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PubMed2006

Fermentable carbohydrate supplementation alters nitrogen excretion in chronic renal failure.

BACKGROUND: Considerable attention has been given to the impact of nutrition on kidney disease. Most dietary attempts to treat chronic renal failure (CRF) and to decrease uremia use a protein restriction. An alternative dietetic approach based on fermentable carbohydrate (FC) supplementation of the diet could lead to the same urea-lowering effect by increasing urea nitrogen (N) excretion in stool, with a concomitant decrease of the total N quantity excreted in urine. METHODS: In the present prospective study, the impact of FC (40 g/d) on uremia and on N excretion routes was investigated during 5 weeks in nine CRF patients in the presence of a moderated restrictive protein diet (0.8 g/kg/d). Patients were their own controls and were treated by the cross-over method after randomization (5 weeks with FC versus 5 weeks without FC). RESULTS: Feeding FC significantly increased the quantity of N excreted in stool from 2.1 +/- 0.8 to 3.2 +/- 1.1 g/d (+51%) (P < .01) and decreased, in parallel, the urinary N excretion from 9.4 +/- 1.7 to 8.3 +/- 1.4 g/d (-12%) (P < .01). The total N quantities excreted by the two routes were unchanged by the FC, which shows that the FC was efficient to shift N excretion from the urinary route toward the digestive route. As a result of the increase of urea transfer into the colon, the plasma urea concentration was significantly decreased from 26.1 +/- 8.7 to 20.2 +/- 8.2 mmol/L (-23%) (P < .05). CONCLUSIONS: These results show the same beneficial effects in CRF as those obtained with a restrictive protein diet without its nutritional drawbacks. This should be confirmed by other prospective works over a longer duration and a larger number of patients to study the effects of FC on CRF progression and on CRF terminal stage tolerance.

Adult↗

PubMed2006

High-viscosity carboxymethylcellulose reduces carbachol-stimulated intestinal chloride secretion in weaned piglets fed a diet based on skimmed milk powder and maltodextrin.

High-viscosity carboxymethylcellulose (CMC) promotes gastrointestinal disorders, tissue alterations and bacterial overgrowth in pigs. The impact of CMC on intestinal absorptive and secretory physiology is not known. We hypothesised that CMC consumption alters intestinal Na-dependent glucose absorption and stimulates electrogenic chloride secretion. For testing this hypothesis, twenty-four piglets were weaned at 21 d of age and pair-fed for 13 d a starter diet based on skimmed milk powder and maltodextrin containing cellulose (control) or CMC. Body weight and faecal total aerobe and coliform counts were measured kinetically. At slaughter, digesta were weighed and characterised for viscosity and pH. Gastrointestinal tissues were weighed and sampled for physiology in Ussing chambers, morphometry and enzymology. Glucose absorption tended to be higher (P = 0.08) and carbachol-stimulated chloride secretion was lower (P = 0.01) with CMC in the small intestine, without changes in the colon. Aerobes were transiently higher at day 7 (P < 0.05) but coliform counts remained unchanged (P = 0.78) and beta-haemolitic Escherichia coli were virtually absent. Stomach and small-intestinal segments were heavier, and viscosity higher with CMC (0.001 < P < 0.05). The pH in the stomach was higher, and in the caecum and proximal colon lower with CMC (0.001 < P < 0.05). Jejunal villus area was slightly reduced with CMC (P < 0.05) without effects on enzyme activities (P > 0.10). In conclusion, CMC supplementation had pro-absorptive effects on the small intestine, possibly due to the absence of pathogenic E. coli in the present study.

Animals↗

PubMed1997

Environmental factors influencing transmission.

The free-living stages of gastro-intestinal nematodes on pasture (i.e. eggs, developing and infective larvae) are often overlooked and not considered by producers. The factors that influence the development, survival, distribution, or migratory behavior of the free-living larvae seen on pasture are primarily weather related. The deposition of helminth eggs in feces is the starting point for the contamination of the pasture and the subsequent development of the parasites. The cumulative numbers of eggs can be considerable by the end of the grazing season. Environmental factors will influence both development and survival of the larvae on pasture, as well as their distribution onto the herbage. Eggs deposited on the pasture will hatch and develop to the infective L3 stage. Under optimal conditions of moisture and temperature, larvae of Ostertagia ostertagi will reach the infective stage in approximately 5-6 days. Developmental time varies from one geographic region to another depending on prevailing weather. Eggs hatch and develop more slowly at lower temperatures. The rate of development increases to a maximum at higher temperatures after which development will be adversely affected and death of the larvae occurs. It is difficult to evaluate the effects of temperature without considering moisture. Moisture must be present to prevent desiccation and death of the developing larvae. Moisture has an effect on the movement and motility of the larvae. As the fecal pat dries out the larvae may desiccate and die. If the environment is dry, movement onto surrounding herbage would probably not be possible, thus forcing movement or migration into the soil beneath the fecal pat. Too much moisture (rain) may disrupt the pat, moving the larvae onto the surrounding herbage or carrying them away in the runoff. When moisture is adequate the movement of larvae on pasture may be affected by temperature. Temperature in the optimal range allows for larval activity and thus motility. Moisture provides a medium in which the larvae can move (there is probably little movement on dry surfaces). The effect of rainfall on dispersal of the larvae is important, a drop may transport larvae as far as 90 cm from the dung pat. However, optimal larval recovery is only approximately 5 cm (2-3 inch) from the edge of the fecal pat, with decreasing numbers out to approximately 25 cm. Several authors report larval migration into the soil as deep as 15 cm and as far as 40 cm from the center of the fecal pat. Soil type may have a major effect of the ability of larvae to migrate. The predilication of larvae to remain relatively close to the fecal pat may have substantial impact on transmission, as cattle do not graze close to fecal pats until forage is very limited. Therefore, intensive rotational grazing may enhance transmission by forcing animals to graze the highly contaminated areas. At the same time, intensive rotational grazing causes increased disruption of fecal pats, thus enhancing desiccation. Many investigators have utilized tracer calves grazing a pasture for a prescribed period of time to provide an indication of both species and numbers of worms present. Some investigators have used pasture larval counts, reporting number of larvae per kg of dry herbage and the genera present.

Animal Feed↗

PubMed2006

[Impact of antifungal prophylaxis on the gastrointestinal yeast colonisation in patients with haematological malignancies].

Patients with haematological malignancies are at high risk for developing invasive Candida infections. They are often colonised with Candida spp. in the gastrointestinal (GI) tract. In order to prevent infection, the prophylactic use of antifungal agents has been established. The widespread use of fluconazole may lead to the emergence of resistant Candida isolates. We studied the yeast colonisation of the GI tract in patients with haematological malignancies receiving antifungal prophylaxis (AP) in comparison with healthy controls. The study cohort included 46 neutropenic patients with 52 stool samples under 52 episodes of AP and 110 healthy controls. The patients received amphotericin B orally (n = 8), amphotericin B and fluconazole (n = 7), amphotericin B and itraconazole (n = 5), fluconazole orally (n = 15) and itraconazole orally (n = 17). Yeasts were cultured from the stool samples of 63.5% of the patients and 60% of the controls with a mean yeast load of 1.6 x 10(3) and 0.4 x 10(3) cfu g(-1), respectively (P = 0.045). Patients and controls had a low faecal yeast load of 10(3) to 10(4) cfu g(-1) in 19.3% and 37.3%, respectively (P = 0.021), and yeast overgrowth of >10(5) cfu g(-1) in 28.9% and 10.9%, respectively (P = 0.004). The rate of Candida albicans was 32.6% and 54.1% in the patients and controls, respectively (P = 0.021). The rates of fluconazole-resistant yeast species were higher in the patient group than in the control group: C. glabrata 20.9% vs. 11.7% (P = 0.168), C. krusei 25.6% vs. 4.7% (P = 0.001). Not a single patient under AP suffered from proven or probable invasive candidosis. In conclusion, oral AP in haematological patients resulted in a higher colonisation rate with fluconazole-resistant Candida species but efficiently prevented invasive candidosis.

Antifungal Agents↗

PubMed1998

Net energy value of non-starch polysaccharide isolates (sugarbeet fibre and commercial inulin) and their impact on nutrient digestive utilization in healthy human subjects.

The energy value of NSP has been expressed as their metabolizable energy (ME) content. The aim of the present study was to determine whether differences in ME and net energy (NE) contents were similar for insoluble and soluble NSP. Nine healthy young men were offered three diets according to a Latin-square design (3 x 3) with three repetitions: diet C (control), diet B (control + 50 g sugarbeet fibre/d) and diet I (control + 50 g commercial inulin/d). After a 16 d adaptation period to NSP isolate, food intake was controlled (duplicate meal method) and faeces and urine were collected for 8 d. A period of 60 h was devoted to measurement of energy expenditure (EE) by whole-body indirect calorimetry. NSP-isolate ingestion induced significant increases in the number of defecations and stool weight resulting from increases in water, DM and microbial mass excretion. After deduction of microbial N, differences in faecal N excretion between diets were not significantly different. Urinary N excretion was slightly decreased by sugarbeet fibre or commercial inulin ingestion but the N balances for the diets were not significantly different. Diet energy, N and lipid apparent digestibilities decreased by only 1-2%. Commercial inulin was entirely fermented and fermentability of sugarbeet fibre averaged 0.886 (SD 0.117). Sugarbeet fibre and commercial inulin ME values averaged 10.7 (SD 1.2) and 13.0 (SD 2.3) kJ/g DM respectively. NSP-isolate ingestion caused significant (sugarbeet) and nonsignificant (inulin) increases in daily EE. The maintenance NE contents of sugarbeet fibre and inulin averaged 5.0 (SD 5.0) and 11.9 (SD 1.3) kJ/g DM respectively. Differences in maintenance NE contents of NSP isolates were much greater than differences in ME values.

Adult↗

PubMed2005

Functional significance of low-intensity polyparasite helminth infections in anemia.

BACKGROUND: We wanted to quantify the impact that polyparasite infections, including multiple concurrent low-intensity infections, have on anemia. METHODS: Three stool samples were collected and read in duplicate by the Kato-Katz method in a cross-sectional sample of 507 children from Leyte, The Philippines. The number of eggs per gram of stool was used to define 3 infection intensity categories--uninfected, low, and moderate/high (M+)--for 3 geohelminth species and Schistosomiasis japonicum. Four polyparasite infection profiles were defined in addition to a reference profile that consisted of either no infections or low-intensity infection with only 1 parasite. Logistic regression models were used to quantify the effect that polyparasitism has on anemia (hemoglobin level <11 g/dL). RESULTS: The odds of having anemia in children with low-intensity polyparasite infections were nearly 5-fold higher (P = .052) than those in children with the reference profile. The odds of having anemia in children infected with 3 or 4 parasite species at M+ intensity were 8-fold greater than those in children with the reference profile (P < .001). CONCLUSION: Low-intensity polyparasite infections were associated with increased odds of having anemia. In most parts of the developing world, concurrent infection with multiple parasite species is more common than single-species infections. This study suggests that concurrent low-intensity infections with multiple parasite species result in clinically significant morbidity.

Adolescent↗

PubMed2001

The dynamics, prevalence and impact of nematode infections in organically raised sheep in Sweden.

A three-year survey (1997-99) was carried out on organically reared sheep flocks throughout Sweden. The aim was to determine the prevalence and intensity of nematode infections and to establish relationships between sheep management practices and parasite infections. Faecal samples from ewes and lambs were collected from 152 organic flocks around lambing-time and during the grazing-period for analysis. Results were compared with the different management practices that farmers use to prevent parasitism in their flocks. A high proportion of the flocks was infected with nematodes. The most prevalent species were Haemonchus contortus, Teladorsagia circumeincta, Trichostrongylus axei. T. colubriformis and Chabertia ovina and infections progressively increased during summer in lambs grazing on permanent pastures. Severity of parasitic infection in lambs was highly dependent on egg output from the ewes. H. contortus was found in 37% of the flocks, even at latitudes approximating the Polar Circle. Nematodirus battus was recorded for the first time in Sweden during the course of this study. Lambs turned out onto permanent pasture showed higher nematode faecal egg counts (epg) than lambs that had grazed on pastures, which had not carried sheep the previous year. This beneficial effect of lambs grazing non-infected pastures persisted if the ewes were treated with an anthelmintic before turn-out and if the lambs were kept on pastures of low infectivity after weaning. In lambs, the prevalence and the magnitude of their egg counts were higher during autumn in flocks where lambs were slaughtered after 8 months of age, compared with flocks where all lambs were slaughtered before this age. These results will be used in providing advice to farmers of ways to modify their flock management in order to minimise the use of anthelmintics, but at the same time efficiently produce prime lambs.

Animals↗

PubMed1998

Reducing parenteral requirement in children with short bowel syndrome: impact of an amino acid-based complete infant formula.

BACKGROUND: The aim of this study was to assess the impact of an amino acid-based complete infant formula on enteral feeding tolerance and parenteral nutrition requirement in children with severe short bowel syndrome. METHODS: Four children (23 months-4.75 years) with short bowel syndrome who required long-term parenteral nutrition due to persistent feeding intolerance while receiving an extensively hydrolyzed formula were assessed before and after the commencement of an amino acid-based complete infant formula for a mean follow-up period of 48 months (range 39-51 months). Assessment included clinical monitoring of feeding tolerance and nutritional status, biochemistry, stool analysis, skin-prick testing to common food antigens, esophagogastroduodenoscopy and colonoscopy or jejunoscopy with biopsies, and measurement of disaccharidase levels and intestinal permeability. RESULTS: All patients ceased parenteral nutrition within 15 months as a result of decreased stool output and resolution of vomiting. Patients had a reduction in hospitalization (mean: 198 versus 98 days/patient/year), episodes of proven (mean: 4.3 versus 3.3/patient/year) and suspected (mean: 6.5 versus 4.0/ patient/year) bacterial sepsis and central line insertions (mean: 2.5 versus 1.5/patient/year). Intestinal permeability to lactulose fell markedly (mean: 69% versus 2.7%). Disaccharidase levels increased in all three patients undergoing repeat studies. CONCLUSIONS: An amino acid-based complete infant formula improved feeding tolerance and eliminated the need for parenteral nutrition in four children with short bowel syndrome who had previously required long-term parenteral nutrition. The clinical improvement was mirrored by improvement in measurements of intestinal function.

Acidosis↗

PubMed2026

Detection of opportunistic bacterial pathogens with intrinsic amoxicillin- and cephalosporin-resistance in wild koala faecal microbiomes.

Opportunistic bacterial pathogens frequently associated with human clinical infections, including antimicrobial-resistant strains, are infiltrating the microbiomes of wild animals, where they have the potential to negatively impact wildlife health. Bacterial genes conferring resistance to amoxicillin have previously been reported in koala (Phascolarctos cinereus) faecal DNA. Koalas are facing several key threats, including wildfires, and affected individuals may receive amoxicillin therapy to treat burn wounds. This study aimed to identify the species of amoxicillin-resistant bacteria in koala gut microbiomes and determine if they are opportunistic pathogens. Faecal samples collected from 98 wild-caught koalas were cultured using amoxicillin-supplemented media to isolate amoxicillin-resistant Gram-negative enteric bacteria. Isolates were screened using 16S rRNA PCR and Sanger sequencing to identify opportunistic pathogenic species, which then underwent whole-genome sequencing and antimicrobial susceptibility testing. Intrinsically amoxicillin-resistant opportunistic pathogens were obtained from 9.2% (9/98) of koala faecal samples and comprised Klebsiella oxytoca (6/98, 6.1%), Klebsiella pneumoniae (1/98, 1.0%) and Citrobacter spp. (2/98, 2.0%). Seven of nine amoxicillin-resistant opportunistic pathogens also exhibited cephalosporin resistance. Four K. oxytoca isolates belonged to lineages associated with human clinical infections, which also have the potential to cause disease in koalas, including fatal systemic infections in pouch young. The presence of amoxicillin- and cephalosporin-resistant strains may also increase the risk of gut dysbiosis and opportunistic infections when penicillins or cephalosporins are required to treat bacterial infections in koalas, highlighting the importance of good antimicrobial stewardship. The study findings demonstrate the One Health perspective of microbial pathogens and the intertwined microbial ecology between humans and wildlife.

Animals↗

PubMed2005

Tracing anthropogenic contamination in the Pearl River estuarine and marine environment of South China Sea using sterols and other organic molecular markers.

5beta-Coprostanol together with eight other sterols and unresolved complex mixtures (UCMs) were quantitatively investigated for surficial sediments and surface waters to assess the impacts of anthropogenic activities on the Pearl River estuarine and marine environment of South China Sea. The studied area extends from the Pearl River Estuary southward to the open sea. 5beta-Coprostanol concentrations ranged from trace amounts to 53 microgg(-1) TOC in surficial sediments. The highest levels and highest percentages of coprostanol were found in the Pearl River estuary, especially in the inner estuary and those sites close to the submarine outfalls of Hong Kong. For waters, only in estuarine samples was coprostanol quantitatively detected, ranging from 11 to 299 ngL(-1). Bimodal UCM "humps" were observed for most sediment samples, with concentrations ranging from 215 to 10,491 microg g(-1) TOC in sediments and from 2 to 26 mcirogL(-1) in waters, respectively. Progressive seaward declines in concentrations were found for both 5beta-coprostanol and UCM in surficial sediments. Trace or no 5beta-coprostanol was found in open-sea samples. Concentrations of coprostanol and UCM in surficial sediments are correlated. These results imply that there are obvious anthropogenic contaminations in the Pearl River estuary. The submarine outfalls in Hong Kong represent important sources of the sewage pollution to the Pearl River estuarine sediments evidenced by a combination of coprostanol concentration, diagnostic indices, sterol profiles and UCM. No obvious dispersion or transport of the sewage contamination occurred from the Pearl River estuary to the open South China Sea indicated by fecal sterol biomarkers.

Chemical Fractionation↗

PubMedDate not supplied

Five-year impact of repeated praziquantel treatment on subclinical morbidity due to Schistosoma japonicum in China.

We report the 5-year impact (1996-2001) of repeated praziquantel chemotherapy on subclinical morbidity related to Schistosoma japonicum infection. We repeated stool examinations and hepatosplenic ultrasonography in a cohort of 120 individuals living on an island with endemic infection in Dongting Lake, China. Prevalence of schistosome infection fell by 43% and intensity (geometric mean eggs per gram) declined by 80% over the 5 years. However, transmission persisted at a dangerously high rate of 13% per year for re-infection or new infection in the cohort. The prevalence of left-lobe enlargement and dilated portal vein fell significantly (P < 0.01) to about half initial levels although a few patients progressed during the study period. At study endpoint, infection was nearly twice as common if the portal vein was dilated (23% versus 13%, respectively), but this association was not statistically significant (P > 0.05). However, endpoint infection was even more strongly associated with left-lobe enlargement (57% versus 15%, P < 0.01). The proportions of subjects with improved parenchymal and periportal fibrosis were much higher than the proportions of subjects that progressed (P < 0.05). Reduction of prevalence and intensity of infection, and improvement of subclinical morbidity, were benefits of repeated treatments. Further research is needed to understand why some patients developed fibrosis despite substantial reductions in egg counts and to evaluate the functional importance of residual subclinical morbidity after chemotherapy-based control in the lake and marshland area of China.

Adolescent↗

PubMed1995

Effect of chronic respiratory acidosis on calcium metabolism in the rat.

Chronic metabolic acidosis typically results in hypercalciuria and negative calcium balance. The impact of chronic respiratory acidosis on calcium metabolism has been less well studied. To address this issue, metabolic balance and static bone histomorphometric data were obtained during a 14-day exposure of rats to 10% CO2 (blood pH 7.33, PaCO2 83 mm Hg) and were compared with pair-fed controls. All rats were fed a 0.8% calcium diet. Urinary calcium excretion (mg/period, mean +/- SEM) was increased during both week 1 and week 2 (16 +/- 3 vs 9 +/- 1 and 16 +/- 2 vs 9 +/- 1, CO2 group vs controls, respectively [p < 0.05]). Net intestinal calcium absorption (intake minus fecal excretion) was increased throughout the period of hypercapnia (week 1, 213 +/- 19 mg vs 135 +/- 15 mg; week 2, 135 +/- 16 mg vs 43 +/- 14 mg; and cumulatively, 344 +/- 27 mg vs 178 +/- 20 mg, CO2 group vs controls [p < 0.01]). As a consequence of the marked increment in intestinal calcium absorption during hypercapnia, mean net calcium balance was more positive than that of controls throughout the study (week 1, 197 +/- 18 mg vs 126 +/- 15 mg; week 2, 120 +/- 15 mg vs 34 +/- 15 mg; and cumulatively, 317 +/- 25 mg vs 159 +/- 20 mg, CO2 group vs controls, respectively [p < 0.01]). There were no significant differences in calcium intake, plasma total calcium, immunoreactive parathyroid hormone, 25-hydroxyvitamin D, or creatinine clearance between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis, Respiratory↗

PubMed2004

Ertapenem pharmacokinetics and impact on intestinal microflora, in comparison to those of ceftriaxone, after multiple dosing in male and female volunteers.

The pharmacokinetics of ertapenem and ceftriaxone were investigated in an open, randomized, two-period crossover study after single- and multiple-dose administration in 10 healthy volunteers (five women and five men). Both antibiotics were administered intravenously once daily for 7 days at dosages of 1 g (ertapenem) and 2 g (ceftriaxone). The concentrations of the antibiotics in serum and urine were quantified by the agar well diffusion method bioassay and, in addition, for ertapenem only, by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). For ertapenem the maximum concentration of the drug in plasma (C(max)) was 256 mg/liter, the half-life was 20.7 h, and the area under the plasma concentration-time curve (AUC) was 830 mg. h/liter. The concentrations in fecal samples were (mean value) 37.2 and 32.7 mg/kg on day 4 and day 8, respectively. Ceftriaxone exhibited a mean C(max) of 315 mg/liter, a half-life of 7.6 h, and an AUC of 1,556 mg. h/liter. The mean concentrations in fecal samples were 153 and 258 mg/kg on day 4 and day 8, respectively. No accumulation of ertapenem or ceftriaxone was detected at steady state. A slightly but significantly decreased AUC for ertapenem was detected for the female volunteers. No serious adverse event was observed. Both antibiotics induced a marked decrease in the anaerobic microflora (4-log-unit decreases in lactobacilli, bifidobacteria, clostridia, and bacteroides) and Escherichia coli, whereas the number of enterococci increased (4 log units). A slight overgrowth of yeasts was observed with both regimens. In all cases the microflora returned to normal levels on days 21 to 35.

Adult↗

PubMed2000

The effect of subclinical Mycobacterium paratuberculosis infection on days open in Michigan, USA, dairy cows.

A prospective cohort study design was used to evaluate the impact of subclinical Mycobacterium paratuberculosis infection on days open in a sample of Michigan dairy herds with a history of cows positive for M. paratuberculosis diagnosed by fecal culture. Participating herds were tested and productivity and reproduction records were monitored for 18 months. All cows > or = 24 months old were tested for M. paratuberculosis infection using the ELISA and radiometric fecal-culture (RFC) techniques. Test-negative cows were re-tested at the conclusion of the monitoring period. Multivariable regression models were used. Using both tests in parallel, the overall sample apparent prevalence for M. paratuberculosis infection was 41.8% (223/533 animals tested). Adjusting for diagnostic sensitivity and specificity, this resulted in a calculated sample true prevalence of 59.9%. ELISA-positive cows (on average) had a 28-day increase in days open when compared to ELISA-negative cows (p=0.02). The diagnostic method used to define a case altered the apparent association between paratuberculosis test status and days open. Fecal culture was a less-effective diagnostic tool for use in herds with a high prevalence of infected animals. The increase in days open in the ELISA-positive cows was an indication that perhaps reduced estrus expression or an increased post-partum anestrous period occurred in the subclinically infected ELISA-positive animals. This might have been due to a negative energy balance associated with M. paratuberculosis infection.

Animals↗

PubMed1999

Impact of simple screening criteria on utilization of low-yield bacterial stool cultures in a Children's Hospital.

OBJECTIVE: To determine diagnostic yield of stool cultures for Salmonella, Shigella, Campylobacter jejuni, Yersinia enterocolitica, and Escherichia coli O157:H7 (SSCYE) among hospitalized children and to develop guidelines for appropriate use of these tests. Setting. Tertiary care pediatric hospital. DESIGN: Computerized records from the Microbiology Laboratory from January 1992 to December 1996 were reviewed retrospectively to collect data on the number of stool cultures performed in inpatients and outpatients, the length of hospital stay at the time cultures were sent, and diagnostic yield of cultures in hospitalized patients. A detailed review of medical records of all patients with a stool pathogen isolated after 3 days of hospitalization was also undertaken. The results from this retrospective analysis were used to develop guidelines to reduce unwarranted stool cultures and to educate medical care providers in the appropriate use of these tests. The impact of these guidelines on reduction in the volume of stool cultures performed on hospitalized patients was measured prospectively from January 1998 to June 1998. RESULTS: A total of 27 110 stool cultures for SSCYE were performed in the 5-year study period. Of the 14 125 cultures from inpatients, 174 (1.2%) were positive. Among the cultures from inpatients, 9378 (66%) were from patients hospitalized for >3 days. Only 13 (.14%) were positive. Of these 13 cultures, 4 represented nosocomial infections, whereas the remaining 9 cultures either were sent to document clearance from a patient known previously to be infected with an enteric pathogen (7), or were attributed to delayed testing in individuals admitted with a diarrheal illness (2). Introduction of guidelines to reject all SSCYE cultures from patients hospitalized for >3 days who did not meet specified criteria was associated with an overall reduction of 689 (43%) in the volume of tests performed in the 6-month period evaluated. This included 497 fewer cultures ordered and 192 cultures that were ordered but rejected because screening criteria were not met. Only 11 (5.4%) of 203 cultures sent >3 days after admission were processed because they met clinical criteria for testing. None were positive. Estimated cost savings were $50 163/year. CONCLUSIONS: Stool cultures for SSCYE among hospitalized patients have very low diagnostic yield and are extremely overutilized. Simple guidelines, such as rejecting (with few exceptions) cultures from patients hospitalized for >3 days, can reduce substantially such unnecessary testing.

Boston↗

PubMedDate not supplied

The impact of infant feeding patterns on infection and diarrheal disease due to enterotoxigenic Escherichia coli.

OBJECTIVE: Determine the impact of dietary risk factors on patterns of infection by heat labile toxin-producing Escherichia coli (LT-ETEC). MATERIALS AND METHODS: Ninety-eight infants were followed from birth for one year in Guadalajara, Mexico, beginning in august of 1986. Stool and breast milk samples were collected weekly from infants and their mothers, respectively. Mothers were also interviewed on a weekly basis regarding the health of the infants. Parametric hazard models were fit to durations of different LT-ETEC disease states determined through the analysis of stools. The child's consumption of supplemental foods and liquids as well as specific levels of LT-ETEC-specific breast milk antibodies were included in each model as time-varying covariates. RESULTS: The hazard of LT-ETEC asymptomatic infection increased 400 percent among children who received oats gruel (hazard rate = 4.01; 95% CI 2.77-5.24). The duration of infection was reduced if the child had had a previous LT-ETEC diarrheal episode (2.12; 95% CI 1.74-2.49) but was prolonged if the child consumed herbal teas (0.53; 95% CI 0.27-0.7). Herbal teas and high LT-ETEC-specific breast milk antibody levels each reduced the hazard of symptomatic infection by ninety percent. Symptomatic episodes became asymptomatic more rapidly if a child was given rice water. CONCLUSIONS: Specific weaning foods increase the risk of infection. Breastmilk antibodies and liquid infusions reduce diarrheal disease and infection duration.

Breast Feeding↗

PubMed2003

Scope of potential bacterial agents of diarrhoea and microbial assessment of quality of river water sources in rural Venda communities in South Africa.

The microbial quality of several, usually untreated, surface domestic water sources, used by rural communities in the Venda Region of South Africa, was assessed to gauge their fitness for human consumption and to highlight the possible impact of waterborne diseases. The water sources studied were six points on the Levubu River and the rivers Mutale, Ngwedi, Tshinane, Makonde, Mutshindudi and Mudaswali. Total and faecal coliform, heterotrophic bacteria, enterococci and coliphage counts were used as indicators/surrogates to estimate the degree of bacterial and viral contamination respectively by standard methods. The presence of potential bacterial agents of diarrhoea such as Salmonella, Shigella, Campylobacter, Plesiomonas, Aeromonas and Vibrio was also determined. Results showed that the ranges of counts with regard to all the water sources investigated were 2.9 x 10(2) - 6.3 x 10(4) CFU/100 mL for faecal coliforms, 6.0 x 10(2) - 3.7 x 10(4) CFU/100 mL for total coliforms, 1.8 x 10(2) - 1.3 x 10(6) CFU/mL for heterotrophic plate count, 1.0 x 10(1) - 3.7 x 10(4) CFU/100 mL for enterococci and 0-13 PFU/100 mL for coliphages. These values are far higher than the acceptable maximum limits prescribed for South Africa by the Dept of Water & Forestry and the Water Research Commission - 0 CFU/100 mL, 5 CFU/100 mL, 1.0 x 10(2) CFU/mL, 0 CFU/100 mL and 1 PFU/100 mL for faecal coliforms, total coliforms, heterotrophic bacteria, enterococci and coliphages respectively. Salmonella, Shigella, Vibrio cholerae, Campylobacter, Aeromonas and Plesiomonas were isolated from several of the water sources investigated. The use of these water sources for drinking and domestic purposes poses a serious threat to the health and well being of the users and calls for urgent government intervention.

Bacteria↗

PubMed1992

Re-assessing disability: the impact of schistosomal infection on daily activities among women in Gezira Province, Sudan.

Schistosoma mansoni is often perceived by governments and international aid agencies to present a major public health problem in the tropical and sub-tropical world. This perception persists in spite of the fact that biomedical practitioners and research workers disagree about the nature and extent of disease and disability caused by schistosomes. This paper raises the question of whether S. mansoni should continue to be given priority as a public health problem in Gezira Province, Sudan. Biomedical and continuous observational data are blended with ethnographic information in order to develop a more integrated picture of the impact of S. mansoni on daily activity patterns among women. Research took place in one village in the Gezira/Managil irrigation scheme. The study is characterized by a small sample and a paired design. That is, 11 infected women were paired with 11 uninfected women. These women were engaged in agricultural activities in the cotton picking season and they were matched for a wide range of social and economic factors that might otherwise have affected their working activities. Observations were conducted on a minute by minute basis in the cotton fields. These data, in combination with ethnographic information and data indicating female productive output, showed that infection with S. mansoni significantly altered activity patterns in the cotton fields. That is, infected women (with an arithmetic mean egg output of 1958 eggs/g) attempted to pick as much cotton as possible in the shortest time period feasible in the morning. This pattern was partially repeated by infected women who returned to the fields in the afternoon. However, a significant number of infected women felt too weak to sustain this work regime and the economic implications of this finding are discussed. Finally, Fisher's exact probability test showed that infected women were significantly less likely to undertake personal care activities between cotton picking sessions and this result suggests they may have been too tired and/or had a diminished perception of their own well-being. The implications of these results for public health policy in Gezira Province are discussed.

Activities of Daily Living↗