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PubMed1999

Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis.

PURPOSE: This study was conducted to evaluate the incidence, identify the risk factors, and assess the prognosis of elderly institutionalized patients who develop fecal incontinence. PATIENTS AND METHODS: We enrolled 1,186 patients 60 years of age and older living in long-term care facilities who did not have fecal incontinence. We assessed their medical history, treatment, mobility, and cognitive function. Patients were followed up for 10 months to determine the incidence of fecal incontinence, defined as at least one involuntary loss of feces. Independent risk factors associated with fecal incontinence were identified using Cox proportional hazards models. The prognosis of incontinent patients was assessed by comparing their survival rate with that in the continent patients. RESULTS: Fecal incontinence occurred in 234 patients (20%), and was usually associated with acute diarrhea or fecal impaction. We identified five risk factors for the development of fecal incontinence: a history of urinary incontinence (rate ratio [RR]: 2.0, 95% confidence interval [CI] 1.5 to 2.6); neurological disease (RR: 1.9, 95% CI 1.0 to 3.4); poor mobility (RR: 1.7, 95% CI 1.2 to 2.4); severe cognitive decline (RR: 1.4, 95% CI 1.1 to 1.9); and age older than 70 years (RR: 1.7, 95% CI 1.0 to 2.8). Ten-month mortality in the 89 patients with long-term (> or = 8 days) incontinence was 26%, significantly greater than that observed in the continent group (6.7%) or in the 145 patients with transient incontinence (10%). CONCLUSIONS: Long-lasting or permanent fecal incontinence was associated with increased mortality, suggesting that this symptom is a marker of poor health in older patients. Actions that improve mobility might help prevent fecal incontinence in elderly patients.

Aged↗

PubMed1992

Pre- and post-treatment immunodiagnostic evaluation in human schistosomiasis mansoni.

Schistosomiasis control seems to be different in countries were low parasitic burden and asymptomatic clinical patients are the features of majority of cases. Immunological methods must substitute the traditional coprologic techniques used for some decades in the Control Program. Circumoval Precipitin Test (COPT), intradermal test and ELISA with soluble egg antigen (SEA) are evaluated for using as tools for seroepidemiologic studies. COPT and ELISA were performed after treatment to known their utility when impact of chemotherapy must be assessed. One hundred sixty five persons were followed up 3, 6, 9 and 12 months after treatment. The mean sensitivity of COPT studied by age groups was 95.6% which is very important considering that 88.4% of the studied population excreted less than 100 eggs/gr of feces, while sensitivity of intradermal test was 58.2%. Children showed the highest reactivity to COPT. When treatment is effective, COPT reactivity progressively diminish until become negative one year later. In the non cure group, the COPT reactivity diminished but never below 20%. ELISA-SEA did not modify one year after treatment. Effort should be made to isolate fractions of eggs of Schistosoma mansoni whose antibodies disappear after treatment.

Adolescent↗

PubMed2005

Management strategy impacts on ammonia volatilization from swine manure.

Ammonia emitted from manure can have detrimental effects on health, environmental quality, and fertilizer value. The objective of this study was to measure the potential for reduction in ammonia volatilization from swine (Sus scrofa domestica) manure by temperature control, stirring, addition of nitrogen binder (Mohave yucca, Yucca schidigera Roezl ex Ortgies) or urease inhibitor [N-(n-butyl) thiophosphoric triamide (NBPT)], segregation of urine from feces, and pH modification. Swine manure [total solids (TS) = 7.6-11.2%, total Kjeldahl nitrogen (TKN) = 3.3-6.2 g/L, ammonium nitrogen NH(+)(4)-N = 1.0-3.3 g/L] was stored for 24, 48, 72, or 96 h in 2-L polyvinyl chloride vessels. The manure was analyzed to determine pre- and post-storage concentrations of TS and volatile solids (VS), TKN, and NH(+)(4)-N. The concentration of accumulated ammonia N in the vessel headspace (HSAN), post-storage, was measured using grab sample tubes. Headspace NH(3) concentrations were reduced 99.3% by segregation of urine from feces (P < 0.0001). Stirring and NBPT (152 microL/L) increased HSAN concentration (119 and 140%, respectively). Headspace NH(3) concentration increased by 2.7 mg/m(3) for every 1 degree C increase in temperature over 35 degrees C. Slurry NH(+)(4)-N concentrations were reduced by segregation (78.3%) and acidification to pH 5.3 (9.4%), and increased with stirring (4.8%) and increasing temperature (0.06 g/L per 1 degree C increase in temperature over 35 degrees C). Temperature control, urine-feces segregation, and acidification of swine manure are strategies with potential to reduce or slow NH(+)(4)-N formation and NH(3) volatilization.

Air Pollution↗

PubMed2005

[Utility of stool culture in inpatient].

Several studies have concluded that it is inappropriate to perform stool cultures (SC) to inpatients that have stayed hospitalized three days or more because nosocomial diarrhea is not due to enteric pathogenic bacteria that are searched through this exam. The aim of this paper was to analyze the SC yield performed to patients hospitalized in the UC Health Net since January to December 2002 and the rate of positive results obtained depending on the length of hospitalization in order to define if international guidelines are useful to the national reality. During twelve months 3474 SC were evaluated, 458 (13.2%) belonged to inpatients. Of them 16 (3.5%) were positive, 13 were obtained on the first day, 2 at the second day and 1 at the fifth day of hospitalization. Only 1/190 (0.5) SC obtained after two days of hospitalization yielded a positive result. These results reinforce the international recommendation of not performing SC to inpatients that have stayed more than three days at the hospital; besides, considering previous figures, we suggest to make a cutoff at day two of hospitalization, after two days there is no a significant clinical impact. This strategy means to reduce 41% of these analyses and to save the corresponding money.

Adolescent↗

PubMed2005

Changing epidemiology of rotavirus G-types circulating in Hong Kong, China.

Group A rotaviruses are the most common cause of severe diarrhoeal disease in young children worldwide. The development of a vaccine is advocated by the World Health Organization. Obtaining local baseline information regarding rotavirus strain variation is important to ensure matching of circulating and vaccine strains. The current study was undertaken to determine the epidemiology of rotavirus G-types in Hong Kong in anticipation of a vaccination program. From 2001 to 2002 over a period of one year, diarrhoeal stool specimens known to be positive for rotavirus were subjected to G-typing by reverse transcriptase-polymerase chain reaction using nested type-specific primers. Rotavirus G-type distribution was correlated with patient demographics. Among 747 rotavirus positive stool specimens, 723 strains could be G-typed as G1 (302, 40.4%), G2 (128, 17.1%), G3 (231, 30.9%), G4 (24, 3.2%), and G9 (38, 5.1%). G1 strains were found predominantly in those 5 years old or younger (P < 0.0001), while G2 strains were more prevalent among those over 5 years of age (P < 0.001). When compared with similar studies in 1983 to 1984 and 1999 to 2000, there were significant changes in the prevalence of various G-types, with consistent detection of G9 strains in the current study. It is concluded that rotavirus G-type distribution in Hong Kong has varied with time. Continuous monitoring of the epidemiology of rotavirus is important, especially in anticipation of the introduction of a vaccine, in order to document its impact and to ensure its continued effectiveness.

Adolescent↗

PubMed2006

The influence of physical-chemical and biological factors on the removal of faecal coliform through down-flow hanging sponge (DHS) system treating UASB reactor effluent.

The mechanism of faecal coliform removal in down-flow hanging sponge (DHS) system treating up-flow anaerobic sludge blanket (UASB) reactor effluent was the subject of this study. The results obtained revealed that the most important removal mechanism of faecal coliform in the DHS system is adsorption, followed by predation. Die-off is a relatively minor removal mechanism in the DHS system. The impact of physical and chemical factors such as contact time, effective sponge bulk volume and pH values on faecal coliform removal has been investigated. Increasing the contact time and sponge bulk volume exerted positive effect on the removal of faecal coliform. Changing the pH values between 6.5 and 9.0 did not show significant impact. Reducing sponge pore size from 1.92 to 0.56 mm, increased faecal coliform removal by a value of 1.3 log10.

Adsorption↗

PubMed2006

Chlorine spot treatment of flooded tube wells, an efficacy trial.

AIMS: To evaluate the water quality of recently flooded tube wells in Bangladesh and the effect of spot chlorination on improving bacteriological quality. METHODS AND RESULTS: The study team identified and tested water samples from 127 tube wells that were flooded within the preceding 4 weeks. Twenty-six of the tube wells with the highest concentration of thermotolerant coliform bacteria were randomly assigned to spot chlorination vs control. On initial screening, water samples from 56 recently inundated tube wells (44%) were contaminated with thermotolerant coliforms. Among the 13 wells randomized to chlorination, there was no change in the proportion of water samples that had no detectable thermotolerant coliform bacteria immediately before chlorine treatment (n = 4, 23%) and 60 min following chlorine treatment (n = 4, 23%). Similarly, there was no difference in the proportion of water samples that had no detectable thermotolerant coliforms between chlorine spot treated and control tube wells 7-18 days later (31 vs 23%P = 0.66). CONCLUSIONS: Spot chlorine treatment of inundated tube wells in Bangladesh three to 6 weeks after the flooding did not improve drinking water quality. SIGNIFICANCE AND IMPACT OF THE STUDY: Unless modified methods improve effectiveness, resources should not be spent promoting spot chlorination of flooded tube wells.

Bangladesh↗

PubMed2004

Helicobacter pylori in Japanese river water and its prevalence in Japanese children.

AIMS: The major transmission route of Helicobacter pylori remains unclear. In this study, we examined H. pylori in the environmental waters in Japan. METHODS AND RESULTS: A total of 24 water samples were collected from the upper, middle and downstream reaches of four Japanese rivers. Helicobacter pylori-specific DNA was examined using nested PCR. In addition, 224 children who lived near one river were studied by the stool antigen test for H. pylori prevalence. Helicobacter pylori DNA was detected in the water from the middle and downstream reaches of all four rivers, but not in the upper reaches. Helicobacter pylori was not found in cultured water samples with positive PCR results. Helicobacter pylori prevalence in the children examined was 9.8% for those living near the middle reaches and 23.8% nearby downstream, both of which were higher than the value in an area distant from the river (0%) (both, P < 0.01). CONCLUSIONS: Difference in H. pylori prevalence in the children may be related to the presence of H. pylori in the river. The results of this study showed that H. pylori DNA is frequently present in river water from the middle and downstream reaches in which the human biosphere is embedded. SIGNIFICANCE AND IMPACT OF THE STUDY: It is suggested that river water in the natural environment could be a risk factor for H. pylori transmission.

Child↗

PubMed2002

Relationship between faecal character and intestinal transit time in normal dogs and diet-sensitive dogs.

The relationship between stool character and whole gut transit time (WGTT), which is the average time for the passage of material through the lumen of the alimentary tract from ingestion to defecation, was studied in eight control dogs and 12 dogs with non-specific dietary sensitivity. Dogs were fed four diets in a cross-over design, and faecal quality was assessed daily and WGTT determined using plastic pellets. Faecal quality was unaffected by diet in the control dogs. Dogs with dietary sensitivity produced looser faeces compared with the control dogs, and this was significant for two of the diets. There was no significant effect of diet on mean WGTT within or between groups. Minimum WGTT, which was the interval to the first appearance of markers in faeces, was shorter in sensitive dogs compared with controls, and this was significant for two of the four diets. There were significant, inverse relationships between minimum WGTT and both mean faeces score and percentage unacceptable defecations. These data suggest that rapid transit of certain dietary components may impact negatively on stool quality and contribute to loose faeces in dogs with non-specific dietary sensitivity.

Animals↗

PubMed2001

The effect of subclinical Mycobacterium paratuberculosis infection on milk production in Michigan dairy cows.

The objective of this study was to determine the effect of subclinical Mycobacterium paratuberculosis infection on mature equivalent milk, protein, and fat production in a sample of Michigan dairy herds with a history of cows positive for M. paratuberculosis diagnosed by fecal culture. A prospective two-group cohort study was conducted. Participating herds were tested, and productivity and reproduction records were monitored for 18 mo. All cows aged 24 mo and greater were tested for M. paratuberculosis infection using the ELISA and radiometric fecal culture (RFC) techniques. Using both tests in parallel, the overall sample apparent prevalence for M. paratuberculosis infection was 41.8%. Adjusting for diagnostic sensitivity and specificity resulted in a calculated sample true prevalence of 59.9%. Subclinical paratuberculosis test-positive status had no statistically significant effect on mature equivalent milk, fat, or protein production. The results of this study concur with the findings of other studies, reporting that the magnitude and direction of the association between subclinical paratuberculosis infection and milk production depends upon the parity of the animal, stage of disease, and the stage in lactation being monitored. Assessment of the impact of subclinical paratuberculosis on milk production must consider the average parity of the sample population. In herds that have an average parity of 2 or less, subclinical paratuberculosis infection may have little impact on milk production.

Animals↗

PubMed2000

Classification of antibiotic resistance patterns of indicator bacteria by discriminant analysis: use in predicting the source of fecal contamination in subtropical waters.

The antibiotic resistance patterns of fecal streptococci and fecal coliforms isolated from domestic wastewater and animal feces were determined using a battery of antibiotics (amoxicillin, ampicillin, cephalothin, chlortetracycline, oxytetracycline, tetracycline, erythromycin, streptomycin, and vancomycin) at four concentrations each. The sources of animal feces included wild birds, cattle, chickens, dogs, pigs, and raccoons. Antibiotic resistance patterns of fecal streptococci and fecal coliforms from known sources were grouped into two separate databases, and discriminant analysis of these patterns was used to establish the relationship between the antibiotic resistance patterns and the bacterial source. The fecal streptococcus and fecal coliform databases classified isolates from known sources with similar accuracies. The average rate of correct classification for the fecal streptococcus database was 62.3%, and that for the fecal coliform database was 63.9%. The sources of fecal streptococci and fecal coliforms isolated from surface waters were identified by discriminant analysis of their antibiotic resistance patterns. Both databases identified the source of indicator bacteria isolated from surface waters directly impacted by septic tank discharges as human. At sample sites selected for relatively low anthropogenic impact, the dominant sources of indicator bacteria were identified as various animals. The antibiotic resistance analysis technique promises to be a useful tool in assessing sources of fecal contamination in subtropical waters, such as those in Florida.

Animals↗

PubMed1995

Fatal human pulmonary infection caused by an Angiostrongylus-like nematode.

An immunocompetent man developed malaise, fever, progressive weight loss, eosinophilia, and transient pulmonary infiltrates that responded to steroid treatment but recurred after its discontinuation. Examinations of feces, bronchoalveolar lavage fluid, and pulmonary tissue obtained during a 50-day period of hospitalization yielded negative results. When a new bronchoalveolar lavage sample and a new pulmonary biopsy specimen showed nematode larvae and adult worms, treatment with thiabendazole was started. However, therapy with this agent and then with mebendazole had no impact on the patient's downhill course, which ended in respiratory distress and death. Autopsy documented an overwhelming pulmonary infection with a metastrongylid nematode resembling a species of Angiostrongylus. Histologic study revealed features of necrotizing angiitis closely mimicking those of Wegener's granulomatosis. To our knowledge, this is the first reported instance of patent metastrongylid parasitism of the human pulmonary arteries with necrotizing angiitis caused by a reaction to the parasite and/or its metabolic products.

Adult↗

PubMed2006

Emerging roles of the intestine in control of cholesterol metabolism.

The liver is considered the major "control center" for maintenance of whole body cholesterol homeostasis. This organ is the main site for de novo cholesterol synthesis, clears cholesterol-containing chylomicron remnants and low density lipoprotein particles from plasma and is the major contributor to high density lipoprotein (HDL; good cholesterol) formation. The liver has a central position in the classical definition of the reverse cholesterol transport pathway by taking up periphery-derived cholesterol from lipoprotein particles followed by conversion into bile acids or its direct secretion into bile for eventual removal via the feces. During the past couple of years, however, an additional important role of the intestine in maintenance of cholesterol homeostasis and regulation of plasma cholesterol levels has become apparent. Firstly, molecular mechanisms of cholesterol absorption have been elucidated and novel pharmacological compounds have been identified that interfere with the process and positively impact plasma cholesterol levels. Secondly, it is now evident that the intestine itself contributes to fecal neutral sterol loss as a cholesterol-secreting organ. Finally, very recent work has unequivocally demonstrated that the intestine contributes significantly to plasma HDL cholesterol levels. Thus, the intestine is a potential target for novel anti-atherosclerotic treatment strategies that, in addition to interference with cholesterol absorption, modulate direct cholesterol excretion and plasma HDL cholesterol levels.

Animals↗

PubMed1996

Detection of cervical bacterial contamination in swine by two methods of swabbing in relation to artificial insemination.

Factors associated with uterine contamination during artificial insemination (AI) are not well defined. A frequently imputed risk factor is vulvar hygiene, although its role has never been assessed objectively. The aim of this study was to identify an objective marker of hygiene during AI and to assess the impact of vulvar hygiene on cervical contamination. In a herd in a depopulation-repopulation process, 68 paired sows of each parity were divided into 2 treatment groups. Before 2 sham AIs, with a 24 hour interval, control sows (CTR) had their vulva cleaned and treatment sows (TRT) had theirs soiled with feces. After the 2nd sham AI, swabbings were taken from the spirette and from the cervix. Bacterial growth was assessed by a semiquantitative method, and aerobic bacterial species identified. The discordance between the paired data was assessed by a McNemar chi-square test. No difference in gram-positive bacterial counts between the 2 groups was found using the cervical swab (P > 0.05). The presence of trace colonies of Escherichia coli were, however, more frequent in TRT (P < 0.05). The spirette showed a greater contamination for mixed flora of bacterial species such as E. coli (P < 0.001) and non-S. suis streptococci (P < 0.05) in TRT sows. A light cervical E. coli growth was more frequent when the vulva had been soiled. Bacterial flora on the spirette following AI may be used as an objective and practical indicator of vulvar hygiene during AI in sows.

Animals↗

PubMed2001

Effects of low levels of ciprofloxacin on a chemostat model of the human colonic microflora.

To study the utility of an in vitro model system for assessing the effect of low concentrations of a fluoroquinolone (FQ) drug on the ecology of the human intestinal microflora, chemostats containing human fecal flora were exposed to 0.43, 4.3, and 43microg of ciprofloxacin (CI) per milliliter. Prior to and during drug exposure, we assayed short-chain fatty acids (SCFA), bacterial populations, and the relative levels of susceptibility of these populations to CI and trovafloxacin (TV), a newer related FQ with increased activity against anaerobes. The degree to which CI affected the chemostat ecology was measured statistically by comparing observed data with the corresponding predicted "no effect" level. No changes in total SCFA were observed; only butyrate was significantly higher at the intermediate and high-dose levels. Enterococci counts and the levels of susceptibility to CI among enterococci were also unaffected. Escherichia coli counts decreased in a dose-dependent manner. Susceptibility levels in E. coli followed no interpretable pattern. Bacteroides fragilis group (BfG) counts decreased significantly following exposure to 43 and 4.3microg/mL CI. Ciprofloxacin susceptibility among the BfG in these chemostats was not determined because the BfG counts were too low (less than 30 colonies per plate) when undiluted chemostat samples were plated. However, within 2 days of exposure to 0.43microg/mL CI, the percentage of BfG resistant to 4microg/mL CI increased to over 95%. Before exposure, all BfG were susceptible to both CI (2microg/mL) and TV (0.25microg/mL). All BfG isolated during exposure were resistant to both CI (4microg/mL) and TV (2microg/mL). Resistance selection in the BfG was unexpected as the MIC(90) of CI for B. fragilis is 8microg/mL. Since the average colon flora is about 20% B. fragilis and other bacteroides, CI may impact the human gut flora even at subtherapeutic levels.

Anti-Infective Agents↗

PubMed2003

Molecular epidemiological survey of Listeria monocytogenes in broilers and poultry products.

AIMS: To investigate the prevalence of Listeria monocytogenes in poultry products, and to elucidate whether poultry products may be linked to listeriosis cases. A further goal was to identify contamination routes for L. monocytogenes to broiler carcasses. METHODS AND RESULTS: Poultry products (385 samples) were screened for L. monocytogenes. The recovered isolates and 19 patient isolates were characterized by multilocus enzyme electrophoresis and restriction enzyme analysis. The poultry isolates showed great genetic diversity, but no identical subclones were identified from poultry sources and patients. One slaughterhouse was examined in detail during a 16-month period. The contamination rates increased along the processing line, and one subclone was found during the whole period. Only low prevalence of the bacteria was revealed from broiler faeces. CONCLUSIONS: The prevalence of L. monocytogenes in poultry products was high, but no listeriosis cases was linked to poultry products. Broilers seem to be contaminated during the slaughter process, and specific strains may persist in the processing environment. Broiler faeces does not seem to be an important source of L. monocytogenes in poultry products. SIGNIFICANCE AND IMPACT OF THE STUDY: Preventive measures to avoid contamination of poultry products by L. monocytogenes must be taken in the processing plants.

Abattoirs↗

PubMed2003

Confirmation of Escherichia coli and its distinction from Klebsiella species by gas and indole formation at 44 and 44.5 degrees C.

AIMS: In the enumeration of coliform bacteria, confirmation of Escherichia coli has been based upon gas and indole production at the elevated incubation temperature. The test for gas production has recently been questioned. The aim of this study was to investigate the impact of gas production test on the reliability of confirmation of E. coli. METHODS AND RESULTS: The impact of several media on growth, gas and/or indole formation was tested at 44 and 44.5 degrees C using 547 environmental isolates. These were mainly E. coli, Klebsiella pneumoniae, K. oxytoca and Enterobacter cloacae strains. Another set of 250 faecal and environmental klebsiellae were tested for their maximum temperature for growth (Tmax) and for gas formation. Escherichia coli and even K. pneumoniae grew well in all the media, but gas production was more dependent on the medium used. Growth of the mainly gas negative Ent. cloacae and K. oxytoca strains was still more sensitive to the medium and incubation conditions. Tryptophan salt broth was the most productive medium for the indole test, followed by lauryl tryptose mannitole and tryptone mannitol ricinoleate broth (TRM). Tmax of K. oxytoca was clearly lower than Tmax of K. pneumoniae but a rather high fraction of its isolates produced indole at 44.5 degrees C. CONCLUSIONS: False-positive E. coli confirmation is possible if gas production is not tested for and the confirmation is based on indole test only. SIGNIFICANCE AND IMPACT OF THE STUDY: Erroneous positive results on routine analysis for E. coli can occur.

Bacterial Typing Techniques↗

PubMed1989

Imipenem concentrations in colorectal surgery and impact on the colonic microflora.

Twenty patients undergoing colorectal surgery were given, as prophylaxis, imipenem-cilastatin intravenously. Ten of them received a dose of 0.5/0.5 g of imipenem-cilastatin at induction of anesthesia, followed by subsequent doses of 0.5/0.5 g every 6 h for 48 h. The other 10 patients were given 1.0/1.0 g imipenem-cilastatin in the same way for 48 h. Samples from serum, intestinal mucosa, and feces were taken for analysis of imipenem concentrations during the day of surgery. The mean concentrations in serum at 1 h after the first imipenem dose were 15.9 +/- 1.7 micrograms/ml for the 0.5-g dose and 68.2 +/- 8.2 micrograms/ml for the 1.0-g dose. The mean half-lives were 1.5 and 1.4 h, respectively, and the mean areas under the serum concentration-time curve were 41.2 +/- 6.0 and 128.3 +/- 13.5 mg.h/liter, respectively. The imipenem concentrations in the intestinal mucosa varied between less than 0.1 and 3.6 mg/kg for the 0.5-g dose and 3.2 and 13.4 mg/kg for the 1.0-g dose. The concentrations in the fecal samples varied between less than 0.1 and 5.0 mg/kg for the 0.5-g dose and 0.7 and 11.3 mg/kg for the 1.0-g dose. Fecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. The aerobic bacteria--staphylococci, streptococci, enterococci, and enteroaerobic enterococci, and enterobacteria--were and anaerobic bacteria. The aerobic bacteria--staphylococci, streptococci, enterococci, and enterobacteria--were suppressed significantly during the imipenem prophylaxis period. Among the anaerobic bacteria, cocci, bifidobacteria, eubacteria, lactobacilli, clostridia, fusobacteria, and bacteroides decreased markedly during the same period. The microfloras were normalized after 2 weeks. There were no differences between the patients receiving 0.5-g doses of imipenem and those receiving 1.0-g of imipenem. No postoperative infections occurred.

Adult↗