Stool Collection Research Articles

Stool bacteriomic profiling in patients with metastatic renal cell carcinoma suggests an etiology of VEGF TKI-related diarrhea.

421 Background: Vascular endothelial growth factor-tyrosine kinase inhibitors (VEGF TKIs) remain a mainstay of therapy for patients with metastatic renal cell carcinoma (mRCC). Diarrhea represents a pervasive toxicity, with all grade diarrhea affecting roughly 50% of patients receiving VEGF TKIs. The underlying cause of diarrhea in these patients is poorly understood. Methods: Patients with mRCC receiving an FDA-approved VEGF TKI therapy for mRCC were consented. Stool was collected in a standardized fashion and total genomic DNA was isolated using the PowerSoil DNA isolation kit (Mo Bio, USA). A standard PCR protocol was used to amplify bacterial 16S rRNA genes from all samples. PCR primers were used to amplify the V4 and V5 regions of the 16S rRNA. Paired-end of sequencing 2X100bp was performed by Illumina HiSeq 2000, and sequences were clustered using the CD-HIT clustering algorithm. Taxonomy was then assigned using the RDP-II classifier. Non-clustered analyses were also performed, stratifying patients by the presence or absence of diarrhea at the time of stool collection. Results: Of 26 patients consented, 23 patients submitted stool specimens and 20 had sufficient data for the current analysis. Amongst these 20 patients, the median age was 63 and the majority of patients (60%) were intermediate risk by Heng criteria. Eight patients (40%) received VEGF TKI therapy in the first-line setting. Across all lines of therapy, the most commonly used VEGF TKI was sunitinib (44%). A total of 141 bacterial species were identified. With respect to differences in patients who did and did not have diarrhea, the Mann-Whitney U-test identified 7 species with a p value of <0.1. The largest difference was seen in two Bifidobacterium species, B. animalis and B. bifidum, with both bacteria more abundant in patients with no diarrhea. Conclusions: This is the first effort to use stool bacteriomic profiling to ascertain the etiology of VEGF TKI related diarrhea in patients with mRCC. Two Bifidobacterium spp identified in this analysis are commonly found in probiotics. Studies to use probiotics enriched with Bifidobacterium spp to prevent or ameliorate VEGF TKI-related diarrhea are currently in development.

Motion for a product to collect a sample of human stool and/or urine KITLAB

A marketing innovation is the key factor of any product to be launched in the consumer market. This research anticipates that had already been patented worldwide launch of a product (non- chemical) pharmaceutical industry to be called KITLAB, which will change for the better the procedure and user form to collect a single sample of feces or urine be taken for laboratory examination. The objective of this paper is to show product innovation to make a collection of these hygienically correct. The methods and techniques are their main advantages it has over its competitors, since it enables the user to make a collection without handling, that is, that a sample collection (feces/urine), is made by everyone (men/women, adults/children) hygienically, in a very different way of unhygienic today make such collections, which are, at best, made directly on the floor without any care with possible contamination toilet that such unsuitable sites can provide samples. The results observed in a study commissioned assessment of market viability showed that the product had total public approval , and in addition , he has numerous competitive advantages over other existing competing products in the market because its use eliminates the so inconvenient, self - embarrassing and unhygienic way of making today a collection of stools, and more, it will give the user a personal satisfaction and comfort, finally, this product will eliminate the so uncomfortable handling necessary that still exists today.

1639A Tale of Two States: An Exploration of Disparities in the Proportion of Long-term Care Facility–onset Clostridium difficile Infections in Minnesota and New Mexico

Background: Long-term care facility (LTCF) residents are at higher risk for developing Clostridium difficile infections (CDI). Both Minnesota (MN) and New Mexico (NM) perform active populationbased surveillance for CDI in select counties. While both states have historically similar overall CDI incidence rates, the proportion of LTCF-onset CDI is much higher in NM. We compared surveillance data from the two states to identify differences. Methods: We analyzed population-based CDI data from January 1, 2011– September 30, 2013. A CDI case was defined as a stool specimen positive for C. difficile obtained from a patient without a C. difficile-positive specimen in the previous 8 weeks. A CDI case was classified as LTCF-onset if positive stool specimen was collected in a LTCF or within 3 days after hospital admission from a LTCF. A medical record review was performed on all LTCF-onset CDI cases in MN and a 10% random sample in NM. LTCF utilization data was obtained from the 2012 Area Resource File. Chi-square test was used for comparisons across the two states. Results: A total of 1597 and 3289 CDI cases were identified in MN and NM, respectively. Among all CDI cases, MN cases were less likely to be LTCF-onset (7% vs. 28%; p<0.0001). Among cases with full review, no differences were detected between MN and NM in median age (83 vs. 78.5 years; p=0.1), recent H2 receptor antagonist (21% vs. 22%; p=0.9), proton pump inhibiter (51% vs. 49%; p=0.7), or antibiotic usage (72% vs. 74%; p=0.7) in the 12 weeks prior to stool collection. MN LTCF-onset cases were more likely to have a positive test as a hospital inpatient (37% vs. 21%; p=0.01). Among persons greater than 65 years, LTCF utilization was higher in MN than NM (5.7% vs 2.9%, p<0.0001) and MN had significantly higher population rate of LTCFs (47 vs. 22 per 100,000 persons; p<0.0001) and LTCF beds (4138 vs. 2495 per 100,000 persons; p<0.0001). Conclusion: Despite LTCF utilization being higher in MN, this state had a lower proportion of LTCF-onset CDI cases compared to NM. No differences in age or prior use of antibiotics or acid reducing medications were detected between LTCF-onset cases in the two states. Further exploration of the variability in testing and infection control practices in LTCFs is warranted to identify prevention strategies directed to this patient population. Stacy Holzbauer Minnesota Department of Health PO Box 64975, St. Paul, MN 55164 651-201-5414, www.health.state.mn.us stacy.holzbauer@state.mn.us A Tale of Two States: An Exploration of Disparities in the Proportion of LongTerm Care Facility-Onset C. difficile Infections in Minnesota and New Mexico S.M. Holzbauer1, T. Whitten1, and E. Phipps 2 1Minnesota Department of Health, Saint Paul, MN; 2University of New Mexico, Albuquerque, NM

The effect of changing stool collection processes on compliance in nationwide organized screening using a fecal occult blood test (FOBT) in Korea: study protocol for a randomized controlled trial.

BackgroundColorectal cancer (CRC) screening by fecal occult blood test (FOBT) significantly reduces CRC mortality, and compliance rates directly influence the efficacy of this screening method. The aim of this study is to investigate whether stool collection strategies affect compliance with the FOBT.Methods/DesignIn total, 3,596 study participants aged between 50 and 74 years will be recruited. The study will be conducted using a randomized controlled trial, with a 2 × 2 factorial design resulting in four groups. The first factor is the method of stool-collection device distribution (mailing vs. visiting the clinic) and the second is the type of stool-collection device (sampling kit vs. conventional container). Participants will be randomly assigned to one of four groups: (1) sampling kit received by mail; (2) conventional container received by mail; (3) sampling kit received at the clinic; (4) conventional container received at the clinic (control group). The primary outcome will be the FOBT compliance rate; satisfaction and intention to be rescreened in the next screening round will also be evaluated. The rates of positive FOBT results and detection of advanced adenomas or cancers through colonoscopies will also be compared between the two collection containers.DiscussionIdentifying a method of FOBT that yields high compliance rates will be a key determinant of the success of CRC screening. The findings of this study will provide reliable information for health policy makers to develop evidence-based strategies for a high compliance rate.Trial registrationCRIS:KCT0000803Date of registration in primary registry: 9 January, 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-461) contains supplementary material, which is available to authorized users.

Methods of analysis of enteropathogen infection in the MAL-ED Cohort Study.

Studies of diarrheal etiology in low- and middle-income countries have typically focused on children presenting with severe symptoms to health centers and thus are best equipped to describe the pathogens capable of leading to severe diarrheal disease. The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study was designed to evaluate, via intensive community surveillance, the hypothesis that repeated exposure to enteropathogens has a detrimental effect on growth, vaccine response, and cognitive development, which are the primary outcome measures for this study. In the setting of multiple outcomes of interest, a longitudinal cohort design was chosen. Because many or even the majority of enteric infections are asymptomatic, the collection of asymptomatic surveillance stools was a critical element. However, capturing diarrheal stools additionally allowed for the determination of the principle causes of diarrhea at the community level as well as for a comparison between those enteropathogens associated with diarrhea and those that are associated with poor growth, diminished vaccine response, and impaired cognitive development. Here, we discuss the analytical methods proposed for the MAL-ED study to determine the principal causes of diarrhea at the community level and describe the complex interplay between recurrent exposure to enteropathogens and these critical long-term outcomes.

Improved acute flaccid paralysis surveillance performance in the Democratic Republic of the Congo, 2010-2012.

The Democratic Republic of the Congo (DRC) began polio eradication activities in 1996. By 2001, DRC was no longer polio endemic. However, wild poliovirus (WPV) transmission was reestablished in 2006 continuing through 2011 (last WPV case onset 20 December 2011), and vaccine-derived poliovirus type 2 (VDPV2) outbreaks occurred during 2004-2012 (last VDPV2 case onset 4 April 2012). Gaps in acute flaccid paralysis (AFP) surveillance have been consistently documented. AFP surveillance indicators were assessed at the national, provincial, and zone de santé (ZS) levels for 2010-2012. A spatiotemporal analysis of compatible, WPV type 1 (WPV1), and VDPV2 cases was performed. During 2010-2012, AFP cases were reported from all provinces but not every ZS, particularly in Equateur province and Province Orientale. A spatiotemporal relationship between compatible, WPV1, and VDPV2 cases was noted. Nonpolio AFP rates met objectives at national and provincial levels but were sub-optimal in certain ZS. National and provincial trends in timely stool collection, stool condition, adequate stool, and 60-day follow-up exams improved. DRC's AFP surveillance system is functional and improved during 2010-2012. Maintaining improvements and strengthening AFP case detection at the ZS level will provide further support for the apparent interruption of WPV and VDPV2 transmission.

Patients' perspectives on providing a stool sample to their GP: a qualitative study.

BackgroundStool specimen collection is challenging and informal feedback has indicated that participants find the process difficult. Increasing stool specimen returns would improve the investigation of outbreaks of diarrhoeal and food-borne disease.AimTo explore the barriers to stool sample collection and specimen return to ascertain which factors may help to improve the process.Design and settingQualitative patient interview study in Gloucester, UK.MethodA two-stage purposive sampling process was used to identify patients who had either previous experience or no experience of collecting a stool sample. The interview schedule, based on the theory of planned behaviour, was used to facilitate interviews with 26 patients. Interview transcripts were analysed using a modified framework analysis.ResultsBarriers to collection included embarrassment, fear of results, concerns around hygiene and contamination, discretion and privacy, and lack of information. Personal gain was identified as the main incentive to collecting and returning a stool sample. The need for an information leaflet on stool collection was emphasised by most patients.ConclusionsGPs could make a number of small changes that could make a big difference for patients and potentially increase stool sample return. If they, rather than receptionists, distributed collection kits it may be easier for patients to ask any questions they had regarding collection. In addition, the provision of a stool-collection information leaflet could increase patients’ confidence regarding collecting the sample, and providing drop-off boxes for specimens could help prevent patients’ embarrassment regarding handing their stool over to a receptionist.

PO-0131 Value Of Stool Culture Of Children

Introduction Acute gastroenteritis (AGE) remains, throughout Europe, a public health issue. Under the age of 5, some 20 to 30% of bacterial microorganisms are identified. However, cost-effectiveness of routine stool cultures yielding only 2% results preclude routine stool culturing. Objective Evaluation of the value of stool culture of children with AGE. Methods Retrospective data collection from clinical records of patients less than 18 years old submitted to stool cultures over a one year period. Results Out of 322 stool culture, 56.8% fulfilled the accepted ESPGHAN criteria and 74.8% had at least 1 clinical predictor of positivity (fever, blood or mucus stools, > 10 bowel actions/24 h, abdominal pain, travelling to highly epidemic countries). There were 121 positive cultures positive, 79.3% in patients obeying the defined criteria and 91.7% with clinical predictors of positivity. Campylobacter was the most frequently identified agent (68.6%), followed by Salmonella. Campylobacter decreased within an increasing age whilst Salmonella showed an inverse pattern. Campylobacter was the most frequently identified agent throughout all seasons of the year, followed by Salmonella , except in the winter when Yersinia took the second place. Discussion Sticking to accepted criteria for stool collection and/or to defined clinical features, increasing the yield of stool cultures.

AB0141 The Mucosal Anti-Citrullinated Peptide Antibody Response in Pre-Clinical Rheumatoid Arthritis

BackgroundRecent data suggest RA may originate from an autoimmune response in inflamed mucosa. RA is associated with gingival and airway inflammation. Porphyroma gingivalis, a bacterium causing gingivitis, has been implicated...

OP0009 Assessment of a colorectal cancer screening programme using a faecal occult blood test kit in Penang state, Malaysia

<h3>Background</h3> The aim of this study was to assess a colorectal cancer (CRC) screening programme using a faecal occult blood test (FOBT) kit in Penang, Malaysia. <h3>Methods</h3> A total of 1000 FOBT kits were distributed between June and November, 2009, to attendees of CRC public health talks in Penang state. Data for demographics, knowledge of CRC, and awareness of stool testing were collected before the FOBT kits were issued to participants who did stool collection at home. Data for the use of the FOBT kits were collected when the FOBT kit was returned for stool analyses. Phone interviews were done with participants who either did not return the FOBT kits or got a positive result. All statistical analyses were done with PASW version 18. <h3>Findings</h3> A total of 617 participants took part in the study. The majority of the participants stated that the FOBT was easy to do. Very few (3.8%) encountered difficulties in doing the test. Of the 31 participants who had positive result, eight participants underwent colonoscopy. One case of CRC (anal cancer) was found; two cases of polyps; one case each of ulcerative colitis and haemorrhoids; and three normal. The level of awareness of stool examination and knowledge of CRC were poor among participants. Education and income per month were factors associated with both knowledge of CRC and the return of the FOBT kit. Family history was associated with knowledge of CRC; age group and ethnicity were associated with the return of FOBT kit. <h3>Interpretation</h3> In conclusion, CRC screening can be done in the community with a single FOBT kit. However, the return rate of the FOBT kit and rate of colonoscopy examination were 56.7% and 0.8%, respectively. Efforts must be made to increase colonoscopy examination rates to ensure success of a CRC screening programme.

120 Fecal Immunochemical Test Performance Over Multiple Rounds of Annual Testing in an Outreach Screening Program

One sample quantitative FIT kits (either NS-Plus Chemistry analyzer, Alfresa Pharma Corp., Japan or OC-Sensor DIANA IFOB Test System, Eiken Chemical Company Ltd., Japan) were used. The primary outcome was return of a completed one sample FIT kit. Patients with positive results (≥75 ng hgb/mL) were recommended colonoscopy. The primary outcome was compared by distribution method, return method and kit type using multivariate regression to adjust for patient, physician factors and kit type. Results Of the 3780 patients in our cohort, 685 (18%) returned a completed FIT kit. Of the 1839 that were mailed a kit, 436 (24%) returned it compared to 249 (13%) of the 1941 who were asked to visit their family physician to pick up a kit. Rates of return were similar in those who were asked to drop off a kit (330 of 1890 (18%)) and those who were asked to mail it back (344 of 1818 (19%)). After adjustment for kit type as well as patient and physician factors, FIT kit return was significantly associated with distribution method (single mail out vs. pick up: O.R. 2.97, 95% C.I. 2.04 4.32, p < 0.0001 and repeat mail out vs. pick up: O.R. 2.75, 95% C.I. 2.27 3.33, p < 0.0001) but not with method of return. 13.6% of participants had result of 75ng hgb/mL or greater while 10.9% had a result of 100 ng hgb/mL or higher. Positivity rates declined with increasing time from stool collection to testing. Conclusions Improved participation rates were associated with directly mailing the FIT kit but not with method of return. Our findings are of considerable interest to decision-makers in jurisdictions where FIT is being considered or is used in organized CRC screening.

Clostridium difficile infection among children across diverse US geographic locations.

Little is known about the epidemiology of Clostridium difficile infection (CDI) among children, particularly children ≤3 years of age in whom colonization is common but pathogenicity uncertain. We sought to describe pediatric CDI incidence, clinical presentation, and outcomes across age groups. Data from an active population- and laboratory-based CDI surveillance in 10 US geographic areas during 2010-2011 were used to identify cases (ie, residents with C difficile-positive stool without a positive test in the previous 8 weeks). Community-associated (CA) cases had stool collected as outpatients or ≤3 days after hospital admission and no overnight health care facility stay in the previous 12 weeks. A convenience sample of CA cases were interviewed. Demographic, exposure, and clinical data for cases aged 1 to 17 years were compared across 4 age groups: 1 year, 2 to 3 years, 4 to 9 years, and 10 to 17 years. Of 944 pediatric CDI cases identified, 71% were CA. CDI incidence per 100,000 children was highest among 1-year-old (66.3) and white (23.9) cases. The proportion of cases with documented diarrhea (72%) or severe disease (8%) was similar across age groups; no cases died. Among the 84 cases interviewed who reported diarrhea on the day of stool collection, 73% received antibiotics during the previous 12 weeks. Similar disease severity across age groups suggests an etiologic role for C difficile in the high rates of CDI observed in younger children. Prevention efforts to reduce unnecessary antimicrobial use among young children in outpatient settings should be prioritized.

Isotope Concentrations from 24-h Urine and 3-h Serum Samples Can Be Used to Measure Intestinal Magnesium Absorption in Postmenopausal Women1–3

Studies suggest a link between magnesium status and osteoporosis. One barrier to more conclusive research on the potential relation is measuring intestinal magnesium absorption (MgA), which requires the use of stable isotopes and a ≥6-d stool or 3-d urine collection. We evaluated alternative methods of measuring MgA. We administered 2 stable magnesium isotopes to 15 postmenopausal women (cohort 1) aged 62 ± 8 y with a dietary magnesium intake of 345 ± 72 mg/d. Participants fasted from 1200 h to 0700 h and then consumed breakfast with ∼23 mg of oral26Mg and ∼11 mg of i.v.25Mg. We measured magnesium isotope concentrations in 72-h urine, spot urine (36, 48, 60, and 72 h), and spot serum (1, 3, and 5 h) samples collected after isotope dosing. We calculated MgA using the dose-corrected fraction of isotope concentrations from the 72-h urine collection. We validated new methods in 10 postmenopausal women (cohort 2) aged 59 ± 5 y with a dietary magnesium intake of 325 ± 122 mg/d. In cohort 1, MgA based on the 72-h urine collection was 0.28 ± 0.08. The 72-h MgA correlated most highly with 0–24 h urine MgA value alone (ρ = 0.95,P < 0.001) or the mean of the 0–24 h urine and the 3-h (ρ = 0.93,P < 0.001) or 5-h (ρ = 0.96,P < 0.001) serum MgA values. In cohort 2, Bland-Altman bias was lowest (−0.003,P = 0.82) using means of the 0–24 h urine and 3-h serum MgA values. We conclude that means of 0–24 h urine and 3-h serum MgA provide a reasonable estimate of 72-h MgA. However, if researchers seek to identify small changes in MgA, we recommend a 3-d urine or extended stool collection. This trial was registered atclinicaltrials.gov> as NCT01593501.

Detection and genotype analysis of Giardia duodenalis from asymptomatic Hungarian inhabitants and comparative findings in three distinct locations

The transmission route of giardiasis not yet understood and why some infected individuals remain asymptomatic while others become quite ill. The drinking water quality is supposedly responsible for the prevalence of asymptomatic Giardia duodenalis infections in different areas, therefore asymptomatic giardiasis has been investigated in three water supply areas of Hungary: three hundred stool samples from inhabitants of Budapest, Füzér and Mátrafüred were examined by immunological and molecular methods for the presence of G. duodenalis infections. Individuals were asked to fill out a validated questionnaire at the time of stool collection and the interview covered demographic data, family life, education and travel history.In Budapest and in Mátrafüred in one stool sample G. duodenalis Assemblage A, whereas in Füzér once G. duodenalis Assemblage A, once Assemblage B and twice mixed infection were detected. We found higher prevalence rate of 4% of G. duodenalis infections of asymptomatic people in the village Füzér, where the removal of the Giardia cysts of the drinking water treatment plant was not effective. This study throws a light the need to look into the possibility of other risks of Giardia infections such as water transmission routes. To our knowledge, this is the first study evaluating the prevalence of G. duodenalis infections in asymptomatic persons in Hungary.

Does a rapid diagnosis of Clostridium difficile infection impact on quality of patient management?

A rapid and accurate diagnosis of Clostridium difficile infection (CDI) is essential for patient management and implementation of infection control measures. During a prospective time-series study, we compared the impact of three different diagnostic strategies on patient care. Each strategy was tested during a 3-month period: P1 (diagnosis based on the stool cytotoxicity assay and the toxigenic culture), P2 (diagnosis based on PCR) and P3 (two-step algorithm based on glutamate dehydrogenase detection followed by nucleic acid amplification test). The following criteria were used to assess the quality of patient management: (i) time for result reporting, (ii) frequency of repeat testing within 7 days, (iii) time elapsed between stool collection and beginning of treatment for patients with CDI, and (iv) frequency of empirical treatment for patients without CDI. Of 1122 stool samples (P1 n = 359, P2 n = 374, P3 n = 389), 36 (10.0%), 47 (12.3%) and 48 (12.3%) were positive for C. difficile during P1, P2 and P3, respectively. The time for reporting of a positive or a negative result was significantly shorter and the frequency of redundant stool samples within 7 days was lower during P2 and P3 than during P1. Patients with CDI were specifically treated with vancomycin or metronidazole earlier during P2 and P3 than patients from P1 (0.5 ± 0.5 days and 1.0 ± 1.8 days vs. 2.0 ± 1.7 days). The empirical therapy among patients without CDI decreased from 13.6% during P1 to 6.4% during P2 and 5.6% during P3. A rapid CDI diagnosis impacts positively on patient care.

Reasons and circumstances for the late notification of Acute Flaccid Paralysis (AFP) cases in health facilities in Luanda.

IntroductionAs the polio eradication effort enters the end game stage, surveillance for Acute Flaccid Paralysis in children becomes a pivotal tool. Thus given the gaps in AFP surveillance as identified in the cases of late notification, this study was designed to explore the reasons and circumstances responsible for late notification of AFP and collection of inadequate stools (more than 14 days of onset of paralysis until collection of the 2nd stool specimen) of AFP cases in health facilities equipped to manage AFP cases.MethodsEleven AFP cases with inadequate stools were reported from January 2 to July 8, 2012 - Epidemiological Weeks 1-27. The families of these cases were interviewed with an in-depth interview guide. The staff of the seven health units, where they later reported, was also enlisted for the study which used in-depth interview guide in eliciting information from them.ResultsIgnorance and wrong perception of the etiology of the cases as well as dissatisfaction with the health units as the major reasons for late reporting of AFP cases. The first port of call is usually alternative health care system such as traditional healers and spiritualists because the people hold the belief that the problem is spiritually induced. The few, who make it to health units, are faced with ill equipped rural health workers who wait for the arrival of more qualified staff, who may take days to do so.ConclusionAn understanding of the health seeking behavior of the population is germane to effective AFP surveillance. There is thus a need to tailor AFP surveillance to the health seeking behavior of the populations and expand it to community structures.

Real time PCR to detect the environmental faecal contamination by Echinococcus multilocularis from red fox stools

The oncosphere stage of Echinococcus multilocularis in red fox stools can lead, after ingestion, to the development of alveolar echinococcosis in the intermediate hosts, commonly small mammals and occasionally humans. Monitoring animal infection and environmental contamination is a key issue in public health surveillance. We developed a quantitative real-time PCR technique (qPCR) to detect and quantify E. multilocularis DNA released in fox faeces. A qPCR technique using a hydrolysis probe targeting part of the mitochondrial gene rrnL was assessed on (i) a reference collection of stools from 57 necropsied foxes simultaneously investigated using the segmental sedimentation and counting technique (SSCT) (29 positive for E. multilocularis worms and 28 negative animals for the parasite); (ii) a collection of 114 fox stools sampled in the field: two sets of 50 samples from contrasted endemic regions in France and 14 from an E. multilocularis-free area (Greenland). Of the negative SSCT controls, 26/28 were qPCR-negative and two were weakly positive. Of the positive SSCT foxes, 25/29 samples were found to be positive by qPCR. Of the field samples, qPCR was positive in 21/50 (42%) and 5/48 (10.4%) stools (2 samples inhibited), originating respectively from high and low endemic areas. In faeces, averages of 0.1pg/μl of DNA in the Jura area and 0.7pg/μl in the Saône-et-Loire area were detected. All qPCR-positive samples were confirmed by sequencing. The qPCR technique developed here allowed us to quantify environmental E. multilocularis contamination by fox faeces by studying the infectious agent directly. No previous study had performed this test in a one-step reaction.

Applicability of Bio‐wipes for the collection of human faecal specimens for detection and characterisation of enteric viruses

To determine whether gastroenteritis viruses and other enteric viruses could be detected in faecal specimens collected with Bio-wipes. Faecal specimens, self-collected with Bio-wipes, from 190 individuals (94 diarrhoeal, 93 non-diarrhoeal, 3 unknown) were screened for eight human enteric viruses (enterovirus, hepatitis A virus, adenovirus, astrovirus, norovirus GI and GII, sapovirus and rotavirus) by real-time (reverse transcription)-polymerase chain reaction. Rotaviruses and noroviruses from positive specimens were genotyped. At least one enteric virus could be detected in 82.6% (157/190) of faecal specimens. Mixed infections of up to four different viruses could be detected in both diarrhoeal and non-diarrhoeal specimens. Enteroviruses were detected most frequently (63.7%), followed by adenoviruses (48.4%) and noroviruses (32.2%). Genotyping was successful for 78.6% of rotaviruses and 44.8% of noroviruses. Bio-wipes provide a user friendly, easier method for stool collection that facilitates enteric virus detection and genetic characterisation.

Determining the community prevalence of acute gastrointestinal illness and gaps in surveillance of acute gastroenteritis and foodborne diseases in Guyana.

Guyana is an English-speaking country in South America and, culturally, it is part of the Caribbean. Objective of this study was to determine the community prevalence and true burden and economic impact of acute gastroenteritis (AGE) and foodborne diseases (FBDs) in Guyana. A cross-sectional population-based survey was conducted in 7 of the 10 regions in Guyana during August and November 2009 to capture the high- and low-AGE season respectively. Overall, 1,254 individual surveys were administered at a response rate of 96.5%. The overall monthly prevalence of self-reported cases of AGE was 7.7% (97 cases) (95% CI 6.3-9.3), and the yearly incidence was 1.0 episodes per person-year. The highest monthly prevalence of AGE was observed in region 4 (8.9%) and in children aged 1-4 year(s) (12.7%). Of the 97 AGE cases, 23% sought medical care; 65% reported spending time at home due to their illness [range 1-20 day(s), mean 2.7 days], of whom 51% required other individuals to look after them while ill. The maximum number of stools per 24 hours ranged from 3 to 9 (mean 4.5), and number of days an individual suffered from AGE ranged from 1 to 21 day(s) (mean 2.7 days). The burden of syndromic AGE cases in the population for 2009 was estimated to be 131,012 cases compared to the reported 30,468 cases (76.7% underreporting), which implies that, for every syndromic case of AGE reported, there were additional 4.3 cases occurring in the community. For every laboratory-confirmed case of FBD/AGE pathogen reported, it was estimated that approximately 2,881 more cases were occurring in the population. Giardia was the most common foodborne pathogen isolated. The minimum estimated annual cost associated with the treatment for AGE was US$ 2,358,233.2, showing that AGE and FBD pose a huge economic burden on Guyana. Underreporting of AGE and foodbome pathogens, stool collection, and laboratory capacity were major gaps, affecting the surveillance of AGE in Guyana.

Commentary: rabeprazole improves symptoms in patients with functional dyspepsia in Japan

of those with higher values. The FGF-19 assay is based on a simple, inexpensive commercial ELISA; in contrast, other diagnostic methods (C4 and faecal bile acids) require high-performance liquid chromatography with tandem mass spectrometry and/or 48 h stool collection. The ability to screen for BAD with serum FGF-19 could dramatically change clinical practice in the assessment and management of diarrhoea in patients with either inflammatory bowel disease or IBS-D.