Milk-borne diseases through the lens of one health.

Reviewing "zoonotic diseases" classically brings to mind human infections contracted in close association with animals, where outdoor occupations and afforested lands usually play a key role in the epidemiological triad. However, there is a very common, yet overlooked route of infection where humans may not come in direct contact with animals or implicated environments. Milk-borne diseases are a unique set of infections affecting all age groups and occupational categories of humans, causing 4% of all the foodborne diseases in the world. The infection reservoir may lie with milch animals and associated enzootic cycles, and the infectious agent is freely secreted into the animal's milk. Commercial pooling and processing of milk create unique environmental challenges, where lapses in quality control could introduce infective agents during downstream processing and distribution. The infectious agent is finally brought to the doorstep of both rural and urban households through such animal products. The domestic hygiene of the household finally determines human infections. One health approach can target preventive measures like immunization in animals, pasteurization and stringent quality control during the commercial processing of milk, and finally, hygienic practices at the level of the consumer, to reduce the burden of milk-borne diseases. This review hopes to draw the attention of policymakers to this unique route of infection, because it can be easily regulated with cost-effective interventions, to ensure the safety of this precious food product, permeating the life and livelihood of humans from all walks of life.

Antibiotic associated diarrhea due to Clostridioides difficile in a tertiary care teaching hospital, central India.

Background and Objectives: The misuse of antibiotics in recent years has led to an increase in antibiotic associated diarrheas (AAD). Out of several implicated pathogens, Clostridioides difficile is responsible for causing 15-25% of all cases of AAD. However, it has remained under diagnosed for a long time. The current study is planned to explore prevalence of C. difficile amongst AAD patients and to study clinical presentation and associated risk factors. Materials and Methods: Hospital based cross sectional study conducted in patients above 2 years of age. Diagnosis of C. difficile was done by two modalities i.e. glutamate dehydrogenase test followed by toxin detection using enzyme immunoassay and stool culture followed by toxin gene detection. Results: Twelve of 65 patients (18.4%) were positive for C. difficile. Maximum cases were found in younger age group. Abdominal pain and fever were most common complaints. 12 (18.4%) out of 65 study subjects were found to be positive by ELISA. 2/65 (3%) patients were positive for culture with presence of only tcdB gene. Ceftriaxone was the most commonly used antibiotic (25%). Conclusion: C. difficile is significant pathogen implicated in AAD with a prevalence rate of 18.4%. GDH antigen detection followed by Toxin A/B ELISA for C. difficile yielded better detection rate as compared to stool culture.