Aetiological Characteristics of Infectious Diarrhea in Yantai City, Shandong Province, China in 2017.

This study aimed to analyse the pathogenic spectrum and epidemiological characteristics of infectious diarrhea in Yantai City, Shandong Province, China and provide a reference for its prevention and control. A total of 713 stool specimens collected within 3 days of diarrhea onset from January to December 2017 at secondary or higher hospitals in Yantai City were tested for 10 causative pathogens, using real-time polymerase chain reaction (RT-PCR). The top two rotaviruses and norovirus were analysed for typing and geographical distribution. The total positive rate was 46.56% (332/713), and 268 of 713 specimens contained at least one pathogen; 64 had at least two pathogens, accounting for 19.28% of the positive specimens (64/332). The positivity rates of rotavirus (RV), norovirus (NoVs) GI, norovirus (NoVs) GII, enterovirus universal (EV), enteric adenoviruses (EAdV), sapovirus (SaV), astrovirus (Astv), Salmonella (SE), Listeria monocytogenes (LiMo), and Vibrio parahaemolyticus (VP) were 20.06% (143/713), 1.82% (13/713), 12.84% (89/713), 10.66% (76/713), 4.07% (29/713), 0.42% (3/713), 2.38% (17/713), 1.54% (11/713), 1.82% (13/713), and 1.54% (11/713), respectively. Infectious diarrhea showed a high prevalence in young children aged 1-5 years, accounting for 48.6% of the total number of cases. Bacterial diarrhea was predominant in summer, and viral diarrhea was distributed throughout the year, without a significant seasonal pattern. Rotavirus is dominated by G9P, accounting for 81.82%, while norovirus is dominated by the GII type and has diverse characteristics. The aetiology of infectious diarrhea in Yantai is mainly viral, with RV, NoVs, EV, EAdV, and Astv being the most frequent pathogens. Continuous surveillance of infectious diarrhea diseases can help us understand its epidemiological and pathogenic characteristics, thereby taking targeted preventive and control measures in different seasons.

Incidence and etiology of clinically-attended, antibiotic-treated diarrhea among children under five years of age in low- and middle-income countries: Evidence from the Global Enteric Multicenter Study.

Diarrhea is a leading cause of antibiotic consumption among children in low- and middle-income countries. While vaccines may prevent diarrhea infections for which children often receive antibiotics, the contribution of individual enteropathogens to antibiotic use is minimally understood. We used data from the Global Enteric Multicenter Study (GEMS) to estimate pathogen-specific incidence of antibiotic-treated diarrhea among children under five years old residing in six countries of sub-Saharan Africa and South Asia before rotavirus vaccine implementation. GEMS was an age-stratified, individually-matched case-control study. Stool specimens were obtained from children presenting to sentinel health clinics with newly-onset, acute diarrhea (including moderate-to-severe and less-severe diarrhea) as well as matched community controls without diarrhea. We used data from conventional and quantitative molecular diagnostic assays applied to stool specimens to estimate the proportion of antibiotic-treated diarrhea cases attributable to each pathogen. Antibiotics were administered or prescribed to 9,606 of 12,109 moderate-to-severe cases and 1,844 of 3,174 less-severe cases. Across all sites, incidence rates of clinically-attended, antibiotic-treated diarrhea were 12.2 (95% confidence interval: 9.0-17.8), 10.2 (7.4-13.9) and 1.9 (1.3-3.0) episodes per 100 child-years at risk at ages 6 weeks to 11 months, 12-23 months, and 24-59 months, respectively. Based on the recommendation for antibiotic treatment to be reserved for cases with dysentery, we estimated a ratio of 12.6 (8.6-20.8) inappropriately-treated diarrhea cases for each appropriately-treated case. Rotavirus, adenovirus serotypes 40/41, Shigella, sapovirus, Shiga toxin-producing Escherichia coli, and Cryptosporidium were the leading antibiotic-treated diarrhea etiologies. Rotavirus caused 29.2% (24.5-35.2%) of antibiotic-treated cases, including the largest share in both the first and second years of life. Shigella caused 14.9% (11.4-18.9%) of antibiotic-treated cases, and was the leading etiology at ages 24-59 months. Our findings should inform the prioritization of vaccines with the greatest potential to reduce antibiotic exposure among children.

Influence of early use of antimicrobial on the health and performance of Holstein calves in the first month of life / Influência do uso precoce de antimicrobiano na sanidade de bezerras holandesas no primeiro mês de vida

The early use of antimicrobial therapy has been introduced in many farms to prevent diarrhea and respiratory disease in young calves; however, there is controversy about whether this practice has a beneficial effect on the health of these animals. This study evaluated the influence of the early use of antimicrobials on the health and performance of neonatal Holstein calves. Twenty-six Holstein calves were screened and divided into two groups, according to the administration (ATB+), or not (ATB-) of tulathromycin (2.5mg/kg, subcutaneously) within the first 12 hours of life. Calves were evaluated by general clinical examination, fecal score, respiratory score, and external palpation of the umbilical region, besides fecal output of dry matter. Anemia was determined by using an automatic system and, also, using a commercial kit for iron dosage. Diarrhea was diagnosed by a centrifuge-flotation technique using a sugar solution (Cryptosporidium) and multiplex semi-nested RT-PCR (rotavirus/coronavirus). The performance of the calves was estimated by Daily Weight Gain (DWG). The young dairy calves were evaluated within 12 hours of birth (≤12h) and at 3-5th (D3-5), 7-9th (D7-9), 13-15th (D13-15), 20-23rd (D20-23), and 27-30th (D27-30) days of life. No difference was noted between the ATB+ and ATB- groups concerning heart rate, respiratory frequency, and rectal temperature. Erythrogram showed a higher frequency of anemia in ATB- group (P=0.016) at the D3-5 check-up; lower values of serum iron were also observed simultaneously (P=0.051). Thirteen cases of respiratory disease were detected during this study; however, no significant difference was observed between the groups in this regard. The frequency of diarrhea (fecal score 2-3) was high in both groups, peaking at D13-D15. No differences were noted between the groups regarding the frequency of diarrhea when considering the dry fecal matter. The predominant etiological agent for diarrhea was Cryptosporidium spp.. The DWG was similar between groups, with maximum weight reduction on D13-15. The administration of tulathromycin in prophylactic dose (2.5mg/kg) at birth decreased the frequency of anemia but did not influence weight gain or the prevalence of diarrhea.(AU)

O uso precoce de antimicrobianos tem sido adotado em muitas fazendas para profilaxia das diarreias e doença respiratória em bezerras, no entanto existem controvérsias sobre os beneficios desta prática na saúde desses animais. Esta pesquisa avaliou a influência do uso precoce de antimicrobiano na sanidade e desempenho de bezerras holandesas recém-nascidas. Para tanto foram selecionadas 26 bezerras Holandesas distribuídas de acordo com a aplicação (ATB+) ou não (ATB-) de tulatromicina (2,5mg/Kg) por via subcutânea até 12h de vida. As bezerras foram examinadas por meio de exame clínico geral, escore fecal, escore respiratório e palpação externa da região umbilical, além da matéria seca fecal. A presença de anemias foi determinada pelo eritrograma utilizando sistema automático e além da dosagem de ferro utilizando kit comercial. O diagnóstico etiológico das diarreias foi investigado por meio da técnica de flutuação em solução saturada de sacarose (Cryptosporidium) e multiplex semi-nested RT-PCR (rotavírus/coronavírus). O desempenho das bezerras foi estimado pelo ganho de peso. As bezerras foram avaliadas até doze horas após o nascimento (≤12h); 3-5º (D3-5); 7-9º (D7-9); 13-15º (D13-15); 20-23º (D20-23); e 27-30º dias de vida (D27-30). Não foram encontradas diferenças entre os grupos ATB+ e ATB- em relação à frequência cardíaca, frequência respiratória e temperatura retal. O eritrograma revelou maior frequência de anemias no grupo ATB- (P=0,016) no D3-5. Neste momento também foram observados menores valores de ferro sérico (P=0,051). Foram detectados treze casos de doença respiratória durante o estudo, no entanto não foi possível detectar diferença entre os grupos. A frequência de diarreias (escore fecal 2 e 3) foi alta em ambos os grupos, observando-se pico no D13-15 (ATB+=92,3%; ATB-=92,3%). Não observamos diferenças entre os grupos em relação a frequência de diarreia considerando-se a matéria seca fecal. O agente etiológico predominante nas diarreias foi o Cryptosporidium. O ganho de peso diário foi igual entre grupos, com intensa redução no GPD no D13-15. A administração de tulatromicina na dose profilática (2,5mg/Kg) ao nascimento diminuiu a frequência de anemias e não influenciou no ganho de peso e prevalência de diarreias.(AU)

Primary Immunodeficiency and the Gut.

This article presents the most common gastrointestinal, hepatic, and pancreatic manifestations of the primary immunodeficiency diseases, including the appropriate laboratory testing, endoscopic evaluation, and recommendations for further management.

Diarrea aguda infecciosa: ¿qué debe saber un gastroenterólogo?, ¿cómo mejoramos el diagnóstico etiológico? / Acute infectious diarrhea: what should a gastroenterologist know? how do we improve the etiological diagnosis?

Acute infectious diarrhea is still a major public health problem, both in developing and developed countries, causing morbidity, mortality and high costs. Acute diarrhea particularly affects people in extrema age ranges, travelers and immunosuppressed individuals. Traditional microbiological study, based on cultures, direct microscope analysis, and antigen tests show poor performance, due to low sensitivity and specificity, slowness and the diversity of bacteria, viruses and parasites that complicate getting the results. New molecular techniques based on multiple polymerase chain reaction (PCR) kits allow for the identification, in few hours and simultaneously, of many agents, such as bacteria, viruses and parasites, with high sensitivity and specificity; which will probably transform etiological diagnosis of acute diarrhea

La diarrea aguda infecciosa continúa siendo un problema de salud pública tanto en países en vías de desarrollo como en países desarrollados, causando morbi-mortalidad y grandes gastos económicos. Las diarreas agudas son especialmente importantes en personas con edades extremas, viajeros e inmunodeprimidos. El estudio microbiológico tradicional basado en cultivos, análisis microscópico directo y pruebas de antígenos tiene un rendimiento pobre, dado por su baja sensibilidad y especificidad, lentitud y la gran diversidad de bacterias, virus y parásitos que dificultan la obtención de resultados. Las nuevas técnicas de diagnóstico molecular basadas en kits de reacción de polimerasa en cadena (PCR) múltiple permiten identificar en pocas horas y en forma simultánea una gran cantidad de agentes, tanto bacterias, virus, como parásitos, con alta sensibilidad y especificidad, lo que probablemente transformará el diagnóstico etiológico de las diarreas agudas.

Diarrea crónica como manifestación inicial de un ganglioneuroblastoma / Chronic diarrhea as the initial manifestation of a ganglioneuroblastoma

Resumen: El neuroblastoma es un tumor maligno del sistema nervioso simpático periférico con presentación y curso clínico heterogéneo. Es el tercer tumor pediátrico más frecuente y el 90% de los casos se diagnostica antes de los 5 años. Los síntomas más comunes se deben a la compresión por la masa tumoral o al dolor óseo causado por la metástasis. La diarrea como síntoma principal es rara por lo que es difícil de diagnosticar en la etapa temprana de la enfermedad. Se presenta el caso clínico de una paciente de 2 años en la que luego de 8 meses de estudio por diarrea crónica se diagnóstica ganglioneuroblastoma secretor de VIP. Se debe plantear como diagnóstico diferencial en los pacientes menores de 3 años con diarrea crónica intratable luego de haber descartado otras etiologías.

Summary: Neuroblastoma is a malignant tumor of the peripheral sympathetic nervous system with heterogeneous clinical presentation and course. It is the third most frequent pediatric tumor and in 90% of cases it is diagnosed before 5 years of age. The most typical symptoms result from the tumor compression or bone pain caused by methastasis. Diarrhea as the main symptom is unusual, and thus it is hard to diagnose in early stages of the disease. We report the case of a 2-year-old patient who, after 8 months of study for chronic diarrhea was diagnosed with VIP-secreting ganglioneuroblastoma. It is necessary for this condition to be considered as a differential diagnosis in patients younger than 3 years old with chronic diarrhea with no evolution, after other etiologies are ruled out.

Campylobacter spp como causa de disentería: opciones diagnósticas: A propósito de dos casos clínicos / Campylobacter spp as a cause of dysentery: diagnostic options: Presentation of two clinical cases

En los últimos años se ha observado un aumento en la incidencia de Campylobacter spp (CSSP) como agente de diarrea, enteritis y disentería. Constituye una zoonosis así como una enfermedad trasmitida por alimentos. El diagnóstico de GEA por CSPP se realiza por identificación del agente etiológico en las heces del paciente. El objetivo de la siguiente observación es presentar dos casos clínicos de GEA en niños con diagnóstico etiológico de colitis causada probablemente por Campylobacter spp mediante la utilización de examen directo de materia fecal. El cultivo de la bacteria es el gold standard; en Uruguay sólo está disponible con fines de investigación. El método más fácil de poner en práctica en los laboratorios clínicos es la tinción y observación directa con un Gram modificado el cual sumado a la clínica, permite un diagnóstico con alto grado de presunción. En ambos pacientes el resultado motivó la instauración de un tratamiento antibiótico específico que determinó una buena evolución.

In recent years an increase in the incidence of Campylobacter spp (CSSP) as the agent of diarrhea, enteritis and dysentery was observed. It constitutes a zoonosis, as well as a food transmitted disease. Diagnosis of acute gastroenteritis by CSPP is done by identifying the etiological agent on the patients’ feces. The objective of the following observation is to present two clinical cases of acute gastroenteritis in children with an etiological diagnosis of colitis, probably caused by Campylobacter spp by means of a direct study of the stool. Culture of the bacteria is the gold standard, although in Uruguay it is only available for research purposes. The easiest method to put into practice in the clinical laboratories is staining and the direct observation with a modified Gram, which, together with the clinical examination, enables diagnosis with a high degree of presumption. In both patients, the result caused the adoption of a specific antibiotic, which determined a good evolution.

Efecto de la combinación de bases nutritivas con el inhibidor sobre la recuperación de salmonelas / Effect of combining nutrient bases and inhibitor on recovery of Salmonella

INTRODUCCIÓN: las salmonelas son las causantes más frecuentes de enfermedades transmitidas por alimentos a nivel mundial. El caldo selenito cistina es un medio de enriquecimiento selectivo utilizado para la recuperación de especies de salmonelas en muestras de alimentos, aguas, heces y otros materiales de importancia sanitaria. OBJETIVO: evaluar la combinación de bases nutritivas obtenidas por métodos originales con el selenito de sodio para garantizar la adecuada recuperación de especies de salmonelas en el caldo selenito cistina. MÉTODOS: se realizó un estudio comparativo con diferentes bases nutritivas, que evaluó la promoción de crecimiento bacteriano de seis cepas de Salmonella y Shigella. Se prepararon dos variantes y se inocularon los microorganismos seleccionados a una concentración aproximada de 3 × 108 unidades formadoras de colonia por mililitro. El incremento de la biomasa se determinó a través de la medición de la absorbancia en un espectrofotómetro a 640 nanómetros cada una hora. Se comparó el comportamiento del medio caldo selenito cistina formulado por ingredientes con el caldo selenito cistina de Merck frente a los microorganismos de interés. Se determinó productividad y selectividad del medio de cultivo. RESULTADOS: la variante que contiene la mezcla de bases nutritivas (peptona bacteriológica Z, peptona de soya e hidrolizado enzimático de caseína) facilitó una mejor recuperación de las cepas ensayadas, mostró diferencias significativas (p< 0,05) con respecto a la variante que contiene solo hidrolizado enzimático de caseína. El medio experimental que contenía la mezcla de bases nutritivas con el selenito de sodio, mostró una recuperación de Salmonella a bajas concentraciones, similar al de referencia e inhibió mejor Escherichia coli a bajas concentraciones. A altas concentraciones ninguno de los dos medios pudo inhibir el crecimiento de E. coli. La productividad para ambos medios, resultó satisfactoria en el intervalo de 0,1 a 1, al igual que la selectividad con un valor aproximado de 3. CONCLUSIONES: la combinación de bases nutritivas originales con el selenito de sodio permitió una adecuada recuperación de las especies de salmonelas.

INTRODUCTION: Salmonella are the most common causes of food-borne disease worldwide. Selenite cystine broth is a selective enrichment medium used for the recovery of Salmonella species in samples of food, water, feces and other materials of clinical importance. OBJECTIVE: Evaluate the combination of nutrition bases obtained by original methods and sodium selenite to ensure appropriate recovery of Salmonella species in selenite cystine broth. METHODS: A comparative study was conducted with various nutrition bases to evaluate the fostering of bacterial growth in six strains of Salmonella and Shigella. Two variants were prepared and the microorganisms selected were inoculated at an approximate concentration of 3 × 108 colony-forming units per milliliter. Absorbance was measured with a 640 nanometer spectrophotometer every hour to determine biomass increase. Behavior of the selenite cystine broth medium formulated by ingredients was compared with that of Merck cystine selenite broth in the presence of the microorganisms of interest. Determination was performed of the productivity and selectivity of the culture medium. RESULTS: The variant containing the mixture of nutrient bases (bacteriological peptone Z, soybean peptone and casein enzymatic hydrolysate) facilitated better recovery of the strains tested, with significant differences (p< 0.05) with respect to the variant containing casein enzymatic hydrolysate alone. The experimental medium containing the mixture of nutrient bases and sodium selenite displayed Salmonella recovery at low concentrations in a manner similar to the reference medium and inhibited Escherichia coli more efficiently at low concentrations. At high concentrations neither medium was able to inhibit the growth of E. coli. Productivity was satisfactory in both media, ranging between 0.1 and 1, and so was selectivity, which reached an approximate value of 3. CONCLUSIONS: The combination of original nutrition bases and sodium selenite allowed appropriate recovery of Salmonella species.

[Bloody diarrhoea - causes, diagnostics and therapy]. / Blutige Diarrhoe - Ätiologie, Diagnostik und Therapie.

Bloody diarrhoea is always a warning sign and should prompt a more thorough history on duration and accompanying symptoms as well as current medications (antibiotics, NSAR) and diseases (HIV, IBD, transplant organ recipients). In this review the most common bacterial, viral and parasitical causes of bloody diarrhoea as well as radiation and ischemic colitis will be discussed. Additionally important diagnostic tools such as stool cultures and calprotectin for infectious causes auf diarrhoea and imaging tools (CT and endoscopy) for ischemic disease are presented. The causes of bloody diarroea in immunosuppressed patients and IBD are additionally addressed.

Atypical clinical course of antineutrophil cytoplasmic autoantibodies-associated vasculitis.

We report a 16-year-old previously healthy boy who was admitted to hospital with fever, constitutional symptoms, purpura, additive arthritis, dysentery, rapid progressive renal failure, resembling Henoch- Schuenlein purpura, accompanied with retropharyngeal abscess. Kidney biopsy revealed rapid progressive glomerulonephritis with crescent formation, without immune deposition in immune fluorescent study. Serologic study revealed positive proteinase antineutrophil cytoplasmic antibody (ANCA). Intravenous methyl prednisolone plus and cyclophosphamide pulse were administered with a diagnosis of ANCA-associated vasculitis. Serum creatinine level reduced during the treatment and the patients was discharged with good clinical condition. This was the first case in which the ANCA-associated vasculitis was presented with retropharyngeal abscess. Other unusual findings were bloody diarrhea, raised purpura, and additive arthritis in an adolescence, which are more characteristic for Henoch-Schuenlein purpura.

Etiología bacteriana de la diarrea aguda en pacientes pediátricos / Bacterial etiology of acute diarrhea in pediatric patients

La diarrea aguda es una causa importante de morbilidad y mortalidad en países en desarrollo. Sólo requiere tratamiento antimicrobiano en situaciones puntuales y el uso adecuado de los mismos depende del conocimiento previo de la epidemiología local. Para conocer estos parámetros se estudiaron en forma retrospectiva los resultados bacteriológicos de 7.075 muestras de materia fecal de niños ambulatorios hasta 15 años, en el período 2001-2003, atendidos en el Hospital de Niños de La Plata. Se aislaron 1.221 bacterias enteropatógenas (17,26%). Los patógenos identificados por métodos estándar fueron: Shigella flexneri(27%), Shigella sonnei(21,2%), Campylobacterspp. (30,1%), Aeromonas spp.(9,4%), Salmonella spp. (5,4%), Escheríchia coli enteropatógena (5,7%), Escheríchia coli enteroinvasiva (0,9%) y Escheríchia coliO157 (0,4%). No se aislaron cepas de Shigella dysenteriae, Shigella boydii ni Yersinia spp. Las cepas de Shigella flexneri presentaron una alta resistencia: ampicilina (92,4%, 89,2% y 91,9%), cotrimoxazol (51,5%, 50% y 44,4%) y cloranfenicol (73,8%, 85,9% y 79,2%) en 2001, 2002 y 2003, respectivamente. En el caso de Shigella sonnei, la resistencia a ampicilina fue menor (39,4%, 20,6% y 12,9%), la resistencia a cotrimoxazol fue similar (60,6%, 54,3% y 38,7%) y para cloranfenicol mucho menor aún (6%, 2,9% y 3,3%) en los mismos años. No se aislaron cepas resistentes a ciprofloxacina, nitrofuranos ni cefalosporinas de tercera generación en el período de estudio.

Acute diarrhea is an important cause of morbidity and mortality in developing countries, and in some cases, it requires antimicrobial therapy .The use of antibiotics needs a previous knowledge of local epidemiology. In order to know these parameters, the result of enteropathogenic bacteria isolated from 7.075 fecal samples from ambulatory patients up to 15 years old, assisted at the Hospital de Niños de La Plata from 2001 to 2003 was retrospectively studied. A total of 1,221 enteropathogenic bacteria were isolated (17.26%). The pathogens identified by standard methods were Shigella flexneri (27%), Shigella sonnei (21.2%), Campylobacter spp.(30.1%), Aeromonas spp.(9.4%), Salmonella spp. (5.4%), enteropathogenic Escherichia coli ( 5.7% ), enteroinvasive Escherichia coli (0.9%) and Escherichia coli 0157 (0.4%). Strains from Shigella dysenteriae, Shigella boydii and Yersinia spp were not isolated in this study. Shigella flexneri strains were resistant to ampicillin (92.4%, 89.2%, 91.9%), cotrimoxazole (51.5%, 50%, 44%) and chloramphenicol (73.8%, 85.9%, 79.2%) for 2001, 2002 and 2003 respectively. Shigella sonnei strains were resistant to ampicillin (39.4%, 20.6%,12.9%), cotrimoxazole (60.6%, 54.3% 38.7%) and chloramphenicol (6%, 2.9%, 3.3%) for each year. Strains resistant to ciprofloxacin, nitrofurans and third generation cephalosporins were not isolated.

The public health significance of Trichuris trichiura.

An estimated 1049 million persons harbour T. trichiura, including 114 million preschool-age children and 233 million school-age children. The prevalence of T. trichiura is high and may reach 95% in children in many parts of the world where protein energy malnutrition and anaemias are also prevalent and access to medical care and educational opportunities is often limited. The Trichuris dysentery syndrome (TDS) associated with heavy T. trichiura, which includes chronic dysentery, rectal prolapse, anaemia, poor growth, and clubbing of the fingers constitutes an important public health problem, as do lighter but still heavy infections, even if not strictly TDS, especially in children. The profound growth stunting in TDS can be reversed by repeated treatment for the infection and, initially, oral iron. However findings from Jamaica strongly suggest that the significant developmental and cognitive deficits seen are unlikely to disappear without increasing the positive psychological stimulation in the child's environment. The severe stunting in TDS now appears likely to be a reaction at least in part to a chronic inflammatory response and concomitant decreases in plasma insulin-like growth factor-1 (IGF-1), increases in tumor necrosis factor-alpha (TNF-alpha) in the lamina propria of the colonic mucosa and peripheral blood (which likely decrease appetite and intake of all nutrients) and a decrease in collagen synthesis. Improvements in cognitive performance have been found after treatment for relatively heavy infections (without chronic dysentery) in school-going children; it is unclear precisely how much T. trichiura interferes with children's ability to access educational opportunities, but treatment of infections whenever possible is obviously sensible. The blood loss that can occur in T. trichiura infection is likely to contribute to anaemia, particularly if the child also harbours hookworm, malaria and/or has a low intake of dietary iron. Community control is important, particularly for the individuals within a population who harbour heavy worm burdens; this means children, with special attention to girls who will experience increased iron requirements and blood loss due to menstruation, pregnancies, and lactation. Mebendazole and albendazole, both of which are on the WHO Essential Drugs List, are very effective against T. trichiura; multiple doses are needed to attain complete parasitological cure in all cases. However the goal of control programmes in endemic areas is morbidity reduction, which follows when intensity of infection is significantly reduced.

Pathogenicity of Serpulina hyodysenteriae: in vivo induction of tumor necrosis factor and interleukin-6 by a serpulinal butanol/water extract (endotoxin).

Lipopolysaccharide (LPS) of Gram-negative bacteria is a classic inducer of inflammatory cytokines. In the present experiments, LPS-like (phenol/water extract) or endotoxin-like (butanol/water extract) preparations from Serpulina hyodysenteriae were examined for their ability to induce serum tumor necrosis factor (TNF) or interleukin (IL)-6 bioactivity in mice and swine. Serpulina hyodysenteriae endotoxin (butanol/water extract) elicited increased serum TNF activity in mice, although serpulinal endotoxin was at least 10 times less potent than the LPS preparations of E. coli or S. typhimurium on a weight basis for induction of TNF bioactivity. S. hyodysenteriae LPS induced lower levels of serum TNF in mice than S. hyodysenteriae endotoxin. In contrast, pigs injected with S. hyodysenteriae endotoxin demonstrated no increase in serum TNF activity. However, an induction of IL-6 bioactivity was observed in serum samples from pigs injected with serpulinal endotoxin. In pigs, the serpulinal preparations were five times less potent (on a weight basis) than E. coli or S. typhimurium LPS for induction of IL-6 bioactivity. These data indicate that serpulinal endotoxin, although less bioactive than E. coli or S. typhimurium LPS, is nonetheless capable of inducing the in vivo production of specific pro-inflammatory cytokines.

The incidence of swine dysentery in pigs can be reduced by feeding diets that limit the amount of fermentable substrate entering the large intestine.

Two experiments were conducted to test the hypothesis that feeding diets which limit the amount of fermentable substrate entering the large intestine would protect pigs against experimental infection with Serpulina hyodysenteriae, the causative agent of swine dysentery. Experiment 1 examined the effect of grain processing (hammer milling vs. steam flaking) and grain type (barley, groats, corn, sorghum and wheat) on indices of fermentation in the large intestine and the incidence of swine dysentery. Experiment 2 examined the role of five diets, steam-flaked corn, steam-flaked sorghum, hammer-milled wheat, extruded wheat and cooked white rice, on these same measures. All diets contained an animal protein supplement and no antibiotics. Pigs fed diets based on steam-flaked corn and steam-flaked sorghum had a lower incidence of disease (11-33%) than pigs fed diets based on other grains (75-100%). Pigs fed the diet based on cooked white rice were fully protected against swine dysentery. Both the soluble non-starch polysaccharide (NSP) concentration and the total NSP concentration of the diets explained a significant proportion of the variation in swine dysentery (R2 = 0.56, P = 0.016, and R2 = 0.71, P = 0.002, respectively), such that pigs eating diets containing <1.0 g/100 g soluble NSP showed reduced disease. However, pigs fed corn, sorghum and steam-flaked sorghum (Experiment 2), which contained only 0.4-0.5 g/100 g soluble NSP, still had a high incidence of disease (>50%). This was attributable to a higher level of resistant starch present in these grains. These data provide evidence that the expression of swine dysentery is associated with an increased concentration of fermentable substrate entering the large intestine.