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Presentación del caso. Paciente femenina de 13 años de edad, sin comórbidos conocidos quien consultó con historia de diez días de presentar fiebre con escalofríos, diarreas líquidas cuatro veces al día y vómitos, fue tratada con acetaminofén. Cuatro días antes de consultar, la paciente había presentado adinamia, confusión y dificultad a la deambulación por lo que fue llevada por su madre a un establecimiento de salud. Intervención terapéutica. Inició la atención en un hospital de segundo nivel, fue ingresada por sospecha de salmonelosis, encefalitis, desequilibrio hidroelectrolítico, lesión renal aguda y gastroenteritis aguda con deshidratación grave. Fue tratada con hidratación parenteral y antibióticos, y se remitió a un hospital de tercer nivel, por presentar distrés respiratorio con necesidad de ventilación mecánica, ahí se obtiene un hemocultivo positivo a Salmonella typhi. Evolución clínica. La paciente presentó síndrome de respuesta inflamatoria sistémica por sepsis que fue manejada con aminas vasoactivas; el décimo sexto día de hospitalización la paciente presentó taquicardia y fiebre, se obtuvo un hemocultivo positivo a Acinetobacter baumannii multirresistente. Presentó miocarditis, deterioro neurológico con Glasgow de8puntos, desarrolló falla multisistémica y falleció con 32 días de estancia hospitalaria

Case presentation. A 13-year-old female patient with no known comorbidities consulted with a ten-day history of fever with chills, diarrhea four times a day and vomiting, treated with acetaminophen. Four days before consulting, the patient experienced adynamia, confusion and difficulty walking. She was taken by her mother to a health facility. Treatment. She was admitted to a second level hospital for suspected salmonellosis, encephalitis, water and electrolyte imbalance, acute renal injury and acute gastroenteritis with severe dehydration. She was treated with parenteral hydration and antibiotics, and was referred to a tertiary hospital for respiratory distress with need for mechanical ventilation, where a positive blood culture for Salmonella typhi was obtained. Outcome. The patient presented systemic inflammatory response syndrome due to sepsis that was managed with vasoactive amines; on the sixteenth day of hospitalization the patient presented tachycardia and fever, a blood culture positive for multidrug-resistant Acinetobacter baumannii was obtained. She presented myocarditis, neurological deterioration with a Glasgow score of 8, developed multisystemic failure and died after 32 days of hospital stay.

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Objetivo: apresentar o panorama epidemiológico das hospitalizações por diarreia aguda em Mato Grosso.Método: estudo ecológico e quantitativo, selecionando dados de pacientes hospitalizados por diarreia aguda em Mato Grosso, Brasil, entre 2014 e 2023. As associações categóricas bivariadas foram obtidas pela razão de prevalência, intervalo de confiança 95% e p<0,05, pelo teste x2de Mantel-Haenszel.Resultados: prevaleceu o sexo feminino (50,8%), faixa etária de 1 a 4 anos (18,6%), raça/cor parda (60,4%), residentes da macrorregião centro-norte (26,1%) e com diagnósticos sensíveis a Atenção Primária à Saúde (93,6%). Houve associação entre tempo de internação > 7 dias e óbito como desfecho (p=0,0005). Tempo de internação > 7 dias relacionou com faixa etária < 5 e ≥ 80 anos (p=0,0009), raça/cor parda(p=0,0001)e macrorregião centro-norte (p=<0,0001). Conclusão: as variáveis faixa etária, a raça/cor e região de residência associaram às hospitalizações em Mato Grosso, assim como maior tempo de hospitalização e óbito.

Objective:presenting the epidemiological panorama of hospitalizations for acute diarrhea in Mato Grosso. Method: ecological and quantitative study, selecting data from patients hospitalized for acute diarrhea in Mato Grosso, Brazil, between 2014 and 2023. Bivariate categorical associations were obtained by the prevalence ratio, 95% confidence interval and p<0.05, using the Mantel-Haenszel x2 test. Results:female gender prevailed (50.8%), age group from 1 to 4 years (18.6%), brown race/color (60.4%), residents of the central-north macroregion (26.1%) and with diagnoses sensitive to Primary Health Care (93.6%). There was an association between length of hospital stay > 7 days and death as an outcome (p=0.0005). Length of hospital stay > 7 days was related to age group < 5 and ≥ 80 years (p=0.0009), brown race/color (p=0.0001) and central-north macroregion (p=<0.0001). Conclusion: hospitalizations for acute diarrhea are more prevalent in females, aged between 1 and 4 years, mixed race/color and in the central-north macro-region.There was an association between prolonged hospital stay and death as an outcome.

Objetivo:presentar el panorama epidemiológico de las hospitalizaciones por diarrea aguda en Mato Grosso. Método:estudio ecológico y cuantitativo, seleccionando datos de pacientes hospitalizados por diarrea aguda en Mato Grosso, Brasil, entre 2014 y 2023. Seobtuvieron asociaciones categóricas bivariadas mediante la razón de prevalencia, el intervalo de confianza del 95% y p<0,05, utilizando la prueba x2 de Mantel-Haenszel. Resultados:predominarem el sexo femenino (50,8%), edades entre 1 y 4 años (18,6%), mestizo (60,4%), residentes en la macrorregión centro-norte (26,1%) y con diagnósticos sensibles a la Atención Primaria de Salud (93,6%). %). Hubo asociación entre la duración de la estancia > 7 días y la muerte como resultado (p=0,0005). La duración de la estancia hospitalaria > 7 días estuvo relacionada con el grupo de edad < 5 y ≥ 80 años (p=0,0009), raza/color marrón (p=0,0001) y macrorregión centro-norte (p=<0,0001). Conclusión:las hospitalizaciones por diarrea aguda son más prevalentes en el sexo femenino, edades entre 1 y 4 años, mestizas y macrorregión centro-norte. Se asociaron estancia hospitalaria prolongada y muerte.

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Una de las enfermedades más comunes es la diarrea. Se presenta una visión general de la epidemiología, el manejo y los tratamientos actuales para la diarrea aguda, así como una revisión de los patógenos más importantes. Después de una descripción de los principios generales del tratamiento de la diarrea, se describen las infecciones gastrointestinales bacterianas más importantes en términos de terapia antimicrobiana dirigida, incluyendo salmonelosis, shigelosis, Campylobacter, así como infecciones por Escherichia coli, yersiniosis y cólera. Ha habido un aumento en la incidencia y gravedad de la diarrea causada por cepas toxigénicas de Clostridium difficile. Por lo tanto, se describirán en detalle nuevos aspectos del tratamiento para estas infecciones. Sigue siendo importante tratar la diarrea infecciosa con terapia sintomática. Los pacientes con enfermedades graves, como alta frecuencia de deposiciones, fiebre, diarrea sanguinolenta, deficiencias inmunitarias subyacentes, edad avanzada o comorbilidades significativas pueden beneficiarse de la terapia antibiótica empírica. La resistencia a las fluoroquinolonas está en aumento, en particular. Las infecciones causadas por E. coli productora de toxina Shiga (STEC), las infecciones por C. difficile (CDI) y la colitis grave no deben tratarse con inhibidores de la motilidad. La recurrencia de CDI puede reducirse con fidaxomicina, un antibiótico macrocíclico. Además, cada vez hay más pruebas de que el trasplante de microbiota fecal es una opción de tratamiento eficaz para las recurrencias múltiples de CDI. Como resultado, la diarrea aguda todavía se trata principalmente con medidas de apoyo. No hay evidencia científica que respalde la prescripción de antibióticos para la diarrea aguda

One of the most common diseases is diarrhea. An overview of epidemiology, management, and current treatments for acute diarrhea is presented, as well as a review of the most important pathogens. Following a description of the general principles of diarrhea therapy, the most important bacterial gastrointestinal infections are described in terms of targeted antimicrobial therapy, including Salmonellosis, Shigellosis, Campylobacter, as well as Escherichia coli, Yersiniosis, and Cholera infections. There has been an increase in the incidence and severity of diarrhea caused by toxigenic Clostridium difficile strains. Therefore, new aspects of treatment will be described in detail for these infections. It is still important to treat infectious diarrhea with symptomatic therapy. Patients with severe illness, such as high frequency of stools, fever, bloody diarrhea, underlying immune deficiencies, advanced age, or significant comorbidities, may benefit from empirical antibiotic therapy. Resistance to fluoroquinolones is on the rise, in particular. Infections caused by Shiga toxin-producing E. coli (STEC), C. difficile infections (CDI), and severe Colitis should not be treated with motility inhibitors. CDI recurrence can be reduced by fidaxomicin, a macrocyclic antibiotic. Additionally, there is increasing evidence that fecal microbiota transplantation is a successful treatment option for multiple recurrences of CDI. As a result, acute diarrhea is still primarily treated with supportive measures. It is not evidence-based to prescribe antibiotics for acute diarrhea

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Cryptosporidium spp. es un protozoario productor de diarrea. Los pacientes inmunocomprometidos pueden desarrollar formas clínicas graves y persistentes. Se describen las características de pacientes con enfermedad de base asociada a inmunosupresión (EAI) con infección por Cryptosporidium spp. (IC) atendidos en un hospital pediátrico referencial de Argentina entre los años 2018 y 2023. Se analizaron datos demográficos, EAI, características de la diarrea y coinfecciones. Se incluyeron 30 pacientes con EAI e IC. La mayoría registró trasplante de órgano sólido, neoplasia hematológica e inmunodeficiencia primaria. Dieciocho presentaron diarrea persistente al momento del diagnóstico. Seis pacientes registraron coinfecciones. Se debe considerar la criptosporidiosis en el diagnóstico diferencial de enfermedad diarreica aguda o persistente en niños con distintos tipos de EAI, como el trasplante de órgano sólido, neoplasias hematológicas e inmunodeficiencias primarias.

Cryptosporidium spp. is a diarrhea-causing protozoan. Immunocompromised patients may develop severe and persistent clinical forms. Here we describe the characteristics of patients with an underlying disease associated with immunosuppression (DAI) and Cryptosporidium spp. infection seen at a referral children's hospital in Argentina between 2018 and 2023. Demographic data, DAI, diarrhea characteristics, and co-infections were analyzed. A total of 30 patients with DAI and cryptosporidiosis were included. Most of them had undergone a solid organ transplant, had a hematologic neoplasm, or primary immunodeficiency. Persistent diarrhea was observed in 18 patients at the time of diagnosis. Co-infections were recorded in 6 patients. Cryptosporidiosis should be considered in the differential diagnosis of acute or persistent diarrhea in children with different types of DAI, such as solid organ transplant, hematologic neoplasms, and primary immunodeficiencies.

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Los postbióticos fueron definidos en 2021 por la Asociación Científica Internacional de Probióticos y Prebióticos (ISAPP) como "una preparación de microorganismos inanimados y/o sus componentes celulares capaces de conferir un efecto benéfico al hospedador". El campo de los postbióticos es un área nueva dentro de la familia de los bióticos; se han desarrollado ya numerosos productos con aplicaciones clínicas, como la estimulación inmunológica, el manejo de diarreas en niños y adultos, el abordaje del intestino irritable, además de tres fórmulas infantiles. En particular, las fórmulas infantiles con postbióticos obtenidos a partir de la fermentación de la leche con Bifidobacterium breve C50 y Streptococcus thermophilus O65, y sus metabolitos, incluido el oligosacárido 3'-GL, han demostrado seguridad y contribución al desarrollo de la microbiota intestinal y el sistema inmune asociado al intestino. Estas modificaciones contribuyen a la prevención y el manejo de los trastornos funcionales digestivos del lactante.

Postbiotics were defined in 2021 by the International Scientific Association for Probiotics and Prebiotics (ISAPP) as a "preparation of inanimate microorganisms and/or their cellular components that confers a health benefit to the host." The field of postbiotics is a new area within the biotics family; numerous products have already been developed for clinical applications, such as immune stimulation, the management of diarrhea in children and adults, the management of irritable bowel syndrome, and 3 infant formulas. In particular, infant formulas with postbiotics obtained from milk fermented with Bifidobacterium breve C50 and Streptococcus thermophilus O65 ­and their metabolites­, including the oligosaccharide 3'-GL, have demonstrated to be safe and to contribute to the development of the gut microbiota and the gutassociated immune system. These modifications help to prevent and manage functional gastrointestinal disorders in infants.

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Introducción: uno de los síndromes clínicos más comunes que afectan a los viajeros es la diarrea de los viajeros (TD). El propósito de esta revisión narrativa es proporcionar una visión general de los descubrimientos clave relacionados con TD en los últimos dos años, junto con una lista de futuros temas de investigación. Métodos: Se realizó una búsqueda de PubMed para ubicar nuevos datos en la investigación de TD publicada entre 2019 y 2023 en comparación con algunos informes publicados entre 2000 y 2018. También se consideró la contribución a la epidemiología, la etiología, el diagnóstico, el manejo y las consecuencias a largo plazo, junto con Salud pública, descubrimiento y práctica clínica. Resultados: Se encontraron un total de 218 artículos durante la búsqueda inicial en la literatura. Obtuvimos 107 y examinamos 84 artículos para su posible inclusión. A pesar de este descubrimiento, todavía existe un riesgo moderado de TD entre los estudiantes y los viajeros militares, y sigue siendo difícil controlar la comida y el agua en grandes reuniones. El aumento en las pruebas independientes del cultivo ha resultado en la identificación continua de patógenos que se conocían anteriormente, así como una mayor frecuencia de detección del norovirus. Las tasas de resistencia a las fluoroquinolonas están aumentando constantemente debido a la escalada de infecciones multipatógeno. Esto requiere considerar la información clínica, epidemiológica y de diagnóstico. Es cada vez más claro que los antibióticos no absorbibles pueden ofrecer una alternativa a las recomendaciones actuales (como azitromicina y fluoroquinolonas). Sin embargo, no se les aconseja la diarrea febril, la disentería o en las regiones/itinerarios donde es probable que los patógenos invasivos causen enfermedades. Investigaciones recientes han explorado la conexión entre el microbioma y la prevención y las consecuencias de la TD. Aunque se han identificado características distintas, todavía existe un nivel significativo de incertidumbre. La adquisición y el transporte de enterobacteriaceae (ESBL-PE) de beta-lactamasa de espectro extendido están en aumento. Por último, la investigación en curso respalda las consecuencias posteriores a la infecciosidad, mientras que se necesita más investigación para comprender los mecanismos detrás de la artritis reactiva y el SII post-infeccioso. Conclusión: El tema de TD sigue siendo un importante problema de salud del viaje en todo el mundo a medida que continuamos aprendiendo más al respecto. Se necesita más investigación para mitigar los factores de riesgo asociados con el uso de antibióticos y sus consecuencias asociadas.

Introduction: One of the most common clinical syndromes a ecting travelers is travelers' diarrhea (TD). The purpose of this narrative review is to provide an overview of the key discoveries related to TD over the past two years, along with a list of future research topics. Methods: A PubMed search was conducted to locate new data in TD research published between 2019 and 2023 compared with some reports published between 2000 - 2018. Contribution to epidemiolo-gy, etiology, diagnostics, management, and long-term consequences was also considered, along with public health, discovery, and clinical practice. Results: A total of 218 articles were found during the initial search in the literature. We obtained 107 and examined 84 articles for potential inclusion. Despite this discovery, there is still a moderate risk of TD among students and military travelers, and it remains challenging to control food and water in large gatherings. The rise in culture-independent testing has resulted in the continuous identi cation of patho-gens that were previously known, as well as a higher frequency of detecting norovirus. The resistance rates to uoroquinolones are consistently increasing due to the escalation of multipathogen infections. This necessitates considering clinical, epidemiological, and diagnostic information. It is increasingly clear that non-absorbable antibiotics may o er an alternative to current recommendations (such as azithromycin and uoroquinolones). However, they are not advised for febrile diarrhea, dysentery, or in regions/itin-eraries where invasive pathogens are likely to cause illness. Recent research has explored the connection between the microbiome and the prevention and consequences of TD. Although distinct characteristics have been identi ed, there is still a signi cant level of uncertainty. The acquisition and carriage of extend-ed-spectrum beta-lactamase­producing Enterobacteriaceae (ESBL-PE) are on the rise. Lastly, ongoing research supports the post-infectious consequences, while further investigation is needed to understand the mechanisms behind reactive arthritis and post-infectious IBS. Conclusion: The issue of TD remains an important travel health issue across the globe as we continue to learn more about it. More research is needed to mitigate risk factors associated with antibiotic use and its associated consequences.

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Introducción. Los datos de frecuencia de los adenovirus entéricos, sapovirus y astrovirus en casos de gastroenteritis aguda esporádica en Argentina son escasos. Métodos. Diseño descriptivo sobre una selección de muestras de heces de menores de 5 años con diarrea remitidas durante el período 2010-2021, con resultado previo negativo para rotavirus y norovirus. Se estudió la presencia de adenovirus entéricos, sapovirus y astrovirus por métodos moleculares, con posterior genotipificación de las muestras positivas. Resultados. De 574 muestras seleccionadas, en 226 (39,4 %) se identificó al menos uno de los virus estudiados. En particular, se detectaron adenovirus, sapovirus y astrovirus en el 30,7 %, el 5,6 % y el 3,1 %, respectivamente. El adenovirus 41, los sapovirus GI.1 y GI.2, y el astrovirus 1 fueron los más frecuentemente detectados. Se identificaron dos muestras con astrovirus no clásicos. Conclusiones. A pesar de ser menos frecuentes, estos enteropatógenos son responsables de un número considerable de episodios de diarrea esporádica. Por lo tanto, su estudio y vigilancia contribuye significativamente a reducir la brecha de casos no diagnosticados.

Introduction. Data on the frequency of enteric adenoviruses, sapoviruses, and astroviruses in cases of sporadic acute gastroenteritis in Argentina are scarce. Methods. Descriptive design of a selection of fecal samples of children with diarrhea younger than 5 years referred between 2010 and 2021, with a previous negative result for rotavirus and norovirus. The presence of enteric adenovirus, sapovirus, and astrovirus was tested by molecular methods, with subsequent genotyping of positive samples. Results. At least 1 of the tested viruses was detected in 226 (39.4%) of the 574 selected samples. Specifically, adenovirus, sapovirus, and astrovirus were detected in 30.7%, 5.6%, and 3.1% of the samples, respectively. The most frequent viruses detected were adenovirus 41, sapoviruses GI.1 and GI.2, and astrovirus 1. Non-classic astroviruses were detected in 2 samples. Conclusions. Despite being less frequent, these enteropathogens are responsible for a large number of sporadic diarrhea events. Therefore, their study and surveillance contribute significantly to reduce the gap of undiagnosed cases.

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La clorhidrorrea congénita es un trastorno genético infrecuente pero importante caracterizado por una alteración grave del balance hidroelectrolítico como resultado de un defecto en la absorción intestinal de cloruros. Los niños afectados presentan diarrea persistente, deshidratación y malnutrición; el control médico y del desarrollo son complejos. Mejorar la detección prenatal es esencial para facilitar la atención del paciente, las intervenciones tempranas y el asesoramiento genético informado. Sin embargo, a pesar de los avances de la medicina, la naturaleza compleja y la escasa frecuencia de esta entidad, constituyen un desafío para la detección prenatal. En este estudio, se reporta el caso de una embarazada donde los estudios por imágenes de resonancia magnética fetales identificaron en forma efectiva las características típicas de la clorhidrorrea congénita. Se proveen conocimientos sobre las complejidades del diagnóstico y se sugieren caminos para las estrategias de detección temprana de esta enfermedad.

Congenital chloride diarrhea (CCD) is a rare but significant genetic disorder characterized by severe electrolyte imbalances resulting from impaired intestinal chloride absorption. Affected children experience persistent diarrhea, dehydration, and malnutrition, complicating medical and developmental care. The enhancement of prenatal detection is crucial for improved patient management, early interventions, and informed genetic counseling. However, despite advancements in medicine, the complex nature and rarity of CCD make prenatal detection challenging. In this study, we report a fetal case where prenatal magnetic resonance imaging (MRI) effectively identified the distinctive characteristics of CCD, providing insights into the complexities of diagnosis and suggesting avenues for enhanced early detection strategies.

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La tuberculosis es una enfermedad infectocontagiosa cuya forma de presentación más frecuente es la pulmonar; la afectación abdominal es poco frecuente, por lo que su diagnóstico continúa siendo un desafío. Las manifestaciones clínicas de la tuberculosis abdominal así como sus hallazgos en el examen físico suelen ser inespecíficos y, en muchas ocasiones, similares a los de otras patologías, por lo que es fundamental considerarla entre los diagnósticos diferenciales. Se presenta el caso clínico de un paciente de sexo masculino, de 15 años de edad, hospitalizado por un síndrome febril prolongado asociado a dolor abdominal, diarrea, sudoración nocturna y pérdida de peso

Tuberculosis is an infectious disease which most commonly compromises the respiratory system, whereas abdominal involvement is rare, thus its diagnosis is a challenge. The clinical manifestations of abdominal tuberculosis as well as its physical examination findings are usually non-specific and, frequently, similar to those of other diseases, so it is critical to consider abdominal tuberculosis among the differential diagnoses. Here we report the clinical case of a 15-year-old male patient hospitalized for a prolonged febrile syndrome associated with abdominal pain, diarrhea, night sweats, and weight loss.

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INTRODUCCIÓN: En la diarrea asociada a Clostridioides dfficile (DACD) leve-moderada se recomienda tratar con vancomicina por sobre metronidazol, a pesar de su difícil acceso y poca evidencia en el medio ambulatorio. OBJETIVO: Comparar la tasa de cura clínica y recurrencia entre vancomicina y metronidazol en adultos chilenos con primer episodio leve-moderado de DACD de manejo ambulatorio. MÉTODOS: Cohorte retrospectiva entre enero 2015 y diciembre 2020 en centros de una red de salud universitaria de pacientes de ≥ 18 años con DACD tratados ambulatoriamente. RESULTADOS: Se obtuvieron 161 pacientes, 59% mujeres, edad promedio de 53 años (entre 18 y 94 años). De ellos, 109 (67,7%) usaron metronidazol y 52 (32,3%) vancomicina. En el análisis multivariado ajustado por edad y comorbilidades se obtuvo un OR 3,00 (IC 95% 1,12-9,59) para cura clínica y 0,27 (IC 95% 0,06-0,88) para recurrencia a ocho semanas, ambos a favor de vancomicina, sin diferencias en recurrencia a 12 meses, necesidad de hospitalización o mortalidad. CONCLUSIÓN: La terapia con vancomicina comparada contra metronidazol en el tratamiento ambulatorio de la infección leve-moderada por C. dfficile se asocia a mayor cura clínica y menor tasa de recurrencia a corto plazo, sin diferencias en desenlaces a largo plazo.

BACKGROUND: Recommended treatment against mild cases of Clostridioides difficile associated diarrhea is vancomycin despite the difficulties of access compared to metronidazole. AIM: To compare the effectiveness of vancomycin and metronidazole in Chilean adults with first mild-moderate episode of Clostridiodes difficile infection (CDI). METHODS: Retrospective cohort of patients with CDI between January 2015 and December 2020 treated in centers of a university health network. The patients were adults treated for C. difficile infection on an outpatient basis. Recurrent and severe cases were excluded. Outcomes included clinical cure and recurrence rate. RESULTS: Data from 161 patients was recovered. Fifty-nine percent were women and average age was 53 (18-94). One hundred and nine patients were treated with metronidazole (67.7%) and 52 (32.3%) used vancomycin. Multivariate analysis adjusted by age and comorbidities showed an Odds Ratio of 3.00 (IC 95% 1.12-9.59) for clinical cure and 0.27 (IC 95% 0.06-0.88) for 8-week recurrence rate, both in favor of vancomycin, without differences in 12-month recurrence rate, hospitalization rate nor mortality. CONCLUSIONS: Vancomycin is associated with better short-term outcomes in the treatment of outpatient mild-moderate first episode C. difficile infection, without differences in long term recurrence or mortality when compared with metronidazole.

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Objective: To analyze the clinical features,treatment and prognosis of drug induced hypersensitivity syndrome related hemophagocytic lymphohistiocytosis (DIHS-HLH). Methods: This was a retrospective case study. Clinical characteristics, laboratory results, treatment and prognosis of 9 patients diagnosed with DIHS-HLH in Beijing Children's hospital between January 2020 and December 2022 were summarized. Kaplan-Meier survival analysis was used to calculate the overall survival rate. Results: Among all 9 cases, there were 6 males and 3 females, with the age ranged from 0.8 to 3.1 years. All patients had fever, rash, hepatomegaly and multiple lymph node enlargement. Other manifestations included splenomegaly (4 cases), pulmonary imaging abnormalities (6 cases), central nervous system symptoms (3 cases), and watery diarrhea (3 cases). Most patients showed high levels of soluble-CD25 (8 cases), hepatic dysfunction (7 cases) and hyperferritinemia (7 cases). Other laboratory abnormalities included hemophagocytosis in bone marrow (5 cases), hypofibrinogenemia (3 cases) and hypertriglyceridemia (2 cases). Ascending levels of interleukin (IL) 5, IL-8 and interferon-γ (IFN-γ) were detected in more than 6 patients. All patients received high dose intravenous immunoglobulin, corticosteroid and ruxolitinib, among which 4 patients were also treated with high dose methylprednisolone, 2 patients with etoposide and 2 patients with cyclosporin A. After following up for 0.2-38.6 months, 7 patients survived, and the 1-year overall survival rate was (78±14)%. Two patients who had no response to high dose immunoglobulin, methylprednisolone 2 mg/(kg·d) and ruxolitinib died. Watery diarrhea, increased levels of IL-5 and IL-8 and decreased IgM were more frequently in patients who did not survive. Conclusions: For children with fever, rash and a suspicious medication history, when complicated with hepatomegaly, impaired liver function and high levels of IL-5 and IL-8, DIHS-HLH should be considered. Once diagnosed with DIHS-HLH, suspicious drugs should be stopped immediately, and high dose intravenous immunoglobulin, corticosteroid and ruxolitinib could be used to control disease.

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Background: Twins constitute a vulnerable subpopulation among children under 5 years of age. In sub-Saharan Africa, it has been found that multiple births tend to be undernourished and the risks of acute malnutrition and stunting are high.Objective: Examining the relationship between acute malnutrition and twins in rural areas Methods: This is a cohort study. 199 villages in the province of Sanmentenga, Burkina Faso. Multiple logistic regression was used to examine the relationship between acute malnutrition and twin status at birth after adjusting for wealth index, presence of latrines, main water source, fever, and presence of diarrhoea. The statistical threshold for significance was P < 0.05 and all analysis were performed using STATA version 14.0.Results: A total of 708 children were included in the study, including 236 children born twins and 472 children born twins.non-twins.Children born to mothers younger than 18 years were more common among non-twins than among twins (5.6% vs. 1.0%, p = 0.001). Acute malnutrition was more common among twins than non-twins (42.1% versus 28.0%, p<0.001). Children with fever were more common among non-twins than among twins (10.2% versus 5.5%, p=0.04).After adjusting for the wealth index, the presence of latrines, the main source of water, the presence of fever and the presence of diarrhea, twins were 1.46 times more malnourished than single children (RR = 1.46 , 95% CI [1.17-1.81], p =0.001).Conclusion: Children receiving rural health and nutrition education, twins were likely to be malnourished before their second birthday compared to non-twins.' Particular attention should be paid to twins to reduce the risk of acute malnutrition before their second birthday.

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Eosinophilic colitis is a rare and severe form of eosinophilic gastrointestinal disease. This study presents the case of a 69-year-old woman from Anadia, Alagoas, Brazil, who experienced intermittent abdominal pain in the right and left iliac fossae, along with recurrent eructations, flatus, in-creased bowel movements, diarrhea, and loss of appetite for approximately six months. The diagnosis of eosinophilic colitis was confirmed through upper digestive endoscopy, colonoscopy, and histopathology, which revealed eosinophilic pancolitis with about 100 eosinophils per high-power field in most tissue fragments. After three months of a restricted diet and treatment with ketotifen 1 mg (twice daily for 30 days) and esomeprazole 40 mg (once daily on an empty stomach for 56 days), the patient showed clinical improvement. This case highlights the diagnostic challenges of eosinophilic colitis due to its non-specific clinical signs and emphasizes the necessity of supplementary examinations (AU)

A colite eosinofílica é uma doença rara, sendo a forma menos frequente e mais grave entre as doenças eosinofílicas gastrintestinais. Este estudo apresenta o caso de uma mulher de 69 anos, natural de Anadia, Alagoas, Brasil, que apresentou dor abdominal intermitente nas fossas ilíacas direita e esquerda, acompanhada de eructações, flatos, aumento da frequência do trânsito intestinal, diarreia e inapetência por aproximadamente seis meses. O diagnóstico de colite eosinofílica foi confirmado por endoscopia digestiva alta, colonoscopia e histopatologia, que revelaram pancolite eosinofílica com cerca de 100 eosinófilos por campo de grande aumento na maioria dos fragmentos de tecido. Após três meses de dieta restritiva e tratamento com cetotifeno 1 mg (duas vezes ao dia por 30 dias) e esomeprazol 40 mg (uma vez ao dia em jejum por 56 dias), a paciente apresentou melhora clínica. Este caso destaca os desafios diagnósticos da colite eosinofílica devido aos seus sinais clínicos inespecíficos e enfatiza a necessidade de exames complementares (AU)

ABSTRACT

INTRODUCCIÓN: La diarrea aguda continúa siendo una de las principales causas de morbilidad en niños; sin embargo, el diagnóstico etiológico presenta limitaciones dada la baja sensibilidad de los métodos tradicionales. OBJETIVO: Describir los microorganismos identificados en niños que acudieron al Servicio de Urgencia (SU) de un hospital universitario en Santiago, Chile, por diarrea aguda y a los que se le solicitó panel molecular gastrointestinal. MÉTODOS: Se revisaron fichas clínicas y resultados de panel gastrointestinal realizados entre junio de 2017 y marzo de 2020. RESULTADOS: Se incluyeron 198 pacientes, edad promedio de 54,5 meses y 60,6% (120/198) de sexo masculino. La positividad del panel fue de 78,8% (156/198) con 35,3% (55/156) de las muestras polimicrobianas. Se identificaron 229 microorganismos, de los cuales 72,9% (167/229) corresponden a bacterias, 25,8% (59/229) a virus y 1,3% (3/229) a parásitos. Destacaron Campylobacter spp. y Escherichia coli enteropatógena (ECEP) como las bacterias más frecuentemente identificadas. Los pacientes con detección de Campylobacter spp. presentaron con mayor frecuencia fiebre (p = 0,00). ECEP se aisló principalmente (82,5%) en muestras polimicrobianas. DISCUSIÓN: Los resultados enfatizan el potencial que poseen los estudios moleculares para mejorar el diagnóstico etiológico de la diarrea, pero a la vez llevan a cuestionar el rol patogénico de algunos microorganismos identificados.

BACKGROUND: Acute diarrhea continues to be one of the main causes of morbidity in children, however the etiologica diagnosis presents limitations given the low sensitivity of traditional methods. AIM: To describe the microorganisms identified in children who attended the emergency department (ED) in Santiago, Chile, due to acute diarrhea and to whom a gastrointestinal panel was requested as part of their study. MATERIAL AND METHODS: Clinical records and results of the gastrointestinal panel carried out between June 2017 and March 2020 were reviewed. RESULTS: 198 patients were included, the average age was 54.5 months and 60.6% (120/198) were males. Positivity was 78.8% (156/198) with 35.3% (55/156) of the samples being polymicrobial. 229 microorganisms were identified, of which 72.9% (167/229) corresponded to bacteria, 25.8% (59/229) to viruses, and 1.3% (3/229) to parasites. Campylobacter spp. and enteropathogenic Escherichia coli (EPEC) were the most frequently identified bacteria. Patients with detection of Campylobacter spp. presented a higher frequency of fever (p = 0.00). EPEC was isolated in 82.5% of the cases in polymicrobial samples. DISCUSSION: The results emphasize the potential of molecular studies to improve the etiological diagnosis of diarrhea and at the same time lead to question the pathogenic role of some microorganisms.

ABSTRACT

Introduction: McKittrick-Wheelock syndrome is a rare entity characterized by chronic diarrhea, acute kidney injury, and hydroelectrolytic imbalance associated with a large rectal tumor, frequently a villous adenoma. Case report: A 69-year-old male with chronic diarrhea with mucus. He underwent a colonoscopy with biopsies, reporting adenocarcinoma of the rectum in situ, and underwent a robot assisted intersphincteric resection with colo-anal anastomosis and a protecitive ileostomy. Discussion: Described in 1954, this syndrome is manifested by electrolyte imbalance and acute renal injury secondary to diarrhea associated with a rectal villous adenoma, often with long lasting symptoms. The most frequent symptom being watery diarrhea with mucus. The definitive treatment consists of surgical resection. Conclusion: Although this is a rare pathology, it should be considered as a differential diagnosis in cases of chronic diarrhea associated with water and electrolyte disorders. (AU)

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El síndrome urémico hemolítico (SUH), descripto en 1955, se caracteriza por la tríada de anemia hemolítica no inmunomediada, trombocitopenia y lesión renal aguda. En su patogenia interviene la toxina Shiga, producida con mayor frecuencia por E. coli O157:H. Puede manifestarse a cualquier edad, aunque es infrecuente en adultos, y se desarrolla en forma esporádica o en brote. Se presenta con un cuadro de dolor abdominal, diarrea, fiebre y vómitos. Puede afectar el sistema nervioso central, pulmones, páncreas y corazón. En adultos, el síndrome evoluciona tras un período de incubación de 1 semana posterior a la diarrea y tiene alta morbimortalidad, a diferencia de los casos pediátricos. Presentamos el caso de una paciente adulta, que cursó internación por síndrome urémico hemolítico. (AU)

Hemolytic uremic syndrome (HUS), described in 1955, is characterized by the triad of non-immune mediated hemolytic anemia, thrombocytopenia, and acute kidney injury. Shiga toxin, produced most frequently by E coli O157:H, is involved in its pathogenesis. Hus can manifest at any age, although it is rare in adults and develops sporadically or in outbreaks. HUS presents with a picture of abdominal pain, diarrhea, fever and vomiting. It can affect the central nervous system, lungs, pancreas, and heart.In adults, the syndrome evolves after an incubation period of 1 week after diarrhea, with high morbidity and mortality, unlike pediatric cases.We present the case of an adult patient who was hospitalized for hemolytic uremic syndrome. (AU)

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Introducción. El síndrome post-colecistectomía fue descrito hace más de 70 años y se define como la presencia de síntomas gastrointestinales que pueden persistir después de la colecistectomía o aparecer como nuevos síntomas. Este síndrome, poco conocido, puede manifestarse desde pocos meses hasta varios años luego de la cirugía y ocurre entre 5 % y 40 % de los pacientes. Método. Estudio de cohorte prospectiva, que incluyó pacientes a quienes se les realizó colecistectomía laparoscópica en tres unidades quirúrgicas de Bogotá, D.C., Colombia, durante un período de ocho meses, con seguimientos periódicos durante dos años. El síndrome post-colecistectomía se definió como la presencia de al menos un síntoma gastrointestinal a partir del primer mes de la cirugía. Resultados. Se incluyeron 380 pacientes de los cuales 183 (48,2 %) desarrollaron el síndrome. La edad tuvo diferencia estadísticamente significativa entre aquellos que lo desarrollaron y los que no (p=0,024). La diarrea fue el único síntoma preoperatorio asociado al desarrollo del síndrome. El síndrome post-colecistectomía se encontró en el 42,1 % de los pacientes al primer mes de seguimiento y en el 17,4 % al segundo año. Conclusiones. El síndrome post-colecistectomía ocurre en un porcentaje importante de pacientes. En concordancia con la literatura, se encontró que la diarrea prequirúrgica es un factor de riesgo independiente para el desarrollo del síndrome. Se recomienda un adecuado seguimiento de los pacientes después de una colecistectomía

Introduction. Post-cholecystectomy syndrome (PCS) was described more than 70 years ago and is defined as the presence of gastrointestinal (GI) symptoms that may persist after cholecystectomy or can present as new symptoms. This little-known syndrome can appear from a few months to several years after surgery and occurs between 5% and 40% of patients. Method. Prospective cohort study, which included patients who underwent laparoscopic cholecystectomy in three surgical units in Bogotá, Colombia, during a period of eight months, with periodic follow-up for two years. PCS was defined as the presence of at least one GI symptom from the first month after surgery. Results. Three-hundred and eighty patients were included, of which 183 (48.2%) developed the syndrome. Age had a statistically significant difference between those who developed PCS and those who did not (p=0.024). Diarrhea was the only preoperative symptom associated with the development of PCS. Post-cholecystectomy syndrome was found in 42.1% at the first month of follow-up and in 17.4% at the second year. Conclusions. Post-cholecystectomy syndrome occurs in a significant percentage of patients. Consistent with the literature, preoperative diarrhea was found to be an independent risk factor for the development of the syndrome. Adequate follow-up of patients after cholecystectomy is recommended

ABSTRACT

El síndrome de enterocolitis inducido por proteínas de los alimentos (FPIES, por su sigla en inglés) es una reacción alérgica no mediada por inmunoglobulina E (IgE) con síntomas gastrointestinales, como vómitos y diarrea. El diagnóstico se basa en criterios clínicos y en una prueba de provocación para confirmarlo. Es una enfermedad desconocida en las unidades neonatales, debido a la inespecificidad de los síntomas en los recién nacidos. La cifra de metahemoglobina elevada es una opción sencilla de aproximación diagnóstica. Se describe el caso clínico de un recién nacido que ingresa al servicio de urgencias por deshidratación, letargia, vómitos, diarrea y acidosis metabólica grave con elevación de metahemoglobina, con mejora clínica y recuperación total tras el inicio del aporte de fórmula elemental. La sospecha diagnóstica se confirmó tras la prueba de provocación positiva.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated allergic reaction with gastrointestinal symptoms, such as vomiting and diarrhea. FPIES diagnosis is based on clinical criteria and on a food challenge test. It is an unknown disease in neonatal units due to its nonspecific symptoms in newborn infants. An elevated methemoglobin level is a simple way to approach diagnosis. Here we describe a clinical case of a newborn admitted to the emergency department because of dehydration, lethargy, vomiting, diarrhea, severe metabolic acidosis, and a high methemoglobin level. Clinical improvement and complete recovery was achieved after initiation of elemental formula. The diagnostic suspicion was confirmed after a positive challenge test.