Mild Gastroenteritis Research Articles

Infantile convulsions in association with mild gastroenteritis: an emerging clinical condition

Infantile convulsions in association with mild gastroenteritis: an emerging clinical condition

Analysis of the Blood and Serum Biochemistry Findings in Patients Demonstrating Convulsion with Mild Gastroenteritis

Analysis of the Blood and Serum Biochemistry Findings in Patients Demonstrating Convulsion with Mild Gastroenteritis

Benign convulsions associated with mild gastroenteritis: A multicenter clinical study

To assess the clinical characteristics and the outcome of benign convulsions associated with mild gastroenteritis (CwG) in Italian children. We studied clinical and EEG features of 128 children with CwG who were hospitalized between January 2004 and February 2008 and then followed for at least 12 months in 14 Italian centers. Age at onset ranged from 6 to 60 months. The seizures were generalized in 73 cases (57%), only focal in 16 (12.5%), and secondarily generalized in 39 (30.5%). The duration of the seizures was under 5 min in 97 patients (75.8%), between 5 and 30 min in 26 (20.3%), and longer than 30 min in 5 (3.9%). Seventy-three participants (57%) had 2 or more seizures, which recurred within 24-48 h. In the acute phase, antiepileptic drugs were used in 72 patients (56.3%). Although interictal abnormalities were present in EEG of 28 children (21.9%), these reverted to normal. During the follow up period, only 6 patients (4.7%) suffered from recurrence of CwG, 7 (5.5%) suffered from simple febrile seizures, and 3 (2.3%) developed epilepsy. Recognition of CwG in children allows pediatricians to avoid extensive evaluations and continuous antiepileptic therapy and to reassure parents regarding the lack of long-term complications.

Convulsions associated with gastroenteritis in the spectrum of benign focal epilepsies in infancy: 30 cases including four cases with ictal EEG recording

Benign convulsions associated with gastroenteritis are now recognized as a clinical entity, characterized by an acute cluster of afebrile seizures during an episode of mild diarrhoea with excellent prognosis. We observed 30 children who each experienced at least two seizures associated with mild gastroenteritis. The inclusion criteria were: afebrile seizures during gastroenteritis, dehydration at ≤ 5%, normal neurological findings, normal psychomotor development and no underlying pathology according to laboratory and neuroimaging studies. Mean age was 21 months (range: 6-38). Familial history for epilepsy was positive in 3/30 (10%) and for febrile convulsions in 11/30 (36.6%). Seizure onset was mainly on the third day of gastroenteritis. Seizures were described as generalised by parents in 16/30 patients (53.3%). We directly observed seizures in 14/30 patients (47.7%), and the semiology was partial with secondary generalisation. Focal onset was confirmed in two patients by EEG and in two patients by video-EEG recording. Twenty of 30 patients (66.6%) received antiepileptic drugs during the acute phase. Ten patients (33.3%) received no treatment. During follow-up (mean duration: 53 months), one patient had an isolated afebrile seizure and two others a febrile seizure. At the end of follow-up, antiepileptic treatment was withdrawn for all but two patients. None developed epilepsy. Although the pathogenesis of this clinical entity is unknown, we hypothesize that mild gastroenteritis may provoke a transient brain dysfunction which in turn provokes seizures in children with genetically determined susceptibility.

Hyperchlorhidrosis Caused by Homozygous Mutation in CA12, Encoding Carbonic Anhydrase XII

Excessive chloride secretion in sweat (hyperchlorhidrosis), leading to a positive sweat test, is most commonly indicative of cystic fibrosis yet is found also in conjunction with various metabolic, endocrine, and dermatological disorders. There is conflicting evidence regarding the existence of autosomal-recessive hyperchlorhidrosis. We now describe a consanguineous Israeli Bedouin kindred with autosomal-recessive hyperchlohidrosis whose sole symptoms are visible salt precipitates after sweating, a preponderance to hyponatremic dehydration, and poor feeding and slow weight gain at infancy. Through genome-wide linkage analysis, we demonstrate that the phenotype is due to a homozygous mutation in CA12, encoding carbonic anhydrase XII. The mutant (c.427G>A [p.Glu143Lys]) protein showed 71% activity of the wild-type enzyme for catalyzing the CO₂ hydration to bicarbonate and H(+), and it bound the clinically used sulfonamide inhibitor acetazolamide with high affinity (K(I) of 10 nM). Unlike the wild-type enzyme, which is not inhibited by chloride, bromide, or iodide (K(I)s of 73-215 mM), the mutant is inhibited in the submicromolar range by these anions (K(I)s of 0.37-0.73 mM).

Convulsions non fébriles bénignes associées à une gastro-entérite aiguë à rotavirus chez l’enfant

Benign afebrile seizures associated with mild gastroenteritis and normal serum electrolytes are often described in Asian infants under the name of convulsions with mild gastroenteritis (CwG). Herein, we report 3 cases of CwG that occurred in Caucasian children. Clinical features and outcomes are described and the cases reported in the literature are reviewed. The CwG syndrome is now recognized as a distinct entity characterized by the following criteria: (1) it occurs in previously healthy 6-month to 3-year-old children who present with afebrile convulsions, (2) it is associated with mild gastroenteritis, (3) seizures tend to occur in a clustered manner, (4) interictal EEG shows no paroxysmal discharge, and (5) laboratory examinations are normal, including normal cerebrospinal fluid, serum electrolytes and glycemia. The CwG syndrome is a self-limited disease with a short course and a good prognosis. Investigations must be targeted and anticonvulsivant therapy is not required. As rotavirus is the most common agent among the diarrheal viruses detected to be the cause of CwG, one could hypothesize that this virus may play a role in the CwG pathogenesis.

Detection of cytokines in serum and cerebrospinal fluid in children with benign infantile convulsions and mild gastroenteritis

Objective To explore the changes of cytokines in serum and cerebrospinal fluid (CSF) in children with benign infantile convulsions and mild gastroenteritis. Methods Serum SIL-2R,IL-enteritis and from 30 children with rotavirus enteritis alone within 3 cays; the cytokines were also collected from those with benign convulsions. 25 nonconvulsive children were selected as control. Results Serum levels of SIL-2R,IL-6,and IL-8 in the acute phase and recovery phase did not differ significantly between the children with benign convulsions and those with enteritis alone. Serum and CSF levels of SIL-2R,IL-6,and IL-8 in the acute phase differed significantly between the the group with convulsions and the control group. Serum levels of SIL2R,IL-6,and IL-8 differed significantly different in the convulsive childre n with varying degrees of dehydration,but the CSF levels of those cytokines had no difference. Conclusions Immune imbalance exists in children with benign infantile convulsions and mild gastroenteritis,and causes pathophysiological changes in the nerve cells. Dynamic detection of cytokines,especially the changes in SIL-2R and IL-6,provides cytological support for predicting prognosis and development of the disease. Key words: Gastroenteritis; Convulsions; Interleukin

Rotavirus y crisis convulsivas. Una asociación poco frecuente aunque bien definida

Introduction Rotavirus infection, besides gastrointestinal symptoms, may cause several neurological complications. Among these, are benign convulsions with mild gastroenteritis (CwG). Despite having well defined clinical features, its incidence is not well known. Methods We selected discharge diagnoses of acute diarrhea in children aged 1 month to 5 years who were admitted to Donostia Hospital between July 1996 and June 2008. Among them, we selected those cases with concomitant diagnosis of seizure. Results Rotavirus was detected in 419 of 1114 children hospitalized for gastroenteritis. (39.2%), Five (1.2%) had symptoms compatible with CwG. The episodes occurred between December and January in all cases. The mean age at diagnosis was 19.6 months. The number of seizures per patient was 2.6 (range 1–4). All the crises were short, the longest being 15 min. The total duration of the episode was 1.6 days on average, with up to 3 days. Additional tests performed in all cases, were normal. In subsequent follow-up, one child at 26 months had another episode compatible with this entity at 26 months. During the follow-up period, all patients displayed normal psychomotor development with noe recurrence of seizures. Conclusion CwG is a rare entity within all acute gastroenteritis associated with rotavirus, but has very specific clinical features that enable it to be identified which could avoid excessive medical tests, and aggressive treatment.

Comparison of Salmonella Serovar Isolation and Antimicrobial Resistance Patterns from Porcine Samples Between 2003 and 2008

Food-borne Salmonella infections can produce symptoms from mild gastroenteritis to severe systemic disease and death, representing an important public health issue in U.S. livestock and livestock products, which have been implicated as frequent sources of Salmonella contamination. Concerns have been raised about the spread of antibiotic resistance in Salmonella strains, particularly those that originate from food animal sources, as a result of prophylactic and therapeutic antimicrobial use in these species. Longitudinal comparisons of Salmonella serovars isolated from porcine tissues submitted to the Iowa State University Veterinary Diagnostic Laboratory in 2003 and 2008 were conducted to evaluate changes in serovar dynamics and antimicrobial resistance. Incidence of recovered group C Salmonella enterica serovar Choleraesuis var. Kunzendorf decreased between 2003 and 2008, while recovery of group B strains Salmonella Typhimurium var. 5-(formerly, Copenhagen), Salmonella Agona, Salmonella Derby, Salmonella Heidelberg, and Salmonella Typhimurium increased. Significant changes in resistance interpretation were seen in Salmonella Derby with regard to spectinomycin and sulfadimethoxine; in Salmonella Heidelberg with regard to florfenicol, spectinomycin, and sulfadimethoxine; and in Salmonella Choleraesuis var. Kunzendorf, Salmonella Typhimurium, Salmonella Typhimurium var. 5-, and Salmonella Agona with regard to spectinomycin. Only 2 of 293 isolates in 2003 and 5 of 395 isolates in 2008 were resistant to enrofloxacin. Utilizing antibiotics approved for use in food animals to evaluate antimicrobial resistance provides more specific information on the selection pressure exerted on Salmonella populations through the use of these drugs.

Benign Convulsions With Mild Gastroenteritis: Is It Associated With Sodium Channel Gene SCN1A Mutation?

Benign convulsions with mild gastroenteritis were afebrile seizures associated with gastroenteritis in previously healthy infants or young children. It has been thought to be a continual spectrum of benign infantile convulsions because of overlapping clinical pictures. Recently, molecular genetic studies have suggested a channelopathy in benign infantile convulsions. The authors prospectively studied the clinical features of benign convulsions with mild gastroenteritis in Taiwanese children and clarified the relationship between neuronal sodium channel alpha 1 subunit (SCN1A) gene and benign convulsions with mild gastroenteritis. The clinical pictures in their patients were similar to those of previous studies except for the low rate of positive rotavirus antigen in the stool, which may indicate a season-related viral infection. No mutations in the SCN1A gene were identified in all patients. This study suggested that SCN1A mutations are probably not associated with benign convulsions with mild gastroenteritis. Other possible pathogenic mechanisms need to be researched in the future.

Clinical trial of minimal treatment for clustering seizures in cases of convulsions with mild gastroenteritis

The aim of this study was to identify means of shortening the treatment period for clustering seizures in patients with convulsions with mild gastroenteritis (CwG). Methods: Sixty-two episodes in 61 patients who presented with CwG managed with carbamazepine (CBZ) or Lidocaine (Lidocaine tape (LDT) or intravenous infusion (Lid-iv)) between November 2005 and October 2008 were studied. The subjects were divided into the following groups: 33 episodes treated with CBZ-1 (5 mg/kg/day, 1 day), 7 with CBZ-3 (5 mg/kg/day, 3 days), 11 with LDT-1 (LDT 2 sheets in 24 h), 4 with LDT-2 (LDT 2 sheets in 48 h), and 7 with Lid-iv (1 mg/kg/h, continuous infusion). Results: One to seven seizures were recognized before starting CBZ or Lidocaine therapy, followed by complete cessation in 57 episodes and one or two recurrent seizures in five. Efficacy rates were 97% for CBZ-1, 100% for CBZ-3, 72.7% for LDT-1, 75% for LID-2, and 100% for Lid-iv. Efficacy was significantly higher in the CBZ groups than the Lidocaine groups ( p = 0.019), while the differences between treatment periods (CBZ-1 vs. CBZ-3, and Lid-1 vs. Lid-2) did not reach statistical significance ( p > 0.999). Conclusions: CBZ and Lidocaine were effective for treating clustering seizures of CwG. We confirmed that the treatment period can be shortened without loss of efficacy. Therefore, we consider 1 day therapy with CBZ or Lidocaine to be sufficient.

An Outbreak of Canine Coronavirus in Puppies in a Greek Kennel

Canine coronavirus (CCoV) is usually the cause of mild gastroenteritis in dogs and is known to have spread worldwide. However, to date, no CCoV cases have been confirmed in Greece. In the present work, the authors investigated an outbreak of enteritis in puppies from a Greek kennel for the presence of CCoV. Dogs were presented with clinical signs of diarrhea, anorexia, weakness, depression, dehydration, and 1 death. Canine coronavirus type II was detected by reverse transcription nested polymerase chain reaction in all 11 puppies, whereas 1 puppy presented dual infection with CCoV type II and canine parvovirus 2. Surprisingly, sequence analysis of the samples revealed higher similarity to the pantropic CCoV II strain CB/05 than to other reference strains, in the most variable region of the S gene.

Transient splenial lesion of the corpus callosum in a case of benign convulsion associated with rotaviral gastroenteritis

Transient magnetic resonance (MR) signal changes in the splenium of the corpus callosum (SCC) arise from many different conditions, including encephalopathy or encephalitis caused by infection, seizures, metabolic derangements, and asphyxia. Few case reports exist on reversible SCC lesions associated with rotavirus infection. A benign convulsion with mild gastroenteritis (CwG) is frequently associated with rotaviral infections. This entity is characterized by normal laboratory findings, electroencephalogram, neuroimaging, and good prognosis. We report a case of a 2.5-year-old Korean girl with rotavirus-associated CwG demonstrating a reversible SCC lesion on diffusion-weighted MR images. She developed 2 episodes of brief generalized tonic-clonic seizure with mild acute gastroenteritis without any other neurologic abnormality. Stool test for rotavirus antigen was positive. Brain MRI done on the day of admission showed a linear high signal intensity and decreased apparent diffusion coefficient values on the SCC. The lesion completely disappeared on follow-up MRI 6 days later. The patient fully recovered without any sequelae.

Convulsiones infantiles asociadas a gastroenteritis leve: características epidemiológicas, clínicas y evolutivas

To analyse the epidemiological, clinical and developmental characteristics of a group of children with seizures associated with mild gastroenteritis in order to facilitate the diagnostic suspicion of the condition in daily clinical practice.We conducted a retrospective review of the medical records of 24 patients who were admitted to hospital between January 2001 and December 2008 because they presented seizures associated with mild gastroenteritis: epidemiological, clinical and developmental data were collected.The mean age at diagnosis was 18.1 months. The female/male ratio was 2.8. The interval between the gastro-enteritis and the seizure was 3.8 days. The mean rectal temperature in the seizure was 37.1 degrees C. The mean number of seizures per hospitalisation was 2.2. Seizures were brief (90.6% < or = 5 min) and 96.8% of them were recorded as generalised. Rotavirus antigenemia in faeces was positive in 55.2% of cases. Lab findings, including the cerebrospinal fluid study, were normal. The electroencephalogram, in an immediate post-seizure situation, showed generalised and/or focal paroxysmal activity in four patients. The mean follow-up time was 4.2 years. The mean age of the group is currently 5.7 years, with normal development and level of schooling. Five patients (20.8%) had recurrences coinciding with new bouts of gastroenteritis. One patient, with a history of maternal epilepsy, was later diagnosed with focal epilepsy, and whether it can be related with the earlier presentation of seizures associated with mild gastroenteritis or not is debatable. CONCLUSIONS; Seizures in children associated with mild gastroenteritis are a well-differentiated convulsive syndrome. Prognosis is excellent, but a relatively important percentage of cases tend to have recurrences if there is a new diarrhoeic process.

Benign infantile seizures with mild gastroenteritis: Study of 22 patients

Purpose To analyze the electroclinical features, aetiology and outcome in patients with normal neurological examination and psychomotor development who presented seizures during a mild gastroenteritis (MG). Patients and methods Evaluation of the clinical charts of 22 patients who were assessed in the Neurology Department, Hospital Nacional de Pediatría Prof. Dr. JP Garrahan between 1999 and 2007. Results Twelve patients were boys and 10 were girls, the age of onset ranged from 5 to 26 months, and the median age was 10 months. Rotavirus antigen test in stool was positive in 9 of 18 studied patients. The seizures were brief, focal with secondary generalization in 15 patients (68.5%), apparently generalized in 5 (22.5%) and focal in two (9%). Seven of the patients (35%) had more than one seizure in 24 h. The interictal EEG was normal in all patients. Neuroradiological studies were performed in 19 patients with a normal result. No patient was put on long-term treatment with antiepileptic drugs. Four patients had subsequent mild gastroenteritis and two of them presented convulsions during the disease. After between 12 and 67 months of follow-up, all patients had normal psychomotor development and neurological examination. Conclusions In this study we confirmed the association of benign infantile seizures (BIS) and MG with or without rotavirus. The identification of this entity allows avoiding unnecessary complementary studies and treatment with antiepileptic drugs.

Clinical study on benign infantile convulsions associated with mild gastroenteritis

Objective To investigate the clinical of benign infantile convulsions(BICE) associated with mild gastroenteritis. Methods Infants with gastroenteritis (GE) accompanied with seizures were observed and followed up from November 2006 to November 2008. Results 9 patients with BICE, including 4 boys and 5 girls,aged 12 -30 months old. The seizures was attacked as generalized tonic-clonic pattern (GTCS) ,The sei-zures were easy to be controlled and no further attack was observed the cases during the follow up period. Con- dusion Some infants with GE can showed afebrile convulsion. The seizure,with a GTCS pattern during the at-tack and a good prognosis in future. Key words: lnfant; Gastroenteritis; Convulsionse

Afebrile benign convulsions with mild gastroenteritis: a new entity?

Afebrile seizures in children usually necessitate investigations in order to determine the etiology and estimate the prognosis. Recently, convulsions that are described as benign but afebrile have been documented in children, in association with diarrhea, and are now recognized as a distinct entity. Benign afebrile seizures with mild gastroenteritis are defined as convulsions accompanying symptoms of mild diarrhea without dehydration or electrolyte derangement and without fever before and after the seizures in healthy children without meningitis, encephalitis or encephalopathy. The convulsions are short, symmetrical, generalized tonic-clonic seizures, occurring in clusters. Laboratory studies (full blood count, blood glucose, creatinine, serum electrolytes, cerebrospinal fluid, bacterial and viral cultures) are usually normal, and other investigations (neuroimaging and electroencephalogram) are not necessary. Prognosis is always favorable (normal psychomotor development, no recurrences of seizures), and anticonvulsant therapy is not warranted. Recognition of this benign infantile convulsion avoids extensive evaluation and long-term anticonvulsant therapy; physicians may reassure the parents regarding the lack of long-term sequelae. In conclusion, this type of seizure seems to be a new entity, but it awaits a correct place in the large group of infantile convulsion disorders.

1087 Hypermethylation of Let-7 Promoter Is Involved in cagA-Induced RAS Upregulation in Gastric Epithelial Cells

The aim of this study was to evaluate the acceptability, safety & effect on diarrhea and accompanying symptoms of a probiotic mixture (Bacilac Forte) compared to placebo in children with a clinical diagnosis of mild acute gastroenteritis. The active product contained 3, 3 10 9CFU pro capsule of a probiotic mixture:20% Lactobacilus rhamnosus, 20% L acidophilus, 20% L casei, 20% L plantarum, 20% Bifidobacterium infantis. Study design was prospective DBPC in a primary care setting. IRB approval was obtained and subjects were included after parental consent. Otherwise healthy eutrophic children ages 1 mth-5 yrs, consulting their GP b/o liquid stools more than 3 tid for less than 48 h with dehydration less than 9% were included. Exclusion criteria were exposure to antibiotics or probiotics within 4 wks, bloody diarrhea & fever. Subjects received active or placebo tid. Parents kept a diary until D9 rating acceptability of the product, various parameters and any adverse event. Subjects were re-examined between D7-9. In total 48 subjects enrolled, 47 were analyzed (22 in the intervention group), 53% were girls, 91% Caucasian, age was 24+-15 mths, with no differences between groups. Average stool frequency was 5/d, 45% had cramps, 21% regurgitation, 45% vomiting and 23% upper respiratory symptoms. Statistical analysis used GLMM and non-parametric tests. Based on diary there was no difference in duration of diarrhea and stool frequency (although a sharper decrease in the active group) but stool consistency returned to normal more rapidly (D3) in the active group (p=0.0205). Also stools were more soft and formed over the observation period in the active group whereas subjects in the placebo group showed more variation (more hard and watery stools). During the course of the study there were no differences in cramps, regurgitation, vomiting, upper respiratory symptoms and appetite between groups. Acceptability of the capsules was rated easy by over 70% on all occasions for both groups, Tolererance was excellent: crying, flatulence, sleep and general behavior were rated similarly. Two adverse events (AE) were recorded in the intervention group: 1 otitis media and 1 gastroenteritis with dehydration necessitating hospitalization (frequency of AE not different for both groups by fisher exact p=0.203). In conclusion: tid administration of the probiotic mixture Bacilac Forte to young childrenwithmild gastro-enteritis was safe, well tolerated and led tomore rapid normalization of stool consistency with overall more formed and soft stools.

Clinical Characteristics of Benign Convulsions With Rotavirus Gastroenteritis

Convulsions sometimes occur in infants and toddlers with mild gastroenteritis. We retrospectively investigated the hospital records of 106 patients admitted to our hospital who had rotavirus gastroenteritis from February 2002 to April 2008. There were 23 patients with convulsions, including 13 with benign convulsions, 9 with febrile seizures, and 1 with epilepsy. Gastroenteritis in patients with benign convulsions was mild from the viewpoint of body weights and serum creatinine concentrations on admission and the duration of admission. Serum Na(+) and Cl(-) concentrations of patients with benign convulsions were relatively lower than those without convulsions on admission (P = .006, and P = .008, respectively). Twelve of thirteen patients had no other seizures after oral administration of 5 mg/kg of carbamazepine, while 1 patient had 1 convulsion 15 minutes after the therapy. In conclusion, carbamazepine therapy was effective for benign convulsions with rotavirus gastroenteritis.

Convulsiones benignas durante gastroenteritis leve por rotavirus

Benign convulsions with mild gastroenteritis (CwG) are a rare diagnosis in Western countries, and it is characterized by afebrile seizures, almost times more than once, during a gastroenteritis without severe hydroelectrolitic affection. The most frequent implied virus is rotavirus. This is a benign disease, in spite of cluster seizures, and neither complementary explorations nor antiepileptic treatment is required.Seven cases between 6 and 27 months aged of CwG due to rotavirus are reported.Four patients had more than one seizure, and all convulsions were generalized hypermotor type. Rotavirus gastroenteritis was mild in all cases; only one patient was admitted for hospitalization before seizures appearance. There were no findings in all cases with lumbar punction or brain neuroimaging. Electroencephalogram was normal in all cases, except in one patient who showed frontal acute waves, which disappeared in a later examination. No patients have shown seizure recurrence or development delay.CwG due to rotavirus are possibly infradiagnosed, and perhaps classified as atypical febrile seizures, febrile status or early infancy benign partial epilepsy. This benign diagnosis should be considered for a correct management and prognosis.