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Maraki S, Mavromanolaki VE, Stafylaki D, Iliaki-Giannakoudaki E, Kasimati A. Prevalence and antimicrobial resistance of bacterial enteropathogens in Crete, Greece, during 2011-2022. Acta Microbiol Immunol Hung 2024; 71:69-75. [PMID: 38345622 DOI: 10.1556/030.2024.02214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/29/2024] [Indexed: 03/27/2024]
Abstract
Diarrheal diseases are of great concern worldwide and are responsible for considerable morbidity and mortality. This study investigated the epidemiology and the antibiotic susceptibility of bacterial enteropathogens among diarrheal patients of all ages in Crete, Greece during 2011-2022. Stool specimens were tested by conventional cultural methods for Salmonella, Shigella, Campylobacter, diarrheagenic Escherichia coli (EPEC, STEC), Yersinia enterocolitica, Aeromonas species and Clostridioides difficile. Antimicrobial susceptibility was determined by the disk diffusion method for Enterobacterales, Campylobacter and Aeromonas, and by the gradient diffusion method for C. difficile. Of the 26,060 stool samples from patients of any age, 1,022 (3.9%) were positive for bacterial enteropathogens. Campylobacter spp. were the most commonly isolated bacteria (56.4%), followed by Salmonella enterica (32.3%), and E. coli (EPEC, STEC) (6.5%). Toxigenic C. difficile was isolated from 341 out of 8,848 diarrheal specimens examined (3.9%). Resistance to ampicillin was observed in 12.4% of Salmonella, 66.7% of Shigella and 34.8% of E. coli (EPEC, STEC) isolates. Resistance to trimethoprim/sulfamethoxazole was observed in 5.8% of Salmonella, 33.3% of Shigella, and 15.1% of E. coli (EPEC, STEC) isolates. High rates of ciprofloxacin resistance (77.3%) were detected among Campylobacter isolates, while resistance to erythromycin was observed in 2.4% of them. All C. difficile isolates were susceptible to vancomycin and metronidazole. Our findings suggest declining trends in prevalence of bacterial enteropathogens, except for Campylobacter spp. and changes in the susceptibility rates to antimicrobials. Continuous surveillance of prevalence and antimicrobial susceptibility of bacterial enteropathogens is mandatory for implementing targeted and effective prevention and infection control measures.
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Affiliation(s)
- Sofia Maraki
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Crete, Greece
| | | | - Dimitra Stafylaki
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Crete, Greece
| | | | - Anna Kasimati
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Crete, Greece
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Majeed M, Nagabhushanam K, Arumugam S, Chadalavada N, Seepana J, Annamalai T, Murali A, Prakasan P, Mundkur L. Probiotic Weizmannia coagulans MTCC 5856 as adjunct therapy in children's acute diarrhea-a randomized, double-blind, placebo-controlled study. Front Pediatr 2024; 11:1338126. [PMID: 38269290 PMCID: PMC10806110 DOI: 10.3389/fped.2023.1338126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Objectives Acute diarrhea in children is generally managed by replacing the lost fluid with oral rehydration solution (ORS). Probiotic supplementation has been reported to reduce the severity of diarrhea. In the present study, we investigated the effect of Weizmannia coagulans (Bacillus coagulans) MTCC 5856, along with ORS on acute diarrhea of all causes in non-hospitalized children. Methods A total of 110 children of ages between 1 and 10 were enrolled in a double-blind placebo-controlled study and were randomly allocated to receive W. coagulans MTCC 5856 (4 × 108 spores, N = 54) + ORS and zinc (Zn) or a placebo (N = 56) + ORS and (Zn) for 5 days. The consistency of the stool, mean duration of diarrhea in hours, mean diarrhea frequency per day, and the dehydration status were collected as efficacy endpoints. Safety was evaluated by the occurrence of adverse events. Results The mean age of the children was 5.55 ± 2.57 years (61 boys and 49 girls). The mean duration of diarrhea was 51.31 ± 20.99 h in the W. coagulans MTCC 5856 group and 62.74 ± 24.51 h in the placebo (p = 0.011) group. The frequency of diarrhea was lower in children supplemented with the probiotic, but the difference was not statistically significant. The perceived efficacy score and dehydration status improved significantly in the W. coagulans MTCC 5856 group compared with the placebo group. No adverse events were recorded. Conclusion The results of the study suggest that W. coagulans MTCC 5856 could be supplemented along with ORS and zinc to reduce the duration of diarrhea in non-hospitalized children. Clinical Trial Registration ClinicalTrials.gov, identifier CTRI/2022/06/043239.
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Affiliation(s)
- Muhammed Majeed
- Research and Development, Sami-Sabinsa Group Limited, Peenya Industrial Area, Bangalore, India
- Research and Development, Sabinsa Corporation, East Windsor, NJ, United States
| | | | - Sivakumar Arumugam
- Research and Development, Sami-Sabinsa Group Limited, Peenya Industrial Area, Bangalore, India
| | | | - Jyotsna Seepana
- Department of Pediatrics, Government Medical College and Government General Hospital (old RIMSGGH), Srikakulam, India
| | - Thumjaa Annamalai
- Department of Pediatrics, Aarupadai Veedu Medical College & Hospital (AVMCH), Pondicherry, India
| | - Avinash Murali
- Research and Development, Sami-Sabinsa Group Limited, Peenya Industrial Area, Bangalore, India
| | - Priji Prakasan
- Research and Development, Sami-Sabinsa Group Limited, Peenya Industrial Area, Bangalore, India
| | - Lakshmi Mundkur
- Research and Development, Sami-Sabinsa Group Limited, Peenya Industrial Area, Bangalore, India
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Xia L, Ye Y, Luo Y, Miao B, Na N. Case report: Application of nonsurgical method in saving transplant renal vein thrombosis caused by acute diarrhea. Front Med (Lausanne) 2023; 10:1275188. [PMID: 38173940 PMCID: PMC10762308 DOI: 10.3389/fmed.2023.1275188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Transplant renal vein thrombosis is a rare complication after kidney transplantation, which can seriously threaten graft survival. Though the measures like thrombolytic therapy or operative intervention could be taken to deal with this complication, allograft loss is the most common outcome. Thus, early finding as well as decisive intervention is crucial to saving the graft. Here we present a 46-year-old male patient who underwent kidney transplantation from a cadaveric donor who developed a transplant renal venous thrombosis induced by acute diarrhea more than 1 year after renal transplantation with an initial symptom of sudden anuria and pain in the graft area. Subsequently, serum creatinine levels increased to 810.0 μmol/L. Pelvic CT showed increased vascular density of the transplanted kidney, and contrast-enhanced ultrasound confirmed venous thrombosis. The patient was treated with heparin sodium alone and diuresis gradually resumed. After more than 1 year of follow-up, serum creatinine returned to the baseline level prior to thrombosis. Our case indicates that quick ancillary examination and treatment without hesitation would be indispensable in rescuing allografts with renal vein thrombus. Unfractionated heparin can be recommended as an effective treatment for mid-long-term renal transplantation patients with renal vein thrombosis.
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Affiliation(s)
| | | | | | | | - Ning Na
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Xiao Q, Chen B, Zhu Z, Yang T, Tao E, Hu C, Zheng W, Tang W, Shu X, Jiang M. Alterations in the Fecal Microbiota Composition in Pediatric Acute Diarrhea: A Cross-Sectional and Comparative Study of Viral and Bacterial Enteritis. Infect Drug Resist 2023; 16:5473-5483. [PMID: 37638073 PMCID: PMC10456034 DOI: 10.2147/idr.s410720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/12/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To examine the association between the fecal microbiota of acute diarrhea in children and provide gut microbiota information related the acute diarrhea with rotavirus. Patients and Methods Children with acute diarrhea aged 3-60 months were selected for the study. Routine stool examination was performed, and stool samples were collected and stored at -80 °C until further analysis. Fecal microbial DNA was extracted, and DNA concentration and quality were detected. PCR amplification and 16S rDNA high-throughput sequencing analysis using the Illumina MiSeq platform were performed, and intestinal flora was statistically analyzed. Results Children with acute diarrhea exhibited gut microbial dysbiosis. Lower microbial diversity and richness were observed in the viral enteritis and bacterial enteritis groups than in the control group. Composition of the microbiota in acute diarrhea differed from that in the control group. The Bacteroidetes/Firmicutes dramatically decreased in the viral enteritis and bacterial enteritis groups. However, the relative abundance of Proteobacteria and Fusobacteria increased, especially in the bacterial enteritis group. In addition, the relative abundance of Actinobacteria had dramatically increased in the viral enteritis group. According to the Kyoto Encyclopedia of Genes and Genomes map analysis, the membrane transport dysfunction was caused by rotavirus infection, while the membrane transport dysfunction was more evident in bacterial infection. Conclusion Acute diarrhea infections cause fecal microbiota dysbiosis in children. Changes in fecal microflora in children suggest that the regulation of intestinal flora in children with acute diarrhea should be strengthened.
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Affiliation(s)
- Qiulin Xiao
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
- Department of Gastroenterology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Bo Chen
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
| | - Zhenya Zhu
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
| | - Ting Yang
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
| | - Enfu Tao
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
| | - Chenmin Hu
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
| | - Wei Zheng
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
| | - Weihong Tang
- Department of Gastroenterology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Xiaoli Shu
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
| | - Mizu Jiang
- Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China
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Bai H, Liu T, Wang S, Gong W, Shen L, Zhang S, Wang Z. Identification of Gut Microbiome and Metabolites Associated with Acute Diarrhea in Cats. Microbiol Spectr 2023; 11:e0059023. [PMID: 37428087 PMCID: PMC10434016 DOI: 10.1128/spectrum.00590-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
Changes in diet and environment can lead to acute diarrhea in companion animals, but the composition and interactions of the gut microbiome during acute diarrhea remain unclear. In this multicenter case-control study, we investigated the relationship between intestinal flora and acute diarrhea in two breeds of cats. Acutely diarrheic American Shorthair (MD, n = 12) and British Shorthair (BD, n = 12) and healthy American Shorthair (MH, n = 12) and British Shorthair (BH, n = 12) cats were recruited. Gut microbial 16S rRNA sequencing, metagenomic sequencing, and untargeted metabolomic analysis were performed. We observed significant differences in beta-diversity (Adonis, P < 0.05) across breeds and disease state cohorts. Profound differences in gut microbial structure and function were found between the two cat breeds. In comparison to healthy British Shorthair cats, Prevotella, Providencia, and Sutterella were enriched while Blautia, Peptoclostridium, and Tyzzerella were reduced in American Shorthair cats. In the case-control cohort, cats with acute diarrhea exhibited an increased abundance of Bacteroidota, Prevotella, and Prevotella copri and a decreased abundance of Bacilli, Erysipelotrichales, and Erysipelatoclostridiaceae (both MD and BD cats, P < 0.05). Metabolomic analysis identified significant changes in the BD intestine, affecting 45 metabolic pathways. Moreover, using a random forest classifier, we successfully predicted the occurrence of acute diarrhea with an area under the curve of 0.95. Our findings indicate a distinct gut microbiome profile that is associated with the presence of acute diarrhea in cats. However, further investigations using larger cohorts of cats with diverse conditions are required to validate and extend these findings. IMPORTANCE Acute diarrhea is common in cats, and our understanding of the gut microbiome variations across breeds and disease states remains unclear. We investigated the gut microbiome of two cat breeds (British Shorthair and American Shorthair) with acute diarrhea. Our study revealed significant effects of breeds and disease states on the structure and function of the gut microbiota in cats. These findings emphasize the need to consider breed-related factors in animal nutrition and research models. Additionally, we observed an altered gut metabolome in cats with acute diarrhea, closely linked to changes in bacterial genera. We identified a panel of microbial biomarkers with high diagnostic accuracy for feline acute diarrhea. These findings provide novel insights into the diagnosis, classification, and treatment of feline gastrointestinal diseases.
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Affiliation(s)
- Huasong Bai
- Nourse Science Centre for Pet Nutrition, Wuhu, China
| | - Tong Liu
- Nourse Science Centre for Pet Nutrition, Wuhu, China
| | - Songjun Wang
- Nourse Science Centre for Pet Nutrition, Wuhu, China
| | - Wenhui Gong
- Nourse Science Centre for Pet Nutrition, Wuhu, China
| | - Liya Shen
- Nourse Science Centre for Pet Nutrition, Wuhu, China
| | - Song Zhang
- Nourse Science Centre for Pet Nutrition, Wuhu, China
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Cerquetella M, Mangiaterra S, Rossi G, Gavazza A, Marchegiani A, Sagratini G, Ricciutelli M, Angeloni S, Fioretti L, Marini C, Pucciarelli S, Vincenzetti S. Fecal Protein Profile in Eight Dogs Suffering from Acute Uncomplicated Diarrhea before and after Treatment. Vet Sci 2023; 10:vetsci10030233. [PMID: 36977272 PMCID: PMC10051911 DOI: 10.3390/vetsci10030233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Acute diarrhea is a very frequent condition affecting dogs; nevertheless, little is known about what happens in the GI tract during such conditions. Proteomics allows the study of proteins present in a specific biologic substrate, and fecal proteomic investigations have been recently implemented to study GI diseases in dogs. In the present study, the fecal protein profiles of eight dogs suffering from acute uncomplicated diarrhea at the time of inclusion was investigated for the first time, and then the same patients were followed, replicating two further evaluations at two subsequent time points (after 2 and 14 days from the first presentation), with the aim of gaining possible new insights regarding the pathologic changes in the gastrointestinal environment during such conditions. Two-dimensional gel electrophoresis (2-DE) was performed, followed by mass spectrometry. Nine spots, corresponding to four (groups of) proteins (i.e., albumin, alkaline phosphatase, chymotrypsin-C-like, and some immunoglobulins), showed significant differences at two or more of the three time points investigated, almost all behaving similarly and decreasing at T1 (2 days after the onset of the condition) and significantly increasing at T2 (14 days after the onset), mainly evidencing a reaction of the organism. Further studies including a greater number of patients and possibly different techniques are needed to confirm the present findings.
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Affiliation(s)
- Matteo Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy
| | | | - Giacomo Rossi
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy
| | - Alessandra Gavazza
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy
| | - Andrea Marchegiani
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy
| | - Gianni Sagratini
- School of Pharmacy, University of Camerino, Via Sant'Agostino 1, 62032 Camerino, Italy
| | - Massimo Ricciutelli
- Chemistry Interdisciplinary Project (ChIP) Laboratory of LC-MS, University of Camerino, 62032 Camerino, Italy
| | - Simone Angeloni
- Chemistry Interdisciplinary Project (ChIP) Laboratory of LC-MS, University of Camerino, 62032 Camerino, Italy
| | | | - Carlotta Marini
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy
| | - Stefania Pucciarelli
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Gentile II da Varano, 62032 Camerino, Italy
| | - Silvia Vincenzetti
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy
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Islam K, Konar MC, Roy A, Biswas B, Nayek K, Middya S. Role of cooked green banana in home management of acute diarrhea in under-5 children. J Trop Pediatr 2022; 69:7000349. [PMID: 36692306 DOI: 10.1093/tropej/fmad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute diarrhea is an important contributor to under-5 mortality. Green banana is traditionally used as a home-based remedy for diarrhea. OBJECTIVES To identify the effect of green banana on duration, recovery and prevention of severe dehydration in under-5 children with acute watery diarrhea with no/some dehydration. METHODS This study was conducted in the rural field practice area of a tertiary care center between January 2020 and December 2021 in under-5 children presenting with acute diarrhea with no/some dehydration. One hundred fifty-three children were divided into group A (received cooked green banana supplementation along with standard management) and group B (received only standard management). Duration of diarrhea, proportion of children recovered, requirement of hospitalization, development of persistent diarrhea and number of diarrheal episodes in 1 year follow-up period were compared between two groups. RESULTS Green banana supplementation was significantly associated with reduction in duration [median (interquartile range)-4 (1.5) day versus 5.5 (1) day, P < 0.001] of diarrhea, less hospitalization (9.2% versus 22.1%, P = 0.03) and early recovery, both at day 3 (17.1% versus 3.9%, P = 0.007) and day 7 (90.8% versus 77.9%, P = 0.03). Green banana also protected children from the development of persistent diarrhea (7.9% versus 19.5%, P = 0.04). It also reduced future episodes of diarrhea by 40.5%. CONCLUSION Green banana supplementation could be a promising adjunct therapy in acute diarrhea and thereby it might reduce under-5 mortality.
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Affiliation(s)
- Kamirul Islam
- Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal 713104, India
| | - Mithun Chandra Konar
- Department of Pediatrics, Kolkata Medical College, Kolkata, West Bengal 700073, India
| | - Atanu Roy
- Department of Pediatrics, Kolkata Medical College, Kolkata, West Bengal 700073, India
| | - Biswajit Biswas
- Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal 713104, India
| | - Kaustav Nayek
- Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal 713104, India
| | - Subhasri Middya
- Department of Zoology, Vidyasagar University, Midnapore, West Bengal 721102, India
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Muacevic A, Adler JR. Perforated Appendicitis Masquerading as Bilateral Tubo-Ovarian Abscess. Cureus 2022; 14:e30464. [PMID: 36407274 PMCID: PMC9673187 DOI: 10.7759/cureus.30464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
Acute appendicitis is a highly common cause of abdominal pain that presents with nausea and vomiting, characteristic physical exam findings, and imaging evidence of appendiceal inflammation. In the absence of these signs, diagnosis can be difficult. This case report demonstrates an uncommon presentation of appendicitis that led to a delay in diagnosis and aims to discuss the ways in which similar misdiagnoses can be avoided for clinicians in the future.
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Choi YJ, Shin SH, Shin HS. Immunomodulatory Effects of Bifidobacterium spp. and Use of Bifidobacterium breve and Bifidobacterium longum on Acute Diarrhea in Children. J Microbiol Biotechnol 2022; 32:1186-1194. [PMID: 36039384 PMCID: PMC9628976 DOI: 10.4014/jmb.2206.06023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
The intake of probiotic lactic acid bacteria not only promotes digestion through the microbiome regulated host intestinal metabolism but also improves diseases such as irritable bowel syndrome and inflammatory bowel disease, and suppresses pathogenic harmful bacteria. This investigation aimed to evaluate the immunomodulatory effects in intestinal epithelial cells and to study the clinical efficacy of the selected the Bifidobacterium breve and Bifidobacterium longum groups. The physiological and biochemical properties were characterized, and immunomodulatory activity was measured against pathogenic bacteria. In order to find out the mechanism of inflammatory action of the eight viable and sonicated Bifidobacterium spp., we tried to confirm the changes in the pro-inflammatory cytokines (TNF-α, interleukin (IL)-6, IL-12) and anti-inflammatory cytokine (IL-10), and chemokines, (monocyte chemoattractant protein-1, IL-8) and inflammatory enzymatic mediator (nitric oxide) against Enterococcus faecalis ATCC 29212 infection in Caco-2 cells and RAW 264.7 cells. The clinical efficacy of the selected B. breve and B. longum group was studied as a probiotic adjuvant for acute diarrhea in children by oral administration. The results showed significant immunomodulatory effects on the expression levels of TNF-α, IL-6, IL-12, MCP-1, IL-8 and NO, in sonicated Bifidobacterium extracts and viable bifidobacteria. Moreover, each of the Bifidobacterium strains was found to react more specifically to different cytokines. However, treatment with sonicated Bifidobacterium extracts showed a more significant effect compared to treatment with the viable bacteria. We suggest that probiotics functions should be subdivided according to individual characteristics, and that personalized probiotics should be designed to address individual applications.
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Affiliation(s)
- Yae Jin Choi
- College of Pharmacy, Duksung Women’s University, Seoul 01369, Republic of Korea
| | - Seon-Hee Shin
- Department of Pediatrics, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea
| | - Hea Soon Shin
- College of Pharmacy, Duksung Women’s University, Seoul 01369, Republic of Korea,Corresponding author Phone: +82-2-901-8398 Fax: +82-2-901-8386 E-mail:
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Chilaúle JJ, Munlela B, Mans J, Mabasa VV, Marques S, Bauhofer AFL, Jane G, Anapakala E, Oliveira F, Cossa-Moiane I, Guimarães E, Sambo J, Bero DM, Chissaque A, de Deus N, Taylor MB. Norovirus Genetic Diversity in Children under Five Years Old with Acute Diarrhea in Mozambique (2014-2015). Viruses 2022; 14:v14092001. [PMID: 36146807 PMCID: PMC9502691 DOI: 10.3390/v14092001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
Norovirus (NoV) is the second most important cause of viral diarrheal disease in children worldwide after rotavirus and is estimated to be responsible for 17% of acute diarrhea in low-income countries. This study aimed to identify and report NoV genotypes in Mozambican children under the age of five years with acute diarrhea. Between May 2014 and December 2015, stool specimens were collected within the Mozambique Diarrhea National Surveillance (ViNaDia) and tested for NoV genogroups I (GI) and II (GII) using conventional reverse transcriptase-polymerase chain reaction (RT-PCR). Partial capsid and RNA-dependent RNA polymerase (RdRp) nucleotide sequences were aligned using the Muscle tool, and phylogenetic analyses were performed using MEGA X. A total of 204 stool specimens were tested for NoV. The detection rate of NoV was 14.2% (29/204). The presence of NoV was confirmed, by real-time RT-PCR (RT-qPCR), in 24/29 (82.8%) specimens, and NoV GII predominated (70.8%; 17/24). NoV GII.4 Sydney 2012[P31] was the predominant genotype/P-type combination detected (30.4%; 7/23). This is the first study which highlights the high genetic diversity of NoV in Mozambican children and the need to establish a continuous NoV surveillance system.
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Affiliation(s)
- Jorfélia J. Chilaúle
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Correspondence:
| | - Benilde Munlela
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Janet Mans
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Victor V. Mabasa
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Selma Marques
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Graziela Jane
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Elda Anapakala
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Fernanda Oliveira
- Hospital Militar de Maputo (HMM), Rua Samuel D. Khumbula Maputo, Maputo 592, Mozambique
| | - Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Institute of Tropical Medicine (ITM), 2000 Antwerp, Belgium
| | - Esperança Guimarães
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Diocreciano Matias Bero
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila-Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Av. Julius Nyerere–Campus Universitário, Maputo 257, Mozambique
| | - Maureen B. Taylor
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
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11
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Candellone A, Girolami F, Badino P, Jarriyawattanachaikul W, Odore R. Changes in the Oxidative Stress Status of Dogs Affected by Acute Enteropathies. Vet Sci 2022; 9. [PMID: 35737327 DOI: 10.3390/vetsci9060276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Canine acute enteropathies (AE) are common morbidities primarily managed with supportive therapy. However, in some cases, unnecessary courses of antibiotics are empirically prescribed. Recent studies in humans have hypothesized the use of antioxidants as a possible alternative and/or support to antimicrobial drugs in uncomplicated cases. Considering the global need to reduce the antibiotic use, the aim of the study was to compare the oxidative burden of the diarrhetic population to that of healthy dogs. Forty-five patients suffering from uncomplicated acute diarrhea (AD) and 30 controls were screened for clinical and biochemical parameters, and serum redox indices (reactive oxygen metabolites, dROMs; serum antioxidant capacity, SAC; oxidative stress index, OSi). The average levels of dROMs in AD dogs were significantly higher (p < 0.001) than in healthy dogs, while SAC did not significantly differ between the two groups. However, the OSi values (ratio between dROMs and SAC) significantly increased (p < 0.001) in AD dogs compared to controls. The study demonstrates that canine AD could induce redox imbalance. Although its role in the etiopathogenesis and evolution of the disease should be further investigated, our results suggest that the improvement of the patient oxidative status, possibly through the dietary administration of antioxidants, could support the management of canine AE, reducing the use of antibiotics.
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Giacosa A, Riva A, Petrangolini G, Allegrini P, Fazia T, Bernardinelli L, Peroni G, Rondanelli M. Positive Effects of a Lecithin-Based Delivery Form of Boswellia serrata Extract in Acute Diarrhea of Adult Subjects. Nutrients 2022; 14:nu14091858. [PMID: 35565826 PMCID: PMC9101471 DOI: 10.3390/nu14091858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
Acute diarrhea is a frequent problem worldwide, mostly due to gastrointestinal infections or food poisoning. Boswellia serrata could be active in the treatment of acute diarrhea due to its anti-inflammatory, antispasmodic, and antimicrobial activity. In this randomized, double-blind, placebo-controlled clinical study, 49 adults with acute diarrhea were randomly allocated to receive 250 mg of a lecithin-based delivery form of Boswellia serrata (CASP) or placebo for 5 days. The time it took to become healthy with stoppage of diarrhea (primary end point) was significantly shorter in the intervention group (3.08 vs. 4.44 days: p-value < 0.0001). The probability of subjects treated with CASP to recover sooner was equal to 80.2%. A significantly lower number of stools was observed in the CASP group over time (β = −0.17, p-value < 0.0001). A significant difference was observed between the two groups for abdominal pain, nausea, and GAE (global assessment of efficacy). In conclusion, the lecithin-based delivery form of Boswellia serrata extract could be a useful addition to the treatment of acute diarrhea in adults. CASP is safe and reduces the time it takes to become healthy, the frequency of stools, the abdominal pain and nausea of subjects with acute diarrhea. Further studies are needed to confirm these promising results.
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Affiliation(s)
| | - Antonella Riva
- R&D Department, Indena SpA, 20139 Milan, Italy; (A.R.); (G.P.); (P.A.)
| | | | - Pietro Allegrini
- R&D Department, Indena SpA, 20139 Milan, Italy; (A.R.); (G.P.); (P.A.)
| | - Teresa Fazia
- Department of Brain and Behavioral Science, University of Pavia, 27100 Pavia, Italy; (T.F.); (L.B.)
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Science, University of Pavia, 27100 Pavia, Italy; (T.F.); (L.B.)
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ‘‘Istituto Santa Margherita’’, University of Pavia, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-0382381739
| | - Mariangela Rondanelli
- IRCCS Mondino Foundation, 27100 Pavia, Italy;
- Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, 27100 Pavia, Italy
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13
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Feng X, Zhuang L, Chen L, Zhao H, Huang R, Guo Z. Comparison of different probiotics in the treatment of acute diarrhea in children: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e28899. [PMID: 35356899 PMCID: PMC10684214 DOI: 10.1097/md.0000000000028899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acute diarrhea has a serious impact on the health and lives of children. Previous studies have shown that probiotics have positive and reliable efficacy in the treatment of acute diarrhea in children, but the efficacy of different types of probiotics varies. This study will evaluate the clinical efficacy of different kinds of probiotics in the treatment of acute diarrhea in children by means of network meta-analysis. METHODS According to the retrieval strategy, randomized controlled studies on probiotics in the treatment of acute diarrhea in children will be searched from PubMed, Embase, Web of Science, the Cochrane Library, CNQI, Wanfang, VIP, and Chinese biomedical databases. The retrieval time limit will be from the establishment of the database to January 2022. The quality level of the included studies will be assessed using the Cochrane Risk Bias Assessment Tool and the strength of evidence for outcome measures will be assessed using the Grading of Recommendation Assessment, Development, and Evaluation method. All data analysis will be performed by Revman5.3, Gemtc 0.14.3 and Stata 14.0. RESULTS This study will evaluate the efficacy of different kinds of probiotics in the treatment of acute diarrhea in children by evaluating diarrhea duration, stool frequency, length of hospital stay, adverse reactions, etc. CONCLUSIONS This study will provide a reliable evidence-based basis for the selection of probiotics for the treatment of acute diarrhea in children. ETHICS AND DISSEMINATION Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/MNJAE.
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Affiliation(s)
- Xiao Feng
Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
| | - LiJuan Zhuang
Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
| | - Ling Chen
Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
| | - Hongying Zhao
Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
| | - Rui Huang
Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
| | - ZhiFeng Guo
Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
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14
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Tang X, Hu Y, Zhong X, Xu H. Molecular Epidemiology of Human Adenovirus, Astrovirus, and Sapovirus Among Outpatient Children With Acute Diarrhea in Chongqing, China, 2017-2019. Front Pediatr 2022; 10:826600. [PMID: 35311045 PMCID: PMC8929441 DOI: 10.3389/fped.2022.826600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the epidemiology of human adenovirus (HAdV), human astrovirus (HAstV), and sapovirus (SaV), children with acute diarrhea in Chongqing, China from 2017 to 2019 were enrolled. Improved surveillance could provide better guidance for diarrhea prevention. METHODS Between 2017 and 2019, fecal specimens were collected from children <14 years of age presenting with acute diarrhea for treatment at the outpatient department of the Children's Hospital, Chongqing Medical University. Human HAdV in the fecal specimens was detected by PCR, while RT-PCR was adopted for the detection of HAstV and SaV. RESULTS A total of 1,352 fecal specimens were screened in this study. The detection rate of HAdV was 4.44% (60/1352), HAstV was 2.81% (38/1352), and SaV was 1.04% (14/1352). The prevalence of enteric viruses in males was not significantly different to females (p > 0.05). We found 96.67% (58/60) of the HAdV-positive cases, 92.11% (35/38) of the HAstV-positive cases, and 100% (14/14) of the SaV-positive cases among the children under 4 years old. HAdV cases were identified throughout the year, while the infection of HAstV peaked from March to May every year. By contrast, SaV was detected in May, July, and from September to December. In total, 41 strains of HAdV-F were identified, including F41 (39/60) and F40 (2/60). Furthermore, A31, B3, B7, C1, C2, C5, and C6 were also detected in the study. In addition, we detected two genotypes of HAstV, HAstV-1 (34/38) and HAstV-5 (4/38), and two genotypes of SaV, GI0.1 (13/14), GI0.2 (1/14). CONCLUSION The enteric viruses HAdV, HAstV, and SaV contribute to the overall burden of diarrhea in Chongqing, especially in children <4 years of age. Two genotypes were identified for HAstV (HAstV-1 and HAstV-5) and SaV (GI.1 and GI.2) with an additional nine genotypes detected in HAdV cases. While the F41 HAdV strain was predominant, HAdV-A31 was also detected in 10% of cases. The study results along with continuous surveillance of enteric viruses will aid in the design and implementation of future enteric vaccines and diarrhea mitigation strategies.
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Affiliation(s)
- Xiang Tang
- Children's Hosptital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Yue Hu
- Children's Hosptital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Hongmei Xu
- Children's Hosptital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
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15
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Huang R, Xing HY, Liu HJ, Chen ZF, Tang BB. Efficacy of probiotics in the treatment of acute diarrhea in children: a systematic review and meta-analysis of clinical trials. Transl Pediatr 2021; 10:3248-3260. [PMID: 35070839 PMCID: PMC8753473 DOI: 10.21037/tp-21-511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/01/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND If acute diarrhea in children is not treated promptly and effectively, it can lead to severe dehydration and serious sequelae. Due to the imbalance of intestinal bacteria in children with acute diarrhea, the supplementation with probiotics is important, which can improve the intestinal microenvironment, promote immunity, and enhance resistance. This meta-analysis provides further evidence and discussion of the therapeutic effect of probiotics on acute diarrhea in children. METHODS MEDLINE, EMBASE, PubMed, and the Cochrane Library databases were searched by rapid matching. The input keywords were as follows: (probiotics/synbiotics) and (child/children) and (acute diarrhea/acute gastroenteritis). Articles reporting on randomized controlled trials (RCTs) of probiotics in treating acute diarrhea in children were retrieved. The studies were published from 2010 to 2020. After screening and quality evaluation, Stata 16.0 software was used for the analysis. RESULTS Twelve articles with 744 patients were included in the study, and the overall quality of the articles was excellent. Meta-analysis showed that the duration of diarrhea in the probiotics group was shorter than that in the control group [standard mean difference (SMD) =-0.74, 95% CI: -1.11 to -0.37, Z=-3.935, P=0.000], the 2-day treatment efficacy for diarrhea in the probiotics group was greater than that in the control group [odds ratio (OR) =2.12, 95% CI: 1.47-3.05, Z=3.998, P=0.000], and the length of hospital stay in the probiotics group was shorter than that of the control group (SMD =-0.60, 95% CI: -0.74 to -0.47, Z=-8.781, P=0.000). In the subgroup analysis, combined probiotics shortened the duration of diarrhea compared with single probiotic use, and Lactobacillus reuteri and Saccharomyces boulardii had a better therapeutic effect than Lactobacillus rhamnosus or Lactobacillus acidophilus. DISCUSSION In the treatment of acute diarrhea in children, the addition of probiotics can shorten the duration of diarrhea, increase treatment efficacy after 2 days of treatment, and shorten the length of hospital stay. However, because of possible publication bias in the current study, further high-quality RCT studies in clinical settings are needed to verify the current results and continue the exploration of this topic.
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Affiliation(s)
- Rao Huang
- Department of Pediatrics, Haikou Hospital of Maternal and Child Health, Haikou, China
| | - Hong-Yi Xing
- Department of Emergency, Haikou Hospital of Maternal and Child Health, Haikou, China
| | - Hong-Juan Liu
- Department of Pediatrics, Haikou Hospital of Maternal and Child Health, Haikou, China
| | - Ze-Fu Chen
- Department of Pediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Bi-Bo Tang
- Department of Pediatrics, Hainan West Central Hospital, Danzhou, China
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16
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Li Z, Zhu G, Li C, Lai H, Liu X, Zhang L. Which Probiotic Is the Most Effective for Treating Acute Diarrhea in Children? A Bayesian Network Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:nu13124319. [PMID: 34959871 PMCID: PMC8706888 DOI: 10.3390/nu13124319] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022] Open
Abstract
Acute diarrhea is a major cause of morbidity and mortality in children under five. Probiotics are beneficial for treating acute diarrhea in children, but unclear which specific probiotic is the most effective. We performed a Bayesian network meta-analysis to examine the comparative effectiveness of probiotics. By searching EMBASE, PubMed, and the Cochrane Library up to 31 March 2021, randomized clinical trials (RCTs) on probiotics for treating acute diarrhea in children were included. Primary outcomes included the duration of diarrhea and diarrhea lasting ≥2 days, and secondary outcomes included the mean stool frequency on day 2 and duration of hospitalization, fever, and vomiting. We assessed the certainty of the evidence of outcomes according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline. Eighty-four studies with twenty-one different interventions in 13,443 children were included. For the primary outcomes, moderate evidence indicated that, Lactobacillus reuteri [mean difference (MD) = -0.84 day; 95% confidence interval (CI), -1.39, -0.29], Bifidobacterium lactis (MD = -0.98 day; 95%CI, -1.82, -0.14), Saccharomyces boulardii (MD = -1.25 day; 95%CI, -1.59, -0.91), Lactobacillus species (spp.) plus Bifidobacterium spp. plus Saccharomyces spp. (MD = -1.19 day; 95%CI, -1.81, -0.58), and Bacillus spp. plus Enterococcus spp. plus Clostridium spp. (MD = -1.1 day; 95%CI, -1.84, -0.35) significantly reduced the duration of diarrhea when compared with placebo. Saccharomyces boulardii [Odds ratio (OR) = 0.22; 95%CI, 0.11, 0.41] and Lactobacillus reuteri (OR = 0.23; 95%CI, 0.090, 0.60) significantly reduced the risk of diarrhea lasting ≥2 days when compared with placebo or no treatment, with moderate evidence. Among all probiotics, Saccharomyces boulardii may be the most effective in reducing both duration of diarrhea (compared with placebo) and risk of diarrhea lasting ≥2 days (compared with placebo or no treatment), with moderate evidence. To be conclusive, Saccharomyces boulardii may be the most effective probiotic for treating acute diarrhea in children, followed by several other single-strain and multi-strain probiotics.
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Affiliation(s)
- Zengbin Li
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (Z.L.); (G.Z.); (H.L.)
| | - Guixian Zhu
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (Z.L.); (G.Z.); (H.L.)
| | - Chao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (C.L.); (X.L.)
| | - Hao Lai
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (Z.L.); (G.Z.); (H.L.)
| | - Xin Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (C.L.); (X.L.)
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (Z.L.); (G.Z.); (H.L.)
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC 3053, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3800, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
- Correspondence: ; Tel.: +86-29-82655135
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17
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Hamadouk RM, Arbab AH, Yousef BA. Assessment of Community Pharmacist's Practice and Patient Counselling Toward Acute Diarrhea Treatment in Khartoum Locality: A Simulated Patient Study. Integr Pharm Res Pract 2021; 10:145-152. [PMID: 34815972 PMCID: PMC8605881 DOI: 10.2147/iprp.s340528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Acute diarrhea is one of the most common health problems globally as a minor ailment, it is widely managed by community pharmacists (CPs). Professional patient counseling provided in community pharmacies is essential to decide about acute diarrhea and avoid treatment failure properly. Objective To assess CPs’ history-taking practice, medication dispensing, and patient counseling in response to acute diarrhea in adults. Methods A cross-sectional, covert simulated patient (SP) study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used, one scenario assesses afterwards compliance to treatment guidelines and patient counseling, and second scenario determines afterwards if pharmacists referred patients to medical consultation. Six final-year pharmacy students were involved as SPs. All encounters were audio-recorded by SP. Then the investigator filled the checklist that was intended to evaluate the overall practice of pharmacists. Results As planned, 235 pharmacies were visited twice, resulting in a total of 470 visits (visit completion rate: 100%). In history taking, the most asked questions were the patient’s age (89.8% for scenario 1 and 88.5% for scenario 2). Followed by the presence of blood in the stool (25.5% for scenario 1 and 28.1% for scenario 2). In scenario 1, loperamide was the most dispensed medication (81.3%), while oral rehydration solution (ORS) was dispensed in 0.9% of the visits. In counseling, verbal and written instructions were provided in 47.7% of the visits. Duration of medications was mentioned in 3.8%, advice about fluid intake was offered in 7.2% of the visits. In scenario 2, 17% of the pharmacists managed patient history well to refer patients to medical consultation, while 42.6% recommended referral after sufficient information was provided by the SP. Conclusion CPs’ practice in counseling toward acute diarrhea was poor; referral to medical consultation was below expectation. The current CPs dispensing practices need improvement; thus, professional education should be encouraged.
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Affiliation(s)
- Riham M Hamadouk
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Ahmed H Arbab
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Bashir A Yousef
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
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18
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Osugi Y, Ishiguro K, Kobayashi D. Association Between Antidiarrheal Drug Prescription and Return Visits Among Adult Patients With Acute Diarrhea. Cureus 2021; 13:e18807. [PMID: 34796079 PMCID: PMC8590859 DOI: 10.7759/cureus.18807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Whether antidiarrheal medications have benefits or demerits when administered to adult patients with diarrhea remains controversial. We aimed to evaluate the association between antidiarrheal drug prescription and clinical outcomes in adult patients with acute diarrhea. This retrospective cohort study was conducted by collecting secondary data of patients' health records at St. Luke’s International Hospital from April 1, 2004, to March 31, 2016. We included all participants aged 20-59 years who visited the division of general internal medicine or the emergency room in the hospital due to acute diarrheal symptoms. We excluded those who had chronic diarrhea or were immunocompromised (e.g., those with cancer or immunosuppressant usage). Our primary outcome was return visits within two weeks; the secondary outcome was admission to the hospital due to acute diarrhea within two weeks from the first visit. We compared the outcomes between patients with and without antidiarrheal drug prescriptions. During the study period, a total of 10,246 patients were included, of which 204 (2.0%) were prescribed antidiarrheal drugs. The mean age of the patients was 35.0 (standard deviation: 10.7) years, and 4,130 (40.3%) were men. Patients who were prescribed antidiarrheal drugs were more likely to be prescribed antibiotics (p<0.01). The adjusted odds ratios for return visits among patients with and without antidiarrheal drug prescription were 1.24-1.59, which were not significant. We demonstrated that antidiarrheal drug prescription was not associated with return visits or hospital admission among adult patients with acute diarrhea. This finding suggests that antidiarrheal medications have more benefits than risks in adult patients with acute diarrhea.
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Affiliation(s)
- Yasuhiro Osugi
- General Medicine, Toyota Regional Medical Center, Toyota, JPN
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19
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Kwon JY, Seo JY, Kim TY, Lee HI, Ju JW. First Identification and Genotyping of Enterocytozoon bieneusi and Prevalence of Encephalitozoon intestinalis in Patients with Acute Diarrhea in the Republic of Korea. Pathogens 2021; 10:pathogens10111424. [PMID: 34832580 PMCID: PMC8622466 DOI: 10.3390/pathogens10111424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
Encephalitozoon intestinalis and Enterocytozoon bieneusi can cause diarrhea in humans, especially severe diarrhea in immunocompromised patients. However, there have been few studies on Enc. intestinalis and Ent. bieneusi in patients with acute diarrhea in the Republic of Korea (ROK). In this study, fecal samples were collected from 1241 patients with acute diarrhea in 2020. Among these, 24 cases of Enc. intestinalis and one case of Ent. bieneusi were detected via PCR amplification of small subunit ribosomal RNA. Genotyping of the internal transcribed spacer region sequence revealed that the detected Ent. bieneusi genotype was in Group 1. This study provides the first evidence that Ent. bieneusi exists in humans in addition to animals in the ROK. To identify the causative agent, continuous monitoring of Enc. intestinalis and Ent. bieneusi is necessary for patients with acute diarrhea in the ROK.
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Zhang XA, Zhao RQ, Chen JJ, Yuan Y, Tang X, Zhou ZW, Ren L, Lu QB, Wang YN, Zhang HY, Zhang PH, Fang LQ, Zhou HS, Liu EM, Xu HM, Liu W. The Identification and Genetic Characterization of Parechovirus Infection Among Pediatric Patients With Wide Clinical Spectrum in Chongqing, China. Front Microbiol 2021; 12:709849. [PMID: 34594310 PMCID: PMC8477803 DOI: 10.3389/fmicb.2021.709849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/05/2021] [Indexed: 12/03/2022] Open
Abstract
Human parechoviruses (HPeVs) are important causes of infection in children. However, without a comprehensive and persistent surveillance, the epidemiology and clinical features of HPeV infection remain ambiguous. We performed a hospital-based surveillance study among three groups of pediatric patients with acute respiratory infection (Group 1), acute diarrhea (Group 2), and hand, foot and mouth disease (Group 3) in Chongqing, China, from 2009 to 2015. Among 10,212 tested patients, 707 (6.92%) were positive for HPeV, with the positive rates differing significantly among three groups (Group 1, 3.43%; Group 2, 14.94%; Group 3, 3.55%; P < 0.001). The co-infection with other pathogens was detected in 75.2% (531/707) of HPeV-positive patients. Significant negative interaction between HPeV and Parainfluenza virus (PIV) (P = 0.046, OR = 0.59, 95% CI = 0.34–0.98) and positive interactions between HPeV and Enterovirus (EV) (P = 0.015, OR = 2.28, 95% CI = 1.23–4.73) were identified. Among 707 HPeV-positive patients, 592 (83.73%) were successfully sequenced, and 10 genotypes were identified, with HPeV1 (n = 396), HPeV4 (n = 86), and HPeV3 (n = 46) as the most frequently seen. The proportion of genotypes differed among three groups (P < 0.001), with HPeV1 and HPeV4 overrepresented in Group 2 and HPeV6 overrepresented in Group 3. The spatial patterns of HPeV genotypes disclosed more close clustering of the currently sequenced strains than those from other countries/regions, although they were indeed mixed. Three main genotypes (HPeV1, HPeV3, and HPeV4) had shown distinct seasonal peaks, highlighting a bi-annual cycle of all HpeV and two genotypes (HPeV 1 and HPeV 4) with peaks in odd-numbered years and with peaks in even-numbered years HPeV3. Significantly higher HPeV1 viral loads were associated with severe diarrhea in Group 2 (P = 0.044), while associated with HPeV single infection than HPeV-EV coinfection among HFMD patients (P = 0.001). It’s concluded that HPeV infection was correlated with wide clinical spectrum in pediatric patients with a high variety of genotypes determined. Still no clinical significance can be confirmed, which warranted more molecular surveillance in the future.
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Affiliation(s)
- Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Rui-Qiu Zhao
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jin-Jin Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yang Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Xiang Tang
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Wei Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Luo Ren
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qin-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Yu-Na Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hai-Yang Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hai-Sheng Zhou
- Key Laboratory of Dermatology, Anhui Medical University, Hefei, China.,Department of Biochemistry and Molecular Biology, Anhui Medical University, Hefei, China
| | - En-Mei Liu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hong-Mei Xu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.,Beijing Key Laboratory of Vector Borne and Natural Focus Infectious Diseases, Beijing, China
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Guzman-Holst A, Ortega-Barria E, Flores ÁA, Carreño-Manjarrez R, Constenla D, Cervantes-Apolinar MY. 15-year experience with rotavirus vaccination in Mexico: a systematic literature review. Hum Vaccin Immunother 2021; 17:3623-3637. [PMID: 34187326 PMCID: PMC8437458 DOI: 10.1080/21645515.2021.1936859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A systematic review was conducted in Mexico to consolidate and evaluate evidence after 15 years of rotavirus vaccination, according to the National Immunization Program. Five databases were screened to identify published articles (January 2000-February 2020) with evidence on all clinical and epidemiological endpoints (e.g. immunogenicity, safety, efficacy, impact/effectiveness) of rotavirus vaccination in Mexico. Twenty-two articles were identified (observational studies including health-economic models: 17; randomized controlled trials: 5). Fourteen studies evaluated a human attenuated vaccine (HRV), four studies evaluated both vaccines, and only two evaluated a bovine-human reassortant vaccine, with local efficacy data only for HRV. Local evidence shows vaccines are safe, immunogenic, efficacious, and provide an acceptable risk-benefit profile. The benefits of both vaccines in alleviating the burden of all-cause diarrhea mortality and morbidity are documented in several local post-licensure studies. Findings signify overall benefits of rotavirus vaccination and support the continued use of rotavirus vaccine in Mexico.
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Pignataro G, Di Prinzio R, Crisi PE, Belà B, Fusaro I, Trevisan C, De Acetis L, Gramenzi A. Comparison of the Therapeutic Effect of Treatment with Antibiotics or Nutraceuticals on Clinical Activity and the Fecal Microbiome of Dogs with Acute Diarrhea. Animals (Basel) 2021; 11:1484. [PMID: 34063855 DOI: 10.3390/ani11061484] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Acute diarrhea in dogs is one of the most common reasons for veterinary visits. Although this disorder is generally self-limiting, antibiotics are still frequently used as treatment for acute diarrhea in clinical practice. Antimicrobial resistance represents a major challenge for public health and requires immediate and drastic solutions. To date, the emergence and spread of antimicrobial resistance has been attributed to the misuse or indiscriminate use of antibiotics. The aim of this study is to compare the effects on clinical activity and fecal microbiota of the administration of an antibiotic combination in comparison to a nutraceutical product in dogs with acute non-hemorrhagic diarrhea. The results of the present study suggest that this nutraceutical treatment had a similar clinical effect compared to the antibiotic formulation and may represent an alternative to commonly used antimicrobial therapy. Abstract Dogs with acute diarrhea are often presented to clinical practice and, although this generally represents a self-limiting condition, antibiotics are still frequently used as treatment. The aim of this study was to evaluate the effects in dogs with acute non-hemorrhagic diarrhea of the administration of an antibiotic combination in comparison to a nutraceutical product. Thirty dogs were enrolled and randomly assigned to two groups: 15 dogs (group A) received a nutraceutical commercial product while 15 dogs (group B) received an antimicrobial combination of metronidazole and spiramycin. For each dog, the Canine Acute Diarrhea Severity Index, the fecal microbiota and the Dysbiosis Index were assessed. Both stool consistency and frequency decreased on day 2 in the dogs of group A compared to baseline, while in group B, these parameters significantly decreased at days 3 and 4. The global concern for rising antibiotic resistance associated with indiscriminate use of antimicrobials, in both humans and animals, suggests the necessity of avoiding empirical and injudicious use of these molecules in diarrheic dogs. These results suggest that the nutraceutical treatment had a similar clinical effect compared to the antibiotic formulation, representing a valid antibiotic-sparing therapeutic approach in canine acute diarrhea.
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Kurahashi Y, Hattasingh W, Chatchen S, Yingtaweesak T, Sirivichayakul C. Association of undernutrition with dengue, malaria and acute diarrhea among children in a Thai-Myanmar border. J Public Health (Oxf) 2021; 44:77-83. [PMID: 33993313 DOI: 10.1093/pubmed/fdab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 03/13/2021] [Accepted: 04/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Undernutrition has been shown to be associated with various infectious diseases. However, the recent improvement in nutritional status and management for infectious diseases worldwide necessitates the re-evaluation of this association. METHODS A retrospective study was conducted in children aged <14 years old with dengue, malaria or acute diarrhea who visited or were admitted to Tha Song Yang hospital, near the Thai-Myanmar border. RESULTS Most of the patients had mild disease and most of the undernourishment was mild. The prevalence of underweight in dengue, malaria and acute diarrhea was 24.0%, 34.7% and 38.7%, respectively, and the prevalence of low height for age was 12.0%, 36.0% and 36.0%, respectively. Malaria and acute diarrhea were associated with underweight but not low height for age. Dengue was neither associated with underweight nor low height for age. CONCLUSION Although there has been an improvement in nutritional status and health care facilities, underweight has been still prevalent in rural areas and associated with malaria and acute diarrhea. IMPLICATION The surveillance for nutritional status should be continuously performed particularly in children with some diseases, e.g. malaria and acute diarrhea, and additional food supplementation should be provided.
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Affiliation(s)
- Yukiya Kurahashi
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.,Department of Pediatric Hospital Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo 650-0047, Japan
| | - Weerawan Hattasingh
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Supawat Chatchen
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | | | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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24
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Cossa-Moiane I, Cossa H, Bauhofer AFL, Chilaúle J, Guimarães EL, Bero DM, Cassocera M, Bambo M, Anapakala E, Chissaque A, Sambo J, Langa JS, Manhique-Coutinho LV, Fantinatti M, Lopes-Oliveira LA, Da-Cruz AM, de Deus N. High Frequency of Cryptosporidium hominis Infecting Infants Points to A Potential Anthroponotic Transmission in Maputo, Mozambique. Pathogens 2021; 10:pathogens10030293. [PMID: 33806380 PMCID: PMC8002024 DOI: 10.3390/pathogens10030293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/16/2022] Open
Abstract
Cryptosporidium is one of the most important causes of diarrhea in children less than 2 years of age. In this study, we report the frequency, risk factors and species of Cryptosporidium detected by molecular diagnostic methods in children admitted to two public hospitals in Maputo City, Mozambique. We studied 319 patients under the age of five years who were admitted due to diarrhea between April 2015 and February 2016. Single stool samples were examined for the presence of Cryptosporidium spp. oocysts, microscopically by using a Modified Ziehl-Neelsen (mZN) staining method and by using Polymerase Chain Reaction and Restriction Fragment Length Polymorphism (PCR-RFLP) technique using 18S ribosomal RNA gene as a target. Overall, 57.7% (184/319) were males, the median age (Interquartile range, IQR) was 11.0 (7-15) months. Cryptosporidium spp. oocysts were detected in 11.0% (35/319) by microscopy and in 35.4% (68/192) using PCR-RFLP. The most affected age group were children older than two years, [adjusted odds ratio (aOR): 5.861; 95% confidence interval (CI): 1.532-22.417; p-value < 0.05]. Children with illiterate caregivers had higher risk of infection (aOR: 1.688; 95% CI: 1.001-2.845; p-value < 0.05). An anthroponotic species C. hominis was found in 93.0% (27/29) of samples. Our findings demonstrated that cryptosporidiosis in children with diarrhea might be caused by anthroponomic transmission.
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Affiliation(s)
- Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Institute of Tropical Medicine, 2000 Antwerp, Belgium
- Correspondence: ; Tel.: +258-84-327-3270
| | - Hermínio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Unidade de Pesquisa Social, Manhiça Foundation (Fundação Manhiça, FM), Manhiça 1929, Mozambique;
| | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Jorfélia Chilaúle
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Esperança Lourenço Guimarães
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Diocreciano Matias Bero
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Miguel Bambo
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Elda Anapakala
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Júlia Sambo
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
| | - Jerónimo Souzinho Langa
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Lena Vânia Manhique-Coutinho
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
| | - Maria Fantinatti
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
| | - Luis António Lopes-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
| | - Alda Maria Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro 22040-360, Brazil; (M.F.); (L.A.L.-O.); (A.M.D.-C.)
- Disciplina de Parasitologia, Faculdade de Ciências Médicas, UERJ/RH, Rio de Janeiro 21040-900, Brazil
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), EN1, Bairro da Vila–Parcela n° 3943, Distrito de Marracuene, Maputo 264, Mozambique; (A.F.L.B.); (J.C.); (E.L.G.); (D.M.B.); (M.C.); (M.B.); (E.A.); (A.C.); (J.S.); (J.S.L.); (L.V.M.-C.); (N.d.D.)
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo 3453, Mozambique
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Santos J, Musta V, Luca CM, Belei OA, Cambrea SC. Randomized, placebo-controlled trial of xyloglucan and gelose for the treatment of acute diarrhea in children. Expert Rev Gastroenterol Hepatol 2021; 15:325-331. [PMID: 33028102 DOI: 10.1080/17474124.2021.1833715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Oral rehydration is the main treatment of acute diarrhea in children. This study was undertaken to evaluate the efficacy and safety of xyloglucan and gelose (agar-agar) plus oral rehydration solution (ORS) compared with placebo and ORS for reduction of acute diarrhea symptoms in children. METHODS In a randomized, double-blind, placebo-controlled trial, children with acute gastroenteritis received xyloglucan/gelose plus ORS (n = 50) or placebo plus ORS (n = 50) for 5 days. Demographic, clinical, anthropometric and laboratory parameters were recorded and analyzed. RESULTS Xyloglucan/gelose plus ORS reduced the total number of type 7 and 6 stools on the Bristol Stool Form scale (p = 0.040 and p = 0.015, respectively, compared to placebo plus ORS), and had a rapid onset of action, evident 6 hours post-treatment. Xyloglucan/gelose plus ORS also improved associated clinical symptoms (apathy, vomiting, flatulence, and blood in stool). compared with placebo plus ORS. Except for a generalized rash of unknown causality in a patient receiving placebo plus ORS, all other adverse events (dehydration, n = 7, cough, n = 1, exacerbation of vomiting, n = 1) were deemed unrelated to study medication. CONCLUSIONS Xyloglucan/gelose plus ORS was effective and safe in treating acute diarrhea in children.
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Affiliation(s)
- Javier Santos
- Vall d'Hebron Institut de Recerca (VHIR) , Barcelona, Spain.,Servei de Aparell Digestiu, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus , Barcelona, Spain.,CIBER de Enfermedades Hepáticas y Digestivas (CIBERHED), Instituto de Salud Carlos III , Madrid, Spain.,Facultat de Medicina, Universitat Autònoma de Barcelona , Bellaterra, Spain
| | - Virgil Musta
- Victor Babes University of Medicine and Pharmacy , Timisoara
| | | | - Oana Andreea Belei
- First Pediatric Clinic, Victor Babes University of Medicine and Pharmacy , Timisoara, Romania
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María Remes Troche J, Coss Adame E, Ángel Valdovinos Díaz M, Gómez Escudero O, Eugenia Icaza Chávez M, Antonio Chávez-Barrera J, Zárate Mondragón F, Antonio Ruíz Velarde Velasco J, Rafael Aceves Tavares G, Antonio Lira Pedrín M, Cerda Contreras E, Carmona Sánchez RI, Guerra López H, Solana Ortiz R. Lactobacillus acidophilus LB: a useful pharmabiotic for the treatment of digestive disorders. Therap Adv Gastroenterol 2020; 13:1756284820971201. [PMID: 33281937 PMCID: PMC7692339 DOI: 10.1177/1756284820971201] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/07/2020] [Indexed: 02/04/2023] Open
Abstract
Dysbiosis, a loss of balance between resident bacterial communities and their host, is associated with multiple diseases, including inflammatory bowel diseases (nonspecific chronic ulcerative colitis and Crohn's disease), and digestive functional disorders. Probiotics, prebiotics, synbiotic organisms and, more recently, pharmabiotics, have been shown to modulate the human microbiota. In this review, we provide an overview of the key concepts relating to probiotics, prebiotics, synbiotic organisms, and pharmabiotics, with a focus on available clinical evidence regarding the specific use of a unique pharmabiotic, the strain Lactobacillus acidophilus LB (Lactobacillus boucardii), for the management of gastrointestinal disorders. Since it does not contain living organisms, the administration of L. acidophilus LB is effective and safe as an adjuvant in the treatment of acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea, even in the presence of immunosuppression.
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Affiliation(s)
- José María Remes Troche
- Instituto e Investigaciones Médico Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - Enrique Coss Adame
- Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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27
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Mourey F, Sureja V, Kheni D, Shah P, Parikh D, Upadhyay U, Satia M, Shah D, Troise C, Decherf A. A Multicenter, Randomized, Double-blind, Placebo-controlled Trial of Saccharomyces boulardii in Infants and Children With Acute Diarrhea. Pediatr Infect Dis J 2020; 39:e347-51. [PMID: 32796401 DOI: 10.1097/INF.0000000000002849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This study was designed to assess the efficacy and safety of Saccharomyces cerevisiae variant boulardii CNCM I-3799 (S. boulardii CNCM I-3799) in the management of acute diarrhea in children. METHODS A total of 100 infants and children 3-36 months of age with acute diarrhea received medical care according to the World Health Organization guidelines on the management of acute diarrhea in children and were randomly allocated to the probiotic group (S. boulardii CNCM I-3799 at a daily dose of 5 billion CFU twice daily) or to the placebo group. Infants and children were treated for 5 days and an extended follow-up was planned 1 and 2 months after the end of the treatment period. Primary endpoint was the time of recovery from diarrhea defined as the duration of diarrhea. Other parameters, such as frequency and consistency of stools, associated with the severity of diarrhea episodes were defined as secondary endpoints. RESULTS The administration of S. boulardii CNCM I-3799 was associated with beneficial effects on duration and severity of diarrhea. The time of recovery from diarrhea was significantly shorter in the probiotic group compared with the placebo group (65.8 ± 12 hours vs. 95.3 ± 17.6 hours, P = 0.0001). Faster remission in the probiotic group was also demonstrated by a shorter time before the first episode of semisolid stool [-23.5 hours, diff (95% CI): -7.99 (-31.49 to -15.51), P = 0.0001] and the faster normalization of stool consistency. S. boulardii CNCM I-3799 was well tolerated. CONCLUSION S. boulardii CNCM I-3799 supplementation in children with acute diarrhea was shown effective in reducing the duration and severity of diarrhea in infants and children.
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Candellone A, Cerquetella M, Girolami F, Badino P, Odore R. Acute Diarrhea in Dogs: Current Management and Potential Role of Dietary Polyphenols Supplementation. Antioxidants (Basel) 2020; 9:antiox9080725. [PMID: 32784917 PMCID: PMC7465157 DOI: 10.3390/antiox9080725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
Acute diarrhea is one of the most common reasons why pet owners seek veterinary care for their canine companions. In many cases, signs resolve spontaneously or with symptomatic therapy without a specific cause being discovered. However, life-threatening cases can occur. The etiology is complex, including infectious diseases (endoparasites, virus, bacteria, protozoa, fungal agents) by both zoonotic and non-zoonotic pathogens, dietary indiscretion, endocrine diseases, and stress (e.g., travel or environmental changes). In the last years, the role played by oxidative stress in the pathogenesis of acute and chronic enteropathies, independently from the initial noxa, has been highlighted by many researches in both humans and animals. As a result, a series of dietary antioxidant compounds have been studied for their potential use in the treatment of intestinal inflammation. This review summarizes the traditional therapeutic and nutritional options to manage canine acute diarrhea, highlighting the need to explore the role of oxidative stress and potential antioxidant supplementation, especially polyphenols, during acute diarrheic episodes.
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Affiliation(s)
- Alessia Candellone
- Department of Veterinary Sciences, University of Turin, Largo Braccini 2, 10095 Grugliasco, Italy; (F.G.); (R.O.)
- Correspondence: (A.C.); (P.B.)
| | - Matteo Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy;
| | - Flavia Girolami
- Department of Veterinary Sciences, University of Turin, Largo Braccini 2, 10095 Grugliasco, Italy; (F.G.); (R.O.)
| | - Paola Badino
- Department of Veterinary Sciences, University of Turin, Largo Braccini 2, 10095 Grugliasco, Italy; (F.G.); (R.O.)
- Correspondence: (A.C.); (P.B.)
| | - Rosangela Odore
- Department of Veterinary Sciences, University of Turin, Largo Braccini 2, 10095 Grugliasco, Italy; (F.G.); (R.O.)
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Greuter T, Michel MC, Thomann D, Weigmann H, Vavricka SR. Randomized, Placebo-Controlled, Double-Blind and Open-Label Studies in the Treatment and Prevention of Acute Diarrhea With Enterococcus faecium SF68. Front Med (Lausanne) 2020; 7:276. [PMID: 32656217 PMCID: PMC7326027 DOI: 10.3389/fmed.2020.00276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/18/2020] [Indexed: 11/13/2022] Open
Abstract
Enterococcus faecium SF68® (SF68) is a licensed pharmaceutical for treatment and prevention of diarrhea in Austria, Italy and Switzerland. However, as for other probiotics, evidence for its efficacy is based on small to medium-sized studies. Four unpublished studies on the treatment of acute diarrhea and the prevention of antibiotic-associated diarrhea were analyzed: one randomized, double blind, placebo-controlled trial (RCT) for treatment (n = 1,143), one open-label study for treatment (n = 5,093), one RCT for prevention (n = 1,397) and one open-label study for prevention (n = 4,340). Patients in the treatment-arm and the open-label studies received SF68 (b.i.d. for the prevention studies, t.i.d. for the treatment trials) for 7 days. Primary end points were time to resolution of diarrhea (treatment) and percentage of development of diarrhea (prevention). The primary endpoint of the treatment study was met with a decreased time to resolution of diarrhea in SF68-treated patients compared to controls (median 3 vs. 4 days, p < 0.001). Time to resolution of secondary symptoms was also significantly reduced. Preventive treatment with SF68 was more effective than placebo with development of diarrhea in 8.6 vs. 16.2% (p < 0.001). Results from the open-label studies were consistent with the RCTs. The incidence of adverse events were low (1.1 and 1.4% in the RCT and 4.7 and 7.4% in the open-label studies). SF68 is effective and safe in the treatment of acute diarrhea and prevention of antibiotic-associated diarrhea.
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Affiliation(s)
- Thomas Greuter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Center for Gastroenterology, Zurich, Switzerland
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
| | | | | | - Stephan R Vavricka
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Department of Internal Medicine, GZO Zurich Regional Health Center, Wetzikon, Switzerland
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Yi R, Tian Y, Tan F, Li W, Mu J, Long X, Pan Y, Zhao X. Intervention effect of Malus pumila leaf flavonoids on senna-induced acute diarrhea in BALB/c mice. Food Sci Nutr 2020; 8:2535-2542. [PMID: 32405409 PMCID: PMC7215224 DOI: 10.1002/fsn3.1549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023] Open
Abstract
The Malus pumila leaves are used as a kind of tea drink in China, and there are abundant flavonoids in the leaves of Malus pumila. In this study, BALB/c mice received senna extract solution via gavage, which induced acute diarrhea, and the interventive effect of Malus pumila leaf flavonoids (MPLF) was observed. The results showed that MPLF decreased the diarrhea index, and MPLF also decreased the capillary permeability in the abdominal cavity of mice. The result of serum cytokine detection indicated that MPLF decreased the levels of inflammatory cytokines, including interleukin 6 (IL‐6), interleukin 12 (IL‐12), and tumor necrosis factor alpha (TNF‐α). The results of quantitative polymerase chain reaction (qPCR) indicated that diarrhea decreased the mRNA and protein expression of aquaporin‐3 (AQP3) in the jejunum and aquaporin‐4 (AQP4) in the ileum, which were inhibited by MPLF. By high performance liquid chromatography (HPLC), MPLF mainly contains 10 flavonoids, which are rutin, hyperoside, isoquercitrin, taxifolin, quercitrin, hesperidin, myricetin, baicalin, neohesperidin dihydrochalcone and quercetin, the synergistic effect of these components plays an antidiarrhea role in MPLF. Therefore, MPLF achieved good antidiarrheal effect, which was better than that of the commonly used montmorillonite powder at the same concentration. MPLF is a natural raw material for functional food with an antidiarrheal effect.
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Affiliation(s)
- Ruokun Yi
- Chongqing Collaborative Innovation Center for Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Research Center of Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Laboratory for Research and Development of Functional Food Chongqing University of Education Chongqing China
| | - Yu Tian
- Department of Critical Care Medicine the First Affiliated Hospital of Chengdu Medical College Chengdu China
| | - Fang Tan
- Department of Public Health Our Lady of Fatima University Valenzuela Philippines
| | - Wenfeng Li
- School of Life Science and Biotechnology Yangtze Normal University Chongqing China
| | - Jianfei Mu
- Chongqing Collaborative Innovation Center for Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Research Center of Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Laboratory for Research and Development of Functional Food Chongqing University of Education Chongqing China
| | - Xingyao Long
- Chongqing Collaborative Innovation Center for Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Research Center of Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Laboratory for Research and Development of Functional Food Chongqing University of Education Chongqing China.,Department of Food Science and Biotechnology Cha University Seongnam South Korea
| | - Yanni Pan
- Chongqing Collaborative Innovation Center for Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Research Center of Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Laboratory for Research and Development of Functional Food Chongqing University of Education Chongqing China.,Department of Food Science and Biotechnology Cha University Seongnam South Korea
| | - Xin Zhao
- Chongqing Collaborative Innovation Center for Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Research Center of Functional Food Chongqing University of Education Chongqing China.,Chongqing Engineering Laboratory for Research and Development of Functional Food Chongqing University of Education Chongqing China
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Abstract
BACKGROUND The Verigene Enteric Pathogens Test (Luminex Corporation) is a polymerase chain reaction (PCR)/nucleic acid microarray-based assay targeting 8 bacterial and viral pathogens that cause diarrhea. OBJECTIVE To compare traditional enteric culture methods with stool testing by Verigene EP (PCR/microarray). METHODS Tests were performed using PCR/microarray between February and August 2016. All specimens also underwent culture for Salmonella and Shigella; specimens that tested positive for bacterial pathogen(s) had confirmatory cultures. RESULTS Valid results were obtained for 99.3% of the 3795 stool specimens. Among these, 497 (13.2%) specimens tested positive for at least 1 pathogen by PCR/microarray; 45.5% of these tested positive for 1 or more bacterial pathogens. Agreement between positive bacterial PCR/microarray results and culture-based testing was 85.3%. Compared with cultures, PCR/microarray demonstrated 95.2% and 87.5% sensitivity and 99.8% and 99.8% specificity for Salmonella and Shigella, respectively. CONCLUSIONS The Verigene EP generated evaluable results for most stool specimens tested and demonstrated good agreement with bacterial cultures.
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Affiliation(s)
| | - Patricia Ferrieri
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis
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Abstract
OBJECTIVE This meta-analysis assessed the effectiveness of probiotics and synbiotics for acute diarrhea (AD) in children and investigated probiotic formulations, types of interventions, and country factors. METHODS Randomized, double-blind, placebo-controlled trials evaluating the effects of probiotics or synbiotics on AD were analyzed. We followed the recommendations of the Cochrane Handbook and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risks of systematic errors (bias) and random errors were assessed, and the overall quality of the evidence was evaluated using the Grades of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS The meta-analysis included 34 studies with 4911 patients. Five and 29 studies presented the results of synbiotic and probiotic interventions, respectively. After intervention, the durations of diarrhea (weighted mean difference (WMD) = -16.63 [-20.16; -12.51]) and hospitalization (risk ratio (RR) = 0.59 [0.48; 0.73]) were shorter, the stool frequency on day 3 (WMD = -0.98 [-1.55; -0.40]) was decreased, and the incidence of diarrhea lasting 3 days was lower in the probiotic and synbiotic groups than in the control groups. Furthermore, in the subgroup analyses, synbiotics were more effective than probiotics at reducing the durations of diarrhea and hospitalization, and Saccharomyces and Bifidobacterium were more effective than Lactobacillus at reducing the duration of diarrhea. CONCLUSION This meta-analysis supports the potential beneficial roles of probiotics and synbiotics for AD in children. Further research is needed to determine problems associated with probiotic/synbiotic mixtures and appropriate dosages.
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Affiliation(s)
- Bo Yang
- Department of Clinical Laboratory, The People's Liberation Arimy Joint Service Support Unit 940 Hospital
- School of Clinical Medicine, Gansu University of Traditional Chinese Medicine (TCM), Lanzhou
| | - Ping Lu
- School of Clinical Medicine, Capital Medical University, Beijing
| | - Mei-Xuan Li
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiao-Ling Cai
- Department of Clinical Laboratory, The People's Liberation Arimy Joint Service Support Unit 940 Hospital
| | - Wan-Yuan Xiong
- School of Clinical Medicine, Gansu University of Traditional Chinese Medicine (TCM), Lanzhou
| | - Huai-Jing Hou
- School of Clinical Medicine, Gansu University of Traditional Chinese Medicine (TCM), Lanzhou
| | - Xiao-Qin Ha
- Department of Clinical Laboratory, The People's Liberation Arimy Joint Service Support Unit 940 Hospital
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Jensen AP, Bjørnvad CR. Clinical effect of probiotics in prevention or treatment of gastrointestinal disease in dogs: A systematic review. J Vet Intern Med 2019; 33:1849-1864. [PMID: 31313372 PMCID: PMC6766488 DOI: 10.1111/jvim.15554] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/24/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gastrointestinal diseases are prevalent in dogs, and probiotics could provide safe alternatives to conventional treatments. OBJECTIVE To evaluate the clinical effects of probiotics when used in the prevention or treatment of gastrointestinal disease in dogs compared with no treatment, only symptomatic treatment, or conventional treatment. METHODS A systematic review was preformed searching AGRICOLA, AGRIS, CAB Abstracts, Embase, Ovid MEDLINE, and Web of Science to identify articles published before April 1, 2017. Selection criteria were original research report, those published in peer reviewed journal, and study investigating in vivo use of probiotic for prevention or treatment of gastrointestinal disease in dogs. Studies were rated based on the level of evidence, and methodological quality was evaluated by the following variables: similarities between groups at baseline, risk of bias, and study group size. RESULTS One hundred sixty-five studies were identified, of which 17 met the inclusion criteria-12 concerned acute gastrointestinal disease and 5 concerned chronic gastrointestinal disease. The level of evidence ranged between randomized controlled studies and crossover uncontrolled trials; estimated risk of bias was generally moderate to high; and sample sizes were small. Feces consistency was the most frequently evaluated clinical variable. CONCLUSIONS AND CLINICAL IMPORTANCE The current data point toward a very limited and possibly clinically unimportant effect for prevention or treatment of acute gastrointestinal disease. For chronic gastrointestinal disease, dietary intervention remains the major key in treatment, whereas probiotic supplement seems not to add significant improvement. However, studies were often underpowered, underscoring the need for future larger, preferably multicenter studies.
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Wielgos K, Setkowicz W, Pasternak G, Lewandowicz-Uszyńska A. [Management of acute gastroenteritis in children]. Pol Merkur Lekarski 2019; 47:76-79. [PMID: 31473758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Acute gastroenteritis is one of the most common infection among children. An estimated 500 million children suffer from the condition worldwide each year. In developed countries the course of acute infectious diarrhea is relatively mild, symptoms usually resolve spontaneously within few days. Unfortunately high mortality rate is still a heavyweight problem in countries with low economic development. Acute diarrhea is defined as a change of the consistency of stools to loose or liquid and/ or increase of an amount of defecations to more than 3 during a day. Other symptoms of gastroenteritis include fever, nausea and vomiting. The most common cause of AGE are viruses, with rotavirus being the most frequent agent. The diagnose is based on medical interview, that include mainly precise information about duration and characteristic of occurred symptoms and epidemiological data. The most important part of diagnostic and therapeutic management is dehydration's assessment, which determine the severity of AGE and is used as one of the factors that decide about hospital admission. The majority of patients can be treated in an outpatients settings, hospitalization should be reserved for those requiring enteral or parenteral rehydration. Oral rehydration with hypoosmolar fluids is standard first-line treatment. Other effective procedures include administration of probiotics (Lactobacillus GG , Saccharomyces boulardii), racecadotril and diosmectite as antidiarrheals and ondansetron reducing the intensity of nausea and vomiting. Antibiotherapy should be only considered in exceptional situations. Acute diarrhea is commonly known medical problem, which can be easily treated by following simple, well-defined rules.
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Affiliation(s)
- Katarzyna Wielgos
- Department of Paediatrics, J. Gromkowski Regional Specialist Hospital in Wroclaw, Poland
| | - Wioletta Setkowicz
- Department of Paediatrics, J. Gromkowski Regional Specialist Hospital in Wroclaw, Poland
| | - Gerard Pasternak
- 3rd Department and Clinic of Paediatrics, Immunology and Rheumatology of Developmental Age, Wroclaw Medical University, Poland; Department of Immunology and Paediatrics, J. Gromkowski Regional Specialist Hospital in Wroclaw; Poland
| | - Aleksandra Lewandowicz-Uszyńska
- 3rd Department and Clinic of Paediatrics, Immunology and Rheumatology of Developmental Age, Wroclaw Medical University, Poland; Department of Immunology and Paediatrics, J. Gromkowski Regional Specialist Hospital in Wroclaw; Poland
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Tian Y, Hu H, Zhang Y, Zhou L, Wang L, Xie C. Zusanli (ST36) acupoint injection for acute diarrhea in children under 5 years old: A protocol of systematic review and meta-analysis of randomized clinical trials. Medicine (Baltimore) 2019; 98:e16949. [PMID: 31441891 PMCID: PMC6716727 DOI: 10.1097/md.0000000000016949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Acute diarrhea is the 2nd highest prevalence disease among children under 5 years of age. It can cause malnutrition and even death in children, especially in developing country. Traditional Chinese medicine therapy has been applied and already in the guidelines for clinical practice of acute infectious diarrhea in children in China, but there is no specific methods or recommendations due to lacking of evidence. Zusanli acupoint injection as a form of acupuncture therapy, which is proved to be effective in randomised controlled trials (RCTs) and very suitable for children, has been used in acute diarrhea in children for a long time; therefore, a systematic review is necessary to provide available evidence for further study. METHODS Different studies from various databases will be involved in this study. Only RCTs of children under 5 years of age diagnosed with acute diarrhea using any recognized diagnostic criteria will be included. We will search manually the literature in the databases from China Conference Paper Database. Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet, WanFang, Chongqing VIP, and China Biomedical Literature CDROM Database. Primary outcomes: clinical cure rate (clinical cure is defined as the frequency, timing and character of stool back to normal status, as well as disappearance of diarrhea symptoms), diarrhea duration (from admission to the cessation of diarrhea). SECONDARY OUTCOMES stool frequency within 24 hours, rate of adverse effect. Data will be extracted by 2 researchers independently; risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. RESULTS This study will synthesize and provide evidence based on the data of the currently published zusanli (ST36) acupoint injection for acute diarrhea in children under 5 years old, especially in terms of clinical efficacy and safety. CONCLUSION This systematic review aims to evaluate the benefits and harms of zusanli acupoint injection for acute diarrhea in children under 5 years old reported in RCTs, and provide evidence reference in TCM field for Chinese guidelines on the treatment of acute diarrhea in children. ETHICS AND DISSEMINATION This study is a systematic review; the outcomes are based on the published evidence, and hence examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. PROSPERO REGISTRATION NUMBER PROSPERO 2019 CRD42019135275.
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Xue L, Cai W, Zhang L, Gao J, Dong R, Li Y, Wu H, Zhang J, Zeng H, Ye Q, Ding Y, Wu Q. Prevalence and genetic diversity of human sapovirus associated with sporadic acute gastroenteritis in South China from 2013 to 2017. J Med Virol 2019; 91:1759-1764. [PMID: 31180139 DOI: 10.1002/jmv.25511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/03/2019] [Indexed: 11/07/2022]
Abstract
Human sapovirus (SaV) is an important viral agent for acute diarrhea worldwide, but timely prevalence data of human SaV in South China are still lacking. In this study, a 4-year surveillance was conducted to characterize the prevalence and genetic characteristics of the circulating SaV associated with sporadic diarrhea in South China. From November 2013 to October 2017, 569 fecal samples from patients with acute diarrhea were collected. SaV was detected in 11 samples with a positive rate of 1.93%. Three human genogroups of GI, GII, and GIV were identified, including five GI.1 strains, three GI.2 strains, one GI.3 strain, one GII.8 strain, and one GIV strain. Furthermore, multiple alignments of complete capsid protein VP1 genes of five local GI.1 strains and other available GI.1 strains in GenBank were performed. Average pairwise identities were calculated at 95.33% and 99.36% at nucleotide and amino acid levels, and only six variable amino acid sites were found during its 36-years' evolution process. GI.1 strains could be further phylogenetically divided into four clusters with an approximate temporal evolution pattern, and local strains belonged to Cluster-d with other four strains from China and Japan. In summary, SaV was identified as an etiological agent responsible for sporadic gastroenteritis in Guangzhou with a low prevalence rate as in other Chinese cities, but its high genetic diversity suggested the necessity of continuous SaV surveillance in the future.
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Affiliation(s)
- Liang Xue
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Weicheng Cai
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Le Zhang
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Junshan Gao
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Ruimin Dong
- Department of Cardiology, Laboratory Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Yonglai Li
- Department of Cardiology, Laboratory Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Haoming Wu
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Jumei Zhang
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Haiyan Zeng
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Qinghua Ye
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
| | - Yu Ding
- Department of Food Science & Technology, Jinan University, Guangzhou, P. R. China.,Institute of Food Safety & Nutrition, Jinan University, Guangzhou, P. R. China
| | - Qingping Wu
- Guangdong Institute of Microbiology, State Key Laboratory of Applied Microbiology Southern China, Guangdong Provincial Key Laboratory of Microbial Culture Collection and Application, Guangdong Open Laboratory of Applied Microbiology, Guangzhou, P. R. China
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Shmalberg J, Montalbano C, Morelli G, Buckley GJ. A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or Metronidazole for Acute Canine Diarrhea. Front Vet Sci 2019; 6:163. [PMID: 31275948 PMCID: PMC6593266 DOI: 10.3389/fvets.2019.00163] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/13/2019] [Indexed: 01/14/2023] Open
Abstract
Acute diarrhea is a common, often self-limiting, cause of presentation for veterinary care, yet there is a paucity of data on frequently-prescribed treatments. The purpose of this randomized, double blinded placebo-controlled clinical trial was to compare two anecdotally-recommended treatments: a probiotic combination and metronidazole. Sixty dogs without concurrent comorbidities were randomized into three treatment groups. The time to resolution of diarrheal signs was evaluated using owner surveys and fecal scoring charts. Dogs presenting with acute diarrhea achieved acceptable fecal consistency after 3.5 ± 2.2 days when receiving probiotic, 4.6 ± 2.4 days with oral metronidazole, and 4.8 ± 2.9 days with placebo; statistically significant differences were not identified between treatment groups (p = 0.17). These findings failed to provide evidence for the common use of metronidazole in this cohort of dogs with acute canine diarrhea, and a larger study population would be required to identify a statistically significant effect of probiotics.
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Affiliation(s)
- Justin Shmalberg
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Christina Montalbano
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Giada Morelli
- Department of Animal Medicine, Production and Health, University of Padua, Padova, Italy
| | - Gareth J Buckley
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
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de Frutos M, Medina R, Aragón R, López-Urrutia L, González-Sagrado M, Ramos C, Domínguez-Gil M, Garcinuño S, Viñuela L, Eiros JM. [Episodes of nontyphoidal salmonellosis in adult patients of the Valladolid West Area in 2017: Evaluation of the suitability of the microbiological culture request and the prescribed treatment]. Rev Esp Quimioter 2019; 32:224-231. [PMID: 30950256 PMCID: PMC6609942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/04/2018] [Accepted: 01/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gastroenteritic salmonellosis is still the second cause diagnosed of infectious diarrhea, most of these clinical pictures are mild and self-limited and therefore the use of antibiotics is limited to few cases. The aim of the study was to describe the episodes of diarrhea caused by Salmonella enterica subsp. enterica, assessing the suitability of the request and the use of antibiotics according to the criteria included in the methodology. METHODS A retrospective, descriptive, observational study was conducted, collecting data from the clinical history. RESULTS A total of 122 episodes were included. The reason for consultation was diarrhea, which generated a greater demand in the Hospital Emergency Services (42.6%). The most frequent serotypes isolated were Enteritidis (53.3%), and Typhimurium (40.2%). The adequate request of the stool was 90.2%. Antibiotic was prescribed in 64.6% (79) of the episodes, most patients under 65 years (58 episodes), the average age was 48.43 years. They were treated mainly with ciprofloxacin and azithromycin, in 57 and 14 episodes, respectively. The average duration of antibiotic treatment was 6 days. There was an adequate use of antibiotics in 49.1% of episodes. When the origin of the request was the Hospital Emergency Service, it was inadequate in 63.5% (33) of them. It was inadequate in 60.0% (39) of episodes when ser. Enteritidis was isolated. Almost half, 48.85% (42) of the 58 episodes in which antibiotics were prescribed among those under 65 (86), were treated without being indicated. CONCLUSIONS Training actions should be implemented focused on optimizing the management of antibiotics in this entity.
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Affiliation(s)
- M de Frutos
- Mónica de Frutos, Hospital Universitario Río Hortega, Calle Dulzaina, 2 - Valladolid 47012, Spain.
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Subbaram K, Gatasheh MK, Al Azzam KM, Kannan H. Molecular identification of diarrheal Aeromonas using immuno magnetic polymerase chain reaction (IM-PCR) technique: a comparative study with conventional culture method. Afr Health Sci 2019; 19:2036-2042. [PMID: 31656487 PMCID: PMC6794535 DOI: 10.4314/ahs.v19i2.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Aeromonas are ubiquitous bacteria causing many clinical conditions including acute diarrhea. Diarrheagenic Aeromonas harbors aerolysin gene secreting virulent enterotoxin, aerolysin. Objectives To develop a molecular and immunological based method for detection of Aeromonas. Methods Diarrheal Aeromonas strains were identified from stool samples using culture, enterotoxicity testing using mice model. During immune magnetic polymerase chain reaction IM-PCR protocol, aerolysin specific antibodies were bound with immuno magnetic binding. Sensitivity and specificity tests for IM-PCR were conducted. Results There was high detection of Aeromonas using IM-PCR (12.4 %) technique when compared to low isolation with culture (5.1%). Our study confirmed that some strains of enterotoxic Aeromonas strains were uncultivable. Enterotoxicity tests on culture isolates revealed many strains were negative. IM-PCR detected high, (62/500) rate of identification of Aeromonas with aerolysin toxin gene. Aeromonas species identified after IM-PCR were A. hydrophila (40.3% ), A. veronii (17.7 %), A. caviae (14.5 %), A. trota (11.2 %), A. jandei (9.6 %) and A. schuberti (6.4%). All A. trota strains were undetected by cultivation. Conclusion High sensitivity and specificity of IM-PCR are due to preparation of aerolysin antibodies and immuno magnetic binding, prior to PCR. Since diseases due to Aeromonas are increasingly reported, IM-PCR is recommended for detection from clinical specimens.
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Affiliation(s)
- Kannan Subbaram
- Preparatory Year Department, Al-Ghad International Colleges for Applied Medical Sciences, 11451 Riyadh, Kingdom of Saudi Arabia
| | - Mansour K Gatasheh
- Clinical Laboratory Sciences, Al-Ghad International Colleges for Applied Medical Sciences, 11451 Riyadh, Kingdom of Saudi Arabia
| | - Khaldun M Al Azzam
- Preparatory Year Department, Al-Ghad International Colleges for Applied Medical Sciences, 11451 Riyadh, Kingdom of Saudi Arabia
| | - Hemalatha Kannan
- Department of Laboratory Sciences & Pathology, P.O.Box-378, Jimma University, Jimma, Oromia, Ethiopia
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Abstract
Introduction Acute diarrhea in young children is a prevalent and distressing pediatric illness. The role of zinc therapy in the improvement of stool consistency and the shortening of the duration of diarrhea is still controversial. The aim of this study is to assess the effect of oral zinc supplementation in acute diarrhea. Methods Children of age 28 days till five years presenting in the outpatient department with acute diarrhea were included. Oral zinc supplementation was included in the anti-diarrheal regime of half of the children (n=50); the other half (n=50) were not given zinc. Mean body weight and the frequency and consistency of stool were noted for both groups on Days 1 and 3. Results The zinc group showed a significantly reduced frequency of diarrheal episodes on the third day of intervention (p<.00001). More children in the zinc group had soft to firm stool consistency than in the non-zinc group (p=.01). Conclusion Oral zinc supplementation has a promising role in reducing the duration of diarrhea and improving stool consistency in children with acute diarrhea. Oral zinc supplementation should be made a mandatory part of the anti-diarrheal regime for Pakistani children.
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Affiliation(s)
| | - Zahid Hussain
- Pediatrics, National Institute of Child Health, Karachi, PAK
| | - Huma Shahzad
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Koeller E, Robertson SE, Garbern SC, Monk G, Nasrin S, Alam NH, Levine AC. Ultrasound Adds No Benefit to Clinical Exam for Predicting Dehydration in Children With Acute Diarrhea in a Resource-Limited Setting. J Ultrasound Med 2019; 38:685-693. [PMID: 30291639 DOI: 10.1002/jum.14752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Diarrhea is one of the most common and deadly conditions affecting children, causing over 525,000 deaths annually, largely in resource-limited settings. Appropriate treatment depends on accurate determination of dehydration status. This study evaluated the accuracy of a new model using clinical and ultrasound measurements for predicting dehydration status in children with acute diarrhea. METHODS The Dehydration: Assessing Kids Accurately (DHAKA) study was a prospective cohort study of children under 5 years of age with acute diarrhea presenting to the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh. Clinical signs and sonographic measurements of the aorta-to-inferior vena cava ratio were recorded. Percent weight change with rehydration was used to classify dehydration severity. Logistic regression was used to create a combined DHAKA-US model based on clinical and sonographic measurements. Area under the curve and calibration slope were used to assess the model's accuracy and compare it to the original DHAKA score model. RESULTS A total of 850 children were enrolled, with 736 included in the final analysis. The combined DHAKA-US model showed equivalent discrimination with the original DHAKA score, with an area under the curve of 0.79 for both models for severe dehydration (95% confidence interval, 0.74-0.84), as well as similar classification (48% versus 50% correctly classified) and calibration (calibration slopes of 0.900 versus 0.904 for presence of any dehydration). CONCLUSION Adding sonographic measurements to the DHAKA score had no effect on discrimination, classification, or calibration when compared to the original DHAKA score. Clinical signs alone may be the most important predictors of dehydration status in children with diarrhea in limited resource settings.
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Affiliation(s)
- Eva Koeller
- Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island, USA
| | - Sarah E Robertson
- Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Stephanie Chow Garbern
- Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island, USA
| | - Grace Monk
- Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island, USA
| | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nur H Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Adam C Levine
- Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island, USA
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Abstract
Gelatin tannate (GT) is a nonabsorbable antidiarrheal agent investigated in few clinical studies. The aim of this study was to investigate the effects of GT on children with acute gastroenteritis. This randomized, placebo-controlled, single-blinded, prospective study involved children aged from six months to 10 years with acute diarrhea. The study group received GT and the control group placebo for five days. Stool frequency and numbers of patients with diarrhea in each group were compared at 12, 24, 48, 72, 96, and 120 hours. Duration of diarrhea and weight changes after 120 hours was recorded. Mean stool frequency was lower in the study group at 0-12 hours (3±1.8 vs. 3.6±1.9, p=0.04). The study group exhibited more weight gain after 120 hours of treatment and shorter total duration of diarrhea, although the difference was not statistically significant. Fewer patients in the study group had diarrhea at the end of 12, 24, 96, and 120 hours. Patients treated with GT with Bristol scores of 7 at admission exhibited more weight gain than patients with Bristol scores of 6 (296±38 vs. 137±39, p=0.04). GT resulted in a decreased stool frequency at 12 hours in children with acute diarrhea. It shortened total duration of diarrhea and resulted in more weight gain compared to placebo. It also had a greater effect on weight gain in the presence of watery, rather than mushy stool.
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Affiliation(s)
- Soner Sertan Kara
- Divisions of Pediatric Infectious Diseases Regional Training and Research Hospital, Erzurum, Turkey
| | - Burcu Volkan
- Divisions of Pediatric Gastroenterology, Regional Training and Research Hospital, Erzurum, Turkey
| | - İbrahim Erten
- Department of Pediatrics, Regional Training and Research Hospital, Erzurum, Turkey
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Ianiro G, Rizzatti G, Plomer M, Lopetuso L, Scaldaferri F, Franceschi F, Cammarota G, Gasbarrini A. Bacillus clausii for the Treatment of Acute Diarrhea in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2018; 10:nu10081074. [PMID: 30103531 PMCID: PMC6116021 DOI: 10.3390/nu10081074] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023] Open
Abstract
Acute diarrhea is a burdensome disease with potentially harmful consequences, especially in childhood. Despite its large use in clinical practice, the efficacy of the probiotic Bacillus clausii in treating acute childhood diarrhea remains unclear. Our objective was to systematically review the efficacy of Bacillus clausii in the treatment of acute childhood diarrhea. The following electronic databases were systematically searched up to October 2017: MEDLINE (via PubMed/OVID), EMBASE (via OVID), Cochrane Central Database of Controlled Trials (via CENTRAL), Google Scholar, and ClinicalTrials.gov. Only randomized controlled trials were included. The overall effect for the meta-analysis was derived by using a random effects model. Six randomized controlled trials (1298 patients) met the eligibility criteria. Data arising from pooled analysis showed that Bacillus clausii significantly reduced the duration of diarrhea (mean difference = -9.12 h; 95% confidence interval [CI]: -16.49 to -1.75, p = 0.015), and the duration of hospitalization (mean difference = -0.85 days; 95% CI: -1.56 to -0.15, p = 0.017), compared with control. There was a trend of decreasing stool frequency after Bacillus clausii administration compared with the control group (mean difference = -0.19 diarrheal motions; 95% CI: -0.43 to -0.06, p = 0.14). Bacillus clausii may represent an effective therapeutic option in acute childhood diarrhea, with a good safety profile.
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Affiliation(s)
- Gianluca Ianiro
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Gianenrico Rizzatti
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Manuel Plomer
- Medical Affairs CHC Germany, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Loris Lopetuso
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Franco Scaldaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Francesco Franceschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Giovanni Cammarota
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00143 Roma, Italy.
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Ravelomanana L, Tsifiregna RL, Rakotomalala LH, Razafimahatombo C, Ravelomanana N. Prescription of medications for acute diarrhea in infants in Antananarivo, Madagascar. Med Sante Trop 2018; 28:182-5. [PMID: 29997077 DOI: 10.1684/mst.2018.0776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the professional practices of physicians in Antananarivo in managing acute diarrhea in infants. METHODS This prospective study was conducted from March 19 to April 21, 2012, as an anonymous survey of randomly selected general practitioners and pediatricians working in the public or private sector in the city of Antananarivo. RESULTS The survey included 125 physicians: 105 general practitioners, 11 pediatricians, and 9 other specialist physicians (7.2%) with pediatric activity. Only 4.8% of the physicians questioned had not received training about diarrhea in the previous two years. One doctor in 4 (25.6%) did not prescribe oral rehydration solution. The reasons given were lack of signs of dehydration (50%) and recommendation of other beverages (15.5%). Zinc prescription was rare (9.6%). Early refeeding was recommended by 41.6% of physicians. Almost half (47.2%) routinely use antibiotics, and 86.4% prescribe antidiarrheal medications. CONCLUSION The WHO recommendations for the treatment of acute diarrhea in children are not followed. Continuing and repeated medical education is necessary.
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Rautenberg TA, Zerwes U, Lee WS. Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia. Clinicoecon Outcomes Res 2018; 10:169-178. [PMID: 29588606 PMCID: PMC5858644 DOI: 10.2147/ceor.s157606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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 case values and over a range of alternate scenarios.
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Affiliation(s)
- Tamlyn Anne Rautenberg
- IGES Institut GmbH, Berlin, Germany.,Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Ute Zerwes
- Assessment in Medicine GmbH, Lörrach, Germany
| | - Way Seah Lee
- Department of Pediatrics, University Malaya, Kuala Lumpur, Malaysia
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Yang F, Jiang Y, Yang L, Qin J, Guo M, Lu Y, Chen H, Zhuang Y, Zhang J, Zhang H, Dai Z, Li M, Yang C, Chen M, Zhang Y, Zhao H. Molecular and Conventional Analysis of Acute Diarrheal Isolates Identifies Epidemiological Trends, Antibiotic Resistance and Virulence Profiles of Common Enteropathogens in Shanghai. Front Microbiol 2018; 9:164. [PMID: 29556217 PMCID: PMC5845389 DOI: 10.3389/fmicb.2018.00164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/24/2018] [Indexed: 12/13/2022] Open
Abstract
Objective: To investigate prevalence of acute diarrhea in Shanghai and analyze virulence associated-genes and antibiotic resistance of major enteropathogens using combination of conventional and molecular epidemiology methods. Method: The 412 stool specimens were obtained by systematic sampling from diarrhea patients throughout entire year 2016. Bacterial and viral pathogens were identified and bacterial isolates were cultured and screened for antibiotic resistance profiles. Two most prevalent bacteria, Vibrio parahaemolyticus and Salmonella were further typed by multi-locus sequence typing (MLST) and analyzed for presence of virulence-associated genes. The association between virulence genes, resistance phenotypes and genetic diversities was analyzed. Results: Among stool specimens testing positive for pathogens (23.1%), 59 bacterial and 36 viral pathogens were identified. V. parahaemolyticus (27/412, 6.6%), Salmonella (23/412, 5.6%) and norovirus GII (21/412, 5.1%) were three most-commonly found. Most bacterial isolates exhibited high levels of antibiotic resistance with high percentage of MDR. The drug resistance rates of V. parahaemolyticus and Salmonella isolates to cephalosporins were high, such as 100.0 and 34.8% to CFX, 55.6 and 43.4% to CTX, 92.6 and 95.7% to CXM, respectively. The most common resistance combination of V. parahaemolyticus and Salmonella was cephalosporins and quinolone. The dominant sequence types (STs) of V. parahaemolyticus and Salmonella were ST3 (70.4%) and ST11 (43.5%), respectively. The detection rates of virulence genes in V. parahaemolyticus were tlh (100%) and tdh (92.6%), without trh and ureR. Most of the Salmonella isolates were positive for the Salmonella pathogenicity islands (SPIs) genes (87-100%), and some for Salmonella plasmid virulence (SPV) genes (34.8% for spvA and spvB, 43.5% for spvC). In addition, just like the drug resistance, virulence genes exhibited wide-spread distribution among the different STs albeit with some detectable frequency linkage among Salmonella STs. Conclusion: Bacterial infections are still the major cause of severe diarrheas in Shanghai. The most common bacteria V. parahaemolyticus and Salmonella show molecular characteristics consistent with preselection of highly virulent types with exceedingly high level of antibiotic resistance.
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Affiliation(s)
- Feng Yang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Yonggen Jiang
- Songjiang Center for Disease Control and Prevention, Shanghai, China
| | - Lihua Yang
- Songjiang Center for Disease Control and Prevention, Shanghai, China
| | - Juanxiu Qin
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingquan Guo
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yuxia Lu
- Department of Gastroenterology, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Hongyou Chen
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yuan Zhuang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jinghao Zhang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Hong Zhang
- Department of Laboratory Medicine, Children’s Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaoyun Dai
- Department of Infectious Diseases, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Min Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Changqing Yang
- Department of Gastroenterology, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Min Chen
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yanmei Zhang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Research Center on Aging and Medicine, Fudan University, Shanghai, China
| | - Hu Zhao
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
- Research Center on Aging and Medicine, Fudan University, Shanghai, China
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Aminshahidi M, Arastehfar A, Pouladfar G, Arman E, Fani F. Diarrheagenic Escherichia coli and Shigella with High Rate of Extended-Spectrum Beta-Lactamase Production: Two Predominant Etiological Agents of Acute Diarrhea in Shiraz, Iran. Microb Drug Resist 2017; 23:1037-1044. [PMID: 29106325 PMCID: PMC5709696 DOI: 10.1089/mdr.2017.0204] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study was conducted to find the etiology of acute diarrhea in Iranian children and determine the antimicrobial resistance patterns. The pathogenic bacteria were recovered from 110/269 (40.9%) diarrheal fecal samples with the following profiles: the most predominant pathogen was diarrheagenic Escherichia coli (DEC) (43.6%), comprising enteroaggregative E. coli (23.6%), enteropathogenic E. coli (10.9%), enteroinvasive E. coli (5.5%), and enterotoxigenic E. coli (3.6%); Shigella spp. (37.3%), Salmonella spp. (12.7%) and Campylobacter jejuni (6.4%) were ranked second and fourth in terms of prevalence, respectively. The rates of extended-spectrum beta-lactamase (ESBL) production were 66.7% and 53.7% in DEC and Shigella, respectively. Resistance to ampicillin (AMP) (95.1%), trimethoprim/sulfamethoxazole (SXT) (73.2%), azithromycin (ATH) (21.9%), and ciprofloxacin (CIP) (14.6%) was observed among Shigella isolates. Multidrug resistance phenotype was observed in 24.4% (10/41) of Shigella isolates, with the most common pattern of resistance to cefotaxime, ceftriaxone, ceftazidime, AMP, SXT, and ATH. This study indicates an alarming increase in the ESBL production of DEC and Shigella spp. and identifies them as the two most prevalent diarrhea-causing enteropathogens in the region. The results show that CIP could be an alternative to third-generation cephalosporins against these two pathogens. Therefore, it is proposed that further investigation be done in the pursuit of alternative antibiotics that are effective against the resistant cases. For instance, one study could look into the comparative clinical effectiveness of third-generation cephalosporins versus CIP, the latter not being presently the drug of choice for the treatment of acute diarrhea in children in Iran.
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Affiliation(s)
- Maneli Aminshahidi
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Amir Arastehfar
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Gholamreza Pouladfar
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Esmayil Arman
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Fereshteh Fani
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
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Liu X, Tong X, Jin L, Ha M, Cao F, Xu F, Chi Y, Zhang D, Xu L. Prospective study on the overuse of blood test-guided antibiotics on patients with acute diarrhea in primary hospitals of China. Patient Prefer Adherence 2017; 11:537-545. [PMID: 28352160 PMCID: PMC5359135 DOI: 10.2147/ppa.s123294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Overuse with antibiotics in the treatment of infectious diseases has become a central focus of public health over the years. The aim of this study was to provide an up-to-date evaluation of the blood test-guided antibiotic use on patients with acute diarrhea in primary hospitals of China. MATERIALS AND METHODS A cross-sectional survey was conducted on 330 patients with acute diarrhea in Shanghai, People's Republic of China, from March 2013 to February 2016. These patients were treated with or without antibiotics based on the results of their blood tests, including examinations of C-reactive protein (CRP), white blood cells (WBC), and the percentage of neutrophils (Neu%). The infection types, which included bacterial, viral, and combination diarrhea, were determined by microbiological culture methods. Antibiotics used in non-bacterial diarrhea patients were considered misused and overused. RESULTS There were significant overall differences in the clinical characteristics and blood tests between patients with diarrhea with a bacterial infection and patients with other types of infections. The patients were divided into four grading groups (0-3) according to the number of the positive results from three blood testes (CRP, WBC, and Neu%). The misuse rates of antibiotics in each group (0-3) were 81.3%, 71.1%, 72.4%, and 64.9%, respectively. CONCLUSION In this prospective study, the current diagnostic criteria (CRP, WBC, and Neu%) based on blood tests are not reliable in diagnosing bacterial diarrhea or guiding antibiotics use. To limit antibiotic overuse, a rapid and accurate differentiation of bacterial diarrhea from other types of diarrhea is pivotal.
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Affiliation(s)
| | - Xueke Tong
- Department of Infectious Diseases, Shanghai Gongli Hospital, The Second Military Medical University
| | - Liyin Jin
- Department of Laboratory, Jinyang Community Health Service Center, Pudong New District
| | - Minghao Ha
- Department of Infectious Diseases and Hepatology, The Affiliated Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine
| | - Feng Cao
- Department of Preventive Care, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, People’s Republic of China
| | | | | | - Denghai Zhang
- Department of Laboratory
- Correspondence: Limin Xu; Denghai Zhang, Department of Clinical Laboratory, Shanghai Gongli Hospital, The Second Military Medical University, 219 Miaopu Rd, Pudong New Area, Shanghai 200135, People’s Republic of China, Tel +86 21 5885 8730 ext 5236; 5177, Fax +86 21 5821 9029, Email ;
| | - Limin Xu
- Department of Laboratory
- Correspondence: Limin Xu; Denghai Zhang, Department of Clinical Laboratory, Shanghai Gongli Hospital, The Second Military Medical University, 219 Miaopu Rd, Pudong New Area, Shanghai 200135, People’s Republic of China, Tel +86 21 5885 8730 ext 5236; 5177, Fax +86 21 5821 9029, Email ;
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García-Menor E, García-Marín F, Vecino-López R, Horcajo-Martínez G, de Ibarrondo Guerrica-Echevarría MJ, Gómez-González P, Velasco-Ortega S, Suárez-Almarza J, Nieto-Magro C. 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. Glob Pediatr Health 2016; 3:2333794X16679587. [PMID: 28229091 PMCID: PMC5308530 DOI: 10.1177/2333794x16679587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Emilia García-Menor
- Servicio de Pediatría del Hospital del Sureste de Arganda del Rey, Madrid, Spain
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50
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Abstract
Despite unproven effectiveness, Lactobacillus acidophilus is a widely used probiotic in the treatment of pediatric diarrhea. In this report, we evaluated the association between length of stay (LOS) for 290 young children hospitalized with acute diarrhea and adjuvant therapy with a probiotic mixture containing 80% L acidophilus that was included in treatment for 22.4% of them. Overall, no association between LOS and use of L acidophilus was recorded after controlling for age, length of diarrhea symptoms, duration of intravenous fluids, and prior exposure to antibiotic. However, LOS was directly associated with use of L acidophilus in children with negative stool studies, and no such association was recorded in children with positive stool for rotavirus or other infections. We concluded that adjuvant therapy with L acidophilus mixture is not beneficial for young children hospitalized with acute diarrhea.
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Affiliation(s)
- Jamie M Pinto
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Anna Petrova
- Jersey Shore University Medical Center, Neptune, NJ, USA Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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