Clinical approach to diarrhea.

Science.gov (United States)

Corinaldesi, Roberto; Stanghellini, Vincenzo; Barbara, Giovanni; Tomassetti, Paola; De Giorgio, Roberto

2012-10-01

Diarrhea is defined as reduced stool consistency, increased water content and number of evacuations per day. A wide array of causes and pathophysiological mechanisms underlie acute and chronic forms of diarrhea. This review focuses on the major clinical aspects which should aid clinicians to diagnose chronic diarrhea. Clinical history, physical examination and stool evaluation and the predominant stool characteristic, i.e., bloody, watery, and fatty diarrhea, may narrow the differential diagnosis. Although mainly involved in acute diarrhea, many different infectious agents, including bacteria, viruses and protozoa, can be identified in chronic bloody/inflammatory diarrhea by appropriate microbiological tests and colonoscopic biopsy analysis. Osmotic diarrhea can be the result of malabsorption or maldigestion, with a subsequent passage of fat in the stool leading to steatorrhea. Secretory diarrhea is due to an increase of fluid secretion in the small bowel lumen, a mechanism often identified in gastroenteropancreatic neuroendocrine tumors. The evaluation of the fecal osmotic gap may help to characterize whether a chronic diarrhea is osmotic or secretory. Fatty diarrhea (steatorrhea) occurs if fecal fat output exceeds the absorptive/digestive capacity of the intestine. Steatorrhea results from malabsorption or maldigestion states and tests should differentiate between these two conditions. Individualized diagnostic work ups tailored on pathophysiological and clinical features are expected to reduce costs for patients with chronic diarrhea.

Side Effects: Diarrhea

Science.gov (United States)

Diarrhea, a side effect of cancer treatment, may cause symptoms such as loose, watery stools. Diarrhea can lead to dehydration and malnutrition in cancer patients. Learn about ways to treat and manage diarrhea during cancer treatment.

Genetic Virulence Profile of Enteroaggregative Escherichia coli Strains Isolated from Danish Children with Either Acute or Persistent Diarrhea

DEFF Research Database (Denmark)

Hebbelstrup Jensen, Betina; Poulsen, Anja; Hebbelstrup Rye Rasmussen, Stig

2017-01-01

targeting the genes sat, sepA, pic, sigA, pet, astA, aatA, aggR, aaiC, aap, agg3/4C, ORF3, aafA, aggA, agg3A, agg4A, and agg5A. Furthermore, the distribution of EAEC genes in strains collected from cases of bloody, mucoid, and watery diarrhea was investigated. The classification and regression tree analysis...... was associated with the combination of the genes aatA and astA (p = 0.03). Non-mucoid diarrhea was associated with strains lacking the aatA gene (p = 0.004). Acute diarrhea was associated with the genes aggR, aap, and aggA by individual odds ratios. Resistance toward gentamicin and ciprofloxacin was observed......-negative-to identify additional factors predisposing to disease. The duration of breastfeeding was positively correlated with the likelihood of belonging to the EAEC-negative group of children....

How to Do in Persistent Diarrhea of Children?: Concepts and Treatments of Chronic Diarrhea

OpenAIRE

Lee, Kun Song; Kang, Dong Soo; Yu, Jeesuk; Chang, Young Pyo; Park, Woo Sung

2012-01-01

Chronic diarrhea is defined as passing watery stools that lasts for more than 2 weeks. Persistent diarrhea belongs to chronic diarrhea and is a chronic episode of diarrhea of infectious etiology. The etiology of chronic diarrhea is varied. It is important to consider the child's age and clinical manifestations with alarm signals for an application of proper treatments to children with chronic diarrhea. Vicious cycle is present in chronic diarrhea and nutritional rehabilitation can break the v...

Genetic Virulence Profile of Enteroaggregative Escherichia coli Strains Isolated from Danish Children with Either Acute or Persistent Diarrhea

Science.gov (United States)

Hebbelstrup Jensen, Betina; Poulsen, Anja; Hebbelstrup Rye Rasmussen, Stig; Struve, Carsten; Engberg, Jørgen H.; Friis-Møller, Alice; Boisen, Nadia; Jønsson, Rie; Petersen, Randi F.; Petersen, Andreas M.; Krogfelt, Karen A.

2017-01-01

Enteroaggregative Escherichia coli (EAEC) is frequently found in diarrheal stools worldwide. It has been associated with persistent diarrhea, weight loss, and failure to thrive in children living in developing countries. A number of important EAEC virulence genes are identified; however, their roles in acute and persistent diarrhea have not been previously investigated. The aim of this study was to identify specific EAEC virulence genes associated with duration and type of diarrhea in Danish children. We aimed to improve the current diagnostics of EAEC and enable targeting of strains with an expected severe disease course. Questionnaires answered by parents provided information regarding duration of diarrhea and presence of blood or mucus. A total of 295 EAEC strains were collected from children with acute (≤7 days) and persistent diarrhea (≥14 days) and were compared by using multiplex PCR targeting the genes sat, sepA, pic, sigA, pet, astA, aatA, aggR, aaiC, aap, agg3/4C, ORF3, aafA, aggA, agg3A, agg4A, and agg5A. Furthermore, the distribution of EAEC genes in strains collected from cases of bloody, mucoid, and watery diarrhea was investigated. The classification and regression tree analysis (CART) was applied to investigate the relationship between EAEC virulence genes and diarrheal duration and type. Persistent diarrhea was associated with strains lacking the pic gene (p = 0.002) and with the combination of the genes pic, sat, and absence of the aggA gene (p = 0.05). Prolonged diarrhea was associated with the combination of the genes aatA and astA (p = 0.03). Non-mucoid diarrhea was associated with strains lacking the aatA gene (p = 0.004). Acute diarrhea was associated with the genes aggR, aap, and aggA by individual odds ratios. Resistance toward gentamicin and ciprofloxacin was observed in 7.5 and 3% of strains, respectively. Multi-drug resistance was observed in 38% of strains. Genetic host factors have been associated with an increased risk of EAEC

Genetic Virulence Profile of Enteroaggregative Escherichia coli Strains Isolated from Danish Children with Either Acute or Persistent Diarrhea.

Science.gov (United States)

Hebbelstrup Jensen, Betina; Poulsen, Anja; Hebbelstrup Rye Rasmussen, Stig; Struve, Carsten; Engberg, Jørgen H; Friis-Møller, Alice; Boisen, Nadia; Jønsson, Rie; Petersen, Randi F; Petersen, Andreas M; Krogfelt, Karen A

2017-01-01

Enteroaggregative Escherichia coli (EAEC) is frequently found in diarrheal stools worldwide. It has been associated with persistent diarrhea, weight loss, and failure to thrive in children living in developing countries. A number of important EAEC virulence genes are identified; however, their roles in acute and persistent diarrhea have not been previously investigated. The aim of this study was to identify specific EAEC virulence genes associated with duration and type of diarrhea in Danish children. We aimed to improve the current diagnostics of EAEC and enable targeting of strains with an expected severe disease course. Questionnaires answered by parents provided information regarding duration of diarrhea and presence of blood or mucus. A total of 295 EAEC strains were collected from children with acute (≤7 days) and persistent diarrhea (≥14 days) and were compared by using multiplex PCR targeting the genes sat, sepA, pic, sigA, pet, astA, aatA, aggR, aaiC, aap, agg3/4C, ORF3, aafA, aggA, agg3A, agg4A , and agg5A . Furthermore, the distribution of EAEC genes in strains collected from cases of bloody, mucoid, and watery diarrhea was investigated. The classification and regression tree analysis (CART) was applied to investigate the relationship between EAEC virulence genes and diarrheal duration and type. Persistent diarrhea was associated with strains lacking the pic gene ( p = 0.002) and with the combination of the genes pic, sat , and absence of the aggA gene ( p = 0.05). Prolonged diarrhea was associated with the combination of the genes aatA and astA ( p = 0.03). Non-mucoid diarrhea was associated with strains lacking the aatA gene ( p = 0.004). Acute diarrhea was associated with the genes aggR, aap , and aggA by individual odds ratios. Resistance toward gentamicin and ciprofloxacin was observed in 7.5 and 3% of strains, respectively. Multi-drug resistance was observed in 38% of strains. Genetic host factors have been associated with an increased risk of

Genetic Virulence Profile of Enteroaggregative Escherichia coli Strains Isolated from Danish Children with Either Acute or Persistent Diarrhea

Directory of Open Access Journals (Sweden)

Betina Hebbelstrup Jensen

2017-05-01

Full Text Available Enteroaggregative Escherichia coli (EAEC is frequently found in diarrheal stools worldwide. It has been associated with persistent diarrhea, weight loss, and failure to thrive in children living in developing countries. A number of important EAEC virulence genes are identified; however, their roles in acute and persistent diarrhea have not been previously investigated. The aim of this study was to identify specific EAEC virulence genes associated with duration and type of diarrhea in Danish children. We aimed to improve the current diagnostics of EAEC and enable targeting of strains with an expected severe disease course. Questionnaires answered by parents provided information regarding duration of diarrhea and presence of blood or mucus. A total of 295 EAEC strains were collected from children with acute (≤7 days and persistent diarrhea (≥14 days and were compared by using multiplex PCR targeting the genes sat, sepA, pic, sigA, pet, astA, aatA, aggR, aaiC, aap, agg3/4C, ORF3, aafA, aggA, agg3A, agg4A, and agg5A. Furthermore, the distribution of EAEC genes in strains collected from cases of bloody, mucoid, and watery diarrhea was investigated. The classification and regression tree analysis (CART was applied to investigate the relationship between EAEC virulence genes and diarrheal duration and type. Persistent diarrhea was associated with strains lacking the pic gene (p = 0.002 and with the combination of the genes pic, sat, and absence of the aggA gene (p = 0.05. Prolonged diarrhea was associated with the combination of the genes aatA and astA (p = 0.03. Non-mucoid diarrhea was associated with strains lacking the aatA gene (p = 0.004. Acute diarrhea was associated with the genes aggR, aap, and aggA by individual odds ratios. Resistance toward gentamicin and ciprofloxacin was observed in 7.5 and 3% of strains, respectively. Multi-drug resistance was observed in 38% of strains. Genetic host factors have been associated with an increased risk

Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study.

Science.gov (United States)

Berhe, Birhane; Bugssa, Gessessew; Bayisa, Sena; Alemu, Megbaru

2018-03-02

Intestinal protozoa are parasites transmitted by consumption of contaminated water and food and mainly affect children and elder people and cause considerable health problems. They are the leading causes of outpatient morbidity due to diarrhea in the developing countries. So, assessing water and food source of diarrheal patients and identifying the main associated factors for transmission of protozoan parasitic infections help for effective control measures of protozoan infections. Hence, the current study was aimed at determining the prevalence of foodborne intestinal protozoa infections and associated factors among diarrheic patients in North Ethiopia. A health facility based cross-sectional study was conducted among 223 patients with watery diarrhea in four selected government health facilities in North Ethiopia from November 2016-June 2017. A structured questionnaire was used to collect data on socio-demography of study participants and factors associated with foodborne protozoa infections. The diarrheic stool samples were collected, transported, and processed using direct wet mount, formal-ether concentration and modified ZiehlNeelson staining methods. The data were analyzed using SPSS version 21 and descriptive statistics, bi-variate, and multivariate logistic regressions were computed. P-value parasite infection .

Treatment of acute diarrhea with Saccharomyces boulardii in infants.

Science.gov (United States)

Corrêa, Naflesia B O; Penna, Francisco J; Lima, Fátima M L S; Nicoli, Jacques R; Filho, Luciano A P

2011-11-01

The aim of the study was to determine whether an oral treatment with a commercial pharmaceutical product containing Saccharomyces boulardii would reduce the duration of diarrhea in infants with acute diarrhea. In the present double-blind, placebo-controlled study, 186 infants, 6 to 48 months old and hospitalized within 72 hours after the onset of acute diarrhea in 2 hospitals in Goiânia, Goiás, Brazil, were randomly assigned to receive twice per day for 5 days 200 mg of a commercial pharmaceutical product containing 4 × 10 viable cells of S boulardii or a placebo. Stool samples were submitted to search for rotavirus. Among the 176 infants who completed the trial, those treated with S boulardii (90) showed a reduction in diarrhea duration (P boulardii was given to children within 72 hours after the onset of acute diarrhea. The present study suggests a complementary treatment of acute diarrhea in infants with daily oral doses of S boulardii.

The Effect of G-ORS Along With Rice Soup in the Treatment of Acute Diarrhea in Children: A Single-Blind Randomized Controlled Trial.

Science.gov (United States)

Kianmehr, Mojtaba; Saber, Ashraf; Moshari, Jalil; Ahmadi, Reza; Basiri-Moghadam, Mahdi

2016-06-01

The world health organization guidelines for treatment of diarrhea in children emphasize on continued feeding together with prescription of oral rehydration solution (ORS) and supplementary zinc therapy. However, conflicting viewpoints exist regarding the optimal diet and dietary ingredients for children with diarrhea. Moreover, few studies have investigated the effect of rice soup along with ORS in the treatment of this disease. This study aimed to explore effects of simultaneous taking of glucose oral rehydration solution (G-ORS) and rice soup in the treatment of acute diarrhea in 8 to 24-month-old children. This single-blind controlled clinical trial was conducted in the pediatric ward of 22nd of Bahman hospital, Gonabad, Iran between June 2013 and February 2014. Forty children aged 8-24 months with acute diarrhea were randomly assigned into an intervention group (G-ORS plus rice soup group) comprising 20 babies and a control group (G-ORS) of 20 children based on balanced blocking randomization. The variables under investigation were diarrhea duration, patient hospitalization, need for intravenous (IV) fluids and stool output frequency. Data was analyzed using independent samples t and chi-square test. At the end of study, the time for treating acute watery diarrhea in the intervention and control groups were 21.10 ± 8.81 and 34.55 ± 5.82 hours (P < 0.001) and hospital stay were 34.05 ± 6.62 and 40.20 ± 6.32 hours (P = 0.005). Moreover, stool output frequency were 4.20 ± 0.95 and 8.00 ± 1.37 (P < 0.001) in the first 24 hours, and 2.18 ± 0.60 and 2.80 ± 0.76 (P = 0.03) in the second 24 hours of treatment in intervention and control groups, respectively. Rice soup regimen was highly effective and inexpensive in the treatment of acute diarrhea in children. Thus, in addition to the common treatment by G-ORS, rice soup can be consumed simultaneously with G-ORS.

Diarrhea caused by circulating agents.

Science.gov (United States)

Fabian, Elisabeth; Kump, Patrizia; Krejs, Guenter J

2012-09-01

Circulating agents cause intestinal secretion or changes in motility with decreased intestinal transit time, resulting in secretory-type diarrhea. Secretory diarrhea as opposed to osmotic diarrhea is characterized by large-volume, watery stools, often more than 1 L per day; by persistence of diarrhea when patients fast; and by the fact that on analysis of stool-water, measured osmolarity is identical to that calculated from the electrolytes present. Although sodium plays the main role in water and electrolyte absorption, chloride is the major ion involved in secretion. Copyright © 2012 Elsevier Inc. All rights reserved.

Acute Rotavirus-Induced Diarrhea in Children: Clinical Picture, Diagnosis, Treatment

Directory of Open Access Journals (Sweden)

S.L. Niankovskyi

2015-09-01

Full Text Available The paper considers the current aspects of epidemiology, diagnosis, clinical picture and treatment of acute rotavirus-induced diarrhea in children. There are presented the basic thesis of ESPGHAN consensus (2014 about acute diarrheas. There was analyzed the effectiveness of probiotic Subalin producing interferon for the treatment of acute rotavirus-induced diarrhea. It was demonstrated its effectiveness according to the literature review and own data.

Campylobacter jejuni diarrhea model in infant chickens

NARCIS (Netherlands)

Sanyal, S. C.; Islam, K. M.; Neogy, P. K.; Islam, M.; Speelman, P.; Huq, M. I.

1984-01-01

To study the pathogenic mechanisms of Campylobacter jejuni infection, 36- to 72-h-old chickens were fed 10(3) to 10(6) live cells, using strains isolated from 40 patients with watery diarrhea and 6 with bloody mucoid diarrhea from whom no other known enteropathogen was detected. Chickens of Starbro

Efficacy and safety of Saccharomyces boulardii for acute diarrhea.

Science.gov (United States)

Feizizadeh, Sahar; Salehi-Abargouei, Amin; Akbari, Vajihe

2014-07-01

The efficacy of Saccharomyces boulardii for treatment of childhood diarrhea remains unclear. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhea. Our data sources included Medline, Embase, CINAHL, Scopus, and The Cochrane Library up to September 2013 without language restrictions. Randomized controlled trials and non-randomized trials that evaluated effectiveness of S. boulardii for treatment of acute diarrhea in children were included. Two reviewers independently evaluated studies for eligibility and quality and extracted the data. In total, 1248 articles were identified, of which 22 met the inclusion criteria. Pooling data from trials showed that S. boulardii significantly reduced the duration of diarrhea (mean difference [MD], -19.7 hours; 95% confidence interval [CI], -26.05 to -13.34), stool frequency on day 2 (MD, -0.74; 95% CI, -1.38 to -0.10) and day 3 (MD, -1.24; 95% CI, -2.13 to -0.35), the risk for diarrhea on day 3 (risk ratio [RR], 0.41; 95% CI, 0.27 to 0.60) and day 4 (RR, 0.38; 95% CI, 0.24 to 0.59) after intervention compared with control. The studies included in this review were varied in the definition of diarrhea, the termination of diarrhea, inclusion and exclusion criteria, and their methodological quality. This review and meta-analysis show that S. boulardii is safe and has clear beneficial effects in children who have acute diarrhea. However, additional studies using head-to-head comparisons are needed to define the best dosage of S. boulardii for diarrhea with different causes. Copyright © 2014 by the American Academy of Pediatrics.

Randomized, double-blind clinical trial of a lactose-free and a lactose-containing formula in dietary management of acute childhood diarrhea.

Science.gov (United States)

Simakachorn, Nipat; Tongpenyai, Yothi; Tongtan, Orapin; Varavithya, Wandee

2004-06-01

Refeeding of artificially fed infants with lactose-containing formula after oral rehydration therapy in the treatment of acute diarrhea was concluded to be indifferent to non-lactose formula by a meta-analysis. In Thai as well as Asian infants and children with low lactase level from genetically determinant and with rotavirus infection, lactose malabsorption is most likely to occur and cause delayed recovery. The aim of this study was to compare the effect of a lactose-free and a lactose-containing formula in dietary management of acute childhood diarrhea. A randomized, double-blind clinical trial of 80 male children, formula-fed, aged 3 to 24 months, admitted with acute watery diarrhea and mild or moderate dehydration, was carried out. All children received oral rehydration therapy for the first 4 hours. After appropriate rehydration, they were fed either a lactose-free formula (Dumex Lactose-Free Formula; treatment group, n = 40) or a lactose-containing formula (Dumex Infant Formula; control group, n = 40) in adjunction with oral rehydration solution. In addition, the infants were fed rice gruel as tolerated. Comparisons of duration of diarrhea, weight gain, vomiting, biochemical changes, stool frequency and weight and unscheduled intravenous fluid were made. Three children (2 treatment, and 1 control) dropped out from the study. The total number of unscheduled intravenous infusions were 6 of 80 children (7.5%), including 2 (5.0%) in the treatment group and 4 (10.0%) in the control group. Three children in the control group did not resolve from diarrhea within 7 days of treatment. Rotavirus was identified in approximately 50% of the children in each group. Using survival analysis, the median duration of diarrhea was significantly shortened by 20.5 hours in the treatment group compared to the control group (77.0 hours in the treatment group vs 97.5 hours in the control group; P = 0.002). Significantly decrease in stool frequency and increase in percent weight gain

Renal abnormalities in congenital chloride diarrhea

International Nuclear Information System (INIS)

Al-Hamad, Nadia M.; Al-Eisa, Amal A.

2004-01-01

Congenital chloride diarrhea CLD is a rare autosomal recessive disorder caused by a defect in the chloride/ bicarbonate exchange in the ileum and colon. It is characterized by watery diarrhea, abdominal distension, hypochloremic hypokalemic metabolic alkalosis with high fecal content of chloride >90 mmol/l. We report 3 patients with CLD associated with various renal abnormalities including chronic renal failure secondary to renal hypoplasia, nephrocalcinosis and congenital nephrotic syndrome. (author)

Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting

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Ener Cagri Dinleyici

2015-07-01

Full Text Available Objective: Two randomized controlled clinical trials have shown that Lactobacillus (L reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea. Methods: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1 × 108 CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours. The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded. Results: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15 h, 60.4 ± 24.5 h [95% CI: 51.0–69.7 h] vs. 74.3 ± 15.3 h [95% CI: 68.7–79.9 h], p < 0.05. The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8% after 48 h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34–0.79, p < 0.01. From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted. Conclusion: L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea. Resumo: Objetivo: Dois ensaios clínicos randomizados controlados demonstraram que o Lactobacillus (L reuteri DSM 17938 reduz a duração de diarreia em crianças hospitalizadas devido a diarreia infecciosa aguda. Este é o primeiro ensaio que avalia a eficácia do L. reuteri DSM 17938 em crianças com diarreia infecciosa aguda no

Effect Of Oligomeric Enteral Nutrition On Symptoms Of Acute Radiation Enteritis

International Nuclear Information System (INIS)

Dubinsky, P.

2008-01-01

Radiotherapy of abdominal and pelvic tumours is frequently associated with acute radiation enteritis. Predominant symptoms include diarrhea, watery stools, abdominal pain, nausea and vomiting. There are very few effective interventions available for this condition. Enteral oligomeric nutrition has been used in bowel diseases with functional failure similar to radiation enteritis. The aim of presented work was to observe occurrence of symptoms of radiation enteritis in patients undergoing abdominal or pelvic radiotherapy. Apart from diet and pharmacological therapy, oral oligomeric enteral nutrition (Peptisorb Powder Nutricia) at the dose of 1000 - 2000 ml per day was administered for minimum of 4 days. Planned period of administration was 14 days and longer. Symptoms of radiation enteritis were evaluated at the beginning and in the end of administration. Prevalence of all evaluated symptoms of radiation enteritis was decreased and difference was statistically significant for diarrhea, watery stools, abdominal pain, nausea and vomiting. The use of evaluated oligomeric nutritional support might, in conjunction with pharmacotherapy and diet, alleviate symptoms of acute radiation enteritis and maintain nutritional status of patients. (author)

Influence of Zinc Supplementation in Acute Diarrhea Differs by the Isolated Organism

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Archana B. Patel

2010-01-01

Full Text Available Zinc supplementation is recommended in all acute diarrheas in children from developing countries. We aimed to assess whether zinc supplementation would be equally effective against all the common organisms associated with acute diarrheas. We used data on 801 children with acute diarrhea recruited in a randomized, double blind controlled trial (ISRCTN85071383 of zinc and copper supplementation. Using prespecified subgroup analyses, multidimensionality reduction analyses, tests of heterogeneity, and stepwise logistic regression for tests of interactions, we found that the influence of zinc on the risk of diarrhea for more than 3 days depended on the isolated organism—beneficial in Klebsiella, neutral in Esherichia coli and parasitic infections, and detrimental in rotavirus coinfections. Although we found similar results for the outcome of high stool volume, the results did not reach statistical significance. Our findings suggest that the current strategy of zinc supplementation in all cases of acute diarrheas in children may need appropriate fine tuning to optimize the therapeutic benefit based on the causative organism, but further studies need to confirm and extend our findings.

Role of zinc supplementation in acute diarrhea in pre-school children

International Nuclear Information System (INIS)

Rao, M.Y.; Malik, B.; Raza, A.

2017-01-01

Objective: To monitor the therapeutic impact of zinc supplementation on clinical course of acute diarrhea i.e. frequency of stool, on stool amount and duration of acute diarrhea. Study Design: Randomized controlled trial. Place and Duration of Study: Family medicine department, PAF Hospital, Islamabad Pakistan from Jul to Dec 2009. Material and Methods: One hundred and twenty eight children aged 6 months to 60 months in an Outpatient pediatric department of PAF Hospital, E-9 Sector Islamabad with acute diarrhea of less than 14 days were included in this randomized controlled trial. They were further divided into two groups zinc supplemented group (n=65) and non-zinc supplemented group (n=65). Results: Baseline characteristics were similar in both the groups. Mean age in zinc supplemented group was 33.67 +- 16.45 months and in non-zinc supplemented group 33.63 +- 16.44 months. Reduction in stool frequency per day was found 62 percent in zinc supplemented group and 26 percent reduction was found in non-zinc supplemented group with obvious difference of 36 percent between these two groups from day 3 to day 5, which was found statistically significant (p=0.01). Similarly, significant difference (p=0.01) was observed for reduction in amount of stool per day from day 3 and day 5 with obvious difference of 45 percent between the study groups. Conclusions: Oral zinc administration in acute diarrhea reduces the frequency of diarrhea, output of stool and decreases total duration of diarrhea. (author)

The Efficacy of Probiotic in Adults with Acute Infectious Diarrhea

Directory of Open Access Journals (Sweden)

Mawin Mahen

2017-04-01

Full Text Available Diarrhea is a global health problem with high morbidity and mortality. In developing countries, acute diarrhea is most commonly caused by infectious pathogens. Regardless of the cause, diarrhea is primarily treated by fluid replacement therapy to decrease the risk of dehydration and death, although it does not affect the duration of diarrhea. Probiotics are able to shorten the duration of diarrhea in children, but its efficacy in adults is unclear. This study aimed to evaluate the benefit of probiotic in reducing the duration of acute diarrhea in adults as compared to placebo. Systematic search was done using four databases: PubMed, Scopus, ProQuest, and Embase, without limit on the year of publication. Randomized clinical trials were selected as the appropriate study design to answer the clinical question and two studies were considered relevant for appraisal. In conclusion, probiotics could improve the recovery of acute infectious diarrhea in adults (level of evidence 1b however more studies should be carried out since only very few strains of probiotics have been investigated. Keywords: probiotics, treatment efficacy, acute diarrhea, adults.     Efektivitas Probiotik pada Orang Dewasa dengan Diare:  Sebuah Laporan Kasus Berbasis Bukti   Abstrak Diare merupakan masalah kesehatan global dengan angka morbiditas dan mortalitas yang tinggi. Di negara berkembang, diare akut biasanya disebabkan oleh infeksi. Terlepas dari penyebabnya, tata laksana utama diare adalah terapi rehidrasi untuk mengurangi dehidrasi dan kematian walaupun hal tersebut tidak memengaruhi durasi diare. Probiotik dapat memperpendek durasi diare pada anak-anak, namun efektivitasnya pada orang dewasa masih belum jelas. Tujuan penelitian ini adalah untuk mengevaluasi efek probiotik dalam mengurangi durasi diare akut pada orang dewasa dibandingkan plasebo. Pencarian sistematik dilakukan pada empat database: PubMed, Scopus, ProQuest, dan Embase, tanpa membatasi tahun publikasi

Genotyping and clinical factors in pediatric diarrhea caused by rotaviruses: one-year surveillance in Surabaya, Indonesia.

Science.gov (United States)

Sudarmo, Subijanto Marto; Shigemura, Katsumi; Athiyyah, Alpha Fardah; Osawa, Kayo; Wardana, Oktavian Prasetia; Darma, Andy; Ranuh, Reza; Raharjo, Dadik; Arakawa, Soichi; Fujisawa, Masato; Shirakawa, Toshiro

2015-01-01

Rotavirus infections are a major cause of diarrhea in children in both developed and developing countries. Rotavirus genetics, patient immunity, and environmental factors are thought to be related to the severity of acute diarrhea due to rotavirus in infants and young children. The objective of this study was to provide a correlation between rotavirus genotypes, clinical factors and degree of severity of acute diarrhea in children under 5 years old in Surabaya, Indonesia. A cross-sectional study was conducted in children aged 1-60 months with acute diarrhea hospitalized in Soetomo Hospital, Surabaya, Indonesia from April to December 2013. Rotavirus in stool specimens was identified by ELISA and genotyping (G-type and P-type) using multiplex reverse transcription PCR. Severity was measured using the Ruuska and Vesikari scoring system. The clinical factors were investigated included patient's age (months), hydration, antibiotic administration, nutritional state, co-bacterial infection and co-viral infection. A total of 88 children met the criteria; 80.7% were aged 6-24 months, watery diarrhea was the most common type (77.3%) and 73.6% of the subjects were co-infected with bacteria, of which pathogenic Escherichia coli was the most common (42.5%). The predominant VP7 genotyping (G-type) was G2 (31.8%) and that of VP4 genotyping (P-type) was P[4] (31.8%). The predominant rotavirus genotype was G2P[4] (19.3%); G1P[4] and G9P[4] were uncommon with a prevalence of 4.5%. There were significant differences between the common genotype and uncommon genotype with respect to the total severity score of diarrhea (p 10 times a day) (p = 0.045) in univariate analyses, but there was no significant correlation between P typing and severity of diarrhea. For combination genotyping of G and P, G2P[4] was significantly correlated with severe diarrhea in multivariate analyses (p = 0.029). There is a correlation between rotavirus genotype and severity of acute diarrhea in

A Rare Cause of Diarrhea in a Kidney Transplant Recipient: Dipylidium caninum.

Science.gov (United States)

Sahin, I; Köz, S; Atambay, M; Kayabas, U; Piskin, T; Unal, B

2015-09-01

We report the first case of dipylidiasis in a kidney transplant recipient. Watery diarrhea due to Dipylidium caninum was observed in a male patient who had been undergone kidney transplantation 2 years before. The patient was successfully treated with niclosamide. D. caninum should be considered as an agent of diarrhea in transplant patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Knowledge, attitudes, and practice of travelers' diarrhea management among frontline providers.

Science.gov (United States)

Hayat, Aatif M; Tribble, David R; Sanders, John W; Faix, Dennis J; Shiau, Danny; Armstrong, Adam W; Riddle, Mark S

2011-01-01

Many studies have found acute gastrointestinal infections to be among the most likely reason for clinic visits among forward deployed soldiers and are considered a significant contributor to morbidity in this population. This occurs despite the controlled food and water distribution systems under which military populations operate. Furthermore, recent studies have indicated that providers often fail to appropriately identify and treat the typical causes of these infections. To adequately address this issue, an assessment of gaps in knowledge, practice, and management of acute diarrhea in deployed troops was conducted. A multiple-choice survey was developed by clinical researchers with expertise in travelers' diarrhea (TD) and provided to a convenience sample of clinical providers with a broad range of training and operational experience. The survey evaluated provider's knowledge of TD along with their ability to identify etiologies of various syndromic categories of acute gastrointestinal infections. Providers were also queried on selection of treatment approaches to a variety of clinical-based scenarios. A total of 117 respondents completed the survey. Most were aware of the standard definition of TD (77%); however, their knowledge about the epidemiology was lower, with less than 24% correctly answering questions on etiology of diarrhea, and 31% believing that a viral pathogen was the primary cause of watery diarrhea during deployment. Evaluation of scenario-based responses showed that 64% of providers chose not to use antibiotics to treat moderate TD. Furthermore, 19% of providers felt that severe inflammatory diarrhea was best treated with hydration only while 25% felt hydration was the therapy of choice for dysentery. Across all provider types, three practitioner characteristics appeared to be related to better scores on responses to the nine management scenarios: having a Doctor of Medicine or Doctor of Osteopathy degree, greater knowledge of TD epidemiology

Campylobacter spp among Children with acute diarrhea attending ...

African Journals Online (AJOL)

Isolation rate in developing countries is between 5-35%. This study aimed at finding prevalence of children with campylobacter infection among children with acute diarrhea attending Mulago hospital. Objective: The objective was to establish the proportion of children infected with Campylobacter spp among children with ...

Probiotics, calcium and acute diarrhea : a randomized trial in Indonesian children

NARCIS (Netherlands)

Agustina, R.

2012-01-01

Background
Acute diarrhea and acute respiratory tract infections (ARTIs) continue to lead the infectious cause of morbidity and mortality among children <5 years of age in developing countries, including Indonesia. Efforts to prevent diarrheal disease by probiotics and milk calcium

Chronic diarrhea as presenting symptom for a metastasic neuroendocrine tumor

International Nuclear Information System (INIS)

Hani A, Albis Cecilia; Garcia A, Jairo Alberto

2007-01-01

We describe the clinical case of a 74 years old female patient presenting with a watery diarrhea syndrome, having severe hypokalaemia and liver metastases. In her necropsy a pancreatic neuroendocrine tumor was found. We present a literature review about pancreas neuroendocrine tumours, focusing in the VIPoma, which may correspond with the clinical features of this particular patient

Assessment of the safety of hydrogenated resistant maltodextrin: reverse mutation assay, acute and 90-day subchronic repeated oral toxicity in rats, and acute no-effect level for diarrhea in humans.

Science.gov (United States)

Yoshikawa, Yuko; Kishimoto, Yuka; Tagami, Hiroyuki; Kanahori, Sumiko

2013-01-01

A series of safety assessments were performed on hydrogenated resistant maltodextrin prepared by converting the reducing terminal glucose of resistant maltodextrin into sorbitol. The reverse mutation assay did not show mutagenicity. Acute and 90-day subchronic oral toxicity studies in rats showed no death was observed in any groups, including the group receiving the highest single dose of 10 g/kg body weight or the highest dose of 5 g/kg body weight per day for 90 days. Mucous or watery stools were observed in the hydrogenated resistant maltodextrin treatment group on the acute study, which were transient and were associated with the osmotic pressure caused by intake of the high concentrations. Subchronic study showed dose-dependent increases in the weights of cecum alone, cecal contents alone, and cecum with cecal contents as well as hypertrophy of the cecal mucosal epithelium, which are considered to be common physiological responses after intake of indigestible carbohydrates. These results indicated that the no observed adverse effect level (NOAEL) of hydrogenated resistant maltodextrin was 10 g/kg body weight or more on the acute oral toxicity study and 5.0 g/kg body weight/day or more on the 90-day subchronic repeated oral toxicity study in rats. Further study performed in healthy adult humans showed that the acute no-effect level of hydrogenated resistant maltodextrin for diarrhea was 0.8 g/kg body weight for men and more than 1.0 g/kg body weight for women. The results of the current safety assessment studies suggest that hydrogenated resistant maltodextrin is safe for human consumption.

The fecal microbiome in dogs with acute diarrhea and idiopathic inflammatory bowel disease.

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Jan S Suchodolski

Full Text Available BACKGROUND: Recent molecular studies have revealed a highly complex bacterial assembly in the canine intestinal tract. There is mounting evidence that microbes play an important role in the pathogenesis of acute and chronic enteropathies of dogs, including idiopathic inflammatory bowel disease (IBD. The aim of this study was to characterize the bacterial microbiota in dogs with various gastrointestinal disorders. METHODOLOGY/PRINCIPAL FINDINGS: Fecal samples from healthy dogs (n = 32, dogs with acute non-hemorrhagic diarrhea (NHD; n = 12, dogs with acute hemorrhagic diarrhea (AHD; n = 13, and dogs with active (n = 9 and therapeutically controlled idiopathic IBD (n = 10 were analyzed by 454-pyrosequencing of the 16S rRNA gene and qPCR assays. Dogs with acute diarrhea, especially those with AHD, had the most profound alterations in their microbiome, as significant separations were observed on PCoA plots of unweighted Unifrac distances. Dogs with AHD had significant decreases in Blautia, Ruminococcaceae including Faecalibacterium, and Turicibacter spp., and significant increases in genus Sutterella and Clostridium perfringens when compared to healthy dogs. No significant separation on PCoA plots was observed for the dogs with IBD. Faecalibacterium spp. and Fusobacteria were, however, decreased in the dogs with clinically active IBD, but increased during time periods of clinically insignificant IBD, as defined by a clinical IBD activity index (CIBDAI. CONCLUSIONS: Results of this study revealed a bacterial dysbiosis in fecal samples of dogs with various GI disorders. The observed changes in the microbiome differed between acute and chronic disease states. The bacterial groups that were commonly decreased during diarrhea are considered to be important short-chain fatty acid producers and may be important for canine intestinal health. Future studies should correlate these observed phylogenetic differences with functional changes in the intestinal

Association between child-care and acute diarrhea: a study in Portuguese children

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Barros Henrique

2003-01-01

Full Text Available OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR and their respective 95% confidence intervals (95% CI, crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]. CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

Multi-antibiotics-resistance plasmid profile of enteric pathogens in ...

African Journals Online (AJOL)

Dr J. T. Ekanem

malnourished children and is usually disproportionately high, accounting for up to. 45% of diarrhea deaths in Brazil, Bangladesh and in several African countries9,22. In Nigeria, the incidence of acute watery diarrhea is approximately 4.9 episodes per year and there are approximately 200,000 diarrhea related deaths of ...

Human rotavirus genotypes causing acute watery diarrhea among ...

African Journals Online (AJOL)

2014-06-17

Jun 17, 2014 ... vaccine with strains peculiar to this environment should be introduced. ..... Safety and efficacy of an attenuated vaccine against severe rotavirus ... prevalence of adenovirus serotypes 40 and 41, astrovirus, and rotavirus.

Chronic diarrhea caused by Blastocystis hominis and Cryptosporidium sp. in immunocompetent patient-a case report

Science.gov (United States)

Andriyani, Y.; Rozi, M. F.; Saragih, R. H.; Darlan, D. M.

2018-03-01

Blastocystis hominis and Cryptosporidium sp. are commonly associated with immunocompromised patients. Severe clinical manifestation can be produced by this organism. It varies according to immune status, and subtype of this organism. Unfortunately, we found an immunocompetent patient with chronic diarrhea caused by this organism. A 38- year old male was admitted to Adam Malik General Hospital because of watery diarrhea since four days ago. Administration of fluid replacement was done to this patient, but the frequency of diarrhea did not decrease. Loperamide as anti-spasmodic was also given in each episode of diarrhea. Surprisingly, fecal smear examination revealed that this patient positive for Blastocystis hominis and Cryptosporidium sp. Thus, diarrhea was resolved for four days without giving any anti-parasitic drugs to the patient.

Effect of Zinc Sulfate Use on Acute Diarrhea in Children (A Clinical Trial

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Z. Movahedi, MD*; , MD*; , MSc**;

2008-07-01

Full Text Available Background and ObjectivesDiarrhea which leads to zinc wasting from body is one of the major causes of mortality in children around the world. Zinc is one of the elements that facilitate the repair of stomach and intestinal mucosa, stimulation of immune system, control and transfer of water and electrolytes in our body. World Health Organization (WHO recommends use of zinc sulfate in all cases of diarrhea in addition to replacement of fluids and continuation of feeding in treatment of children with diarrhea. The objective of this study is evaluation of the effect of zinc sulfate (ZnSo4 on the recovery duration and appetite in children with diarrhea. This study evaluates the effect of ZnSo4 in prevention of respiratory infection and diarrhea for two months after taking the ZnSo4.MethodsTwo groups of children (total n=153 with non dysenteric acute diarrhea who were hospitalized in Qom’s children hospital in 2007 were used in this clinical trials. Sixty four of these children (n=64 were randomized to the study group and eighty nine (n=89 to the control group. The children in the control group received the standard therapy (fluid & electrolyte therapy &continuation of feeding for treatment of diarrhea and the children in the study group received standard treatment, and 5 mg of zinc sulfate twice daily for two weeks. Neither of these two groups received any anti diarrhea therapy and/or antibiotics. Both groups were monitored for occurrence of new episodes of diarrhea and/or respiratory tract infection for two months after the end of their hospitalization. T-score and Fisher tools were used for statistical analysis of the gathered data.ResultsChildren in two groups had several similarities such as gender, decrease in appetite, nausea and vomiting. There was not a significant difference between two groups with respect to the length of recovery, new incidence of diarrhea, and respiratory tract infection within two months after hospitalization. However

Country characteristics and acute diarrhea in children from developing nations: a multilevel study.

Science.gov (United States)

Pinzón-Rondón, Ángela María; Zárate-Ardila, Carol; Hoyos-Martínez, Alfonso; Ruiz-Sternberg, Ángela María; Vélez-van-Meerbeke, Alberto

2015-08-21

Each year 2.5 billion cases of diarrheal disease are reported in children under five years, and over 1,000 die. Country characteristics could play a role on this situation. We explored associations between country characteristics and diarrheal disease in children under 5 years of age, adjusting by child, mother and household attributes in developing countries. This study included 348,706 children from 40 nations. We conducted a multilevel analysis of data from the Demographic and Health Surveys and the World Bank. The prevalence of acute diarrhea was 14 %. Country inequalities (OR = 1.335; 95 % CI 1.117-1.663) and country's low income (OR = 1.488; 95 % CI 1.024-2.163) were associated with diarrhea, and these country characteristics changed the associations of well-known determinants of diarrhea. Specifically, living in poor countries strengthens the association of poor household wealth and mother's lack of education with the disease. Other factors associated with diarrhea were female sex of the child (OR = 0.922; 95 % CI 0.900-0.944), age of the child (OR = 0.978; 95 % CI 0.978-0.979), immunization status (OR = 0.821; 95 % CI 0.799-0.843), normal birthweight (OR = 0.879; 95 % CI 0.834-0.926), maternal age (OR = 0.987; 95 % CI 0.985-0.989), lack of maternal education (OR = 1.416; 95 % CI 1.283-1.564), working status of the mother (OR = 1.136; 95 % CI 1.106-1.167), planned pregnancy (OR = 0.774; 95 % CI 0.753-0.795), a nuclear family structure (OR = 0.949; 95 % CI 0.923-0.975), and household wealth (OR = 0.948; 95 % CI 0.921-0.977). Inequalities and lack of resources at the country level in developing countries -but not health expenditure- were associated with acute diarrhea, independently of child, family and household features. The broad environment considerably modifies well-known social determinants of acute diarrhea and public health campaigns designed to target diarrhea should consider macro characteristics of the

Strategic control of acute diarrhea of newborn calves

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Siti Chotiah

2012-10-01

Full Text Available Economic performance of beef cattle operations can be severely hampered by acute calfhood diarrhea. Accordingly, a study was conducted at Bbalitvet to identify the causal agents, reduce clinical incidence, and increase body weight gain of newborn calves. One potential control is application of suitable vaccines to pregnant cows. The study was begun by identifying cases of diarrhea followed by isolation and identification of the causal agents in 12 beef cattle farms in West Java. A field trial was then designed for controlling calf diarrhea in such farms. Inactive vaccines Ecoli-Closvak polivalen were administered to pregnant cows to increase specific resistance of the newborn calves. At 2 months prepartum, 12 pregnant cows were assigned either to a vaccination or a placebo group, with a booster vaccination 3 weeks prior to parturition. Strict hygenic management was provided to both groups, and all calves were provided adequately with colostrum. Subjects were observed for 5 months, starting from the time of initial vaccination until the calves were 3 months of age. In the initial farm surveys, entero-pathogenic bacteria such as Escherichia coli serotype K99 and Clostridium perfringens type A and C were isolated and identified in fecal samples from 4 beef cattle farms in 3 districts (Garut, Tasikmalaya, Ciamis and 2 beef cattle farms in 2 districts (Tasikmalaya and Ciamis of West Java. In the vaccination trial, good immune responses to E. coli and C. perfringens alpha toxin measured by ELISA were observed. Application of effective control of calf diarrhea including vaccination and good livestock management showed good results. No death or signs of diarrhea were found in the new born calves up to 3 months of age. The rate of body weight gain was significantly higher in calves of vaccinated dams than in calves of non-vaccinated dams.

Complete Genome Sequences of Porcine Epidemic Diarrhea Virus Strains JSLS-1/2015 and JS-2/2015 Isolated from China.

Science.gov (United States)

Tao, Jie; Li, Benqiang; Zhang, Chunling; Liu, Huili

2016-11-10

Two porcine epidemic diarrhea virus (PEDV) strains, JSLS-1/2015 and JS-2/2015, were isolated from piglets with watery diarrhea in South China. Two genomic sequences were highly homologous to the attenuated DR13 strain. Furthermore, JSLS-1/2015 contains a 24-amino-acid deletion in open reading frame 1b, which was first reported in PEDV isolates. Copyright © 2016 Tao et al.

Enteric bacterial pathogens in children with diarrhea in Niger: diversity and antimicrobial resistance.

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Céline Langendorf

Full Text Available Although rotavirus is the leading cause of severe diarrhea among children in sub-Saharan Africa, better knowledge of circulating enteric pathogenic bacteria and their antimicrobial resistance is crucial for prevention and treatment strategies.As a part of rotavirus gastroenteritis surveillance in Maradi, Niger, we performed stool culture on a sub-population of children under 5 with moderate-to-severe diarrhea between April 2010 and March 2012. Campylobacter, Shigella and Salmonella were sought with conventional culture and biochemical methods. Shigella and Salmonella were serotyped by slide agglutination. Enteropathogenic Escherichia coli (EPEC were screened by slide agglutination with EPEC O-typing antisera and confirmed by detection of virulence genes. Antimicrobial susceptibility was determined by disk diffusion. We enrolled 4020 children, including 230 with bloody diarrhea. At least one pathogenic bacterium was found in 28.0% of children with watery diarrhea and 42.2% with bloody diarrhea. Mixed infections were found in 10.3% of children. EPEC, Salmonella and Campylobacter spp. were similarly frequent in children with watery diarrhea (11.1%, 9.2% and 11.4% respectively and Shigella spp. were the most frequent among children with bloody diarrhea (22.1%. The most frequent Shigella serogroup was S. flexneri (69/122, 56.5%. The most frequent Salmonella serotypes were Typhimurimum (71/355, 20.0%, Enteritidis (56/355, 15.8% and Corvallis (46/355, 13.0%. The majority of putative EPEC isolates was confirmed to be EPEC (90/111, 81.1%. More than half of all Enterobacteriaceae were resistant to amoxicillin and co-trimoxazole. Around 13% (46/360 Salmonella exhibited an extended-spectrum beta-lactamase phenotype.This study provides updated information on enteric bacteria diversity and antibiotic resistance in the Sahel region, where such data are scarce. Whether they are or not the causative agent of diarrhea, bacterial infections and their antibiotic

Effect of Zinc Sulfate Use on Acute Diarrhea in Children (A Clinical Trial

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M Movahedi

2012-05-01

Full Text Available

Background and Objectives

Diarrhea which leads to zinc wasting from body is one of the major causes of mortality in children around the world. Zinc is one of the elements that facilitate the repair of stomach and intestinal mucosa, stimulation of immune system, control and transfer of water and electrolytes in our body. World Health Organization (WHO recommends use of zinc sulfate in all cases of diarrhea in addition to replacement of fluids and continuation of feeding in treatment of children with diarrhea. The objective of this study is evaluation of the effect of zinc sulfate (ZnSo4 on the recovery duration and appetite in children with diarrhea. This study evaluates the effect of ZnSo4 in prevention of respiratory infection and diarrhea for two months after taking the ZnSo4.

Methods

Two groups of children (total n=153 with non dysenteric acute diarrhea who were hospitalized in Qom’s children hospital in 2007 were used in this clinical trials. Sixty four of these children (n=64 were randomized to the study group and eighty nine (n=89 to the control group. The children in the control group received the standard therapy (fluid & electrolyte therapy &continuation of feeding  for treatment of diarrhea and the children in the study group received standard treatment, and 5 mg of zinc sulfate twice daily for two weeks. Neither of these two groups received any anti diarrhea therapy and/or antibiotics. Both groups were monitored for occurrence of new episodes of diarrhea and/or respiratory tract infection for two months after the end of their hospitalization. T-score and Fisher tools were used for statistical analysis of the gathered data.

Results

Children in two groups had several similarities such as gender, decrease in appetite, nausea and vomiting. There was not a significant difference between two groups with respect to the length of recovery, new incidence of

Oral Administration of Astrovirus Capsid Protein Is Sufficient To Induce Acute Diarrhea In Vivo

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Victoria A. Meliopoulos

2016-11-01

Full Text Available The disease mechanisms associated with the onset of astrovirus diarrhea are unknown. Unlike other enteric virus infections, astrovirus infection is not associated with an inflammatory response or cellular damage. In vitro studies in differentiated Caco-2 cells demonstrated that human astrovirus serotype 1 (HAstV-1 capsid protein alone disrupts the actin cytoskeleton and tight junction complex, leading to increased epithelial barrier permeability. In this study, we show that oral administration of purified recombinant turkey astrovirus 2 (TAstV-2 capsid protein results in acute diarrhea in a dose- and time-dependent manner in turkey poults. Similarly to that induced by infectious virus, TAstV-2 capsid-induced diarrhea was independent of inflammation or histological changes but was associated with increased intestinal barrier permeability, as well as redistribution of sodium hydrogen exchanger 3 (NHE3 from the membrane to the cytoplasm of the intestinal epithelium. Unlike other viral enterotoxins that have been identified, astrovirus capsid induces diarrhea after oral administration, reproducing the natural route of infection and demonstrating that ingestion of intact noninfectious capsid protein may be sufficient to provoke acute diarrhea. Based on these data, we hypothesize that the astrovirus capsid acts like an enterotoxin and induces intestinal epithelial barrier dysfunction.

Acute diarrhea: evidence-based management

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Kátia Galeão Brandt

2015-11-01

Full Text Available Objectives: To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. Data source: PubMed, Scopus, Google Scholar. Data summary: There has been little progress in the use of oral rehydration salts (ORS in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. Conclusions: Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea. Resumo: Objetivos: descrever as recomendações atuais sobre a melhor maneira de conduzir o paciente pediátrico com doença diarreica aguda. Fonte dos dados: PubMed, Scopus, Scholar Google. Síntese dos dados: Houve pouco avanço na utilização dos sais de reidratação oral (SRO nas últimas décadas apesar de ser amplamente divulgado através de diretrizes internacionais. Vários estudos vêm sendo realizados na tentativa de melhorar a eficácia do SRO. Hidratação venosa com solução salina isotônica, infundida de forma rápida, deve ser indicada em casos de desidratação grave. A nutrição deve ser assegurada logo após a resolução da desidratação, sendo primordial para a saúde intestinal e imunológica. Restrições alimentares usualmente não são benéficas e podem ser prejudiciais. As medicações sintomáticas têm indicação restrita e antibióticos são indicados em casos específicos, cólera e shiguelose moderada a grave. Conclusões: a hidratação e a nutri

Economic evaluation of zinc and copper use in treating acute diarrhea in children: A randomized controlled trial

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Dhande Leena A

2003-08-01

Full Text Available Abstract Background The therapeutic effects of zinc and copper in reducing diarrheal morbidity have important cost implications. This health services research study evaluated the cost of treating a child with acute diarrhea in the hospital, the impact of micronutrient supplementation on the mean predicted costs and its cost-effectiveness as compared to using only standard oral rehydration solution (ORS, from the patient's and government's (providers perspective. Methods Children aged 6 months to 59 months with acute diarrhea were randomly assigned to receive either the intervention or control. The intervention was a daily dose of 40 mg of zinc sulfate and 5 mg of copper sulfate powder dissolved in a liter of standard ORS (n = 102. The control was 50 mg of standard ORS powder dissolved in a liter of standard ORS (n = 98. The cost measures were the total mean cost of treating acute diarrhea, which included the direct medical, the direct non-medical and the indirect costs. The effectiveness measures were the probability of diarrhea lasting ≤ 4 days, the disability adjusted life years (DALYs and mortality. Results The mean total cost of treating a child with acute diarrhea was US $14 of which the government incurred an expenditure of 66%. The factors that increased the total were the number of stools before admission (p = 0.01, fever (p = 0.01, increasing grade of dehydration (p = 0.00, use of antibiotics (p = 0.00, use of intra-venous fluids (p = 0.00, hours taken to rehydrate a child (p = 0.00, the amount of oral rehydration fluid used (p = 0.00, presence of any complications (p = 0.00 and the hospital stay (p = 0.00. The supplemented group had a 8% lower cost of treating acute diarrhea, their cost per unit health (diarrhea lasting ≤ 4 days was 24% less and the incremental cost-effectiveness ratio indicated cost savings (in Rupees with the intervention [-452; 95%CI (-11306, 3410]. However these differences failed to reach conventional levels

Effect of probiotics on diarrhea in children with severe acute malnutrition

DEFF Research Database (Denmark)

Grenov, Benedikte; Namusoke, Hanifa; Lanyero, Betty

2017-01-01

OBJECTIVES: To assess the effect of probiotics on diarrhea during in- and outpatient treatment of children with severe acute malnutrition (SAM). METHODS: A randomized, double-blind, placebo-controlled study was conducted involving 400 children admitted with SAM. Patients received one daily dose...

Acute treatment-related diarrhea during postoperative adjuvant therapy for high-risk rectal carcinoma

International Nuclear Information System (INIS)

Miller, Robert C.; Martenson, James A.; Sargent, Daniel J.; Kahn, Michael J.; Krook, James E.

1998-01-01

Purpose: The combination of pelvic radiotherapy and 5-fluorouracil-based chemotherapy is associated with an increase in acute gastrointestinal toxicity during rectal adjuvant therapy, most notably an increased incidence of diarrhea. Previous randomized, prospective studies have limited their analysis to presenting rates of severe and life-threatening diarrhea (Grade 3 or greater), and few data are available detailing the extent of mild to moderate diarrhea. To provide baseline data for future studies, we conducted a detailed analysis of diarrhea from a prior clinical trial of adjuvant therapy for rectal cancer. Methods and Materials: In a multiinstitutional clinical trial, 204 eligible patients with rectal carcinoma that either was deeply invasive (T3-T4) or involved regional lymph nodes were randomized to receive either postoperative pelvic radiotherapy alone (45 to 50.4 Gy) or pelvic radiotherapy and bolus 5-fluorouracil-based chemotherapy. Toxicity was assessed prospectively. Results: For the 99 eligible patients who received pelvic radiotherapy alone, rates of Grades 0, 1, 2, 3, and 4 diarrhea during treatment were 59, 20, 17, 4, and 0%, respectively. For the 96 eligible patients who received radiotherapy and 5-fluorouracil, the overall rates of grades 0, 1, 2, 3, and 4 diarrhea were 21, 34, 23, 20, and 2%, respectively. The increased rates of diarrhea during adjuvant rectal therapy were manifested across all toxicity levels for patients receiving chemotherapy and pelvic radiotherapy. Of primary clinical importance is the substantial increase in severe or life-threatening diarrhea (Grade 3 or more) (22 vs. 4%, p = 0.001) Additionally, increased rates of any diarrhea and also severe or life-threatening diarrhea were observed in patients who had a low anterior resection compared with those who had an abdominoperineal resection (p < 0.001 and p = 0.006, respectively). Conclusion: These results will be of value as a baseline for investigators who want to use

Management of children’s acute diarrhea by community pharmacies in five towns of Ethiopia: simulated client case study

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Abegaz TM

2016-04-01

Full Text Available Tadesse Melaku Abegaz,1 Sewunet Admasu Belachew,1 Tamrat Befekadu Abebe,1 Begashaw Melaku Gebresilassie,1 Fitsum Sebsibe Teni,2 Habtamu Gebremeskel Woldie3 1Department of Clinical Pharmacy, School of Pharmacy, Gondar University, Gondar, 2Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, 3Department of Hospital Pharmacy, Debremarkos Teaching and Referral Hospital, Debremarkos, Ethiopia Background: Acute diarrhea is the major cause of child morbidity and mortality in low-income nations. It is the second most common cause of death among children <5 years of age globally. The indispensable role of community pharmacists is clearly observed in the prevention and treatment of diarrhea. However, there is a paucity of data on how community pharmacies manage acute childhood diarrhea cases in Ethiopia. This study aimed to evaluate the experience of community pharmacies in the management of acute diarrhea in northern Ethiopia.Methods: A simulated case-based cross-sectional study was conducted in community pharmacies from five towns of northern Ethiopia between April 2015 and September 2015. Convenience sampling technique was used to select sample towns. A structured questionnaire was organized to collect the information. Descriptive statistics, chi-squared test, one-way analysis of variance, and binary logistic regression were performed to describe, infer, and test for association between the variables. SPSS for Windows Version 21 was used to enter and analyze the data. A 95% confidence interval and P-value of 0.05 were set to test the level of significance.Results: Approximately 113 community pharmacies were visited to collect the required data from five towns. Majority (78, 69% of them were located away from hospitals and health care areas. Nine components of history taking were presented for dispensers. Regarding the patient history, “age” was frequently taken, (90

Clinical results of galantase for diarrhea due to gynecological radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Tokunaga, A [Niigata Univ. (Japan). School of Medicine; Higuchi, A

1977-10-01

Galantase, a preparation of lactose-decomposing enzyme, was used for 20 radiotherapeutic patients for prevention and treatment of diarrhea. The results were compared with those of 58 control cases without administration. In the 58 cases, the timing of onset of diarrhea during irradiation was examined, and the mechanism of onset of radioinjury in the digestive tract was discussed. Galantase 6 g/day was administered to 13 of the 20 patients simultaneously with institution of irradiation and to 7 patients simultaneously with the onset of diarrhea during irradiation. As radiotherapy, the patients were given remote cobalt irradiation 5 times a week, each consisting of 200 rad, a total dose of 5,000 rad, in a field of 14 - 16 x 14 - 16 cm by way of 2 ports (anterior and posterior). Diarrhea and soft stool both appeared by irradiation of less than 300 rad, and diarrhea was observed in 84%. Temporal diarrhea occurred in 3 of the 13 patients given galantase simultaneously with irradiation. Diarrhea continued for 6 days in one of the 6 cases in which galantase was administered simultaneously with the onset of diarrhea or watery stool. In the other 5, the stool recovered to be soft or normal 2-3 days after administration. Diarrhea during irradiaion appeared in 21.4% of the cases given galantase and 42.1% of those without it. The clinical value of galantase was recognized.

The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years

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Rodrigo Locatelli Pedro Paulo

Full Text Available Summary Introduction: Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1 was added to the Brazilian National Immunization Program. Objectives: To analyze the impact of the RV1 on emergency department (ED visits and hospital admissions for acute diarrhea. Method: A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003–2005 and the post-vaccine (2007–2009 periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (% = (1 - odds ratio x 100. Results: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001. The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001. Conclusion: The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years.

Science.gov (United States)

Paulo, Rodrigo Locatelli Pedro; Rodrigues, André Broggin Dutra; Machado, Beatriz Marcondes; Gilio, Alfredo Elias

2016-09-01

Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1) was added to the Brazilian National Immunization Program. To analyze the impact of the RV1 on emergency department (ED) visits and hospital admissions for acute diarrhea. A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003-2005) and the post-vaccine (2007-2009) periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 - odds ratio) x 100. The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

Diarrhea in severely burned children.

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Thakkar, Kalpesh; Kien, C Lawrence; Rosenblatt, Judah I; Herndon, David N

2005-01-01

Diarrhea is a common problem in critically ill patients. Our patients are fed a high-carbohydrate enteral formula. We hypothesized that diarrhea in our patients may be related to the osmotic effects of unabsorbed carbohydrate in the small intestine and colon. We studied 19 patients, 3 months to 17 years, with burns >40% total body surface area. Each subject was studied weekly for up to 4 weeks postburn. Breath H2 concentration was measured. For the 24-hour period before the breath H2 measurement, the enteral carbohydrate intake, stool volume, and total enteral fluid volume were recorded. At each of several weekly intervals for each subject, the times when stool volume and enteral carbohydrate intake were each maximal were noted. Maximal stool volume ranged from 12 to 69 mL/kg/d. At the time point of maximal carbohydrate intake, diarrhea (stool volume >10 mL/kg/d) occurred in 18 of 19 patients, and maximal stool volume occurred in 10 of 19. Breath H2 concentration (ppm/5% CO2; mean +/- SEM) was 5.5 +/- 3.5 at the time of maximal carbohydrate intake, and was 25 +/- 20 at maximal stool volume. There were no correlations among breath H2 concentration, stool volume, enteral fluid intake, and enteral carbohydrate intake. Almost all the subjects had diarrhea over several weeks postburn. The lack of correlation of either carbohydrate intake or breath H2 with stool volume suggests that diarrhea in these patients may be caused by factors other than carbohydrate malabsorption. These data do not support altering nutrition support because of watery diarrhea.

Time Series Analysis of the Microbiota of Children Suffering From Acute Infectious Diarrhea and Their Recovery After Treatment

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Ener C. Dinleyici

2018-06-01

Full Text Available Gut microbiota is closely related to acute infectious diarrhea, one of the leading causes of mortality and morbidity in children worldwide. Understanding the dynamics of the recovery from this disease is of clinical interest. This work aims to correlate the dynamics of gut microbiota with the evolution of children who were suffering from acute infectious diarrhea caused by a rotavirus, and their recovery after the administration of a probiotic, Saccharomyces boulardii CNCM I-745. The experiment involved 10 children with acute infectious diarrhea caused by a rotavirus, and six healthy children, all aged between 3 and 4 years. The children who suffered the rotavirus infection received S. boulardii CNCM I-745 twice daily for the first 5 days of the experiment. Fecal samples were collected from each participant at 0, 3, 5, 10, and 30 days after probiotic administration. Microbial composition was characterized by 16S rRNA gene sequencing. Alpha and beta diversity were calculated, along with dynamical analysis based on Taylor's law to assess the temporal stability of the microbiota. All children infected with the rotavirus stopped having diarrhea at day 3 after the intervention. We observed low alpha diversities in the first 5 days (p-value < 0.05, Wilcoxon test, larger at 10 and 30 days after probiotic treatment. Canonical correspondence analysis (CCA showed differences in the gut microbiota of healthy children and of those who suffered from acute diarrhea in the first days (p-value < 0.05, ADONIS test, but not in the last days of the experiment. Temporal variability was larger in children infected with the rotavirus than in healthy ones. In particular, Gammaproteobacteria class was found to be abundant in children with acute diarrhea. We identified the microbiota transition from a diseased state to a healthy one with time, whose characterization may lead to relevant clinical data. This work highlights the importance of using time series for the

Epidemiology of functional diarrhea and comparison with diarrhea-predominant irritable bowel syndrome: a population-based survey in China.

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Yan-Fang Zhao

Full Text Available BACKGROUND: The epidemiology of functional diarrhea and its impacts on Chinese remain unclear, and there are no data on the comparative epidemiology of functional diarrhea and diarrhea-predominant irritable bowel syndrome (IBS-D. This study was to explore the epidemiology of functional diarrhea and its impacts, and to identify its distinction from IBS-D. METHODS AND FINDINGS: A cross-sectional survey was conducted in 16078 respondents, who were interviewed under a randomized stratified multi-stage sampling design in five cities of China. All respondents completed the modified Rome II questionnaire, and the 36-item Short Form health survey (SF-36 was used for assessing health-related quality of life in 20% of the sample. Overall, 248 respondents (1.54% had functional diarrhea and 277 (1.72% had IBS-D. Functional diarrhea was positively associated with increasing age and body mass index (trend test P<0.05. The three most common symptoms for at least 3 weeks in the past months were loose, mushy or watery stools (n = 203, 81.85%, more than three bowel movements a day (n = 100, 40.32% and having to rush to the toilet to have a bowel movement (n = 72, 29.03%. Meaningful impairment was observed in 5 of the 8 SF-36 domains in respondents with functional diarrhea. The demographics are mostly similar between the respondents with functional diarrhea and IBS-D; however, respondents with IBS-D had more frequent symptoms of diarrhea and even lower scores in SF-36 domains than those with functional diarrhea. CONCLUSIONS: The prevalence of functional diarrhea in China is substantially lower than that in Western countries and relatively higher than that in other Asian countries. It impaired health-related quality of life, and respondents with IBS-D have even worse quality of life. Further population-based studies are needed to investigate the epidemiology of functional diarrhea and the differences between functional diarrhea and IBS-D.

Diarrheagenic Escherichia coli and acute and persistent diarrhea in returned travelers

NARCIS (Netherlands)

Schultsz, C.; van den Ende, J.; Cobelens, F.; Vervoort, T.; van Gompel, A.; Wetsteyn, J. C.; Dankert, J.

2000-01-01

To determine the role of diarrheagenic Escherichia coli in acute and persistent diarrhea in returned travelers, a case control study was performed. Enterotoxigenic E. coli (ETEC) was detected in stool samples from 18 (10.7%) of 169 patients and 4 (3.7%) of 108 controls. Enteroaggregative E. coli

Secretory diarrhea.

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Schiller, L R

1999-10-01

Diarrhea, defined as loose stools, occurs when the intestine does not complete absorption of electrolytes and water from luminal contents. This can happen when a nonabsorbable, osmotically active substance is ingested ("osmotic diarrhea") or when electrolyte absorption is impaired ("secretory diarrhea"). Most cases of acute and chronic diarrhea are due to the latter mechanism. Secretory diarrhea can result from bacterial toxins, reduced absorptive surface area caused by disease or resection, luminal secretagogues (such as bile acids or laxatives), circulating secretagogues (such as various hormones, drugs, and poisons), and medical problems that compromise regulation of intestinal function. Evaluation of patients with secretory diarrhea must be tailored to find the likely causes of this problem. Specific and nonspecific treatment can be valuable.

Dynamical speckles in watery surfaces

International Nuclear Information System (INIS)

Llovera-Gonzalez, J.J.; Moreno-Yeras, A.; Garcia-Diaz, M.; Alvarez-Salgado, Y.

2009-01-01

Recovery of watery surfaces with monolayer of surfactant substances is of interest in diverse technological applications. The format ion and study of molecular monolayer deposited in these surfaces require the application of measurements techniques that allow evaluating the recovery grade locally without modifying practically the studied surface. In this paper the preliminary results obtained by the authors it plows exposed applying the technique of dynamic speckle interferometry in watery surfaces and their consideration like to possible resource to measure the grade of local recovery of these surfaces on the it bases that the speckles pattern dog reveal the dynamics of evaporation that takes place in the same ones. (Author)

Clinical results of galantase for diarrhea due to gynecological radiotherapy

International Nuclear Information System (INIS)

Tokunaga, Akiteru; Higuchi, Akira.

1977-01-01

Galantase, a preparation of lactose-decomposing enzyme, was used for 20 radiotherapeutic patients for prevention and treatment of diarrhea. The results were compared with those of 58 control cases without administration. In the 58 cases, the timing of onset of diarrhea during irradiation was examined, and the mechanism of onset of radioinjury in the digestive tract was discussed. Galantase 6 g/day was administered to 13 of the 20 patients simultaneously with institution of irradiation and to 7 patients simultaneously with the onset of diarrhea during irradiation. As radiotherapy, the patients were given remote cobalt irradiation 5 times a week, each consisting of 200 rad, a total dose of 5,000 rad, in a field of 14 - 16 x 14 - 16 cm by way of 2 ports (anterior and posterior). Diarrhea and soft stool both appeared by irradiation of less than 300 rad, and diarrhea was observed in 84%. Temporal diarrhea occurred in 3 of the 13 patients given galantase simultaneously with irradiation. Diarrhea continued for 6 days in one of the 6 cases in which galantase was administered simultaneously with the onset of diarrhea or watery stool. In the other 5, the stool recovered to be soft or normal 2-3 days after administration. Diarrhea during irradiaion appeared in 21.4% of the cases given galantase and 42.1% of those without it. The clinical value of galantase was recognized. (Chiba, N.)

Probiotics for Infectious Diarrhea and Traveler's Diarrhea - What Do We Really Know?

Science.gov (United States)

Hibberd, Patricia L.

Worldwide, diarrhea is the sixth leading cause of premature death (Lopez et al., 2006), accounting for more than two million deaths each year. The majority of the burden is borne in lower and middle income countries, and in children under age 5 (Kosek et al., 2003). Even in the United States where there is easy access to “safe” food and water, there are an estimated 211-375 million episodes of acute diarrhea each year, resulting in 900,000 hospitalizations and 6,000 deaths (Herikstad et al., 2002; Mead et al., 1999). While mortality from diarrhea has decreased over the last 30 years, the incidence and morbidity associated with diarrhea has not improved (Kosek et al., 2003). During the same time period an ever increasing number of enteric pathogens as well as non-infectious conditions have been recognized as causes of acute diarrhea (Guerrant et al., 2001).

Anti-diarrheal effects of diosmectite in the treatment of acute diarrhea in children: a review.

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Dupont, Christophe; Vernisse, Bernard

2009-01-01

Acute diarrhea caused by an infectious organism is highly prevalent, particularly in developing countries, and is usually self-limiting. The condition is a major contributor to the global disease burden and is associated with a significant economic cost. The disease is common in children aged Diarrhea almost always occurs by one or more of four mechanisms: disruption of osmotic forces in the intestine; disruption of normal secretory processes; disruption of epithelial cells or the epithelial tight junctions; or motility disorders. Oral rehydration therapy (ORT) is central to the management of acute diarrhea, and is sufficient to prevent complications due to dehydration in most patients while the disease runs its course. However, ORT has no effect on the duration of the disease or frequency of bowel motions, and any agent that could meet these needs would therefore be a useful addition to ORT. Diosmectite is a natural aluminomagnesium silicate clay with a lamellar, non-fibrous crystalline structure that gives it strong adsorbent properties. Its mechanisms of action are not yet fully understood, but are probably multiple. Diosmectite reduces inflammation, modifies mucus rheologic properties, inhibits mucolysis, and adsorbs bacteria, bacterial enterotoxins, viruses and other potentially diarrheogenic substances. A number of studies have shown that diosmectite reduces the duration of diarrhea and decreases the frequency of bowel motions after 2 days of treatment in children with mild-to-moderate acute diarrhea. Two recent trials have indicated a reduction in stool output with diosmectite. Because of its very favorable safety profile, with no serious adverse effects, diosmectite is frequently used, mainly in European countries but also in Asia and Africa. Diosmectite should be used as an adjunct, not an alternative, to ORT and, when needed, to antibacterial therapy.

A comprehensive comparison of the efficacy and tolerability of racecadotril with other treatments of acute diarrhea in adults

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Wolfgang Fischbach

2016-10-01

Full Text Available Racecadotril is a guideline-recommended treatment to alleviate symptoms of acute diarrhea. A systematic review of randomized studies was performed comparing efficacy and safety of treatment with racecadotril to that with placebo or active treatments in adults. In five double-blind studies, racecadotril and placebo had comparable tolerability but racecadotril was more effective. This was consistent across multiple efficacy parameters including duration of diarrhea, number of diarrheic stools, abdominal pain and meteorism; it was also consistent across countries in Africa, Asia and Europe. In six randomized studies in outpatients comparing racecadotril to loperamide, resolution of symptoms occurred with similar speed and efficacy; however, racecadotril treatment was associated with less rebound constipation and less abdominal discomfort. A seventh comparative study performed in geriatric nursing home residents reported a superior efficacy of racecadotril. In direct comparison with Saccharomyces boulardii treatment, racecadotril exhibited similar tolerability but was more efficacious. One study compared racecadotril to octreotide in patients with acute diarrhea requiring hospitalization, rehydration and antibiotic treatment; in this cohort, octreotide was more efficacious than racecadotril. In conclusion, in adults with acute diarrhea racecadotril is more efficacious than placebo or Saccharomyces boulardii, similarly efficacious as loperamide and, in patients with moderate to severe disease as add-on to antibiotics, less than octreotide. The tolerability of racecadotril is similar to that of placebo or Saccharomyces boulardii and better than that of loperamide, particularly with regard to risk of rebound constipation. Taken together these data demonstrate that racecadotril is a suitable treatment to alleviate symptoms of acute diarrhea in adults.

Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis.

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Schrader, Andrew J; Tribble, David R; Riddle, Mark S

2017-12-01

To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers' diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER -$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

Acute diarrhea in hospitalized children of the municipality of juiz de fora, MG, Brazil: prevalence and risk factors associated with disease severity

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Monica Couto Guedes Sejanes da Rocha

2012-12-01

Full Text Available CONTEXT: Acute diarrhea is a common cause of hospitalization among children under 5 years of age. Knowing the prevalence and risk factors associated with the severity of acute diarrhea is essential to control morbidity and mortality. OBJECTIVE: Describe the prevalence of demographic, epidemiologic and clinical features of children under 6 years of age hospitalized for acute diarrhea, and investigate the association between these determinants and the severity of the diarrheic episode. METHOD: Retrospective, cross-sectional study, during the period from January, 2005 through December, 2008, in the municipality of Juiz de Fora, MG, Brazil. Files from 6,201 children from 0 to 6 years of age, hospitalized in two public teaching institutions (which account for 84% of all the hospitalizations in the municipality, were assessed. Acute diarrhea was defined as the presence of at least three evacuations of liquid or loose stools, within 24 hours, for a maximum period of 14 days. The patients with acute diarrhea were divided in two groups, according to disease severity, severe diarrhea being considered whenever hospitalization lasted for at least 4 days. Epidemiologic and clinical data were assessed and compared through the application of the chi-squared test and the binomial logistic regression model. RESULTS: The prevalence rate for admission due to acute diarrhea was 8.4%. The factors significantly associated with the severity of the diarrheic episode were: age under 6 months (P = 0.01, OR = 2.762; disease onset during fall (P = 0.033, OR = 1.742, presence of fever (P = 0.017, OR = 1.715 and antibiotic use during hospitalization (P = 0.000, OR = 3.872. CONCLUSIONS: Diarrhea is the third most common cause of hospitalization among children under 6 years of age in Juiz de Fora. Young age (under or equal to 6 months, fever, antibiotic use during hospitalization and disease onset during fall are risk factors associated with longer hospital stay.

Genetic Virulence Profile of Enteroaggregative Escherichia coli Strains Isolated from Danish Children with Either Acute or Persistent Diarrhea

OpenAIRE

Betina Hebbelstrup Jensen; Anja Poulsen; Stig Hebbelstrup Rye Rasmussen; Carsten Struve; Jørgen H. Engberg; Alice Friis-Møller; Nadia Boisen; Rie Jønsson; Randi F. Petersen; Andreas M. Petersen; Andreas M. Petersen; Andreas M. Petersen; Karen A. Krogfelt

2017-01-01

Enteroaggregative Escherichia coli (EAEC) is frequently found in diarrheal stools worldwide. It has been associated with persistent diarrhea, weight loss, and failure to thrive in children living in developing countries. A number of important EAEC virulence genes are identified; however, their roles in acute and persistent diarrhea have not been previously investigated. The aim of this study was to identify specific EAEC virulence genes associated with duration and type of diarrhea in Danish ...

[Drug induced diarrhea].

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Morard, Isabelle; Hadengue, Antoine

2008-09-03

Diarrhea is a frequent adverse event involving the most frequently antibiotics, laxatives and NSAI. Drug induced diarrhea may be acute or chronic. It may be due to expected, dose dependant properties of the drug, to immuno-allergic or bio-genomic mechanisms. Several pathophysiological mechanisms have been described resulting in osmotic, secretory or inflammatory diarrhea, shortened transit time, or malabsorption. Histopathological lesions sometimes associated with drug induced diarrhea are usually non specific and include ulcerations, inflammatory or ischemic lesions, fibrous diaphragms, microscopic colitis and apoptosis. The diagnosis of drug induced diarrhea, sometimes difficult to assess, relies on the absence of other obvious causes and on the rapid disappearance of the symptoms after withdrawal of the suspected drug.

A Case of Acute Budd-Chiari Syndrome Complicating Primary Antiphospholipid Syndrome Presenting as Acute Abdomen and Responding to Tight Anticoagulant Therapy

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Naofumi Chinen

2016-01-01

Full Text Available A 34-year-old woman with primary antiphospholipid syndrome was admitted to the Gastroenterology Department of our hospital with fever, acute abdomen, watery diarrhea, and extremely high levels of inflammatory parameters. She had a history of left lower limb deep vein thrombosis and pulmonary embolism and was taking warfarin potassium. Acute gastroenteritis was suspected and an antibiotic was administered, but symptoms progressed. Abdominal ultrasonography showed occlusion of the left hepatic vein and the middle hepatic vein and her D-dimer level was high. Accordingly, Budd-Chiari syndrome was diagnosed and high-dose intravenous infusion of heparin was initiated. Her abdominal symptoms improved and the levels of inflammatory parameters and D-dimer decreased rapidly. It is known that antiphospholipid syndrome can be complicated by Budd-Chiari syndrome that usually occurs as subacute or chronic onset, but acute onset is rare. It is difficult to diagnose acute Budd-Chiari syndrome complicating antiphospholipid syndrome and this complication generally has a poor outcome. However, the present case can get early diagnosis and successful treatment with tight anticoagulant therapy.

Herbal and dietary supplements related to diarrhea and acute kidney injury: a case report.

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Wanitsriphinyo, Suphamat; Tangkiatkumjai, Mayuree

2017-03-01

Background There is very little evidence relating to the association of herbal medicine with diarrhea and the development of acute kidney injury (AKI). This study reports a case of diarrhea-induced AKI, possibly related to an individual ingesting copious amounts of homemade mixed fruit and herb puree. Case presentation A 45-year-old Thai man with diabetes had diarrhea for 2 days, as a result of taking high amounts of a puree made up of eight mixed fruits and herbs over a 3-day period. He developed dehydration and stage 2 AKI, with a doubling of his serum creatinine. He had been receiving enalapril, as a prescribed medication, over one year. After he stopped taking both the puree and enalapril, and received fluid replacement therapy, within a week his serum creatinine had gradually decreased. The combination of puree, enalapril and AKI may also have induced hyperkalemia in this patient. Furthermore, the patient developed hyperphosphatemia due to his worsening kidney function, exacerbated by regularly taking some dietary supplements containing high levels of phosphate. His serum levels of potassium and phosphate returned to normal within a week, once the patient stopped both the puree and all dietary supplements, and had begun receiving treatment for hyperkalemia. Results The mixed fruit and herb puree taken by this man may have led to his diarrhea due to its effect; particularly if the patient was taking a high concentration of such a drink. Both the puree and enalapril are likely to attenuate the progression of kidney function. The causal relationship between the puree and AKI was probable (5 scores) assessed by the modified Naranjo algorithm. This is the first case report, as far as the authors are aware, relating the drinking of a mixed fruit and herbal puree to diarrhea and AKI in a patient with diabetes. Conclusions This case can alert health care providers to the possibility that herbal medicine could induce diarrhea and develop acute kidney injury.

The effect of aqueous Elaeagnus angustifolia extract on acute non-inflammatory diarrhea in 1-5 year old children

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Khoshdel Abofazl

2014-01-01

Full Text Available Introduction: Acute diarrhea is one of the most important causes of global childhood mortality and morbidity. The most common complication of acute diarrhea is dehydration. The aim of this study was to evaluate the use of aqueous Elaeagnus angustifolia extract in controlling non-inflammatory diarrhea in a hospital setting. Methods: In this case–controlled randomized double blind clinical trial 80 children in age range of 1-5 years were admitted in pediatric ward with diagnosis of non-inflammatory diarrhea. The patients were randomly divided into two equal groups of 40 cases. The subject in the first group received aqueous Elaeagnus angustifolia extract, 1.2 ml/Kg single dose for 4 days duration and the second group (control group 1.2 cm/Kg distilled water single dose for 4 days duration. Data analysis were performed by Chi-square and t-tests, using SPSS software. Results: The groups were similar regarding gender, mean age, and frequency, and consistency of defecation (p> 0.05. Although the children seemed better in regard to frequency and consistency of defecation, however the results showed that aqueous extract of Elaeagnus angustifolia was not significantly effective in the treatment of non-inflammatory diarrhea. Conclusion: The results of this study demonstrated that the use of aqueous extract of Elaeagnus angustifolia was not effective in the treatment of non-inflammatory diarrhea in children.

Polymer-based oral rehydration solution for treating acute watery diarrhoea

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Gregorio, Germana V; Gonzales, Maria Liza M; Dans, Leonila F; Martinez, Elizabeth G

2016-01-01

Background Acute diarrhoea is one of the main causes of morbidity and mortality among children in low-income countries. Glucose-based oral rehydration solution (ORS) helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization (WHO) has recommended the osmolarity of less than 270 mOsm/L (ORS ≤ 270) versus greater than 310 mOsm/L formulation (ORS ≥ 310). Polymer-based ORS (for example, prepared using rice or wheat) slowly releases glucose and may be superior to glucose-based ORS. Objectives To compare polymer-based oral rehydration solution (polymer-based ORS) with glucose-based oral rehydration solution (glucose-based ORS) for treating acute watery diarrhoea. Search methods We searched the following sources up to 5 September 2016: the Cochrane Infectious Diseases Group (CIDG) Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (1966 to 5 September 2016), EMBASE (1974 to 5 September 2016), LILACS (1982 to 5 September 2016), and mRCT (2007 to 5 September 2016). We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists. Selection criteria We included randomized controlled trials (RCTs) of people with acute watery diarrhoea (cholera and non-cholera associated) that compared polymer-based and glucose-based ORS (with identical electrolyte contents). Data collection and analysis Two review authors independently assessed the search results and risk of bias, and extracted data. In multiple-treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group. Main results Thirty-five trials that included 4284 participants met the inclusion criteria: 28 trials exclusively included children, five included adults, and two included both adults and children. Polymer-based ORS versus glucose-based ORS (osmolarity ≤ 270) Eight trials

Probiotics do not improve the benefits of a hospital treatment protocol for acute diarrhea in the breastfed child.

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Sergio Santana Porbén

2016-11-01

Full Text Available Rationale: Probiotics have been used in the treatment of acute diarrhea occurring in pediatric ages with mixed results. Objective: To assess the impact of a probiotic (CFU per capsule: Lactobacillus rhamnosus G: 2 x 109, Lactobacillus cassei: 1 x 109, Bifidobacterium brevis: 2 x 109 upon the features and duration of acute diarrhea in breastfed children. Study location: Digestive Diseases and Nutrition Service, “Juan Manuel Márquez” Pediatric Teaching Hospital (Marianao, Havana City, Cuba. Study design: Open, quasi-experimental trial. Thirty children with ages 0.05; Improvement of the features of stools: Non-Treated: 93.3% vs. Treated: 96.1% (p > 0.05. Use of probiotics produced an increase of Hemoglobin ( = -0.44; p 0.05 values of indicators of systemic inflammatory response. Conclusions: Inclusion of probiotics within an institutional protocol for treatment of acute diarrhea does not significantly change the stool pattern of the breastfed child, but might reduce the systemic inflammatory tone which, in turn, would result in a better use of body iron.

Clinical benefits of probiotic canine-derived Bifidobacterium animalis strain AHC7 in dogs with acute idiopathic diarrhea.

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Kelley, R L; Minikhiem, Debbie; Kiely, Barry; O'Mahony, Liam; O'Sullivan, David; Boileau, Tom; Park, Jean Soon

2009-01-01

This study evaluated the effect of supplementation with canine-derived probiotic Bifidobacterium animalis strain AHC7 (lams Prostora, Procter & Gamble Pet Care) on the resolution rate of acute idiopathic diarrhea in dogs randomly assigned to receive a placebo (n=18) or the probiotic (n=13). Nutritional management with the probiotic fed at 2 x 10(10) CFU/day significantly reduced the time to resolution (3.9 +/- 2.3 versus 6.6 +/- 2.7 days; P dogs that were administered metronidazole (38.5% versus 50.0%) compared with placebo. Probiotic B. animalis AHC7 may provide veterinarians another tool for management of acute diarrhea in dogs.

DIARRHEA IN CHILDREN: MAIN CAUSES AND WAYS OF TREATMENT

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S.V. Bel’mer

2010-01-01

Full Text Available The article discusses main questions of diagnostics of diarrhea in children. Main cause of acute diarrhea is infection, mainly viral (rotavirus, etc.. Chronic diarrhea frequently has non-infectious origin. The need of multi-aspect diagnostics of diarrhea cause in children is related to the significance of treatment of main disease. Besides, treatment of chronic and acute diarrhea include major component: adsorbents based on smectite. In total treatment of diarrhea has to be complex with the use of dietotherapy and medications: mucocytoprotectors, regulators of motoric, pre- and probiotics.Key words: children, diarrhea, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(6:135-138

Colopancreatic Fistula: An Uncommon Complication of Recurrent Acute Pancreatitis

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Mouhanna Abu Ghanimeh

2018-01-01

Full Text Available Colonic complications, including colopancreatic fistulas (CPFs, are uncommon after acute and chronic pancreatitis. However, they have been reported and are serious. CPFs are less likely to close spontaneously and are associated with a higher risk of complications. Therefore, more definitive treatment is required that includes surgical and endoscopic options. We present a case of a 62-year-old male patient with a history of heavy alcohol intake and recurrent acute pancreatitis who presented with a 6-month history of watery diarrhea and abdominal pain. His abdominal imaging showed a possible connection between the colon and the pancreas. A further multidisciplinary workup by the gastroenterology and surgery teams, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and colonoscopy, resulted in a diagnosis of CPF. A distal pancreatectomy and left hemicolectomy were performed, and the diagnosis of CPF was confirmed intraoperatively. The patient showed improvement afterward.

Clinical characteristics of rotavirus diarrhea in hospitalized Romanian infants.

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Lesanu, Gabriela; Becheanu, Cristina Adriana; Vlad, Raluca Maria; Pacurar, Daniela; Tincu, Iulia Florentina; Smadeanu, Roxana Elena

2013-01-01

Clinical characteristics of rotavirus enteritis were evaluated by comparison with acute diarrhea of other etiologies. We reviewed the medical records of children (aged 0-12 months) admitted with acute diarrhea in our hospital between January and December 2011. Of the 839 patients, 49.3% had rotavirus diarrhea. The incidence of severe disease was significantly higher for rotavirus diarrhea (65.2%, P < 0.01) than for other types of diarrheal disease.

[Persistent diarrhea

Science.gov (United States)

Andrade, J A; Moreira, C; Fagundes Neto, U

2000-07-01

INTRODUCTION: Persistent diarrhea has high impact on infantile morbidity and mortality rates in developing countries. Several studies have shown that 3 to 20% of acute diarrheal episodes in children under 5 years of age become persistent. DEFINITION: Persistent diarrhea is defined as an episode that lasts more than 14 days. ETIOLOGY: The most important agents isolated in persistent diarrhea are: Enteropathogenic E. coli (EPEC), Salmonella, Enteroaggregative E. coli (EAEC), Klebisiella and Cryptosporidium. CLINICAL ASPECTS: In general, the clinical characteristics of patients with persistent diarrhea do not change with the pathogenic agent. Persistent diarrhea seems to represent the final result of a several insults a infant suffers that predisposes to a more severe episode of diarrhea due to a combination of host factors and high rates of enviromental contamination. Therefore, efforts should be made to promptly treat all episodes of diarrhea with apropriate follow-up. THERAPY: The aim of the treatment is to restore hydroelectrolytic deficits and to replace losses until the diarrheal ceases. It is possible in the majority of the cases, using oral rehydration therapy and erly an appropriate type of diet. PREVENTION: It is imperative that management strategies also focus on preventive aspects. The most effective diarrheal prevention strategy in young infants worldwide is promotion of exclusive breast feeding.

Detection and Molecular Characterization of Human Adenovirus Infections among Hospitalized Children with Acute Diarrhea in Shanghai, China, 2006–2011

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Lijuan Lu

2017-01-01

Full Text Available Background: Human adenovirus (HAdV is considered a significant enteropathogen associated with sporadic diarrhea in children. However, limited data are available regarding the epidemiology of HAdV in hospitalized children with viral diarrhea in Shanghai. The aim of this study was to characterize the epidemiology of HAdVs and describe their association with acute diarrhea in hospitalized children. Methods: A total of 674 fecal samples were subjected to PCR or RT-PCR to detect RVA, HuCV, HAstV, and HAdV. Results: HAdV infections were detected in 4.7% (32/674 of specimens, with detection rates of 13.4% (11/82, 4.6% (8/174, 3.2% (4/124, 4.1% (3/74, 2.0% (2/100, and 3.3% (4/120 from 2006 to 2011, respectively. Comprehensive detection of the four viruses revealed the presence of a high percentage (90.6% of coinfections among HAdV-positive samples, where HAdV+RVA was the most prevalent coinfection. Of the 32 HAdV-positive samples, 50.0% (16/32 were classified as HAdV-41, and 18.8% (6/32 were classified as HAdV-3. Almost 94.0% of children infected with HAdV were less than 24 months of age. Conclusions: These results clearly indicated diversity across the HAdV genotypes detected in inpatient children with acute diarrhea in Shanghai and suggested that HAdVs play a role in children with acute diarrhea.

COMPLEX TREATMENT OF DIARRHEA IN CHILDREN

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E.G. Tsimbalova

2010-01-01

Full Text Available The article presents modern data on syndrome of acute diarrhea in children, its etiology and mechanisms of development of different types of this disease, its clinical symptoms, differential diagnosis, laboratory and instrumental methods of diagnostics. Author gives review of pathogenetic treatment and opportunities of therapy with enterosorbates, taking into account etiology of diarrhea. Another chapter of the article describes opportunities and methods of oral hydration depending of extent of exicosis. Key words: acute diarrhea, children, etiology, pathogenesis, clinical symptoms, etiotropic therapy, enterosorbates, oral hydration.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(5:111-1116

Acute Portomesenteric Venous Thrombosis following Laparoscopic Small Bowel Resection and Ventral Hernia Repair

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Bhradeev Sivasambu

2015-01-01

Full Text Available Acute portomesenteric venous thrombosis is a rare but life-threatening complication of laparoscopic surgery that has been described in literature. Prompt diagnosis and early initiation of treatment are vital to prevent life-threatening complications such as mesenteric ischemia and infarction. A 51-year-old lady had laparoscopic small bowel resection and primary anastomosis with ventral hernia repair 4 weeks earlier for partial small bowel obstruction. Her postoperative period was uneventful and she was discharged home. Four weeks after surgery she developed watery diarrhea and generalized abdominal pain for four-day duration. A computed tomography of the abdomen revealed portomesenteric venous thrombosis although a computed tomography of abdomen before surgery 4 weeks back did not show any portomesenteric venous thrombosis. We are reporting a case of acute portomesenteric venous thrombosis as a complication of laparoscopic surgery.

Impact of Childhood Nutritional Status on Pathogen Prevalence and Severity of Acute Diarrhea.

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Tickell, Kirkby D; Pavlinac, Patricia B; John-Stewart, Grace C; Denno, Donna M; Richardson, Barbra A; Naulikha, Jaqueline M; Kirera, Ronald K; Swierczewski, Brett E; Singa, Benson O; Walson, Judd L

2017-11-01

Children with acute and chronic malnutrition are at increased risk of morbidity and mortality following a diarrheal episode. To compare diarrheal disease severity and pathogen prevalence among children with and without acute and chronic malnutrition, we conducted a cross-sectional study of human immunodeficiency virus-uninfected Kenyan children aged 6-59 months, who presented with acute diarrhea. Children underwent clinical and anthropometric assessments and provided stool for bacterial and protozoal pathogen detection. Clinical and microbiological features were compared using log binomial regression among children with and without wasting (mid-upper arm circumference ≤ 125 mm) or stunting (height-for-age z score ≤ -2). Among 1,363 children, 7.0% were wasted and 16.9% were stunted. After adjustment for potential confounders, children with wasting were more likely than nonwasted children to present with at least one Integrated Management of Childhood Illness danger sign (adjusted prevalence ratio [aPR]: 1.3, 95% confidence interval [CI]: 1.0 to 1.5, P = 0.05), severe dehydration (aPR: 2.4, 95% CI: 1.5 to 3.8, P malnutrition which may be explained by a delay in care-seeking or diminished immune response to infection. Combating social determinants and host risk factors associated with severe disease, rather than specific pathogens, may reduce the disparities in poor diarrhea-associated outcomes experienced by malnourished children.

Control of radiation-induced diarrhea with cholestyramine

International Nuclear Information System (INIS)

Heusinkveld, R.S.; Manning, M.R.; Aristizabal, S.A.

1978-01-01

Cholestyramine is a non-absorbable ion-exchange resin which specifically binds bile salts. We have treated seven patients with acute or chronic radiation-induced diarrhea that was refractory to the usual methods of control with cholestyramine. In each case, the diarrhea was controlled with cholestyramine. This observation supports previous experimental work with animals which indicated that bile salts contribute to the genesis of radiation-induced diarrhea. Cholestyramine is well-tolerated, but should not be administered with certain oral medications. The results of this small series are preliminary, but point the way toward a more extensive clinical trial to define the usefulness of cholestyramine in the treatment of refractory acute or chronic radiation-induced diarrhea

Enteral Formula Containing Egg Yolk Lecithin Improves Diarrhea.

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Akashi, Tetsuro; Muto, Ayano; Takahashi, Yayoi; Nishiyama, Hiroshi

2017-09-01

Diarrhea often occurs during enteral nutrition. Recently, several reports showed that diarrhea improves by adding egg yolk lecithin, an emulsifier, in an enteral formula. Therefore, we evaluated if this combination could improve diarrhea outcomes. We retrospectively investigated the inhibitory effects on watery stools by replacing a polymeric fomula with that containing egg yolk lecithin. Then, we investigated the emulsion stability in vitro. Next, we examined the lipid absorption using different emulsifiers among bile duct-ligated rats and assessed whether egg yolk lecithin, medium-chain triglyceride, and dietary fiber can improve diarrhea outcomes in a rat model of short bowel syndrome. Stool consistency or frequency improved on the day after using the aforementioned combination in 13/14 patients. Average particle size of the egg yolk lecithin emulsifier did not change by adding artificial gastric juice, whereas that of soy lecithin and synthetic emulsifiers increased. Serum triglyceride concentrations were significantly higher in the egg yolk lecithin group compared with the soybean lecithin and synthetic emulsifier groups in bile duct-ligated rats. In rats with short bowels, the fecal consistency was a significant looser the dietary fiber (+) group than the egg yolk lecithin (+) groups from day 6 of test meal feedings. The fecal consistency was also a significant looser the egg yolk lecithin (-) group than the egg yolk lecithin (+) groups from day 4 of test meal feeding. The fecal consistency was no significant difference between the medium-chain triglycerides (-) and egg yolk lecithin (+) groups. Enteral formula emulsified with egg yolk lecithin promotes lipid absorption by preventing the destruction of emulsified substances by gastric acid. This enteral formula improved diarrhea and should reduce the burden on patients and healthcare workers.

Clinical Efficacy Comparison of Saccharomyces boulardii and Yogurt Fluid in Acute Non-Bloody Diarrhea in Children: A Randomized, Controlled, Open Label Study

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Eren, Makbule; Dinleyici, Ener C.; Vandenplas, Yvan

2010-01-01

The purpose of this trial is to evaluate the clinical efficacy and cost/effectiveness of Saccharomyces boulardii compared with yogurt fluid (YF) in acute non-bloody diarrhea in children. This randomized, prospective open-label clinical trial includes 55 children (36 boys, 19 girls; mean age 21.2 ± 28.2 months). Group A (N = 28) received lyophilized S. boulardii and group B (N = 27) received YF. The duration of diarrhea was shorter with S. boulardii but the hospital stay was reduced with YF, although these differences were not significant. However, diarrhea had resolved in significantly more children on day 3 in the S. boulardii group (48.5% versus 25.5%; P < 0.05). In outpatient cases, yogurt treatment was cheaper than S. boulardii whereas in hospitalized patients, treatment cost was similar. In conclusion, the effect of daily freshly prepared YF was comparable to S. boulardii in the treatment of acute non-bloody diarrhea in children. The duration of diarrhea was shorter in the S. boulardii group, expressed as a significantly higher number of patients with normal stools on day 3. PMID:20207879

Clinical efficacy comparison of Saccharomyces boulardii and yogurt fluid in acute non-bloody diarrhea in children: a randomized, controlled, open label study.

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Eren, Makbule; Dinleyici, Ener C; Vandenplas, Yvan

2010-03-01

The purpose of this trial is to evaluate the clinical efficacy and cost/effectiveness of Saccharomyces boulardii compared with yogurt fluid (YF) in acute non-bloody diarrhea in children. This randomized, prospective open-label clinical trial includes 55 children (36 boys, 19 girls; mean age 21.2 +/- 28.2 months). Group A (N = 28) received lyophilized S. boulardii and group B (N = 27) received YF. The duration of diarrhea was shorter with S. boulardii but the hospital stay was reduced with YF, although these differences were not significant. However, diarrhea had resolved in significantly more children on day 3 in the S. boulardii group (48.5% versus 25.5%; P boulardii whereas in hospitalized patients, treatment cost was similar. In conclusion, the effect of daily freshly prepared YF was comparable to S. boulardii in the treatment of acute non-bloody diarrhea in children. The duration of diarrhea was shorter in the S. boulardii group, expressed as a significantly higher number of patients with normal stools on day 3.

DIAGNOSTICS AND THERAPY IN CHILDREN'S ACUTE GASTROENTERITIS

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M.D. Bakradze

2007-01-01

Full Text Available The work aimed at studying a series of diagnostic aspects and determination of the possible treatment of children with acute gastroenetrites according to the protocol based on international recommendations and standards. The study involved 130 children, of whom in 71 patients the presence of rotavirus antigen in coprofilters was checked via latex particle agglutination method. In 85% rotavirus infection was confirmed. It was shown that the majority of cases fall on November to may. Infant and early children are the most susceptible to rotavirus gastroenteritis. The analysis of therapy results showed that antibioticsfree treatment of watery diarrhea patients worked well, and prescription of antibacterial therapy for the concomitant bacterial infection does not influence the time of gastroenteritis reduction. The results of dehydration therapy show that oral rehydration is not always effective for the 2nd stage dehydration, especially with late treatment. However, the time of recovery (diarrhea reduction does not depend on the type of rehydration or symptomatic therapy. A diagnostic algorithm that helps use the minimum diagnostic methods in stationary conditions and at the same time provides the optimum scope of therapeutic intervention was worked out.Key words: rotavirus infection, children, rehydration, antibacterial therapy.

[Efficacy of racecadotril vs. smectite, probiotics or zinc as an integral part of treatment of acute diarrhea in children under five years: A meta-analysis of multiple treatments].

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Gutiérrez-Castrellón, Pedro; Ortíz-Hernández, Anna Alejandra; Llamosas-Gallardo, Beatriz; Acosta-Bastidas, Mario A; Jiménez-Gutiérrez, Carlos; Diaz-García, Luisa; Anzo-Osorio, Anahí; Estevez-Jiménez, Juliana; Jiménez-Escobar, Irma; Vidal-Vázquez, Rosa Patricia

2015-01-01

Despite major advances in treatment, acute diarrhea continues to be a public health problem in children under five years. There is no systematic approach to treatment and most evidence is assembled comparing active treatment vs. placebo. Systematic review of evidence on efficacy of adjuvants for treatment of acute diarrhea through a network meta-analysis. A systematic search of multiple databases searching clinical trials related to the use of racecadotril, smectite, Lactobacillus GG, Lactobacillus reuteri, Saccharomyces boulardii and zinc as adjuvants in acute diarrhea was done. The primary endpoint was duration of diarrhea. Information is displayed through network meta-analysis.The superiority of each coadjutant was analyzed by Sucra approach. Network meta-analysis showed race cadotril was better when compared with placebo and other adjuvants. Sucra analysis showed racecadotril as the first option followed by smectite and Lactobacillus reuteri. Considering a strategic decision making approach, network meta-analysis allows us to establish the therapeutic superiority of racecadotril as an adjunct for the comprehensive management of acute diarrhea in children aged less than five years.

Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

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Modi, Payal; Glavis-Bloom, Justin; Nasrin, Sabiha; Guy, Allysia; Chowa, Erika P; Dvor, Nathan; Dworkis, Daniel A; Oh, Michael; Silvestri, David M; Strasberg, Stephen; Rege, Soham; Noble, Vicki E; Alam, Nur H; Levine, Adam C

2016-01-01

Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy. To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children. A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity. 850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor. Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

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Payal Modi

Full Text Available Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b. Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60, sensitivity (67%, and specificity (49%, for predicting severe dehydration were all poor.Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

The Genetic Diversity and Phylogenetic Characteritics of Rotavirus VP4(P Genotypes in Children With Acute Diarrhea

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Haghshenas Z

2011-11-01

Full Text Available Background: Acute gastroenteritis is a major cause of morbidity and mortality among children in developing countries. Rotaviruses are recognized as the most common etiologic factors of gastroenteritis. In this study, we determined the epidemiologic features, clinical symptoms and molecular structure of rotavirus VP4(P genotypes in children with acute diarrhea in Bahrami Hospital in Tehran Iran, during 2009 for justifying the routine use of rotavirus vaccines in children. Methods: One hundred fifty fecal samples from 150 children with acute diarrhea in Bahrami Pediatric Hospital in Tehran, Iran were collected from January to December 2009. The patients’ mean age was 20.90+18.19 years (ranging from 1 month to 14 years. Fecal samples were transported on ice to the laboratory of virology department of Pasture Institute of Iran. The demographic and clinical data for each case were entered in an author-devised questionnaire. Group A rotavirus was detected by dsRNA-PAGE. Subsequently, rotavirus genotyping (VP4 was performed by semi-nested multiple RT-PCR and the phylogenetic tree of the Rotavirus nucleotides was constructed. The data were analyzed by statistical tests including Wilcoxon signed and Mann-Whitney U. Results: Rotavirus was isolated in 19.3% of the samples, more than 90% of which had long RNA patterns. The predominant genotype (VP4 was P[8] (86% and other genotypes respectively were P[6] (6.9% and P[4] (6.9%. Conclusion: A high prevalence of the P[8] genotype was found to be the cause of acute diarrhea. The analysis of P[8] genotype sequence showed a high level of similarity of the virus in this study with those of other Asian countries.

Clinical Efficacy Comparison of Saccharomyces Boulardii and Lactic Acid as Probiotics in Acute Pediatric Diarrhea.

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Asmat, Shakila; Shaukat, Fouzia; Asmat, Raheela; Bakhat, Hafiz Faiq Siddique Gul; Asmat, Tauseef M

2018-03-01

To compare the efficacy of Saccharomyces boulardii and lactic acid producing probiotics in addition to usual treatment regimen to cure diarrhea among children (6 months to 5 years of age). Randomized controlled trial. Department of Pediatrics, Sheikh Zayed Hospital, Lahore, from February to July 2015. Children suffering from acute diarrhea were orally administered Saccharomyces boulardii and lactic acid producing probiotics for 5 days. The efficacy of administered probiotics was monitored. Patients were given Saccharomyces boulardii and lactic acid producing probiotics randomly to remove the bias. Two hundred patients randomly selected for trials; out of which, 100 were treated with Saccharomyces boulardii while the other 100 were supplemented with lactic acid concomitantly along with conventional diarrhea treatment. Results indicated that Saccharomyces boulardii treatment group has significantly higher efficacy rate (45%) compared to lactic acid producing probiotics (26%). This study concluded that Saccharomyces boulardii has a better efficacy compared to lactic acid and may be adopted as a probiotic of choice.

Nutritional Management of Acute Diarrhea in Infants and Children.

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National Academy of Sciences-National Research Council, Washington, DC. Food and Nutrition Board.

Written primarily for health professionals advising on programs and policy related to nutrition and diarrhea therapy, this report is aimed at management of diarrhea in less-developed countries, but its information and technical insights are relevant to an understanding of diarrhea and its management throughout the world. Technical in orientation…

Intestinal ameliorative effects of traditional Ogi-tutu, Vernonia ...

African Journals Online (AJOL)

Background: Cholera, a severe acute watery diarrhea caused by Vibrio cholerae is endemic in Nigeria with most cases occurring in the rural areas. In South West Nigeria, some individuals resort to alternative treatments such as Ogi-tutu, Psidium guajava and Vernonia amygdalina during infections. The effectiveness of ...

Ringers lactate vs Normal saline for children with acute diarrhea and severe dehydration- a double blind randomized controlled trial.

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Mahajan, Vidushi; Sajan, Shiv Saini; Sharma, Amit; Kaur, Jasbinder

2012-12-01

WHO recommends Ringers lactate (RL) and Normal Saline (NS) for rapid intravenous rehydration in childhood diarrhea and severe dehydration. We compared these two fluids for improvement in pH over baseline during rapid intravenous rehydration in children with acute diarrhea. Double-blind randomized controlled trial Pediatric emergency facilities at a tertiary-care referral hospital. Children with acute diarrhea and severe dehydration received either RL (RL-group) or NS (NS-group), 100 mL/kg over three or six hours. Children were reassessed after three or six hours. Rapid rehydration was repeated if severe dehydration persisted. Blood gas was done at baseline and repeated after signs of severe dehydration disappeared. Primary outcome was change in pH from baseline. Secondary outcomes included changes in serum electrolytes, bicarbonate levels, and base-deficit from baseline; mortality, duration of hospital stay, and fluids requirement. Twenty two children, 11 each were randomized to the two study groups. At primary end point (disappearance of signs of severe dehydration), the improvement in pH from baseline was not significant in RL-group [from 7.17 (0.11) to 7.28 (0.09)] as compared to NS-group [7.09 (0.11) to 7.21 (0.09)], P=0.17 (after adjusting for baseline serum Na/ Cl). Among this limited sample size, children in RL group required less fluids [median 310 vs 530 mL/kg, P=0.01] and had shorter median hospital stay [38 vs 51 hours, P=0.03]. There was no difference in improvement in pH over baseline between RL and NS among children with acute diarrhea and severe dehydration.

Diarrhea is a Major killer of Children with Severe Acute Malnutrition Admitted to Inpatient Set-up in Lusaka, Zambia

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Mwambazi Mwate

2011-10-01

Full Text Available Abstract Introduction Mortality of children with Severe Acute Malnutrition (SAM in inpatient set-ups in sub-Saharan Africa still remains unacceptably high. We investigated the prevalence and effect of diarrhea and HIV infection on inpatient treatment outcome of children with complicated SAM receiving treatment in inpatient units. Method A cohort of 430 children aged 6-59 months old with complicated SAM admitted to Zambia University Teaching Hospital's stabilization centre from August to December 2009 were followed. Data on nutritional status, socio-demographic factors, and admission medical conditions were collected up on enrollment. T-test and chi-square tests were used to compare difference in mean or percentage values. Logistic regression was used to assess risk of mortality by admission characteristics. Results Majority, 55.3% (238/430 were boys. The median age of the cohort was 17 months (inter-quartile range, IQR 12-22. Among the children, 68.9% (295/428 had edema at admission. The majority of the children, 67.3% (261/388, presented with diarrhea; 38.9% (162/420 tested HIV positive; and 40.5% (174/430 of the children died. The median Length of stay of the cohort was 9 days (IQR, 5-14 days; 30.6% (53/173 of the death occurred within 48 hours of admission. Children with diarrhea on admission had two and half times higher odds of mortality than those without diarrhea; Adjusted OR = 2.5 (95% CI 1.50-4.09, P Conclusion Diarrhea is a major cause of complication in children with severe acute malnutrition. Under the current standard management approach, diarrhea in children with SAM was found to increase their odds of death substantially irrespective of other factors.

Characterization of thymus-associated lymphoid depletion in bovine calves acutely or persistently infected with bovine viral diarrhea virus 1, bovine viral diarrhea 2 or HoBi-like pestivirus

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Viruses from recognized pestivirus species bovine viral diarrhea 1 (BVDV-1) and BVDV-2 and the proposed pestivirus species HoBi-like virus infect primarily cattle. Exposure of cattle to these viruses can lead to either acute or persistent infections depending on the timing and status of the animal ...

[Diarrhea, from the gastroenterologist's point of view].

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Bajor, Judit; Beró, Tamás

2009-08-30

Patients seeking help from gastroenterologist have frequent complaints of changes in the quality and quantity of stool as well in the frequency of bowel movements. Definition of diarrhea includes: more than three bowel movements daily, more than 200 grams of the stool daily, and its water content exceeding 75-85%. Diarrhea lowers the quality of life and can be a sign of organic disease. Its course can be acute and chronic. According to the pathomechanism, diarrheas can be divided into four different types: exudative (inflammatory), osmotic, dismotility and secretory. Acute diarrheas are usually infective, and sometimes they result in very serious conditions. Their course runs from a few days to a couple of weeks. If diarrhea persists more than four weeks, it is the chronic variant and it justifies gastroenterological examination. During the evaluation, we have to think of endocrine, autoimmune, allergic, postoperative states and the side effect of medications beside primer gastroenterological causes. To differentiate from a number of wide scale of clinical pictures and to reach the correct diagnosis, we are aided by the characteristics of diarrhea, the accompanying symptoms, laboratory values and invasive examinations. With the present summary, we would like to give a guide to the practicing physicians, mainly with a symptom-oriented approach.

Reduction in Diarrhea- and Rotavirus-related Healthcare Visits Among Children Introduction in Zimbabwe.

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Mujuru, Hilda A; Yen, Catherine; Nathoo, Kusum J; Gonah, Nhamo A; Ticklay, Ismail; Mukaratirwa, Arnold; Berejena, Chipo; Tapfumanei, Ottias; Chindedza, Kenneth; Rupfutse, Maxwell; Weldegebriel, Goitom; Mwenda, Jason M; Burnett, Eleanor; Tate, Jacqueline E; Parashar, Umesh D; Manangazira, Portia

2017-10-01

In Zimbabwe, rotavirus accounted for 41%-56% of acute diarrhea hospitalizations before rotavirus vaccine introduction in 2014. We evaluated rotavirus vaccination impact on acute diarrhea- and rotavirus-related healthcare visits in children. We examined monthly and annual acute diarrhea and rotavirus test-positive hospitalizations and Accident and Emergency Department visits among children introduction (2012-2013) with postvaccine introduction (2015 and 2016) data for 2 of the hospitals. We examined monthly acute diarrhea hospitalizations by year and age group for 2013-2016 from surveillance hospital registers and monthly acute diarrhea outpatient visits reported to the Ministry of Health and Child Care during 2012-2016. Active surveillance data showed winter seasonal peaks in diarrhea- and rotavirus-related visits among children introduction; the percentage of rotavirus test-positive visits followed a similar seasonal pattern and decrease. Hospital register data showed similar pre-introduction seasonal variation and post-introduction declines in diarrhea hospitalizations among children 0-11 and 12-23 months of age. Monthly variation in outpatient diarrhea-related visits mirrored active surveillance data patterns. At 2 surveillance hospitals, the percentage of rotavirus-positive visits declined by 40% and 43% among children 0-11 months of age and by 21% and 33% among children 12-23 months of age in 2015 and 2016, respectively. Initial reductions in diarrheal illness among children introduction are encouraging. These early results provide evidence to support continued rotavirus vaccination and rotavirus surveillance in Zimbabwe.

Prevalence of Aeromonas Hydrophila and Yersinia Enterocolitica in Children with Acute Diarrhea Attending Health Centers in Hamadan

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S. Kazemi

2016-01-01

Full Text Available Introduction & Objective: Diarrhea is the most common cause of morbidity and mortality in all age groups, especially children, the elderly and immunocompromised patients. Various studies have been reported regarding the relationship between the children acute diarrhea and Aeromonashydrophila and Yersinia enterocolitica. This study aimed to investigate the prevalence of the bacteria and their sensitivity to common antibiotics and the prevalence of virulence genes in the bacteria in Hamadan, Iran. Materials & Methods: In this study, 120 stool samples collected from children less than 10 years of age with acute diarrhea were examined for Aeromonashydrophila and Yersinia enterocolitica. Identification of the bacteria was performed by biochemical reactions and PCR using 16S rRNA genes. Moreover, the prevalence of virulence genes earA and hyl of Aeromonashydrophila and ail and ystB genes of Yersinia enterocolitica were investigated using PCR. Antibiotic susceptibility of isolated bacteria was performed by disk diffusion method. Results: Out of 120 stool samples, 2 (1.7 % Aeromonashydrophila and 3 (2.5% Yersinia enterocolitica were isolated. All isolates of Aeromonashydrophila were sensitive to the chloramphenicol, co-trimoxazole, gentamicin, meropenem, amikacin and 50% of isolates were sensitive to the ceftriaxone and azithromycin. All Aeromonashydrophila isolates were resistant to erythromycin. All isolates of Yersinia enterocolitica were sensitive to the chloramphenicol, co-trimoxazole and meropenem. The 33.3% of the isolates were sensitive to gentamicin and amikacin and 66.6% of them were susceptible to ceftriaxone. However, all of Yersinia enterocolitica isolates were resistant to erythromycin and azithromycin. The prevalence aerA and hyl genes in Aeromonashydrophila were reported 100% and 50%, respectively. The prevalence of ail and ystB genes in Yersinia enterocolitica was reported as 66.6%. Conclusions: Identification and analysis of

Following Watery Relations in Early Childhood Pedagogies

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Pacini-Ketchabaw, Veronica; Clark, Vanessa

2016-01-01

Working methodologically and theoretically with the hydro-logics of bodies of water, this article addresses the limitations of humanistic perspectives on water play in early childhood classrooms, and proposes pedagogies of watery relations. The article traces the fluid, murky, surging, creative, unpredictable specificities of bodies of water that…

Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea

DEFF Research Database (Denmark)

Rosenfeldt, Vibeke; Michaelsen, Kim Fleischer; Jakobsen, Mogens

2002-01-01

intervention, the length of hospitalization was reduced by 48% (3.5 vs. 1.7 days, P = 0.03). At the end of the intervention, rotavirus antigen was found in 12% of patients from the treatment group vs. 46% from the control group (P = 0.02). CONCLUSIONS: The two probiotics, L. rhamnosus 19070-2 and L. reuteri...... DSM 12246, ameliorated acute diarrhea in hospitalized children and reduced the period of rotavirus excretion. Oral bacteriotherapy was associated with a reduced length of hospital stay. The beneficial effects were most prominent in children treated early in the diarrheal phase....

Prevalence and factors associated with rotavirus infection among children admitted with acute diarrhea in Uganda

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Mworozi Edison A

2010-09-01

Full Text Available Abstract Background Rotavirus remains the commonest cause of severe dehydrating diarrhea among children worldwide. Children in developing countries die more because of several factors including poorer access to hydration therapy and greater prevalence of malnutrition. Hitherto, the magnitude of rotavirus disease in Uganda has remained unknown. This study was therefore done to determine the prevalence and factors associated with rotavirus infection among children aged 3-59 months admitted with acute diarrhea to paediatric emergency ward of Mulago Hospital, Uganda Methods Three hundred and ninety children, aged between 3-59 months with acute diarrhoea were recruited. The clinical history, socio-demographic characteristics, physical examination findings and laboratory investigations were recorded. Stool samples were tested for rotavirus antigens using the DAKO IDEIA rotavirus EIA detection kit. Results The prevalence of rotavirus infection was 45.4%. On multivariate analysis rotavirus was significantly associated with a higher education (above secondary level of the mother [OR 1.8; 95% CI 1.1-2.7]; dehydration [OR 1.8; 95% CI 1.1-3.0] and breastfeeding [OR 2.6; 95% CI 1.4-4.0]. Although age was significantly associated with rotavirus on bivariate analysis; this association disappeared on multivariate analysis. No significant association was found between rotavirus infection and nutritional status, HIV status and attendance of day care or school. Conclusions Rotavirus infection is highly prevalent among children with acute diarrhoea admitted to Mulago Hospital in Uganda.

Evaluation of WHO Criteria to Determine Degree of Dehydration in Children with Acute Diarrhea

OpenAIRE

Sari, Suprawita; Supriatmo; Margaretha, S. L.; Nafianti, S.; Hasibuan, B.; Sinuhaji, A. B.

2005-01-01

Objective To evaluate the diagnostic accuracy and agreement between the 1980 and 1990 WHO criteria for determining the degree of dehydration in children with acute diarrhea. Methods This prospective study was conducted in two hospitals from October 2002 to February 2003. Clinical signs of dehydration all patients were recorded. The degree of dehydration based on the 1980 and 1990 WHO criteria was determined and compared with fluid deficit measured by the difference of body weight on admiss...

The role of probiotics in the prevention and treatment of childhood infectious diarrhea

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Maria Maragkoudaki

2013-10-01

Full Text Available Probiotics are beneficial bacteria that colonize and replicate in the human intestinal tract providing a positive benefit to the host. Several clinical trials support the efficacy of certain probiotics in the prevention and treatment of various diarrheal illnesses. This paper reviews published clinical trials assessing the efficacy of various probiotic species and strains in preventing and treating acute diarrhea in children. The available evidence shows that few probiotic species (mostly Lactobacillus GG and Saccharomyces boulardii are efficacious in decreasing the duration and the severity of acute gastroenteritis, with the most prominent of the reported benefits, the reduction of the duration of diarrhea by approximately 1 day. With regard to the prevention of acute diarrhea in the community and the hospital, there is modest evidence that some probiotic species may be efficacious in preventing community acquired diarrhea (Bifidobacterium lactis, Lactobacillus reuteri, Lactobacillus GG, nosocomial acquired diarrhea (Lactobacillus GG and Clostridium difficile diarrhea (Lactobacillus GG and Saccharomyces boulardii. In conclusion, the available evidence suggests that probiotics are safe when used in healthy children and effective in reducing the duration of acute infectious diarrhea. Further studies are required to assess the efficacy of selected probiotic species and strains at different dosages for different clinical indications and patient groups.

A reliable, practical, and economical protocol for inducing diarrhea and severe dehydration in the neonatal calf.

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Walker, P G; Constable, P D; Morin, D E; Drackley, J K; Foreman, J H; Thurmon, J C

1998-07-01

Fifteen healthy, colostrum-fed, male dairy calves, aged 2 to 7 d were used in a study to develop a diarrhea protocol for neonatal calves that is reliable, practical, and economical. After instrumentation and recording baseline data, diarrhea and dehydration were induced by administering milk replacer [16.5 mL/kg of body weight (BW), PO], sucrose (2 g/kg in a 20% aqueous solution, p.o.), spironolactone and hydrochlorothiazide (1 mg/kg, PO) every 8 h, and furosemide (2 mg/kg, i.m., q6h). Calves were administered sucrose and diuretic agents for 48 h to induce diarrhea and severe dehydration. Clinical changes after 48 h were severe watery diarrhea, severe depression, and marked dehydration (mean, 14% BW loss). Cardiac output, stroke volume, mean central venous pressure, plasma volume, thiocyanate space, blood pH and bicarbonate concentration, base excess, serum chloride concentration, and fetlock temperature were decreased. Plasma lactate concentration, hematocrit, and serum potassium, creatinine, phosphorus, total protein and albumin concentrations were increased. This non-infectious calf diarrhea protocol has a 100% response rate, while providing a consistent and predictable hypovolemic state with diarrhea that reflects most of the clinicopathologic changes observed in osmotic/maldigestive diarrhea caused by infection with rotavirus, coronavirus or cryptosporidia. Limitations of the protocol, when compared to infectious diarrhea models, include failure to induce a severe metabolic acidosis, absence of hyponatremia, renal instead of enteric loss of chloride, renal as well as enteric loss of free water, absence of profound clinical depression and suspected differences in the morphologic and functional effect on intestinal epithelium. Despite these differences, the sucrose/diuretic protocol should be useful in the initial screening of new treatment modalities for calf diarrhea. To confirm their efficacy, the most effective treatment methods should then be examined in

How do the rotavirus NSP4 and bacterial enterotoxins lead differently to diarrhea?

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Vasseur Monique

2007-03-01

Full Text Available Abstract Rotavirus is the major cause of infantile gastroenteritis and each year causes 611 000 deaths worldwide. The virus infects the mature enterocytes of the villus tip of the small intestine and induces a watery diarrhea. Diarrhea can occur with no visible tissue damage and, conversely, the histological lesions can be asymptomatic. Rotavirus impairs activities of intestinal disaccharidases and Na+-solute symports coupled with water transport. Maldigestion of carbohydrates and their accumulation in the intestinal lumen as well as malabsorption of nutrients and a concomitant inhibition of water reabsorption can lead to a malabsorption component of diarrhea. Since the discovery of the NSP4 enterotoxin, diverse hypotheses have been proposed in favor of an additional secretion component in the pathogenesis of diarrhea. Rotavirus induces a moderate net chloride secretion at the onset of diarrhea, but the mechanisms appear to be quite different from those used by bacterial enterotoxins that cause pure secretory diarrhea. Rotavirus failed to stimulate Cl- secretion in crypt, whereas it stimulated Cl- reabsorption in villi, questioning, therefore, the origin of net Cl- secretion. A solution to this riddle was that intestinal villi do in fact secrete chloride as a result of rotavirus infection. Also, the overall chloride secretory response is regulated by a phospholipase C-dependent calcium signaling pathway induced by NSP4. However, the overall response is weak, suggesting that NSP4 may exert both secretory and subsequent anti-secretory actions, as did carbachol, hence limiting Cl- secretion. All these characteristics provide the means to make the necessary functional distinction between viral NSP4 and bacterial enterotoxins.

Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

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2013-01-01

Background Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea. Methods We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately. Results Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these

[Value of history and clinical and laboratory data for the diagnosis of dehydration due to acute diarrhea in children younger than 5 years].

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Pruvost, Isabelle; Dubos, François; Aurel, Marie; Hue, Valérie; Martinot, Alain

2008-04-01

Acute diarrhea is frequent, costly because of the number of hospital admissions required, and sometimes serious, even fatal to children in France. The clinical diagnosis of dehydration is difficult, but essential to determine management. To summarize the published data on the value of clinical history, clinical signs and laboratory results for diagnosing dehydration during acute diarrhea in young (1 month-5 years) non-malnourished children. Four databases (Medline, INIST, Ovid, and Cochrane) were searched through November 2006, with the key words "dehydration" subcategories "diagnosis, or etiology, or history", "diarrhea" subcategory "diagnosis", and age limits "infant or preschool child". We selected the articles and reviews that included as an endpoint for dehydration "weight gain > 5% after recovery" (the gold standard). Thirteen studies were selected. No single clinical history item, clinical sign or laboratory value was sufficient to discriminate between children with and without dehydration. The reproducibility of clinical signs varied substantially between studies. Persistent skin folds and signs of vasoconstriction contributed the most information, with good specificity but sensitivity dehydration. No dehydration scale has been validated. None of the studies selected had a very high level of proof (level 1 and 2); neither signs nor scores have been validated internally or externally because of the low number of subjects. The diagnosis of dehydration due to acute diarrhea in young children depends on the number of signs present, since no individual element of clinical history, clinical picture or laboratory tests distinguished dehydration. Other studies are necessary.

Epidemiological and microbiological aspects of acute bacterial diarrhea in children from Salvador, Bahia, Brazil

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Diniz-Santos, Daniel R.; Santana, José S.; Barretto, Junaura R.; Andrade, Maria Goreth M.; Silva, Luciana R.

2005-01-01

In the few cases of acute childhood diarrhea that require antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains. In order to establish such parameters in our city, we reviewed the results of all 260 positive stool cultures of children between 0 and 15 years of age during two years at a pediatric tertiary care facility in Salvador, Brazil. Bacterial strains had been presumptively identified by culturing in selective media and by biochemic...

Lactobacillus acidophilus, Lactobacillus reuteri and metabolites of intestinal bacteria as therapeutic agents in acute diarrhea in children

Czech Academy of Sciences Publication Activity Database

Tláskal, P.; Kokešová, A.; Schramlová, J.; Tlaskalová, Helena; Adamus, J.; Bubáková, D.; Kočnarová, N.; Kopecký, J.; Mucková, M.; Pacovská, J.; Sládková, J.

2007-01-01

Roč. 2, č. 1 (2007), s. 67-74 ISSN 1555-1431 Grant - others:CZ(CZ) 00000064203/6041; CZ(CZ) 00064203/6309 Institutional research plan: CEZ:AV0Z50200510 Source of funding: V - iné verejné zdroje ; V - iné verejné zdroje Keywords : acute diarrhea * metabolites of intestinal bacteria * probiotics Subject RIV: EE - Microbiology, Virology

COMPLEX TREATMENT OF DIARRHEA IN CHILDREN

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E.G. Tsimbalova

2010-01-01

The article presents modern data on syndrome of acute diarrhea in children, its etiology and mechanisms of development of different types of this disease, its clinical symptoms, differential diagnosis, laboratory and instrumental methods of diagnostics. Author gives review of pathogenetic treatment and opportunities of therapy with enterosorbates, taking into account etiology of diarrhea. Another chapter of the article describes opportunities and methods of oral hydration depending of extent ...

Serum Zinc Level and Its Correlation with Vesikari System Scoring in Acute Pediatric Diarrhea.

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Eskander, Ayman E; Sherif, Lobna S; Nabih, Mohammad; Baroudy, Nevine R El; Marcos, Ghobrial C; Badawy, Ehsan A; Refay, Amira S El

2017-08-15

Diarrhea remains the most common infectious disease worldwide. Zinc has been studied extensively recently for its potential effect on prevention, control and treatment of acute diarrhoea. This study was designed to correlate the level of zinc with the severity of pediatric diarrhoea estimated by Vesikari Scoring System. The present study included 80 children aged two months to 30 months from those suffering from the acute diarrheal episode and admitted to Pediatric Hospital "Abo El Rish" Cairo University. Serum Zinc level was assessed by a colorimetric method with a spectrophotometer. Zinc deficiency was detected in 45 (56.2%) patient of the studied group Significant negative correlations were found between serum zinc level and severity of dehydration and duration of hospitalization (p Zinc level has an essential role in acute pediatric diarrhoea. Zinc therapy should be considered beside Oral rehydration salts (ORS) to achieve maximum impact on diarrheal diseases; clinical trials are recommended to support the zinc supplementation in developing countries.

The fecal microbiome in cats with diarrhea.

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Jan S Suchodolski

Full Text Available Recent studies have revealed that microbes play an important role in the pathogenesis of gastrointestinal (GI diseases in various animal species, but only limited data is available about the microbiome in cats with GI disease. The aim of this study was to evaluate the fecal microbiome in cats with diarrhea. Fecal samples were obtained from healthy cats (n = 21 and cats with acute (n = 19 or chronic diarrhea (n = 29 and analyzed by sequencing of 16S rRNA genes, and PICRUSt was used to predict the functional gene content of the microbiome. Linear discriminant analysis (LDA effect size (LEfSe revealed significant differences in bacterial groups between healthy cats and cats with diarrhea. The order Burkholderiales, the families Enterobacteriaceae, and the genera Streptococcus and Collinsella were significantly increased in diarrheic cats. In contrast the order Campylobacterales, the family Bacteroidaceae, and the genera Megamonas, Helicobacter, and Roseburia were significantly increased in healthy cats. Phylum Bacteroidetes was significantly decreased in cats with chronic diarrhea (>21 days duration, while the class Erysipelotrichi and the genus Lactobacillus were significantly decreased in cats with acute diarrhea. The observed changes in bacterial groups were accompanied by significant differences in functional gene contents: metabolism of fatty acids, biosynthesis of glycosphingolipids, metabolism of biotin, metabolism of tryptophan, and ascorbate and aldarate metabolism, were all significantly (p<0.001 altered in cats with diarrhea. In conclusion, significant differences in the fecal microbiomes between healthy cats and cats with diarrhea were identified. This dysbiosis was accompanied by changes in bacterial functional gene categories. Future studies are warranted to evaluate if these microbial changes correlate with changes in fecal concentrations of microbial metabolites in cats with diarrhea for the identification of potential diagnostic or

Mothers’ beliefs and barriers about childhood diarrhea and its management in Morang district, Nepal

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Ansari Mukhtar

2012-10-01

Full Text Available Abstract Background In developing countries, mothers usually manage diarrhea at home with the pattern of management depending on perceived disease severity and beliefs. The study was carried out with the objective of determining mothers’ beliefs and barriers about diarrhea and its management. Methods Qualitative methods involving two focus group discussions and eight in-depth interviews were used to collect the data. The study was conducted at the following places: Tankisinuwari, Kanchanbari and Pokhariya of Morang district, Nepal during the months of February and March 2010. Purposive sampling method was adopted to recruit twenty mothers based on the inclusion criteria. A semi-structured interview guide was used to conduct the interviews. Written informed consent was obtained from all of the participants before conducting the interviews. The interviews were moderated by the main researcher with the support of an expert observer from Nobel Medical College. The interviews were recorded with the permission of the participants and notes were written by a pre trained note-taker. The recordings were transcribed verbatim. All the transcribed data was categorized and analyzed using thematic content analysis. Results Twenty mothers participated in the interviews and most (80% of them were not educated. About 75% of the mothers had a monthly income of up to 5000 Nepalese rupees (US$ 60.92. Although a majority of mothers believed diarrhea to be due to natural causes, there were also beliefs about supernatural origin of diarrhea. Thin watery diarrhea was considered as the most serious. There was diversity in mothers’ beliefs about foods/fluids and diarrhea management approaches. Similarly, several barriers were noted regarding diarrhea prevention and/or management such as financial weakness, lack of awareness, absence of education, distance from healthcare facilities and senior family members at home. The elderly compelled the mothers to visit

A Multicenter, Prospective, Randomized Controlled Trial to Evaluate the Additional Benefit of a Multistrain Synbiotic (Prodefen® in the Clinical Management of Acute Viral Diarrhea in Children

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Emilia García-Menor MD

2016-11-01

Full Text Available This randomized, open-label study evaluated the additional benefits of the synbiotic Prodefen® in the clinical management of acute diarrhea of suspected viral origin in children between 6 months and 12 years of age. Study outcomes included the duration of diarrhea, the recovery from diarrhea, and the tolerability and acceptance of the treatment. The proportion of patients without diarrhea over the study period was greater in the synbiotic group than in the control group at all study time points, showing a statistically significant difference on the fifth day (95% vs 79%, p < 0.001. The duration of diarrhea (median and interquartile range was reduced by 1 day in the synbiotic-treated patients (3 [2-5] vs 4 [3-5], p = 0.377. The tolerability of the treatment regimen, as evaluated by the parents, was significantly better in those receiving the synbiotic than in the control group. Overall, 96% of the parents of children receiving the synbiotic reported being satisfied to very satisfied with the treatment regimen. The results of this study indicate that the addition of the synbiotic Prodefen® is a well-tolerated and well-accepted approach that provides an additional benefit to the standard supportive therapy in the management of acute viral diarrhea in children.

[Characterisation of viral agents with potential to cause diarrhea in Djibouti].

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Maslin, J; Kohli, E; Leveque, N; Chomel, J J; Nicand, E; Fouet, C; Haus, R; Depina, J J; Mathecowitsch, P; Dampierre, H

2007-06-01

Due to limited laboratory facilities in the tropics, the exact role of enteric viruses in causing diarrhea among adults in the tropics is unknown. The purpose of this report is to describe a multicenter study undertaken in Djibouti to determine the prevalence of a large panel of enteric viruses using immunochromatography; antigenic detection by ELISA, RT-PCR cellular inoculation, sequence analysis; and indirect serology. Study samples were collected from 108 patients presenting acute and sporadic diarrhea. Although they are well known causes of diarrhea in children, rotavirus and adenovirus were identified in only 2 and 5% of adults respectively. In contrast human caliciviruses (HuCVs) and enterovirus were identified in 25 and 42% of adult cases respectively. Uncommon genotypes of HuCVs and recombinant forms (junction pol/l cap) as well as a significant number of sapovirus (30%) were identified. Further study is needed to clarify the role of enterovirus (echovirus) in the etiology of acute diarrhea in adults. No polivirus was identified. These new data from the Horn of Africa increase our knowledge about the epidemiology of acute infectious diarrhea that is a major public health problem and potential danger for travelers.

Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI and Diarrhea in Children: A Multi-Country Study?

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Rahul Bawankule

Full Text Available Pneumonia and diarrhea occur either as complications or secondary infections in measles affected children. So, the integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD by WHO and UNICEF includes measles vaccination as preventive measure in children. The objective of the study is to examine the effect of measles vaccination on Acute Respiratory Infection (ARI and diarrhea in children in the Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan.We analyzed data from the most recent rounds of Demographic and Health Surveys (DHS in the selected countries. We included children age 12-59 months in the analysis. We used multivariable binary logistic regression to examine the effect of measles vaccination on ARI and diarrhea in children. We also estimated Vaccination Effectiveness (VE.More than 60 percent of the children age 12-59 months were given measles vaccine before the survey in the Democratic Republic of Congo, Ethiopia, India and Pakistan. Children who were given the measles vaccine were less likely to suffer from ARI than unvaccinated children in India and Pakistan. Children who were given the measles vaccine had a lower risk of diarrhea than those who did not receive it in all the selected countries except Ethiopia. Measles vaccination was associated with reduction in ARI cases by 15-30 percent in India and Pakistan, and diarrhea cases by 12-22 percent in the Democratic Republic of Congo, India, Nigeria and Pakistan.The receipt of the measles vaccine was associated with decrease in ARI and diarrhea in children. The immunization program must ensure that each child gets the recommended doses of measles vaccine at the appropriate age. The measles vaccination should be given more attention as a preventive intervention under the Global Action Plan for Pneumonia and Diarrhea (GAPPD in all low and middle-income countries.

Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study?

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Bawankule, Rahul; Singh, Abhishek; Kumar, Kaushalendra; Shetye, Sadanand

2017-01-01

Pneumonia and diarrhea occur either as complications or secondary infections in measles affected children. So, the integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD) by WHO and UNICEF includes measles vaccination as preventive measure in children. The objective of the study is to examine the effect of measles vaccination on Acute Respiratory Infection (ARI) and diarrhea in children in the Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan. We analyzed data from the most recent rounds of Demographic and Health Surveys (DHS) in the selected countries. We included children age 12-59 months in the analysis. We used multivariable binary logistic regression to examine the effect of measles vaccination on ARI and diarrhea in children. We also estimated Vaccination Effectiveness (VE). More than 60 percent of the children age 12-59 months were given measles vaccine before the survey in the Democratic Republic of Congo, Ethiopia, India and Pakistan. Children who were given the measles vaccine were less likely to suffer from ARI than unvaccinated children in India and Pakistan. Children who were given the measles vaccine had a lower risk of diarrhea than those who did not receive it in all the selected countries except Ethiopia. Measles vaccination was associated with reduction in ARI cases by 15-30 percent in India and Pakistan, and diarrhea cases by 12-22 percent in the Democratic Republic of Congo, India, Nigeria and Pakistan. The receipt of the measles vaccine was associated with decrease in ARI and diarrhea in children. The immunization program must ensure that each child gets the recommended doses of measles vaccine at the appropriate age. The measles vaccination should be given more attention as a preventive intervention under the Global Action Plan for Pneumonia and Diarrhea (GAPPD) in all low and middle-income countries.

Oral Zinc Supplementation for the Treatment of Acute Diarrhea in Children: A Systematic Review and Meta-Analysis

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Laura M. Lamberti

2013-11-01

Full Text Available Evidence supporting the impact of therapeutic zinc supplementation on the duration and severity of diarrhea among children under five is largely derived from studies conducted in South Asia. China experiences a substantial portion of the global burden of diarrhea, but the impact of zinc treatment among children under five has not been well documented by previously published systematic reviews on the topic. We therefore conducted a systematic literature review, which included an exhaustive search of the Chinese literature, in an effort to update previously published estimates of the effect of therapeutic zinc. We conducted systematic literature searches in various databases, including the China National Knowledge Infrastructure (CNKI, and abstracted relevant data from studies meeting our inclusion and exclusion criteria. We used STATA 12.0 to pool select outcomes and to generate estimates of percentage difference and relative risk comparing outcomes between zinc and control groups. We identified 89 Chinese and 15 non-Chinese studies for the review, including studies in 10 countries from all WHO geographic regions, and analyzed a total of 18,822 diarrhea cases (9469 zinc and 9353 control. None of the included Chinese studies had previously been included in published pooled effect estimates. Chinese and non-Chinese studies reported the effect of therapeutic zinc supplementation on decreased episode duration, stool output, stool frequency, hospitalization duration and proportion of episodes lasting beyond three and seven days. Pooling Chinese and non-Chinese studies yielded an overall 26% (95% CI: 20%−32% reduction in the estimated relative risk of diarrhea lasting beyond three days among zinc-treated children. Studies conducted in and outside China report reductions in morbidity as a result of oral therapeutic zinc supplementation for acute diarrhea among children under five years of age. The WHO recommendation for zinc treatment of diarrhea

A Systematic Review and Meta-analysis of the Association Between Giardia lamblia and Endemic Pediatric Diarrhea in Developing Countries

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Muhsen, Khitam; Levine, Myron M.

2012-01-01

We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38–.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50–6.76; P diarrhea in children in developing countries. PMID:23169940

The cost utility and budget impact of adjuvant racecadotril for acute diarrhea in children in Thailand

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Rautenberg TA

2017-07-01

Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes3 1IGES Institut, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, School of Accounting, Economics and Finance, University of KwaZulu Natal, KwaZulu Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany Objective: To evaluate the cost utility and the budget impact of adjuvant racecadotril for the treatment of acute diarrhea in children in Thailand. Methods: A cost utility model has been adapted to the context of Thailand to evaluate racecadotril plus oral rehydration solution (R+ORS versus oral rehydration solution (ORS alone for acute diarrhea in children <5 years old. The decision tree Excel model evaluates the costs and effects (quality-adjusted life years over a 6-day time horizon from a public health care payer’s perspective in Thailand. Deterministic sensitivity analysis and budget impact analysis have been undertaken. Results: According to the cost utility model, the intervention (R+ORS is less costly and more effective than the comparator (ORS for the base case with a dominant incremental cost-effectiveness ratio of −2,481,390฿ for the intervention. According to the budget impact analysis (assuming an increase of 5% market share for R+ORS over 5 years, the year-on-year reduction for diarrhea as a percentage of the total health care expenditure is −0.0027%, resulting in potential net cost savings of −35,632,482฿ over 5 years. Conclusion: Subject to the assumptions and limitations of the models, adjuvant racecadotril versus ORS alone is potentially cost-effective for children in Thailand and uptake could translate into savings for the Thailand public health care system. Keywords: economic evaluation, cost utility, decision analysis, health technology assessment

Piped water supply interruptions and acute diarrhea among under-five children in Addis Ababa slums, Ethiopia: A matched case-control study.

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Adane, Metadel; Mengistie, Bezatu; Medhin, Girmay; Kloos, Helmut; Mulat, Worku

2017-01-01

The problem of intermittent piped water supplies that exists in low- and middle-income countries is particularly severe in the slums of sub-Saharan Africa. However, little is known about whether there is deterioration of the microbiological quality of the intermittent piped water supply at a household level and whether it is a factor in reducing or increasing the occurrence of acute diarrhea among under-five children in slums of Addis Ababa. This study aimed to determine the association of intermittent piped water supplies and point-of-use (POU) contamination of household stored water by Escherichia coli (E. coli) with acute diarrhea among under-five children in slums of Addis Ababa. A community-based matched case-control study was conducted from November to December, 2014. Cases were defined as under-five children with acute diarrhea during the two weeks before the survey. Controls were matched by age and neighborhood with cases by individual matching. Data were collected using a pre-tested structured questionnaire and E. coli analysis of water from piped water supplies and household stored water. A five-tube method of Most Probable Number (MPN)/100 ml standard procedure was used for E. coli analysis. Multivariable conditional logistic regression with 95% confidence interval (CI) was used for data analysis by controlling potential confounding effects of selected socio-demographic characteristics. During the two weeks before the survey, 87.9% of case households and 51.0% of control households had an intermittent piped water supply for an average of 4.3 days and 3.9 days, respectively. POU contamination of household stored water by E. coli was found in 83.3% of the case households, and 52.1% of the control households. In a fully adjusted model, a periodically intermittent piped water supply (adjusted matched odds ratio (adjusted mOR) = 4.8; 95% CI: 1.3-17.8), POU water contamination in household stored water by E. coli (adjusted mOR = 3.3; 95% CI: 1.1-10.1), water

[Efficacy and safety of reduced osmolarity oral rehydration salts in treatment of dehydration in children with acute diarrhea--a multicenter, randomized, double blind clinical trial].

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Yang, Dao-Feng; Guo, Wei; Tian, De-Ying; Luo, Xiao-Ping; He, Yong-Wen; Dai, Yong-An; Xu, Hua-Lin

2007-04-01

To assess the efficacy and safety of reduced osmolarity oral rehydration salts (ROORS) in treatment of mild to moderate dehydration caused by acute diarrhea in children. A multicenter, randomized, double-blind, positive drug controlled clinical trial was conducted in 125 cases aged 1 to 17 years. These children with acute diarrhea and signs of dehydration were randomly assigned to receive either ROORS (trial group, n = 62) or oral rehydration salts II (ORS II) (control group, n = 63). The volume of intravenous infusion were recorded. The improvements of systemic symtoms and signs, diarrhea, dehydration and total scores were compared between the two groups. The adverse events and changes of electrolyte and other laboratory tests during treatment were also observed and analyzed. The overall effective rates in trial group and control group were 96.8% and 96.8%, respectively. The recovery of systemic symptoms, dehydration signs and diarrhea occurred in 96%, 97% and 78% patients in trial groups, and 96%, 98% and 85% patients in control group. The scores of symptoms and signs in both groups decreased significantly after treatment. All the above parameters and the number of cases who needed intravenous infusion (41 vs. 39) were not statistically different between two groups. However, the average volume of intravenously infused fluids in trial group was (450.98 +/- 183.07) ml, 24.5% less than that in the control group (597.30 +/- 343.37) ml (P 0.05). A case in trial group had mild abdominal distention and recovered spontaneously. ROORS was shown to be effective and safe in the treatment of mild and moderate dehydration induced by acute diarrhea. Compared to ORS II, ROORS could decrease the intravenous supplement of fluid and lower the risk of hypernatremia.

The effect of a natural food based tube feeding in minimizing diarrhea in critically ill neurological patients.

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Schmidt, Simone B; Kulig, Willibald; Winter, Ralph; Vasold, Antje S; Knoll, Anette E; Rollnik, Jens D

2018-01-09

Diarrhea has negative consequences for patients, health care staff and health care costs when neurological patients are fed enterally over long periods. We examined the effect of tube feeding with natural foods in reducing the number of fluid stool evacuations and diarrhea in critically ill neurological patients. A multicenter, prospective, open-label and randomized controlled trial (RCT) was conducted at facilities in Germany specializing in early rehabilitation after neurological damage. Patients of the INTERVENTION group were fed by tube using a commercially available product based on real foods such as milk, meat, carrots, whereas CONTROL patients received a standard tube-feed made of powdered raw materials. All received enteral nutrition over a maximum of 30 days. The number of defecations and the consistency of each stool according to the Bristol Stool Chart (BSC) were monitored. In addition, daily calories, liquids and antibiotic-use were recorded. 118 Patients who had suffered ischemic stroke, intracerebral hemorrhage, traumatic brain injury or hypoxic brain damage and requiring enteral nutrition were enrolled; 59 were randomized to receive the intervention and 59 control feed. There were no significant differences in clinical screening data, age, sex, observation period or days under enteral nutrition between the groups. Patients in both groups received equivalent amount of calories and fluids. In both groups antibiotics were frequently prescribed (69.5% in the INTERVENTION group and 75.7% in the CONTROL group) for 10-11 days on average. In comparison to the CONTROL group, patients in the INTERVENTION group had a significant reduction of the number of watery stool evacuations (type 7 BSC) (minus 61%, IRR = 0.39, p natural based food was effective in reducing the number of watery defecations and diarrhea in long term tube-fed critically ill neurological patients, compared to those fed with standard tube feeding. Copyright © 2018 The Authors. Published

Development and validation of a patient-reported questionnaire assessing systemic therapy induced diarrhea in oncology patients.

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Lui, Michelle; Gallo-Hershberg, Daniela; DeAngelis, Carlo

2017-12-22

Systemic therapy-induced diarrhea (STID) is a common side effect experienced by more than half of cancer patients. Despite STID-associated complications and poorer quality of life (QoL), no validated assessment tools exist to accurately assess STID occurrence and severity to guide clinical management. Therefore, we developed and validated a patient-reported questionnaire (STIDAT). The STIDAT was developed using the FDA iterative process for patient-reported outcomes. A literature search uncovered potential items and questions for questionnaire construction used by oncology clinicians to develop questions for the preliminary instrument. The instrument was evaluated on its face validity and content validity by patient interviews. Repetitive, similar and different themes uncovered from patient interviews were implemented to revise the instrument to the version used for validation. Patients starting high-risk STID treatments were monitored using the STIDAT, bowel diaries and EORTC QLQ-C30. The STIDAT was evaluated for construct validity using exploratory factor analysis (EFA) using minimal residual method with Promax rotation, reliability and consistency. A weighted scoring system was developed and a receiver-operating characteristic (ROC) curve evaluated the tool's ability to detect STID occurrence. Median scores and variability were analysed to determine how well it differentiates between diarrhea severities. A post-hoc analysis determined how diarrhea severity impacted QoL of cancer patients. Patients defined diarrhea based on presence of watery stool. The STIDAT assessed patient's perception of having diarrhea, daily number of bowel movements, daily number of diarrhea episodes, antidiarrheal medication use, the presence of urgency, abdominal pain, abdominal spasms or fecal incontinence, patient's perception of diarrhea severity, and QoL. These dimensions were sorted into four clusters using EFA - patient's perception of diarrhea, frequency of diarrhea, fecal

Successful pregnancy in a female patient with congenital chloride diarrhea (CLD) and renal impairment.

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Shimizu, Yoshio; Kamoda, Tomohiro; Nagata, Michio; Yoh, Keigyo; Hashimoto, Yuko; Matsui, Akira; Yoshikawa, Hiroyuki; Yamagata, Kunihiro; Koyama, Akio

2009-01-01

We report a successful case of pregnancy in a female patient with congenital chloride diarrhea (CLD) and reduced renal function due to interruption of treatment. CLD is an autosomal recessive disorder of intestinal electrolyte absorption caused by mutations in the solute carrier family 26, member 3 (SLC26A3) gene, and continuous production of watery diarrhea induces dehydration, metabolic alkalosis and many kinds of electrolyte disturbances in CLD patients. The patient in our case was a 24-year-old female CLD patient with moderate renal impairment; a renal biopsy specimen showed minimal glomerular changes, but tubulointerstitial damage by crystal formation, consistent with renal function data. One year after our initial examination and reinstitution of therapy, the patient got married and soon conceived. There were no major problems during the course of pregnancy, and the patient successfully delivered a healthy full-term infant vaginally. The symptoms and clinical course of the patient were particularly mild, and we discuss possible reasons for these observations from a perspective of genotype, phenotype and environmental conditions.

Intestinal coccidia in Cuban pediatric patients with diarrhea

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Núñez FA

2003-01-01

Full Text Available From May to August 1999, we evaluated 401 patients from a pediatric hospital of Havana City. One group was composed of 113 patients with diarrhea admitted to the Gastroenterology ward and a second consisted of 288 patients without diarrhea, admitted for other reasons, and hospitalized within the same time period. Three stool samples were collected from each child and were examined using three parasitological techniques. When we compared the frequency of parasite species between both groups, we found Cryptosporidium spp. and Cyclospora cayetanensis, only in the group of children with diarrhea (P 0.05. In addition, in those children infected with Cryptosporidium, the diarrhea had a more prolonged duration (P < 0.01, while those infected with Cyclospora, the abdominal cramps or pain, and acute diarrhea were more frequently detected (P < 0.01. Our results showed that emerging intestinal coccidia are pathogens strongly associated in this group of children with diarrhea.

Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

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Rautenberg TA

2018-03-01

Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes,3 Way Seah Lee4 1IGES Institut GmbH, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany; 4Department of Pediatrics, University Malaya, Kuala Lumpur, Malaysia Objective: To perform cost utility (CU and budget impact (BI analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS for children under 5 years with acute diarrhea in Malaysia.Methods: A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components.Results: According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of –RM 1,272,833/quality-adjusted life year (USD –312,726/quality-adjusted life year in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years, the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of –RM 73,193,603 (USD –17,983,595 over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components.Conclusion: Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base

Clinical experience of Phelloberin A in diarrhea during the treatment of cancer of the cervix uteri with radiation

International Nuclear Information System (INIS)

Kagabu, Teruo; Takano, Toshiaki; Sano, Toshiyuki; Kaneda, Osamu; Saito, Masataka

1978-01-01

This drug containing chlorinated berberine and Gennoshoko extract was administered to cases which suffered from diarrhea during external irradiation, and its effect on them were observed. Out of 35 cases of cancer of the cervix uteri from stage I to III, 20 cases in which watery diarrhea was induced over three times a day by external irradiation were given 12 tablets per a day in four divided doses for 7 days. In external irradiation a total of 3000 rads was irradiated in 200 rads per a day (1000 rads per a week) by the whole pelvic irradiation, and after that, irradiation was performed up to 6000 rads by shielding the center. Diarrhea was observed in 20 of 35 cases during external irradiation (57.1%). Diarrhea was recognized in 4 cases in the range from 1000 to 2000 rads (20%), in 13 cases in the range from 2000 to 3000 rads (65%), and 3 cases irradiated by shielding the center (15%). Response to this drug was effective within 3 days after the administration in 9 cases (45%), a little effective in 7 cases (35%), and ineffective in 4 cases (20%). There was a past history of hypertension in cases whose response was ineffective. In the clinical examination after the administration of this drug, abnormalities in kidney and liver functions were not recognized. From the above-mentioned results, it was suggested that this drug was effective on diarrhea which occurred during external irradiation. (Kanao, N.)

Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study.

Science.gov (United States)

Bittencourt, Amanda F; Martins, Juliana R; Logullo, Luciana; Shiroma, Glaucia; Horie, Lilian; Ortolani, Maria Claudia; Silva, Maria de Lourdes T; Waitzberg, Dan L

2012-08-01

Digestive complications in enteral nutrition (EN) can negatively affect the nutrition clinical outcome of hospitalized patients. Diarrhea and constipation are intestinal motility disorders associated with pharmacotherapy, hydration, nutrition status, and age. The aim of this study was to analyze the frequency of these intestinal motility disorders in patients receiving EN and assess risk factors associated with diarrhea and constipation in hospitalized patients receiving exclusive EN therapy in a general hospital. The authors performed a sequential and observational study of 110 hospitalized adult patients fed exclusively by EN through a feeding tube. Patients were categorized according to the type of intestinal transit disorder as follows: group D (diarrhea, 3 or more watery evacuations in 24 hours), group C (constipation, less than 1 evacuation during 3 days), and group N (absence of diarrhea or constipation). All prescription drugs were recorded, and patients were analyzed according to the type and amount of medication received. The authors also investigated the presence of fiber in the enteral formula. Patients classified in group C represented 70% of the study population; group D comprised 13%, and group N represented 17%. There was an association between group C and orotracheal intubation as the indication for EN (P constipation (logistic regression analysis: P Constipation is more frequent than diarrhea in patients fed exclusively by EN. Enteral diet with fiber may protect against medication-associated intestinal motility disorders. The addition of prokinetic drugs seems to be useful in preventing constipation.

The “First” Case of Cholera in Haiti: Lessons for Global Health

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Ivers, Louise C.; Walton, David A.

2012-01-01

Cholera is an acute watery diarrheal disease caused by infection with Vibrio cholerae. The disease has a high fatality rate when untreated and outbreaks of cholera have been increasing globally in the past decade, most recently in Haiti. We present the case of a 28-year-old Haitian male with a history of severe untreated mental health disorder that developed acute fatal watery diarrhea in mid-October 2010 in central Haiti after drinking from the local river. We believe he is the first or among the first cases of cholera in Haiti during the current epidemic. By reviewing his case, we extracted lessons for global health on the importance of mental health for overall health, the globalization of diseases in small communities, and the importance of a comprehensive approach to the health of communities when planning services in resource-poor settings. PMID:22232448

Predominant enteropathogens in acute diarrhea and associated variables in children at the Lambayeque Regional Hospital, Peru

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Heber Silva-Díaz

2017-01-01

Full Text Available Objective: To determine the type and frequency of predominant enteropathogens in acute diarrhea and their associated characteristics in children treated at Hospital Regional Lambayeque (HRL - Peru. Materials and methods: A cross-sectional analytical study was carried out in 70 fecal samples between March and May 2015. These samples were studied by coproculture and immunochromatography for the detection of enteropathogenic bacteria and viruses, respectively, while enteroparasites were sought by direct microscopic examination, Kinyoun staining method and ELISA for the detection of coproantigens (Entamoeba histolytica, Giardia lamblia and Cryptosporidium spp. Leukocyte count and chemical tests (Benedict, Thevenon and Sudan III were also performed for the functional study of the diarrheal disease. Results: In 48.6% of the samples, the infectious etiology of diarrhea was detected, prevailing the parasitic cause (25.8%, followed by the bacterial (17.1% and viral (5.8% ones. The most common enteropathogens were G. lamblia (18.6% and Salmonella enteritidis (10.0%. An association between greater than 100 fecal leukocytes per field and the bacterial etiology (p=0.027 was observed, while less than 10 fecal leukocytes per field (p=0.002 and a positive Sudam III test (p=0.003 were associated with the parasitic etiology. Conclusions: In more than half of the samples (51.4% the infectious etiology of diarrhea could not be proven, whereas Giardia lamblia was the most frequent cause of diarrhea in the studied population. However, it is necessary to implement more sensitive and specific techniques for the detection of a greater range of enteropathogens with which to improve the diagnosis and treatment of the disease

The efficacy of octreotide in the therapy of acute radiation-induced diarrhea: a randomized controlled study

International Nuclear Information System (INIS)

Yavuz, Melek N.; Yavuz, A. Aydin; Aydin, Fazil; Can, Gamze; Kavgaci, Halil

2002-01-01

Purpose: Although the somatostatin analog octreotide is currently used in the treatment of chemotherapy-induced diarrhea and secretory diarrhea associated with various disorders, its role in the management of radiation enteritis is not well defined. We performed a randomized study that compared octreotide acetate with diphenoxylate hydrochloride plus atropine sulfate, the drug commonly used as therapy for acute radiation-induced diarrhea (ARID). Methods and Materials: Sixty-one patients with Grade 2 (four to six stools per day) or Grade 3 (≥ seven stools per day, National Cancer Institute Common Toxicity Criteria) diarrhea associated with pelvic radiotherapy were assigned randomly to receive octreotide s.c., 100 μg three times daily (n=33) or diphenoxylate and atropine orally, 2.5 mg four times daily (n = 28). Radiotherapy was delivered to all patients in a conventional manner, with high-energy photons in a total dose ≥45 Gy, which exceeds the tolerance of intestine. Overall, there was no significant difference in patient characteristics or radiotherapy applied between the two arms. Patients were evaluated daily for the primary study end point, resolution of diarrhea, as well as for interruption of pelvic radiotherapy. Results: Within 3 days, ARID completely resolved in 20 patients in the octreotide arm (2 within the first day, 11 within the second day, and 7 within the third day) vs. only 4 (all within the second day of therapy) in the diphenoxylate arm (p=0.002). On the diphenoxylate arm, 15/28 patients were required to discontinue pelvic radiotherapy; on the octreotide arm, 6/33 patients were required to discontinue pelvic radiotherapy for an average of 1.89±0.5 and 0.45±0.2 days, respectively (p=0.003). No side effects were observed in either arm. Three patients on the diphenoxylate arm and only 1 on the octreotide arm required further treatment for parenteral replenishment of fluids and electrolytes or other antidiarrheal treatments. Conclusion

Prebiotic and...

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_ Hashemi

2014-04-01

Full Text Available Prebiotic: A nondigestible food ingredient that benefits the host by selectively stimulating the favorable growth and/ or activity of 1 or more indigenous prebiotic bacteria. Prebiotics can modify the intestinal flora and interact with the immune system of the host against specific pathogens. However clinical trials are currently limited and a beneficial effect of prebiotic in treatment acute diarrhea is still lacking. Prebiotics is not helpful to prevention of diarrhea. there is a paucity of data on the use of Prebiotics in the prevention of ADD (antibiotic – associated diarrhea. Probiotic: An oral supplement or a food product that contains a sufficient number of viable microorganisms to alter the micro flora of the host and has the potential for beneficial health effects. Result of published randomized controlled trials (RCT have indicated that there is modest benefit of giving probiotics in preventing acute gastroenteritis but have good therapeutic benefit in treatment of acute diarrhea. LGG is the most effective. Probiotics also more effective  when given early in the course of diarrhea and are most helpful for otherwise healthy children with watery diarrhea secondary to vial gastroenteritis but no invasive bacterial infection. Probitic can be use to reduce the incidence of ADD specially when started in initiate of treatment. Probiotics is associated with a significant reduced risk of diarrhea lasting more than 3 days.  

Oral Phage Therapy of Acute Bacterial Diarrhea With Two Coliphage Preparations: A Randomized Trial in Children From Bangladesh

Science.gov (United States)

Sarker, Shafiqul Alam; Sultana, Shamima; Reuteler, Gloria; Moine, Deborah; Descombes, Patrick; Charton, Florence; Bourdin, Gilles; McCallin, Shawna; Ngom-Bru, Catherine; Neville, Tara; Akter, Mahmuda; Huq, Sayeeda; Qadri, Firdausi; Talukdar, Kaisar; Kassam, Mohamed; Delley, Michèle; Loiseau, Chloe; Deng, Ying; El Aidy, Sahar; Berger, Bernard; Brüssow, Harald

2016-01-01

Background Antibiotic resistance is rising in important bacterial pathogens. Phage therapy (PT), the use of bacterial viruses infecting the pathogen in a species-specific way, is a potential alternative. Method T4-like coliphages or a commercial Russian coliphage product or placebo was orally given over 4 days to Bangladeshi children hospitalized with acute bacterial diarrhea. Safety of oral phage was assessed clinically and by functional tests; coliphage and Escherichia coli titers and enteropathogens were determined in stool and quantitative diarrhea parameters (stool output, stool frequency) were measured. Stool microbiota was studied by 16S rRNA gene sequencing; the genomes of four fecal Streptococcus isolates were sequenced. Findings No adverse events attributable to oral phage application were observed (primary safety outcome). Fecal coliphage was increased in treated over control children, but the titers did not show substantial intestinal phage replication (secondary microbiology outcome). 60% of the children suffered from a microbiologically proven E. coli diarrhea; the most frequent diagnosis was ETEC infections. Bacterial co-pathogens were also detected. Half of the patients contained phage-susceptible E. coli colonies in the stool. E. coli represented less than 5% of fecal bacteria. Stool ETEC titers showed only a short-lived peak and were otherwise close to the replication threshold determined for T4 phage in vitro. An interim analysis after the enrollment of 120 patients showed no amelioration in quantitative diarrhea parameter by PT over standard care (tertiary clinical outcome). Stool microbiota was characterized by an overgrowth with Streptococcus belonging to the Streptococcus gallolyticus and Streptococcus salivarius species groups, their abundance correlated with quantitative diarrhea outcome, but genome sequencing did not identify virulence genes. Interpretation Oral coliphages showed a safe gut transit in children, but failed to achieve

Prevalence and genetic diversity of norovirus among patients with acute diarrhea in Guatemala.

Science.gov (United States)

Estévez, Alejandra; Arvelo, Wences; Hall, Aron J; López, María R; López, Beatriz; Reyes, Lissette; Moir, Juan Carlos; Gregoricus, Nicole; Vinjé, Jan; Parashar, Umesh D; Lindblade, Kim A

2013-07-01

Noroviruses (NoVs) are a leading cause of acute gastroenteritis outbreaks and sporadic cases of diarrhea in industrialized countries. To study the prevalence and genetic diversity of NoVs in Guatemala, stool specimens were collected from hospitalized and ambulatory patients presenting with diarrhea (≥3 loose or liquid stools in a 24-hr period) who were enrolled in a prospective surveillance system in the Departments of Santa Rosa (October 2007 to August 2010) and Quetzaltenango (August 2009 to August 2010), Guatemala. Specimens were tested for rotavirus, enteric bacteria, and parasites by routine methods and for genogroups I and II NoV by real-time reverse transcription-PCR. A total of 2,403 stool specimens were collected from hospitalized (n = 528) and ambulatory patients (n = 1,875). Overall, 341 (14%) samples tested positive for NoVs including 114 (22%) hospitalized and 227 (12%) ambulatory patients. NoVs disease peaked during the winter (November-January) months. Among the 341 NoVs-positive patients, 32 (9%) were also positive for rotavirus, 32 (9%) for bacteria, and 9 (3%) for protozoa. Nucleotide sequences were obtained from 84 samples collected from hospitalized children aged Guatemala. The findings highlight the need to implement laboratory diagnostics for NoVs to improve appropriate clinical management of diarrheal diseases and guide vaccine development. Copyright © 2013 Wiley Periodicals, Inc.

Management of children with prolonged diarrhea [version 1; referees: 3 approved

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Antonietta Giannattasio

2016-02-01

Full Text Available Prolonged diarrhea is usually defined as acute-onset diarrhea lasting 7 days or more, but less than 14 days. Its trend has been declining in recent years because of improvement in the management of acute diarrhea, which represents the ideal strategy to prevent prolonged diarrhea. The pathogenesis of prolonged diarrhea is multifactorial and essentially based on persistent mucosal damage due to specific infections or sequential infections with different pathogens, host-related factors including micronutrient and/or vitamin deficiency, undernutrition and immunodeficiency, high mucosal permeability due to previous infectious processes and nutrient deficiency with consequential malabsorption, and microbiota disruption. Infections seem to play a major role in causing prolonged diarrhea in both developing and developed areas. However, single etiologic pathogens have not been identified, and the pattern of agents varies according to settings, host risk factors, and previous use of antibiotics and other drugs. The management of prolonged diarrhea is complex. Because of the wide etiologic spectrum, diagnostic algorithms should take into consideration the age of the patient, clinical and epidemiological factors, and the nutritional status and should always include a search for enteric pathogens. Often, expensive laboratory evaluations are of little benefit in guiding therapy, and an empirical approach may be effective in the majority of cases. The presence or absence of weight loss is crucial for driving the initial management of prolonged diarrhea. If there is no weight loss, generally there is no need for further evaluation. If weight loss is present, empiric anti-infectious therapy or elimination diet may be considered once specific etiologies have been excluded.

Epidemiologic and clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh.

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Haque, Rashidul; Mondal, Dinesh; Kirkpatrick, Beth D; Akther, Selim; Farr, Barry M; Sack, R Bradley; Petri, William A

2003-10-01

The epidemiology, clinical features, nutritional status, and causative agents of diarrhea were studied in 289 Bangladeshi children (147 boys and 142 girls) 2-5 years old. The use of improved diagnostic tests for amebiasis enabled for the first time analysis of the contribution of Entamoeba histolytica to total diarrheal illness in this community setting. The average incidence rate of diarrhea was 1.8/child-year, and the average number of diarrheal days was 3.7 days/child-year over an average observation period of 2.8 years/child. Seventy-five percent of the diarrheal episodes were sp. (10%), E. histolytica (8.7%), Campylobacter jejunii (5.8%), P. shigelloides (4.3%), and A. caviae (4.3%). The overall incidence rate of E. histolytica-associated diarrhea was 0.08/child-year. Visible blood and hemoccult test-detected blood loss was found in 7% and 25%, respectively, of cases of E. histolytica-associated diarrhea. Children who had recovered from a diarrheal episode with E. histolytica, but not E. dispar, had half the chance of developing subsequent E. histolytica-associated diarrhea, consistent with the development of species-specific acquired immunity. In conclusion, the use of modern diagnostic tests demonstrated that E. histolytica contributed to overall morbidity from diarrheal illness. Understanding the etiology, frequency, and consequences of acute diarrhea in children from a developing country should aid in the design of interventions to improve child health.

Experiences of galantase used for diarrhea in radiotherapy of carcinoma of the uterus and ovary

International Nuclear Information System (INIS)

Kuno, Hiroshi

1977-01-01

Fourty seven patients who received radiotherapy of the malignant tumors in the uterine cervix, uterine body, and ovary were devided in to two groups; a group of 22 galantase administered patients, and a group of 25 non-galantase administered patients, and the clinical effect of galantase was studied. Galantase was given orally 6 gr. a day in three divided doses after meal from the begining to the end of radiotherapy. Total of 5,200 to 7,000 R of 60 Co was irradiated in dosed of 200 R a day for 5 times a week. The evaluation of the effectiveness galantase to diarrhea were decided clinically depending on the interrupted days of radiotherapy; radiotherapy was paused when the patients had their bowel movement more than four times a day, or the stool became watery, and resumed when the stool improved to be soft, and the frequency of defecation became twice a day. The cases in which radiotherapy was interrupted were 4 cases in galantase administered group (18.1 per cent), and 10 cases in non-administered group (40.0 per cent). The mean duration of interrupting radiotherapy was 6.5 days in administered group, and 7.7 days in non-administered group. In galantase administered group, the occurrence of diarrhea was fewer, and the developed diarrhea improved faster than non-administered group. (Serizawa, K.)

Anti-diarrhea activity of the aqueous root bark extract of Byrsocarpus coccineus on castor oil-induced diarrhea in Wistar rats.

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Ejeh, Sunday A; Onyeyili, Patrick; Abalaka, Samson E

2017-07-01

The use of traditional medicine as an alternative source of cure for many ailments has played an important role in health care delivery in both developing and developed countries. Byrsocarpus coccineus Schum and Thonn ( Connaraceae ) is used in traditional medicine for treatment of various disease conditions, including diarrhea. The anti-diarrhea activity of the root bark aqueous extract of B. coccineus was investigated in this study. Acute toxicity evaluation of the aqueous extract of B. coccineus root bark was performed in exposed rats. Diarrhea was induced in exposed rats with castor oil, and the effect of the extract on castor oil-induced gastrointestinal motility and enteropooling was consequently investigated. In the acute toxicity study, the extract caused no death in treated rats nor produced signs of delayed toxicity, even at 5000 mg/kg. The aqueous root bark extract of B. coccineus also decreased the distance travelled by activated charcoal in the gastrointestinal tract of treated rats when compared to control rats. Results of castor oil-induced enteropooling revealed slight reduction in the weight of intestinal contents of treated rats compared to control rats. There was significant (pcastor oil-induced diarrhea at 100 mg/kg dose with 74.96% inhibition of defecation. The study demonstrated the anti-diarrheic property of the aqueous extract of B. coccineus root bark as currently exploited in our traditional herbal therapy.

Forecasting non-stationary diarrhea, acute respiratory infection, and malaria time-series in Niono, Mali.

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Medina, Daniel C; Findley, Sally E; Guindo, Boubacar; Doumbia, Seydou

2007-11-21

Much of the developing world, particularly sub-Saharan Africa, exhibits high levels of morbidity and mortality associated with diarrhea, acute respiratory infection, and malaria. With the increasing awareness that the aforementioned infectious diseases impose an enormous burden on developing countries, public health programs therein could benefit from parsimonious general-purpose forecasting methods to enhance infectious disease intervention. Unfortunately, these disease time-series often i) suffer from non-stationarity; ii) exhibit large inter-annual plus seasonal fluctuations; and, iii) require disease-specific tailoring of forecasting methods. In this longitudinal retrospective (01/1996-06/2004) investigation, diarrhea, acute respiratory infection of the lower tract, and malaria consultation time-series are fitted with a general-purpose econometric method, namely the multiplicative Holt-Winters, to produce contemporaneous on-line forecasts for the district of Niono, Mali. This method accommodates seasonal, as well as inter-annual, fluctuations and produces reasonably accurate median 2- and 3-month horizon forecasts for these non-stationary time-series, i.e., 92% of the 24 time-series forecasts generated (2 forecast horizons, 3 diseases, and 4 age categories = 24 time-series forecasts) have mean absolute percentage errors circa 25%. The multiplicative Holt-Winters forecasting method: i) performs well across diseases with dramatically distinct transmission modes and hence it is a strong general-purpose forecasting method candidate for non-stationary epidemiological time-series; ii) obliquely captures prior non-linear interactions between climate and the aforementioned disease dynamics thus, obviating the need for more complex disease-specific climate-based parametric forecasting methods in the district of Niono; furthermore, iii) readily decomposes time-series into seasonal components thereby potentially assisting with programming of public health interventions

WateriD User Manual (WERF Report INFR9SG09a)

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The Water Infrastructure Database (WATERiD; http://waterid.org ) is designed to be a knowledge base where water and wastewater utilities can upload and gather information about asset management technology and practice experiences. The main emphasis is on pipe location, condition...

Adenovirus Infection in Children with Diarrhea Disease in ...

African Journals Online (AJOL)

Ad40) and type 41(Ad41), can cause acute and severe diarrhea in young children worldwide. This study was conducted to delineate the epidemiological features of adenoviruses identified in children with gastroenteritis in Northwestern Nigeria.

The Effect of Probiotics on Diarrhea in Children with Severe Acute Malnutrition

DEFF Research Database (Denmark)

Grenov, Benedikte

with diarrhea and dehydration during hospitalization. In addition the association between days with diarrhea as well as dehydration and mortality during hospitalization were assessed. Results The study children had a mean age of 17.0 months, 58% were boys, 66% had edematous malnutrition and 14% were HIV...

Microscopic colitis - a missed diagnosis in diarrhea-predominant irritable bowel syndrome.

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Stoicescu, Adriana; Becheanu, Gabriel; Dumbrava, Mona; Gheorghe, Cristian; Diculescu, Mircea

2012-01-01

Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine. From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome. All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost superimposable, but a few distinct features can be noticed. The proper

Role of octreotide in chemo and radiotherapy induced diarrhea

International Nuclear Information System (INIS)

Farooqi, J.I.; Farooqi, R. J.

2000-01-01

An international, quasi-experimental, clinical trial of 'before-and-after type' was conducted to find out the role of octreotide in chemo and radiotherapy-induced diarrhea on thirty patients. Among these 19 patients had advanced cancer and 11 with acute leukemia. All patients were given IV fluids and Loperamide for 5 days. The patients who did not respond during this period were administered with octreotide subcutaneously for another 5 days and response against diarrhea was noted. We found that only 10% patients responded to loperamide therapy whereas in the remaining 90% patients an excellent response was noted as 96.29% of these patients responded to octreotide therapy which stopped their diarrhea (P<0.005) leading us to the conclusion that, octreotide is a safe and effective drug in the management of chemo and radiotherapy-induced diarrhea. (author)

Characteristics of Rotavirus Diarrhea in Hospitalized Children in Kosovo

Science.gov (United States)

Ismaili-Jaha, Vlora; Shala, Muje; Azemi, Mehmedali; Hoxha-Kamberi, Teuta; Avdiu, Muharrem; Spahiu, Shqipe; Jaha, Luan

2014-01-01

Background: Diarrhea is a leading cause of child mortality worldwide. Rotavirus is one of the most common causes of severe diarrhea and dehydration in children. Authors reviewed epidemiological and clinical data of the rotavirus diarrhea in Kosovo. Methods: This is a prospective study carried between January 1st and December 31st 2011. All data, comprising demographics, nutrition, clinical presentation, laboratory findings, management and outcome of the rotavirus diarrhea are collected on the specially designed form. Results: 116 children with rotavirus diarrhea are included in the study. The majority boys (74.4%) and children aged 0 – 12 months (82.75%). Mean age of children in the study was 16.38 months. Almost every third child in the study was hypotrophic (29.2%). More than half of the infants (55.2%) were on mixed food, somewhat more than every third was breast feeding (36.45%), and every twelfth (8.33%) was on artificial milk (animal or formula). Apart from diarrhea, present in all patients, vomiting (97.41%) and fever (43.96%) were characteristics of the clinical presentation of the diarrhea. Two thirds of the children had mild grade dehydration (70.7%). All patients recovered with no sequels. Conclusion: Rotavirus continues to be responsible for a significant portion of acute diarrhea in Kosovo. Clinical features, epidemiological data and the agglutination test are safe enough to establish the diagnosis. Treated correctly rotavirus diarrhea has a favorable outcome. PMID:25568634

Microscopic Colitis – A Missed Diagnosis in Diarrhea-Predominant Irritable Bowel Syndrome

Science.gov (United States)

STOICESCU, Adriana; BECHEANU, Gabriel; DUMBRAVA, Mona; GHEORGHE, Cristian; DICULESCU, Mircea

2012-01-01

ABSTRACT Background: Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. Aim: To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. Material and methods: Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine. Results: From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome. Conclusions: All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost

[Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea].

Science.gov (United States)

Corral-Terrazas, Martha; Martínez, Homero; Flores-Huerta, Samuel; Duque-L, Ma Ximena; Turnbull, Bernardo; Levario-Carrillo, Margarita

2002-01-01

To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Dextran sulfate sodium-induced acute colitis impairs dermal lymphatic function in mice.

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Agollah, Germaine D; Wu, Grace; Peng, Ho-Lan; Kwon, Sunkuk

2015-12-07

To investigate whether dermal lymphatic function and architecture are systemically altered in dextran sulfate sodium (DSS)-induced acute colitis. Balb/c mice were administered 4% DSS in lieu of drinking water ad libitum for 7 d and monitored to assess disease activity including body weight, diarrhea severity, and fecal bleeding. Control mice received standard drinking water with no DSS. Changes in mesenteric lymphatics were assessed following oral administration of a fluorescently-labelled fatty acid analogue, while dermal lymphatic function and architecture was longitudinally characterized using dynamic near-infrared fluorescence (NIRF) imaging following intradermal injection of indocyanine green (ICG) at the base of the tail or to the dorsal aspect of the left paw prior to, 4, and 7 d after DSS administration. We also measured dye clearance rate after injection of Alexa680-bovine serum albumin (BSA). NIRF imaging data was analyzed to reveal lymphatic contractile activity after selecting fixed regions of interest (ROIs) of the same size in fluorescent lymphatic vessels on fluorescence images. The averaged fluorescence intensity within the ROI of each fluorescence image was plotted as a function of imaging time and the lymphatic contraction frequency was computed by assessing the number of fluorescent pulses arriving at a ROI. Mice treated with DSS developed acute inflammation with clinical symptoms of loss of body weight, loose feces/watery diarrhea, and fecal blood, all of which were aggravated as disease progressed to 7 d. Histological examination of colons of DSS-treated mice confirmed acute inflammation, characterized by segmental to complete loss of colonic mucosa with an associated chronic inflammatory cell infiltrate that extended into the deeper layers of the wall of the colon, compared to control mice. In situ intravital imaging revealed that mice with acute colitis showed significantly fewer fluorescent mesenteric lymphatic vessels, indicating impaired

Digestive Disorders in Children with Antibiotic-Associated Diarrhea

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O.A. Radutna

2016-08-01

Full Text Available Introduction. The most notable problem of the widespread use of antibiotics is the changes in microbial ecology, imbalance of intestinal biocenosis, the appearance of antibiotic-resistant strains of microorganisms with pathogenic properties and due to this the pathological changes in the intestine that cause symptoms of digestive disorders in patients with antibiotic-associated diarrhea. Objective. To identify the symptoms of malabsorption in order to improve early diagnosis of antibiotic-associated diarrhea in children. Materials and methods. The object of the study were 116 patients treated with antibiotics, aged 6 months to 18 years. The examination of children included clinical, biochemical, bacteriological, immunoenzyme, immunochromatographic, instrumental, mathematical methods. Results. In the development of diarrhea in patients with negative test on clostridial toxins, such cases were qualified as idiopathic antibiotic-associated diarrhea, with positive — like intestinal Clostridium difficile infection. The study revealed significant differences in scatological indices between the children with acute idiopathic and antibiotic-associated diarrhea caused by clostridial infection. During microscopic and biochemical studies of feces, we have revealed symptomatic signs of impaired digestion and absorption of fats and carbohydrates, which manifested by clinical symptoms of malabsorption. All children with antibiotic-associated diarrhea are characterized by increased concentrations of carbohydrates in feces. Signs of digestive disorders with the development of malabsorption of lipids were detected n children with antibiotic-associated diarrhea, primarily caused by Clostridium difficile infection. Conclusions. Maldigestion and lipid and carbohydrate absorption, as well as symptoms of inflammation in the intestines (leukocytes, occult blood, mucus are the markers of antibiotic-associated diarrhea and can be used for its early diagnosis

Management of the returning traveler with diarrhea.

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de Saussure, Philippe P H

2009-11-01

Traveler's diarrhea (TD) strikes 20-60% of travelers visiting developing countries. It occurs shortly after the return and can be distinguished into two categories: acute and persistent TD. Acute TD, mostly caused by bacterial and viral pathogens, is usually mild and self-limited, and deserves empirical symptomatic and/or antibiotic therapy in selected cases. Fluoroquinolones are progressively superseded in this indication by azithromycin, a well tolerated macrolide active against most bacteria responsible for TD, including the quinolone-resistant species of Campylobacter jejuni that are now pervasive, especially in Southeast Asia and India. Persistent TD in the returning traveler is much rarer than its acute counterpart and may be associated with three types of causes. Persistent infections, among which Giardia and possibly Entamoeba predominate, account for a significant proportion of cases. Postinfectious processes represent a second cause and comprise temporary lactose malabsorption and postinfectious irritable bowel syndrome, now considered a major cause of persistent TD. Finally, apparently unrelated chronic diseases causing diarrhea are occasionally unmasked by TD and represent a third type of persistent TD, among which the well established case of incident inflammatory bowel disease poses intriguing pathogenesis questions. This review discusses recent advances in the field and provides practical recommendations for the management of TD in adult, immunocompetent returning travelers.

Sensitivity and Specificity of Procalcitonin to Determine Etiology of Diarrhea in Children Younger Than 5 Years

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Ismaili-Jaha, Vlora; Shala, Mujë; Azemi, Mehmedali; Spahiu, Shqipe; Hoxha, Teuta; Avdiu, Muharrem; Spahiu, Lidvana

2014-01-01

Aim: The aim of this study is to assess the sensitivity and specificity of procalcitonin to determine bacterial etiology of diarrhea. The examinees and methods: For this purpose we conducted the study comprising 115 children aged 1 to 60 months admitted at the Department of Pediatric Gastroenterology, Pediatric Clinic, divided in three groups based on etiology of the diarrhea that has been confirmed with respective tests during the hospitalization. Each group has equal number of patients – 35. The first group was confirmed to have bacterial diarrhea, the second viral diarrhea and the third extra intestinal diarrhea. The determination of procalcitonin has been established with the ELFA methods of producer B.R.A.H.M.S Diagnostica GmbH, Berlin, (Germany). Results: From the total number of 1130 patient with acute diarrhea procalcitonin was assessed in 105. 67 (63.8%) of these patient were male. More than one third (38.14%) of the children in our study were younger then 12 months. Approximately the same was the number of children 13-24 months (33 patients or 31.43%) and 25-60 months (32 patients or 30.43%). The mean value of PRC in children with viral diarrhea was 0.13±0.5 ng/mL in children with bacterial diarrhea was 5.3±4.9 ng/m Land in children with extra intestinal diarrhea was 1.7±2.8 ng/mL. When measured using ANOVA and Turkey HSD tests, results have shown the statistical significance when comparing viral with bacterial and extra intestinal diarrhea but were statistically insignificant when comparing bacterial and extra intestinal diarrhea. Conclusion: Procalcitonin is an important but not conclusive marker of bacterial etiology of acute diarrhea in children younger than 5 years. PMID:24944526

Sensitivity and specificity of procalcitonin to determine etiology of diarrhea in children younger than 5 years.

Science.gov (United States)

Ismaili-Jaha, Vlora; Shala, Mujë; Azemi, Mehmedali; Spahiu, Shqipe; Hoxha, Teuta; Avdiu, Muharrem; Spahiu, Lidvana

2014-04-01

The aim of this study is to assess the sensitivity and specificity of procalcitonin to determine bacterial etiology of diarrhea. For this purpose we conducted the study comprising 115 children aged 1 to 60 months admitted at the Department of Pediatric Gastroenterology, Pediatric Clinic, divided in three groups based on etiology of the diarrhea that has been confirmed with respective tests during the hospitalization. Each group has equal number of patients - 35. The first group was confirmed to have bacterial diarrhea, the second viral diarrhea and the third extra intestinal diarrhea. The determination of procalcitonin has been established with the ELFA methods of producer B.R.A.H.M.S Diagnostica GmbH, Berlin, (Germany). From the total number of 1130 patient with acute diarrhea procalcitonin was assessed in 105. 67 (63.8%) of these patient were male. More than one third (38.14%) of the children in our study were younger then 12 months. Approximately the same was the number of children 13-24 months (33 patients or 31.43%) and 25-60 months (32 patients or 30.43%). The mean value of PRC in children with viral diarrhea was 0.13±0.5 ng/mL in children with bacterial diarrhea was 5.3±4.9 ng/m Land in children with extra intestinal diarrhea was 1.7±2.8 ng/mL. When measured using ANOVA and Turkey HSD tests, results have shown the statistical significance when comparing viral with bacterial and extra intestinal diarrhea but were statistically insignificant when comparing bacterial and extra intestinal diarrhea. Procalcitonin is an important but not conclusive marker of bacterial etiology of acute diarrhea in children younger than 5 years.

[Current situation on the treatment modules of diarrhea cases in 12 counties/cities of Guangdong, Henan and Gansu provinces in China].

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Zhang, Jing; Liu, Min

2008-10-01

To understand the situation of diarrhea cases treatment modules in the areas and to provide reference data for setting up national strategies for treatment and control of diarrhea diseases. Using the method of multistage and cluster random sampling, we selected twelve counties/cities and 60 streets communities/villages from Guangdong, Henan and Gansu provinces that representing three kinds of economic development. According to the definition of diarrhea case published by World Health Organization, we conducted a four-time investigation at the community level in four different seasons. The overall incidence of diarrhea within two weeks was 0.79% (95%CI: 0.74% - 0.84%) in the residents from twelve counties/districts in Guangdong, Henan and Gansu. The incidence rate within two weeks under the 5 years old was 2.30% (95%CI: 1.96% - 2.67%), obviously higher than the incidence rates seen in other age groups. The average percentage of visiting a doctor seeking for help on diarrhea within the two weeks was 55.89% for the three provinces. The highest percentage was 79.88% in the age group under 5 years old. 35.38% of the patients with diarrhea in urban area went to the community or street clinics for treatment, but 75.04% of the diarrhea cases in rural areas went to see village or private rural doctors. Factors influencing the behaviors of visiting a doctor seeking for help were found by logistic Regression method. It was found that factors as: when diarrhea cases with voluminous or soft-rice like watery stools or with dark blood stools; when a patient was with fever, more episodes per day or with longer duration, the patients would turn more to the doctors for help. Diarrhea cases from the rural areas would see doctors more often than the cases from the urban areas. People having had partial 'new rural medical insurance' would see doctors more often than those without medical insurance. We studied the modules of diarrhea case treatment between the urban and rural area in

Clinical trial evaluating cholestyramine to prevent diarrhea in patients maintained on low-fat diets during pelvic radiation therapy

International Nuclear Information System (INIS)

Chary, S.; Thomson, D.H.

1984-01-01

A prospective randomized trial to determine the value of a low fat diet with or without cholestyramine in the treatment of acute intestinal complications of pelvic irradiation is presented. A total of 35 patients receiving pelvic irradiation were entered in the study and all patients had received a 40 gm fat diet. The group was then randomized to receive either placebo (17 patients) or cholestyramine (18 patients). Diarrhea occurred in six out of 16 evaluable patients in the control group and only one of the 17 evaluable patients in the cholestyramine group. The frequency of diarrhea and the diarrhea scale remained high in the placebo group in the entire observation period. Statistical analysis had revealed better diarrhea control in the cholestyramine group. In this report mechanism by which diarrhea occurs following pelvic irradiation is discussed. The adverse effects associated with the use of cholestyramine have been presented. It was concluded that cholestyramine is effective in preventing acute diarrhea induced by pelvic irradiation in patients receiving a low fat diet but is associated with side effects

Epidemiological and microbiological aspects of acute bacterial diarrhea in children from Salvador, Bahia, Brazil

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Daniel R. Diniz-Santos

Full Text Available In the few cases of acute childhood diarrhea that require antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains. In order to establish such parameters in our city, we reviewed the results of all 260 positive stool cultures of children between 0 and 15 years of age during two years at a pediatric tertiary care facility in Salvador, Brazil. Bacterial strains had been presumptively identified by culturing in selective media and by biochemical testing, and their antimicrobial susceptibility patterns were automatically detected by the MicroScan Walkaway System. Data about patients' sex and age, monthly distribution of the cases, pathogens isolated and their antimicrobial resistance patterns were recorded. Males corresponded to 55.4% of our sample, and most of our patients (42.7% were between one and four years of age. Shigella was the commonest pathogen, being found in 141 (54.3% cultures, while Salmonella was found in 100 (38.4% cultures and Enteropathogenic E. coli in 19 (7.3%. Salmonella was the main causal agent of diarrhea in children younger than five years old, whereas Shigella was the most frequent pathogen isolated from the stools of children between five and 15 years old. The peaks of incidence correspond to the periods of school vacations. Shigella specimens presented a very high resistance rate to trimethoprim-sulfamethoxazole (90.1% and to ampicillin (22.0%, while Salmonella presented very low resistance rates to all drugs tested. These data are useful for practitioners and they reinforce the need for continuous microbiological surveillance.

Epidemiological and microbiological aspects of acute bacterial diarrhea in children from Salvador, Bahia, Brazil.

Science.gov (United States)

Diniz-Santos, Daniel R; Santana, José S; Barretto, Junaura R; Andrade, Maria Goreth M; Silva, Luciana R

2005-02-01

In the few cases of acute childhood diarrhea that require antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains. In order to establish such parameters in our city, we reviewed the results of all 260 positive stool cultures of children between 0 and 15 years of age during two years at a pediatric tertiary care facility in Salvador, Brazil. Bacterial strains had been presumptively identified by culturing in selective media and by biochemical testing, and their antimicrobial susceptibility patterns were automatically detected by the MicroScan Walkaway System. Data about patients' sex and age, monthly distribution of the cases, pathogens isolated and their antimicrobial resistance patterns were recorded. Males corresponded to 55.4% of our sample, and most of our patients (42.7%) were between one and four years of age. Shigella was the commonest pathogen, being found in 141 (54.3%) cultures, while Salmonella was found in 100 (38.4%) cultures and Enteropathogenic E. coli in 19 (7.3%). Salmonella was the main causal agent of diarrhea in children younger than five years old, whereas Shigella was the most frequent pathogen isolated from the stools of children between five and 15 years old. The peaks of incidence correspond to the periods of school vacations. Shigella specimens presented a very high resistance rate to trimethoprim-sulfamethoxazole (90.1%) and to ampicillin (22.0%), while Salmonella presented very low resistance rates to all drugs tested. These data are useful for practitioners and they reinforce the need for continuous microbiological surveillance.

Diarrhea in the International Traveler.

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Duchini; Rodgers

1999-06-01

International travelers to developing countries have a 40% risk of developing a diarrheal illness, usually acute and occasionally chronic. Preventive measures, including diet and lifestyle modifications, are highly recommended but may not be sufficient. Prophylaxis with bismuth subsalicylate or an antimicrobial should be considered in travelers with immunodeficiencies, co-morbid conditions, achlorhydria, or those who cannot afford a loss of time. Oral rehydration is the primary goal of therapy. Bismuth-subsalicylate is a first-line agent for treatment of milder cases with less than three watery bowel movements per day and prominent nausea. Use of an antibiotic is indicated for more severe cases or in the presence of fever, dysentery, or severe dehydration. A short course of a quinolone is highly effective, safe and well tolerated. Antimicrobial resistance among enteropathogens is growing and appropriate therapeutic modifications should be considered according to specific geographic areas. Metronidazole may be empirically added in those cases that do not respond to quinolones. Specific guidelines for particular pathogens are highlighted.

Diagnostic approach to acute infectious diarrhea: the state of the art

Directory of Open Access Journals (Sweden)

1995-01-01

ás relevantes identificados tienen que ver con los diseños de estudio, el efecto de la variación en la validez de los estudios sobre la exactitud diagnóstica, y la factibilidad de generalizar los resultados. Igualmente, se enfatiza sobre las fuentes potenciales de confusión y sesgo (tales como manifestaciones clínicas y epidemiológicas diferentes, y el hallazgo frecuente de diarreas mixtas, particularmente para estudios realizados en países en desarrollo. La lactoferrina fecal parece ser una prueba prometedora para distinguir las diarreas inflamatorias, si bien su utilidad final en diferentes contextos clínicos y de campo requiere de estudios adicionales. Finalmente, se puntualiza sobre la necesidad de llevar a cabo un estudio cuantitativo (meta-analítico de los estudios primarios realizados sobre el tema, como una estrategia potencialmente útil para resolver las preguntas que todavía quedan sin respuesta definitiva. A continuously increasing number of enteric microorganisms is being recognized as responsible for acute infectious diarrhea. Accordingly, the need of a low cost and effective approach to diagnosis and management of diarrhea is at present a pressing problem for both policy makers and physicians. This paper reviews the available information on the issue, attempting to answer whether fecal leukocytes, occult blood, fecal lactoferrin or any combination of these screening tests with clinical data allow the identification of a majority of cases of inflammatory, invasive diarrhea. After a preliminary section dealing with pathophysiological considerations on the inflammatory response of intestinal mucosa to infection by pathogenic agents and a summarized revision of the pioneering studies on the value of fecal leukocytes in the discrimination between bacillary and amebic dysentery, a critical analysis is made of later studies which addresses to the reliability of different approaches in the discrimination between invasive and noninvasive diarrhea. Several

Clinical application of continent anal plug in bedridden patients with intractable diarrhea.

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Kim, J; Shim, M C; Choi, B Y; Ahn, S H; Jang, S H; Shin, H J

2001-08-01

Some patients bedridden from various causes such as stroke or spinal cord injury experience poor control of bowel movement. This causes fecal leakage and diarrhea, increases the risk of perianal excoriation and bed sores, and is a burden on caregivers. To evaluate the efficacy of fecal evacuation and the prevention and treatment of skin complications in intractable diarrhea patients using a new device. A continent anal plug (US Patent No. 5 569 216) comprises an inner balloon surrounded by an outer balloon, both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable outer balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty-two patients (21 male; median age 61 (range, 28-76) years) were evaluated after fully informed consent. Median duration was 12 (range, 3-37) days. The continent anal plug evacuated efficiently in those patients with loose or watery stools who only required irrigation once daily or not at all. Skin excoriations improved in three to seven days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days. The continent anal plug is an efficient method of treating patients with loss of bowel control and incontinence because it enables controlled fecal evacuation and helps reduce skin complications without causing anorectal mucosal injury.

Acute diarrhea in West African children: diverse enteric viruses and a novel parvovirus genus.

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Phan, Tung G; Vo, Nguyen P; Bonkoungou, Isidore J O; Kapoor, Amit; Barro, Nicolas; O'Ryan, Miguel; Kapusinszky, Beatrix; Wang, Chunling; Delwart, Eric

2012-10-01

Parvoviruses cause a variety of mild to severe symptoms or asymptomatic infections in humans and animals. During a viral metagenomic analysis of feces from children with acute diarrhea in Burkina Faso, we identified in decreasing prevalence nucleic acids from anelloviruses, dependoviruses, sapoviruses, enteroviruses, bocaviruses, noroviruses, adenoviruses, parechoviruses, rotaviruses, cosavirus, astroviruses, and hepatitis B virus. Sequences from a highly divergent parvovirus, provisionally called bufavirus, were also detected whose NS1 and VP1 proteins showed parvoviruses. Four percent of the fecal samples were PCR positive for this new parvovirus, including a related bufavirus species showing only 72% identity in VP1. The high degree of genetic divergence of these related genomes from those of other parvoviruses indicates the presence of a proposed new Parvoviridae genus containing at least two species. Studies of the tropism and pathogenicity of these novel parvoviruses will be facilitated by the availability of their genome sequences.

The effects of galantase on radiation enteritis due to radiotherapy in the field of gynecology

International Nuclear Information System (INIS)

Akitani, Kiyoshi; Ota, Akio; Gomi, Hideki; Taniguchi, Jiro; Hiraiwa, Mikio

1976-01-01

Three to 6 g/day of galantase were administered daily to the patients with cancer of the cervix of the uterus and malignant tumor of the ovaries, to compare galantase administered group with non-administered group concerning the findings of stooles and other incidental symptoms, blood pictures, and liver functions. In the patients to whom this drug was administered, no diarrhea was observed with given dose of 1,000 rads, but diarrhea was observed in 46.9% with 3,000 rads, in 9.6% with 4,000 rads, in 11.3% with 5,000 rads. No watery stool was observed. When compared the findings between 6 g galantase administered patients and 3 g administered patients, there was no difference with 1,000 rads, but with 2,000 rads diarrhea was observed in 6.5% of 6 g patients, and in 38.2% of 3 g patients. With 3,000 rads it was observed in 10.8% of 6 g administered and 58.7% of 3 g administered patients. In nonadministered patients diarrhea was observed in 16.8% with 1,000 rads, and in 35.4% including 29.3% of watery stool with 2,000 rads, and with 3,000 rads, in 61.1% including 47.5% of watery stool which needed the administration of antidiarrhoica. As above mentioned, there was a remarkable difference in the incidence of diarrhea between non-administered group (40.7%) and administered group (15.5%). Watery stool was observed only in non-administered patients (26.1%). There was a statistically significant difference in the incidence of diarrhea between 6 g administered group and 3 g or non-administered group. This indicated the clinical effectiveness of this drug in these cases. The results of various tests showed slight variation with irradiation doses, but no significant difference was observed between each group. (Kanao, N.)

Diarrhea in infants

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When your infant has diarrhea; When your baby has diarrhea; BRAT diet; Diarrhea in children ... Children who have diarrhea may have less energy, dry eyes, or a dry, sticky mouth. They may also not wet their diaper as ...

Effects of olestra and sorbitol consumption on objective measures of diarrhea: impact of stool viscosity on common gastrointestinal symptoms.

Science.gov (United States)

McRorie, J; Zorich, N; Riccardi, K; Bishop, L; Filloon, T; Wason, S; Giannella, R

2000-02-01

The aim of this study was to determine the effects of olestra and sorbitol consumption on three accepted objective measures of diarrhea (stool output >250 g/day, liquid/watery stools, bowel movement frequency >3/day), and how stool composition influences reports of common gastrointestinal symptoms. A double-blind, placebo-controlled study compared the effects of sorbitol (40 g/day in candy), a poorly absorbed sugar-alcohol with known osmotic effects, with those of olestra (20 or 40 g/day in potato chips), a nonabsorbed fat, on objective measures of stool composition and GI symptoms. Sixty-six subjects resided on a metabolic ward for 12 days: 2 days lead-in, 4 days baseline, 6 days treatment. Sorbitol 40 g/day resulted in loose/liquid stools within 1-3 h of consumption. In contrast, olestra resulted in a dose-responsive stool softening effect after 2-4 days of consumption. Subjects reported "diarrhea" when mean stool apparent viscosity (peak force (PF), g) decreased from a perceived "normal" (mean +/- SE, 1355 +/- 224 g PF; firm stool) to loose (260 +/- 68 g PF) stool. Mean apparent viscosity of stool during treatment: placebo, 1363 +/- 280 g (firm); olestra 20 g/day 743 +/- 65 g (soft); olestra 40 g/day, 563 +/- 105 g (soft); and sorbitol 40 g/day, 249 +/- 53 g (loose). Of the 1098 stool samples collected, 38% (419/1098) were rated by subjects as "diarrhea," yet only 2% of treatment days (all in the sorbitol treatment group) met commonly accepted criteria for a clinical diarrhea. Sorbitol, but not olestra, increased the severity of abdominal cramping, urgency and nausea compared to placebo. Olestra consumption, at levels far in excess of normal snacking conditions, resulted in a gradual stool softening effect after several days of consumption, did not meet any of the three objective measures of diarrhea, and did not increase GI symptoms. Sorbitol consumption, at only 80% of the dose requiring a "laxative effect" information label, resulted in rapid onset loose

The effect of high-dose vitamin A supplementation given with bacille Calmette-Guérin vaccine at birth on infant rotavirus infection and diarrhea: a randomized prospective study from Guinea-Bissau

DEFF Research Database (Denmark)

Diness, Birgitte Rode; Christoffersen, Dorthe; Pedersen, Ulla Britt

2010-01-01

Prophylactic vitamin A supplementation (VAS) reduces mortality and may reduce morbidity associated with diarrhea in children >6 months of age. Rotavirus is the most common cause of acute dehydrating diarrhea among children worldwide.......Prophylactic vitamin A supplementation (VAS) reduces mortality and may reduce morbidity associated with diarrhea in children >6 months of age. Rotavirus is the most common cause of acute dehydrating diarrhea among children worldwide....

Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

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Silviu Grisaru

2011-01-01

Full Text Available Acute kidney injury (AKI is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43% required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD. Most patients, 47 (81%, received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%, peritonitis 11 (20%, and catheter malfunction 5 (9%. Nine patients (16% needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5 × 103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS.

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he had diarrhea and fever for one week. Initially the diarrhea was frequent watery yellow, and non bloody and during the last two ... Fever of about 38, vomiting coffee ground and failure to ... Laboratory investigations showed leucocytosis of.

Diarrhea

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... by replacing lost fluids and electrolytes to prevent dehydration. Depending on the cause of the problem, you may need medicines to stop the diarrhea or treat an infection. Adults with diarrhea should drink water, fruit juices, sports drinks, sodas without caffeine, and salty ...

Porcine epidemic diarrhea virus infection: Etiology, epidemiology, pathogenesis and immunoprophylaxis.

Science.gov (United States)

Jung, Kwonil; Saif, Linda J

2015-05-01

Porcine epidemic diarrhea virus (PEDV), a member of the genera Alphacoronavirus in the family Coronaviridae, causes acute diarrhea/vomiting, dehydration and high mortality in seronegative neonatal piglets. For the last three decades, PEDV infection has resulted in significant economic losses in the European and Asian pig industries, but in 2013-2014 the disease was also reported in the US, Canada and Mexico. The PED epidemic in the US, from April 2013 to the present, has led to the loss of more than 10% of the US pig population. The disappearance and re-emergence of epidemic PED indicates that the virus is able to escape from current vaccination protocols, biosecurity and control systems. Endemic PED is a significant problem, which is exacerbated by the emergence (or potential importation) of multiple PEDV variants. Epidemic PEDV strains spread rapidly and cause a high number of pig deaths. These strains are highly enteropathogenic and acutely infect villous epithelial cells of the entire small and large intestines although the jejunum and ileum are the primary sites. PEDV infections cause acute, severe atrophic enteritis accompanied by viremia that leads to profound diarrhea and vomiting, followed by extensive dehydration, which is the major cause of death in nursing piglets. A comprehensive understanding of the pathogenic characteristics of epidemic or endemic PEDV strains is needed to prevent and control the disease in affected regions and to develop an effective vaccine. This review focuses on the etiology, epidemiology, disease mechanisms and pathogenesis as well as immunoprophylaxis against PEDV infection. Copyright © 2015 Elsevier Ltd. All rights reserved.

Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea

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Maria de Lourdes Teixeira Masukawa

2014-10-01

Full Text Available The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

Acute diarrhea during adjuvant therapy for rectal cancer: a detailed analysis from a randomized intergroup trial

International Nuclear Information System (INIS)

Miller, Robert C.; Sargent, Daniel J.; Martenson, James A.; Macdonald, John S.; Haller, Daniel; Mayer, Robert J.; Gunderson, Leonard L.; Rich, Tyvin A.; Cha, Stephen S.; O'Connell, Michael J.

2002-01-01

Purpose: During adjuvant radiotherapy (RT) for rectal cancer, patients receiving 5-fluorouracil (5-FU) by protracted venous infusion have a higher risk of diarrhea than have patients receiving bolus 5-FU. Toxicity from a previously reported randomized clinical trial was analyzed to quantify the difference in this risk. Additionally, the persistence of diarrhea after RT was analyzed. Methods and Materials: A total of 656 patients were eligible. Patients with T3-4 N0-2 M0 or T1-2 N1-2 M0 resected, high-risk rectal cancer were randomly allocated to receive 5-FU by either protracted venous infusion or bolus during RT (50.4-54.0 Gy). Two cycles of bolus 5-FU were given before and after RT. One-half of the first 445 patients were also randomly allocated to receive lomustine in conjunction with the bolus 5-FU. The incidence and severity of diarrhea in relation to patient and treatment characteristics were evaluated. Results: The rate of diarrhea was significantly greater in patients receiving 5-FU by protracted venous infusion than in patients receiving bolus 5-FU; the difference was most pronounced for Grade 3 (severe) diarrhea (21% versus 13%, p=0.007). The incidence and magnitude of diarrhea before and after RT were similar. Patients treated with an anterior resection had a higher rate of severe or life-threatening diarrhea than did patients treated with an abdominoperineal resection (31% vs. 12%, p<0.001). Conclusions: During pelvic RT, patients who receive 5-FU by protracted venous infusion rather than by bolus have a higher risk of severe or life-threatening diarrhea during RT. This risk does not appear to persist during chemotherapy after completion of pelvic RT

Escherichia coli pathotypes

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Escherichia coli strains are important commensals of the intestinal tract of humans and animals; however, pathogenic strains, including diarrhea-inducing E. coli and extraintestinal pathogenic E. coli. Intestinal E. coli pathotypes may cause a dehydrating watery diarrhea, or more severe diseases su...

Dosimetric predictors of diarrhea during radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Sanguineti, Giuseppe; Endres, Eugene J.; Parker, Brent C.; Sormani, Maria Pia

2009-01-01

Purpose: to investigate dosimetric predictors of diarrhea during radiotherapy (RT) for prostate cancer. Patients and methods: all patients who underwent external-beam radiotherapy as part of treatment for localized prostate cancer at the University of Texas Medical Branch, Galveston, TX, USA, from May 2002 to November 2006 were extracted from the own database. From the cumulative dose-volume histogram (DVH), the absolute volumes (V-value) of intestinal cavity (IC) receiving 15, 30, and 45 Gy were extracted for each patient. Acute gastrointestinal toxicity was prospectively scored at each weekly treatment visit according to CTC (common toxicity criteria) v2.0. The endpoint was the development of peak grade ≥ 2 diarrhea during RT. Various patient, tumor, and treatment characteristics were evaluated using logistic regression. Results: 149 patients were included in the analysis, 112 (75.2%) treated with whole-pelvis intensity-modulated radiotherapy (WP-IMRT) and 37 (24.8%) with prostate-only RT, including or not including, the seminal vesicles (PORT ± SV). 45 patients (30.2%) developed peak grade ≥ 2 diarrhea during treatment. At univariate analysis, IC-V 15 and IC-V 30 , but not IC-V 45 , were correlated to the endpoint; at multivariate analysis, only IC-V 15 (p = 0.047) along with peak acute proctitis (p = 0.041) was independently correlated with the endpoint. Conclusion: these data provide a novel and prostate treatment-specific ''upper limit'' DVH for IC. (orig.)

Post-infectious sequelae of travelers' diarrhea.

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Connor, Bradley A; Riddle, Mark S

2013-01-01

Travelers' diarrhea (TD) has generally been considered a self-limited disorder which resolves more quickly with expeditious and appropriate antibiotic therapy given bacteria are the most frequently identified cause. However, epidemiological, clinical, and basic science evidence identifying a number of chronic health conditions related to these infections has recently emerged which challenges this current paradigm. These include serious and potentially disabling enteric and extra-intestinal long-term complications. Among these are rheumatologic, neurologic, gastrointestinal, renal, and endocrine disorders. This review aims to examine and summarize the current literature pertaining to three of these post-infectious disorders: reactive arthritis, Guillain-Barré syndrome, and post-infectious irritable bowel syndrome and the relationship of these conditions to diarrhea associated with travel as well as to diarrhea associated with gastroenteritis which may not be specifically travel related but relevant by shared microbial pathogens. It is hoped this review will allow clinicians who see travelers to be aware of these post-infectious sequelae thus adding to our body of knowledge in travel medicine. Data for this article were identified by searches of PubMed and MEDLINE, and references from relevant articles using search terms "travelers' diarrhea" "reactive arthritis" "Guillain-Barré syndrome" "Post-Infectious Irritable Bowel Syndrome." Abstracts were included when related to previously published work. A review of the published literature reveals that potential consequences of travelers' diarrhea may extend beyond the acute illness and these post-infectious complications may be more common than currently recognized. In addition since TD is such a common occurrence it would be helpful to be able to identify those who might be at greater risk of post-infectious sequelae in order to target more aggressive prophylactic or therapeutic approaches to such individuals. It is

Incidence of diarrhea in children living in urban slums in Salvador, Brazil

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Maria Clotildes N. de Melo

Full Text Available Diarrhea remains a major health issue in developing countries, with high morbidity and mortality rates. Determining the incidence of acute diarrhea in children and its associated factors is crucial to the planning of preventive approaches. The objective of this study was to determine the incidence of diarrhea and to assess some relevant associated factors to it in children younger than 40 months living in two slums of Salvador, Brazil. This is the first prospective cohort, community-based study that was performed in two periurban slums of Salvador, Brazil. Eighty-four children younger than 40 months were randomly selected and visited every other day for one year. The chi-square test was used to evaluate the occurrence of diarrhea and its associated factors. During the surveillance period, 232 diarrhea episodes were identified, resulting in an incidence rate of 2.8 episodes/child/year. In average (mean value of 84 children,each child suffered 11.1 days of diarrhea per year, yielding an average duration of 3.9 days per episode. The highest incidence rates were found among children under one year old. Early weaning, male sex, malnutrition, having a mother younger than 25 years or who considered her child malnourished, missed immunizations and previous pneumonia were associated factors for suffering diarrheal episodes. The rates of incidence and duration of diarrhea that we found are in accordance to those reported by others. Additionally, our results reinforce the importance of environmental and health-related associated factors to the onset of diarrhea.

Role of colonic short-chain fatty acid transport in diarrhea.

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Binder, Henry J

2010-01-01

Short-chain fatty acids (SCFA) are the major anion in stool and are synthesized from nonabsorbed carbohydrate by the colonic microbiota. Nonabsorbed carbohydrate are not absorbed in the colon and induce an osmotically mediated diarrhea; in contrast, SCFA are absorbed by colonic epithelial cells and stimulate Na-dependent fluid absorption via a cyclic AMP-independent process involving apical membrane Na-H, SCFA-HCO(3), and Cl-SCFA exchanges. SCFA production represents an adaptive process to conserve calories, fluid, and electrolytes. Inhibition of SCFA synthesis by antibiotics and administration of PEG, a substance that is not metabolized by colonic microbiota, both result in diarrhea. In contrast, increased production of SCFA as a result of providing starch that is relatively resistant to amylase digestion [so-called resistant starch (RS)] to oral rehydration solution (RS-ORS) improves the efficacy of ORS and represents an important approach to improve the effectiveness of ORS in the treatment of acute diarrhea in children under five years of age.

Comparing the Accuracy of the Three Dehydration Scales in Children with Acute Diarrhea in a Developing Country of Kosovo.

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Hoxha, Teuta; Xhelili, Luan; Azemi, Mehmedali; Avdiu, Muharrem; Ismaili-Jaha, Vlora; Efendija-Beqa, Urata; Grajcevci-Uka, Violeta

2015-06-01

Although diarrhea is a preventable disease, it remains the second leading cause of death (after pneumonia) among children aged under five years worldwide. The World Health Organization (WHO) scale, the Gorelick scale, and the Clinical Dehydration Scale (CDS) were created to estimate dehydration status using clinical signs. The purpose of this study is to determine whether these clinical scales can accurately assess dehydration status of children in a developing country of Kosovo. Children aged 1 month to 5 years with a history of acute diarrhea were enrolled in the study. After recording the data about the patients historical features the treating physician recorded the physical examination findings consistent with each clinical score. Receiver operating characteristic (ROC) curves were constructed to evaluate the performance of the three scales, compared to the gold standard, percent weight change with rehydration. Sensitivity, specificity and likelihood ratios were calculated using the best cut-off points of the ROC curves. We enrolled 230 children, and 200 children met eligibility criteria. The WHO scale for predicting significant dehydration (≥5 percent weight change) had an area under the curve (AUC) of 0.71 (95% : CI= 0.65-0.77). The Gorelick scales 4- and 10-point for predicting significant dehydration, had an area under the curve of 0.71 (95% : CI=0.63- 0.78) and 0.74 (95% : CI= 0.68-0.81) respectively. Only the CDS for predicting the significant dehydration above ≥6% percent weight change, did not have an area under the curve statistically different from the reference line with an AUC of 0.54 (95% CI = 0.45- 0.63). The WHO dehydration scale and Gorelick scales were fair predictors of dehydration in children with diarrhea. Only the Clinical Dehydration Scale was found not to be a helpful predictor of dehydration in our study cohort.

Comparing the Accuracy of the Three Dehydration Scales in Children with Acute Diarrhea in a Developing Country of Kosovo

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Hoxha, Teuta; Xhelili, Luan; Azemi, Mehmedali; Avdiu, Muharrem; Ismaili-Jaha, Vlora; Efendija-Beqa, Urata; Grajcevci-Uka, Violeta

2015-01-01

Background. Although diarrhea is a preventable disease, it remains the second leading cause of death (after pneumonia) among children aged under five years worldwide. The World Health Organization (WHO) scale, the Gorelick scale, and the Clinical Dehydration Scale (CDS) were created to estimate dehydration status using clinical signs. The purpose of this study is to determine whether these clinical scales can accurately assess dehydration status of children in a developing country of Kosovo. Methodology. Children aged 1 month to 5 years with a history of acute diarrhea were enrolled in the study. After recording the data about the patients historical features the treating physician recorded the physical examination findings consistent with each clinical score. Receiver operating characteristic (ROC) curves were constructed to evaluate the performance of the three scales, compared to the gold standard, percent weight change with rehydration. Sensitivity, specificity and likelihood ratios were calculated using the best cut-off points of the ROC curves. Results. We enrolled 230 children, and 200 children met eligibility criteria. The WHO scale for predicting significant dehydration (≥5 percent weight change) had an area under the curve (AUC) of 0.71 (95% : CI= 0.65-0.77). The Gorelick scales 4- and 10-point for predicting significant dehydration, had an area under the curve of 0.71 (95% : CI=0.63- 0.78) and 0.74 (95% : CI= 0.68-0.81) respectively. Only the CDS for predicting the significant dehydration above ≥6% percent weight change, did not have an area under the curve statistically different from the reference line with an AUC of 0.54 (95% CI = 0.45- 0.63). Conclusion. The WHO dehydration scale and Gorelick scales were fair predictors of dehydration in children with diarrhea. Only the Clinical Dehydration Scale was found not to be a helpful predictor of dehydration in our study cohort. PMID:26244042

Hypokalemic Rhabdomyolysis Induced Acute Renal Failure As a Presentation of Coeliac Disease

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Funda Sarı

2012-03-01

Full Text Available Adult coeliac disease commonly presents without classical symptoms as chronic diarrhea and weight loss. We describe the case of a 31-year-old woman with persistent life-threatening hypokalemia, acute renal failure, and acute quadriplegia due to diarrhea that had continued for one month. Although there are cases of coeliac disease diagnosed with hypokalemic rhabdomyolysis in the literature, none of the cases developed acute renal failure. This is the first case in the literature diagnosed with acute renal failure due to hypokalemic rhabdomyolysis as a presentation of coeliac disease. In acute renal failure cases that present with hypokalemic rhabdomyolysis due to severe diarrhea, coeliac disease should be considered as a differential diagnosis despite the negative antigliadin IgA antibody.

Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

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Hu Sung-Yuan

2011-03-01

Full Text Available Abstract Background Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. Case presentations We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. Conclusion Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.

Diarrhea

OpenAIRE

Warren, Ralph E.

1983-01-01

The four major mechanisms of diarrhea are osmotic forces, secretory forces, exudation from a disrupted intestinal mucosa, and disturbed intestinal motility. In many illnesses, more than one mechanism produces diarrhea. The rotaviruses and the Norwalk viruses have recently been recognized as common causes of viral gastroenteritis. Also, the major cause of antibiotic-associated colitis is now known to be an overgrowth of Clostridium difficile. Campylobacter has also been identified as a common ...

Prevalência baixa de adenovírus em crianças com diarreia em Belo Horizonte-MG Low prevalence of adenoviruses in children with acute diarrhea in Belo Horizonte-MG

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Ricardo Jenner Duarte

2012-08-01

Full Text Available INTRODUÇÃO: Diversos microrganismos são reconhecidos como agentes de diarreia aguda, entre eles, os adenovírus, cuja associação com a doença apresenta variações geográficas e é pouco conhecida no Brasil. OBJETIVOS: Investigar a presença de adenovírus em fezes de crianças com diarreia aguda e sem diarreia, em Belo Horizonte-MG, e estudar os fatores epidemiológicos associados à adenovirose intestinal. MATERIAL E MÉTODOS: O teste imunocromatográfico qualitativo (kit VIKIA® Rota-Adeno, bioMérieux foi utilizado para pesquisa de antígenos de adenovírus em amostras fecais obtidas de 268 crianças com diarreia aguda e 124 sem diarreia, em 2005 e 2006, no Hospital Infantil João Paulo II, Belo Horizonte-MG. Dados laboratoriais, clínicos e epidemiológicos foram registrados em banco de dados (SPSS Statistical package, IBM. RESULTADOS: Adenovírus foi detectado nas fezes de 16 crianças (4,1%: 12 (4,5% com diarreia e quatro (3,2% sem diarreia. A virose foi mais comum em meninas e a distribuição etária da infecção foi homogênea. Entre as 16 crianças com infecção pelo vírus, 11 (68,8% tinham até 12 meses de idade. Entretanto, diferença significativa não foi observada para os parâmetros analisados. Distribuição sazonal da infecção por adenovírus não foi detectada. CONCLUSÃO: Nossos dados demonstram que a prevalência da adenovirose é baixa na população pediátrica no nosso meio.INTRODUCTION: Several microorganisms, among them enteric adenovirus, are widely recognized as etiological agents of acute diarrhea. The association between adenovirus and the disease varies among geographical regions and is poorly known in Brazil. OBJECTIVES: To investigate the presence of adenovirus in stool samples from children with and without diarrhea in Belo Horizonte-MG. To study factors associated with enteric adenovirus infection. MATERIAL AND METHOD: A qualitative immunochromatographic assay (kit VIKIA® Rota-Adeno, bio

Efficacy of Bacillus clausii and Saccharomyces boulardii in Treatment of Acute Rotaviral Diarrhea in Pediatric Patients

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Salloju Vineeth

2017-06-01

Full Text Available Diarrhea disease is considered as major health problem in developing countries. Rotavirus is the most common identifiable viral cause of diarrhea in all children and belongs to Reoviridae family. Rotavirus infection occasionally leads to severe dehydration in infants and children. The objective of the study is to assess the efficacy of Bacillus clausii and Saccharomyces boulardii on the treatment of rotaviral diarrhea, and also to assess its effect on vomiting and fever in pediatric patients. This study conducted at Rainbow Children’s Hospital, Hyderabad, India, from January 2016 until June 2016 and adopts prospective observational parallel study design. From 104 patients enrolled, 80 fulfilled inclusion criteria and 24 were excluded from the study. Patients were divided into two groups based on the treatment. Group I patients were treated with Bacillus clausii and Group II patients were treated with Saccharomyces boulardii. Total mean duration of diarrhea was significantly shorter in Group II (S. boulardii in comparison with Group I (B. clausii. S. boulardii significantly (p≤0.005 decreased the duration of diarrhea which is 25.2 hours over B. clausii. Both probiotic preparations were equal in efficacy on treating the vomiting and fever (p≥0.005. S. boulardii and B. clausii were well accepted and tolerated by the children and there were no reports of any adverse effects during the study period.

[Chronic diarrhea: etiologies and diagnostic evaluation].

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Schoepfer, A

2008-04-30

Chronic diarrhea is defined as a decrease in fecal consistency lasting for four or more weeks. A myriad of disorders are associated with chronic diarrhea. In developed countries, chronic diarrhea is mostly caused by non-infectious diseases. There are four pathogenic mechanisms leading to chronic diarrhea: osmotic diarrhea, secretory diarrhea, inflammatory diarrhea, and dysmotility. Overlaps between these mechanisms are possible. A 72-hour fecal collection as well as the fasting test are important diagnostic tools to identify the underlying pathomechanism. The identification of the pathomechanism narrows down the possible etiologies of chronic diarrhea and allows therefore a cost-saving diagnostic workup. The endoscopy is well established in the workup of chronic diarrhea. This article gives an overview about the main causes and mechanisms leading to chronic diarrhea and proposes an algorithm for the diagnostic evalution.

Testing for Chronic Diarrhea.

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Raman, M

Chronic diarrhea is a frequently encountered symptom in clinical practice. The etiologies for chronic diarrhea are diverse and broad with varying clinical implications. A useful method of categorizing chronic diarrhea to guide a diagnostic work-up is a pathophysiology-based framework. Chronic diarrhea may be categorized as malabsorptive, secretory, osmotic, and inflammatory or motility related. Frequently, overlap between categories may exist for any given diarrhea etiology and diagnostic testing must occur with an understanding of the differential diagnosis. Investigations to achieve a diagnosis for chronic diarrhea range from screening blood and stool tests to more directed testing such as diagnostic imaging, and endoscopic and histological evaluation. The pathophysiology-based framework proposed in this chapter will allow the clinician to select screening tests followed by targeted tests to minimize cost and complications to the patient, while providing a highly effective method to achieve an accurate diagnosis. © 2017 Elsevier Inc. All rights reserved.

Drug-induced diarrhea

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... pain and arthritis, such as ibuprofen and naproxen. Metformin used to treat diabetes. Some herbal teas contain senna or other "natural" laxatives that can cause diarrhea. Other vitamins, minerals, or supplements may also cause diarrhea.

A Study to Determine the Incidence of Urinary Tract Infections in Infants and Children Ages 4 Months to 6 Years With Febrile Diarrhea.

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Nibhanipudi, Kumara V

2016-01-01

To determine the incidence of urinary tract infections (UTIs) in infants and children (4 months to 6 years of age) with febrile diarrhea, as outpatients. This was a prospective institutional review board-approved study. patients (between 4 months and 6 years of age) were enrolled in the study who presented to the pediatric emergency room with a complaint of fever (rectal temperature 101°F or more) and diarrhea (watery stools >3 in number). The patients were evaluated for state of hydration, and also urine samples were collected. For those children not toilet trained, urine specimens were collected by bladder catheterization, and for those children toilet trained, urine specimens were obtained by midstream collection method. The urine samples obtained were sent for analysis and culture. Eighty patients were enrolled in the study. The number of specimens obtained by clean catch midstream was 20, and by bladder catheterization was 60. None of the urine specimens obtained by both methods of collection grew any organism. There was no increased incidence of infections in male children whether circumcised (10/60) or uncircumcised (50/60). The mean temperature was 102.8°F (range = 101°F to 105°F). Using in silico online 2 × 2 χ(2) test by comparing both the positive and negative urine culture results, 2-tailed P value is <.0001. Our prospective randomized study concluded that there is no increased incidence of UTIs in infants and children (4 months to 6 years of age) with febrile diarrhea.

A Study to Determine the Incidence of Urinary Tract Infections in Infants and Children Ages 4 Months to 6 Years With Febrile Diarrhea

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Kumara V. Nibhanipudi MD, FAAP, FAAEM

2016-08-01

Full Text Available Objective: To determine the incidence of urinary tract infections (UTIs in infants and children (4 months to 6 years of age with febrile diarrhea, as outpatients. Methods: This was a prospective institutional review board–approved study. patients (between 4 months and 6 years of age were enrolled in the study who presented to the pediatric emergency room with a complaint of fever (rectal temperature 101°F or more and diarrhea (watery stools >3 in number. The patients were evaluated for state of hydration, and also urine samples were collected. For those children not toilet trained, urine specimens were collected by bladder catheterization, and for those children toilet trained, urine specimens were obtained by midstream collection method. The urine samples obtained were sent for analysis and culture. Results: Eighty patients were enrolled in the study. The number of specimens obtained by clean catch midstream was 20, and by bladder catheterization was 60. None of the urine specimens obtained by both methods of collection grew any organism. There was no increased incidence of infections in male children whether circumcised (10/60 or uncircumcised (50/60. The mean temperature was 102.8°F (range = 101°F to 105°F. Statistics: Using in silico online 2 × 2 χ2 test by comparing both the positive and negative urine culture results, 2-tailed P value is <.0001. Conclusions: Our prospective randomized study concluded that there is no increased incidence of UTIs in infants and children (4 months to 6 years of age with febrile diarrhea.

[Chronic diarrhea with uncommon etiology].

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Gil Borrás, R; Juan Vidal, O; Talavera Encinas, M I; Bixquert Jiménez, M

2005-03-01

Chronic diarrhea is a common syndrome. An etiological diagnosis is often reached through clinical history, physical examination and simple tests. In some cases, when the etiology is not found, the syndrome is called functional diarrhea, even though established criteria are often not fulfilled. We present the case of a patient with diarrhea for several months. The most common causes were ruled out through clinical history, physical examination, radiographic studies and laboratory tests, and the patient was diagnosed with functional diarrhea. Three months later, the patient presented a neck mass, and biopsy revealed medullary carcinoma of the thyroid. A review of recommendations for the systematic evaluation of chronic diarrhea is presented. A general approach should include careful history taking characteristics of diarrhea (onset, associated symptoms, epidemiological factors, iatrogenic causes such as laxative ingestion), a thorough physical examination with special attention to the anorectal region, and routine laboratory tests (complete blood count and serum chemistry). In addition, stool analysis including electrolytes (fecal osmotic gap), leukocytes, fecal occult blood, excess stool fat and laxative screening can yield important objective information to classify the diarrhea as: osmotic (osmotic gaps > 125 mOsm/Kg), secretory (osmotic gaps diarrhea described above. A systematic approach to the evaluation of chronic diarrhea is warranted. Medullary thyroid carcinoma and other endocrine syndromes causing chronic diarrhea are very rare. Measurement of serum peptide concentrations should only be performed when clinical presentation and findings in stool or radiographic studies suggest this etiology.

Mujer joven con diarrea crónica

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María Vares González

2013-12-01

Chronic diarrhea is frequent. The causes are multiple, so reaching the definitive diagnosis can be complex. The diagnostic delay can be deadly. We describe the case of a young woman who developed severe hypokalemia secondary to VIPoma, neuroendocrine tumor secreting vasoactive intestinal peptide, a hormone responsible for the clinical: watery diarrhea, hypokalemia and achlorhydria

Analiza przyczyn biegunki ostrej u niemowląt jako wyznacznik profilaktyki pierwotnej i wtórnej = Analysis of the causes of acute diarrhea in infants as a marker of primary and secondary prevention

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Sabina Katarzyna Stadnicka

2016-07-01

  Streszczenie Wprowadzenie: W populacji dziecięcej jednym z najczęstszych zaburzeń rytmu wypróżniania są biegunki. Na ostrą biegunkę choruje praktycznie każde dziecko poniżej 3. roku życia. Cel: Celem pracy jest przedstawienie przyczyn występowania i zasad postępowania w biegunce ostrej u niemowląt ze zwróceniem szczególnej uwagi na profilaktykę i postępowanie przedszpitalne. Metoda: Przegląd tematyczny literatury przedmiotu obejmujący okres od 2006 do 2016 roku. Wyniki: Za większość ostrych nieżytów żołądkowo-jelitowych odpowiedzialne są zakażenia rota wirusowe. Infekcje mogą mieć zróżnicowany przebieg. Zakażenie o łagodnym przebiegu, charakteryzuje się wodnistymi stolcami, współwystępowaniem wymiotów oraz nieżytu górnych dróg oddechowych. Przebieg ciężki biegunki często powoduje powstanie objawów znacznego odwodnienia i zaburzenia gospodarki wodno-elektrolitowej i kwasowo-zasadowej. Pojawiająca się krew w stolcu świadczy o współistniejącym zakażeniu bakteryjnym. Podstawowym postępowaniem w trakcie biegunek jest wypełnienie łożyska naczyniowego za pomocą doustnych płynów nawadniających. W niektórych przypadkach konieczne jest leczenie w warunkach szpitalnych. Podsumowanie: Ze względu na najczęstszą etiologię biegunki u dzieci, czyli zakażenia wirusowe i łatwość przenoszenia zakażeń, profilaktykę opiera się na zachowaniu szczególnej dbałości o higienę (w tym przede wszystkim częste mycie rąk.   Słowa kluczowe: biegunka ostra, niemowlęta, rotawirusy, profilaktyka.   Abstract   Introduction: in the pediatric population one of the most common irregular bowel movements are diarrhea. Acute diarrhoea have virtually every child below 3. year of life. Objective: the aim of the work is the presentation of the causes of and the rules of conduct in acute diarrhea in infants with special attention to the prevention and treatment przedszpitalne. Method: a review of thematic literature

Graft-Versus-Host Disease after Liver Transplantation Complicated by Systemic Aspergillosis with Pancarditis

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Joseph Romagnuolo

2000-01-01

Full Text Available Acute graft-versus-host disease (GVHD is a common complication after bone marrow transplantation, with characteristic rash and diarrhea being the most common features. After liver transplantation, however, this phenomenon is very rare. Most transplant patients are on a variety of medications, including immunosuppressants; therefore, the differential diagnosis of skin rash or diarrhea is broad. A 37-year-old man who underwent liver transplantation for primary biliary cirrhosis, and developed a rash and watery diarrhea, is presented. Skin and colonic biopsies confirmed acute GVHD. A pulse of intravenous steroids was given. The skin rash improved, but he developed pancytopenia. His course was complicated by central line infection, jugular and subclavian vein thrombosis, pseudomembranous colitis, recurrent bacteremia, cholestasis on total parenteral nutrition and cytomegalovirus infection. After the onset of pleuritic chest pain and clinical sepsis, spiral computed tomography scan of his chest and abdomen revealed septic infarcts in multiple organs. Despite empirical treatment with amphotericin B, he died of multiorgan dysfunction syndrome within 72 h. Autopsy revealed systemic aspergillosis with pancarditis, endocardial vegetations, and septic pulmonary, splenic, hepatic and renal infarcts. The pathogenesis and experience with this rare, but often fatal, complication of liver transplantation are reviewed. In contrast to GVHD after bone marrow transplantation, pancytopenia is common and liver dysfunction is rare. One should have a high level of suspicion in the liver transplant recipient presenting with rash and/or diarrhea.

High protective efficacy of probiotics and rice bran against human norovirus infection and diarrhea in gnotobiotic pigs

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Shaohua Lei

2016-11-01

Full Text Available Probiotics have been recognized as vaccine adjuvants and therapeutic agents to treat acute gastroenteritis in children. We previously showed that rice bran reduced human rotavirus diarrhea in gnotobiotic pigs. Human noroviruses (HuNoVs are the major pathogens causing nonbacterial acute gastroenteritis worldwide. In this study, Lactobacillus rhamnosus GG (LGG and Escherichia coli Nissle 1917 (EcN were first screened for their ability to bind HuNoV P particles and virions derived from clinical samples containing HuNoV genotype GII.3 and GII.4, then the effects of LGG+EcN and rice bran on HuNoV infection and diarrhea were investigated using the gnotobiotic pig model. While LGG+EcN colonization inhibited HuNoV shedding, probiotic cocktail regimens in which rice bran feeding started 7 days prior to or 1 day after viral inoculation in the LGG+EcN colonized gnotobiotic pigs exhibited high protection against HuNoV diarrhea and shedding, characterized by significantly reduced incidence (89% versus 20% and shorter mean duration of diarrhea (2.2 versus 0.2 days, as well as shorter mean duration of virus shedding (3.2 versus 1.0 days. In both probiotic cocktail groups, the diarrhea reduction rates were 78% compared with the control group, and diarrhea severity was reduced as demonstrated by the significantly lower cumulative fecal scores. The high protective efficacy of the probiotic cocktail regimens was attributed to stimulation of IFN-γ+ T cell responses, increased production of intestinal IgA and IgG, and maintenance of healthy intestinal morphology (manifested as longer villi compared with the control group. Therefore, probiotic cocktail regimens containing LGG+EcN and rice bran may represent highly efficacious strategies to prevent and treat HuNoV gastroenteritis, and potentially other human enteric pathogens.

Microbial ecology of watery kimchi.

Science.gov (United States)

Kyung, Kyu Hang; Medina Pradas, Eduardo; Kim, Song Gun; Lee, Yong Jae; Kim, Kyong Ho; Choi, Jin Joo; Cho, Joo Hyong; Chung, Chang Ho; Barrangou, Rodolphe; Breidt, Frederick

2015-05-01

The biochemistry and microbial ecology of 2 similar types of watery (mul) kimchi, containing sliced and unsliced radish and vegetables (nabak and dongchimi, respectively), were investigated. Samples from kimchi were fermented at 4, 10, and 20 °C were analyzed by plating on differential and selective media, high-performance liquid chromatography, and high-throughput DNA sequencing of 16S rDNA. Nabak kimchi showed similar trends as dongchimi, with increasing lactic and acetic acids and decreasing pH for each temperature, but differences in microbiota were apparent. Interestingly, bacteria from the Proteobacterium phylum, including Enterobacteriaceae, decreased more rapidly during fermentation at 4 °C in nabak cabbage fermentations compared with dongchimi. Although changes for Proteobacterium and Enterobacteriaceae populations were similar during fermentation at 10 and 20 °C, the homolactic stage of fermentation did not develop for the 4 and 10 °C samples of both nabak and dongchimi during the experiment. These data show the differences in biochemistry and microbial ecology that can result from preparation method and fermentation conditions of the kimchi, which may impact safety (Enterobacteriaceae populations may include pathogenic bacteria) and quality (homolactic fermentation can be undesirable, if too much acid is produced) of the product. In addition, the data also illustrate the need for improved methods for identifying and differentiating closely related lactic acid bacteria species using high-throughput sequencing methods. © 2015 Institute of Food Technologists®. This article has been contributed by US Government employees and their work is in the public domain in the USA.

Fatores de risco para diárreia persistente em lactentes Risk factors to persistent diarrhea in infants

Directory of Open Access Journals (Sweden)

Maria das Graças Moura Lins

2003-12-01

Full Text Available RACIONAL: A diarréia persistente é uma doença multicausal. A análise do risco para o prolongamento do quadro diarréico envolve variáveis ambientais, biológicas e do manejo clínico. OBJETIVO: Identificar fatores de risco para a diarréia persistente em crianças hospitalizadas na fase aguda do quadro diarréico. PACIENTES E MÉTODOS: O estudo foi do tipo caso-controle. A amostra consistiu de 216 crianças menores de 24 meses hospitalizadas por diarréia de início abrupto, no Instituto Materno-Infantil de Pernambuco, Recife, PE. O grupo de casos incluiu as crianças com diarréia persistente e o de controles aquelas com diarréia aguda. Foram analisadas variáveis socioeconômicas, biológicas, de morbidade anterior, clínicas e do manejo terapêutico prévio à admissão. Utilizou-se o odds ratio não ajustado e ajustado, com seus respectivos intervalos de confiança de 95%, observando-se o nível de significância de 5%. A análise multivariada foi feita através de regressão logística. RESULTADOS: O risco de persistência da diarréia foi maior nas crianças com: disenteria, febre no início do quadro, dieta suspensa e uso de antibiótico à admissão hospitalar. O risco de diarréia persistente foi cerca de três vezes maior para crianças sem geladeira no domicílio e que apresentavam hiperemia perianal ao exame físico na admissão hospitalar, sendo estas as variáveis que apresentaram significância estatística após o ajuste para fatores de confusão. CONCLUSÕES: A melhoria das condições ambientais e o manejo adequado e individualizado da criança hospitalizada por diarréia pode contribuir para a redução da morbidade da doença.BACKGROUND: Persistent diarrhea is a multicausal disease. The analysis of risk factors for persistent diarrhea includes environmental and biological variables as well as therapeutical management. AIM: To identify risk factors for persistent diarrhea among children hospitalized with acute diarrhea

Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: a community-based cross-sectional study

OpenAIRE

Adane, Metadel; Mengistie, Bezatu; Mulat, Worku; Kloos, Helmut; Medhin, Girmay

2017-01-01

Background Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. Methods A community-based cross-sectional study design was employed in five rounds of surveys...

Characterization and Virulence Assessment of Two 091:821 Enterohemorrhagic Escherichia Coli Isolates

Science.gov (United States)

1993-04-30

stable toxin (ST) . ETEC cause profuse watery diarrhea similar to the diarrhea caused by Vibrio cholerae infection (Sack, 1975). EIEC, unlike ETEC...Fr •• ley, R. B. Sack, W. B. Cr •• ch, A. Z. Itapikian, B. J. Gang_ro ••• 1976. Travelers diarrhea in Mexico . A prospective study of physicians...p.153- 158 . Proceedings of the U. S.-Japan 27th Joint Conference on Cholera and Related Diarrheal Diseases. Virginia. Charlottesville, Yu, J

Safety and Efficacy of Low-osmolarity ORS vs. Modified Rehydration Solution for Malnourished Children for Treatment of Children with Severe Acute Malnutrition and Diarrhea: A Randomized Controlled Trial.

Science.gov (United States)

Kumar, Ruchika; Kumar, Praveen; Aneja, S; Kumar, Virendra; Rehan, Harmeet S

2015-12-01

World Health Organization-recommended rehydration solution for malnourished children (ReSoMal) for rehydrating severe acute malnourished children is not available in India. In present study, 110 consecutive children aged 6-59 months with severely acute malnourishment and acute diarrhea were randomized to low-osmolarity oral rehydration solution (ORS) (osmolarity: 245, sodium: 75) with added potassium (20 mmol/l) or modified ReSoMal (osmolarity: 300, sodium: 45). In all, 15.4% of modified ReSoMal group developed hyponatremia as compared with 1.9% in low-osmolarity ORS, but none developed severe hyponatremia or hypernatremia. Both groups had equal number of successful rehydration (52 each). Both types of ORS were effective in correcting hypokalemia and dehydration, but rehydration was achieved in shorter duration with modified ReSoMal. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Carotid Flow Time Test Performance for the Detection of Dehydration in Children With Diarrhea.

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Mackenzie, David C; Nasrin, Sabiha; Atika, Bita; Modi, Payal; Alam, Nur H; Levine, Adam C

2017-11-09

Unstructured clinical assessments of dehydration in children are inaccurate. Point-of-care ultrasound is a noninvasive diagnostic tool that can help evaluate the volume status; the corrected carotid artery flow time has been shown to predict volume depletion in adults. We sought to determine the ability of the corrected carotid artery flow time to identify dehydration in a population of children presenting with acute diarrhea in Dhaka, Bangladesh. Children presenting with acute diarrhea were recruited and rehydrated according to hospital protocols. The corrected carotid artery flow time was measured at the time of presentation. The percentage of weight change with rehydration was used to categorize each child's dehydration as severe (>9%), some (3%-9%), or none (dehydration. Linear regression was used to model the relationship between the corrected carotid artery flow time and percentage of dehydration. A total of 350 children (0-60 months) were enrolled. The mean corrected carotid artery flow time was 326 milliseconds (interquartile range, 295-351 milliseconds). The area under the receiver operating characteristic curve for the detection of severe dehydration was 0.51 (95% confidence interval, 0.42, 0.61). Linear regression modeling showed a weak association between the flow time and dehydration. The corrected carotid artery flow time was a poor predictor of severe dehydration in this population of children with diarrhea. © 2017 by the American Institute of Ultrasound in Medicine.

DEHYDRATION IN CHILDREN WITH ACUTE DIARRHEA

Directory of Open Access Journals (Sweden)

S. V. Khaliullina

2014-01-01

Full Text Available The article is focused on the main issues of the regulation of water-electrolyte metabolism in children, possible variants of its disorder in acute diarrhoeal diseases. The clinical features of dehydration depending on the severity and qualitative component of losses are described, recommendations on laboratory diagnosis and treatment are provided. 

Loperamide plus azithromycin more effectively treats travelers' diarrhea in Mexico than azithromycin alone.

Science.gov (United States)

Ericsson, Charles D; DuPont, Herbert L; Okhuysen, Pablo C; Jiang, Zhi-Dong; DuPont, Margaret W

2007-01-01

Because the combination of loperamide and some antimicrobials has proven to be more efficacious than the antimicrobial agent alone in the treatment of travelers' diarrhea, we set out to prove loperamide plus azithromycin was more efficacious than azithromycin alone. During the summers of 2002 to 2003, 176 US adults recently arrived in Guadalajara, Mexico were enrolled in a prospective, double-blinded, randomized trial of the treatment of acute diarrhea. Subjects received single doses (1,000 or 500 mg) of azithromycin or a single 500 mg dose of azithromycin plus loperamide. Subjects gave a pre- and post-treatment stool sample for analysis and maintained daily diaries of symptoms and passage of stools. The duration of diarrhea was significantly (p=0.0002) shorter following treatment with azithromycin plus loperamide (11 h) than with either dose of azithromycin alone (34 h). In the first 24 hours, the average number of unformed stools passed was 3.4 (azithromycin alone) and 1.2 (combination) for a significant (ptravelers' diarrhea in an Escherichia coli predominant region of the world, a single 500 mg dose of azithromycin appeared as effective as a 1,000 mg dose. Loperamide plus 500 mg of azithromycin was safe and more effective than either dose of azithromycin. To realize the substantial clinical benefit that accrues to a subset of subjects, we feel loperamide should routinely be used in combination with an antimicrobial agent to treat travelers' diarrhea.

The pathophysiology of diarrhea.

Science.gov (United States)

Sellin, J H

2001-01-01

Diarrhea is a very common event after transplantation, but its cause may be difficult to identify. The first step in determining the cause in any particular case is an understanding of the etiology of diarrhea in general. Although diarrhea often is categorized into such types as secretory versus osmotic, or electrolyte transport-related versus motility-related, a thorough understanding of the problem requires knowledge of how the paracrine, immune, nervous and endocrine systems react to each other as well as to infection, drugs or other stimuli.

In Vitro Digestibility of Aluminum from Hibiscus sabdariffa Hot Watery Infusion and Its Concentration in Urine of Healthy Individuals

Czech Academy of Sciences Publication Activity Database

Frankova, A.; Malik, J.; Drabek, O.; Szakova, J.; Sperlingova, I.; Kloucek, P.; Novy, P.; Tejnecky, V.; Landa, Přemysl; Leuner, O.; Kokoska, L.

2016-01-01

Roč. 174, č. 2 (2016), s. 267-273 ISSN 0163-4984 Institutional support: RVO:61389030 Keywords : dialysis dementia * tea * bioavailability * speciation * toxicity * Aluminum * In vitro digestion * Hot watery infusion * Urine * Hibiscus sabdariffa L Subject RIV: EF - Botanics Impact factor: 2.399, year: 2016

[Chronic diarrhea].

Science.gov (United States)

Stelzer, Teresa; Heuss, Ludwig Theodor

2014-09-01

Defined by lasting more than four weeks - is a common but often challenging clinical scenario. It is important to be aware that diarrhoea means different things to different patients. The evaluation of chronic diarrhoea depends on taking an excellent history and careful physical examination as well as planning investigations thoughtfully. Functional diarrhea ist the most common cause of chronic diarrhea in the developed countries and motility disorders are more common than inflammatory, osmotic or secretory causes. In some cases categorizing patients by their stool characteristics can be helpful in directing further evaluation.

Diarrhea in enterally fed patients: blame the diet?

Science.gov (United States)

Chang, Sue-Joan; Huang, Hsiu-Hua

2013-09-01

Diarrhea has great impact on enteral nutrition. The purpose of this review is to identify the factors leading to diarrhea during enteral nutrition and to provide the published updates on diarrhea prevention through nutritional intervention. Diarrhea in enteral fed patients is attributed to multiple factors, including medications (major contributor), infections, bacterial contamination, underlying disease, and enteral feeding. Diet management can alleviate diarrhea in enteral feeding. High content of fermentable oligosaccharides, disaccharides, and monosaccharides and polyols (FODMAPs) in enteral formula is postulated to induce diarrhea and lower FODMAPs formula may reduce the likelihood of diarrhea in enterally fed patients. Fiber-enriched formula can reduce the incidence of diarrhea and produce short-chain fatty acids for colonocytes. Ingesting prebiotics, nonviable probiotics or probiotic derivatives, and human lactoferrin may provide alternatives for reducing/preventing diarrhea. Enteral feeding is not generally considered the primary cause of diarrhea, which is frequently linked to prescribed medications. When diarrhea is apparent, healthcare members should evaluate the possible risk factors and systematically attempt to eliminate the underlying causes of diarrhea before reducing or suspending enteral feeding. Lower FODMAPs formula, prebiotics, probiotic derivatives, and lactoferrin may be used to manage enteral feeding-related diarrhea.

Modeling and design of a spiral-shaped Mach-Zehnder interferometric sensor for refractive index sensing of watery solutions

NARCIS (Netherlands)

Hoekman, M.; Dijkstra, Marcel; Dijkstra, Mindert; Hoekstra, Hugo

2006-01-01

The modeling and design of a spiral-shaped Mach-Zehnder Interferometric sensor (sMZI sensor) for refractive index sensing of watery solutions is presented. The goal of the running project is to realise a multi-sensing array by placing multiple sMZIs in series to form a sensing branch, and to place

Plesiomonas shigelloides Periprosthetic Knee Infection After Consumption of Raw Oysters.

Science.gov (United States)

Hustedt, Joshua W; Ahmed, Sarim

Periprosthetic infections are a leading cause of morbidity after total joint arthroplasty. Common pathogens include Staphylococcus aureus, streptococcus, enterococcus, Escherichia coli, and Pseudomonas aeruginosa. However, there are many cases in which rare bacteria are isolated. This case report describes a periprosthetic knee infection caused by Plesiomonas shigelloides. In the United States, P shigelloides and 2 other Vibrionaceae family members, Vibrio vulnificus and Vibrio parahaemolyticus, are most often contracted from eating raw oysters and shellfish. P shigelloides usually causes a self-limiting watery diarrhea, but in immunosuppressed people it can cause septicemia. In this case report, a chemically and biologically immunosuppressed man consumed raw oysters and developed P shigelloides septicemia and acute periprosthetic knee infection that required surgical intervention.

Review of sangre de drago (Croton lechleri)--a South American tree sap in the treatment of diarrhea, inflammation, insect bites, viral infections, and wounds: traditional uses to clinical research.

Science.gov (United States)

Jones, Kenneth

2003-12-01

The objective of this review is to provide an overview of the pharmacologic evidence that may or may not support clinical and ethnomedical uses of the sap of sangre de drago (dragon's blood; Croton lechleri Müll. Arg.). Data sources used were BIOSIS, EMBASE, PubMed, TOXLIT, International Pharmaceutical Abstracts, manual searches, papers on file from peer-reviewed journals, textbooks available at Armana Research, Inc., and researchers in the field of South American botanical medicine. The results of in vitro and in vivo studies largely support the majority of ethnomedical uses of sangre de drago including the treatment of diarrhea, wounds, tumors, stomach ulcers, herpes infection, the itching, pain and swelling of insect bites, and other conditions. Clinical studies of sangre de drago products have reported positive results in the treatment of traveler's and watery diarrhea and the symptoms of insect bites. Because the sap has shown low toxicity and preparations used in clinical studies were well tolerated, further clinical and pharmacologic studies are anticipated. Acknowledgment of the diversity in the chemical makeup of the sap from one geographic area to another and the recent characterization of alkaloid chemotypes of sangre de drago will require that materials developed for clinical use are standardized.

Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers

DEFF Research Database (Denmark)

Rosenfeldt, Vibeke; Michaelsen, Kim Fleischer; Jakobsen, Mogens

2002-01-01

BACKGROUND: Certain strains of lactobacilli have been shown to promote recovery from rotavirus enteritis in hospitalized children. Few studies have examined the effect of probiotics in nonhospitalized children with mild diarrhea. METHODS: We studied in a randomized placebo-controlled trial the ef.......03). CONCLUSIONS: In children from day-care centers with mild gastroenteritis, the combination of L. rhamnosus 19070-2 and L. reuteri DSM 12246 was effective in reducing the duration of diarrhea....

Myo5b knockout mice as a model of microvillus inclusion disease

NARCIS (Netherlands)

Carton-Garcia, Fernando; Overeem, Arend W.; Nieto, Rocio; Bazzocco, Sarah; Dopeso, Higinio; Macaya, Irati; Bilic, Josipa; Landolfi, Stefania; Hernandez-Losa, Javier; Schwartz, Simo; Ramon y Cajal, Santiago; van Ijzendoorn, Sven C. D.; Arango, Diego

2015-01-01

Inherited MYO5B mutations have recently been associated with microvillus inclusion disease (MVID), an autosomal recessive syndrome characterized by intractable, life-threatening, watery diarrhea appearing shortly after birth. Characterization of the molecular mechanisms underlying this disease and

Clostridium Difficile Infections

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Clostridium difficile (C. difficile) is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis. Symptoms include Watery ... Loss of appetite Nausea Abdominal pain or tenderness C. difficile is more common in people who need ...

Acute toxicity after a diverting stoma and spacer prior to chemoradiation in locally advanced rectal cancer

International Nuclear Information System (INIS)

Voort van Zyp, Jochem R.N. van der; Ceha, Heleen M.; Niehe, Valerie; Marinelli, Andreas W.K.S.; Putter, Hein; Marijnen, Corrie A.M.

2015-01-01

Background and purpose: Chemoradiotherapy (CRT) followed by surgery is the standard of care for locally advanced rectal cancer (LARC). For grade ⩾3 acute diarrhea there is a relationship between dose and irradiated small bowel volume. The aim of this study was to evaluate whether combined placement of a diverting stoma and sigmoid spacer (DSSS) led to reduced irradiated small bowel volume and less grade ⩾3 acute diarrhea in the treatment of LARC. Materials/methods: Between 2003 and 2010, 54 of 189 LARC patients treated with CRT in two institutions had a DSSS prior to CRT. Data on patient and treatment characteristics and outcomes were collected retrospectively. Delineation of small bowel was performed with planning CT-scans. CTCAE version 4.0 was used for acute toxicity. Results: Patients with a DSSS had significantly less small bowel volume irradiated up to doses of 20 Gy. This difference was not observed for the higher dose levels. CRT induced grade ⩾3 acute diarrhea was not different between the two groups (8.3% vs. 12.8%; p = 0.41). Conclusion: DSSS is not clearly beneficial to reduce grade ⩾3 acute diarrhea, and it must be considered whether placement of a DSSS is justified for this purpose

Improved detection of Bovine Viral Diarrhea Virus in Bovine lymphoid cell lines using PrimeFlow RNA assay

Science.gov (United States)

Bovine viral diarrhea virus (BVDV) infections, whether as acute, persistent or contributing to co-infections, result in significant losses for cattle producers. BVDV can be identified by real-time PCR and ELISA, detection and quantification of viral infection at the single cell level is extremely di...

Saccharomyces boulardii CNCM I-745 reduces the duration of diarrhoea, length of emergency care and hospital stay in children with acute diarrhoea.

Science.gov (United States)

Dinleyici, E C; Kara, A; Dalgic, N; Kurugol, Z; Arica, V; Metin, O; Temur, E; Turel, O; Guven, S; Yasa, O; Bulut, S; Tanir, G; Yazar, A S; Karbuz, A; Sancar, M; Erguven, M; Akca, G; Eren, M; Ozen, M; Vandenplas, Y

2015-01-01

Evidence from the literature has shown that Saccharomyces boulardii provides a clinically significant benefit in the treatment of acute infectious diarrhoea in children. In this multicentre, randomised, prospective, controlled, single blind clinical trial performed in children with acute watery diarrhoea, we aimed to evaluate the impact of S. boulardii CNCM I-745 in hospitalised children, in children requiring emergency care unit (ECU) stay and in outpatient settings. The primary endpoint was the duration of diarrhoea (in hours). Secondary outcome measures were duration of hospitalisation and diarrhoea at the 3(rd) day of intervention. In the whole study group (363 children), the duration of diarrhoea was approximately 24 h shorter in the S. boulardii group (75.4±33.1 vs 99.8±32.5 h, Pboulardii (diarrhoea-free children) was observed starting at 48 h. After 72 h, only 27.3% of the children receiving probiotic still had watery diarrhoea, in contrast to 48.5% in the control group (Pboulardii group (4.60±1.72 vs 6.12±1.71 days, Pboulardii CNCM I-745 in adjunction to oral rehydration solution in acute infectious gastroenteritis in children.

Diarrhea (image)

Science.gov (United States)

... drinking water contaminated with organisms like bacteria and parasites. Medications can also cause diarrhea, especially antibiotics, laxatives containing magnesium, and chemotherapy for cancer treatment.

Treatment of travelers' diarrhea: randomized trial comparing rifaximin, rifaximin plus loperamide, and loperamide alone.

Science.gov (United States)

Dupont, Herbert L; Jiang, Zhi-Dong; Belkind-Gerson, Jaime; Okhuysen, Pablo C; Ericsson, Charles D; Ke, Shi; Huang, David B; Dupont, Margaret W; Adachi, Javier A; De La Cabada, F Javier; Taylor, David N; Jaini, Sridvya; Martinez Sandoval, Francisco

2007-04-01

Antimotility agents provide rapid temporary relief of acute diarrhea, whereas antibiotics slowly cure the illness. Thus, the combination of an antimotility agent and an antibiotic may provide greater therapeutic benefit than either drug alone. This study evaluated the efficacy and safety of rifaximin-loperamide in the treatment of travelers' diarrhea. Consenting adults with acute diarrhea (> or =3 unformed stools in 24 hours with > or =1 symptom of enteric infection) were randomized to receive rifaximin 200 mg 3 times daily for 3 days; loperamide 4 mg initially followed by 2 mg after each unformed stool; or a combination of both drugs using the same dosing regimen. The primary end point was the median time from beginning therapy until passing the last unformed stool. A total of 310 patients completed treatment with rifaximin (n = 102), loperamide (n = 104), or rifaximin-loperamide combination therapy (n = 104). The groups showed demographic similarity. Rifaximin and rifaximin-loperamide significantly reduced the median time until passage of the last unformed stool (32.5 +/- 4.14 h and 27.3 +/- 4.13 h, respectively) vs loperamide (69 +/- 4.11 h; P = .0019). The mean number of unformed stools passed during illness was lower with rifaximin-loperamide (3.99 +/- 4.28) compared with rifaximin (6.23 +/- 6.90; P = .004) or loperamide alone (6.72 +/- 6.93; P = .002). All treatments were well tolerated with a low incidence of adverse events. Rifaximin-loperamide therapy provided rapid symptomatic improvement and greater overall wellness compared with either agent alone.

Empirically Derived Dehydration Scoring and Decision Tree Models for Children With Diarrhea: Assessment and Internal Validation in a Prospective Cohort Study in Dhaka, Bangladesh

OpenAIRE

Levine, Adam C; Glavis-Bloom, Justin; Modi, Payal; Nasrin, Sabiha; Rege, Soham; Chu, Chieh; Schmid, Christopher H; Alam, Nur H

2015-01-01

Introduction: Diarrhea remains one of the most common and most deadly conditions affecting children worldwide. Accurately assessing dehydration status is critical to determining treatment course, yet no clinical diagnostic models for dehydration have been empirically derived and validated for use in resource-limited settings. Methods: In the Dehydration: Assessing Kids Accurately (DHAKA) prospective cohort study, a random sample of children under 5 with acute diarrhea was enrolled between Feb...

Pathological studies on bovine viral diarrhea

International Nuclear Information System (INIS)

Elkady, A.A.M.A.

2002-01-01

Bovine viral diarrhea virus (BVDV) is classified as an RNA virus in the family flavin viride and is a member of the genus pest virus (Collet et al 1989). BVDV has a worldwide distribution and infections in cattle populations (Kahrs et al 1970). It was recognized since 50 years ago, the initial description of an acute enteric disease of cattle in North America, which was characterized by outbreaks of diarrhea and erosive of digestive tract (Olafsonp et al 1946). The disease and causative agent were named bovine viral diarrhea (B V D ) and (B V DV), respectively. This virus was subsequently associated with a sporadically occurring and highly fatal enteric disease that was termed mucosal disease (M D), (Ramsey and Chivers 1953). The initial isolate of BVDV did not produce cytopathic effect in cell culture, whereas an isolate from MD did produce cytopathic effects (Lee et al 1957). In vitro characteristic of non cytopathic or sytopathic effects of BVDV is referred to as the biotype of the virus. It has now been established that MD occurs only when xattle that are born immuno tolerant to and persistently infected with a noncyropathic BVDV become super infected with a cytopathic BVDV. The knowledge of the molecular biology. Pathogenesis and epidemiology of BVDV has greatly evolved in the past 10-15 years and has provided a better understanding of this complex infectious agent. Infection with BVDV can result in a wide spectrum of diseases ranging from subclinical infection s to a highly fatal from known as mucosal disease (ND). The clinical response to infection depends on multiple interactive factors. Host factors that influence the clinical outcome of BVDV infection include whether the host is immunocompetent or immuno tolerant to BVDV, pregnancy status, gestational age of the fetus, immune status (passively derived or actively derived from previous infection or vaccination) and concurrent level of environmental stress

Chronic Diarrhea: A Concern After Gallbladder Removal?

Science.gov (United States)

Chronic diarrhea: A concern after gallbladder removal? I had my gallbladder removed six months ago, and I'm still having diarrhea. Is this ... mild diarrhea after cholecystectomy is not cause for concern, but speak to your doctor if you are ...

Enteric disease in broiler chickens following experimental infection with chicken parvovirus

Science.gov (United States)

Day-old broiler chickens were inoculated orally with the chicken parvovirus strain, chicken parvovirus-P1. In four independent experiments, characteristic clinical signs of enteric disease including watery, mustard color diarrhea and growth retardation were observed following infection. The virus wa...

Identification of Eimeria acervulina conoid antigen using chicken monoclonal antibody and liquid chromatography coupled to mass spectrometry

Science.gov (United States)

Protozoan parasites of the phylum Apicomplexa include a large number of medically important species. Among them, Toxoplasma gondii, Plasmodium, Cryptosporidium that cause watery diarrhea and mortality in humans and livestock, and Eimeria which induces gastrointestinal disorder in livestock and poul...

Evaluating the Patient With Diarrhea: A Case-Based Approach

Science.gov (United States)

Sweetser, Seth

2012-01-01

The evaluation of the patient with diarrhea can be complex and the treatment challenging. In this article, the definition of diarrhea and the pathophysiologic mechanisms that lead to diarrhea are reviewed. A simplified 5-step approach to the patient with diarrhea is provided and applied in a case-oriented manner applicable to everyday clinical practice. On completion of this article, you should be able to (1) define diarrhea, (2) outline various pathophysiologic mechanisms of diarrhea, and (3) describe a simplified 5-step approach to facilitate the evaluation of diarrhea. PMID:22677080

Probiotics and Antibiotic-Associated Diarrhea and Clostridium difficile Infection

Science.gov (United States)

Surawicz, Christina M.

Diarrhea is a common side effect of antibiotics. Antibiotics can cause diarrhea in 5-25% of individuals who take them but its occurrence is unpredictable. Diarrhea due to antibiotics is called antibiotic-associated diarrhea (AAD). Diarrhea may be mild and resolve when antibiotics are discontinued, or it may be more severe. The most severe form of AAD is caused by overgrowth of Clostridium difficile which can cause severe diarrhea, colitis, pseudomembranous colitis, or even fatal toxic megacolon. Rates of diarrhea vary with the specific antibiotic as well as with the individual susceptibility.

[Lactose intolerance in neonates with non-infectious diarrhea].

Science.gov (United States)

Su, Hui-Min; Jiang, Yi; Hu, Yu-Lian; Yang, Hui; Dong, Tian-Jin

2016-04-01

To investigate the development of lactose intolerance in neonates with non-infectious diarrhea and its association with diarrhea, and to evaluate the diagnostic values of fecal pH value and urine galactose determination for neonatal lactase deficiency. Seventy hospitalized neonates who developed non-infectious diarrhea between October 2012 and June 2015 were enrolled as the diarrhea group, and 162 hospitalized neonates without non-infectious diarrhea were enrolled as the non-diarrhea group. Test paper was used to determine fecal pH value. The galactose oxidase method was used to detect urine galactose. The neonates with positive galactose oxidase were diagnosed with lactase deficiency, and those with lactase deficiency and diarrhea were diagnosed with lactose intolerance. According to the results of urine galactose detection, 69 neonates in the diarrhea group who underwent urine galactose detection were classified into lactose intolerance group (45 neonates) and lactose tolerance group (24 neonates), and their conditions after treatment were compared between the two groups. The follow-up visits were performed for neonates with diarrhea at 3 months after discharge. Fecal pH value and positive rate of urine galactose (65% vs 54%) showed no significant differences between the diarrhea and non-diarrhea groups (P>0.05). Fecal pH value showed no significant difference between the lactose intolerance and lactose tolerance groups (P>0.05), while the neonates in the lactose intolerance group had a significantly longer time to recovery of defecation than those in the lactose tolerance group (Plactose intolerance tends to occur. Determination of fecal pH value has no significance in the diagnosis of lactose intolerance in neonates with diarrhea.

Syndromic (phenotypic diarrhea in early infancy

Directory of Open Access Journals (Sweden)

Bodemer Christine

2008-02-01

Full Text Available Abstract Syndromic diarrhea (SD, also known as phenotypic diarrhea (PD or tricho-hepato-enteric syndrome (THE, is a congenital enteropathy presenting with early-onset of severe diarrhea requiring parenteral nutrition (PN. To date, no epidemiological data are available. The estimated prevalence is approximately 1/300,000–400,000 live births in Western Europe. Ethnic origin does not appear to be associated with SD. Infants are born small for gestational age and present with facial dysmorphism including prominent forehead and cheeks, broad nasal root and hypertelorism. Hairs are woolly, easily removed and poorly pigmented. Severe and persistent diarrhea starts within the first 6 months of life (≤ 1 month in most cases and is accompanied by severe malabsorption leading to early and relentless protein energy malnutrition with failure to thrive. Liver disease affects about half of patients with extensive fibrosis or cirrhosis. There is currently no specific biochemical profile, though a functional T-cell immune deficiency with defective antibody production was reported. Microscopic analysis of the hair show twisted hair (pili torti, aniso- and poilkilotrichosis, and trichorrhexis nodosa. Histopathological analysis of small intestine biopsy shows non-specific villous atrophy with low or no mononuclear cell infiltration of the lamina propria, and no specific histological abnormalities involving the epithelium. The etiology remains unknown. The frequent association of the disorder with parental consanguinity and/or affected siblings suggests a genetic origin with an autosomal recessive mode of transmission. Early management consists of total PN. Some infants have a rather milder phenotype with partial PN dependency or require only enteral feeding. Prognosis of this syndrome is poor, but most patients now survive, and about half of the patients may be weaned from PN at adolescence, but experience failure to thrive and final short stature. Disease name

Diarrhea associated with typhoid fever

NARCIS (Netherlands)

Roy, S. K.; Speelman, P.; Butler, T.; Nath, S.; Rahman, H.; Stoll, B. J.

1985-01-01

To study the pathogenesis of diarrhea occurring with typhoid fever, we selected 42 patients with diarrhea and blood cultures positive for Salmonella typhi or Salmonella paratyphi A, but without diarrheal copathogens, for measurement of stool output and examination of fecal composition. The mean

Acute viral gastroenteritis in children hospitalized in Iksan, Korea during December 2010 - June 2011

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Cheol Whoan So

2013-09-01

Full Text Available Purpose: Viral etiology is common in cases of children with acute diarrhea, and antibiotic therapy is usually not required. Therefore, it is important to determine the distribution of common viruses among children hospitalized with acute diarrhea. Methods: We included 186 children who suffered from acute diarrhea and were hospitalized at the Wonkwang University Hospital Pediatric ward from December 1, 2010 to June 30, 2011 in this study. Stool samples were collected and multiplex reverse transcriptase polymerase chain reaction (multiplex RT-PCR was used to simultaneously determine the viral etiology such as rotavirus, norovirus, astrovirus, or adenovirus.&lt;br&gt; Results: Causative viruses were detected in 72 of the 186 cases (38.7%. The mean age of the viruspositive cases was 1 year and 9 months (range, 1 month to 11 years. Rotavirus was detected in 50/186 (26.9%; norovirus, in 18/186 (9.7%; and astrovirus, in 3/186 cases (1.6%. Adenovirus was not detected in any of the cases. Proportions of norovirus genogroups I and II were 21.1% and 78.9%, respectively. Four of the 51 rotavirus-positive cases (7.8% had received rotavirus vaccination at least once. The mean duration of diarrhea was 2.8 days (range, 1 to 10 days and vomiting occurred in 39 of the 72 cases (54.2%.&lt;br&gt; Conclusion: Viral etiology was confirmed in about one-third of the children with acute diarrhea, and the most common viral agent was rotavirus, followed by norovirus.

Treatment of Infantile Diarrhea by Acupuncture and Laser Irradiation - A Report of 60 Cases

Institute of Scientific and Technical Information of China (English)

丁渡明

2004-01-01

@@ Infantile diarrhea is a common disease in babies of less than 2 years old in summer or autumn. It is due to acute dyspepsia mainly caused by improper feeding or attack of cold or damp pathogens.Clinically, it is characterized by increased times of defecation (5-6, or even dozens of times a day),yellow-green or blue-green thin feces intermingled with mucus, milk-mass and indigested food which have a sour and fetid odor, accompanied with loss of appetite, abdominal distending pain, nausea,vomiting, and even fever, irritability, dehydration and electrolyte disturbance in severe cases. The microscopy reveals that there are leukocytes and fat globules in feces. We have treated 60 cases of infantile diarrhea with acupuncture and He-Ne laser point irradiation and obtained satisfactory therapeutic results.

Molecular Analysis of the Enteric Protozoa Associated with Acute Diarrhea in Hospitalized Children.

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Boughattas, Sonia; Behnke, Jerzy M; Al-Ansari, Khalid; Sharma, Aarti; Abu-Alainin, Wafa; Al-Thani, Asma; Abu-Madi, Marawan A

2017-01-01

Pediatric diarrhea is a common cause of death among children under 5 years of age. In the current study, we investigated the frequency of intestinal parasites among 580 pediatric patients with chronic diarrhea. Parasitic protozoa (all species combined) were detected by molecular tools in 22.9% of the children and the most common parasite was Cryptosporidium spp. (15.1%). Blastocystis hominis was detected in 4.7%, Dientamoeba fragilis in 4%, Giardia duodenalis in 1.7%, and Entamoeba histolytica in 0.17%. Protozoan infections were observed among all regional groups, but prevalence was highest among Qatari subjects and during the winter season. Typing of Cryptosporidium spp. revealed a predominance of Cryptosporidium parvum in 92% of cases with mostly the IIdA20G1 subtype. Subtypes IIdA19G2, IIdA18G2, IIdA18G1, IIdA17G1, IIdA16G1, and IIdA14G1 were also detected. For Cryptosporidium hominis , IbA10G2 and IbA9G3 subtypes were identified. This study provides supplementary information for implementing prevention and control strategies to reduce the burden of these pediatric protozoan infections. Further analyses are required to better understand the local epidemiology and transmission of Cryptosporidium spp. in Qatar.

Chromosomal and plasmid-encoded factors of Shigella flexneri induce secretogenic activity ex vivo.

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Christina S Faherty

Full Text Available Shigella flexneri is a Gram-negative, facultative intracellular pathogen that causes millions of cases of watery or bloody diarrhea annually, resulting in significant global mortality. Watery diarrhea is thought to arise in the jejunum, and subsequent bloody diarrhea occurs as a result of invasion of the colonic epithelium. Previous literature has demonstrated that Shigella encodes enterotoxins, both chromosomally and on the 220 kilobase virulence plasmid. The ShigellaEnterotoxins 1 and 2 (ShET1 and ShET2 have been shown to increase water accumulation in the rabbit ileal loop model. In addition, these toxins increase the short circuit current in rabbit tissue mounted in Ussing chambers, which is a model for the ion exchange that occurs during watery diarrhea. In this study, we sought to validate the use of mouse jejunum in Ussing chamber as an alternative, more versatile model to study bacterial pathogenesis. In the process, we also identified enterotoxins in addition to ShET1 and ShET2 encoded by S. flexneri. Through analysis of proteins secreted from wildtype bacteria and various deletion mutants, we have identified four factors responsible for enterotoxin activity: ShET1 and Pic, which are encoded on the chromosome; ShET2 (encoded by sen or ospD3, which requires the type-III secretion system for secretion; and SepA, an additional factor encoded on the virulence plasmid. The use of mouse jejunum serves as a reliable and reproducible model to identify the enterotoxins elaborated by enteric bacteria. Moreover, the identification of all Shigella proteins responsible for enterotoxin activity is vital to our understanding of Shigella pathogenicity and to our success in developing safe and effective vaccine candidates.

Optimization of Pathogenetic Treatment of Secretory Diarrhea in Infants

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O.K. Koloskova

2014-02-01

Full Text Available The aim of the research was to access clinical efficacy of oral rehydration therapy using III generation solutions in the treatment of secretory diarrhea in infants. To achieve this aim, on the basis of infectious box unit (enteric infections of regional clinical hospital (Chernivtsi we examined 116 infants, randomly selected, with acute gastroenteritis, who admitted to the hospital with signs of exycosis due to secretory diarrhea. Among examined patients, 73 (67.5 % children with the purpose of oral rehydration therapy received rehydration solutions, and 35 (32.4 % patients received other rehydration solutions. Monitoring of the dynamics of patients’ state enabled to state that, when we used III generation mixture as a main component of oral rehydration therapy, rate of positive dynamics in terms of clinical status of patients was significantly faster, in particular, body temperature, frequency and nature of bowel movements normalized significantly earlier, vomiting disappeared. In children treated with rehydration solutions, compared with patients receiving other rehydration solutions, odds ratio to confine only oral rehydration was 3.7 (95% CI 0.4–38.9 with an absolute risk to avoid the need for infusion therapy — 11 %.

Evaluating the Patient With Diarrhea: A Case-Based Approach

OpenAIRE

Sweetser, Seth

2012-01-01

The evaluation of the patient with diarrhea can be complex and the treatment challenging. In this article, the definition of diarrhea and the pathophysiologic mechanisms that lead to diarrhea are reviewed. A simplified 5-step approach to the patient with diarrhea is provided and applied in a case-oriented manner applicable to everyday clinical practice. On completion of this article, you should be able to (1) define diarrhea, (2) outline various pathophysiologic mechanisms of diarrhea, and (3...

Particularly acute intestinal infections in children with atopic dermatitis. Case-control study

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S. V. Khaliullina

2016-01-01

Full Text Available Aim — determine the clinical and laboratory features of acute intestinal infection in children, occurring in conjunction with atopic dermatitis (AD.Material and methods. We conducted a study of «case-control», which included observation of 144 children hospitalized in the infectious hospital with a clinic of acute infectious diarrhea in the period from January to December 2012. In the study group were selected 72 children with atopic dermatitis clinic and acute infectious diarrhea in a couple of which, from the group of patients without burdened premorbid background were selected 72 «controls» matched by sex, age and etiology developed acute intestinal infection. The observation time was 5±2 days, which corresponds to the average length of stay of the child, patients with moderate forms of acute intestinal infection in the hospital.Results and discussion. About 2 times more often than in the control, acute intestinal infections in children with atopic dermatitis lesions were characterized by clinic middle and lower gastrointestinal — 31.9% (CI 21,1–42,7 vs. 15.3% (CI 7–23 6, p=0.03. A number of bowel movements 6 or more times per day significantly more frequently observed in children with a combination of acute intestinal infections and atopic dermatitis — 54.1% (CI 42,6–65,6 vs. 33.3% (CI 22,4–43.9 in the control, p=0.011. The duration of diarrhea was higher in the study group (Med 6 IQR 4–7 days and Med 5 IQR 3–6 days, respectively, p=0.046. The proportion of patients with high fever was also higher in the study group than in the controls –15.3% (CI 7–23,6 vs. 2,8% (CI 1–6,6, p=0.016.Conclusion. Acute intestinal infections in children with atopic dermatitis have a more pronounced clinical symptoms, which is characterized by clinic enterocolitis, severity and duration of diarrhea syndrome, usually accompanied by a high fever. 

Two cases of Kawasaki disease presented with acute febrile jaundice.

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Kaman, Ayşe; Aydın-Teke, Türkan; Gayretli-Aydın, Zeynep Gökçe; Öz, Fatma Nur; Metin-Akcan, Özge; Eriş, Deniz; Tanır, Gönül

2017-01-01

Kawasaki disease is an acute, systemic vasculitis of unknown etiology. Although gastrointestinal involvement does not belong to the classic diagnostic criteria; diarrhea, abdominal pain, hepatic dysfunction, hydrops of gallbladder, and acute febrile cholestatic jaundice are reported in patients with Kawasaki disease. We describe here two cases presented with fever, and acute jaundice as initial features of Kawasaki disease.

Diarrhea - overview

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... What to do if you are breastfeeding What danger signs to watch out for Avoid medicines for ... with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

Bile acids in radiation-induced diarrhea

International Nuclear Information System (INIS)

Arlow, F.L.; Dekovich, A.A.; Priest, R.J.; Beher, W.T.

1987-01-01

Radiation-induced bowel disease manifested by debilitating diarrhea is an unfortunate consequence of therapeutic irradiation for pelvic malignancies. Although the mechanism for this diarrhea is not well understood, many believe it is the result of damage to small bowel mucosa and subsequent bile acid malabsorption. Excess amounts of bile acids, especially the dihydroxy components, are known to induce water and electrolyte secretion and increase bowel motility. We have directly measured individual and total bile acids in the stool samples of 11 patients with radiation-induced diarrhea and have found bile acids elevated two to six times normal in eight of them. Our patients with diarrhea and increased bile acids in their stools had prompt improvement when given cholestyramine. They had fewer stools and returned to a more normal life-style

Angiographic diagnosis of a pancreatic islet tumor in a patient with the WDHA syndrome

International Nuclear Information System (INIS)

Inamoto, K.; Yoshino, F.; Nakao, N.; Kawanaka, M.

1980-01-01

A patient with an islet cell tumor of the pancreas that produced the watery diarrhea, hypokalemia, achlorhydria syndrome is presented. On celiac angiography an extremely vascular mass was seen in the body of pancreas with hypertrophied arteries and persistent, dense tumor staining. (orig.) [de

Post-irradiation diarrhea

International Nuclear Information System (INIS)

Meerwaldt, J.H.

1984-01-01

In radiotherapy of pelvic cancers, the X-ray dose to be delivered to the tumour is limited by the tolerance of healthy surrounding tissue. In recent years, a number of serious complications of irradiation of pelvic organs were encountered. Modern radiotherapy necessitates the acceptance of a calculated risk of complications in order to achieve a better cure rate. To calculate these risks, one has to know the radiation dose-effect relationship of normal tissues. Of the normal tissues most at risk when treating pelvic tumours only the bowel is studied. In the literature regarding post-irradiation bowel complications, severe and mild complications are often mixed. In the present investigation the author concentrated on the group of patients with relatively mild symptoms. He studied the incidence and course of post-irradiation diarrhea in 196 patients treated for carcinoma of the uterine cervix or endometrium. The aims of the present study were: 1) to determine the incidence, course and prognostic significance of post-irradiation diarrhea; 2) to assess the influence of radiotherapy factors; 3) to study the relation of bile acid metabolism to post-irradiation diarrhea; 4) to investigate whether local factors (reservoir function) were primarily responsible. (Auth.)

Characteristics of diarrheagenic Escherichia coli among children under 5 years of age with acute diarrhea: a hospital based study.

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Zhou, Yu; Zhu, Xuhui; Hou, Hongyan; Lu, Yanfang; Yu, Jing; Mao, Lie; Mao, Liyan; Sun, Ziyong

2018-02-01

Diarrhea is the leading infectious cause of childhood morbidity and mortality. Among bacterial agents, diarrheagenic Escherichia coli (DEC) is the major causal agent of childhood diarrhea in developing countries, particularly in children under the age of 5 years. Here, we performed a hospital-based prospective study to explore the pathotype distribution, epidemiological characteristics and antibiotic resistance patterns of DEC from coli (EPEC) isolates were identified simultaneously with serology. Furthermore, antimicrobial sensitivity tests and sequencing of antibiotic resistance-related genes were conducted. DEC strains were identified in 7.9% of the 684 stool samples. Among them, the most commonly detected pathotype was EPEC (50.0% of DEC), of which 77.8% were classified as atypical EPEC (aEPEC). Age and seasonal distribution revealed that DEC tended to infect younger children and to occur in summer/autumn periods. Multidrug-resistant DEC isolates were 66.7%; resistance rates to ampicillin, co-trimoxazole, cefazolin, cefuroxime, cefotaxime, and ciprofloxacin were ≥ 50%. Among 5 carbapenem-resistant DEC, 60.0% were positive for carbapenemase genes (2 blaNDM-1 and 1 blaKPC-2). Among 30 cephalosporin-resistant DEC, 93.3% were positive for extended-spectrum β-lactamase (ESBL) genes, with blaTEM-1 and blaCTX-M-55 being the most common types. However, no gyrA or gyrB genes were detected in 16 quinolone-resistant isolates. Notably, aEPEC, which has not received much attention before, also exhibited high rates of drug resistance (81.0%, 66.7%, and 14.3% for ampicillin, co-trimoxazole , and carbapenem resistance, respectively). EPEC was the most frequent DEC pathotype in acute diarrheal children, with aEPEC emerging as a dominant diarrheal agent in central China. Most DEC strains were multidrug-resistant, making even ciprofloxacin unsuitable for empiric treatment against DEC infection. Among carbapenem-resistant DEC strains, those harboring blaNDM-1 and blaKPC-2

Epidemiologic Observations on Diarrhea Developing in U.S. and Mexican Students Living in Guadalajara, Mexico.

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Ericsson; DuPont; Mathewson

1995-03-01

Background: A previous study suggested that U.S. students who lived in Mexico for 1 year had a risk of diarrhea intermediate between the rate for newly arrived U.S. students and Mexican students; however, the study was not controlled for changes of risky behavior over time. Methods: An analysis of acute diarrhea occurring among U.S. and Mexican student groups living in Guadalajara, Mexico was conducted to explore the association of diarrhea developing during selected 28-day periods with length of residence, season, and risk factors such as locations of food consumption, consumption of tap water, unsafe ice, alcohol, and antibiotics. Results: Compared to U.S. and Mexican student groups, newly arrived U.S. college students in July had the highest rate of diarrhea (55%), highest enteropathogen isolation rate (46%), and most consumption of alcohol and antibiotics; they also ate most frequently at restaurants and in Mexican family homes. Compared to a 34% rate of diarrhea among newly arrived U.S. medical students in August, the rate was only 6% among established medical students in January. This drop in attack rate was attended by less tap water and unsafe ice consumption by established students in January compared to the habits of newly arrived students in January or August when risky behavior was otherwise similar among these groups. The role of tap water and unsafe ice in the acquisition of wintertime diarrhea is further supported by the relatively high 29% rate of diarrhea among U.S. medical students newly arrived in January, who also consumed more tap water and ice than established students in January. Enterotoxigenic E. coli disease was observed only during the summer months; whereas, Campylobacter jejuni disease and disease associated with no detected pathogen were more common in winter. Conclusions: These data imply that wintertime diarrhea in Guadalajara is more likely than summertime diarrhea to be waterborne and to be caused by agents such as viruses or

Características etiológicas, clínicas y sociodemográficas de la diarrea aguda en Venezuela Etiological, clinical, and sociodemographic characteristics of acute diarrhea in Venezuela

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María I. Urrestarazu

1999-09-01

Full Text Available En cuatro ciudades de Venezuela se llevó a cabo un estudio para evaluar las características epidemiológicas, clínicas y etiológicas de la diarrea aguda en niños menores de 5 años. Entre junio de 1993 y mayo de 1995 se estudiaron 2 552 niños con diarrea y 793 controles que fueron atendidos en el hospital. Para el análisis estadístico de los resultados se empleó la prueba exacta de Fisher. Los rotavirus fueron los agentes más importantes, tanto por su frecuencia (30% como por su asociación con la deshidratación (58%. Le siguieron en importancia Campylobacter spp. (13% y Escherichia coli serogrupos O clásicos (9%, pero su asociación con la diarrea solo fue estadísticamente significativa en los niños menores de 3 meses, hecho de particular importancia desde el punto de vista del tratamiento. Se confirmó la importancia de la edad como factor determinante de la prevalencia y gravedad de la diarrea.In four cities of Venezuela a study was carried out to evaluate the epidemiological, clinical, and etiological characteristics of acute diarrhea in children under 5 years of age. The study was done between June 1993 and May 1995 and involved children who were seen in a hospital, 2 552 with diarrhea and 793 controls. The Fisher exact test was used for the statistical analysis of the results. Rotaviruses were the most important agents, both in terms of their frequency (30% and their association with dehydration (58%. Following in importance were Campylobacter spp. (13% and Escherichia coli classical O serogroups (9%, but their association with diarrhea was only statistically significant among children less than 3 months old, a fact that is particularly important from the standpoint of treatment. The importance of age was confirmed as a determining factor in the prevalence and severity of diarrhea.

Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program

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El-Khoury, Marianne; Banke, Kathryn; Sloane, Phoebe

2016-01-01

ABSTRACT Diarrhea is the fourth leading cause of child mortality in Ghana. In 2010, Ghana endorsed guidelines from the World Health Organization and the United Nations Children’s Fund for use of zinc with low-osmolarity oral rehydration salts (ORS) for the treatment of acute childhood diarrhea. From late 2011 through 2014, the Strengthening Health Outcomes through the Private Sector (SHOPS) project implemented a comprehensive program in 3 regions of Ghana to increase the availability and use of ORS and zinc and to decrease incorrect use of antibiotics and antidiarrheals. The program included (1) partnering with local pharmaceutical firms to introduce and market locally produced zinc products, (2) collaborating with the Ghanaian Pharmacy Council to provide training and supportive supervision of private-sector providers on diarrhea management, and (3) conducting mass media campaigns to raise caregiver awareness. We evaluated the effect of this program using a baseline survey of 754 caregivers of children under 5 with diarrhea at the start of the intervention in 2012 and a follow-up survey of 751 caregivers in 2014. Regression analysis showed that use of ORS with zinc increased from 0.8% in 2012 to 29.2% in 2014 (Pzinc. Additional efforts are required to reduce persistent incorrect antibiotic use. PMID:27353619

Fluid curtailment during childhood diarrhea: a countdown analysis.

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Perin, Jamie; Carvajal-Velez, Liliana; Carter, Emily; Bryce, Jennifer; Newby, Holly

2015-06-26

The foundation of recommended diarrhea management in young children is increased fluids and continued feeding. This increase in fluids is necessary to replace those lost during diarrhea and ultimately prevent dehydration. There may be an opportunity to prevent deaths in children under five by discouraging the practice of reducing or curtailing fluids during diarrhea episodes across different settings worldwide. We quantify and describe the extent of fluid curtailment in children with diarrhea in a selection of countries (Burkina Faso, Democratic Republic of Congo, Ethiopia, Nigeria, Tanzania, and Uganda) with high burden of diarrhea-related mortality with national cross sectional survey data. We examine the practice of fluid curtailment in these countries and its relationship to child and household traits and to characteristics of diarrhea management. The prevalence of fluid curtailment among children under five with diarrhea is strikingly high in these countries: 55 % in Nigeria, 49 % in Ethiopia, 44 % in Uganda, 37 % in Tanzania, 36 % in DR Congo and 32 % in Burkina Faso. Fluid curtailment is associated with giving less food, potentially worsening the impact of this harmful practice. Children who were reported to have had fluids curtailed during diarrhea episodes were also 3.51 (95 % confidence, 2.66 - 4.64) times more likely to be reported to have food withheld (α = 0.05; p water source. Children of poorer or less educated mothers and those living in rural areas are more likely to have curtailed fluids, compared to children of less poor or more educated mothers, or those living in urban areas. The harmful practice of curtailing fluids for a child with diarrhea is highly prevalent, representing an increased risk of dehydration and complications due to diarrhea, including death, especially for children in specific subgroups.

Nutritional status, exclusive breastfeeding and management of acute respiratory illness and diarrhea in the first 6 months of life in infants from two regions of Indonesia.

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Oktaria, V; Lee, K J; Bines, J E; Watts, E; Satria, C D; Atthobari, J; Nirwati, H; Kirkwood, C D; Soenarto, Y; Danchin, M H

2017-12-21

Infant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years. We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants from two regions of Indonesia during the first 6 months of life. This study was an observational study conducted in parallel to an immunogenicity and efficacy trial of an oral rotavirus vaccine (RV3-BB) in the Klaten and Yogyakarta regions, Indonesia. Mothers were interviewed at 3 time points: within the first 6 days of their infant's life, and at 8-10 and 22-24 weeks of age. Questions asked included pregnancy history, infant nutritional status, feeding status and health of infants within up to 2 weeks prior to the assessment. Between February 2013 and January 2014, 233 mother-infant pairs were recruited. 60% (136/223) of infants were exclusively breastfed (EBF) until 6 months of age with the strongest support for EBF reported by mothers themselves 70% (101/223) and 25% (36/223) from their partners. At 6 months, 6% (14/223) of infants were underweight and severely underweight; 4% (8/ 223) wasted and severely wasted; and 12% (28/223) were stunted and severely stunted. Non-recommended medication use was high, with 54% (21/39) of infants with reported cough within 2 weeks of an assessment receiving cough medication, 70% (27 /39) an antihistamine, 26% (10/39) a mucolytic and 15% (6 /39) an oral bronchodilator. At age 22-24 week, infants with reported diarrhea within 2 weeks of an assessment had low use of oral rehydration solutions (ORS) (3/21;14%) and zinc therapy (2/ 21;10%). In this unique observational study, breastfeeding rates of 60% at 6 months were below the Indonesian national target of >75%. Adherence to WHO guidelines for management of ARI and diarrhea was poor, with high use of non-recommended cough medications and oral bronchodilators in the first 6 months of life

Update on traveler's diarrhea.

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Strum, W B

1988-07-01

Traveler's diarrhea affects a substantial number of travelers to high-risk areas of the world. The key to controlling this troublesome disease is prevention. The most important preventive measures depend on educating patients to consume only safe foods and pure water. Physicians cannot overemphasize the importance of avoiding high-risk foods and of boiling water if a safe water supply is not available. Prophylactic medications are a secondary consideration and should be prescribed with discretion. In most cases, diarrhea is mild and self-limited, requiring only fluid and electrolyte replacement and perhaps an antidiarrheal agent. In moderate to severe cases, the addition of an antimicrobial agent may be of benefit. Until an efficacious polyvalent vaccine is developed, caution and common sense, together with discretionary dietary and hygienic practices, are the best defenses against traveler's diarrhea. The ultimate solution is greatly improved sanitation and personal hygiene, especially in high-risk countries. However, only dreamers will consider waiting for this transformation to occur.

The Dose-Volume Relationship of Small Bowel Irradiation and Acute Grade 3 Diarrhea During Chemoradiotherapy for Rectal Cancer

International Nuclear Information System (INIS)

Robertson, John M.; Lockman, David; Yan Di; Wallace, Michelle

2008-01-01

Purpose: Previous work has found a highly significant relationship between the irradiated small-bowel volume and development of Grade 3 small-bowel toxicity in patients with rectal cancer. This study tested the previously defined parameters in a much larger group of patients. Methods and Materials: A total of 96 consecutive patients receiving pelvic radiation therapy for rectal cancer had treatment planning computed tomographic scans with small-bowel contrast that allowed the small bowel to be outlined with calculation of a small-bowel dose-volume histogram for the initial intended pelvic treatment to 45 Gy. Patients with at least one parameter above the previously determined dose-volume parameters were considered high risk, whereas those with all parameters below these levels were low risk. The grade of diarrhea and presence of liquid stool was determined prospectively. Results: There was a highly significant association with small-bowel dose-volume and Grade 3 diarrhea (p ≤ 0.008). The high-risk and low-risk parameters were predictive with Grade 3 diarrhea in 16 of 51 high-risk patients and in 4 of 45 low-risk patients (p = 0.01). Patients who had undergone irradiation preoperatively had a lower incidence of Grade 3 diarrhea than those treated postoperatively (18% vs. 28%; p = 0.31); however, the predictive ability of the high-risk/low-risk parameters was better for preoperatively (p = 0.03) than for postoperatively treated patients (p = 0.15). Revised risk parameters were derived that improved the overall predictive ability (p = 0.004). Conclusions: The highly significant dose-volume relationship and validity of the high-risk and low-risk parameters were confirmed in a large group of patients. The risk parameters provided better modeling for the preoperative patients than for the postoperative patients

Diarrhea: Cancer-Related Causes and How to Cope

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... soon as your diarrhea starts, switch to a diet of clear liquids, such as water, apple juice, clear broth and ice pops. Avoid milk products, as lactose intolerance may be part of your diarrhea. When you have diarrhea, you ... fiber to your diet, such as bananas, rice, applesauce and toast. Eat ...

Village-randomized clinical trial of home distribution of zinc for treatment of childhood diarrhea in rural Western kenya.

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Daniel R Feikin

Full Text Available BACKGROUND: Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities. METHODS: We randomized 16 Kenyan villages (1,903 eligible children to receive a 10-day course of zinc and two oral rehydration solution (ORS sachets every two months at home and 17 villages (2,241 eligible children to receive ORS at home, but zinc at the health-facility only. Children's caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children's age. RESULTS: There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed, 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001. There were no differences in ORS use between zinc (59.6% and comparison villages (58.8%. Among children with fever or cough without diarrhea, zinc use was low (<0.5%. There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46-0.99, but not presenting at clinic. CONCLUSIONS: In this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low. TRIAL REGISTRATION: ClinicalTrials.gov NCT

Maternal knowledge, attitudes and practice in diarrhea.

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Kapoor, P; Rajput, V J

1993-01-01

In developing countries where diarrhea is a major health problem, mothers are often ignorant about the cause and management of the disease and tend to restrict fluid intake instead of taking steps to prevent dehydration. 300 mothers of children hospitalized in Rewa, India, were interviewed with a pretested questionnaire on their diarrhea knowledge. 74.3% were rural and 80.6% were aged 20-30 years. 70% were illiterate and belonged to the upper lower or lower middle class. Causes of diarrhea cited by the mothers included teething (64.3%), evil eye (46%), contact with another case (36.6%), malnutrition (28.3), worm infestation (22.6%), eating mud (18.6%), mother's food habits (17.6%), eating sweets (17.3%), dirty water (15.3%), hot/cold foods (10.6%), change of food (8.3), and dirty environment (6%). During diarrhea, 266 mothers allowed breast milk, 118 pulses and rice gruel, 104 diluted cow's milk, 57 undiluted cow's milk, 25 boiled pulses water, 23 boiled rice water, 16 banana, 13 oral rehydration solution, 10 a whole diet, 8 tea, and 7 curd. Half of the mothers considered passage of liquid stools 3-5 times a day as diarrhea. Only 3% of the mothers listed dehydration as an important complication of the disease. Of the mothers using oral rehydration therapy, the fluid was often not reconstituted properly, and inadequate amounts were administered. Improved health education for mothers, with information on general hygiene, adequate diet during illness, and the use of oral rehydration solution in diarrhea would reduce diarrhea deaths.

Acute renal failure by ingestion of Euphorbia paralias

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Karima Boubaker

2013-01-01

Full Text Available Euphorbia paralias is known in traditional medicine as an anti-inflammatory agent, a purgative and for its local anesthetic property. To the best our knowledge, renal toxicity of this substance has not been previously reported. In this paper, we report the case of a 29-year-old male who developed renal damage following ingestion of Euphorbia paralias. He had been on follow-up for nephrotic syndrome since 1986, although irregularly, with several relapses but each responding well to steroid therapy. A kidney biopsy had not been performed earlier due to refusal by the patient. He was off steroids since April 2008 because the patient developed osteoporosis. He was admitted with general malaise and oliguria to our department in May 2009, following repeated vomiting and watery diarrhea for three days. On examination, he was edematous but had normal vital signs except for a pulse rate of 120/min. Hemoglobin was only 5.5 g/dL but with normal white cell and platelet counts. Blood biochemistry showed evidence of advanced renal failure with a serum creatinine level of 1835 μmol/L and urea at 44.6 mmol/L, sodium of 132 μmol/L and potassium at 4.3 mmol/L. He had features of nephrotic syndrome with severe hypoproteinamia and 24-h urinary protein of 10.45 g. Ultrasonography revealed enlarged kidneys with a reduced echogenecity of the medulla and the papillae. Subsequently, after hemodialysis with blood transfusion, a kidney biopsy was performed that showed focal segmental glomerulosclerosis associated with an acute tubular injury. On intensive interrogation, the patient gave a history of ingesting boiled Euphorbia paralias as a native treatment for edema, ten days prior to the onset of the current illness. A diagnosis of acute renal failure (ARF resulting from the possible nephrotoxic effect of Euphorbia paralias poisoning was made. He was treated with intermittent hemodialysis and corticosteroids. Serum creatinine values improved after 48 days. At six

Mechanism of diarrhea in microscopic colitis.

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Protic, Marijana; Jojic, Njegica; Bojic, Daniela; Milutinovic, Svetlana; Necic, Dusanka; Bojic, Bozidar; Svorcan, Petar; Krstic, Miodrag; Popovic, Obren

2005-09-21

To search the pathophysiological mechanism of diarrhea based on daily stool weights, fecal electrolytes, osmotic gap and pH. Seventy-six patients were included: 51 with microscopic colitis (MC) (40 with lymphocytic colitis (LC); 11 with collagenous colitis (CC)); 7 with MC without diarrhea and 18 as a control group (CG). They collected stool for 3 d. Sodium and potassium concentration were determined by flame photometry and chloride concentration by titration method of Schales. Fecal osmotic gap was calculated from the difference of osmolarity of fecal fluid and double sum of sodium and potassium concentration. Fecal fluid sodium concentration was significantly increased in LC 58.11+/-5.38 mmol/L (Pdiarrhea compared to fecal osmotic gap. Seven (13.3%) patients had osmotic diarrhea. Diarrhea in MC mostly belongs to the secretory type. The major pathophysiological mechanism in LC could be explained by a decrease of active sodium absorption. In CC, decreased Cl/HCO3 exchange rate and increased chloride secretion are coexistent pathways.

Experiencia con pacientes hospitalizados en la unidad de capacitación para el tratamiento de la diarrea del Hospital Univertario San Vicente de Paúl de Medellín Experience with hospitalized children at a training unit for diarrhea treatment, in Medellín, Colombia

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Carlos A. Bernal Parra

1995-02-01

Full Text Available

Entre 1988 y 1994 se atendieron 1.755 niños en la sala de hospitalización de la Unidad de Capacitación para el Tratamiento de la Diarrea, del Hospital Universitario San Vicente de Paúl, de Medellín; 1.022 (58.2% fueron hombres y 733 (41.8% mujeres; mil setenta y ocho eran menores de un año (61.4% y 677 (38.6% tenían más de un año. Eran desnutridos 888 (50.6%. Presentaban diarrea persistente 418 (23.8%; 1.056 (82.2% diarrea acuosa, 213 (16.6% diarrea disentérica y 16 (1.2% solamente vómitos. Novecientos trece pacientes (52% consultaron o estuvieron en la sala de hidratación oral y 276 (15.7% habían estado hospitalizados por diarrea durante el último mes. Al ingreso 670 (38.2% se encontraban hidratados, 151 (8.6% tenían deshidratación grave y 934 (53.2% presentaban otros grados de deshidratación. La bacteria más frecuentemente identificada fue Salmonella enteritidis (258 casos; 23.9%. Setecientos ochenta y seis pacientes (44.8% recibieron los líquidos solamente por vía oral o por sonda nasogástrica y 969 (55.2% por vía intravenosa. Al egreso 1.088 (62% tuvieron el diagnóstico de diarrea aguda y 667 (38% el de diarrea persistente. La mortalidad fue de 1.5% (27 pacientes.

We present the results of our experience in the in-patient treatment of children with diarrhea. Between 1988 and 1994,1.755 children were hospitalized for this purpose at the Training Unit for Diarrhea Treatment, Hospital San Vicente, in Medellín, Colombia; 1.022 (58.2% were males and 733 (41.8% females; 1.078 (61.4% were younger than one year and 677 (38.6% were above this age. Eight hundred and eighty eight (50.6% were undernourished. At admission, persistent diarrhea was found in 418 (23.8%; stools were watery in 1.056 (82.2% and dysenteric in 213 (16.6%; 16

ACUTE INTESTINAL INFECTION AS A DISGUISE OF ACUTE APPENDICITIS IN CHILDREN

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Y. Y. Dyakonova

2016-01-01

Full Text Available The issue of differential diagnosis of acute appendicitis and acute intestinal infections in contemporary medicine remains relevant for clinical practice of surgeons and pediatricians. Late diagnosis of appendicitis results in development of complicated forms of vermiform appendix inflammation. This prolongs operative intervention, duration of antibacterial therapy and duration of a child’s inpatient stay. The article presents clinical observation of three children treated for perforated appendix and generalized purulent peritonitis. The described cases demonstrate the need in multidisciplinary approach and complex diagnosis of patients with such complaints as abdominal pain, fever and diarrhea.

Cholera

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... causes a large amount of watery diarrhea. Causes Cholera is caused by the bacterium Vibrio cholerae . These bacteria release a toxin that causes an ... include: Africa Some parts of Asia India Bangladesh Mexico South and Central America ... Symptoms of cholera can be mild to severe. They include: Abdominal ...

An inducible mouse model for microvillus inclusion disease reveals a role for myosin Vb in apical and basolateral trafficking

NARCIS (Netherlands)

Schneeberger, Kerstin; Vogel, Georg F; Teunissen, Hans; van Ommen, Domenique D; Begthel, Harry; El Bouazzaoui, Layla; van Vugt, Anke H M; Beekman, Jeffrey M; Klumperman, Judith; Müller, Thomas; Janecke, Andreas; Gerner, Patrick; Huber, Lukas A; Hess, Michael W; Clevers, Hans; van Es, Johan H; Nieuwenhuis, Edward E S; Middendorp, Sabine

2015-01-01

Microvillus inclusion disease (MVID) is a rare intestinal enteropathy with an onset within a few days to months after birth, resulting in persistent watery diarrhea. Mutations in the myosin Vb gene (MYO5B) have been identified in the majority of MVID patients. However, the exact pathophysiology of

Travelers' diarrhea.

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Barrett-Connor, E

1973-03-01

On the average, one-fourth of North Americans visiting developing countries experience a self-limited diarrheal illness that interferes with holiday or business activities. Recent work suggests that these episodes are caused by a small inoculum of enteropathogenic Escherichia coli which are common in the country visited and rare in the country of origin. Neither antimicrobial treatment nor anti-diarrheal agents have proven benefit once the illness has begun. Despite its frequent use, iodochlorhydroxyquin has not been shown in double blind studies to be effective as a preventive agent, and may be dangerous. The status of furazolidone for prevention of tourist diarrhea is questionable. Both neomycin sulfate and phythalylsulfathiazole have demonstrated efficacy as chemoprophylactics in Mexico. However, their use should be restricted to limited types of travel and travelers. General admonitions concerning avoidance of certain ingestibles are recommended; despite questionable value in preventing travelers' diarrhea such precautions may prevent more serious gastrointestinal illness.

Fluid management in children with diarrhea-related hyponatremic-hypernatremic dehydration: a retrospective study of 83 children.

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Kocaoglu, Celebi; Selma Solak, Ece; Kilicarslan, Cengizhan; Arslan, Sukru

2014-02-01

To investigate serum creatinine and electrolyte status of children with diarrhea-related hyponatremic or hypernatremic dehydration. Medical history of 83 patients admitted to the Pediatric Intensive Care Unit of the Konya Education and Research Hospital, Konya, Turkey with diarrhea, dehydration and electrolyte imbalance was retrospectively evaluated according to the degree of dehydration, serum creatinine, electrolytes, blood gas, approaches to the treatment such as content of given fluid, HCO3- and acute periotenal dialysis. Of 65 patients with hyponatremia, 44 (67.7%) were given fluids at appropriate concentration according to their age, and 21 (32.3%) were given fluids at higher concentration. Of 18 hypernatremic patients, 11 (61.1%) were given fluids at appropriate concentration for age, and seven (38.9%) were given fluids at higher concentration. Mean duration of amelioration of serum sodium levels for those admitted with hyponatremia and given fluids at appropriate concentration for age and at higher concentration were 33.9 ± 28.3 h and 53.7 ± 31.6 h, respectively. Mean duration of amelioration of serum sodium levels for hypernatremics and given fluids at appropriate concentration for age and at higher concentration were 34.7 ± 22.1 h and 46.3 ± 32 h, respectively. Four (4.8%) hyponatremic patients and three (3.6%) with hypernatremia were treated with acute peritoneal dialysis. Mortality rate was 6% (five of all patients). The children with severe diarrhea should be closely followed-up as to clinical examination, serum electrolytes, creatinine and blood gases, and because no single intravenous fluid management is optimal for all children, intravenous fluid therapy should be individualized for each patient.

Breastfeeding and the risk for diarrhea morbidity and mortality

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Victora Cesar

2011-04-01

Full Text Available Abstract Background Lack of exclusive breastfeeding among infants 0-5 months of age and no breastfeeding among children 6-23 months of age are associated with increased diarrhea morbidity and mortality in developing countries. We estimate the protective effects conferred by varying levels of breastfeeding exposure against diarrhea incidence, diarrhea prevalence, diarrhea mortality, all-cause mortality, and hospitalization for diarrhea illness. Methods We systematically reviewed all literature published from 1980 to 2009 assessing levels of suboptimal breastfeeding as a risk factor for selected diarrhea morbidity and mortality outcomes. We conducted random effects meta-analyses to generate pooled relative risks by outcome and age category. Results We found a large body of evidence for the protective effects of breastfeeding against diarrhea incidence, prevalence, hospitalizations, diarrhea mortality, and all-cause mortality. The results of random effects meta-analyses of eighteen included studies indicated varying degrees of protection across levels of breastfeeding exposure with the greatest protection conferred by exclusive breastfeeding among infants 0-5 months of age and by any breastfeeding among infants and young children 6-23 months of age. Specifically, not breastfeeding resulted in an excess risk of diarrhea mortality in comparison to exclusive breastfeeding among infants 0-5 months of age (RR: 10.52 and to any breastfeeding among children aged 6-23 months (RR: 2.18. Conclusions Our findings support the current WHO recommendation for exclusive breastfeeding during the first 6 months of life as a key child survival intervention. Our findings also highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and mortality throughout the first 2 years of life.

Characteristics of Rotavirus Diarrhea in Hospitalized Children in Kosovo

OpenAIRE

Ismaili-Jaha, Vlora; Shala, Muje; Azemi, Mehmedali; Hoxha-Kamberi, Teuta; Avdiu, Muharrem; Spahiu, Shqipe; Jaha, Luan

2014-01-01

Background: Diarrhea is a leading cause of child mortality worldwide. Rotavirus is one of the most common causes of severe diarrhea and dehydration in children. Authors reviewed epidemiological and clinical data of the rotavirus diarrhea in Kosovo. Methods: This is a prospective study carried between January 1st and December 31st 2011. All data, comprising demographics, nutrition, clinical presentation, laboratory findings, management and outcome of the rotavirus diarrhea are collected on the...

Oral Ondansetron in Management of Dehydrating Diarrhea with Vomiting in Children Aged 3 Months to 5 Years: A Randomized Controlled Trial.

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Danewa, Arun Singh; Shah, Dheeraj; Batra, Prerna; Bhattacharya, Swapan Kumar; Gupta, Piyush

2016-02-01

To evaluate the role of oral ondansetron in facilitating successful rehydration of under-5-year-old children suffering from acute diarrhea with vomiting and some dehydration. Children (n = 170) aged 3 months to 5 years with acute diarrhea with vomiting and some dehydration were enrolled in this double blind, randomized, placebo-controlled trial. The participants were randomized to receive either single dose of oral ondansetron (n = 85) or placebo (n = 85) in addition to standard management of dehydration according to World Health Organization guidelines. Failure of oral rehydration therapy (ORT), administration of unscheduled intravenous fluids, and amount of oral rehydration solution intake in 4 hours were the primary outcomes. Secondary outcome measures included duration of dehydration correction, number of vomiting episodes, adverse effects, and caregiver satisfaction. Failure of ORT was significantly less in children receiving ondansetron compared with those receiving placebo (31% vs 62%; P children in the ondansetron group received intravenous fluids compared with those in the placebo group, but it was not statistically significant (P = .074; relative risk 0.56, 95% CI 0.30-1.07). The oral rehydration solution consumption was significantly more in the ondansetron group (645 mL vs 554 mL; mean difference 91 mL; 95% CI: 35-148 mL). Patients in the ondansetron group also showed faster rehydration, lesser number of vomiting episodes, and better caregiver satisfaction. A single oral dose of ondansetron, given before starting ORT to children <5 years of age with acute diarrhea and vomiting results in better oral rehydration. Clinical Trial Registry of India: CTRI-2011/07/001916. Copyright © 2016 Elsevier Inc. All rights reserved.

Looking for evidence that personal hygiene precautions prevent traveler's diarrhea.

Science.gov (United States)

Shlim, David R

2005-12-01

In the 50 years during which traveler's diarrhea has been studied, it has always been assumed that personal hygiene precautions can prevent or reduce the likelihood of developing traveler's diarrhea. However, 7 of 8 studies that specifically addressed this issue showed no correlation between the types of food selected and the risk of acquiring traveler's diarrhea. The eighth study showed a correlation between a few dietary mistakes and a decreased risk of acquiring traveler's diarrhea. A further increase in the number of dietary mistakes, however, did not continue to increase the risk of acquiring traveler's diarrhea. Personal hygiene precautions, when performed under the direct supervision of an expatriate operating his or her own kitchen, can prevent traveler's diarrhea, but poor restaurant hygiene in most developing countries continues to create an insurmountable risk of acquiring traveler's diarrhea.

Diarrhea in infants

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... Rare diseases such as cystic fibrosis . Diarrhea Causes Dehydration Infants and young children under age 3 can ... as: Apple juice Milk Fried foods Full-strength fruit juice Preventing Diaper Rash Your baby might get ...

Diarrhea due to Cryptosporidium parvum in immunocompromised ...

African Journals Online (AJOL)

Objective: The objective of this study is to search for Cryptosporidium parvum in Sudanese immunocompromised and immunocompetent patients presenting with diarrhea. Methods: Two hundred and thirteen stool specimens were collected from different groups of patients presenting with diarrhea and healthy control ...

[Effects of secretory and osmotic diarrhea on rats intestinal function and morphology].

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de Lima de Mon, Margarita; Cioccia, Anna M; González, Eduardo; Hevia, Patricio

2002-03-01

In order to compare intestinal morphology and function, diarrhea was produced in rats using laxatives in the diet. The 14 day study included two groups of rats with diarrhea (osmotic or secretory), two groups without diarrhea but with a degree of malnutrition which was similar to that seen in the rats with diarrhea (malnourished without diarrhea) and a well-nourished group (control). The inclusion of laxatives(lactose or bisoxatin acetate) cause a reduction in food intake, diarrhea an malnutrition. It also caused a reduction in dietary protein and fat digestibility which was proportional to the severity of diarrhea and more pronounced in secretory diarrhea. In the malnourished rats without diarrhea, malnutrition did not affect their absorptive function. Both in the rats with secretory and osmotic diarrhea an intestinal hypertrophy was observed. This hypertrophy was proportional to the severity of diarrhea and independent of its aetiology. In the intestines of the rats with both types of diarrhea there was inflammation, a greater number of mitotic figures but the flattening of the villi seen in the malnourished rats without diarrhea was not seen. In osmotic diarrhea there was, in addition, a patchy damage of the surface of the jejunal mucosa and an increment in the number of goblet cells, indicating a more severe intestinal deterioration. Since despite this greater deterioration, these rats absorbed more protein and fat we concluded that the alterations in intestinal morphology seen in this study was not predictive of intestinal function. The study also showed that diarrhea had a trophic effect on the intestine which did not occur in malnourished rats without diarrhea.

Zinc treatment ameliorates diarrhea and intestinal inflammation in undernourished rats.

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de Queiroz, Camila A A; Fonseca, Said Gonçalves C; Frota, Priscila B; Figueiredo, Italo L; Aragão, Karoline S; Magalhães, Carlos Emanuel C; de Carvalho, Cibele B M; Lima, Aldo Ângelo M; Ribeiro, Ronaldo A; Guerrant, Richard L; Moore, Sean R; Oriá, Reinaldo B

2014-08-05

WHO guidelines recommend zinc supplementation as a key adjunct therapy for childhood diarrhea in developing countries, however zinc's anti-diarrheal effects remain only partially understood. Recently, it has been recognized that low-grade inflammation may influence stunting. In this study, we examined whether oral zinc supplementation could improve weight, intestinal inflammation, and diarrhea in undernourished weanling rats. Rats were undernourished using a northeastern Brazil regional diet (RBD) for two weeks, followed by oral gavage with a saturated lactose solution (30 g/kg) in the last 7 days to induce osmotic diarrhea. Animals were checked for diarrhea daily after lactose intake. Blood was drawn in order to measure serum zinc levels by atomic absorption spectroscopy. Rats were euthanized to harvest jejunal tissue for histology and cytokine profiles by ELISA. In a subset of animals, spleen samples were harvested under aseptic conditions to quantify bacterial translocation. Oral zinc supplementation increased serum zinc levels following lactose-induced osmotic diarrhea. In undernourished rats, zinc improved weight gain following osmotic diarrhea and significantly reduced diarrheal scores by the third day of lactose intake (p diarrhea and undernutrition and support the use of zinc to prevent the vicious cycle of malnutrition and diarrhea.

Perfil etiológico das diarréias agudas de crianças atendidas em São Paulo Etiologic profile of acute diarrhea in children in the city of São Paulo

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Eloisa C. Souza

2002-02-01

ção.Conclusões: as bactérias foram os enteropatógenos mais detectados nos casos de diarréia aguda, sendo a Escherichia coli a mais freqüente. Na maior parte, as cepas de Escherichia coli eram de biovariedade não-EPEC, habitualmente não investigadas nos laboratórios de patologia clínica. O rotavírus foi encontrado em grande parcela dos casos, muitas vezes em associação com as bactérias. Os protozoários tiveram importância reduzida.Objective: to evaluate the etiologic profile of acute diarrhea in socioeconomically deprived children assisted at a regional pediatric emergency care service. Methods: during two years all children with acute diarrhea assisted at a previously established day and week time schedule were included in the study. Other selective criteria were: a age less than 5 years; b nonuse of antibiotics in the previous month; and c no travel outside the city in the previous month. Stool examination was used for the detection of the following microorganisms: a rotavirus (immunofluorescence and counterimmunoelectrophoresis; b bacteria - culture in MacConkey agar, SS agar, Columbia agar, bright green, serotyping, detection of toxins - INV, LT,ST,SLT I, SLT II, Sereny test, detection of virulence factors - EAF, eae, BFP; and c protozoa (Hoffman and Faust. In the same period, a control group without diarrhea was also evaluated for the same fecal pathogens. Results: between March 1994 and June 1996, 154 children with acute diarrhea (AD and 42 control children (WAD, that is, without acute diarrhea, were selected. In the AD group, intestinal pathogens were detected in 112 (72.8% cases, and in 9 (21.5% cases in the WAD group. The association of two or more intestinal pathogens occurred in 47 (30.5% cases in the AD group, and in 3 (7.1% cases in the WAD group. The pathogens identified in the AD cases were: Rotavirus: 32 (20.8%, bacteria: 53 (34.4%, both: 25 (16.2%, and 2 (1.4% with Giardia lamblia (in one case associated with Rotavirus and in another one associated with

Catch-Up Growth Occurs after Diarrhea in Early Childhood123

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Richard, Stephanie A.; Black, Robert E.; Gilman, Robert H.; Guerrant, Richard L.; Kang, Gagandeep; Lanata, Claudio F.; Mølbak, Kåre; Rasmussen, Zeba A.; Sack, R. Bradley; Valentiner-Branth, Palle; Checkley, William

2014-01-01

Diarrhea and linear growth faltering continue to burden low-income countries and are among the most important contributors to poor health during early childhood. Diarrhea is thought to adversely affect linear growth, but catch-up growth can occur if no additional insults are experienced. We sought to characterize catch-up growth in relation to diarrhea burden in a multisite dataset of 1007 children. Using longitudinal anthropometry and diarrheal surveillance data from 7 cohort studies in 4 countries, we examined the relation between diarrhea prevalence and growth in 3- to 6-mo periods using linear mixed-effect models. Growth during each period was calculated as a function of age using linear splines. We incorporated the longitudinal prevalence of diarrhea in both current and previous periods into the model. Diarrhea during the current period was associated with slower linear and ponderal growth. Faster (catch-up) growth in length was observed in children with no diarrhea in age groups immediately after an age group in which diarrhea was experienced [age group >6–12 mo: 0.03 mm/mo for each percentage diarrhea prevalence in the previous period (95% CI: 0.007, 0.06) relative to 11.3 mm/mo mean growth rate; age group >12–18 mo: 0.04 mm/mo (95% CI: 0.02, 0.06) relative to 8.9 mm/mo mean growth rate; age group >18–24 mo: 0.04 mm/mo (95% CI: 0.003, 0.09) relative to 7.9 mm/mo mean growth rate]. The associations were stronger in boys than in girls when separate models were run. Similar results were observed when weight was the outcome variable. When diarrheal episodes are followed by diarrhea-free periods in the first 2 y of life, catch-up growth is observed that may allow children to regain their original trajectories. The finding of a greater effect of diarrhea on linear growth in boys than in girls was unexpected and requires additional study. Diarrhea burdens are high throughout the first 2 y of life in these study sites, therefore reducing the likelihood of

Predictors of under-five childhood diarrhea: Mecha District, West ...

African Journals Online (AJOL)

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Bivariate and multivariate logistic regression analyses were undertaken to identify predictors of childhood diarrhea. Results: The prevalence of diarrhea among mothers and under-five children was 8.2% and 18.0%, respectively. Maternal education (AOR=5.6, 95% CI: 1.5 - 19.4), maternal history of recent diarrhea (AOR, 5.5 ...

Diarrhea - what to ask your doctor - child

Science.gov (United States)

What to ask your doctor about diarrhea - child; Loose stools - what to ask your doctor - child ... FOODS What foods can make my child's diarrhea worse? How should I prepare the foods for my child? If my child is still breastfeeding or bottle feeding, do I ...

Intractable diarrhea in hyperthyroidism: management with beta-adrenergic blockade.

Science.gov (United States)

Bricker, L A; Such, F; Loehrke, M E; Kavanaugh, K

2001-01-01

To describe a patient with intractable diarrhea and thyrotoxic Graves' disease, for whom b-adrenergic blockade ultimately proved to be effective therapy for the diarrhea, and to review the types of hyperthyroidism-associated diarrhea. We present the clinical course of a young man with a prolonged siege of diarrhea that proved elusive to diagnostic inquiries and resistant to all means of management until its endocrine basis was discovered. Control of such cases with b-adrenergic blockade is discussed, as are the pathophysiologic bases of intestinal hypermotility in hyperthyroidism. A 26-year-old man with Down syndrome, and no prior gastrointestinal disorder, had insidious, chronic, constant diarrhea, which was associated with loss of 14 kg during a 5-month period. Numerous laboratory and imaging studies and endoscopic examinations failed to disclose the cause of the diarrhea. Furthermore, a broad range of antibiotics and other empiric remedies failed to control the problem. No other symptoms of hyperthyroidism were reported, but when the endocrinopathy was suspected and identified, the diarrhea was promptly controlled by treatment with propranolol. In patients with hyperthyroidism, two types of diarrheal disorders have been described-secretory diarrhea and steatorrhea; bile acid malabsorption may have a role in either of these settings. In addition to its capacity for blocking the peripheral effects of thyroid hormone on the heart and central nervous system, b-adrenergic blockade is effective in slowing intestinal transit time and ameliorating the uncommon diarrhea associated with hyperthyroidism. Thyroid hormone in excess, among its other possible effects on the gastrointestinal tract, may exert a stimulatory effect by means of intermediary sympathetic activation, as it does with the heart. Thus, sympathetic blockade can mimic the salutary effects on the gastrointestinal tract conventionally brought about by direct antithyroid therapy, and well before the

Comparison of two control groups for estimation of oral cholera vaccine effectiveness using a case-control study design.

Science.gov (United States)

Franke, Molly F; Jerome, J Gregory; Matias, Wilfredo R; Ternier, Ralph; Hilaire, Isabelle J; Harris, Jason B; Ivers, Louise C

2017-10-13

Case-control studies to quantify oral cholera vaccine effectiveness (VE) often rely on neighbors without diarrhea as community controls. Test-negative controls can be easily recruited and may minimize bias due to differential health-seeking behavior and recall. We compared VE estimates derived from community and test-negative controls and conducted bias-indicator analyses to assess potential bias with community controls. From October 2012 through November 2016, patients with acute watery diarrhea were recruited from cholera treatment centers in rural Haiti. Cholera cases had a positive stool culture. Non-cholera diarrhea cases (test-negative controls and non-cholera diarrhea cases for bias-indicator analyses) had a negative culture and rapid test. Up to four community controls were matched to diarrhea cases by age group, time, and neighborhood. Primary analyses included 181 cholera cases, 157 non-cholera diarrhea cases, 716 VE community controls and 625 bias-indicator community controls. VE for self-reported vaccination with two doses was consistent across the two control groups, with statistically significant VE estimates ranging from 72 to 74%. Sensitivity analyses revealed similar, though somewhat attenuated estimates for self-reported two dose VE. Bias-indicator estimates were consistently less than one, with VE estimates ranging from 19 to 43%, some of which were statistically significant. OCV estimates from case-control analyses using community and test-negative controls were similar. While bias-indicator analyses suggested possible over-estimation of VE estimates using community controls, test-negative analyses suggested this bias, if present, was minimal. Test-negative controls can be a valid low-cost and time-efficient alternative to community controls for OCV effectiveness estimation and may be especially relevant in emergency situations. Copyright © 2017. Published by Elsevier Ltd.

Optimal control of diarrhea transmission in a flood evacuation zone

Science.gov (United States)

Erwina, N.; Aldila, D.; Soewono, E.

2014-03-01

Evacuation of residents and diarrhea disease outbreak in evacuation zone have become serious problem that frequently happened during flood periods. Limited clean water supply and infrastructure in evacuation zone contribute to a critical spread of diarrhea. Transmission of diarrhea disease can be reduced by controlling clean water supply and treating diarrhea patients properly. These treatments require significant amount of budget, which may not be fulfilled in the fields. In his paper, transmission of diarrhea disease in evacuation zone using SIRS model is presented as control optimum problem with clean water supply and rate of treated patients as input controls. Existence and stability of equilibrium points and sensitivity analysis are investigated analytically for constant input controls. Optimum clean water supply and rate of treatment are found using optimum control technique. Optimal results for transmission of diarrhea and the corresponding controls during the period of observation are simulated numerically. The optimum result shows that transmission of diarrhea disease can be controlled with proper combination of water supply and rate of treatment within allowable budget.

Genetic virulence profile of enteroaggregative Escherichia coli strains isolated from Danish children with either acute or persistent diarrhea

DEFF Research Database (Denmark)

Jensen, Betina Hebbelstrup; Poulsen, Anja; Rasmussen, Stig Hebbelstrup Rye

2017-01-01

Enteroaggregative Escherichia coli (EAEC) is frequently found in diarrheal stools worldwide. It has been associated with persistent diarrhea, weight loss, and failure to thrive in children living in developing countries. A number of important EAEC virulence genes are identified; however...

Mortalidad por enfermedad diarreica en menores, antes y después de la introducción de la vacuna contra el rotavirus Analysis of the mortality due to diarrhea in younger children, before and after the introduction of rotavirus vaccine

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Marcelino Esparza-Aguilar

2009-08-01

Full Text Available OBJETIVO: Analizar la mortalidad por diarrea en menores de cinco años en México, antes y después de la vacunación contra el rotavirus. MATERIAL Y MÉTODOS: Se compararon defunciones y mortalidad por diarrea mediante diferencias porcentuales anuales por grupo etario, antes (2000-2005 y después (2006-2007 de la vacunación. RESULTADOS: Entre 2000 y 2007 la mortalidad por diarrea disminuyó 42%. En los estados con vacunación, la mortalidad se redujo 15.8 y 27.7% en menores de uno y de uno a cuatro años, respectivamente, en el periodo de 2006 a 2007. DISCUSIÓN: La reducción observada en la mortalidad por diarrea en menores de cinco años después de 2005 puede atribuirse en parte a la vacunación contra el rotavirus.OBJECTIVE: To analyze the mortality due to acute diarrhea in children younger than five years old, before and after the introduction of rotavirus vaccine in Mexico. MATERIAL AND METHODS: Number of deaths and mortality rates due to acute diarrhea were compared by children's age and states' vaccine status using annual percentage differences before (2000-2005 and after (2006-2007 the introduction of the HRV. RESULTS: From 2000-2007, deaths due to acute diarrhea in children under five years of age dropped 42%. In those states that received the HRV early in 2006, diarrhea mortality decreased between 2006-2007 15.8% in children younger than one year old and 22.7% in children 1-4 years old. DISCUSSION: The observed reduction in mortality due to acute diarrhea in children under five years of age after 2005 can be, in part, attributed to the HRV.

Breast milk reduces the risk of illness in children of mothers with cholera

DEFF Research Database (Denmark)

Qureshi, Katja; Mølbak, Kåre; Sandström, Anita

2006-01-01

BACKGROUND: A protective effect of breastfeeding against cholera has been demonstrated in areas endemic of cholera. To assess the protection offered by breast milk from mothers living in an area that had been free from cholera for 7 years, we investigated mothers with cholera and their children...... during an epidemic with Vibrio cholerae El Tor in the capital of Guinea-Bissau. METHODS: Eighty mothers with clinical cholera and their children were identified, and interviewed. Blood samples for vibriocidal and antitoxin antibodies were collected from mother-and-child pairs. Breast milk samples were...... collected from lactating mothers.Cholera was defined as acute watery diarrhea during the epidemic and a vibriocidal reciprocal titer of 20 or above. RESULTS: Three (7%) of 42 breastfed children had cholera as defined above compared with 9 (24%) of 38 nonbreastfed children (RR for breastfed children, 0...

Campylobacter jejuni and Campylobacter coli in Children With Acute Diarrhea in Health Centers of Hamadan, Iran

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Rastyani

2015-11-01

Full Text Available Background Enteritis caused by Campylobacter is considered as the most common acute bacterial diarrhea around the world. In most cases, infection occurs as a result of consuming contaminated water or food, especially raw meat of fowls. Objectives The purpose of the present study was to determine the prevalence and antibiotic resistance of campylobacter species among pediatrics of Hamadan city, Iran. Patients and Methods A total of 120 stool samples from children less than 10 years old were examined from January 2013 to December 2014 in Hamadan, Iran. The samples were incubated in Campy-Thio enrichment medium for 1 - 2 hours and then cultured on a specific medium; after that, the suspected colonies were analyzed for Campylobacter spp. identification by conventional tests. The identified species by biochemical methods were confirmed by polymerase chain reaction (PCR. Antimicrobial susceptibility testing was performed by disk agar diffusion (DAD method. Results Twelve (10% Campylobacter spp. from 120 stool samples were isolated including C. coli and C. jejuni. In the antibiotic susceptibility test, the most frequent resistance was observed to ciprofloxacin 8 (88.8%, followed by 7 (77.7% resistant strains to tetracycline, 7 (77.7% to erythromycin, 6 (66.6% to clindamycin, 5 (55.5% to meropenem, 4 (44.4% to gentamicin, 3 (33.3% to nalidixicacid and only 1 (11.1% to chloramphenicol. Conclusions Campylobacter is responsible for some important clinical problems such as enteritis and is also associated with meningitis and hemolytic-uremic syndrome. It is imperative to monitor the prevalence and antibiotic resistance of Campylobacter spp. as well as other the zoonotic bacteria.

Failure of Syndrome-Based Diarrhea Management Guidelines to Detect Shigella Infections in Kenyan Children.

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Pavlinac, P B; Denno, D M; John-Stewart, G C; Onchiri, F M; Naulikha, J M; Odundo, E A; Hulseberg, C E; Singa, B O; Manhart, L E; Walson, J L

2016-12-01

Shigella is a leading cause of childhood diarrhea mortality in sub-Saharan Africa. Current World Health Organization guidelines recommend antibiotics for children in non cholera-endemic areas only in the presence of dysentery, a proxy for suspected Shigella infection. To assess the sensitivity and specificity of the syndromic diagnosis of Shigella-associated diarrhea, we enrolled children aged 6 months to 5 years presenting to 1 of 3 Western Kenya hospitals between November 2011 and July 2014 with acute diarrhea. Stool samples were tested using standard methods for bacterial culture and multiplex polymerase chain reaction for pathogenic Escherichia coli. Stepwise multivariable logit models identified factors to increase the sensitivity of syndromic diagnosis. Among 1360 enrolled children, median age was 21 months (interquartile range, 11-37), 3.4% were infected with human immunodeficiency virus, and 16.5% were stunted (height-for-age z-score less than -2). Shigella was identified in 63 children (4.6%), with the most common species being Shigella sonnei (53.8%) and Shigella flexneri (40.4%). Dysentery correctly classified 7 of 63 Shigella cases (sensitivity, 11.1%). Seventy-eight of 1297 children without Shigella had dysentery (specificity, 94.0%). The combination of fecal mucous, age over 23 months, and absence of excessive vomiting identified more children with Shigella-infection (sensitivity, 39.7%) but also indicated antibiotics in more children without microbiologically confirmed Shigella (specificity, 82.7%). Reliance on dysentery as a proxy for Shigella results in the majority of Shigella-infected children not being identified for antibiotics. Field-ready rapid diagnostics or updated evidence-based algorithms are urgently needed to identify children with diarrhea most likely to benefit from antibiotic therapy. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions

Incidence of Diarrhea in Hospitalized Patients with Standard Enteral Formula

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Shabbu Ahmadi bonakdar

2014-10-01

Conclusion: Evaluation of patients receiving Milatech standard formula showed that diarrhea wasn’t seen in hospitalized patients. Diarrhea was reported by the nurses may refer to other diarrhea genic causes including of long length of stay, entral duration or medical side effects or infections.

Rota virus Diarrhea in Hospitalized Children

International Nuclear Information System (INIS)

Habib, M. I.; Khan, K. M. A.; Zia, N.; Kazi, S. G.

2014-01-01

Objective: To determine the frequency and clinical features of Rota virus diarrhea in children presenting in a tertiary care hospital. Study Design: A cross-sectional, observational study. Place and Duration of Study: National Institute of Child Health, Karachi, from January to June 2007. Methodology: A total of three hundred children of either gender aged 1 month to 5 years, who presented with diarrhea of < 7 days as a primary illness were enrolled. Children with bloody diarrhea or nosocomial gastroenteritis acquired during hospitalization for other disease were not included. Detection of Rota virus in stool was done by enzyme linked immunoassay. Results: Out of 300 children, 188 (63%) tested positive and 112 (37%) tested negative for Rota virus. Positive Rota virus cases in 7 - 12 months of age was (n = 34, 18.08%). Overall, 151 (80.3%) children with Rota virus were less than 3 years old. 182 (60.7%) had fever, 118 (39.3%) had vomiting and 156 (82.9%) children had both fever and vomiting. Conclusion: This study shows that Rota virus is a common organism causing diarrhea in children less than 3 years of age. There is a need to incorporate Rota virus vaccine in the national EPI program to decrease the disease burden as highlighted in this study. (author)

Water, sanitation and hygiene interventions for acute childhood diarrhea: a systematic review to provide estimates for the Lives Saved Tool.

Science.gov (United States)

Darvesh, Nazia; Das, Jai K; Vaivada, Tyler; Gaffey, Michelle F; Rasanathan, Kumanan; Bhutta, Zulfiqar A

2017-11-07

In the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, sanitation facilities, and hygiene behaviours (WASH) represent key opportunities to improve child health and well-being by preventing the spread of infectious diseases and improving nutritional status. We conducted a systematic review of studies evaluating the effects of WASH interventions on childhood diarrhea in children 0-5 years old. Searches were run up to September 2016. We screened the titles and abstracts of retrieved articles, followed by screening of the full-text reports of relevant studies. We abstracted study characteristics and quantitative data, and assessed study quality. Meta-analyses were performed for similar intervention and outcome pairs. Pooled analyses showed diarrhea risk reductions from the following interventions: point-of-use water filtration (pooled risk ratio (RR): 0.47, 95% confidence interval (CI): 0.36-0.62), point-of-use water disinfection (pooled RR: 0.69, 95% CI: 0.60-0.79), and hygiene education with soap provision (pooled RR: 0.73, 95% CI: 0.57-0.94). Quality ratings were low or very low for most studies, and heterogeneity was high in pooled analyses. Improvements to the water supply and water disinfection at source did not show significant effects on diarrhea risk, nor did the one eligible study examining the effect of latrine construction. Various WASH interventions show diarrhea risk reductions between 27% and 53% in children 0-5 years old, depending on intervention type, providing ample evidence to support the scale-up of WASH in low and middle-income countries (LMICs). Due to the overall low quality of the evidence and high heterogeneity, further research is required to accurately estimate the magnitude of the effects of these interventions in different contexts.

An overview of calf diarrhea - infectious etiology, diagnosis, and intervention

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Cho, Yong-il

2014-01-01

Calf diarrhea is a commonly reported disease in young animals, and still a major cause of productivity and economic loss to cattle producers worldwide. In the report of the 2007 National Animal Health Monitoring System for U.S. dairy, half of the deaths among unweaned calves was attributed to diarrhea. Multiple pathogens are known or postulated to cause or contribute to calf diarrhea development. Other factors including both the environment and management practices influence disease severity or outcomes. The multifactorial nature of calf diarrhea makes this disease hard to control effectively in modern cow-calf operations. The purpose of this review is to provide a better understanding of a) the ecology and pathogenesis of well-known and potential bovine enteric pathogens implicated in calf diarrhea, b) describe diagnostic tests used to detect various enteric pathogens along with their pros and cons, and c) propose improved intervention strategies for treating calf diarrhea. PMID:24378583

Surveillance of Food- and Smear-Transmitted Pathogens in European Soldiers with Diarrhea on Deployment in the Tropics: Experience from the European Union Training Mission (EUTM Mali

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Hagen Frickmann

2015-01-01

Full Text Available Introduction. Since 2013, European soldiers have been deployed on the European Union Training Mission (EUTM in Mali. From the beginning, diarrhea has been among the most “urgent” concerns. Diarrhea surveillance based on deployable real-time PCR equipment was conducted between December 2013 and August 2014. Material and Methods. In total, 53 stool samples were obtained from 51 soldiers with acute diarrhea. Multiplex PCR panels comprised enteroinvasive bacteria, diarrhea-associated Escherichia coli (EPEC, ETEC, EAEC, and EIEC, enteropathogenic viruses, and protozoa. Noroviruses were characterized by sequencing. Cultural screening for Enterobacteriaceae with extended-spectrum beta-lactamases (ESBL with subsequent repetitive sequence-based PCR (rep-PCR typing was performed. Clinical information was assessed. Results. Positive PCR results for diarrhea-associated pathogens were detected in 43/53 samples, comprising EPEC (n=21, ETEC (n=19, EAEC (n=15, Norovirus (n=10, Shigella spp./EIEC (n=6, Cryptosporidium parvum (n=3, Giardia duodenalis (n=2, Salmonella spp. (n=1, Astrovirus (n=1, Rotavirus (n=1, and Sapovirus (n=1. ESBL-positive Enterobacteriaceae were grown from 13 out of 48 samples. Simultaneous infections with several enteropathogenic agents were observed in 23 instances. Symptoms were mild to moderate. There were hints of autochthonous transmission. Conclusions. Multiplex real-time PCR proved to be suitable for diarrhea surveillance on deployment. Etiological attribution is challenging in cases of detection of multiple pathogens.

Rotavirus mortality confirmed by etiologic identification in Venezuelan children with diarrhea.

Science.gov (United States)

Pérez-Schael, Irene; Salinas, Belén; González, Rosabel; Salas, Hans; Ludert, Juan Ernesto; Escalona, Marisol; Alcalá, Ana; Rosas, María Alejandra; Materán, Mercedes

2007-05-01

Hospital-based studies to determine the etiology of deaths from diarrhea are scarce. In this study, we specifically analyzed deaths due to rotavirus to assess the rotavirus impact on diarrhea mortality. To determine the rotavirus proportion contributing to mortality due to diarrhea, we analyzed data obtained from a hospital-based mortality surveillance, conducted over 7 years, in the Ciudad Hospitalaria Dr. Enrique Tejera, Valencia, Venezuela. Rotavirus was identified in stool samples collected from children who died of diarrhea, by a confirmatory ELISA and/or reverse transcription polymerase chain reaction. Our results show that rotavirus (21%; 21/100) is the leading cause of death due to diarrhea among children causes in this age group. Shigella spp. (19%; 13/69) was the second most important cause of death, followed by calicivirus (6%; 3/53). Furthermore, this study documents a seasonal pattern in the deaths due to rotavirus (odds ratio 3.28; 95% confidence interval 1.13-9.76). For Venezuela, it is estimated that approximately 300 children cause of death due to diarrhea, which supports previous estimations. This is the first study to present data of cause-specific mortality due to diarrhea based on hospital surveillance of diarrhea etiologies.

Incidence of Rotavirus Diarrhea in Children Under 6 years Referred to the Pediatric Emergency and Clinic of Ghaem Hospital, Mashhad, Iran

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Ali Sadeghian

2010-07-01

Full Text Available "nRotavirus is the most important pathogen responsible for acute diarrhea in infants and young children. The incidence of rotavirus infection was studied in 156 children less than six years of age who were suffering from acute gastroenteritis, between February 22, 2006 and February 21, 2007 in Mashhad. Rotavirus antigen was detected by latex agglutination test (Rotascreen in 28.8% of the stool samples examined. The frequency of rotavirus infection was significantly higher among patients under 24 months of age (69% than among children two years old or more (31%. The peak of incidence was in the winter. This study revealed that rotavirus is an important etiological agent of acute gastroenteritis among children in Mashhad.

Fecal osmotic gap and pH in experimental diarrhea of various causes.

Science.gov (United States)

Eherer, A J; Fordtran, J S

1992-08-01

Although the osmotic gap of fecal fluid is often used to distinguish osmotic diarrhea from secretory diarrhea, there has never been a scientific evaluation of the validity of this concept. Similarly, although a low fecal fluid pH value is used to indicate that diarrhea is mediated by carbohydrate malabsorption, the validity of this method is unproven. Therefore, in the present study, diarrhea was induced in normal subjects by different mechanisms and fecal fluid osmotic gap (using an assumed fecal fluid osmolality of 290 mOsm/kg) and pH were measured. In secretory diarrhea caused by phenolphthalein, the osmotic gap was always less than 50 mOsm/kg, whereas in osmotic diarrhea caused by polyethylene glycol, magnesium hydroxide, lactulose, and sorbitol, the osmotic gap always exceeded 50 mOsm/kg. In osmotic diarrhea caused by sodium sulfate, the fecal fluid osmotic gap was less than 50 mOsm/kg, but phenolphthalein-induced secretory diarrhea could be distinguished from sodium sulfate-induced osmotic diarrhea by the fecal chloride concentration. When diarrhea was caused by carbohydrate malabsorption (lactulose or sorbitol), the fecal fluid pH was always less than 5.6 and usually less than 5.3; by contrast, other causes of diarrhea rarely caused a fecal pH as low as 5.6 and never caused a pH less than 5.3. It is concluded that measurement of fecal fluid osmotic gap and pH can distinguish various mechanisms of experimental diarrhea in normal subjects. The concepts on which these tests are based are therefore verified experimentally.

Alterations in the colonic microbiota in response to osmotic diarrhea.

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Gorkiewicz, Gregor; Thallinger, Gerhard G; Trajanoski, Slave; Lackner, Stefan; Stocker, Gernot; Hinterleitner, Thomas; Gülly, Christian; Högenauer, Christoph

2013-01-01

Diseases of the human gastrointestinal (GI) tract are often accompanied by diarrhea with profound alterations in the GI microbiota termed dysbiosis. Whether dysbiosis is due to the disease itself or to the accompanying diarrhea remains elusive. With this study we characterized the net effects of osmotic diarrhea on the composition of the GI microbiota in the absence of disease. We induced osmotic diarrhea in four healthy adults by oral administration of polyethylene glycol 4000 (PEG). Stool as well as mucosa specimens were collected before, during and after diarrhea and 16S rDNA-based microbial community profiling was used to assess the microbial community structure. Stool and mucosal microbiotas were strikingly different, with Firmicutes dominating the mucosa and Bacteroidetes the stools. Osmotic diarrhea decreased phylotype richness and showed a strong tendency to equalize the otherwise individualized microbiotas on the mucosa. Moreover, diarrhea led to significant relative shifts in the phyla Bacteroidetes and Firmicutes and to a relative increase in the abundance of Proteobacteria on the mucosa, a phenomenon also noted in several inflammatory and diarrheal GI diseases. Changes in microbial community structure induced by osmotic diarrhea are profound and show similarities to changes observed in other GI diseases including IBD. These effects so must be considered when specimens from diarrheal diseases (i.e. obtained by stratification of samples according to diarrheal status) or conditions wherein bowel preparations like PEG (i.e. specimens obtained during endoscopy) are used.

Alterations in the colonic microbiota in response to osmotic diarrhea.

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Gregor Gorkiewicz

Full Text Available BACKGROUND & AIMS: Diseases of the human gastrointestinal (GI tract are often accompanied by diarrhea with profound alterations in the GI microbiota termed dysbiosis. Whether dysbiosis is due to the disease itself or to the accompanying diarrhea remains elusive. With this study we characterized the net effects of osmotic diarrhea on the composition of the GI microbiota in the absence of disease. METHODS: We induced osmotic diarrhea in four healthy adults by oral administration of polyethylene glycol 4000 (PEG. Stool as well as mucosa specimens were collected before, during and after diarrhea and 16S rDNA-based microbial community profiling was used to assess the microbial community structure. RESULTS: Stool and mucosal microbiotas were strikingly different, with Firmicutes dominating the mucosa and Bacteroidetes the stools. Osmotic diarrhea decreased phylotype richness and showed a strong tendency to equalize the otherwise individualized microbiotas on the mucosa. Moreover, diarrhea led to significant relative shifts in the phyla Bacteroidetes and Firmicutes and to a relative increase in the abundance of Proteobacteria on the mucosa, a phenomenon also noted in several inflammatory and diarrheal GI diseases. CONCLUSIONS: Changes in microbial community structure induced by osmotic diarrhea are profound and show similarities to changes observed in other GI diseases including IBD. These effects so must be considered when specimens from diarrheal diseases (i.e. obtained by stratification of samples according to diarrheal status or conditions wherein bowel preparations like PEG (i.e. specimens obtained during endoscopy are used.

Gastrointestinal Infections and Diarrhea

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... parasite, Cryptosporidium , is a common culprit behind diarrhea epidemics in childcare centers and other public places. Cryptosporidium ... take prescription antibiotics to prevent the infection from spreading throughout the body. What Can I Do to ...

Exploring spatial patterns and hotspots of diarrhea in Chiang Mai, Thailand

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Tripathi Nitin K

2009-06-01

Full Text Available Abstract Background Diarrhea is a major public health problem in Thailand. The Ministry of Public Health, Thailand, has been trying to monitor and control this disease for many years. The methodology and the results from this study could be useful for public health officers to develop a system to monitor and prevent diarrhea outbreaks. Methods The objective of this study was to analyse the epidemic outbreak patterns of diarrhea in Chiang Mai province, Northern Thailand, in terms of their geographical distributions and hotspot identification. The data of patients with diarrhea at village level and the 2001–2006 population censuses were collected to achieve the objective. Spatial analysis, using geographic information systems (GIS and other methods, was used to uncover the hidden phenomena from the data. In the data analysis section, spatial statistics such as quadrant analysis (QA, nearest neighbour analysis (NNA, and spatial autocorrelation analysis (SAA, were used to identify the spatial patterns of diarrhea in Chiang Mai province. In addition, local indicators of spatial association (LISA and kernel density (KD estimation were used to detect diarrhea hotspots using data at village level. Results The hotspot maps produced by the LISA and KD techniques showed spatial trend patterns of diarrhea diffusion. Villages in the middle and northern regions revealed higher incidences. Also, the spatial patterns of diarrhea during the years 2001 and 2006 were found to represent spatially clustered patterns, both at global and local scales. Conclusion Spatial analysis methods in GIS revealed the spatial patterns and hotspots of diarrhea in Chiang Mai province from the year 2001 to 2006. To implement specific and geographically appropriate public health risk-reduction programs, the use of such spatial analysis tools may become an integral component in the epidemiologic description, analysis, and risk assessment of diarrhea.

Diarrhea - what to ask your health care provider - adult

Science.gov (United States)

What to ask your health care provider about diarrhea - adult; Loose stools - what to ask your health ... medicines, vitamins, herbs, or supplements I take cause diarrhea? Should I stop taking any of them? What ...

Probiotics in antibiotic associated diarrhea in children

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Matjaž Homan

2013-10-01

Full Text Available The use of antibiotics that disturb the gastrointestinal microbiota is associated with diarrhea, which occurs in up to half of treated children. Symptoms are usually mild and children do not need hospitalization. Probiotics are live microorganisms, which restore intestinal microbiota during antibiotic therapy through different mechanisms such as stimulation of immunity, secretion of anti-inflammatory factors, and production of antimicrobial substances. The use of different strains of probiotics in antibiotic-associated diarrhea was evaluated in several studies in adults but less frequently in pediatric population. They also confirmed the value of probiotics in the prevention of antibiotic-associated diarrhea in children, particularly Lactobacillus strain GG and Saccharomyces boulardii. The use of probiotics in childhood is safe. A proper strain must be introduced at the beginning of antibiotic treatment in a sufficient concentration.

Syndromic diarrhea/Tricho-hepato-enteric syndrome

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Fabre Alexandre

2013-01-01

Full Text Available Abstract Syndromic diarrhea/Tricho-hepato-enteric syndrome (SD/THE is a rare and severe bowel disorder caused by mutation in SKIV2L or in TTC37, 2 genes encoding subunits of the putative human SKI complex. The estimated prevalence is 1/1,000,000 births and the transmission is autosomal recessive. The classical form is characterized by 5 clinical signs: intractable diarrhea of infancy beginning in the first month of life, usually leading to failure to thrive and requiring parenteral nutrition; facial dysmorphism characterised by prominent forehead and cheeks, broad nasal root and hypertelorism; hair abnormalities described as woolly and easily removable; immune disorders resulting from defective antibody production; intrauterine growth restriction. The aetiology is a defect in TTC37, a TPR containing protein, or in the RNA helicase SKIV2L, both constituting the putative human ski complex. The ski complex is a heterotetrameric cofactor of the cytoplasmic RNA exosome which ensures aberrants mRNAs decay. The diagnosis SD/THE is initially based on clinical findings and confirmed by direct sequencing of TTC37 and SKIV2L. Differential diagnosis with the other causes of intractable diarrhea is easily performed by pathologic investigations. During their clinical course, most of the children require parenteral nutrition and often immunoglobulin supplementation. With time, some of them can be weaned off parenteral nutrition and immunoglobulin supplementation. The prognosis depends on the management and is largely related to the occurrence of parenteral nutrition complications or infections. Even with optimal management, most of the children seem to experience failure to thrive and final short stature. Mild mental retardation is observed in half of the cases. Abstract in French Les diarrhées syndromiques ou syndrome tricho-hepato-enterique (SD/THE sont un syndrome rare et sévère dont l’incidence est estimée à 1 cas pour 1 million de naissances et la

Zinc supplementation for treating diarrhea in children: a systematic review and meta-analysis Administración de suplementos de zinc para tratar la diarrea infantil: revisión sistemática y metanálisis

OpenAIRE

Tais Freire Galvao; Maria Fernanda Reis e Silva Thees; Rossana Ferreira Pontes; Marcus Tolentino Silva; Mauricio Gomes Pereira

2013-01-01

OBJECTIVE: To update the available evidence about zinc use for treating diarrhea in children and to assess its effect on the malnourished population, a subgroup that has not been fully explored in previous analyses. METHODS: A systematic review was performed of randomized clinical trials that assessed children up to 5 years old with acute diarrhea who received zinc supplementation. Controls received a placebo or oral rehydration therapy. After searching the main databases, without language re...

Chronic unexplained diarrhea: what to do when the initial workup is negative?

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Talley, Nicholas J

2008-01-01

Diagnosing the patient with chronic diarrhea can still be a major challenge despite modern testing. It is useful initially to consider what may be the likely underlying pathophysiologic explanation for diarrhea from the history (osmotic, secretory, inflammatory, or motility related) and let this information drive the management algorithm. However, gastroenterologists frequently ask how far the workup should go and when a confident diagnosis of functional diarrhea can be made. In contrast to diarrhea-predominant irritable bowel syndrome, the evidence that functional diarrhea exists as a real diagnostic entity is actually remarkably unconvincing.

[Safety Evaluation of Rare Sugar Syrup: Single-dose Oral Toxicity in Rats, Reverse Mutation Assay, Chromosome Aberration Assay, and Acute Non-Effect Level for Diarrhea of a Single Dose in Humans].

Science.gov (United States)

Yamada, Takako; Iida, Tetsuo; Takamine, Satoshi; Hayashi, Noriko; Okuma, Kazuhiro

2015-01-01

The safety of rare sugar syrup obtained from high-fructose corn syrup under slightly alkaline conditions was studied. Mutagenicity of rare sugar syrup was assessed by a reverse mutation assay using Salmonella typhimurium and Escherichia coli, and an in vitro chromosomal aberration assay using Chinese hamster lung cell line (CHL/IU). No mutagenicity of rare sugar syrup was detected under these experimental conditions. Oral administration of single dose (15,000 mg/kg) of rare sugar syrup to rats caused no abnormalities, suggesting no adverse effect of rare sugar syrup. In humans, the acute non-effect level of rare sugar syrup for causing diarrhea was estimated as 0.9 g/kg body weight as dry solid base in both males and females.

The Anti-Diarrhea Properties Of Zingibier Offcinale | Nwoko ...

African Journals Online (AJOL)

Introduction: The crude extract of the plant Zingiber officinale has a high folkloric reputation for anti-diarrhea activity. This study investigated the scientific basis of this folkloric claim. Materials and Methods: Diarrhea was induced in albino mice and albino wistar rats using Castor-oil. The animals (mice) were offered the ...

Rotavirus genotypes associated with acute diarrhea in Egyptian infants.

Science.gov (United States)

Ahmed, Salwa F; Mansour, Adel M; Klena, John D; Husain, Tupur S; Hassan, Khaled A; Mohamed, Farag; Steele, Duncan

2014-01-01

Before the introduction of rotavirus vaccine in Egypt, information on the burden of disease and the circulating rotavirus genotypes is critical to monitor vaccine effectiveness. A cohort of 348 Egyptian children was followed from birth to 2 years of age with twice-weekly home visits to detect diarrheal illness. VP7 and VP4 genes were genotyped by reverse-transcription polymerase chain reaction and DNA sequencing. Forty percentage of children had rotavirus-associated diarrhea at least once by their second birthday. One hundred and twelve children experienced a single rotavirus diarrheal episodes (RDE) at a median age of 9 months; while 27 infants had their second RDE at a median age of 15 months and 1 infant had 3 RDE at the age of 2, 16 and 22 months. Of the 169 RDE, 82% could be assigned a G-type, while 58% had been identified a P-type. The most prevalent genotype was G2 (32%), followed by G1 (24%) and G9 (19%). G2P[4] rotavirus episodes were significantly associated with fever (P = 0.03) and vomiting (P = 0.06) when compared with other genotypes. G2 strains were the predominant genotype causing 50% of the second RDE while G9 represented 25% of the second RDE. Genotypes identified are similar to those detected globally except for absence of G4. Our finding that 75% of the second RDE were due to G2 and G9 indicates a possible reduction in natural protection afforded by these types compared with G1, where 90% of G1 cases did not experience a second xposure, indicating greater protection against recurrent symptomatic infection.

Ischemic Colitis of the Left Colon in a Diabetic Patient

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Anastasios J. Karayiannakis

2011-04-01

Full Text Available Diabetes mellitus may affect the gastrointestinal tract possibly as a result of autonomic neuropathy. Here we present a 68-year-old male with non-insulin-dependent diabetes mellitus who presented with prolonged watery diarrhea and in whom imaging studies demonstrated ischemic colitis of the left colon. Resection of the affected colon resulted in sustained disappearance of symptoms.

THERAPY OF DIARRHEA AND DEHYDRATION IN CHILDREN

OpenAIRE

E.G. Tsymbalova; R.F. Tepaev

2011-01-01

Dehydration is one of the leading causes of mortality in children. The most frequent cause of dehydration in children is diarrhea syndrome. Timely differential diagnostics of etiological causes, assessment of severity, dehydration type are critical conditions of successful therapy of diarrhea syndrome. The article provides modern recommendations on diagnostics and treatment of dehydration depending on the type and severity, on correction of electrolyte abnormalities. The authors also highligh...

Ecotoxicology evaluation of watery extracts of plants on seeds of radish, lettuce and tomato

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Edisleidy Águila Jiménez

2016-02-01

Full Text Available The effect of watery extracts of Nicotiana acuminata, Piper aduncum L. and Crotalaria juncea was evaluated on the germination and the elongación of the roots of seeds of Raphanus sativus (radish, Lactuca sativa L (lettuce and Lycopersicon esculentum (tomato. The extracts were produced at medium scale in the laboratory of formulation of the Faculty of Química- Pharmacy of the “Universidad Central Marta Abreu de las Villas” . It was demonstrated upon concluding the work that the lettuce was the most sensitive species for this type of study. It was concluded that the extracts could be poured to the means to minor concentrations that 0.01% with a margin of security that they are not going to affect the processes of germination and elongacion of the roots. It was determined that one could use the alone rehearsal using the seeds of lettuce like species of rehearsal.

Survey of caregivers in Kenya to assess perceptions of zinc as a treatment for diarrhea in young children and adherence to recommended treatment behaviors

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Evan Simpson

2013-06-01

Full Text Available In 2004, the United Nations Children’s Fund (UNICEF and the World Health Organization (WHO revised their recommendations for management of acute diarrhea in children to include zinc treatment as well as oral rehydration solution (ORS. Little is known about how caregivers in low–resource settings perceive and use zinc treatment.

Socio-demographic, Epidemiological and Environmental Determinants of Acute Gastroenteritis in Western India

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Mihir Prafulbhai Rupani

2016-03-01

Conclusions: Socio-demographic factors (higher socio-economic status, epidemiological correlates (change in taste of water, another family member been affected with acute gastroenteritis and eating outside food and environmental determinants (waste disposal in a common dump and waste accumulation around house significantly determines the occurrence of cases of acute gastroenteritis. Keywords: case-control studies;diarrhea; epidemiologic determinants; gastroenteritis; social determinants of health. | PubMed

Diarrhea following whole pelvis irradiation in female pelvic cancer

International Nuclear Information System (INIS)

Sakurai, Tomoyasu; Moriya, Hiroshi; Hareyama, Masato; Nishio, Masamichi

1975-01-01

Investigations were made on the following points which were possible factors in the appearance of diarrhea during irradiation of the whole pelvis for uterine cancer: (a) daily dose of 200 and 180 rads, (b) age, (c) radical operation for uterine cancer, (d) previous history of abdominal operation, (e) disease stage of II or III, and (f) grade of infiltration of the rectum with cancer cells. Results thereby obtained are summarized as follows: 1) A significant difference between the dose of 200 and 180 rads in causing diarrhea was found only in patients receiving radiation therapy alone, without a previous history of abdominal operation. 2) Patients who underwent a radical operation for uterine cancer showed a significantly higher incidence of diarrhea than those without such an operation. 3) The age of patients, previous history of abdominal operation, and grade of infiltration of cancer cells into the rectum had almost no effect on the incidence of diarrhea. 4) There was no significant difference in the frequency of diarrhea between stage II and III, although the higher incidence recorded for the latter group was between a 10 and 20% level of significance. (auth.)

Surveillance of Rotavirus Diarrhea in Hasan Sadikin Hospital Bandung

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Dwi Prasetyo

2010-12-01

Full Text Available The diarrhea morbidity in Indonesia has increased, however, all the reports had not been done carefully, so that accurate surveillance are essential for improving quality of morbidity data. To determine the prevalence and clinical manifestations of rotavirus diarrhea and to characterize the circulating rotavirus strains, children below 5 years old who were admitted to Hasan Sadikin Hospital, Bandung because of diarrhea, from January 2006 through March 2007 were enrolled in a surveillance study and had stool specimens tested for the presence of rotavirus using enzyme immunoassay (EIA. The strains of rotavirus were determined using reverse transcriptase-polymerase chain reaction (RT-PCR. Rotavirus were detected in 47.8% analyzed samples (87/184, G and P-genotype of rotavirus were G[1] (37.5% and P[6] (53.5%. Most subjects were males (56%, 6–11 months of age (35%. Most common clinical manifestations besides diarrhea were dehydration (72.7% and vomiting (50%. Subjects with positive rotavirus more common had dehydration (72% vs 28% and vomiting (61% vs 39%. In conclusion, vomiting and dehydration are the prominent clinical manifestations of diarrhea with positive rotavirus infection. G1 and P6 are the most common genotype of rotavirus.

Location of food consumption and travelers' diarrhea.

Science.gov (United States)

Tjoa, W S; DuPont, H L; Sullivan, P; Pickering, L K; Holguin, A H; Olarte, J; Evans, D G; Evans, D J

1977-07-01

Daily food histories for one month were obtained in summer, 1975, from students attending a Mexican university to determine the influence of food consumption on the development and etiology of diarrhea. In newly-arrived students from the U.S. who ate half or more of their meals in the school cafeteria and public restaurants there were significant increases in diarrhea (p less than 0.005); shigella infection (p less than 0.05) and toxigenic E. coli infection (p less than 0.025) compared to the students eating a comparable number of meals in private homes. In the summer U.S. students there was also an association of diarrhea and eating from street vendors (p less than 0.05). In full-time U.S. students who had lived in Mexico a year or longer as well as in Latin American students a relationship between location of meals and occurrence of enteric disease was not apparent. High numbers of enteric bacteria were recovered from food from the school's cafeteria, public restaurants, street vendors and small grocery stores. Shigella were isolated from cooked and uncooked hamburger patties from the school cafeteria. Four shigella carriers were found among kitchen personnel at the school. This study demonstrates that food serves as a major vehicle through which travelers' diarrhea occurs.

Mobile phone-based syndromic surveillance system, Papua New Guinea.

Science.gov (United States)

Rosewell, Alexander; Ropa, Berry; Randall, Heather; Dagina, Rosheila; Hurim, Samuel; Bieb, Sibauk; Datta, Siddhartha; Ramamurthy, Sundar; Mola, Glen; Zwi, Anthony B; Ray, Pradeep; MacIntyre, C Raina

2013-11-01

The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone-based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance.

Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program.

Science.gov (United States)

El-Khoury, Marianne; Banke, Kathryn; Sloane, Phoebe

2016-06-20

Diarrhea is the fourth leading cause of child mortality in Ghana. In 2010, Ghana endorsed guidelines from the World Health Organization and the United Nations Children's Fund for use of zinc with low-osmolarity oral rehydration salts (ORS) for the treatment of acute childhood diarrhea. From late 2011 through 2014, the Strengthening Health Outcomes through the Private Sector (SHOPS) project implemented a comprehensive program in 3 regions of Ghana to increase the availability and use of ORS and zinc and to decrease incorrect use of antibiotics and antidiarrheals. The program included (1) partnering with local pharmaceutical firms to introduce and market locally produced zinc products, (2) collaborating with the Ghanaian Pharmacy Council to provide training and supportive supervision of private-sector providers on diarrhea management, and (3) conducting mass media campaigns to raise caregiver awareness. We evaluated the effect of this program using a baseline survey of 754 caregivers of children under 5 with diarrhea at the start of the intervention in 2012 and a follow-up survey of 751 caregivers in 2014. Regression analysis showed that use of ORS with zinc increased from 0.8% in 2012 to 29.2% in 2014 (P<.001), and antibiotic use declined from 66.2% to 38.2% (P<.001) during the same period. The magnitude and statistical significance of these results remained the same after including potential confounding factors as covariates. Inappropriate antibiotic use, however, remained high at follow-up. We conclude that similar programs applied in other settings have the potential to rapidly scale up use of ORS and zinc. Additional efforts are required to reduce persistent incorrect antibiotic use. © El-Khoury et al.

Diarréia por parasitas Parasites induced diarrheas

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Maria Eugênia Farias Almeida Motta

2002-08-01

Full Text Available A diarréia é uma causa importante de morbimortalidade nos países em desenvolvimento. Os agentes etiológicos mais comuns são os vírus e as bactérias. Este artigo tem o objetivo de analisar a ocorrência de diarréia como manifestação clínica de parasitose. Discute-se quais os protozoários e os helmintos que podem causar diarréia, as bases científicas atuais que explicam os mecanismos fisiopatológicos que desencadeiam a diarréia, bem como os exames complementares e o tratamento adequado para cada parasita implicado.Diarrhea is an important cause of morbidity and mortality in developing countries. The most common etiological agents are viruses and bacteria. This article has the objective of analyzing diarrhea as a clinical symptom of parasitosis. Protozoa and helminthes that may cause diarrhea are discussed, current scientific basis clarifying the pathological and physiological mechanisms causing diarrhea as well as supplementary tests and adequate treatment for each parasite involved are focused.

The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families.

Science.gov (United States)

Burke, Rachel M; Rebolledo, Paulina A; Embrey, Sally R; Wagner, Laura Danielle; Cowden, Carter L; Kelly, Fiona M; Smith, Emily R; Iñiguez, Volga; Leon, Juan S

2013-08-02

Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs. From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages). Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (pcosts to families were significantly higher for inpatients as compared to outpatients of urban (pcosts made up a large proportion of total costs. Forty-five percent of patients' families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden. This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers.

Chronic diarrhea. Diagnosis and clinical evaluation

International Nuclear Information System (INIS)

Pineda O, Luis F; Otero R, William; Arbelaez M, Victor

2004-01-01

Chronic diarrhea is a syndrome of great clinical complexity, which is frequently encountered by general physicians, internists and gastroenterologists. Differential diagnosis is very broad and sometime finding the precise cause can be difficult, expensive and frustration. Literature published about this topic lack, in general, adequate controlled studies and for this reason recommendations for diagnostic evaluation and treatment are based upon series of cases, experience of the institutions or expert opinion and not on reasonable evidence. On the other hand, many of the classical diagnostic tests that have survived until now were designed over physiologic foundations and have not been validated extensively with the precision of a clinical test. This limits its acceptance, application and standardization in the daily practice. There is not a general agreement about diagnosis and treatment of chronic diarrhea and many of the experts divert recommendation about their recommendations. The purpose of this paper is to define some general guidelines about the clinical evaluation of patients with chronic diarrhea that lead us to a rational approach based upon clinical trials and the appropriate use of the many different tests

Acute gastroenteritis: evidence-based management of pediatric patients [digest].

Science.gov (United States)

Brady, KeriAnne; Pade, Kathryn H

2018-02-01

Although most cases of acute gastroenteritis require minimal medical intervention, severe dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea. The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution. Antiemetics allow for improved tolerance of oral rehydration solution, and, when used appropriately, can decrease the need for intravenous fluids and hospitalization. This issue reviews the common etiologies of acute gastroenteritis, discusses more-severe conditions that should be considered in the differential diagnosis, and provides evidence-based recommendations for management of acute gastroenteritis in patients with mild-to-moderate dehydration, severe dehydration, and hypoglycemia. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Diarrhea associated with myenteric ganglionitis in a dog

International Nuclear Information System (INIS)

Willard, M.D.; Mullaney, T.; Karasek, S.; Yamini, B.

1988-01-01

Diarrhea in a Border Terrier was associated with inflammatory lesions of the myenteric plexus. This lesion has been documented rarely in dogs. It is speculated that the myenteric plexus lesions were responsible for an autonomic nervous system dysfunction, which resulted in extreme intestinal hypermotility and subsequent diarrhea. Suggested tests for dogs suspected to have autonomic dysfunction are given

Diarrhea and parasitosis in Salta, Argentina.

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Aramayo, Cristian F; Gil, José F; Cruz, Mercedes C; Poma, Hugo R; Last, Michael S; Rajal, Verónica B

2009-03-01

Salta city is the capital of the province with the same name located in the northwest of Argentina. Its great growth over the last decade was not organized and the population expanded to occupy places where water and sanitation were not yet available. Although the Arenales River, crossing the city, receives the impact of point and non-point source pollution, the water is used for many purposes, including domestic in the poorest areas, industrial, and recreational with children as the main users. According to the World Health Organization, an estimated 24% of the global disease burden and 23% of all deaths can be attributed to environmental factors. In particular, an estimated 94% of the diarrheal burden of disease is attributable to environment, and is associated with risk factors such as unsafe drinking water and poor sanitation and hygiene. Chronic diarrhea can be caused by an infection or other etiologies; however, most of the times the etiological agent is not identified. All the cases of diarrhea and parasitosis reported during 2005 in four public health centers of the city of Salta were classified by gender and age, analyzed, and represented geographically to show areas of higher morbidity rates, which were probably related to environmental factors. Water, poor sanitation, and pollution are candidate risk factors. Diarrhea cases showed seasonality, with the highest incidence during late spring and summer, while parasitosis was persistent throughout the year. Our spatial analysis permitted us to detect the regions of higher incidence of diarrhea and parasitosis during 2005 in the area of study.

Association of Atypical Enteropathogenic Escherichia coli with Diarrhea and Related Mortality in Kittens.

Science.gov (United States)

Watson, Victoria E; Jacob, Megan E; Flowers, James R; Strong, Sandra J; DebRoy, Chitrita; Gookin, Jody L

2017-09-01

Diarrhea is responsible for the death of approximately 900,000 children per year worldwide. In children, typical enteropathogenic Escherichia coli (EPEC) is a common cause of diarrhea and is associated with a higher hazard of death. Typical EPEC infection is rare in animals and poorly reproduced in experimental animal models. In contrast, atypical EPEC (aEPEC) infection is common in both children and animals, but its role in diarrhea is uncertain. Mortality in kittens is often attributed to diarrhea, and we previously identified enteroadherent EPEC in the intestines of deceased kittens. The purpose of this study was to determine the prevalence and type of EPEC in kittens and whether infection was associated with diarrhea, diarrhea-related mortality, gastrointestinal pathology, or other risk factors. Kittens with and without diarrhea were obtained from two shelter facilities and determined to shed atypical EPEC at a culture-based prevalence of 18%. In contrast, quantitative PCR detected the presence of the gene for intimin ( eae ) in feces from 42% of kittens. aEPEC was isolated from kittens with and without diarrhea. However, kittens with diarrhea harbored significantly larger quantities of aEPEC than kittens without diarrhea. Kittens with aEPEC had a significantly greater severity of small intestinal and colonic lesions and were significantly more likely to have required subcutaneous fluid administration. These findings identify aEPEC to be prevalent in kittens and a significant primary or contributing cause of intestinal inflammation, diarrhea, dehydration, and associated mortality in kittens. Copyright © 2017 American Society for Microbiology.

Incidence of Norovirus-Associated Diarrhea and Vomiting Disease Among Children and Adults in a Community Cohort in the Peruvian Amazon Basin.

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Romero, Candice; Tinoco, Yeny O; Loli, Sebastian; Razuri, Hugo; Soto, Giselle; Silva, María; Galvan, Patricia; Kambhampati, Anita; Parashar, Umesh D; Kasper, Matthew R; Bausch, Daniel G; Simons, Mark P; Lopman, Benjamin

2017-09-01

Data on norovirus epidemiology among all ages in community settings are scarce, especially from tropical settings. We implemented active surveillance in 297 households in Peru from October 2012 to August 2015 to assess the burden of diarrhea and acute gastroenteritis (AGE) due to norovirus in a lower-middle-income community. During period 1 (October 2012-May 2013), we used a "traditional" diarrhea case definition (≥3 loose/liquid stools within 24 hours). During period 2 (June 2013-August 2015), we used an expanded case definition of AGE (by adding ≥2 vomiting episodes without diarrhea or 1-2 vomiting episodes plus 1-2 loose/liquid stools within 24 hours). Stool samples were tested for norovirus by reverse-transcription polymerase chain reaction. During period 1, overall diarrhea and norovirus-associated diarrhea incidence was 37.2/100 person-years (PY) (95% confidence interval [CI], 33.2-41.7) and 5.7/100 PY (95% CI, 3.9-8.1), respectively. During period 2, overall AGE and norovirus-associated AGE incidence was 51.8/100 PY (95% CI, 48.8-54.9) and 6.5/100 PY (95% CI, 5.4-7.8), respectively. In both periods, children aged accounting for 35% (7/20) of all cases in this age group. Noroviruses were identified in 7% (23/335) of controls free of gastroenteric symptoms. Norovirus was a significant cause of AGE in this community, especially among children definition resulted in a 20% improvement for detection of norovirus cases. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Home Management Of Diarrhea Among Underfives In A Rural ...

African Journals Online (AJOL)

Main outcome measures: Perceived causes of childhood diarrhoea, action taken during diarrhea, fluid intake, recognition of signs of dehydration, feeding during convalescence, adherence to treatment and advice. Results: Majority of the respondents 807(87.1%) reported that their children had suffered from diarrhea within ...

THE CLINICAL EFFICACY OF HYPOOSMOLYARNY ORAL SOLUTION WITH LACTOBACILLUS GG FOR REHYDRATION IN INTESTINAL INFECTIONS IN CHILDREN

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V. F. Uchaikin

2015-01-01

Full Text Available In 60 patients with moderate forms of the OCI «osmotic» (76.7% and «invasive» (23.3% such as diarrhea, aged 3—12 years, to evaluate the clinical effectiveness, impact on water and electrolyte metabolism, acid-base balance and intestinal microbiocenosis hypoosmolyarny solution with Lactobacillus rhamnosus GG «Regidron Bio» (30 patients and hyperosmolarny solution (30 patients. It was found that in the group of patients receiving «Regidron Bio», in contrast to the hyperosmolarny solution, is rapidly disappearing symptoms of intoxication and exsicosis, abdominal pain, meteorism and liquid watery diarrhea. The average duration of the acute period is reduced from 4,06 ± 0,32 to 3,07 ± 0,27 day (P < 0,05. Already by the end of the 1st day of the beginning of rehydration, almost all patients (90% are normalized malformations of blood electrolytes and glucose, hematocrit, and on the 2nd day, which took place in 80% of patients with metabolic acidosis. The addition of the «Bio rehydron» Lactobacillus rhamnosus GG facilitates, unlike hyperosmolarny solution indicator normalizing lg Lactobacilli (in 73.3% and Enterococci (93.3%, but has no significant positive impact on the amount of Bifidobacteria and Escherichia coli.

Malaria parasitemia and childhood diarrhea in a peri-urban area of Guinea-Bissau

DEFF Research Database (Denmark)

Sodemann, Morten; Jakobsen, M S; Mølbak, Kare

1999-01-01

To examine the association between diarrhea in early childhood and malaria parasitemia, we conducted a nested case-control study in Guinea-Bissau of 297 children with diarrhea and a similar number of children without diarrhea matched for age, season, and residential area. There were no associations...... between diarrhea and parasite rate, parasite density, or clinical malaria. However, anti-malarials were easily available and frequently used, which was reflected by a 0.7% prevalence of children with a parasite density > 100/200 leukocytes. Thus, the findings do not preclude that diarrhea may be a sign...

The Prevalence of Norovirus in returning international travelers with diarrhea

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Löscher Thomas

2010-05-01

Full Text Available Abstract Background There is a high incidence of diarrhea in traveling populations. Norovirus (NV infection is a common cause of diarrhea and is associated with 7% of all diarrhea related deaths in the US. However, data on the overall prevalence of NV infection in traveling populations is limited. Furthermore, the prevalence of NV amongst travelers returning to Europe has not been reported. This study determined the prevalence of NV among international travelers returning to Germany from over 50 destinations in and outside Europe. Methods Stool samples of a total of 104 patients with a recent ( Results In our cohort, NV infection was detected in 15.7% of returning travelers with diarrhea. The closer to the date of return symptoms appeared, the higher the incidence of NV, ranging as high as 21.2% within the first four days after return. Conclusions In our cohort, NV infection was shown to be frequent among returning travelers especially in those with diarrhea, with over 1/5 of diarrhea patients tested positive for NV within the first four days after their return to Germany. Due to this prevalence, routine testing for NV infection and hygienic precautions may be warranted in this group. This is especially applicable to patients at an increased risk of spreading the disease, such as healthcare workers, teachers or food-handlers.

Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size

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Black Robert E

2011-04-01

Full Text Available Abstract Background Diarrhea mortality remains a leading cause of child death and rotavirus vaccine an effective tool for preventing severe rotavirus diarrhea. New data suggest vaccine efficacy may vary by region. Methods We reviewed published vaccine efficacy trials to estimate a regional-specific effect of vaccine efficacy on severe rotavirus diarrhea and hospitalizations. We assessed the quality of evidence using a standard protocol and conducted meta-analyses where more than 1 data point was available. Results Rotavirus vaccine prevented severe rotavirus episodes in all regions; 81% of episodes in Latin America, 42.7% of episodes in high-mortality Asia, 50% of episodes in sub-Saharan Africa, 88% of episodes low-mortality Asia and North Africa, and 91% of episodes in developed countries. The effect sizes observed for preventing severe rotavirus diarrhea will be used in LiST as the effect size for rotavirus vaccine on rotavirus-specific diarrhea mortality. Conclusions Vaccine trials have not measured the effect of vaccine on diarrhea mortality. The overall quality of the evidence and consistency observed across studies suggests that estimating mortality based on a severe morbidity reduction is highly plausible.

Diagnosis and Management of AIDS-related Diarrhea

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John F Johanson

1996-01-01

Full Text Available The spectrum of illness associated with the acquired immunodeficiency syndrome (AIDS has been increasing since the initial description in 1981. While virtually all organ systems may be affected, the gastrointestinal tract appears to be a major target. Diarrhea is the most common symptom, affecting up to half of all AIDS patients during the course of their disease. Although diarrhea occurs frequently, its optimal management remains controversial. An extensive evaluation including stool studies and endoscopic biopsies of both the colon and small intestine has been widely recommended to identify all potential pathogenic organisms. An alternative approach is a more limited evaluation consisting of stool and blood cultures followed by symptomatic treatment with antidiarrheal agents if no specific organisms are identified. The clinical presentation of the most common opportunistic pathogens are reviewed, including several recently discovered organisms. Recommendations for treatment are followed by a brief discussion of management strategies used to care for patients with AIDS-related diarrhea.

Role of FODMAP content in enteral nutrition-associated diarrhea.

Science.gov (United States)

Halmos, Emma P

2013-12-01

Gastrointestinal symptoms including diarrhea are common complications of enteral nutrition (EN); however, the cause is unclear. Mode of EN delivery that alters digestion and possibly absorption is suggested to contribute to the high incidence of diarrhea; however, enteral formula is frequently blamed. Most research has focused on fiber-supplemented EN, with a meta-analysis showing that fiber reduces the incidence of diarrhea in non-intensive care unit studies. Other hypotheses include formula osmolality and FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) content. FODMAPs are poorly absorbed short-chain carbohydrates that exert an osmotic effect. Dietary FODMAPs have been shown to reduce gastrointestinal symptoms, including diarrhea, in those with irritable bowel syndrome and, given a high-enough dose, will induce a laxative effect in most people. As FODMAPs are commonly added to enteral formula and EN is frequently used as the main source of nutrition, it is reasonable to hypothesize that EN provides more FODMAPs than usual dietary intake and increases risk for developing diarrhea. This hypothesis was assessed through a retrospective study showing that the standard-use enteral formula Isosource 1.5 had a protective effect of developing diarrhea. The only characteristic unique to Isosource 1.5 was the lower FODMAP content as determined through methodologies previously validated for food analysis. Methodologies for application to enteral formulas are currently undergoing formal validation. Once confirmed for application in enteral formula, future directions include FODMAP analysis of specific ingredients to increase understanding of potential problems associated with enteral formula and a randomized, controlled trial investigating the role of formula FODMAP content. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Midupper Arm Circumference Outperforms Weight-Based Measures of Nutritional Status in Children with Diarrhea.

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Modi, Payal; Nasrin, Sabiha; Hawes, Meagan; Glavis-Bloom, Justin; Alam, Nur H; Hossain, M Iqbal; Levine, Adam C

2015-07-01

Undernutrition contributes to 45% of all deaths in children children with diarrhea and possible dehydration. This study assessed the validity of different measures of undernutrition in children with diarrhea. A prospective cohort study was conducted at an urban hospital in Bangladesh. Children children for screening, of which 1025 were eligible, 850 were enrolled, and 721 had complete data for analysis. Anthropometric measurements, including weight-for-age z score (WAZ), weight-for-length z score (WLZ), midupper arm circumference (MUAC), and midupper arm circumference z score (MUACZ), were calculated pre- and posthydration in all patients. Measurements were evaluated for their ability to correctly identify undernutrition in children with varying degrees of dehydration. Of the 721 patients with full data for analysis, the median percent dehydration was 4%. Of the 4 measures evaluated, MUAC and MUACZ demonstrated 92-94% agreement pre- and posthydration compared with 69-76% for WAZ and WLZ. Although each 1% change in hydration status was found to change weight-for-age by 0.0895 z scores and weight-for-length by 0.1304 z scores, MUAC and MUACZ were not significantly affected by dehydration status. Weight-based measures misclassified 12% of children with severe underweight and 14% with severe acute malnutrition (SAM) compared with only 1-2% for MUAC and MUACZ. MUAC and MUACZ were the most accurate predictors of undernutrition in children with diarrhea. WAZ and WLZ were significantly affected by dehydration status, leading to the misdiagnosis of many patients on arrival with severe underweight and SAM. This trial was registered at clinicaltrials.gov as NCT02007733. © 2015 American Society for Nutrition.

ACUTE INTESTINAL INFECTIONS: THERAPEUTICAL TACTICS IN CHILDREN

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A.N. Surkov

2011-01-01

Full Text Available Acute intestinal infections are quite common among children. Their clinical presentations include intoxication syndrome (drowsiness, low appetite, fever etc, infectious toxic syndrome (toxicosis with exicosis, neurotoxicosi, hypovolemic or infectious-toxic shockand diarrhea syndrome. Sometimes intestinal infections can be quite severe and even lethal. However disease duration and outcome depend on timelines and adequacy of prescribed treatment. Main guidelines of intestinal infections treatment include probiotics. That is why the right choice of probiotics is important for a pediatrician. The article contains basic information upon etiopathogenesis, classification, diagnostic criteria and acute pediatric intestinal infections treatment guidelines.Key words: acute intestinal infections, etiopathogenesis, diagnostic criteria, treatment, probiotics, children. (Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6: 141–147

Observational Study of Travelers' Diarrhea.

Science.gov (United States)

Meuris

1995-03-01

Background: European air travelers returning from Algeria, Egypt, Mexico, Morocco, and Tunisia were interviewed about their experience of travelers' diseases upon arrival in Brussels. Diarrhea was mentioned by 37% of the adults and 27% of the children. These subjects were questioned about the types of measures taken, type and duration of drug treatment (if any), and about duration of diarrhea and side effects experienced. Methods: Final analysis was performed based on 2160 interviews. The largest proportion of diarrhea was reported in the age group 15-24 years (46%). Results: The majority of the 2160 subjects had opted for drug treatment (81%): 927 subjects for loperamide alone, 235 for loperamide in combination with nifuroxazide, and 178 for nifuroxazide alone. Other drugs had been used less frequently. The median time to recovery was 2.4 days with loperamide compared to 3.2 days with nifuroxazide and to 3.4 days for the no-treatment group. Conclusions: A stratification of the results by severity of the diarrhea suggests a rank of antidiarrheal potency as follows: loperamide > nifuroxazide > no-drug treatment. The side effect with the highest incidence was constipation (2.4% with loperamide). (J Travel Med 2:11-15, 1995) Travelers' diarrhea is usually defined as the passage of at least three unformed stools per day or any number of such stools when accompanied by fever, abdominal cramping, or vomiting. The definition may be broadened to include more trivial bowel disturbance.1,2 The duration of this self-limited disease generally is 3 to 5 days. Medical intervention aims at shortening the duration of disease, thus allowing the sufferer to resume his or her usual activities at an early stage. A shortened period of recovery to physical well-being has obvious favorable economic implications if the traveler is on business and may help the maintenance of a desired level of quality of life while a traveler is on holiday. An observational study of various medical

Systems Approach to Climate, Water, and Diarrhea in Hubli-Dharwad, India.

Science.gov (United States)

Mellor, Jonathan; Kumpel, Emily; Ercumen, Ayse; Zimmerman, Julie

2016-12-06

Anthropogenic climate change will likely increase diarrhea rates for communities with inadequate water, sanitation, or hygiene facilities including those with intermittent water supplies. Current approaches to study these impacts typically focus on the effect of temperature on all-cause diarrhea while excluding precipitation and diarrhea etiology while not providing actionable adaptation strategies. We develop a partially mechanistic, systems approach to estimate future diarrhea prevalence and design adaptation strategies. The model incorporates downscaled global climate models, water quality data, quantitative microbial risk assessment, and pathogen prevalence in an agent-based modeling framework incorporating precipitation and diarrhea etiology. It is informed using water quality and diarrhea data from Hubli-Dharwad, India-a city with an intermittent piped water supply exhibiting seasonal water quality variability vulnerable to climate change. We predict all-cause diarrhea prevalence to increase by 4.9% (Range: 1.5-9.0%) by 2011-2030, 11.9% (Range: 7.1-18.2%) by 2046-2065, and 18.2% (Range: 9.1-26.2%) by 2080-2099. Rainfall is an important modifying factor. Rotavirus prevalence is estimated to decline by 10.5% with Cryptosporidium and E. coli prevalence increasing by 9.9% and 6.3%, respectively, by 2080-2099 in this setting. These results suggest that ceramic water filters would be recommended as a climate adaptation strategy over chlorination. This work highlights the vulnerability of intermittent water supplies to climate change and the urgent need for improvements.

Pneumatosis Intestinalis in a Patient with Acute Promyelocytic Leukemia

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Abhishek Mangaonkar

2015-01-01

Full Text Available Pneumatosis Intestinalis is a rare condition characterized by the presence of gas within the intestinal wall. We describe a case of a 33-year-old woman with acute promyelocytic leukemia who developed nausea and nonbloody diarrhea. CT showed intramural air in transverse and descending colon. Patient clinically improved with conservative management.

Detection of rotavirus and other enteropathogens in children hospitalized with acute gastroenteritis in Havana, Cuba.

Science.gov (United States)

Ribas, María de Los Angeles; Tejero, Yahisel; Cordero, Yanislet; de Los Angeles León, María; Rodriguez, Misladys; Perez-Lastre, Jorge; Triana, Thelma; Guerra, Mabel; Ayllón, Lucía; Escalante, Gladys; Hadad, Jorge

2015-08-01

The aim of the study was to diagnose infections with rotavirus and other enteric pathogens in children under five years old with acute gastroenteritis and to identify the most common epidemiological and clinical characteristics of these pathogens. The study was conducted using 110 stool samples from the same number of children under five years old who were inpatients at three paediatric hospitals in Havana, Cuba, between October and December 2011. The samples were tested for rotavirus and other enteric pathogens using traditional and molecular microbiological methods. Pathogens were detected in 85 (77.3 %) of the children. Rotavirus was the most commonly found, appearing in 54.5 % of the children, followed by bacteria (29 %) and parasites (10.9 %). Other viral pathogens detected included adenovirus (6.4 %) and astrovirus (3.6 %). In rotavirus-positives cases, at least one other pathogen was detected, usually a bacterium (26.6 %). More than three episodes of watery diarrhea in 24 hours were observed in 78.3 % of the cases. Dehydration was found in 30 (50 %) rotavirus-positive children, of whom seven (11.6 %) were transferred to an intensive care unit due to complications of metabolic acidosis. Rotavirus was most commonly observed among children under 12 months old (65 %). The highest incidence of infection occurred in children who were under the care of a relative at home (78.3 %), had not been breastfed (65 %), or had been breastfed for less than six months (28.3 %). The genotype combinations most frequently found were G9P8 (28.3 %) and G1P8 (10 %). This study demonstrates the presence of rotavirus and other enteric pathogens as causes of gastroenteritis in hospitalized infants and young children in Cuba.

Diarrea funcional como causa de diarrea crónica Functional diarrhea as cause of chronic diarrhea

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Trini Fragoso Arbelo

2010-12-01

Full Text Available La diarrea funcional se presenta con frecuencia en la práctica pediátrica, y generalmente no se asocia a alteraciones nutricionales, pero sí a esquemas dietéticos incorrectos. Se actualiza su importancia clínica, se hace énfasis en la patogenia, diagnóstico y en los métodos de tratamiento. Consideramos que es la causa más frecuente de diarrea crónica inespecífica, y que el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con esta enfermedad en la infancia deben ser tratados en la atención primaria.The functional diarrhea is frequent in the pediatric practice and in general it is not associated with nutritional alterations, but to incorrect dietary schemes. Its clinical significance is updated and its pathogenesis, diagnosis and treatment methods are emphasized. Authors considered that the functional diarrhea is the more frequent cause of unspecific chronic diarrhea and the questioning directed according the Rome criteria is very useful for its diagnosis. Most of patients presenting with this disease during childhood must to be treated in primary care services.

Rapid Transient Production of a Monoclonal Antibody Neutralizing the Porcine Epidemic Diarrhea Virus (PEDV) in Nicotiana benthamiana and Lactuca sativa.

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Rattanapisit, Kaewta; Srijangwad, Anchalee; Chuanasa, Taksina; Sukrong, Suchada; Tantituvanont, Angkana; Mason, Hugh S; Nilubol, Dachrit; Phoolcharoen, Waranyoo

2017-12-01

Porcine epidemic diarrhea virus (PEDV) causes acute diarrhea, vomiting, dehydration, weight loss, and high mortality rate in neonatal piglets. Porcine epidemic diarrhea (PED) has been reported in Europe, America, and Asia including Thailand. The disease causes substantial losses to the swine industry in many countries. Presently, there is no effective PEDV vaccine available. In this study, we developed a plant-produced monoclonal antibody (mAb) 2C10 as a prophylactic candidate to prevent the PEDV infection. Recently, plant expression systems have gained interest as an alternative for the production of antibodies because of many advantages, such as low production cost, lack of human and animal pathogen, large scalability, etc. The 2C10 mAb was transiently expressed in Nicotiana benthamiana and lettuce using geminiviral vector. After purification by protein A affinity chromatography, the antibody was tested for the binding and neutralizing activity against PEDV. Our result showed that the plant produced 2C10 mAb can bind to the virus and also inhibit PEDV infection in vitro . These results show excellent potential for a plant-expressed 2C10 as a PEDV prophylaxis and a diagnostic for PEDV infection. Georg Thieme Verlag KG Stuttgart · New York.

A Rare Case of Chronic Diarrhea in an Elderly Male

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Ming-Jong Bair

2009-06-01

Full Text Available Chronic diarrhea is a common condition in older age groups, and many patients do not seek medical attention unless their diarrhea is associated with other symptoms, such as weight loss, gastrointestinal bleeding or abdominal pain. It is a critical condition in the elderly, especially with systemic disease. We report the case of an elderly patient with chronic diarrhea secondary to intestinal capillariasis. Human intestinal capillariasis is a rare parasitosis of the gastrointestinal tract, which may be a fatal disease if early treatment is not given. The clinical hallmarks of capillariasis include chronic diarrhea, abdominal pain, borborygmi, marked weight loss, protein and electrolyte loss, and cachexia. Most patients die from electrolyte loss resulting in heart failure and/or septicemia. Taiwan, particularly in Taitung County, is a Capillaria-prevalent area. Thus, parasitosis must be considered in the differential diagnosis of patients with debilitating chronic diarrhea, especially in the elderly aboriginal population of Taitung County. A careful dietary and travel history is important in any such case; but even in the absence of clear-cut exposure, a parasitic infection should be considered and carefully investigated.

Spruelike Enteropathy Associated with Olmesartan: An Unusual Case of Severe Diarrhea

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Stephanie E. Dreifuss

2013-01-01

Full Text Available A 64-year-old male with a history of hypertension presented with worsening diarrhea and 25-pound weight loss over the preceding three months. Prior screening colonoscopy was unremarkable, and the patient failed conservative management. On presentation, the patient had orthostatic hypotension associated with prerenal azotemia for which olmesartan (40 mg/day was held. Initial workup for chronic diarrhea was essentially unremarkable. Then, EGD was performed with small bowel biopsy, which showed a moderate villous blunting and an intraepithelial lymphocyte infiltration. Celiac disease was excluded by negative conventional serology tests and the absence of clinical response to a gluten-free diet. In the interim, diarrhea became resolving without any other interventions, and clinical response was achieved even with gluten-containing diet. Two months later, he achieved a complete resolution of diarrhea and regained 20-pound weight. Spruelike enteropathy is a clinical entity manifested by chronic diarrhea and intestinal villous atrophy. Spruelike enteropathy associated with olmesartan as a cause of drug-induced diarrhea is rare, and it has been reported only in a case series to date. This case highlighted the importance for clinicians to maintain a high index of suspicion for olmesartan as a precipitant of spruelike enteropathy.

Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size

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Fischer Walker, Christa L; Black, Robert E

2011-01-01

Abstract Background Diarrhea mortality remains a leading cause of child death and rotavirus vaccine an effective tool for preventing severe rotavirus diarrhea. New data suggest vaccine efficacy may vary by region. Methods We reviewed published vaccine efficacy trials to estimate a regional-specific effect of vaccine efficacy on severe rotavirus diarrhea and hospitalizations. We assessed the quality of evidence using a standard protocol and conducted meta-analyses where more than 1 data point ...

Is there a relationship between low vitamin D and rotaviral diarrhea?

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Bucak, Ibrahim Hakan; Ozturk, Agah Bahadır; Almis, Habip; Cevik, Muhammer Özgür; Tekin, Mehmet; Konca, Çapan; Turgut, Mehmet; Bulbul, Mehmet

2016-04-01

For children under 5 years of age, 1700 000 000 episodes of diarrhea are seen worldwide, and death occurs in 700 000 of these cases due to diarrhea. Rotavirus is an important cause of diarrhea in this age group, and many studies have shown that vitamin D plays a pivotal role in the immune system, as well as in antimicrobial peptide gene expression. In addition, lower vitamin D has been correlated with higher rates of infectious diseases such as respiratory tract infection, tuberculosis, and viral infection. Seventy patients with rotaviral diarrhea and 67 healthy patients were enrolled in this study. Serum 25-hydroxy vitamin D(3) (25(OH)D(3)), parathormone, calcium, phosphate, alkaline phosphatase, complete blood count parameters, and C-reactive protein were compared between pre-school children hospitalized due to rotaviral diarrhea and healthy children. Additionally, birthweight, feeding habits in the first 6 months of life, vitamin D and multivitamin supplements, and rotaviral vaccinations were also evaluated in each group. There were no differences between the groups with regard to gender and age, but 25(OH)D(3) was significantly different: 14.6 ± 8.7 ng/mL in the rotaviral diarrhea patients versus 29.06 ± 6.51 ng/mL in the health controls (P vitamin D is associated with rotaviral diarrhea. This is the first study in the literature to show this, and this result needs to be repeated in larger controlled clinical studies. © 2015 Japan Pediatric Society.

Managing Chemotherapy Side Effects: Diarrhea

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... have dairy products, such as milk, cheese, and sour cream. You may want to try “lactose-free” ... drinks can make diarrhea worse. ● ● Don’t have beer, wine, and other drinks with alcohol in them. ● ● ...

Impact of antibiotics on necrotizing enterocolitis and antibiotic-associated diarrhea

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Silverman, Michael A.; Konnikova, Liza; Gerber, Jeffrey S.

2017-01-01

Summary Antibiotics induce changes or dysbiosis of the intestinal microbiome. These antibiotic-induce changes may contribute to the pathogenesis of necrotizing enterocolitis (NEC) and antibiotic-associated diarrhea (AAD). Studies are beginning to unravel the contribution of specific groups of microbes to these diseases—most notably Gammaproteobacteria for NEC and bile acid- and carbohydrate-metabolizing microbes for AAD. Antibiotic-associated diarrhea occurs when antibiotic treatment induces diarrhea by altering the metabolic function of the patient’s intestinal microbiota leading to either an osmotic or infectious diarrhea, most notably Clostridium difficile infection (CDI). Antibiotic therapy impairs the host microbiota’s ability to resist colonization or expansion of pathogenic bacteria. In the case of CDI, there is growing evidence that microbiota-mediated bile acid metabolism is critical in the pathogenesis of this infection. Probiotics or other microbiota-targeted therapies may provide effective strategies to prevent and treat NEC and AAD. PMID:28164853

Mobile Phone–based Syndromic Surveillance System, Papua New Guinea

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Ropa, Berry; Randall, Heather; Dagina, Rosheila; Hurim, Samuel; Bieb, Sibauk; Datta, Siddhartha; Ramamurthy, Sundar; Mola, Glen; Zwi, Anthony B.; Ray, Pradeep; MacIntyre, C. Raina

2013-01-01

The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone–based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance. PMID:24188144

The correlation of acute toxicity and late rectal injury in radiotherapy for cervical carcinoma: Evidence suggestive of consequential late effect (CQLE)

International Nuclear Information System (INIS)

Wang, C.-J.; Leung, Stephen Wan; Chen, H.-C.; Sun, L.-M.; Fang, F.-M.; Huang, E.-Y.; Hsiung, C.-Y.; Changchien, C.-C.

1998-01-01

Purpose: To correlate the acute toxicity during pelvic irradiation and the development of late rectal injury following radiation therapy for cervical carcinoma. Methods and Materials: Two hundred and twenty patients treated with curative-intent radiation therapy between November 1987 and January 1992 were analyzed. Patients were treated initially with external beam irradiation, 40-44 Gy/20-22 fractions to whole pelvis, followed by high dose rate intracavitary brachytherapy, 7.2 Gy to point A for 3 fractions. Severity of diarrhea during radiation therapy was scored according to six criteria: fecal characteristics, frequency, onset, prescription of antidiarrheal agents, body weight loss during irradiation, and extramedical care needed. Patients were categorized as group ND (no obvious diarrhea), group MD (moderate diarrhea), and group SD (severe diarrhea) for sum score 0-1, 2-5, and ≥6, respectively. The rate of radiation proctitis was expressed, analyzed, and compared with actuarial proctitis-free rate and prevalence. Results: 1) According to the score, 76 (35%), 89 (40%), and 55 (25%) patients were categorized as group ND, group MD, and group SD, respectively. Distribution of patients and treatment characteristics among the three groups appeared similar. Patients treated with a larger field size, ≥16.5 cm 2 , tended to have increased severity of diarrhea. 2) Overall, 103 patients (47%, 103 of 220) developed radiation proctitis. Twenty-one patients were in group ND (28%, 21 of 76), 43 in group MD (48%, 43 of 89), and 39 in group SD (71%, 39 of 55). 3) The five-year actuarial proctitis-free rate was 72, 52, and 29% for group ND, MD, and SD, respectively (p s = 0.229, p = 0.098). 6) Cox's multivariate analysis revealed that severity of diarrhea was the only factor that significantly correlated with the development of radiation proctitis. Conclusion: Patients with increased acute toxicity and diarrhea during radiation therapy of cervical carcinoma significantly

Prophylaxis of radiotherapy induced diarrhea after irradiation of the pelvis or the abdomen

International Nuclear Information System (INIS)

Hombrink, J.; Voss, A.C.; Froehlich, D.; Glatzel, M.; Krauss, A.; Glaser, F.H.

1995-01-01

Radiotherapy induced diarrhea and convulsive pain are severe side-effects of irradiation of the pelvis and the abdomen leading often to an interruption of the treatment. Up to now these side-effects were only treated symptomatically, prophylactic therapies are not known. During the years 1992 and 1993 174 patients who obtained radiotherapy in the pelvis or the abdomen because of different malignancies were observed referring to the diarrhea-prophylactic effect of Smectite (=Skilpin R ). 80 patients received Smectite at the beginning of radiotherapy, 94 patients of the controlgroup were treated with motility modifying drugs when diarrhea appeared. The following parameters were compared: Frequency, consistence and incontinence of stool, tenesmus and the onset of diarrhea. 67,0% (n=63) of the patients in the controlgroup developed diarrhea, whereas in the pretreated Smectite-group only 37,5% of the cases (n=30) developed diarrhea. The first appearance of diarrhea was at day 17 in the pretreated group and averagely at day 11 in the controlgroup. 44% of the patients in the controlgroup suffered from tenesmus versus 25% in the Smectite-group. In comparison to the symptomatic treatment of radiation enteritis the prophylactic application of Smectite is able to reduce the diarrhea from the beginning of raditherapy or at least to reduce the pathological frequency of stool and therefore to increase the quality of life. (orig.) [de

Suggested classification of acute radiation sickness

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Yao, Guo; Mingyue, Zhu; Zhiqin, Zhao

1984-08-01

Acute radiation sickness is usually classified into three types. Over the last decade, we have been engaged in experimental studies on the classification of this syndrome. Our findings from these studies, however, point to the fact that between the hemopoietic and intestinal types, and between the intestinal and cerebral types there are transitive forms, namely, hemopoieto-intestinal type and cardio-vascular type, respectively. In this article the required radiation doses and the clinical courses of these transitive forms with special emphasis on their histological and clinical manifestations are described. In case of the hemopoieto-intestinal form, histological examination may reveal residual crypts and typical ''abnormal cells'' in the intestinal mucosa, and clinical manifestations include almost the whole spectrum of symptoms and signs of infection and hemorrhage. The watery stool in pink colour may be specific and helpful in diagnosis. In case of the cardio-vascular form, shock may occur immediately after exposure, and histological examination may show myocardial edema, hemorrhage, cell-infiltration and even necrosis. We propose that the acute radiation sickness should be divided into 5 forms, namely, hemopoietic, hemopoieto-intestinal, intestinal, cardio-vascular and cerebral types. Accurate diagnosis can only be made by taking an comprehensive view of radiation dose, clinical course, clinical manifestations and histological findings. (author).

Assessment of chronic diarrhea in early infancy in Tehran Tertiary Care Center; Tehran-Iran

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Farzaneh Motamed

2015-03-01

Full Text Available Introduction Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was investigating chronic diarrhea, its etiologies, clinical features and outcomes in infancy.Materials and Methods Retrospective study investigating infants hospitalized in the gastroenterology department of Tehran tertiary care center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyzed by SPSS software,version 16.Results In this study, 63/9% of cases were female and 36/1% were male. 24 cases (66/7% had osmotic diarrhea and 11 (30/6% had secretory diarrhea. In this study there was no significant statistical correlation between type of diarrhea and sex, gestational Age, severity of dehydration, birth weight and nutrition. The majority of patients with osmotic (58/3% and secretory diarrhea (63/6%, had weight percentile below 3%, which showed a significant statistical difference (p value

Aldosterone Response in Severe Hypokalemia and Volume Depletion: A Case Report and Review of the Recent Research

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Keiko Kai

2016-01-01

Full Text Available We report a case of severe hypokalemia and volume depletion complicated by chronic watery diarrhea resulting from chronic alcoholism in a 57-year-old man. Prompt replacement of normal saline with potassium chloride and cessation of alcohol intake resulted in a favorable outcome. We discuss the pathophysiology of the case, emphasizing the response of aldosterone in both hypokalemia and volume depletion, and provide a review of recent research.

Midupper Arm Circumference Outperforms Weight-Based Measures of Nutritional Status in Children with Diarrhea12

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Modi, Payal; Nasrin, Sabiha; Hawes, Meagan; Glavis-Bloom, Justin; Alam, Nur H; Hossain, M Iqbal; Levine, Adam C

2015-01-01

Background: Undernutrition contributes to 45% of all deaths in children children with diarrhea and possible dehydration. Objective: This study assessed the validity of different measures of undernutrition in children with diarrhea. Methods: A prospective cohort study was conducted at an urban hospital in Bangladesh. Children children for screening, of which 1025 were eligible, 850 were enrolled, and 721 had complete data for analysis. Anthropometric measurements, including weight-for-age z score (WAZ), weight-for-length z score (WLZ), midupper arm circumference (MUAC), and midupper arm circumference z score (MUACZ), were calculated pre- and posthydration in all patients. Measurements were evaluated for their ability to correctly identify undernutrition in children with varying degrees of dehydration. Results: Of the 721 patients with full data for analysis, the median percent dehydration was 4%. Of the 4 measures evaluated, MUAC and MUACZ demonstrated 92–94% agreement pre- and posthydration compared with 69–76% for WAZ and WLZ. Although each 1% change in hydration status was found to change weight-for-age by 0.0895 z scores and weight-for-length by 0.1304 z scores, MUAC and MUACZ were not significantly affected by dehydration status. Weight-based measures misclassified 12% of children with severe underweight and 14% with severe acute malnutrition (SAM) compared with only 1–2% for MUAC and MUACZ. Conclusions: MUAC and MUACZ were the most accurate predictors of undernutrition in children with diarrhea. WAZ and WLZ were significantly affected by dehydration status, leading to the misdiagnosis of many patients on arrival with severe underweight and SAM. This trial was registered at clinicaltrials.gov as NCT02007733. PMID:25972523

Existing and emerging therapies for managing constipation and diarrhea.

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Bharucha, Adil E; Wouters, Mira M; Tack, Jan

2017-12-01

Functional bowel disorders (i.e., constipation and diarrhea) are characterized by abdominal pain, bloating, distention, and/or bowel habit abnormalities in the absence of obvious anatomic or physiologic abnormalities on routine diagnostic tests. These symptoms are attributable to gastrointestinal sensorimotor dysfunctions resulting from peripheral and/or central mechanisms. Available drugs target the underlying bowel disturbance (i.e., constipation, diarrhea, or both), supplemented when necessary by management of pain. Osmotic and stimulant laxatives, secretagogues, and serotonin 5-HT 4 receptor agonists are approved for treating constipation. Loperamide, anticholinergic agents, rifaximin, bile-acid binding agents, eluxadoline, and clonidine are used to treat diarrhea. Several exciting new compounds, some of which have been evaluated in humans, are currently under development. Copyright © 2017 Elsevier Ltd. All rights reserved.

SKIV2L Mutations Cause Syndromic Diarrhea, or Trichohepatoenteric Syndrome

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Fabre, Alexandre; Charroux, Bernard; Martinez-Vinson, Christine; Roquelaure, Bertrand; Odul, Egritas; Sayar, Ersin; Smith, Hilary; Colomb, Virginie; Andre, Nicolas; Hugot, Jean-Pierre; Goulet, Olivier; Lacoste, Caroline; Sarles, Jacques; Royet, Julien; Levy, Nicolas; Badens, Catherine

2012-01-01

Syndromic diarrhea (or trichohepatoenteric syndrome) is a rare congenital bowel disorder characterized by intractable diarrhea and woolly hair, and it has recently been associated with mutations in TTC37. Although databases report TTC37 as being the human ortholog of Ski3p, one of the yeast Ski-complex cofactors, this lead was not investigated in initial studies. The Ski complex is a multiprotein complex required for exosome-mediated RNA surveillance, including the regulation of normal mRNA and the decay of nonfunctional mRNA. Considering the fact that TTC37 is homologous to Ski3p, we explored a gene encoding another Ski-complex cofactor, SKIV2L, in six individuals presenting with typical syndromic diarrhea without variation in TTC37. We identified mutations in all six individuals. Our results show that mutations in genes encoding cofactors of the human Ski complex cause syndromic diarrhea, establishing a link between defects of the human exosome complex and a Mendelian disease. PMID:22444670

Citrullus colocynthis as the Cause of Acute Rectorrhagia

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Hamid Reza Javadzadeh

2013-01-01

Full Text Available Introduction. Citrullus colocynthis Schrad. is a commonly used medicinal plant especially as a hypoglycemic agent. Case Presentation. Four patients with colocynth intoxication are presented. The main clinical feature was acute rectorrhagia preceeded by mucosal diarrhea with tenesmus, which gradually progressed to bloody diarrhea and overt rectorrhagia within 3 to 4 hours. The only colonoscopic observation was mucosal erosion which was completely resolved in follow-up colonoscopy after 14 days. Conclusion. The membranolytic activity of some C. colocynthis ingredients is responsible for the intestinal damage. Patients and herbalists should be acquainted with the proper use and side effects of the herb. Clinicians should also be aware of C. colocynthis as a probable cause of lower GI bleeding in patients with no other suggestive history, especially diabetics.

Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006.

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Creek, Tracy L; Kim, Andrea; Lu, Lydia; Bowen, Anna; Masunge, Japhter; Arvelo, Wences; Smit, Molly; Mach, Ondrej; Legwaila, Keitumetse; Motswere, Catherine; Zaks, Laurel; Finkbeiner, Thomas; Povinelli, Laura; Maruping, Maruping; Ngwaru, Gibson; Tebele, Goitebetswe; Bopp, Cheryl; Puhr, Nancy; Johnston, Stephanie P; Dasilva, Alexandre J; Bern, Caryn; Beard, R S; Davis, Margarett K

2010-01-01

In 2006, a pediatric diarrhea outbreak occurred in Botswana, coinciding with heavy rains. Surveillance recorded a 3 times increase in cases and a 25 fold increase in deaths between January and March. Botswana has high HIV prevalence among pregnant women (33.4% in 2005), and an estimated 35% of all infants under the age of 6 months are not breastfed. We followed all children <5 years old with diarrhea in the country's second largest referral hospital at the peak of the outbreak by chart review, interviewed mothers, and conducted laboratory testing for HIV and enteric pathogens. Of 153 hospitalized children with diarrhea, 97% were <2 years old; 88% of these were not breastfeeding. HIV was diagnosed in 18% of children and 64% of mothers. Cryptosporidium and enteropathogenic Escherichia coli were common; many children had multiple pathogens. Severe acute malnutrition (kwashiorkor or marasmus) developed in 38 (25%) patients, and 33 (22%) died. Kwashiorkor increased risk for death (relative risk 2.0; P = 0.05); only one breastfeeding child died. Many children who died had been undersupplied with formula. Most of the severe morbidity and mortality in this outbreak occurred in children who were HIV negative and not breastfed. Feeding and nutritional factors were the most important determinants of severe illness and death. Breastfeeding is critical to infant survival in the developing world, and support for breastfeeding among HIV-negative women, and HIV-positive women who cannot formula feed safely, may prevent further high-mortality outbreaks.

Ultrasound assessment of severe dehydration in children with diarrhea and vomiting.

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Levine, Adam C; Shah, Sachita P; Umulisa, Irenee; Munyaneza, Richard B Mark; Dushimiyimana, Jean Marie; Stegmann, Katrina; Musavuli, Juvenal; Ngabitsinze, Protogene; Stulac, Sara; Epino, Henry M; Noble, Vicki E

2010-10-01

The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale). The authors enrolled a prospective cohort of children presenting with diarrhea and/or vomiting to three rural Rwandan hospitals. Children were assessed clinically using the WHO scale and then underwent US of the IVC by a second clinician. All children were weighed on admission and then fluid-resuscitated according to standard hospital protocols. A percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. Receiver operating characteristic (ROC) curves were created for each of the three tests of severe dehydration compared to the criterion standard. Children ranged in age from 1 month to 10 years; 29% of the children had severe dehydration according to the criterion standard. Of the three different measures of dehydration tested, only US assessment of the aorta/IVC ratio had an area under the ROC curve statistically different from the reference line. At its best cut-point, the aorta/IVC ratio had a sensitivity of 93% and specificity of 59%, compared with 93% and 35% for IVC inspiratory collapse and 73% and 43% for the WHO scale. Ultrasound of the aorta/IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea and may be helpful in guiding clinical management. © 2010 by the Society for Academic Emergency Medicine.

Characterization of the human gut microbiome during travelers' diarrhea.

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Youmans, Bonnie P; Ajami, Nadim J; Jiang, Zhi-Dong; Campbell, Frederick; Wadsworth, W Duncan; Petrosino, Joseph F; DuPont, Herbert L; Highlander, Sarah K

2015-01-01

Alterations in the gut microbiota are correlated with ailments such as obesity, inflammatory bowel disease, and diarrhea. Up to 60% of individuals traveling from industrialized to developing countries acquire a form of secretory diarrhea known as travelers' diarrhea (TD), and enterotoxigenic Escherichia coli (ETEC) and norovirus (NoV) are the leading causative pathogens. Presumably, TD alters the gut microbiome, however the effect of TD on gut communities has not been studied. We report the first analysis of bacterial gut populations associated with TD. We examined and compared the gut microbiomes of individuals who developed TD associated with ETEC, NoV, or mixed pathogens, and TD with no pathogen identified, to healthy travelers. We observed a signature dysbiotic gut microbiome profile of high Firmicutes:Bacteroidetes ratios in the travelers who developed diarrhea, regardless of etiologic agent or presence of a pathogen. There was no significant difference in α-diversity among travelers. The bacterial composition of the microbiota of the healthy travelers was similar to the diarrheal groups, however the β-diversity of the healthy travelers was significantly different than any pathogen-associated TD group. Further comparison of the healthy traveler microbiota to those from healthy subjects who were part of the Human Microbiome Project also revealed a significantly higher Firmicutes:Bacteriodetes ratio in the healthy travelers and significantly different β-diversity. Thus, the composition of the gut microbiome in healthy, diarrhea-free travelers has characteristics of a dysbiotic gut, suggesting that these alterations could be associated with factors such as travel.

HEXAMITIASIS (Hexamita eleagridis IN TURKEY COMMERCIAL FARMS IN YUCATÁN, MÉXICO

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Ronald Santos Ricalde

2014-12-01

Full Text Available The objective of the study was to estimate the prevalence and to describe the lesions and signs found in an outbreak of Hexamita meleagridis in three turkey farms in Yucatan, Mexico. Three hundred randomly selected, turkeys were sacrificed and their intestines explored for lesions associated with H. Meleagridis infection. Also, gut content, feces samples and fresh intestine smears were taken to determine the presence of H. Meleagridis parasites. Macroscopic lesions such as the presence of congested areas, and watery and foamy content in duodenum, presence of gases, fetid odor and the presence of watery and yellowish feces in the caeca were identified. The overall prevalence of H. Meleagridis was 25.3% and there was not association of the parasite with sex, age or farm. However, the thickening of some sections of the duodenum (52.3%, the presence of congested areas (23%, the watery and yellowish content of the duodenum (24.3%, the presence of gas (21.0%, fetid odor of the content (22.3%, and the watery and yellowish feces of the caeca (20.0% were associated with H. meleagridis Presence of H. meleagridis in those farms was confirmed. Diarrhea signs and intestine lesions observed in the sacrificed turkeys were associated to hexamitiasis infection. Sex, age and farm were not associated with the presence of H. meleagridis.

Ancylostoma ceylanicum, novel etiological agent for traveler's diarrhea-report of four Japanese patients who returned from Southeast Asia and Papua New Guinea.

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Yoshikawa, Masahide; Ouji, Yukiteru; Hirai, Nobuyasu; Nakamura-Uchiyama, Fukumi; Yamada, Minoru; Arizono, Naoki; Akamatsu, Naoaki; Yoh, Takaharu; Kaya, Daisuke; Nakatani, Toshiya; Kikuchi, Eiryo; Katanami, Yuichi; Satoh, Kimitoshi; Maki, Ryosuke; Miyazato, Yusuke; Oba, Yuichiro; Kasahara, Kei; Mikasa, Keiichi

2018-01-01

Countries in the Southeast Asia region have a high prevalence of soil-transmitted helminth, such as roundworm, whipworm, and hookworms [ Ancylostoma duodenale , Necator americanus , Ancylostoma ceylanicum ]. Recent molecular-based surveys have revealed that A . ceylanicum , a zoonotic hookworm, is likely the second most prevalent hookworm species infecting humans in that part of the world, while others have noted that this infection is an emerging public health risk not only for indigenous people but also for visitors from other countries. We recently encountered four cases of A . ceylanicum infection in Japanese individuals who returned from Southeast Asia and Papua New Guinea. Case 1 was a 25-year-old male who stayed in a rainforest in Malaysia for 4 weeks, where he developed abdominal pain and diarrhea in the third week. Eleven adult worms (five males, six females) were expelled after treatment with pyrantel pamoate and identified as A . ceylanicum based on morphological characteristics and DNA sequences of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene. Case 2 was a 26-year-old male who spent 2 years as an overseas cooperation volunteer for agriculture in Papua New Guinea. He did not note any symptoms at that time, though eggs were detected in feces samples at a medical check-up examination after returning. Although collection of adult worms was unsuccessful, DNA analysis of the eggs for cox1 and the ribosomal internal transcribed spacer (ITS)-1 and ITS-2 genes demonstrated that they were A . ceylanicum. Case 3 was a 47-year-old male who spent 1 month in a rural village in Lao People's Democratic Republic and began suffering from watery diarrhea from the third week. A total of nine adult worms (three males, six females) were collected by endoscopic procedures and following treatment with pyrantel pamoate. Morphological examination and molecular analyses of the cox1 gene showed that they were A . ceylanicum. Case 4 was a 27-year-old male who

Colestipol hydrochloride prophylaxis of diarrhea during pelvic radiotherapy

International Nuclear Information System (INIS)

Stryker, J.A.; Chung, C.K.; Layser, J.D.

1983-01-01

Thirty-three patients were randomized prior to pelvic radiotherapy to receive the bile acid-sequestering resin colestipol hydrochloride, 5 grams qid, during the entire time of their therapy or diphenoxylate hydrochloride and atropine sulfate 2.5-20 mg per day (control) if they experienced diarrhea. The colestipol patients also took diphenoxylate if they had diarrhea. The patients in the colestipol group often experienced nausea, vomiting, and abdominal cramps and 8 were forced to discontinue the drug. There was no difference in the weekly stool frequency between the colestipol and the control patients but the colestipol patients who took at least 50% of the prescribed dose required fewer diphenoxylate tablets than the controls. The data suggest that colestipol hydrochloride is not of value in preventing radiation-induced diarrhea because of the side effects associated with the drug, but the theory on which the use of bile acid-sequestering agents is based may be correct

THE USE OF A DOMESTIC PROBIOTIC WITH LACTOBACILLUS ACIDOPHILUS FOR THE TREATMENT OF ACUTE INTESTINAL INFECTIONS AND OTHER PATHOLOGIES IN CHILDREN

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A. A. Novokshonov

2017-01-01

Full Text Available The results of studies showing the effectiveness of the use of the domestic probiotic Acipol containing Lactobacillus acidophilus and the kefiric fungal polysaccharide are summarized in a wide range of diseases in children, such as acute intestinal infections of bacterial, viral (rotavirus and mixed etiology, for the prevention of the development of antibiotic-associated diarrhea, for the normalization of the intestinal microflora in various conditions (acute respiratory diseases, atopic dermatitis, often ill children, etc.. The appointment of Acipol contributed to a reduction in the duration of clinical manifestations, restoration of normoflora, rapid elimination of pathogenic and conditionally pathogenic microorganisms, and reduced the risk of developing of antibiotic-associated diarrhea.

Vitamin A supplementation and childhood morbidity from diarrhea, fever, respiratory problems and anemia in sub-Saharan Africa

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Gebremedhin S

2017-07-01

Full Text Available Samson Gebremedhin School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia Background: Systematic reviews consistently indicated that vitamin A supplementation (VAS (100,000–200,000 international unit [IU] semiannually to children aged 6–59 months substantially reduces all-cause child mortality. Yet, its effect on morbidity is inconsistent and its contribution to the reduction of anemia has not been sufficiently explored.Objective: The objective of this study was to assess the association between routine VAS (100,000 IU for children aged 6–11 months and 200,000 IU for children aged 1–5 years and the occurrence of common childhood illnesses (fever, diarrhea, acute respiratory infection [ARI] and anemia in preschool children in sub-Saharan Africa (SSA.Methods: The analysis was made based on the data of 28 demographic and health surveys (DHSs conducted in SSA since 2010. The data of 152,406 children were included. The VAS status in the preceding 6 months and the occurrence of the illnesses in the past 2 weeks were determined based on the information given by the caregivers. The hemoglobin level was determined using a portable photometer. Data were analyzed using mixed-effects logistic regression model. The outputs were provided using adjusted odds ratio (AOR with the respective 95% confidence intervals (CIs. The practical significance of the association was measured via Cohen’s effect size (d.Results: The coverage of VAS was 56.3% (95% CI: 56.1–56.5. VAS was modestly associated with increased odds of fever (AOR=1.12 [95% CI: 1.09–1.15], diarrhea (AOR=1.09 [95% CI: 1.05–1.13] and ARI (AOR=1.18 [95%: 1.12–1.24]. Conversely, in the supplemented children, the odds of anemia were reduced by 10.1% (95% CI: 7.0–13.1. All the associations translated into trivial effect sizes (d<0.2.Conclusion: VAS is associated with an inconsequential increase in the occurrence of common childhood ailments. Keywords

Maternal Education and Diarrhea among Children aged 0-24 Months in Nigeria.

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Desmennu, Adeyimika T; Oluwasanu, Mojisola M; John-Akinola, Yetunde O; Oladunni, Opeyemi; Adebowale, Ayo S

2017-09-01

Childhood diarrhea remains a problem in countries like Nigeria where access to potable water, good hygiene and sanitation are lacking. Maternal education is an important determinant of health status of under-five children. Very few studies have investigated the relationship between maternal education and diarrhea in children in Nigeria. Therefore, this study was implemented to fill the gap. The study design was cross-sectional and 2013 National Survey was used. Children aged 0-24 months were investigated and the dependent variable was diarrhea status of the index child in the last two weeks prior the survey. The main independent variable was maternal education. Data were analyzed using Chi-square and Logistic regression models (α=0.05). Diarrhea prevalence was 13.7% and higher (15.5%) among children of women who have no formal education, and mothers living in the North East region of Nigeria experienced the highest prevalence (26.4%). Children whose mothers had no formal education were 2.69(CI= 1.800-4.015, p education. Maternal education is an important predictor of diarrhea among children aged 0-24 months in Nigeria. Policies to reduce diarrhea among children in Nigeria should target children of the illiterate, less educated mothers and those living in the North-West.

Epidemiology of rotavirus diarrhea in children under 5 years in ...

African Journals Online (AJOL)

Background: Rotavirus still remains the major cause of diarrhea in children below 5 years. No data on rotavirus epidemiology is available in the Northern regions of Cameroon. We aimed to determine the prevalence of group A rotavirus (RVA) in children below 5 years with diarrhea in two regions of Northern Cameroon ...

Cyclospora cayetanensis: Presentación de 20 casos

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Isabel Martínez Silva

2002-06-01

Full Text Available Se presentan 20 pacientes (0,2 % de un total de 7 956 que acudieron de enero de 2000 a julio de 2001 a la Consulta de Parasitología del Hospital Pediátrico Universitario "William Soler" con un cuadro de diarreas acuosas y otras manifestaciones clínicas, y donde se aisló en muestras de heces frescas el protozoario Cyclospora cayetanensis. Las diarreas estuvieron presentes en 17 enfermos (85 %, los vómitos y la anorexia en 9 pacientes (45 %, el dolor abdominal en 7 (35 %, el decaimiento y la fiebre se evidenciaron en 3 pacientes (15 %. El estado nutricional de estos niños fue normal. El Cyclospora cayetanensis es un parásito que puede observarse en edades pediátricas y uno más que se tendrá en cuenta en la etiología de las diarreas acuosas.The paper presents a report of 20 patients (0,2% selected from 7956 patients who went to the Parasitology Department of "William Soler" University Pediatric Hospital with watery diarrheas and other clinical manifestations from January 2000 to July 2001. Protozoon Cyclospora cayetanensis was isolated in samples of fresh feces from the mentioned cases. Diarrheas affected 17 patients (85%, vomits and anorexia were present in 9 patients (45%, abdominal pain in 7 (35%, and fatigue and fever in 3 patients (15% The nutritional condition of these children was normal. Cyclospora cayetanensis is a parasite that may be observed in pediatric ages and an additional one to be taken into account in the etiology of watery diarrheas.

Acute toxicity of chemoradiation for rectal cancer

International Nuclear Information System (INIS)

Roedel, C.; Fietkau, R.; Keilholz, L.; Grabenbauer, G.G.; Kessler, H.; Martus, P.; Sauer, R.

1997-01-01

Between 1987 and 1995, 120 patients with rectal cancer (73 patients with primary tumor, 47 with recurrent disease) received chemoradiation for rectal cancer. Fifty-six patients received preoperative chemoradiation, 64 patients were treated postoperatively. Radiation was given by 4-field box technique with 6 to 10 MV-photons. Daily fraction size was 1.8 Gy, total dose 50.4 Gy (range: 41,4 to 56 Gy) ± 5.4 Gy (range: 3.6 to 19.8 Gy) local boost in selected cases, specified to the ICRU reference point. During the first and fifth week of radiation 5-FU at a dose of 1000 m 2 /d for 120 hours was administered by continuous infusion. Toxicity was recorded following (modified) WHO-criteria. Results: Acute grade 3 toxicity occurred mainly as diarrhea (33%), perineal skin reaction (37%), and leukopenia (10%). Extension of the treatment volume including paraaortic lymph nodes (L3) led to a significant increase of grade 3-diarrhea (68% vs. 25%, p = 0.0003) and grade 3-leukopenia (18% vs. 8%, p 0.03). After abdominoperineal resection less patients suffered from grade 3-diarrhea (8% vs. 47% after sphincter preserving procedures, p = 0.0006), whereas severe perineal erythema occurred more frequently (56% vs. 29%, p 0.02). Women had significantly more toxic side effects (grade 3-diarrhea: 39% vs. 16% in men, p = 0,04; grade 2 to 3-nausea/emesis: 21% vs 8% in men, p 0.018; grade 2 to 3-leukopenia 53% vs. 31% in men, p = 0.02). After preoperative chemoradiation a significant reduction of grade 3-diarrhea (11% vs 29%, p 0.03) and grade 3-erythema (16% vs. 41%, p = 0.04) was noted. (orig./AJ) [de

Effect of diet and tylosin on chronic diarrhea in beagles.

Science.gov (United States)

Westermarck, Elias; Frias, Rafael; Skrzypczak, Teresa

2005-01-01

Seven beagles in a colony of dogs had chronic diarrhea for at least 30 days. The dogs were subsequently treated with tylosin 20 mg/kg BW q24h PO for 10 days. During the treatment period, the feces became firmer but remained loose. When the treatment was discontinued, the diarrhea reappeared in 3 weeks. The feces remained abnormally loose in all dogs treated with metronidazole, trimethoprim-sulfadiazine, or doxycycline and prednisone. The diet was then changed for 10 days from a highly digestible moist pet food to a dry food developed for normal adult dogs. The feces again became firmer, although still loose in some dogs. The period was then extended to 3 month, but the fecal consistency continued to fluctuate from ideal to diarrhea. The dogs were treated a 2nd time with tylosin 20 mg/kg BW q24h PO for 10 days. The feces then became significantly firmer and remained so throughout a 3-month follow-up. We conclude that the combination of diet and tylosin was more effective than either agent alone in control of chronic diarrhea.

A suggested classification of acute radiation sickness

International Nuclear Information System (INIS)

Guo Yao; Zhu Mingyue; Zhao Zhiqin

1984-01-01

Acute radiation sickness is usually classified into three types. Over the last decade, we have been engaged in experimental studies on the classification of this syndrome. Our findings from these studies, however, point to the fact that between the hemopoietic and intestinal types, and between the intestinal and cerebral types there are transitive forms, namely, hemopoieto-intestinal type and cardio-vascular type, respectively. In this article the required radiation doses and the clinical courses of these transitive forms with special emphasis on their histological and clinical manifestations are described. In case of the hemopoieto-intestinal form, histological examination may reveal residual crypts and typical ''abnormal cells'' in the intestinal mucosa, and clinical manifestations include almost the whole spectrum of symptoms and signs of infection and hemorrhage. The watery stool in pink colour may be specific and helpful in diagnosis. In case of the cardio-vascular form, shock may occur immediately after exposure, and histological examination may show myocardial edema, hemorrhage, cell-infiltration and even necrosis. We propose that the acute radiation sickness should be divided into 5 forms, namely, hemopoietic, hemopoieto-intestinal, intestinal, cardio-vascular and cerebral types. Accurate diagnosis can only be made by taking an comprehensive view of radiation dose, clinical course, clinical manifestations and histological findings. (author)

Straight Poop on Kids and Diarrhea

Science.gov (United States)

... coma, organ failure, and, in rare circumstances, death. Rehydration “Mild diarrhea is a discomfort, but not dangerous ... a change in diet and treatment with oral rehydration solutions may be necessary. Oral rehydration solutions, also ...

Mutations in the Histone-like Nucleoid Structuring Regulatory Gene (hns) Decrease the Adherence of Shiga Toxin-producing Escherichia coli 091:H21 Strain B2F1 to Human Colonic Epithelial Cells and Increase the Production of Hemolysin

Science.gov (United States)

1999-10-19

osmoregulation of outer membrane proteins and virulence determinants in Vibrio cholerae requires toxR. J. Bacteriol. 170:2575-2583. Mobley, H. L., D. M. Green...produced by ETEC organisms is homologous to the toxin encoded by Y: cholerae . These toxins are the primary cause of the watery diarrhea associated with ETEC...Escherichia coli as a cause ofdiarrhea among children in Mexico . J. Clin. Microbiol. 25:1913-1919. Maurelli, A. T., and P. J. Sansonetti. 1988

Compliance of zinc supplementation by care givers of children suffering from diarrhea

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Smita S Valekar

2014-12-01

Full Text Available Background: Over 2 million children die as a result of diarrhea and dehydration every year. A new ORS formula and introduction of Zinc supplementation offers much improved outcomes for the treatment of childhood diarrhea. Aims: To assess the compliance of Zinc supplementation by caregivers Objectives: 1. To assess the compliance of Zinc supplementation by caregivers, 2. To find out the reason for non-compliance 3. To study the association of socio-demographic variables and non-compliance of children suffering from diarrhea Materials & Method:  Study Design: Cross-sectional survey Study Period: from 1st Sept. 2014 to 31st Oct. 2014 Study Area: Pediatric Outpatient department of Tertiary Care Hospital Inclusion Criteria: Under five children suffering from diarrhea attending Pediatric OPD Study Tool: Questionnaire was administered to care givers and follow up was done on 3rd, 7th & 14th day of Zinc supplementation. Result: 84% of non-compliance was seen in this study. Conclusion: The compliance of Zinc supplementation is poor among caretakers of children suffering from diarrhea.

Diarrhea and related factors among passengers on world cruises departing from Japan.

Science.gov (United States)

Yamakawa, Michiyo; Sasai, Megumi; Kasai, Yosuke; Tsuda, Toshihide; Suzuki, Etsuji

2018-01-25

Despite growth in the number of cruises worldwide, evidence about diarrhea experienced by cruise ship passengers remains sparse. We investigated rates of diarrhea and related factors among passengers on world cruises departing from Japan. Targeting passengers on five world cruises (n = 4180) from 2012 to 2013 (85-103 travel days), we calculated rates of health seeking behavior for diarrhea by sex, age group, and number of roommates for each cruise. We estimated rate ratios and 95% confidence intervals, using the group aged 20-39 years, women, and 2-4 roommates as referent categories. We found 5.04-6.00 cases per 10,000 person-days in the five cruises, with an elevated number after calling at ports. Older passengers (>60 years) and passengers with fewer roommates had an elevated risk of health seeking behavior for diarrhea, although passengers aged 60 years and without roommates. Older passengers and passengers with fewer roommates may be more likely to seek medical treatment for diarrhea during travel on a world cruise, and should take preventive measures. Copyright © 2018. Published by Elsevier Ltd.

Traveler’s Diarrhea Market: Evolving market trends and dynamics

OpenAIRE

Smita Deshmukh

2016-01-01

Traveler’s Diarrhea Market: Overview Traveler’s diarrhea refers to intestinal and stomach infection and occurs due to unsanitary conditions during handling of food. This disorder is characterized by frequent abdominal cramps resulting in loose stools and is usually caused by consumption of contaminated water or food. Travelling from one place to another where the sanitary conditions, social conditions, climate and other factors are different and hence presents high risk of developin...

Comparing the Accuracy of the Three Dehydration Scales in Children with Acute Diarrhea in a Developing Country of Kosovo

OpenAIRE

Hoxha, Teuta; Xhelili, Luan; Azemi, Mehmedali; Avdiu, Muharrem; Ismaili-Jaha, Vlora; Efendija-Beqa, Urata; Grajcevci-Uka, Violeta

2015-01-01

Background. Although diarrhea is a preventable disease, it remains the second leading cause of death (after pneumonia) among children aged under five years worldwide. The World Health Organization (WHO) scale, the Gorelick scale, and the Clinical Dehydration Scale (CDS) were created to estimate dehydration status using clinical signs. The purpose of this study is to determine whether these clinical scales can accurately assess dehydration status of children in a developing country of Kosovo. ...

Knowledge of the mothers of hospitalized children in a university hospital regarding diarrhea

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Ana Paula do Rego

2014-04-01

Full Text Available This qualitative research aimed at identifying the knowledge of the mothers regarding diarrhea. It was conducted with eight mothers of hospitalized children in a university hospital located in Santa Cruz, Rio Grande do Norte, Brazil, in 2012. Data were collected through open interviews and the analysis was based on Bardin. The categories emerging from the analysis were: understanding diarrhea and preventing/treating diarrhea. Regarding the understanding of diarrhea, mothers conceptualize and understand it from the symptoms, habits/eating mistakes and/or cultural beliefs. Concerning the prevention and treatment of the disease, the mothers highlight hygiene and home cleaning as preventive measures, as well the importance of home and hospital care measures. The interviewees have basic knowledge of pathology, further studies are necessary in order to define the current gap between the knowledge of mothers and recurrence of diarrhea cases, resulting in hospitalization and expenses with unnecessary treatment.

Available studies fail to provide strong evidence of increased risk of diarrhea mortality due to measles in the period 4-26 weeks after measles rash onset.

Science.gov (United States)

Jackson, Bianca D; Black, Robert E

2017-11-07

Measles vaccination effectiveness studies showed dramatic decreases in all-cause mortality in excess of what would be expected from the prevention of measles disease alone. This invited speculation that measles infection may increase the risk of diarrhea morbidity and mortality subsequent to the acute phase of the disease. The aim of the present systematic review is to summarize the existing evidence in the publically available literature pertaining to the putative causal link between measles and diarrhea in the period 4-26 weeks following measles rash onset. We searched the PubMed, Embase, Open Grey and Grey Literature Report databases for relevant literature using broad search terms. Prospective, retrospective and case-control studies in low- and middle-income countries involving children under five wherein relevant evidence were presented were included. Data were extracted from the articles and summarized. Fifty abstracts retrieved through the database searches met the initial screening criteria. Twelve additional documents were identified by review of the references of the documents found in the initial searches. Six documents representing five unique studies that presented evidence relevant to the research question were found. Four of the included studies took place in Bangladesh. One of the included studies took place in Sudan. Some measles vaccine effectiveness studies show lower diarrhea morbidity and mortality among the vaccinated. However, children who received vaccine may have differed in important ways from children who did not, such as health service utilization. Additionally, cohort studies following unvaccinated children showed no difference in diarrhea morbidity and mortality between cases and controls more than 4 weeks after measles rash onset. One study showed some evidence that severe measles may predispose children to gastroenteritis, but was not able to show a corresponding increase in the risk of diarrhea mortality. The available evidence

Microbiological diagnosis of infections caused by Campylobacter jejuni and Campylobacter coli in humans

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Natalia Rokosz

2014-01-01

Full Text Available Campylobacter jejuni and Campylobacter coli are Gram-negative, microaerophilic bacteria which are worldwide in distribution, causing a zoonotic disease in humans called campylobacteriosis. These infections are mainly caused by eating contaminated food products, most often improperly prepared poultry meat. Campylobacteriosis usually takes the form of gastroenteritis, or inflammation of the intestines, and the characteristic symptoms are watery-mucous diarrhea often with the presence of blood in stool, nausea, vomiting, abdominal pain and fever. The epidemiological data suggest that in Europe, as well as in North America, bacteria of the genus Campylobacter, especially C. jejuni and C. coli, are the most commonly isolated pathogens in infections of the gastrointestinal tract in humans. Epidemiological data indicate that these organisms are a much more common cause of acute diarrhea, mostly in young children, than Salmonella and Yersinia. The lack of specific symptoms makes the diagnosis of campylobacteriosis necessary to carry out specialized microbiological diagnostics. Because so far these studies are performed in our country only in a few laboratories, the overwhelming number of cases of campylobacteriosis are not recorded in Polish epidemiological statistics. The purpose of this paper is to discuss issues related to the microbiological diagnosis of infections caused by C. jejuni and C. coli. It also describes the basic epidemiological and clinical data, as well as current treatment of campylobacteriosis.

Risk Factors of Diarrhea in Children Under Five Years in Urban Slums

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Balakrishna Kalakheti

2016-12-01

Full Text Available Introduction: Diarrhea is a leading cause of mortality in children in developing countries and the condition is worse in slums. In order to provide effective preventive and management strategies, it is important to identify factors associated with the disease. This study was carried out to investigate the risk factors of diarrhea in  children under five years of age in urban slums. Methods: Parents of all children under five years from the urban slums of Tansen municipality, Palpa, Nepal were interviewed using a standardized pretested questionnaire and proforma. Parental variables, environmental factors, and presence of diarrhea in those children in past three months were collected by trained enumerators and the data were analyzed with statistical software SPSS-10. Results: A total of 450 under five years children were enrolled in the study. There were 216 (48% male and 234 (52% female children with F:M ratio of 1.08:1. Occurrence of diarrhea was lower if the children were breast-fed for more than six months, well-nourished, used fountain water for drinking, or used boiled or treated water. Similarly, diarrhea prevalence was lower if father had a regular job, daily income in the family was more than one US dollar, there was a toilet in the house, practice of hand washing was followed before feeding or preparing food, or there was no child suffering from diarrhea in the neighborhood. Conclusion: There are a few variables that are significantly related to diarrhea in children under five years of age. In order to decrease the diarrheal episodes in children in the slums of the developing countries, priority could be given in the improvement of those variables.

Viral etiology and incidence of acute gastroenteritis in young children attending day-care centers

DEFF Research Database (Denmark)

Rosenfeldt, Vibeke; Vesikari, Timo; Pang, Xiao-Li

2005-01-01

BACKGROUND: The purpose of the study was to investigate the frequency, morbidity and cause of acute gastroenteritis in children attending day-care centers in Denmark. METHODS: Children with acute diarrhea (> or =2 consecutive loose stools in 24 hours, with duration of ... 19 day-care centers, were included. Gastroenteritis viruses, group A rotavirus, sapoviruses, noroviruses and astroviruses were detected with reverse transcription-polymerase chain reaction assays. In addition, stool specimens were cultured for bacterial pathogens. Children who were brought...

Management of chemotherapy induced diarrhea (abstract)

International Nuclear Information System (INIS)

Qureshi, A.M.

1998-01-01

Diarrhoea is seen with many tumors and following several chemotherapy regimen esp. those containing 5-fluorouracil and high dose folinic acid it causes debility even death, delays cancer treatment, reduces compliance increases cost. It causes dehydration, renal failure volume depletion. Quality of life is worsened and hospitalization may be needed in multifactorial, with secretion; absorption imbalance due to mucosal damage, necrosis or inflammation. Local infection is set up by opportunistic organism and cell necrosis. The large volume of fluid and electrolytes overwhelms colonic absorptive capacity. Agent usually used for treatment is opioids (such as Diphenoxylate / Loperamide]. Bismuth (for inflammatory diarrhea). NSAIDs or alpha 2-agonists. For optimal management, the cause and severity should be assessed and treatment planned. Advice is given about certain dietary restraints and avoidance of some drugs. Fever, infection, dehydration and electrolyte losses are treated, pain relieved. Diphenoxylate / Loperamide (later is more effective; 4 mg, STAT, then 2mg every 4 hours or even 2 hourly) may be used. It is moderately effective in CID. Octreotide is useful in carcinoid. VIPoma, AIDS idiopathic secretary diarrhea, ileostomy, dumping syndrome. It acts directly on epithelial cells to reduce secretin, motilin pancreatic polypeptide. It slows transit time, reduces fluid and electrolyte secretin, increases absorption of electrolytes. It is effective in 5 FU and high dose chemotherapy with a 90% response rates seen after 3 days treatment. High Dose Chemotherapy and total body irradiation - induced diarrhea usually resolves within 72 hours. (author)

Diseases of the small bowel in chronic diarrhea: diagnosis and treatment

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M. Simadibrata

2002-09-01

Full Text Available The incidence of chronic diarrhea in Asia is between 0.8-1.0%. The diseases and abnormalities according to the location, which can cause chronic diarrhea, are divided into three locations: the small bowel, the large bowel and extraintestinal. The small bowel diseases include infectious and non-infectious diseases. The infectious diseases are bacterial infections, parasitic infections etc. The non-infectious diseases include of Crohn’s disease, Celiac sprue, NSAID enteropathy, lactose intolerance, benign tumor, carcinoid tumor, carcinoma, post surgery complications, laxative etc. The approaches to diagnosis include good anamnesis, careful physical examination, supporting laboratory tests, more specialized supporting examinations including X-ray of the colon, esophagogastroduodenum follow-through, enteroclysis, ileo-colonoscopy and endoscopy on the upper portion of the digestive tract including the small intestine with biopsy for histopathology examinations. The treatment for chronic diarrhea is divided into supportive and causal therapy. (Med J Indones 2002; 11: 179-89 Keywords: small bowel, chronic diarrhea, approaches to diagnosis, treatment

RISK FACTORS AND PECULIARITIES OF NUTRITION OF INFANTS WITH CHRONIC DIARRHEA

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T.S. Lazareva

2008-01-01

Full Text Available Results of observation of children from 2,5 months to 4 years old, treated in hospital with diagnosis chronic diarrhea are analyzed in this article. Diarrhea debuted in first year of living in most cases. The reason of onset of diarrhea often was alimentary factor. Hereditary predisposition, pathologic pregnancy, and diseases in women at the time of pregnancy played an important role in development of disease. Nutrition of children in early age was characterized by low duration of breast feeding and early conversion of children to the mixed and artificial feeding. Main food stuffs in children's nutrition on mixed and artificial feeding was adapted milk formulas, and rarely non adapted milk food (cow's and goat's milk, kefir. Only 30% of mothers had a definite knowledge of proper child's feeding and advantages of breast feeding. This fact indicates necessity of more active educational work by medical staff.Key words: children, chronic diarrhea, nutrition.

Diarrhea & Child Care: Controlling Diarrhea in Out-of-Home Child Care. NCEDL Spotlights, No. 4.

Science.gov (United States)

Churchill, Robin B.; Pickering, Larry K.

This report, the fourth in the National Center for Early Development and Learning's (NCEDL) "Spotlights" series, is based on excerpts from a paper presented during a "Research into Practice in Infant/Toddler Care" synthesis conference in fall 1997. The report addresses controlling diarrhea in out-of-home child care. The report…

Clinical Correlates of Diarrhea and Gut Parasites among Human Immunodeficiency Virus Seropositive Patients

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Elvis Bisong

2017-09-01

Full Text Available Cluster differentiation 4 (CD4 count estimation, which is not readily available in most resource poor settings in Nigeria, is an important indexdetermining commencement of antiretroviral therapy (ART. It is imperative for physicians who come in contact with these patients in such settings to recognize other parameters to evaluate these patients. The clinical correlates of diarrhea and gut parasites among human immunodeficiency virus (HIV-seropositive patients attending our special treatment clinic were studied. Three hundred and forty consenting HIV-positive adult subjects were enrolled. Their stool and blood specimens were collected for a period of three months. Stool samples were analyzed for the presence of diarrhea and gut parasites. The patients were clinically evaluated by physical examination for the presence of pallor, dehydration, oral thrush, wasting lymphadenopathy, dermatitis, skin hyperpigmentation, and finger clubbing. Participants with diarrhea represented 14.1% of the population, while 21.5% harbored one or more parasites. In the subjects with diarrhea, 14.6% harbored gut parasites. The presence of diarrhea was associated with a low CD4 count. Clinically, oral thrush, wasting, and rashes were more reliable predictors of low CD4 count levels; whereas, the presence of pallor, dehydration, wasting, and rashes correlated with the presence of diarrhea. HIV patients presenting with pallor, dehydration, wasting, and rashes should be evaluated for the presence of diarrhea. The clinical variables associated with low CD4 count in this study may guide commencing antiretroviral therapy in resource poor settings.

Rapid intestinal transit as a primary cause of severe chronic diarrhea in patients with amyloidosis.

Science.gov (United States)

Guirl, Michael J; Högenauer, Christoph; Santa Ana, Carol A; Porter, Jack L; Little, Katherine H; Stone, Marvin J; Fordtran, John S

2003-10-01

The cause of severe diarrhea in patients with systemic amyloidosis is obscure. We therefore performed pathophysiological studies in three such patients in an effort to determine the mechanism of amyloid diarrhea. Epithelial cell absorption rate of electrolytes was measured during steady state GI perfusion of a saline-mannitol solution. GI transit time of PEG and absorption of radiolabeled bile acid were measured simultaneously while subjects ingested three meals per day. To obtain a diarrhea control group for transit time and bile acid absorption, normal subjects were studied when they had diarrhea caused by ingestion of Milk of Magnesia (MOM). Diarrhea could not be explained by malabsorption of ingested nutrients, bacterial overgrowth, bile acid malabsorption, or epithelial cell malabsorption of electrolytes. However, 25% of polyethylene glycol (PEG) ingested with a standard meal was recovered in stool in 45 min, which is 10 times faster than in normal subjects with equally severe diarrhea caused by ingestion of MOM. All of the patients had autonomic neuropathy that remained unrecognized for 15-36 months after onset of chronic diarrhea; it seems likely that this was the cause of rapid transit. Severe chronic diarrhea in three patients with systemic amyloidosis was mediated by extremely rapid transit of chyme and digestive secretions through the intestine.

Acute toxicity of chemoradiation therapy (CRT) for rectal cancer: Impact of irradiated volume, type of surgery, sex and sequence of treatment modalities

International Nuclear Information System (INIS)

Fietkau, R.; Roedel, C.; Grabenbauer, G.G.; Kessler, H.; Martus, P.; Sauer, R.

1996-01-01

Purpose: In an attempt to reduce acute toxicity of CRT for rectal cancer we retrospectively evaluated potential factors that influence the severity of toxic side-effects. Materials and Methods: Between 1987 and 1995, 120 patients (pts, 73 with primary tumor, 47 with recurrent disease) received CRT for rectal cancer. RT was given by 3-4 field box technique with 6-10 MV-photons. Daily fraction size was 180 cGy, total dose 5040 cGy including 540 cGy local boost. Dose was specified to the ICRU reference point. During the first and fifth week of RT 5-FU (1000 mg/m 2 /24 h) was administered by continuous infusion for 120 hours. 56 pts received preoperative CRT, 64 pts were treated postoperatively. Toxicity was recorded following (modified) WHO-criteria. Results: Acute grade 4 toxicity was limited to 3 pts (leukopenia, sepsis, arrhythmia). Acute grade 3 toxicity occurred mainly as diarrhea (33%), perineal skin reaction (37%), and leukopenia (9%). Extension of the treatment volume including paraaortic lymph nodes (L3) led to a significant increase of grade 3 diarrhea (68% vs. 25%, p = 0,0003) and grade 3 leukopenia (18% vs. 8%, p = 0,03). After abdominoperineal resection less pts suffered from grade 3 diarrhea (8% vs. 47% after sphincter-preserving procedures, p = 0,0006), whereas severe perineal erythema occurred more frequently (56% vs. 29%, p = 0,02). Women had significantly more toxic side effects (grade 3 diarrhea: 39% vs. 16% in men, p = 0.04; grade 2 to 3 nausea/emesis: 21% vs. 8% in men, p = 0.018; grade 2 to 3 leukopenia: 53% vs. 31% in men, p = 0, 02). After preoperative CRT a significant reduction of grade 3 diarrhea (11% vs. 29%, p = 0.03) and grade 3 erythema (16% vs. 41%, p = 0.04) was noted. Conclusion: In order to reduce acute treatment related toxicity preoperative CRT deserves further evaluation. Careful attention should be paid to the extension of treatment volume to the paraaortic region. Individual adjustment of 5-FU dosage by monitoring its systemic

Socioeconomic, hygienic, and sanitation factors in reducing diarrhea in the Amazon

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Katiuscia Shirota Imada

Full Text Available ABSTRACT OBJECTIVE To analyze the contributions of the socioeconomic, hygienic, and sanitation improvements in reducing the prevalence of diarrhea in a city of the Amazon. METHODS In this population-based cross-sectional study, we analyzed data from surveys conducted in the city of Jordão, Acre. In 2005 and 2012, these surveys evaluated, respectively, 466 and 826 children under five years old. Questionnaires were applied on the socioeconomic conditions, construction of houses, food and hygienic habits, and environmental sanitation. We applied Pearson’s Chi-squared test and Poisson regression to verify the relationship between origin of water, construction of homes, age of introduction of cow’s milk in the diet, place of birth and the prevalence of diarrhea. RESULTS The prevalence of diarrhea was reduced from 45.1% to 35.4%. We identified higher probability of diarrhea in children who did not use water from the public network, in those receiving cow’s milk in the first month after birth, and in those living in houses made of paxiúba. Children born at home presented lower risk of diarrhea when compared to those who were born in hospital, with this difference reversing for the 2012 survey. CONCLUSIONS Sanitation conditions improved with the increase of bathrooms with toilets, implementation of the Programa de Saúde da Família (PSF – Family Health Program, and water treatment in the city. The multivariate regression model identified a statistically significant association between use of water from the public network, construction of houses, late introduction of cow’s milk, and access to health service with occurrence of diarrhea.

Diarrhea and the social marketing of oral rehydration salts in Bangladesh.

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Green, E C

1986-01-01

An anthropological study of knowledge, attitudes and practices relating to child diarrhea and specifically to ORS was carried out in Bangladesh. The purpose of the study was to help design a culturally-sensitive social marketing program. Information was gathered on indigenous classification of diarrheas, patterns of therapy recourse and diarrhea management, and understanding of dehydration symptoms as well as use and attitudes regarding ORS. Among the findings were that 58% of households sampled had tried ORS at least once; ORS was perceived as a medicine with several positive attributes; literacy was positively related to ORS use; and there were no significant cultural barriers to ORS adoption.

Is microscopic colitis a missed diagnosis in diarrhea-predominant Irritable Bowel Syndrome?

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Hamid Tavakoli

2008-08-01

Full Text Available

• BACKGROUND: There are controversies about the importance of biopsies of normal colon mucosa in the investigation of patients with diarrhea predominant irritable bowel syndrome (IBS. On the other hand, microscopic colitis may bemissed based on normal colonoscopy and laboratory examination in this group of patients
• METHODS: The study took place in Alzahra and Noor hospitals and Poursina Hakim Research Institute, from 2002 to 2004. Eligible patients were those suffering from diarrhea for at least 4 weeks. A total of 138 patients were included in the study after meeting Rome criteria (II with normal CBC, ESR, stool examination and no endoscopic abnormality.
• RESULTS: The histologic findings in 138 patients with diarrhea predominant IBS with mean age of 34.7 years (female 55.1% and male 44.9% were as follows: 10 patients (7.2% had collagenous colitis and 3 patients (2.2% were compatible with lymphocytic colitis. No significant diagnostic histologic findings were seen in the rest of patients. Collagenouscolitis was detected in 13% of right colon biopsies and in 10% of sigmoid and transverse colon biopsies. Nocturnal diarrhea was found in 30% of collagenous colitis patients.
• CONCLUSIONS: Total colonoscopy and multiple biopsies in diarrhea predominant IBS patients are necessary for earlydiagnosis of microscopic colitis.
• KEY WORDS: Irritable bowel syndrome, microscopic colitis, colonoscopy, biopsy, diarrhea.

Zinc treatment ameliorates diarrhea and intestinal inflammation in undernourished rats

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de Queiroz, Camila AA; Fonseca, Said Gonçalves C; Frota, Priscila B; Figueiredo, Ítalo L; Aragão, Karoline S; Magalhães, Carlos Emanuel C; de Carvalho, Cibele BM; Lima, Aldo Ângelo M; Ribeiro, Ronaldo A; Guerrant, Richard L; Moore, Sean R; Oriá, Reinaldo B

2014-01-01

Background WHO guidelines recommend zinc supplementation as a key adjunct therapy for childhood diarrhea in developing countries, however zinc’s anti-diarrheal effects remain only partially understood. Recently, it has been recognized that low-grade inflammation may influence stunting. In this study, we examined whether oral zinc supplementation could improve weight, intestinal inflammation, and diarrhea in undernourished weanling rats. Methods Rats were undernourished using a northeastern Br...

Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose.

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Hammer, H F; Santa Ana, C A; Schiller, L R; Fordtran, J S

1989-01-01

The purpose of these studies was to gain insight into the pathophysiology of pure osmotic diarrhea and the osmotic diarrhea caused by carbohydrate malabsorption. Diarrhea was induced in normal volunteers by ingestion of polyethylene glycol (PEG), which is nonabsorbable, not metabolized by colonic bacteria, and carries no electrical charge. In PEG-induced diarrhea, (a) stool weight was directly correlated with the total mass of PEG ingested; (b) PEG contributed 40-60% of the osmolality of the ...

Comparison of endogenous and radiolabeled bile acid excretion in patients with idiopathic chronic diarrhea

International Nuclear Information System (INIS)

Schiller, L.R.; Bilhartz, L.E.; Santa Ana, C.A.

1990-01-01

Fecal recovery of radioactivity after ingestion of a bolus of radiolabeled bile acid is abnormally high in most patients with idiopathic chronic diarrhea. To evaluate the significance of this malabsorption, concurrent fecal excretion of both exogenous radiolabeled bile acid and endogenous (unlabeled) bile acid were measured in patients with idiopathic chronic diarrhea. Subjects received a 2.5-microCi oral dose of taurocholic acid labeled with 14C in the 24th position of the steroid moiety. Endogenous bile acid excretion was measured by a hydroxysteroid dehydrogenase assay on a concurrent 72-h stool collection. Both radiolabeled and endogenous bile acid excretion were abnormally high in most patients with chronic diarrhea compared with normal subjects, even when equivoluminous diarrhea was induced in normal subjects by ingestion of osmotically active solutions. The correlation between radiolabeled and endogenous bile acid excretion was good. However, neither radiolabeled nor endogenous bile acid excretion was as abnormal as is typically seen in patients with ileal resection, and none of these diarrhea patients responded to treatment with cholestyramine with stool weights less than 200 g. These results suggest (a) that this radiolabeled bile acid excretion test accurately reflects excess endogenous bile acid excretion; (b) that excess endogenous bile acid excretion is not caused by diarrhea per se; (c) that spontaneously occurring idiopathic chronic diarrhea is often associated with increased endogenous bile acid excretion; and (d) that bile acid malabsorption is not likely to be the primary cause of diarrhea in most of these patients

Rotavirus I in feces of a cat with diarrhea.

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Phan, Tung G; Leutenegger, Christian M; Chan, Roxanne; Delwart, Eric

2017-06-01

A divergent rotavirus I was detected using viral metagenomics in the feces of a cat with diarrhea. The eleven segments of rotavirus I strain Felis catus encoded non-structural and structural proteins with amino acid identities ranging from 25 to 79% to the only two currently sequenced members of that viral species both derived from canine feces. No other eukaryotic viral sequences nor bacterial and protozoan pathogens were detected in this fecal sample suggesting the involvement of rotavirus I in feline diarrhea.

Antidiarrheal Medicines: OTC Relief for Diarrhea

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... types of OTC medicines treat diarrhea? You can buy over-the-counter (OTC) medicines without a prescription from your doctor. Some OTC ... short for "over-the-counter." OTC drugs are medicines you can buy without a prescription from your doctor. About Support ...

Watery rot of pseudo-stem (Dickeya sp. management in banana (Musa sp. under greenhouse conditions

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Joaquín Guillermo Ramírez

2014-12-01

Full Text Available This crop has serious constraints with diseases, including those caused by bacteria, such as Dickeya sp. This research aimed to evaluate the effect of 4 resistance inductors and 3 doses in Chlorine Dioxide in handling watery rot of pseudo-stem (Dickeya sp. in banana. Resistance inducers and their doses were Potassium Phosphite: 1.5 cm 3 .l -1 ; 3-Aminobutanoic Acid: 1.0 g.l -1 ; Methyl Jasmonate: 0.2 g.l -1 ; S-Methyl-Acibenzolar: 0.3 ml.l -1 , all by foliar application, while Chlorine Dioxide was injected into the pseudo-stem, in doses of 10, 20 and 30 mg.l -1 . The evaluated variables were: development of the disease, total biomass and quantification of the bacterium in the inoculated pseudo-stems. Applications of Chlorine Dioxide achieved a reduction of disease by 65.4, 91.99 and 61.5%, in addition to an inhibition of 100% of the pathogen, using 30 and 50 mg.l -1 doses. Meanwhile, the use of resistance inductors reduced up to 60.6% of the disease, but this effect failed to improve plant growth.

Therapeutic Targeting of CPT-11 Induced Diarrhea: A Case for Prophylaxis

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Swami, Umang; Goel, Sanjay; Mani, Sridhar

2014-01-01

CPT-11 (irinotecan), a DNA topoisomerase I inhibitor is one of the main treatments for colorectal cancer. The main dose limiting toxicities are neutropenia and late onset diarrhea. Though neutropenia is manageable, CPT-11 induced diarrhea is frequently severe, resulting in hospitalizations, dose reductions or omissions leading to ineffective treatment administration. Many potential agents have been tested in preclinical and clinical studies to prevent or ameliorate CPT-11 induced late onset diarrhea. It is predicted that prophylaxis of CPT-11 induced diarrhea will reduce sub-therapeutic dosing as well as hospitalizations and will eventually lead to dose escalations resulting in better response rates. This article reviews various experimental agents and strategies employed to prevent this debilitating toxicity. Covered topics include schedule/dose modification, intestinal alkalization, structural/chemical modification, genetic testing, anti-diarrheal therapies, transporter (ABCB1, ABCC2, BCRP2) inhibitors, enzyme (β-glucuronidase, UGT1A1, CYP3A4, carboxylesterase, COX-2) inducers and inhibitors, probiotics, antibiotics, adsorbing agents, cytokine and growth factor activators and inhibitors and other miscellaneous agents. PMID:23597015

Impact of Clostridium difficile-associated diarrhea on acute care length of stay, hospital costs, and readmission: A multicenter retrospective study of inpatients, 2009-2011.

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Magee, Glenn; Strauss, Marcie E; Thomas, Sheila M; Brown, Harold; Baumer, Dorothy; Broderick, Kelly C

2015-11-01

The recent epidemiologic changes of Clostridium difficile-associated diarrhea (CDAD) have resulted in substantial economic burden to U.S. acute care hospitals. Past studies evaluating CDAD-attributable costs have been geographically and demographically limited. Here, we describe CDAD-attributable burden in inpatients, overall, and in vulnerable subpopulations from the Premier hospital database, a large, diverse cohort with a wide range of high-risk subgroups. Discharges from the Premier database were retrospectively analyzed to assess length of stay (LOS), total inpatient costs, readmission, and inpatient mortality. Patients with CDAD had significantly worse outcomes than matched controls in terms of total LOS, rates of intensive care unit (ICU) admission, and inpatient mortality. After adjustment for risk factors, patients with CDAD had increased odds of inpatient mortality, total and ICU LOS, costs, and odds of 30-, 60- and 90-day all-cause readmission versus non-CDAD patients. CDAD-attributable costs were higher in all studied vulnerable subpopulations, which also had increased odds of 30-, 60- and 90-day all-cause readmission than those without CDAD. Given the significant economic impact CDAD has on hospitals, prevention of initial episodes and targeted therapy to prevent recurrences in vulnerable patients are essential to decrease the overall burden to hospitals. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Solanum paniculatum root extract reduces diarrhea in rats

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Jonh A.B. Tenório

Full Text Available Abstract Solanum paniculatum L., Solanaceae, locally known as "jurubeba", is widely used in Brazil for culinary purposes, and in folk medicine to treat of diverse disorder including gastric dysfunctions. In this study we investigated the antidiarrheal activity of S. paniculatum roots extract in rats at different concentrations (125, 250 and 500 mg/kg, p.o using different experimental models such as castor oil-induced diarrhea, enteropooling and gastrointestinal motility, determined by in vivo experimental models. The major compound of root extract was characterized as chlorogenic acid based in the IR, 1D and 2D NMR analysis. All the extract doses achieved antidiarrheal potency, as indicated by reduced weight of feces in castor oil-induced diarrhea, decreased intestinal motility and significantly inhibited castor oil-induced enteropooling compared to the vehicle group. The highest dose (500 mg/kg produced greater anti-motility effect and better reduction of enteropooling, similar to the reference drug Loperamide (5 mg/kg. Extract from S. paniculatum L. roots had antidiarrheal activity, as shown by the lower weight of the feces as well as decrease in the accumulation of intestinal fluid and slower transit, justifying the traditional use of plant for diarrhea.

Congenital chloride diarrhea misdiagnosed as pseudo-Bartter syndrome.

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Saneian, Hossein; Bahraminia, Emad

2013-09-01

Congenital chloride diarrhea (CCD) is a rare autosomal recessive disease which is characterized by intractable diarrhea of infancy, failure to thrive, high fecal chloride, hypochloremia, hypokalemia, hyponatremia and metabolic alkalosis. In this case report, we present the first female and the second official case of CCD in Iran. A 15-month-old girl referred to our hospital due to failure to thrive and poor feeding. She had normal kidneys, liver and spleen. Treating her with Shohl's solution, thiazide and zinc sulfate did not result in weight gain. Consequently, pseudo-Bartter syndrome was suspected, she was treated with intravenous (IV) therapy to which she responded dramatically. In addition, hypokalemia resolved quickly. Since this does not usually happen in patients with the pseudo-Bartter syndrome, stool tests were performed. Abnormal level of chloride in stool suggested CCD and she was thus treated with IV fluid replacement, Total parentral nutrition and high dose of oral omeprazole (3 mg/kg/day). She gained 1 kg of weight and is doing fine until present. CCD is a rare hereditary cause of intractable diarrhea of infancy. It should be considered in infants with unknown severe electrolyte disturbances.

Effective prophylaxis against rotavirus diarrhea using a combination of Lactobacillus rhamnosus GG and antibodies

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Hammarström Lennart

2007-09-01

Full Text Available Abstract Background Rotavirus is a worldwide cause of infectious infantile diarrhea that claims over 600,000 lives annually. Recently, two new vaccine candidates have been developed but their efficacy in developing countries, still remains to be proven. Oral delivery of specific immunoglobulins provides passive immunity and is a fast acting treatment for rotavirus diarrhea. Probiotic bacteria have also gained considerable attention lately as treatment for rotavirus diarrhea. Here we report an evaluation of the therapeutic potential of different probiotics and their combination with anti – rotavirus antibodies in a mouse model of rotavirus diarrhea. Results Of the six probiotic bacteria tested, Lactobacillus rhamnosus strain GG had the strongest influence in reducing prevalence, duration and severity of diarrhea and was therefore chosen for combination treatment with immunoglobulins. The combination treatment reduced the diarrhea outcome measures significantly, prevented histopathological changes and reduced the virus load in the intestines. Conclusion The advantages associated with immunoglobulins and probiotics based therapy is that the treatment provides a rapid therapeutic effect and is cost efficient. These components do not require special storage conditions and could potentially complement the rehydration therapy that is currently used.

Meta-analysis of staphylococcal diarrhea in some developing African countries

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George P. Einstein

2017-06-01

Full Text Available Staphylococcal diarrhea is a common gastro-intestinal illness caused by poor water supply and unhygienic food preparation. Although, about 70% of diarrheal cases per year have been attributed to the consumption of contaminated foods, in Africa, few studies have reported the incidence of Staphylococcus-related diarrhea and the implicated virulence factors. We investigated the implications of common factors such as age of children, age of mothers, maternal level of education, gender of children, overall bacteria isolated, sanitary condition status and feeding type of mothers on the burden of staphylococcal diarrhea. A literature search was performed using Pubmed, Googlescholar, American society for microbiology (ASM journals and other sources. The quality of studies was assessed. Adjusted odds ratios with 95% confidence intervals (CI for the occurrence of Staphylococcus aureus amongst other causes were extracted. For each study, a multivariate logistic regression analysis of the adjusted odds ratio was performed to identify the risk factors on the burden of staphylococcal diarrhea. Six case-control studies were included in the meta–analysis. Quality of individual studies rages from 0.57–0.84 (median, 0.69. meta-analysis gave pooled odds ratios 3.27 (95% CI; 2.88–4.17. The results identified inadequate sanitary conditions and type of feeding as major risk factors.

Assessment of chronic diarrhea in early infancy in Tehran Tertiary Care Center; Tehran-Iran

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Farzaneh Motamed; Naheid Kazemi; Raheleh Nabavizadeh

2015-01-01

Introduction Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was investigating chronic diarrhea, its etiologies, clinical features and outcomes in infancy.Materials and Methods Retrospective study investigating infants hospitalized in the gastroenterology department of Tehran tertiary care center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyze...

Watery and dark axons in Wallerian degeneration of the opossum's optic nerve: different patterns of cytoskeletal breakdown?

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MARCELO S. NARCISO

2001-06-01

Full Text Available In this paper we report a qualitative morphological analysis of Wallerian degeneration in a marsupial. Right optic nerves of opossums Didelphis marsupialis were crushed with a fine forceps and after 24, 48, 72, 96 and 168 hours the animals were anaesthetized and perfused with fixative. The optic nerves were immersed in fixative and processed for routine transmission electron microscopy. Among the early alterations typical of axonal degeneration, we observed nerve fibers with focal degeneration of the axoplasmic cytoskeleton, watery degeneration and dark degeneration, the latter being prevalent at 168 hours after crush. Our results point to a gradual disintegration of the axoplasmic cytoskeleton, opposed to the previous view of an "all-or-nothing'' process (Griffin et al 1995. We also report that, due to an unknown mechanism, fibers show either a dark or watery pattern of axonal degeneration, as observed in axon profiles. We also observed fibers undergoing early myelin breakdown in the absence of axonal alterations.Neste trabalho, relatamos uma análise morfológica qualitativa da degeneração Walleriana em um marsupial. Os nervos ópticos direito de gambás da espécie Didelphis marsupialis foram esmagados com uma pinça fina. Após 24, 48, 72, 96 e 168 horas, os animais foram anestesiados e perfundidos com fixador. A seguir, os nervos foram imersos em fixador e processados para microscopia eletrônica de rotina. Entre as alterações precoces típicas da degeneração, observamos fibras nervosas com degeneração focal do citoesqueleto axoplasmático, degeneração aquosa e degeneração escura, com o último tipo prevalente às 168 horas após esmagamento. Nossos resultados indicam uma desintegração gradual do citoesqueleto axoplasmático, oposta à prévia visão de um processo "tudo-ou-nada''. Relatamos também que, devido a um mecanismo desconhecido, as fibras mostram ou um padrão aquoso ou um padrão escuro de degeneração axonal

Celiac Disease Presenting as Profound Diarrhea and Weight Loss - A Celiac Crisis.

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Bul, Vadim; Sleesman, Brett; Boulay, Brian

2016-08-05

BACKGROUND Celiac disease is a hypersensitivity enteropathy that can have various presentations in adults. Rarely, patients can present with severe lab abnormalities, dehydration and weight loss caused by celiac disease - a celiac crisis. CASE REPORT A 46-year-old male with a past medical history significant for diabetes mellitus, type 2 (DM2) and recently treated Bell's Palsy presented to the emergency room complaining of weakness, diarrhea and lightheadedness. On presentation, the patient had a systolic blood pressure (SBP) of 60 mm Hg and a lactic acidosis with pH of 7.28. Infectious etiologies of diarrhea were ruled out. The patient had an EGD which showed erythema of the duodenal bulb. Serum anti-gliadin and anti-TTG IgA were both elevated suggesting Celiac disease. Biopsies showed histopathology consistent with celiac disease. The patient's diarrhea resolved after initiation of a gluten free diet. He gained 25 kilograms after discharge and did not require further hospitalizations for diarrhea. CONCLUSIONS Celiac crisis is a very rare presentation of celiac disease in adults but nonetheless should be considered in patients with marked metabolic derangements in the setting of osmotic diarrhea. Treatment consists of a gluten free diet and may require management with steroids and total parenteral nutrition (TPN).

Modelo de indução de diarréia osmótica em bezerros holandeses Model for osmotic diarrhea in holstein calves

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Marta Lizandra do Rego Leal

2008-09-01

Full Text Available Com o objetivo de avaliar um protocolo de diarréia osmótica induzida, foram utilizados 18 bezerros hígidos, com idade entre oito e 30 dias de vida, e peso variando de 37 a 50kg. A diarréia e a desidratação foram induzidas por meio da administração de leite integral (16,5mL kg-1, sacarose (4g kg-1, espirolactona e hidroclorotiazida (2mg kg-1, a cada oito horas, durante dois dias. O exame físico e as coletas de sangue para determinações de componentes do hemograma, hemogasometria e de constituintes bioquímicos foram realizados em T0 (0h, T1 (24hi e T2 (48hi. O protocolo de indução da diarréia obteve 100% de eficiência, produzindo diarréia aquosa e desidratação intensa (13% do peso corpóreo acompanhadas de azotemia pré-renal, aumento nos valores do hematócrito, hemoglobina e proteína total, hipercalemia, hiperlactemia, hiperfosfatemia, acidose metabólica e diminuição do défict de volume plasmático e da pressão venosa central.Eighteen health Holstein calves between 18 and 30 days old and 37 weighting 50kg (body weight - BW were used to develop a model for inducing osmotic diarrhea in order to cause a status of dehydration. Thus, sucrose (4g kg BW-1 and spirolactone and hydrochlorothiazide (2mg g BW-1 were added to the whole milk (16.5mL kg-1 each 8h for two days. Physical examination and blood samples for hemogram, acid:base status and biochemical analysis were obtained at 0 (T0, 24h (T1 and 48h (T2. Watery diarrhea and severe dehydration (13% of the BW were seen in all calves, followed by pre-renal azotemia, high values of hematocrit, hemoglobin and total protein levels, hiperkalemia, hyperlactemia, and hyperphosphatemia, metabolic acidosis and decreased plasma volume and central venous pressure.

[Effect of glutamine on small intestinal repair in weanling rats after chronic diarrhea].

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Huang, Zu-xiong; Ye, Li-yan; Zheng, Zhi-yong; Chen, Xin-min; Ren, Rong-na; Tong, Guo-yuan

2005-05-01

To investigate the nutrient effect of glutamine on small intestinal repair in weanling rats after chronic diarrhea. Forty 21-day-old wistar rats were randomly divided into five groups (8 in each). Animal model of chronic diarrhea was induced by a lactose enriched diet in the weanling Wistar rat, normal control group was fed with a standard semipurified diet, and after 14 days the rats in both groups were killed to test the establishment of the model. After the establishment of the model, the other groups were fed with the standard semipurified diet to recover for 7 days, and were randomly divided into three groups: non-intervention group, glutamine (Gln)-intervention group and control group. Glutamine concentrations in blood was detected by high-performance liquid chromatography (HPLC). Morphological changes including villus height and villus surface area of the jejunum were measured under a light microscope and electron microscope, expression of proliferating cell nuclear antigen (PCNA) as an index of cell proliferation was observed using immunohistochemical staining and image analysis. The diarrhea rate in model group was 100 percent, average diarrhea index was 1.16 +/- 0.06, but both diarrhea rate and average diarrhea index in control group were 0 (P body weight, plasma Gln concentration, villus height, villus surface area and expression of PCNA in non-intervened group compared with the control group (P body weight, villus height and villus surface area in Gln-intervened group compared with control group (P 0.05). And compared with non-intervened group, except for body weight (P > 0.05), plasma glutamine, villus height, villus surface area and expression of PCNA were all significantly increased in Gln-intervened group. Chronic diarrhea can induce malnutrition and reduce the villus height, villus surface area, expression of PCNA and plasm glutamine concentration. Oral glutamine could improve the proliferation of crypt cell and promote repair of intestinal mucosa

Acute toxicity after a diverting stoma and spacer prior to chemoradiation in locally advanced rectal cancer

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Van Der Voort Van Zyp, Jochem R N; Ceha, Heleen M.; Niehe, Valerie; Marinelli, Andreas W K S; Putter, Hein; Marijnen, Corrie A M

2015-01-01

Abstract Background and purpose Chemoradiotherapy (CRT) followed by surgery is the standard of care for locally advanced rectal cancer (LARC). For grade ≥3 acute diarrhea there is a relationship between dose and irradiated small bowel volume. The aim of this study was to evaluate whether combined

Investigation of a cholera outbreak in a tea garden of Sivasagar district of Assam

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Bhupendra Narayan Mahanta

2013-01-01

Full Text Available Background: In late May 2012, Bagjan division of Borbam tea estate, of Sivasagar district of Assam was affected by an outbreak of acute watery diarrhea, subsequently confirmed as Vibrio cholerae O1. Objectives: Our objective is to investigate and control the acute diarrheal disease outbreak in Sivasagar district of Assam. Materials and Methods: A physician-epidemiologist-led team did rapid outbreak investigation to confirm the outbreak and instituted treatment and control measures. Quantitative data collection was done using standard schedule and qualitative data by using key informant interview schedule. Results: Spot mapping of cases was done along the garden residential lines. About 120 suspected cases were line listed; with 1:1.23 male: female ratio. Ages ranged from 3 to 70 years (median - 40.5 years. Attack rate was 4.79% with one death; case fatality rate was 0.83%. Open air defecation was practiced by 94.6%. Rectal swabs were positive for V. cholerae O1 (Ogawa. All the piped water samples were class IV unsatisfactory for domestic use. Conclusions: There is a need to improve water and sanitation facility in the tea garden lines along with implementation of a strengthened disease surveillance system through integrated disease surveillance project covering all tea estates.

[Cow's milk protein sensitive enteropathy].

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Harms, H K

1982-01-01

Cow's milk protein sensitive enteropathy (CMPSE) is characterized by the following items: 1. The great majority of affected infants have not been breast fed or only for a few days. Additional risks are immaturity, preceding enteritis, trisomy 21, and abdominal operation in the newborn. 2. Half of the patients become ill during the first two weeks after starting cow's milk formula. The main symptoms are watery, mucus containing diarrhea, vomiting, abdominal distension, pallor and rapid weight loss. 3. In CMPSE the small intestinal mucosa shows varying degrees of inflammation and villous atrophy. Bloody stools refer to large bowel affection. 4. CMPSE is always transitory and usually persists for less than one year. Inadequate treatment leads to "severe protracted diarrhea" or "intractable diarrhea" syndrome. Soya-based formula should not be the diet of first choice, since secondary intolerance to soya proteins will frequently develop. Exclusive breast feeding during the first months of life is the best prophylaxis of CMPSE.

Effect of gum arabic in an oral rehydration solution on recovery from diarrhea in rats.

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Teichberg, S; Wingertzahn, M A; Moyse, J; Wapnir, R A

1999-10-01

It has been shown that gum arabic, a soluble fiber, enhances water, electrolyte, and glucose absorption from oral rehydration solutions in jejunal perfusion of healthy rats and in animals with theophylline-induced secretion or chronic osmotic-secretory diarrhea. This report concerns a study of the effectiveness of an oral rehydration solution supplemented with gum arabic, during recovery from chronic osmotic secretory diarrhea in free-living rats. Chronic diarrhea was induced in 60- to 80-g juvenile rats by providing a magnesium citrate-phenolphthalein solution as the sole fluid source for 7 days. This led to diarrhea characterized by dehydration, soft stools, increased cecal volume, decreased food and fluid intake and failure to gain weight. After 7 days of diarrhea, rats recovered for 24 hours with either tap water or an oral rehydration solution (90 mM Na, 111 mM glucose, 20 mM K, 80 mM chloride, 20 mM citrate) with or without 2.5 g/l gum arabic. Although all three solutions improved the diarrhea, optimal recovery from diarrhea was achieved with the gum arabic-supplemented oral rehydration solution. After 4 hours and 24 hours, rats drinking the gum arabic-supplemented solution gained more weight and had lower fecal output than rats receiving water or the rehydration solution without gum arabic. All three solutions normalized plasma osmolality after 24 hours. The positive effects of the gum arabic-supplemented rehydration solution on fluid and electrolyte absorption seen during jejunal perfusion also occurred during recovery from chronic osmotic secretory diarrhea, when free-living animals drank the solution ad libitum.

[A prospective control study of Saccharomyces boulardii in prevention of antibiotic-associated diarrhea in the older inpatients].

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Zhang, D M; Xu, B B; Yu, L; Zheng, L F; Chen, L P; Wang, W

2017-06-01

Objective: To study the value of Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in older inpatients. Methods: A total of 163 older patients who were treated with wide-spectrum antibiotics at least three days during January 2014 to December 2015 were randomly divided into control and study group. In study group, 81 patients were administrated with oral Saccharomyces boulardii 500 mg twice a day for 21 days. The control group was of no intervention. Morbidity rate of antibiotic-associated diarrhea and Clostridium difficile -associated diarrhea, frequency and duration of diarrhea were recorded. Results: The incidence of antibiotic-associated diarrhea in study group was significantly lower than that in control group [14.8%(12/81) vs 28.0%(23/82), P 0.05] in two groups. The frequency and duration of diarrhea in the study group were significantly lower and shorter than those in control group[(4.3±1.7) times/day vs (6.9±2.0) times/day; (3.0±1.1) days vs (5.7±1.8) days, both P Saccharomyces boulardii may reduce the incidence of antibiotic-associated diarrhea therefore improving the symptom of diarrhea in older inpatients.

Epidemiology and vaccine of porcine epidemic diarrhea virus in China: a mini-review.

Science.gov (United States)

Sun, Dongbo; Wang, Xinyu; Wei, Shan; Chen, Jianfei; Feng, Li

2016-03-01

Porcine epidemic diarrhea (PED) is an intestinal infectious disease caused by porcine epidemic diarrhea virus (PEDV); manifestations of the disease are diarrhea, vomiting and dehydration. Starting from the end of 2010, a PED outbreak occurred in several pig-producing provinces in southern China. Subsequently, the disease spread throughout the country and caused enormous economic losses to the pork industry. Accumulating studies demonstrated that new PEDV variants that appeared in China were responsible for the PED outbreak. In the current mini-review, we summarize PEDV epidemiology and vaccination in China.

An uncommon cause of unexplained nonbloody diarrhea: When mind knows eyes may see

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Hemanta Kumar Nayak

2016-01-01

Full Text Available Collagenous colitis (CC is characterized by chronic secretory diarrhea with the apparently normal gross appearance of the colonic mucosa. A biopsy is usually diagnostic. The symptoms of CC appear most commonly in the elderly. In CC, the major microscopic characteristic is a thickened collagen layer beneath the colonic mucosa. The reported case represents unexplained nonbloody diarrhea of a systemic lupus erythematosus patient, on extensive evaluation found to have CC. This case highlights the importance of considering a rare possibility of CC as a differential in a patient of unexplained nonbloody diarrhea.

The application of 1,8-cineole, a terpenoid oxide present in medicinal plants, inhibits castor oil-induced diarrhea in rats.

Science.gov (United States)

Jalilzadeh-Amin, Ghader; Maham, Massoud

2015-04-01

1,8-Cineole, a terpene, characterized as a major constituent occurring in the essential oils of several aromatic plants. It is widely used in pharmaceutical industry, as a food additive and for culinary purposes. This study investigates the inhibitory effect of 1,8-cineole on transit time and diarrhea in animal models. Acute toxicity and lethality of 1-8-cineole was determined by Lork's guidelines. The antidiarrheal effect of 1,8-cineole was investigated by determining the intestinal transit and enterpooling in rats. In all experiments, different doses of 1,8-cineole (20-120 mg/kg), atropine, and loperamide were administered orally. The LD50 of 1,8-cineole for oral administration was estimated to be 1280 mg/kg. 1,8-Cineole (20-120 mg/kg) did not show a significant decrease in small intestine transit (p > 0.05); however, the highest dose displayed a significant decrease in comparison with atropine (p castor oil transit test. 1,8-Cineole significantly delayed the onset of diarrhea to -142.33 ± 6.08 min at 120 mg/kg, while the time was 103.66 ± 20.73 min for the control and >240 min for the loperamide. Moreover, 1,8-cineole significantly decreased intestinal fluid accumulation (p < 0.05). This study demonstrated antispasmodic and antisecretory activities of 1,8-cineole and rationalized the traditional use of the plant containing various levels of this terpene in the treatment of gastrointestinal complains such as diarrhea.

Disposal of children's stools and its association with childhood diarrhea in India.

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Bawankule, Rahul; Singh, Abhishek; Kumar, Kaushalendra; Pedgaonkar, Sarang

2017-01-05

Children's stool disposal is often overlooked in sanitation programs of any country. Unsafe disposal of children's stool makes children susceptible to many diseases that transmit through faecal-oral route. Therefore, the study aims to examine the magnitude of unsafe disposal of children's stools in India, the factors associated with it and finally its association with childhood diarrhea. Data from the third round of the National Family Health Survey (NFHS-3) conducted in 2005-06 is used to carry out the analysis. The binary logistic regression model is used to examine the factors associated with unsafe disposal of children's stool. Binary logistic regression is also used to examine the association between unsafe disposal of children's stool and childhood diarrhea. Overall, stools of 79% of children in India were disposed of unsafely. The urban-rural gap in the unsafe disposal of children's stool was wide. Mother's illiteracy and lack of exposure to media, the age of the child, religion and caste/tribe of the household head, wealth index, access to toilet facility and urban-rural residence were statistically associated with unsafe disposal of stool. The odds of diarrhea in children whose stools were disposed of unsafely was estimated to be 11% higher (95% CI: 1.01-1.21) than that of children whose stools were disposed of safely. An increase in the unsafe disposal of children's stool in the community also increased the risk of diarrhea in children. We found significant statistical association between children's stool disposal and diarrhea. Therefore, gains in reduction of childhood diarrhea can be achieved in India through the complete elimination of unsafe disposal of children's stools. The sanitation programmes currently being run in India must also focus on safe disposal of children's stool.

Antibiotic-associated diarrhea and the older dental patient: how do dentists respond?

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Zwetchkenbaum, Samuel R; Overbeck, Kevin J; Pomerantz, Sherry C

2015-01-01

Gastrointestinal complications from antibiotic use, including Clostridium difficile infection (CDI), can have significant morbidity, especially among older patients. This descriptive study surveyed dentists to find out how they would respond to a patient with signs indicating potential CDI. A survey on prescribing medications for older patients was mailed to 1,000 dentists in New Jersey. Questions were asked regarding antibiotic selection, probiotic use, and approach to a patient scenario of diarrhea after antibiotic use. Respondents chose amoxicillin most frequently as an antibiotic, and clindamycin if penicillin allergy. When informed their patients had diarrhea, 64.5% advised them to stop the antibiotic. If the patient continued to have diarrhea on follow-up, 75.5% contacted the patient's physician. Most (61.6%) do not prescribe probiotics prophylactically. Most dentists respond appropriately to antibiotic-associated diarrhea in advising to stop the antibiotic, and seeking physician involvement if no improvement, but there are still many who make recommendations that could delay appropriate care. Dentists may wish to learn more about benefits of probiotics. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.

A case of acute diarrhea due to the emerging pathogen Campylobacter jejuni subsp. doylei in Southern Chile Um caso de diarréia aguda devido ao patógeno emergente Campylobacter jejuni subsp. doylei no sul do Chile

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Heriberto Fernández

2003-04-01

Full Text Available The first documented case of acute diarrhea due to C. jejuni subsp. doylei in Chile is reported. The clinical findings, the absence of other enteropathogens, virus or parasites and the fact that C. jejuni subsp. doylei was the only bacteria isolated support the assumption that it was the etiological agent of this diarrheal case.O primeiro caso documentado de diarréia aguda por C. jejuni subsp. doylei no sul do Chile é apresentado. As características clínicas, a ausência de outros enteropatógenos, vírus ou parasitas, e o fato de C. jejuni subsp. doylei ter sido a única bactéria isolada, permitem assumir que este microrganismo é o agente etiológico neste caso de diarréia.

Suppressive effect of cellulose on osmotic diarrhea caused by maltitol in healthy female subjects.

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Oku, Tsuneyuki; Hongo, Ryoko; Nakamura, Sadako

2008-08-01

Using a single-group time-series design, we determined that osmotic diarrhea caused by maltitol ingestion was suppressed by the addition of not only soluble but also insoluble dietary fiber in healthy humans. We then clarified that cellulose delayed gastric emptying in rats. Twenty-seven healthy volunteers ingested maltitol step-wise at doses of 15, 20, 25, 30, 35, 40 and 45 g from small to large amounts. Within that range of ingested amounts, 22 out of 27 subjects experienced osmotic diarrhea from maltitol ingestion, and the minimal dose level of maltitol that induced osmotic diarrhea (MMD) was established for each subject. When 5 g of cellulose was added to the MMD, osmotic diarrhea was suppressed in 13 out of 19 subjects (68.4%), while partially hydrolyzed alginate-Na (PHA-Na), a soluble dietary fiber, suppressed osmotic diarrhea in 10 out of 20 subjects (50.0%). When a mixed solution of cellulose and maltitol was administered to rats, the gastric emptying of maltitol was significantly delayed at 30 and 60 min after administration (p=0.019, p=0.013), respectively. PHA-Na also significantly delayed gastric emptying at 30 min (p=0.013). In conclusion, cellulose can suppress the osmotic diarrhea caused by maltitol ingestion in humans and delay the gastric emptying of maltitol in rats. A new physiological property of cellulose was clarified in this study.

Extracellular Calcium Dictates Onset, Severity, and Recovery of Diarrhea in a Child with Immune-Mediated Enteropathy

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Johnathan Fraebel

2018-01-01

Full Text Available Diarrhea causes monovalent and divalent ion losses that can influence clinical outcome. Unlike the losses of monovalent ions, such as Na+, K+, Cl−, and HCO3−, which are generally large in quantity (osmoles and therefore determine the severity of diarrhea, the losses of divalent ions are relatively small in osmoles and are often overlooked during diarrheal treatment. Studies now suggest that despite divalent ions being small in osmoles, their effects are large due to the presence of divalent ion-sensing receptors and their amplifying effects in the gut. As a result, losses of these divalent ions without prompt replacement could also significantly affect the onset, severity, and/or recovery of diarrheal disease. Herein, we report a case of a malnourished child with an immune-mediated enteropathy who developed episodes of “breakthrough” diarrhea with concurrent hypocalcemia while on appropriate immunotherapy. Interestingly, during these periods of diarrhea, stool volume fluctuated with levels of blood Ca2+. When Ca2+ was low, diarrhea occurred; when Ca2+ levels normalized with replacement, diarrhea stopped. Based on this and other observations, a broader question arises as to whether the Ca2+ lost in diarrhea should be replaced promptly in these patients.

Vibrio isolates from cases of acute diarrhea and their antibiotic susceptibility pattern in a tertiary care hospital of Punjab

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Atul Kumar

2014-01-01

Full Text Available Introduction: Vibrio cholerae, the cause of cholera, is one of the leading causes of morbidity and mortality in many developing countries. Especially during monsoon season, cholera outbreaks have been frequently reported from one or the other part of this country. However, occasional sporadic cases have also been reported, majorly due to lack of proper sanitation and impure water supply. Aim: To determine the prevalence of serotypes of Vibrio isolates from cases of acute diarrhea and their antibiotic susceptibility pattern in a tertiary care hospital, North India. Materials and Methods: A retrospective study was conducted over a period of 1 year from January 2013 to December 2013 in the department of microbiology, in a tertiary care hospital in Punjab. The diagnosis was suggested by the clinical picture and confirmed by stool culture. The stool samples received in the laboratory were processed by standard microbiological techniques for identification of V. cholerae. The suspected colonies of Vibrio were identified by standard biochemical tests and serotyping was done by group specific antisera. The susceptibility of all the isolated Vibrio species to different antibiotics were done by Kirby-Bauer′s disk diffusion technique as per the Clinical and Laboratory Standards Institute (CLSI guidelines. Results: V. cholerae were isolated from 41 (3.8% of total 1063 stool samples received during the study period. On serotyping, 100% (41 of these positive samples were identified as V. cholerae 01 ogawa serotype. 95% (39 cases were encountered during monsoon season. In the present study analysis of the antibiotic susceptibility data showed highest susceptibility to gentamicin, amikacin, tetracycline and chloramphenicol. There is gradual increase in resistance to ampicillin and high level of resistance was observed for furazolidone and trimethoprim-sulphamethoxazole during the same period. Conclusions: Our study reveals a significant increase in cases of

Probiotic or Conventional Yogurt for Treating Antibiotic-associated Diarrhea: A Clinical Trial Study

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Majid Khademian

2018-03-01

Full Text Available Background The popularity of probiotics is on the rise. Despite the beneficial effects of antibiotics, gastrointestinal health is at risk of diarrhea. This study aimed to investigate whether probiotic yogurt is of capability to prevent the incidence of diarrhea versus conventional yogurt. Materials and Methods This controlled, randomized, double-blind trial was designed to recruit 48 hospitalized children, whose treatments included different types of antibiotics. They were subsequently assigned into a 1:1 ratio into groups A and B at random. The first group was instructed to consume probiotic yogurt (Bifidobacterium strains and Lactobacillus acidophilus, while the second were on conventional yogurt (placebo containing Streptococcus thermophiles and Lactobacillus bulgaricus at least for 7 days. The incidence of diarrhea, its onset and duration were compared between the two groups. Results The findings indicated that there was no statistically significant difference between the experimental and control groups (p > 0.05. No significant decrease was observed in the incidence of diarrhea between the groups following adjustment for negative C-reactive protein (CRP (p > 0.05. Conclusion According to the results, the consumption of yogurt, either probiotic or conventional, reduced the incidence, duration, and onset of antibiotic-associated diarrhea in pediatric population. This study showed no significantly better performance for probiotic yogurt than conventional yogurt.

Bovine Virus Diarrhea (BVD)

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Hoar, Bruce R.

2004-01-01

Bovine virus diarrhea (BVD) is a complicated disease to discuss as it can result in a wide variety of disease problems from very mild to very severe. BVD can be one of the most devastating diseases cattle encounter and one of the hardest to get rid of when it attacks a herd. The viruses that cause BVD have been grouped into two genotypes, Type I and Type II. The disease syndrome caused by the two genotypes is basically the same, however disease caused by Type II infection is often more severe...

Cryptosporidiosis and other intestinal parasitic infections in patients with chronic diarrhea.

Science.gov (United States)

Mahdi, Nadham K; Ali, Naeel H

2004-09-01

To consider the relationship of the parasitic infections including cryptosporidium with chronic diarrhea. Also the effect of chronic disease as pulmonary tuberculosis (TB) and nosocomial infection on the occurrence rate of parasites in cases of chronic diarrhea. Stool samples were collected from 205 patients in teaching, general, child and maternity hospitals in Basrah, Iraq, suffering from chronic diarrhea during 2000. Out of these patients, there were 40 patients with pulmonary TB and 50 inpatients with nosocomial infection. Also 175 apparently healthy individuals who have no episodes of diarrhea for at least 2-months were served as a control group. Direct smear method and then formalin ether sedimentation method were carried out for stool samples to detect intestinal parasites. Fecal smears were prepared from the sediment and stained by the modified Ziehl Neelsen stain for the recovery of red pink oocysts of cryptosporidium. Out of the 205 examined patients, cryptosporidium oocysts were found to be excreted in 20 (9.7%) patients in comparing to 1.1% of the control group. The difference is statistically significant. There were 109 (53.2%) patients found to be positive for intestinal parasitic infections compared to 26 (14.8%) of the control group. The difference is also statistically significant. Out of the 40 TB patients, 2 (5%) were found to excrete cryptosporidium oocysts and also 27 (67.3%) were positive for intestinal parasites. In addition, there were 4 (8%) excreting cryptosporidium oocysts and 23 (46%) infecting by intestinal parasites among the in patients with nosocomial infection. Both acid and non-acid fast parasites should be considered in the differential diagnosis of undiagnosed chronic diarrhea especially among patients with pulmonary TB or nosocomial infection.

Fructus mume Extracts Alleviate Diarrhea in Breast Cancer Patients Receiving the Combination Therapy of Lapatinib and Capecitabine

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Hua Xing

2018-05-01

Full Text Available Lapatinib and capecitabine have been widely used in the therapy of breast cancer. However, long-term use of lapatinib and capecitabine often causes the most common side effect diarrhea, which limit the medicine use. Fructus mume (F. mume has been proved to be effective to treat chronic diarrhea with few side effects. The compounds from F. mume were extracted by using an ethanol method. Extracts of F. mume (EFM were analyzed by HPLC. We investigated the protective effects of EFM on the diarrhea caused by lapatinib and capecitabine. From March 1st, 2016 to June 1st, 2017, 208 breast cancer patients with diarrhea caused by lapatinib and capecitabine were recruited. The patients were evenly assigned into two groups: EG group (the patients took 100 mg EFM daily and CG group (the patients took placebo daily. The effects of EFM on diarrhea and gastrointestinal symptoms were measured by a semiquantitative method seven-point Likert scale. Overall quality of life was measured by SF-36 questionnaire and Hospital Anxiety and Depression Scale (HADS. The HPLC analysis showed that there were three components in EFM, including citric acid, 5-hydroxymethylfurfural (5-HMF, and chlorogenic acid. Breast cancer types were observed by using Hematoxylin and eosin (H&E stain. The breast cancer can be divided into leaflet, gland and fibroblast types. Patient age, skin metastases, treatment, and grade 1 diarrhea were significant risk factors associated with for grade 2 diarrhea. EFM reduced diarrhea and gastrointestinal symptoms by reducing the average scores of the diarrhea symptom and seven-point Likert scale, and improved life quality of patients significantly by improving SF-36 scores and reducing HADS scores when compared to that in the CG group after 6-week therapy and further 4-week follow-up (P < 0.05. EFM may be a potential choice for the diarrhea therapy in breast cancer patients.

Etiologies, Risk Factors and Impact of Severe Diarrhea in the Under-Fives in Moramanga and Antananarivo, Madagascar.

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Rindra Vatosoa Randremanana

Full Text Available Diarrheal disease remains a leading cause of death in children in low-income countries. We investigated the etiology, risk factors and effects on nutritional status of severe diarrhea in children from two districts in Madagascar.We performed a matched case-control study in 2011 to 2014, on children under the age of five years from Moramanga and Antananarivo. The cases were children hospitalized for severe diarrhea and the controls were children without diarrhea selected at random from the community. Stool samples were collected from both groups. Anthropometric measurements were made during follow-up visits about one and two months after enrolment.We enrolled 199 cases and 199 controls. Rotavirus infection was the most frequently detected cause of diarrhea. It was strongly associated with severe diarrhea (OR: 58.3; 95% CI: 7.7-439.9, accounting for 42.4% (95% CI: 37.6-43.1 of severe diarrhea cases. At the household level, possession of cattle (OR = 0.3; 95% CI: 0.1-0.6 and living in a house with electricity (OR = 0.4; 95% CI: 0.2-0.8 were protective factors. The presence of garbage around the house was a risk factor for severe diarrhea (OR = 3.2; 95% CI: 1.9-5.4. We found no significant association between severe diarrhea and the nutritional status of the children at follow-up visits, but evident wasting at enrolment was associated with a higher risk of severe diarrhea (OR = 9; 95% CI: 4.5-17.9.Severe childhood diarrhea is mostly caused by rotavirus infection. An anti-rotavirus vaccine has already been introduced in Madagascar and should be promoted more widely. However, post-licensing surveillance is required. Interventions to improve the nutritional status of children, preventive measures focused on household and personal hygiene and nutritional rehabilitation during severe diarrheal disease should be reinforced.

Temperature as a predictor of fouling and diarrhea in Slaughter pigs

DEFF Research Database (Denmark)

Jensen, Dan Børge; Toft, Nils; Kristensen, Anders Ringgaard

2015-01-01

The PigIT Project aims at improving welfare and production of slaughter pigs by integration of various sensor systems for alarm purposes. Here we present an exploratory analysis to assess the predictive value of temperature sensor data with respect to pen fouling and diarrhea. We recorded...... the temperature at four locations in two double-pens (by the drinking nipples and by the corridor) between November 2013 and December 2014. Logistic regression models were made to express the probability of fouling and diarrhea per day, and were reduced via backwards elimination. Furthermore, fitting the models...... was attempted with the raw temperature data as well as data averaged over 10, 15, 30 and 60 minutes. The predictive performances were evaluated with Matthews Correlation Coefficient (MCC). For diarrhea, the minimal and maximal temperatures at the water nipple and the corridor, as well as the maximal rate...

Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose.

Science.gov (United States)

Hammer, H F; Santa Ana, C A; Schiller, L R; Fordtran, J S

1989-10-01

The purpose of these studies was to gain insight into the pathophysiology of pure osmotic diarrhea and the osmotic diarrhea caused by carbohydrate malabsorption. Diarrhea was induced in normal volunteers by ingestion of polyethylene glycol (PEG), which is nonabsorbable, not metabolized by colonic bacteria, and carries no electrical charge. In PEG-induced diarrhea, (a) stool weight was directly correlated with the total mass of PEG ingested; (b) PEG contributed 40-60% of the osmolality of the fecal fluid, the remainder being contributed by other solutes either of dietary, endogenous, or bacterial origin; and (c) fecal sodium, potassium, and chloride were avidly conserved by the intestine, in spite of stool water losses exceeding 1,200 g/d. Diarrhea was also induced in normal subjects by ingestion of lactulose, a disaccharide that is not absorbed by the small intestine but is metabolized by colonic bacteria. In lactulose-induced diarrhea, (a) a maximum of approximate 80 g/d of lactulose was metabolized by colonic bacteria to noncarbohydrate moieties such as organic acids; (b) the organic acids were partially absorbed in the colon; (c) unabsorbed organic acids obligated the accumulation of inorganic cations (Na greater than Ca greater than K greater than Mg) in the diarrheal fluid; (d) diarrhea associated with low doses of lactulose was mainly due to unabsorbed organic acids and associated cations, whereas with larger doses of lactulose unmetabolized carbohydrates also played a major role; and (e) the net effect of bacterial metabolism of lactulose and partial absorption of organic acids on stool water output was done dependent. With low or moderate doses of lactulose, stool water losses were reduced by as much as 600 g/d (compared with equimolar osmotic loads of PEG); with large dose, the increment in osmotically active solutes within the lumen exceeded the increment of the ingested osmotic load, and the severity of diarrhea was augmented.

Role of serotonin in the intestinal mucosal epithelium barrier in weaning mice undergoing stress-induced diarrhea.

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Dong, Yulan; Wang, Zixu; Qin, Zhuoming; Cao, Jing; Chen, Yaoxing

2018-02-01

Stress-induced diarrhea is a frequent and challenging threat to humans and domestic animals. Serotonin (5-HT) has been shown to be involved in the pathological process of stress-induced diarrhea. However, the role of 5-HT in stress-induced diarrhea remains unclear. A stress-induced diarrhea model was established in 21-day-old ICR weaning mice through an intragastric administration of 0.25 mL of 0.4 g/mL folium sennae and restraint of the hind legs with adhesive tape for 4 h to determine whether 5-HT regulates the mucosal barrier to cause diarrhea. Mice with decreased levels of 5-HT were pretreated with an intraperitoneal injection of 300 mg/kg p-chlorophenylalanine (PCPA), a 5-HT synthesis inhibitor. After 5 days of treatment, the stress level, body weight and intestinal mucosal morphology indexes were measured. Compared to the controls, the mice with stress-induced diarrhea displayed a stress reaction, with increased corticosterone levels, as well as increased 5-HT-positive cells. However, the mice with stress-induced diarrhea exhibited decreased body weights, villus height to crypt depth ratios (V/C), and Occludin and Claudin1 expression. The PCPA injection reversed these effects in mice with different degrees of stress-induced diarrhea. Based on these findings, inhibition of 5-HT synthesis relieved the stress response and improved the health of the intestinal tract, including both the intestinal absorption capacity, as determined by the villus height and crypt depth, and the mucosal barrier function, as determined by the tight junction proteins of epithelial cell.

Association between floods and infectious diarrhea and their effect modifiers in Hunan province, China: A two-stage model.

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Liu, Zhidong; Zhang, Feifei; Zhang, Ying; Li, Jing; Liu, Xuena; Ding, Guoyong; Zhang, Caixia; Liu, Qiyong; Jiang, Baofa

2018-06-01

Understanding the potential links between floods and infectious diarrhea is important under the context of climate change. However, little is known about the risk of infectious diarrhea after floods and what factors could modify these effects in China. This study aims to quantitatively examine the relationship between floods and infectious diarrhea and their effect modifiers. Weekly number of infectious diarrhea cases from 2004 to 2011 during flood season in Hunan province were supplied by the National Notifiable Disease Surveillance System. Flood and meteorological data over the same period were obtained. A two-stage model was used to estimate a provincial average association and their effect modifiers between floods and infectious diarrhea, accounting for other confounders. A total of 134,571 cases of infectious diarrhea were notified from 2004 to 2011. After controlling for seasonality, long-term trends, and meteorological factors, floods were significantly associated with infectious diarrhea in the provincial level with a cumulative RR of 1.22 (95% CI: 1.05, 1.43) with a lagged effect of 0-1 week. Geographic locations and economic levels were identified as effect modifiers, with a higher impact of floods on infectious diarrhea in the western and regions with a low economic level of Hunan. Our study provides strong evidence of a positive association between floods and infectious diarrhea in the study area. Local control strategies for public health should be taken in time to prevent and reduce the risk of infectious diarrhea after floods, especially for the vulnerable regions identified. Copyright © 2018 Elsevier B.V. All rights reserved.

Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under–five in Uttar Pradesh, India

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Laura M Lamberti

2015-12-01

Full Text Available There is limited evidence on adherence to the recommended dose and duration of zinc supplementation for diarrheal episodes in children under five years of age. In selected districts of Uttar Pradesh, India, we sought to assess adherence to the nationally advised zinc treatment regimen (ie, 10 mg/day for ages 2–6 months and 20 mg/day for ages 7–59 months for 14 days among caregivers of zinc–prescribed children. We identified and conducted follow–up visits to children advised zinc for the treatment of diarrhea. At the initial visit, we collected data on the treatment instructions received from providers. Caregivers were asked to record treatments administered on a pictorial tracking form and were asked to retain all packaging for collection at follow–up. We quantified the average dose and duration of zinc therapy and built logistic regression models to assess the factors associated with caregiver adherence to national guidelines. Caregivers administered zinc for an average of 10.7 days (standard deviation (SD = 3.9 days; median = 13 days, and 47.8% continued treatment for the complete 14 days. Among children receiving zinc syrups and tablets respectively, the age appropriate dose was received by 30.8% and 67.3%. Adherence to age appropriate dose and continuation of zinc for 14 days were highly associated with having received appropriate provider instructions. Our results indicate moderate–to–good adherence to national zinc treatment guidelines for diarrhea among caregivers in rural India. Our findings also highlight the importance of provider guidance in ensuring adherence to zinc dose and duration. Programs aiming to scale–up zinc treatment for childhood diarrhea should train providers to successfully communicate dosing instructions to caregivers, while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

急性感染后多颅神经炎(附2例报告)%Acute Post-infectious Multiple Cranial Neuritis (2 Case Report)

Institute of Scientific and Technical Information of China (English)

李海峰; 丛志强; 阎文静

2003-01-01

@@ Acute autoimmune polyneuritis may occur after non-specific infections (upper respiratory tract infection or diar-rhea), which may involve spinal and cranial nerves, and nerveroots symmetrically, the most common manifestation beingGuillain- Barre syndrome (GBS).

Diarrhea Management Training in Early Childhood Settings.

Science.gov (United States)

Winnail, Scott D.; Artz, Lynn M.; Geiger, Brian F.; Petri, Cynthia J.; Bailey, Rebecca; Mason, J.W.

2001-01-01

Addresses the health of young children and how to safely and effectively care for children with diarrhea in the home and in early child care settings. Discusses specific intervention and program activities, including specially designed materials for mixing homemade oral rehydration usage. (Author/SD)

Mothers’ Hand washing Practice and Diarrhea Cases in Children under Five in Baleendah, Bandung

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M Syafril Firdaus

2015-06-01

Full Text Available ackground: Diarrhea is a disease, especially in children, with high mortality and morbidity rate in developing countries, including Indonesia. Diarrhea can be prevented if people can apply clean and healthy behaviors, especially hand washing. Hand washing is the cheapest, simplest, and the most effective methods for prevention of diarrhea. The objective of this study is to identify the knowledge, attitude, and practice of mothers’ hand washing and diarrhea cases in children under five in Baleendah District, Bandung. Methods: A descriptive study was conducted during September−November 2012 to 210 mothers who had children (ages 12−59 months in Baleendah using rapid survey technique. The time allocated for each village was adjusted to the population proportion for each region. The data were analyzed using computer and was represented using frequency distribution. Results: This study showed that the respondents had good level of knowledge and attitude of hand washing (83.8% and 61%, respectively, but only 21% of the respondents’ practices of hand washing was in good level. Most of the respondents did not wash their hands according to the 7 steps of correct hand washing. Moreover the percentage of children with diarrhea in Baleendah was 43.8% (92 cases during the study. Conclusions: There should be dissemination of information about the benefit of washing hands with 7 steps of correct hands washing so that families can practice it and can prevent diarrhea in children under five.

Acute toxemic schistosomiasis complicated by a acute flaccid paraplegia due to schistosomal myeloradiculopathy in Sudan

Energy Technology Data Exchange (ETDEWEB)

Ahmed, Abdelmonim F [Dept. of Medicine, Faculty of Medicine, Taibah Univ., Al-Madinah Al-Munwarah (Saudi Arabia); Kareem, Abid M [Dept. of Gastroenterology, King Fahd Hospital, Al- Madinah Al-Munwarah (Saudi Arabia); Dawoud, Talal A [Dept. of Neurology, King Fahd Hospital, Al-Madinah Al-Munawarh (Saudi Arabia); Idris, Abdelrehman S [Dept. of Neurology, Hiraa Hospital, Mecca (Saudi Arabia)

2008-07-01

A 55-year old Sudanese physician presented with one month history of diarrhea, loss of weight 10 kg and low grade nocturnal fever. Following colonoscopy, he rapidly developed paraparesis and retention of urine. Magnetic resonance imaging (MRI) of the spinal cord showed low cord lesion suggestive of transverse myelitis. We present a detailed account of diagnostic and management challenges and a literature review of the final diagnosis of acute toxemic schistosomiasis, complicated by acute flaccid paraplegia due to schistosomal myeloradiculopathy. We are reporting this case to increase the awareness of physicians of schistosomal myeloradiculopathy, as it needs urgent specific treatment praziquantel and steroids. An early follow-up with MRI of the spinal cord 2 weeks treatment may help in preventing unnecessary neurosurgical intervention. Bilharziasis may be contracted on the banks of river White Nile in urban areas. Finally clinicians should make use of the Google search for diagnosis in difficult cases. (author)

Acute toxemic schistosomiasis complicated by a acute flaccid paraplegia due to schistosomal myeloradiculopathy in Sudan

International Nuclear Information System (INIS)

Ahmed, Abdelmonim F.; Kareem, Abid M.; Dawoud, Talal A.; Idris, Abdelrehman S.

2008-01-01

A 55-year old Sudanese physician presented with one month history of diarrhea, loss of weight 10 kg and low grade nocturnal fever. Following colonoscopy, he rapidly developed paraparesis and retention of urine. Magnetic resonance imaging (MRI) of the spinal cord showed low cord lesion suggestive of transverse myelitis. We present a detailed account of diagnostic and management challenges and a literature review of the final diagnosis of acute toxemic schistosomiasis, complicated by acute flaccid paraplegia due to schistosomal myeloradiculopathy. We are reporting this case to increase the awareness of physicians of schistosomal myeloradiculopathy, as it needs urgent specific treatment praziquantel and steroids. An early follow-up with MRI of the spinal cord 2 weeks treatment may help in preventing unnecessary neurosurgical intervention. Bilharziasis may be contracted on the banks of river White Nile in urban areas. Finally clinicians should make use of the Google search for diagnosis in difficult cases. (author)

Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic irradiation? Results of a double-blind randomized trial

International Nuclear Information System (INIS)

Martin, Thomas; Uhder, Kerstin; Kurek, Ralf; Roeddiger, Sandra; Schneider, Lida; Vogt, Hans-Georg; Heyd, Reinhard; Zamboglou, Nikolaos

2002-01-01

Purpose: Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic radiotherapy? Material and methods: Fifty-six patients with an indication for adjuvant pelvic irradiation after curative surgery were double-blind randomized. All patients took 3x4 capsules study medication daily during radiotherapy. Twenty-eight patients in the enzyme group (EG) received capsules containing papain, trypsin and chymotrypsin, 28 in the placebo group (PG) received placebo capsules. All patients were irradiated with 5x1.8 Gy weekly to 50.4 Gy using four-field-box technique after CT-based planning. Primary objective was the grade of diarrhea, nausea, vomiting, fatigue and epitheliolysis during radiotherapy. Secondary objectives were the number of supportive medications and treatment interruptions due to acute toxicity. Results: None/mild diarrhea: 43% EG, 64% PG. Moderate/severe diarrhea: 57% EG, 36% PG (P=0.11). Mean duration: 11 days in EG, 10 days in PG. None/mild nausea: 93% EG, 93% PG. Moderate/severe nausea: 7% EG, 7% PG. None/mild vomiting: 100% EG, 97% PG. None/mild fatigue: 82% EG, 93% PG. Moderate/severe fatigue: 18% EG, 7% PG (P=0.23). None/mild epitheliolysis: 75% EG, 93% PG. Moderate/severe epitheliolysis: 25% EG, 7% PG (P=0.16). Treatment interruption (mean days): 2.44 in EG, 1.46 in PG. Number of supportive medication: 29 in EG, 19 in PG. Conclusions: The prophylactic use of proteolytic enzymes does not reduce acute toxicities, treatment interruptions and number of supportive medication and therefore does not improve tolerance of adjuvant pelvic radiotherapy

Protective Benefits of Deep Tube Wells Against Childhood Diarrhea in Matlab, Bangladesh

Science.gov (United States)

Winston, Jennifer Jane; Escamilla, Veronica; Perez-Heydrich, Carolina; Carrel, Margaret; Yunus, Mohammad; Streatfield, Peter Kim

2013-01-01

Objectives. We investigated whether deep tube wells installed to provide arsenic-free groundwater in rural Bangladesh have the added benefit of reducing childhood diarrheal disease incidence. Methods. We recorded cases of diarrhea in children younger than 5 years in 142 villages of Matlab, Bangladesh, during monthly community health surveys in 2005 and 2006. We surveyed the location and depth of 12 018 tube wells and integrated these data with diarrhea data and other data in a geographic information system. We fit a longitudinal logistic regression model to measure the relationship between childhood diarrhea and deep tube well use. We controlled for maternal education, family wealth, year, and distance to a deep tube well. Results. Household clusters assumed to be using deep tube wells were 48.7% (95% confidence interval = 27.8%, 63.5%) less likely to have a case of childhood diarrhea than were other household clusters. Conclusions. Increased access to deep tube wells may provide dual benefits to vulnerable populations in Matlab, Bangladesh, by reducing the risk of childhood diarrheal disease and decreasing exposure to naturally occurring arsenic in groundwater. PMID:23409905

Intranasal P particle vaccine provided partial cross-variant protection against human GII.4 norovirus diarrhea in gnotobiotic pigs.

Science.gov (United States)

Kocher, Jacob; Bui, Tammy; Giri-Rachman, Ernawati; Wen, Ke; Li, Guohua; Yang, Xingdong; Liu, Fangning; Tan, Ming; Xia, Ming; Zhong, Weiming; Jiang, Xi; Yuan, Lijuan

2014-09-01

Noroviruses (NoVs) are the leading cause of nonbacterial acute gastroenteritis worldwide in people of all ages. The P particle is a novel vaccine candidate derived from the protruding (P) domain of the NoV VP1 capsid protein. This study utilized the neonatal gnotobiotic pig model to evaluate the protective efficacies of primary infection, P particles, and virus-like particles (VLPs) against NoV infection and disease and the T cell responses to these treatments. Pigs either were vaccinated intranasally with GII.4/1997 NoV (VA387)-derived P particles or VLPs or were inoculated orally with a GII.4/2006b NoV variant. At postinoculation day (PID) 28, pigs either were euthanized or were challenged with the GII.4/2006b variant and monitored for diarrhea and virus shedding for 7 days. The T cell responses in intestinal and systemic lymphoid tissues were examined. Primary NoV infection provided 83% homologous protection against diarrhea and 49% homologous protection against virus shedding, while the P particle and VLP vaccines provided cross-variant protection (47% and 60%, respectively) against diarrhea. The protection rates against diarrhea are significantly inversely correlated with T cell expansion in the duodenum and are positively correlated with T cell expansion in the ileum and spleen. The P particle vaccine primed for stronger immune responses than VLPs, including significantly higher numbers of activated CD4+ T cells in all tissues, gamma interferon-producing (IFN-γ+) CD8+ T cells in the duodenum, regulatory T cells (Tregs) in the blood, and transforming growth factor β (TGF-β)-producing CD4+ CD25- FoxP3+ Tregs in the spleen postchallenge, indicating that P particles are more immunogenic than VLPs at the same dose. In conclusion, the P particle vaccine is a promising vaccine candidate worthy of further development. The norovirus (NoV) P particle is a vaccine candidate derived from the protruding (P) domain of the NoV VP1 capsid protein. P particles can be

A Systems Approach to Climate, Water and Diarrhea in Hubli-Dharward, India

Science.gov (United States)

Mellor, J. E.; Zimmerman, J.

2014-12-01

Although evidence suggests that climate change will negatively impact water resources and hence diarrheal disease rates in the developing world, there is uncertainty surrounding prior studies. This is due to the complexity of the pathways by which climate impacts diarrhea rates making it difficult to develop interventions. Therefore, our goal was to develop a mechanistic systems approach that incorporates the complex climate, human, engineered and water systems to relate climate change to diarrhea rates under future climate scenarios.To do this, we developed an agent-based model (ABM). Our agents are households and children living in Hubli-Dharward, India. The model was informed with 15 months of weather, water quality, ethnographic and diarrhea incidence data. The model's front end is a stochastic weather simulator incorporating 15 global climate models to simulate rainfall and temperature. The water quality available to agents (residents) on a model "day" is a function of the simulated day's weather and is fully validated with field data. As with the field data, as the ambient temperature increases or it rains, the quality of water available to residents in the model deteriorates. The propensity for an resident to get diarrhea is calculated with an integrated Quantitative Microbial Risk Assessment model with uncertainty simulated with a bootstrap method. Other factors include hand-washing, improved water sources, household water treatment and improved sanitation.The benefits of our approach are as follows: Our mechanistic method allows us to develop scientifically derived adaptation strategies. We can quantitatively link climate scenarios with diarrhea incidence over long time periods. We can explore the complex climate and water system dynamics, rank risk factor importance, examine a broad range of scenarios and identify tipping points. Our approach is modular and expandable such that new datasets can be integrated to study climate impacts on a larger scale. Our

Antibiotic treatment for Clostridium difficile-associated diarrhea in adults.

Science.gov (United States)

Nelson, R

2007-07-18