Symptoms Of Acute Gastroenteritis Research Articles

Enhancing enteric pathogen detection: implementation and impact of multiplex PCR for improved diagnosis and surveillance

BackgroundSyndromic surveillance of acute gastroenteritis plays a significant role in the diagnosis and management of gastrointestinal infections that are responsible for a substantial number of deaths globally, especially in developing countries. In Lebanon, there is a lack of national surveillance for acute gastroenteritis, and limited data exists regarding the prevalence of pathogens causing diarrhea. The one-year study aims to investigate the epidemiology of common gastrointestinal pathogens and compare our findings with causative agents of diarrhea reported by our study collaborative centers.MethodsA multicenter, cross-sectional study was conducted over a one-year period. A total of 271 samples were obtained from outpatients and inpatients presenting with symptoms of acute gastroenteritis at various healthcare facilities. The samples were then analyzed using Allplex gastrointestinal assay that identifies a panel of enteric pathogens.ResultsOverall, enteropathogens were detected in 71% of the enrolled cases, 46% of those were identified in patients as single and 54% as mixed infections. Bacteria were observed in 48%, parasites in 12% and viruses in 11%. Bacterial infections were the most prevalent in all age groups. Enteroaggregative E. coli (26.5%), Enterotoxigenic E. coli (23.2%) and Enteropathogenic E. coli (20.3%) were the most frequently identified followed by Blastocystis hominis (15.5%) and Rotavirus (7.7%). Highest hospitalization rate occurred with rotavirus (63%), Enterotoxigenic E. coli (50%), Blastocystis hominis (45%) and Enteropathogenic E. coli (43%). Enteric pathogens were prevalent during summer, fall and winter seasons.ConclusionsThe adoption of multiplex real-time PCR assays in the diagnosis of gastrointestinal infections has identified gaps and improved the rates of detection for multiple pathogens. Our findings highlight the importance of conducting comprehensive surveillance to monitor enteric infections. The implementation of a syndromic testing panel can therefore provide healthcare professionals with timely and accurate information for more effective treatment and public health interventions.

Etiology of acute gastroenteritis among pre-school children in Peshawar-KP Pakistan, a case control study.

Objective: This study aimed to investigate the etiology of acute viral gastroenteritis among preschool children in Pesha-war, Khyber Pakhtunkhwa, Pakistan.Methodology: A total of 420 stool samples were gathered from children under five, displaying symptoms like diarrhea, vomiting, nausea, and abdominal cramps. Recruitment took place at a Peshawar tertiary care hospital, approved by the institute's IRB. The cohort was split evenly into 210 cases and 210 controls. Healthy controls\ originated from the outpa-tient department with no diarrhea within the last 10 days, while cases were from the emergency, inpatient, and outpa-tient units. Diagnosis criteria encompassed at least one vomiting episode in the last 24 hours and over three loose stools daily, enduring less than 5 days. Moderate to severe cases included indicators like skin turgor loss, sunken eyes, IV treatment, dysentery, or gastroenteritis-related hospitalization. A 2-month follow-up tracked complications and mortal-ity, with parental consent secured.Results: Among participants, 60% (n=126/210) were male and 40% (n=84/210) were female. The average age was 20 months (range 1-50 months). Clinical symptoms were evident during enrollment; cases displayed watery diarrhea (4 episodes on average in 24 hours, lasting 2.50 days), and 48% (n=101) experienced vomiting (3 episodes on average in 24 hours). Acute gastroenteritis symptoms persisted for an average of 4.0 days. Severe and mild dehydration were ob-served in 12% (n=25) and 28% (n=58) of patients, respectively. Additional symptoms included fever (8%, n=17), ab-dominal pain (8%, n=17), and dysentery (5%, n=10). The majority (90%, n=189) received intravenous fluids, while 10% (n=21) were treated orally.Conclusion: The common causative organism for childhood diarrhea is adenovirus.
 Key words: Acute gastroenteritis, Acute diarrhea, Vomiting, Nausea, Abdominal Cramps

Methotrexate-induced multi-organ chronic toxicity in a rheumatoid arthritis patient: a case report

This case report highlights the clinical presentation, diagnosis, and management of a 48-year-old female diagnosed with rheumatoid arthritis (RA) who developed toxicity due to prolonged use of methotrexate (MTX) in combination with other immunomodulatory drugs. The patient exhibited erythematous rashes, skin peeling, angular stomatitis, oral candidiasis, symptoms of acute gastroenteritis and pancytopenia. This report discusses the importance of monitoring, managing polypharmacy in patients with chronic diseases, to prevent adverse events and management of drug-induced toxicity in RA patients and improve patient outcomes.

A Comparative Study of Acute Gastroenteritis Symptoms in Single- versus Multiple-Virus Infections.

Many different enteric viruses can cause acute gastroenteritis in humans worldwide. While a single virus can indeed cause disease, multiple-virus infections are commonly reported. However, data regarding a comparison between single- and multiple-virus infections upon clinical manifestations of acute gastroenteritis are relatively limited. In this study, a total of 2383 fecal specimens were collected from children with acute gastroenteritis during June 2014-July 2017 in a pediatric clinic in Japan and tested for 11 viruses by multiplex RT-PCR. At least 1 virus was found in 1706 (71.6%) specimens and norovirus GII was the most frequent agent, followed by rotavirus A and other viruses. Multiple-virus infections were identified in 565 cases (33.1%). While major clinical symptoms were found to be significantly different in some single- vs. multiple-virus infections, the disease severity was statistically non-significant. Our study highlights the burden of multiple-virus infections for acute gastroenteritis and the clinical features of patients with multiple-virus infections.

A Theoretical Approach on the Action of Vilwadi Agada in Relieving the Symptoms of Acute Gastroenteritis

Ayurveda a unique science of life, which emphasized on the principle of protecting the health of a healthy individual and eradicating the disease in diseased persons. Now a days, people living in the midst of diseases that disturb them to achieve a good health. The people are trying to overcome this situation by developing an art of medicine and science of healing. Agadatantra is one of the branches in Ayurveda. Literally’ Agada’ means a disease-free condition. It deals with different type of poisoning from animate and inanimate objects with its management. The poisoning from the bite of snakes, spiders, insects, rodents and from the combination of different poisons with their management are included in this branch. Vilwadi agada is a polyherbal combination can be used in various toxicological conditions, GIT problems, concocted poisoning, systemic symptoms like fever, infectious conditions. Today Vilwady agada is marketing as Vilwady gutika by different pharmaceutical companies. Classical reference of Vilwadi agada mentioned in Ashtangahridaya, Ashtangasamgraha, Sahasrayogam, Visha Jyotsnika and Kriyakoumudhi. Acute gastroenteritis (stomach flu) is an infection characterised by diarrhoea, cramps, nausea, vomiting and fever with inflammation of gastric mucosa. Viruses are the important causative factors for 70% of the episodes of acute gastroenteritis in children especially the rota virus. In contemporary science the first choice is oral rehydration therapy and then gives anti diarrhoeal drugs, antiemetics, antispasmodic drugs according to the condition of the patient. The drugs in Vilwadi agada having antimicrobial, antiviral, analgesic, anti- inflammatory, antioxidant, carminative properties. These attributes of this combination is very effective in relieving the cardinal symptoms such as abdominal cramps, nausea, vomiting diarrhoea and fever in acute gastroenteritis.

Development and validation of an efficient nomogram for risk assessment of norovirus infection in pediatric patients

This study aimed to establish a predictive model and nomogram based on routine laboratory blood indicators and clinical symptoms, subsequently providing a rapid risk assessment of norovirus (NoV) infection in children. This retrospective study enrolled 307 pediatric patients with symptoms of acute gastroenteritis and detected NoV using real-time quantitative polymerase chain reaction. Significant indicators selected by multivariate logistic regression, including routine blood tests and consultation symptoms, were used to develop the nomogram. We divided the sample into training and internal validation sets and performed external validation of the final model. Furthermore, we evaluated the clinical performance using the Akaike information criterion (AIC), area under the curve (AUC), calibration curve, decision curve analysis (DCA), sensitivity, specificity, concordance rate, positive predictive value, and negative predictive value. Overall, 153 cases were NoV-PCR-positive, and 154 were negative. The multivariate logistic regression included five predictors of NoV infection, including symptoms of vomiting, upper respiratory tract infection, and indicators of white blood cells, lymphocyte absolute counts, and platelet counts. The nomogram showed a significant predictive value with overall internal set diagnosis, with an AUC of 0.827 (95% confidence interval (CI): 0.785–0.868), and 0.812 (95% CI: 0.755–0.869) with 0.799 (95% CI: 0.705–0.894) in the training and internal validation sets, respectively. Nevertheless, the AUC in the external validation set was higher (0.915; 95% CI: 0.862–0.968). This nomogram is a useful tool for risk assessment for NoV infection. Moreover, the evaluated indicators are accessible, substantially reducing the time for laboratory testing.

Direct Outpatient Health Care Costs Among Commercially Insured Persons for Common Foodborne Pathogens and Acute Gastroenteritis, 2012-2015.

Foodborne illness is common in the United States with most, but not all, foodborne pathogens causing symptoms of acute gastroenteritis (AGI). Outpatient care is the most frequent type of medical care sought; however, more accurate estimates of outpatient costs are needed to inform food safety policy decision. Using the U.S. MarketScan Commercial Claims and Encounters database, we quantified the per-visit cost of outpatient visits with any AGI-related diagnosis (including pathogen-specific and nonspecific or symptom-based diagnoses) and for those with a pathogen-specific diagnosis for 1 of 29 pathogens commonly transmitted through food (including pathogens that cause AGI and some that do not). Our estimates included the per-case cost of office visits and associated laboratory tests and procedures as well as the conservative estimates of prescription cost. Most AGI outpatient visits were coded using nonspecific codes (e.g., infectious gastroenteritis), rather than pathogen-specific codes (e.g., Salmonella). From 2012 to 2015, we identified more than 3.4 million initial outpatient visits with any AGI diagnosis and 45,077 with a foodborne pathogen-specific diagnosis. As is typical of treatment cost data, severe cases of illness drove mean costs above median. The mean cost of an outpatient visit with any AGI was $696 compared with the median of $162. The mean costs of visits with pathogen-specific diagnoses ranged from $254 (median $131; interquartile range [IQR]: $98-184) for Streptococcus spp. Group A (n = 22,059) to $1761 (median $161; IQR: $104-$1101) for Clostridium perfringens (n = 30). Visits with two of the most common causes of foodborne illness, nontyphoidal Salmonella and norovirus, listed as a diagnosis, had mean costs of $841 and $509, respectively. Overall, the median per-case costs of outpatient visits increased with age, with some variation by pathogen. More empirically based estimates of outpatient costs for AGI and specific pathogens can enhance estimates of the economic cost of foodborne illness used to guide food policy and focus prevention efforts.

Death due to kodalikkizhangu poisoning: A case report

Deaths due to accidental ingestion, suicidal consumption and homicide poisoning with colchicine alkaloid containing extracts have been documented and reported in innumerable literature across the world. The lowest reported lethal dose of oral colchicine are 7-26 mg. Gloriosa superba, regionally known as Kodalikkizhangu is a highly poisonous flowering plant, seen wide spread in south and south East Asia. Colchicine is concentrated in the seeds and tubers of the plant. Colchicine content of Gloriosa tuber is 0.3%. These tubers are often mistaken as yams and accidentally ingested. Ingestion of tubers of Gloriosa results in colchicine poisoning. Toxicity of Gloriosa is due to the anti-mitotic effect of its toxic principle namely colchicine and Gloriosin on the rapidly proliferating cells such as stomach and oesophagus. Cardiac manifestation of Gloriosa poisoning is due to the impaired cardio myocyte conduction and contractility. Deaths in these cases are due to multi-organ failure. No specific antidote is available. A 71-year-old male who was a chronic alcoholic and known hypertensive got admitted in toxicology ward, with symptoms of acute gastroenteritis, 11 hours after alleged consumption of tubers of a wild plant. 24 hours after ingestion the patient succumbed to death and post-mortem was done to establish cause of death.

Understanding Variation in Rotavirus Vaccine Effectiveness Estimates in the United States: The Role of Rotavirus Activity and Diagnostic Misclassification.

Estimates of rotavirus vaccine effectiveness (VE) in the United States appear higher in years with more rotavirus activity. We hypothesized rotavirus VE is constant over time but appears to vary as a function of temporal variation in local rotavirus cases and/or misclassified diagnoses. We analyzed 6 years of data from eight US surveillance sites on 8- to 59-month olds with acute gastroenteritis symptoms. Children's stool samples were tested via enzyme immunoassay (EIA); rotavirus-positive results were confirmed with molecular testing at the US Centers for Disease Control and Prevention. We defined rotavirus gastroenteritis cases by either positive on-site EIA results alone or positive EIA with Centers for Disease Control and Prevention confirmation. For each case definition, we estimated VE against any rotavirus gastroenteritis, moderate-to-severe disease, and hospitalization using two mixed-effect regression models: the first including year plus a year-vaccination interaction, and the second including the annual percent of rotavirus-positive tests plus a percent positive-vaccination interaction. We used multiple overimputation to bias-adjust for misclassification of cases defined by positive EIA alone. Estimates of annual rotavirus VE against all outcomes fluctuated temporally, particularly when we defined cases by on-site EIA alone and used a year-vaccination interaction. Use of confirmatory testing to define cases reduced, but did not eliminate, fluctuations. Temporal fluctuations in VE estimates further attenuated when we used a percent positive-vaccination interaction. Fluctuations persisted until bias-adjustment for diagnostic misclassification. Both controlling for time-varying rotavirus activity and bias-adjusting for diagnostic misclassification are critical for estimating the most valid annual rotavirus VE.

Kampylobakterioza w Polsce w latach 2018-2019

Campylobacteriosis is a zoonotic disease caused by bacteria of the genus Campylobacter. This disease usually presents with symptoms of acute gastroenteritis. The majority of Campylobacter infections are usually acquired through consumption of contaminated water or food, less frequently through direct contact with an infected animal or person. In Poland, campylobacteriosis is notifiable disease, according to the EU deffinition implemented in the polish surveillance system. The aim of this study is to assess epidemiological situation of campylobacteriosis in Poland in years 2018-2019 and compare it to previous years. The study was based on data from the bulletins 'Infectious Diseases and Poisonings in Poland' for 2018-2019 issued by the National Institute of Public Health NIH - National Research Institute and data submitted to the System for Registration of Epidemiological Interwiews (SRWE) by District Sanitary and Epidemiological Stations. In Poland 726 cases of Campylobacterosis were reported in 2018 and 715 in 2019. There was a decrease in the number of reported cases in comparision to 2017 by 17% and 19% in 2018 and 2019 respectively. Cases of campylobacteriosis were reported in all voivodeships, with the highest incidence in both described years in Lubuskie voivodeship. Campylobacteriosis was diagnosed in patients in all age groups but the majority of patients were children under the age of 4. The most frequently identified species was Campylobacter jejuni. Data on the number of campylobacteriosis infections in Poland for 2018 and 2019, demonstrate a stabilized epidemiological situation regarding this disease entity in the country. The high hospitalization rate of patients diagnosed with campylobacteriosis, demonstrates the need to implement microbiological diagnostics in cases of suspected disease. Data show a much lower incidence rate of campylobacteriosis in Poland, compared to other EU countries, which suggests potential underestimation of the actual number of infected case.

Characterization of rotavirus strains isolated from children with acute gastroenteritis in Rawalpindi, Pakistan.

Diarrhea is the leading cause of childhood morbidity and mortality particularly in developing countries and rotavirus has been identified as the major pathogen associated with diarrheal infections. This study was conducted to detect genotypic distribution of predominant rotavirus strains circulating in children suffering from acute gastroenteritis in Rawalpindi, Pakistan. Stool specimens were collected from children ≤5 years of age, visiting Military Hospital, Rawalpindi, with signs and symptoms of acute gastroenteritis. Two hundred and eighty-four specimens were collected during the period from April 2017 to March 2018. Enzyme immunoassay was performed for detection of rotavirus and reverse transcription-PCR (RT-PCR) was carried out for amplification of VP7 and VP4 gene segments followed by multiplex PCR using genotype-specific primers. Out of 284 children, 71 were found rotavirus positive and among them, 54% were females and 46% males. Our findings showed 92% of infection among children ≤2 years of age, while, the peak age of rotavirus incidence was found to be 6-12 months. Although, rotavirus infection was observed throughout the year but frequency increased in winter. Subtype G1P[8] was more prevalent followed by G2P[4], G3P[8], and G4P[6] subtypes. The results of this study provide insight into the disease burden as well as information on rotavirus diversity which will be useful to develop future strategies to control and prevent diarrheal infections among children.

ОСОБЕННОСТИ ТЕЧЕНИЯ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ У ДЕТЕЙ

A prospective observation of 524 pediatric patients with laboratory-verified coronavirus infection was carried out. The main epidemiological data were analyzed, including the age structure, as well as the features of the clinical course of the disease. Most often, the clinical picture was dominated by symptoms of ARVI: hyperemia of the fauces — in 501 patients (95.6% of cases), while fever — in 412 (78.6%), and cough — in 89 (16.9%). The involvement of the gastrointestinal tract was manifested mainly by the symptoms of acute gastroenteritis, and was observed in 37.6% of cases, specifically diarrhea — 21.2%, vomiting — 16.5%, abdominal pain syndrome — 9.2%. These manifestations were significantly more frequently recorded in patients under one year, as well as children of the first three years of life (p ≤ 0.05).

The Initial Timing and Burden of Viral Gastrointestinal Infections in Australian Infants: A Birth Cohort Study.

The timing and nature of initial infections by potentially vaccine-preventable gastrointestinal viruses (group-F adenoviruses, classic human astrovirus, norovirus I/II, and sapovirus I/II/IV/V) was investigated in a community-based birth cohort. Weekly stool samples were collected from 158 children aged <2 years in an Australian subtropical city. Median age at initial infection was lowest for norovirus II (13.8 months) followed by sapovirus (14.3 months) and classic human astrovirus (17.6 months), and was >24 months for the remaining viruses. Norovirus II and sapovirus were most often associated with acute gastroenteritis symptoms (57% and 44%, respectively). Overall, healthcare was sought for 45% of symptomatic initial infections, which varied between 17% for norovirus I to 55% for norovirus II. Age at initial infection was lower when participants were exposed to other children. Norovirus II and sapovirus were the most important pathogens in this cohort, providing further evidence for them being priority targets for vaccine development.

Gastrointestinal tract diseases at different stages of COVID-19 in children

Purpose of the study.To investigate the features of lesions of the gastrointestinal tract in diff erent variants of the course of COVID-19 in children.Materials and methods.A single-center prospective study was carried out to study the clinical and laboratory manifestations of gastrointestinal tract (GIT) lesions in different variants of the course of COVID-19 in children. The study was carried out in the following groups: group No. 1 — pediatric patients with a verified diagnosis (according to ICD 10) “U07.1. COVID-19 virus identified, confirmed by laboratory tests, regardless of the severity of clinical signs or symptoms ”, n = 524; group No. 2 — pediatric patients with a verified diagnosis (according to ICD 10) “U10.9 Multisystem inflammatory syndrome associated with COVID-19, unspecified”, n = 46. The article provides a brief description of the observations of the development of autoimmune pathologies (ulcerative colitis, autoimmune hepatitis) in pediatric patients, for whom a postponed COVID-19 infection could be a probable trigger.Results.The leading symptoms of the gastrointestinal tract in patients of group No. 1 were symptoms of acute gastroenteritis, registered in 37.6% of cases. Diarrhea was detected in 21.2% of cases, vomiting — in 16.5%; abdominal pain syndrome — 9.2%. These manifestations were statistically more significant in patients under one year of age, as well as in children of the first three years of life (p≤0.05). Gastrointestinal syndrome in patients of group No. 2 was registered in 67.4% of cases, with vomiting — 60.9% of cases, diarrheal syndrome — 23.9% of cases, abdominal pain syndrome — 82.6%. Other manifestations of the gastrointestinal tract in patients of this group were: reactive hepatitis — 69.6% of cases (average ALT — 98 (47; 347); AST — 107 (34; 347)), reactive pancreatitis — 60.8% of cases (average values of amylase — 127 (28; 269); lipase — 196 (47; 107)). These lesions were of a reactive inflammatory nature, with a probable immune development mechanism.

A Salmonella-related foodborne outbreak in a snack bar in Jeju Province: an epidemiological investigation

Many people reported suspected food poisoning after consuming food at the same snack bar on June 18, 2020. Thus, an in-depth epidemiological investigation was conducted to identify the infectious agent and establish additional food poisoning prevention measures. The study included people who reported to the local public health center after June 18 with acute gastroenteritis symptoms within 4 days of consuming food from the snack bar. The onset of symptoms and food items consumed by individuals were then investigated via phone calls and on-site visits. Afterward, the infectious agent was identified from human samples (stool or rectal swab) of four restaurant employees and 89 people and from environmental samples (materials, cooking utensils, and water). The analysis revealed that the incubation period ranged from 2 hours to 92 hours, with a median and mode of 16 hours and 12 hours, respectively. Moreover, the epidemic curve had a unimodal shape because of common exposure, which reached its peak on June 18. After monitoring for 8 days, which is more than twice the maximum incubation period of 92 hours, the end of the epidemic was declared on June 28 as no additional cases were reported. Analysis of human and environmental samples revealed Salmonella bareilly of the pulsed-field gel electrophoresis pulsotype SAPX01.017 as the causative agent. Therefore, it was concluded that the food poisoning outbreak was caused by S. bareilly.

Prevalence and Genetic Diversity of Group A Rotavirus Genotypes in Moscow (2019-2020).

Group A rotavirus (RVA) infection is the leading cause of hospitalization of children under 5 years old, presenting with symptoms of acute gastroenteritis. The aim of our study was to explore the genetic diversity of RVA among patients admitted to Moscow Infectious Disease Clinical Hospital No. 1 with symptoms of acute gastroenteritis. A total of 653 samples were collected from May 2019 through March 2020. Out of them, 135 (20.67%) fecal samples were found to be positive for rotavirus antigen by ELISA. RT-PCR detected rotavirus RNA in 80 samples. Seven G-genotypes (G1, G2, G3, G4, G8, G9, and G12) and three P-genotypes (P[8], P[4], and P[6]) formed 9 different combinations. The most common combination was G9P[8]. However, for the first time in Moscow, the combination G3P[8] took second place. Moreover, all detected viruses of this combination belonged to Equine-like G3P[8] viruses that had never been detected in Russia before. The genotype G8P[8] and G9P[4] rotaviruses were also detected in Moscow for the first time. Among the studied rotaviruses, there were equal proportions of Wa and DS-1-like strains; previous studies showed that Wa-like strains accounted for the largest proportion of rotaviruses in Russia.

A Study of Paratyphoid Fever in Bulgarian Children

Abstract Objective. To study both the molecular discrimination of D-tartrate fermenting and non-fermenting strains of Salmonella enterica subsp. enterica serotype Paratyphi B isolated from patients with paratyphoid fever and the clinical course of this disease. Materials and methods. The isolates examined were from children aged 3 months to 9 years. A total of 33 Salmonella strains were serotyped as Salmonella Paratyphi B, with an antigenic formula based on O- and H- antigens: 1,4, [5], 12: b: 1,2 by Kauffmann–White classification. Results. Multiplex PCR analysis confirmed all tested strains as d-tartrate fermenting (dT+), also referred to as variant Java. Discussion. We found that the most common cause of paratyphoid fever among children in Bulgaria is variant Java Salmonella Paratyphi B. Most children had classic symptoms of acute gastroenteritis – fever, watery diarrhea and vomiting.

Prevalence and Genetic Diversity of Norovirus in Acute Gastroenteritis Cases in the Southwest Province of Turkey.

Aims:Noroviruses may cause both epidemic and sporadic acute gastroenteritis globally. Thus, this study evaluated the prevalence of norovirus in stool samples of hospitalized patients with acute gastroenteritis in Aydin, Turkey using enzyme-linked immunoassay (ELISA) and real-time reverse transcription-polymerase chain reaction (rRT-PCR) and genotyped positive samples to detect which genotypes have currently circulated.Methods:This retrospective descriptive study collected 92 stool samples from patients with acute gastroenteritis symptoms from Aydın Adnan Menderes University Hospital from September 2017 to May 2019. The samples were tested using the commercial Third Generation Ridascreen norovirus ELISA and rRT-PCR. Positive samples were genotyped by sequencing of conventional positive RT-PCR products followed by phylogenetic analysis.Results:Of the 92 samples, 5 (5.4%) using ELISA and 12 (13%) using rRT-PCR tested positive for norovirus. All positive samples were genogroup II (GII). Two norovirus positive samples were genotyped successfully using DNA sequencing of the nested conventional PCR products. One sample (GII/Hu/TR/2019/Aydin25) could be categorized as GII.3 and the other (GII/Hu/TR/2019/Aydin20) as GII.13.Conclusion:rRT-PCR testing of stool samples is more sensitive than Ridascreen ELISA. Data from our study provide protocols for how to study norovirus epidemiology.

Acute arsenic suicidal poisoning – a rare case

Arsenic is a naturally occurring element in the earth's crust. Chronic arsenic poisoning has been regularly reported predominantly due to occupational exposure in the literature. Acute arsenic poisoning is very rare. A 27-year-old gentleman was brought to the hospital with a history of suicide attempt by consumption of arsenic trioxide diluted in water. He initially manifested with gastrointestinal manifestations along with tachycardia. The patient was treated with fluid resuscitation, antidote-Dimercaprol, dialysis, and other supportive treatment. The patient continued to deteriorate with deranged liver and renal function, coagulopathy, and neurological symptoms. The presence of coagulopathy further complicated the scenario, as the antidote which is administered as an intramuscular injection could not be given. The patient continued to deteriorate and eventually succumbed. Acute arsenic poisoning is very rare, and very few reports of suicide are reported. It initially presents with acute gastroenteritis symptoms followed by multi organ involvement. Fatal doses will invariably result in death irrespective of treatment modality. Rapid administration of antidote and supportive treatment might increase the chances of survival. Difficulty in the availability of oral antidote and unavailability of any Intravenous preparations further complicates the scenario.

Clinical Characteristics, Risk Factors, and Population Attributable Fraction for Campylobacteriosis in a Nicaraguan Birth Cohort.

Campylobacteriosis is an important contributor to the global burden of acute gastroenteritis (AGE). In Nicaragua, the burden, risk factors, and species diversity for infant campylobacteriosis are unknown. Between June 2017 and December 2018, we enrolled 444 infants from León, Nicaragua, in a population-based birth cohort, conducting weekly household AGE surveillance. First, we described clinical characteristics of symptomatic Campylobacter infections, and then compared clinical characteristics between Campylobacter jejuni/coli and non-jejuni/coli infections. Next, we conducted a nested case-control analysis to examine campylobacteriosis risk factors. Finally, we estimated the population attributable fraction of campylobacteriosis among infants experiencing AGE. Of 296 AGE episodes in the first year of life, Campylobacter was detected in 59 (20%), 39 were C. jejuni/coli, and 20 were non-jejuni/coli species, including the first report of Campylobacter vulpis infection in humans. Acute gastroenteritis symptoms associated with C. jejuni/coli lasted longer than those attributed to other Campylobacter species. In a conditional logistic regression model, chickens in the home (odds ratio [OR]: 3.8, 95% CI: 1.4-9.8), a prior AGE episode (OR: 3.3; 95% CI: 1.4-7.8), and poverty (OR: 0.4; 95% CI: 0.2-0.9) were independently associated with campylobacteriosis. Comparing 90 infants experiencing AGE with 90 healthy controls, 22.4% (95% CI: 11.2-32.1) of AGE episodes in the first year of life could be attributed to Campylobacter infection. Campylobacter infections contribute substantially to infant AGE in León, Nicaragua, with non-jejuni/coli species frequently detected. Reducing contact with poultry in the home and interventions to prevent all-cause AGE may reduce campylobacteriosis in this setting.