attribution models to assign the etiology of diarrhea associated with severe dehydration. The IMCI or GTFCC guidelines classified 2284 of the 5304 (43%) cases with moderate-to-severe diarrhea as having severe dehydration. In one-third of the cases with severe dehydration, no pathogens were attributed. The top pathogens attributed to children with guidelines-classified severe dehydration varied by age and were similar among those requiring intravenous hydration and hospitalization. Rotavirus (30.9%), Cryptosporidium (12.0%), and heat-stable (ST) enterotoxigenic Escherichia coli (ETEC) (10.3%) were the most common pathogens for ages 0-11 months, while Shigella/enteroinvasive E coli (EIEC) (25.8%), rotavirus (19.3%), and ST-ETEC (10.9%) were the most common for ages 12-23 months. Shigella/EIEC (25.9%), Vibrio cholerae (10.4%), and rotavirus (9.2%) were the most common among ages 24-59 months. The findings inform prioritization of pathogens, in addition to V cholerae, that cause severe dehydration for future preventive and treatment efforts. The schema for prioritization is driven primarily by age stratifications.

An RPA-Based CRISPR/Cas12a Assay in Combination with a Lateral Flow Assay for the Rapid Detection of Shigella flexneri in Food Samples.

Among the pathogens that cause infectious diarrhea in China, Shigella is the most prominent. Shigellosis affects both adults and children, particularly those in developing nations, with nearly 190 million annual cases and a third resulting in fatalities. The recently emerged CRISPR/Cas system has also been increasingly applied for the detection of different biological targets. The lateral flow assay (LFA) has the advantages of short detection time, simple operation, high sensitivity, and low cost, and it provides an ideal platform for on-site detection. In this study, a recombinase polymerase amplification-CRISPR/Cas12a-LFA test for Shigella flexneri was constructed. The established method had good specificity and sensitivity, and the qualitative accuracy of 32 tested strains reached 100%. The detection limit of genomic DNA reached 8.3 copies/μL. With the advantages of high accuracy and portability, this diagnostic apparatus represents a novel method of identification and detection of Shigella flexneri, particularly in settings that lack complex laboratory infrastructure.

Early treatment for Clostridioides difficile infection: retrospective cohort study.

Clostridioides difficile (CDI) is a common cause of infectious diarrhea. The current recommendation is to initiate empirical antibiotic treatment for suspected CDI who have an anticipated delay of confirmatory results or fulminant colitis. This is based on limited clinical trials. The study aims to examine the impact of early treatment on mortality and clinical outcomes. This retrospective cohort study included adult patients with CDI. Early treatment was defined as the initiation of an anti-Clostridioides medication within the first 24h following stool sampling. Outcomes were 30 and 90day mortality, length of hospital stay (LOS), recurrence, and colectomy rate. To address potential bias, propensity score matching followed by logistic regression was performed, P value less than 5% was considered statistically significant. Study cohort consisted of 796 patients; clinical characteristics were balanced following matching. There was no difference, in favor of early treatment, between the groups regarding 30day mortality and 90day mortality with HR of 0.91 (95% CI 0.56-1.47) and 0.7 (95% CI 0.45-1.08), respectively. No statistically significant difference in recurrence rate, ICU admission or colectomy rate was observed. The LOS was shorter in the early-treatment group with 6days vs. 8days. Early treatment for CDI had shortened hospital stay. However, it did not affect clinical outcomes in adult patients.

An outbreak associated with Escherichia albertii in a junior high school, China.

Escherichia albertii is an emerging foodborne enteropathogen associated with infectious diarrhoea in humans. In February 2023, an outbreak of acute gastroenteric cases was reported in a junior high school located in Hangzhou, Zhejiang province, China. Twenty-two investigated patients presented diarrhoea (22/22, 100%), abdominal pain (21/22, 95.5%), nausea (6/22, 27.3%), and vomiting (3/22, 13.6%). E. albertii strains were successfully isolated from anal swabs collected from six patients. Each isolate was classified as sequence type ST2686, harboured eae-β gene, and carried both cdtB-I and cdtB-II subtypes, being serotyped as EAOg32:EAHg4 serotype. A comprehensive whole-genome phylogenetic analysis revealed that the six isolates formed a distinct cluster, separate from other strains. These isolates exhibited minimal genetic variation, differing from one another by 0 to 1 single nucleotide polymorphism, suggesting a common origin from a single clone. To the best of our knowledge, this represented the first reported outbreak of gastroenteritis attributed to E. albertii outside of Japan on a global scale.

Relation between Irritable Bowel Syndrome and Acute Infectious Gastroenteritis in Children

Abstract Background Post-infectious irritable bowel syndrome (PI-IBS) has been defined as a new onset of IBS following an episode of acute infectious diarrhea. Objective To determine the frequency of postinfectious irritable bowel syndrome (PI-IBS) among children who have an episode of acute infectious diarrhea. Subjects and Methods A case control longitudinal study was conducted on 93 children who fulfilled the criteria for diagnosis of acute infectious gastroenteritis. Patients were recruited from the Outpatient Clinic, Children’s Hospital, Ain Shams University, during a period of 6 months and were followed up for 3 months for the development of symptoms of IBS according to Rome IV criteria for diagnosis of IBS. They were compared to 100 age- and sex-matched controls who do not have history of acute infectious gastroenteritis during the last 3 months before enrollment. Result The age of studied cases ranged between (4-15) years old with a mean ±SD=9.26 ± 3.20 years. Females represented 61.3% of cases. PI-IBS occurred in 14%of cases with age ranged between (4-14) years old and females represented 61.5% of PI-IBS cases. Meanwhile, the incidence of IBS 3.2% of uninfected controls (relative risk, RR = 4.33). Most cases of PI-IBS were diarrhea prominent. There was no significant association with the causative organism identified among cases. Rota virus represented the most common organism among our patients with incidence of (32.3%) followed by campylobacter, salmonella, adeno virus, and giardia with incidence of (9.7%), (8.6%), (5.4%), (6.5%), respectively, while (37.6%) of patients have negative stool cultures for the mentioned organisms. Conclusion The frequency of PI-IBS is common among pediatrics but does not seem to be associated with the causative organism of the preceding episode of infectious diarrhea. Raising the awareness about this entity is of outmost importance as this will allow targeted treatment.

Impact of oral azithromycin and intermittent preventive treatment with sulfadoxine-pyrimethamine regimen on child mortality in Sierra Leone: trial protocol for a randomised, two-arm, double-blinded, placebo-controlled clinical trial (ICARIA)

BackgroundAzithromycin has been shown to be beneficial in preventing infectious diseases, including malaria, infectious diarrhoea and pneumonia. A cluster randomised control trial on azithromycin MDA in children in Niger, Malawi and Tanzania found a reduction in all-cause under-five (U5) mortality in communities who received azithromycin compared to placebo. However, the reduction was largest and statistically significant only in Niger. The purpose of this trial is to evaluate the impact of azithromycin plus intermittent preventive treatment in infants (IPTi), recently renamed by the World Health Organisation as perennial malaria chemoprevention (PMC), with sulfadoxine-pyrimethamine (SP) on all-cause mortality up to 18 months of age in children living in areas of high mortality burden through the Expanded Program on Immunisation (EPI) in Sierra Leone.MethodsThe Improving Care through Azithromycin Research for Infants in Africa (ICARIA) trial is a phase III two-arm, individually randomised, double-blinded, placebo-controlled trial administering oral AZI (20 mg/kg bodyweight) at three time points to children attending EPI visits in Sierra Leone. A total of 20,560 infants attending the first EPI contact at around 6 weeks of age are recruited and randomised to AZI or placebo in a 1:1 ratio. The second and third AZI/placebo doses are given at 9 and 15 months of age. The primary outcome of the trial is all-cause mortality rate at 18 months of age assessed through mortality surveillance. Other trial outcomes include the impact on antimicrobial resistance, and on the immune response to certain key routine EPI immunisations, the safety of the intervention, the prevalence of SP resistance markers and the feasibility, and acceptability of adding AZI to the EPI programme.DiscussionThe trial will provide the evidence needed to inform policy regarding the adoption and large-scale implementation of AZI in areas of high-mortality burden in sub-Saharan Africa.Trial registrationClinicalTrials.gov NCT04235816. Registered on 22 January 2020.Pan-African Clinical Trials Registry PACTR202004540256535. Registered on 14 April 2020.

Modern epidemiological features of viral acute intestinal infections in children and adolescents of Sakhalin region

Objective: to identify modern epidemiological features of viral acute intestinal infections in children and adolescents in the Sakhalin Region.Materials and methods. Data on acute intestinal infection incidence obtained from statistical reports of the Rospotrebnadzor during 2021-2023 was compared with long-term average incidence rates calculated over the period before the COVID-19 pandemic (2010-2019) to perform epidemiological analysis. Incidence was calculated for different age groups; according to months of the year, monthly long-term average incidence rates were established. Index of seasonality, coefficient of seasonality, and index of seasonal growth were determined.Results and discussion. Manifestations of acute intestinal infections epidemic process in the Sakhalin Region indicate persisting conditions for an increase in the registration of both sporadic cases of diseases and outbreaks of infectious diarrhea. Viruses were prevailing in the structure of cases of known etiology (mainly caused by rotaviruses and noroviruses). Their intra-annual dynamics showed changes in rotavirus and norovirus infection incidence rates: a shift in periods of increased incidence, a decrease in the coefficient of seasonality, and for rotavirus infection, a decrease in the index of seasonal growth. Age-adjusted rotavirus infection incidence showed predominance of the infection among preschool-aged children; norovirus infection was frequently detected among schoolchildren and adolescents. An increase in the focality index may indicate ongoing problems in the public catering sector, non-compliance with sanitary rules and hygiene standards, and untimely detection and isolation of patients with acute intestinal infections.Conclusion. Obtained results confirm the epidemiological significance of viral gastroenteritis and the necessity of anti-epidemic measures optimization.

Repeat modules and N-linked glycans define structure and antigenicity of a critical enterotoxigenic E. coli adhesin.

Enterotoxigenic Escherichia coli (ETEC) cause hundreds of millions of cases of infectious diarrhea annually, predominantly in children from low-middle income regions. Notably, in children, as well as volunteers challenged with ETEC, diarrheal severity is significantly increased in blood group A (bgA) individuals. EtpA, is a secreted glycoprotein adhesin that functions as a blood group A lectin to promote critical interactions between ETEC and blood group A glycans on intestinal epithelia for effective bacterial adhesion and toxin delivery. EtpA is highly immunogenic resulting in robust antibody responses following natural infection and experimental challenge of volunteers with ETEC. To understand how EtpA directs ETEC-blood group A interactions and stimulates adaptive immunity, we mutated EtpA, mapped its glycosylation by mass-spectrometry (MS), isolated polyclonal (pAbs) and monoclonal antibodies (mAbs) from vaccinated mice and ETEC-infected volunteers, and determined structures of antibody-EtpA complexes by cryo-electron microscopy. Both bgA and mAbs that inhibited EtpA-bgA interactions and ETEC adhesion, bound to the C-terminal repeat domain highlighting this region as crucial for ETEC pathogen-host interaction. MS analysis uncovered extensive and heterogeneous N-linked glycosylation of EtpA and cryo-EM structures revealed that mAbs directly engage these unique glycan containing epitopes. Finally, electron microscopy-based polyclonal epitope mapping revealed antibodies targeting numerous distinct epitopes on N and C-terminal domains, suggesting that EtpA vaccination generates responses against neutralizing and decoy regions of the molecule. Collectively, we anticipate that these data will inform our general understanding of pathogen-host glycan interactions and adaptive immunity relevant to rational vaccine subunit design.

Adherence to Clinical Practice Guidelines on the Management of Acute Infectious Gastroenteritis in Children as a Measure of Quality of Care Delivered by a Primary Care Facility in Rural Philippines: A Descriptive Retrospective Study.

This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH). A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low. There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%. Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.

Experience of practical use of enterosorbents in the treatment of HIV-infected children with diarrhea syndrome

Despite advances in antiretroviral therapy (ART), diarrhea is common among people living with HIV (PLHIV) and negatively impacts quality of life. Although diarrheal diseases caused by opportunistic infections have decreased in the ART era, the overall prevalence of diarrhea remains unchanged, estimated at 28% to 60% of PLHIV.The aim of the study: to conduct a comparative assessment of the clinical efficacy of enterosorbents in the treatment of diarrheal syndrome in children with HIV infection.Materials and methods. The study material included 80 HIV-infected children who experienced acute infectious diarrhea aged 5 to 14 years. The main group included 40 children who received enterosgel, 2 times 1 tablespoon included in the traditional treatment regimen, and the control group included 40 children who received the drug lactofiltrum against the background of traditional therapy, 1 tablet 3 times a day. The duration of treatment was 10 days.Results and discussion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a significant decrease in the daily amount and in the duration of diarrhea was observed, which leads to a noticeable loss of signs of dehydration (P&lt;0.05). Elimination of acute diarrhea in children with HIV infection may also have eliminated the underlying intoxication syndrome due to the underlying and burning disease, which may lead to a reduction in health care costs and socioeconomic burden.Conclusion. During the treatment of acute diarrhea in children with HIV infection with Enterosgel, a decrease in the daily amount and in the duration of diarrhea is reliably observed, which leads to a significant disappearance of signs of dehydration (р&lt;0.05).

Significance of detecting cardiac troponin I and creatine kinase MB in critically Ill children without primary cardiac illness.

To investigate the incidence of myocardial injury in children with critically ill children without primary cardiac disease and the association between elevated cardiac troponin I (cTnl) and creatine kinase MB (CK-MB) concentrations and disease progression and prognosis to guide early treatment. The serum cTnI and CK-MB concentrations of 292 children with critically ill children without primary cardiac disease in Yantai Yuhuangding Hospital between January 2021 and January 2024 were retrospectively analyzed within 24 h after entering the Pediatric Intensive Care Unit (PICU). The children were divided into normal and abnormal groups according to the myocardial marker results. The abnormal group was further divided into the cTnI-elevated, CK-MB-elevated, single-elevated (cTnI- or CK-MB-elevated) and double-elevated (cTnI- and CK-MB-elevated) groups. The differences in the clinical indicators and their relationships with prognosis for the groups were compared. The incidence of myocardial injury among the critically ill children without primary cardiac disease was 55.1%. The incidence of myocardial injury in children with infectious diarrhea combined with moderate and severe dehydration reached 85.19%. The pediatric critical illness score; frequency of use of vasoactive drugs; hypotension, shock, heart failure, respiratory failure, and multiple organ dysfunction syndrome; and mortality indexes differed significantly for the normal and abnormal myocardial marker groups (P < 0.05). The single-elevated and normal groups only showed a difference in mortality (P < 0.017). The cTnI and CK-MB concentrations were negatively correlated with prognosis (P < 0.01). Myocardial injury, as evidenced by elevated cardiac biomarkers, is common in critically ill children without primary cardiac illness. cTnI and CK-MB are associated with outcomes. Shock, heart failure, and multiple organ dysfunction syndromes are independently associated with simultaneous elevations of CK-MB and cTnI concentrations. Further prospective studies are needed to elucidate the clinical utility of these biomarkers.

Etiology, clinical features, and epidemiological analysis of diarrhea patients visiting a gastrointestinal clinic in a comprehensive hospital in Beijing, China, in 2023

AbstractObjectiveTo investigate the clinical features and epidemiology of diarrhea patients and analyze the current distribution of enteropathogens causing diarrhea in a comprehensive hospital in Beijing, China, in 2023.Materials and MethodsFrom April to October 2023, we enrolled patients with diarrheal diseases who visited the gastrointestinal clinic in our hospital. The patients' demographic, epidemiological, and clinical features were obtained via a questionnaire. Stool samples were examined for 20 enteropathogens by multiplex polymerase chain reaction testing.ResultsWe enrolled 260 patients; men and adults accounted for 55.77% and 95.77% of the patients, respectively. The median age was 37 years. Eighty‐four enteropathogens, 72 bacteria and 12 viruses, were identified in 74 patients. Enteroaggregative Escherichia coli was the predominant agent. Patients with and without pathogens detected in stool samples showed no significant differences in age, sex, gastrointestinal symptoms, and stool characteristics. Possible food‐related events were recorded in 57.31% of the patients. Leukocyte counts in patients with bacterial infections were higher than those of patients with viral infections and those with no detected pathogens (p &lt; 0.05). Seasonality of bacterial distribution was observed (p &lt; 0.05).ConclusionBacteria were predominant pathogens among the diarrhea patients. The incidence of diarrhea was related to hot weather and foodborne illness. Bacterial diarrhea may cause systemic infection. The clinical symptoms of infectious diarrhea were usually non‐specific and unrelated to the type of infection. Timely and comprehensive multi‐pathogen surveillance might be helpful to detect suspected pathogens and promote epidemic prevention and control.