Enterotoxigenic Escherichia coli and Reovirus-like agent in rural Bangladesh.
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Adult↗
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Results for “Diarrhea, Infantile--etiology”
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An outbreak of Cryptosporidium diarrhea in a pediatric hospital.
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Acquired Immunodeficiency Syndrome↗
Bacterial indicators of risk of diarrhoeal disease from drinking-water in the Philippines.
Inadequate measures of water quality have been used in many studies of the health effects associated with water supplies in developing countries. The present 1-year epidemiological-microbiological study evaluated four bacterial indicators of tropical drinking-water quality (faecal coliforms, Escherichia coli, enterococci and faecal streptococci) and their relationship to the prevalence of diarrhoeal disease in a population of 690 under-2-year-olds in Cebu, Philippines. E. coli and enterococci were better predictors than faecal coliforms of the risk of waterborne diarrhoeal disease. Methods to enumerate E. coli and enterococci were less subject to interference from the thermotolerant, non-faecal organisms that are indigenous to tropical waters. Little difference was observed between the illness rates of children drinking good quality water (less than 1 E. coli per 100 ml) and those drinking moderately contaminated water (2-100 E. coli per 100 ml). Children drinking water with greater than 1000 E. coli per 100 ml had significantly higher rates of diarrhoeal disease than those drinking less contaminated water. This threshold effect suggests that in developing countries where the quality of drinking-water is good or moderate other transmission routes of diarrhoeal disease may be more important; however, grossly contaminated water is a major source of exposure to faecal contamination and diarrhoeal pathogens.
Bacterial Infections↗
Infant feeding and risk of severe diarrhoea in Basrah city, Iraq: a case-control study.
A case-control study of the relationship between feeding mode and risk of hospitalized diarrhoea in infants (aged 2-11 months) in Basrah city was conducted between September 1983 and May 1984. A total of 597 cases were recruited from among infants admitted with diarrhoea to the major paediatric hospital in the city, while 723 controls were recruited from among healthy infants attending any of the seven maternal and child health clinics in Basrah. A variety of potentially confounding variables were controlled in the analysis. For infants aged 2-5 months, breast-feeding alone or breast-feeding plus food were the least risky feeding modes. Bottle-feeding was dangerous and bottle-feeding alone was associated with a risk of 55 among infants aged 2-3 months, and 37 among infants aged 4-5 months, relative to exclusive breast-feeding. For older infants (6-11 months), the risks of hospitalized diarrhoea were not significantly different among different partial breast-feeding modes, but non-breastfeeding was dangerous, especially exclusive bottle-feeding. Food intake was associated with a reduced risk of severe diarrhoea among bottle-fed infants but not with an increased risk among breast-fed infants. Among bottle-fed infants, no association was found between risk of severe diarrhoea and method of bottle-cleaning. Previous breast-feeding conferred no current protection.
Bottle Feeding↗
[Past and present aspects of diarrheal disease in childhood. Clinical study and treatment (author's transl)].
The etiologic and pathophysiologic findings described in the first part of this paper have important consequences: The recognition of the specific etiology of diarrhea requires new laboratory methods: most of these, however, are technically easy to perform and do not require a large laboratory. A long-ranging consequence of this changed concept is a well-founded modification of therapy. The most important discovery was, that in a well balanced glucose electrolyte solution sodium and glucose enhance their absorption mutually and increase the absorption of water by solvent drag. Since in most acute diarrheas the mechanisms of absorption of glucose and electrolytes are retained this mechanism can be utilized for fast oral rehydration and reinstitution of normal intestinal homeostasis. Prompt institution of a diet consisting of the previously mentioned glucose-electrolyte solution usually prevents severe dehydration and the need for stationary treatment. The elimination of lactose and long chain fatty acids from the diet prevents continuation of the pathologic osmotic and chemical conditions in the intestine. Antibiotics are not indicated in acute diarrhea with the exception of diarrhea caused by enteroinvasive E. Coli or Shigella, in the case of Salmonella-gastroenteritis even contraindicated. Further research concentrates on the development of drugs for neutralisation of E. Coli enterotoxin and the prevention of diarrheas by development of effective vaccines.
Acid-Base Equilibrium↗
Knowledge and practices among rural mothers in Haryana about childhood diarrhea.
Knowledge and practices of 108 rural mothers about childhood diarrhea, were determined by using pretested semi-structured interview schedules. The common causes of diarrhea reported were eruption of teeth (67.59%), eating of mud (51.85%), worm infestation (47.22%), change of climate (35.18%), poor personal hygiene (34.25%) and changes in diet (25.92%). Majority (83.33%) of mothers practiced food restriction during diarrhea. Seventy seven percent consulted their mother-in-laws in the first instance for treatment of diarrhea. The home remedies tried by mothers were, isabgol husk with curd (30.55%), ghee with tea (28.70%) water boiled with mint leaves (25.92%), local ghutti (22.22%) and unripe mango juice (16.66%). Majority of mothers (83.33%) believed that oral rehydration therapy alone, cannot treat diarrhea.
Child, Preschool↗
Protection of breast-fed infants against Campylobacter diarrhea by antibodies in human milk.
To investigate the role of breast-feeding in preventing diarrhea caused by Campylobacter jejuni, we followed 98 Mexican children prospectively for 2 years beginning at their birth. Attack rates of diarrhea in children less than 6 months of age who were not fed human milk were 2.3 times greater than those in children of the same age who were fed human milk. Breast-fed children remained free of diarrhea for a longer time than non-breast-fed children (p less than 0.0005). The diarrhea attack rate caused by C. jejuni for non-breast-fed infants was significantly greater (p less than 0.005) than that in the breast-fed group. Secretory IgA milk antibody titers against glycine acid-extractable antigen of C. jejuni were high in colostrum, decreased during the first month of breast-feeding, and generally persisted throughout lactation. Human milk consumed by children in whom Campylobacter diarrhea developed did not contain secretory IgA antibodies to the glycine acid-extractable common antigen of Campylobacter. This study shows an association between Campylobacter antibodies in human milk and prevention of diarrhea caused by Campylobacter.
Antibodies, Bacterial↗
Acute diarrheal infections in infants. I. Epidemiology, Treatment, and prospects for immunoprophylaxis.
Epidemiologic differences that appear to be geographic or climatic actually relate more closely to socioeconomics and sanitation. Regardless of etiology, the major management problems are those of dehydration and its sequelae. Progress toward development of antibacterial and antiviral vaccines is discussed. Next month the viral and bacterial agents that cause diarrheal infections will be reviewed.
Bacterial Vaccines↗
Prospects for development of a rotavirus vaccine against rotavirus diarrhea in infants and young children.
Major advances have been made in elucidating the etiologic agents of severe infantile diarrhea, and it is clear that rotaviruses are the single most important etiologic agents. Progress in the development of rotavirus vaccine candidates has also moved swiftly with the "Jennerian" approach, in which a related live, attenuated rotavirus strain from a nonhuman host is used as the immunizing antigen. If this strategy is not effective against all rotavirus serotypes, reassortant rotaviruses hold great promise for the development of a multivalent vaccine. Field trials with the "Jennerian" approach vaccines are under way, and phase 1 trials with the reassortants have been initiated.
Animals↗
A prospective study of persistent diarrhea among children in an urban Brazilian slum. Patterns of occurrence and etiologic agents.
Persistent diarrhea is a major health problem among children in developing areas of the world. Since few community-based studies have addressed the epidemiology or etiology of this condition, we undertook prospective diarrheal surveillance among a cohort of 175 children less than 5 years of age over a 28-month period in an urban slum in northeastern Brazil. Very high diarrhea illness burdens were found. The children in this cohort had an average of 11 episodes per year and spent 82 days per year with diarrhea. A total of 65% of children had at least one episode of persistent diarrhea (greater than or equal to 14 days duration). These episodes accounted for 50% of all days of diarrhea and 11% of all episodes. The occurrence of at least one episode of persistent diarrhea identified all children who spent at least 15% percent of days with diarrhea. Among children with and without diarrhea, rotavirus was the agent isolated most frequently, followed by Giardia lamblia and enterotoxigenic coliforms. The agents isolated from children with acute and persistent diarrhea were similar, which suggests that other factors must be operative in the development of persistent diarrhea.
Brazil↗
The role of home environment in infant diarrhea in rural Egypt.
In 1982 and 1983, a descriptive environmental survey was conducted in 317 households with newborn infants in rural Bilbeis, Egypt. The incidence of infant diarrhea in these households was ascertained by twice-weekly home visits for a 1-year period (1981-1982). Using univariate and multivariate analyses, the authors identified household factors that were statistically associated with infant diarrhea incidence, including number of children in the house under 4 years of age; number of persons per household; incidence of diarrhea in other family members; having a dirt (vs. concrete) dining room floor; having multiple living areas in the house; having a house or roof in need of repair; using well water rather than tap water for cooking or bathin; the absence of a sewer for waste bathwater; food being left out at room temperature between meals; and having many rodents in the house. Two practices involving interaction with the environment appeared to be protective: butchering of cattle by the family for home consumption, and protection of the infant from flies by a veil during napping. The combined household variables explained 25% of the variance in the total incidence of diarrhea. Categories of variables that accounted for most of the total variance explained by environmental factors are, in decreasing order: house structure (28%); water usage (24%); toilet and bathing area (12%); animal management (11%); food preparation area (10%); hygiene (8%); and wastewater management (6%). This approach may be useful in identifying environmental characteristics whose change would reduce diarrheal illness among infants.
Abattoirs↗
Persistent diarrhea in children: epidemiology, risk factors, pathophysiology, nutritional impact, and management.
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Child, Preschool↗
Intestinal permeability assessed with polyethylene glycols in children with diarrhea due to rotavirus and common bacterial pathogens in a developing community.
Intestinal permeability was assessed with different-sized polyethylene glycols (PEG 400 and PEG 1,000) in small children with acute diarrhea. All children with acute diarrhea absorbed and excreted less PEG of all molecular sizes into the urine when compared with healthy control children (p less than 0.001). Children with acute rotavirus infection excreted significantly less PEG of all sizes than children with Shigella, Salmonella, and enteropathogenic Escherichia coli (EPEC) infection (p less than 0.001-0.01), suggesting a more severe mucosal lesion caused by rotavirus. In patients with severe malnutrition there was also a significant decrease in absorption of PEGs observed. In addition, malnourished patients with rotavirus diarrhea showed a pronounced decrease of PEGs in comparison with well-nourished patients. The ratio between the recovery of a large PEG molecule, 1,074 Da, and a small molecule, 370 Da, was utilized to assess the absorption of large molecules in relation to that of smaller ones. On applying this ratio, it was noted that the intestine in children with Shigella and EPEC infection was relatively more permeable to larger molecules than in healthy controls, while in rotavirus and Salmonella infection it was less permeable to larger molecules. In this study significant differences in the permeability characteristics were observed, suggesting etiology-specific effects on the mucosal barrier.
Child, Preschool↗
Upper small intestinal microflora in diarrhea and malnutrition in Nigerian children.
The upper small intestinal microflora was determined quantitatively and qualitatively in a group of well-nourished diarrhea-free Nigerian children and compared with those of well-nourished children with acute diarrhea and malnourished children with or without diarrhea. Intestinal aspirate was collected by intubation after a 6-h fast. Well-nourished children without diarrhea had flora consisting predominantly of gram-positive cocci. Total bacterial counts were less than 10(5) organisms/ml; 18.2% of aspirates were sterile. In contrast, malnourished children with or withour diarrhea had a wider microbial spectrum including Enterobacteriaceae, Bacteroides, and Candida. Total bacterial counts were between 10(3) and 10(9) organisms/ml; none were sterile. In both well-nourished and malnourished groups, no significant quantitative bacteriologic differences were found between patients who had diarrhea and those who did not. Candida and Pseudomonas were found more frequently in malnourished patients with diarrhea. In such diarrheal patients, Pseudomonas, Klebsiella, and enteropathogenic Escherichia coli grew as pure isolates in intestinal aspirates and could be detected concomitantly in their stools. These results establish the upper small intestinal flora of well-nourished diarrhea-free Nigerian children, confirm bacterial overgrowth as a feature of malnourished children with or without diarrhea, and suggest that Candida, Pseudomonas, and Klebsiella may account partly for the diarrhea seen in malnourished children.
Child, Preschool↗
Factors influencing the duration of acute diarrheal disease in infancy.
The majority of episodes of acute infectious diarrhea in infancy are of relatively short duration. Prolongation of the diarrhea presents problems in management, deterioration of the infant's nutritional status, and an increased mortality. As part of a prospective study of the etiology of acute infectious diarrhea, some factors associated with the probability (more or less) of having self-limiting disease have been identified. The well-nourished infant over 6 months of age is more likely to have self-limiting disease, whereas this outcome is least likely in the very young infant under 3 months of age, particularly if underweight for age. With the exception of Shigella, bacterial enteropathogens (Campylobacter fetus jejuni, Salmonella B, and certain enteropathogenic Escherichia coli types) were also associated with a decreased likelihood of self-limiting disease. Rotavirus infection was associated with self-limiting disease except in the infant under 3 months of age, where the probability of self-limiting disease was decreased.
Acute Disease↗
Enteroaggregative Escherichia coli and Salmonella associated with nondysenteric persistent diarrhea.
A hospital-based case-control study including 92 children with diarrhea for longer than 14 days and 92 controls without gastrointestinal symptoms was performed to describe the association between the excretion of enteric pathogens and persistent diarrhea. In patients the most frequently isolated stool pathogens were enteroaggregative Escherichia coli (19.6%), nontyphoidal Salmonella spp. (17.4%), E. coli with diffuse adherence pattern (7.6%), G. lamblia (7.6%) and enterotoxigenic E. coli (5.4%). The excretion rates in patients were significantly greater than in controls only for nontyphoidal Salmonella spp. (P = 0.0006) and enteroaggregative E. coli (P = 0.016).
Diarrhea, Infantile↗
Microbial etiology of acute gastroenteritis in hospitalized children in Kuwait.
During a period of 15 months 621 hospitalized children with acute gastroenteritis and 152 control children were investigated for etiologic agents of the disease. Putative enteropathogens were identified in 86% of the patients and 10% of the controls. Common viral agents associated with gastroenteritis among children included rotaviruses (45%) and enteric adenoviruses (4%). Bacterial pathogens infecting children were Salmonella serotypes (24%), enterotoxigenic Escherichia coli (9%), Campylobacter jejuni (7%), enteropathogenic E. coli (7%), Shigella (4%) and enterotoxigenic Aeromonas sp. (1%). The highest incidence of infections was observed in the 3- to 25-month age group. Mixed infections were observed in 12% of the patients. Viral gastroenteritis was clinically mild and of short duration. Upper respiratory tract infections, vomiting and watery stools were common features. In contrast bacterial gastroenteritis was more severe; stools were frequently bloody and abdominal pain, cramps, shock, convulsions and milk intolerance were predominant clinical features. Comparative analysis revealed differential features of bacterial and viral gastroenteritis which should help clinicians to make a tentative diagnosis and to start treatment early.
Acute Disease↗
Incidence of enteric adenoviruses among children in Thailand and the significance of these viruses in gastroenteritis.
In countries with temperate climates, enteric adenoviruses have been shown to be a substantial cause of pediatric gastroenteritis. To determine the incidence of adenovirus infection in a tropical climate, stools were collected from children under age 7 during a 1-year period at an outpatient clinic in Bangkok, Thailand. Stools from 1,114 children with gastroenteritis and from 947 children without gastroenteritis were tested. Each stool was tested for adenovirus group antigen and for specific enteric adenovirus types (Ad40 and Ad41) by monoclonal antibody enzyme immunoassays. We found that 4.4% (49 of 1,114) of children with gastroenteritis and 1.8% (17 of 947) of children without gastroenteritis were positive for adenovirus group antigen. In tests for specific enteric adenovirus types, 2.0% (22 of 1,114) of the tests were positive in children with gastroenteritis and 0.6% (6 of 947) were positive in children without gastroenteritis. There was a significant correlation (P less than 0.02) of gastroenteritis with nonenteric adenovirus types (27 of 1,114) as well as with specific enteric adenovirus types (P less than 0.01). By comparison, 19.7% of children with gastroenteritis and 0.7% of those without gastroenteritis were positive for rotavirus infection. In the adenovirus-infected children with gastroenteritis, there were coinfections with rotavirus only in those with nonenteric adenovirus infection (7 of 27 children). There were no significant differences in the association of bacterial or parasitic infections with either enteric or nonenteric adenovirus infections in either group of children studied. These data demonstrate that Ad40 and Ad41 are causes of gastroenteritis in this population, but among the spectrum of diarrheal etiologies, they may be proportionately less important than they are in countries with temperate climates.
Adenoviridae Infections↗