Infectious etiology and indicators of malabsorption or intestinal injury in childhood diarrhea / Etiología infecciosa e indicadores de malabsorción o daño intestinal en diarrea infantil

Abstract Introduction. The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease. Objective. To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity. Materials and methods. The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests. Results. We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method. Conclusions. Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.

Resumen Introducción. La etiología multifactorial de la gastroenteritis enfatiza la necesidad de usar diferentes métodos de laboratorio para identificar o excluir agentes infecciosos y evaluar la gravedad de la enfermedad diarreica. Objetivo. Diagnosticar la etiología infecciosa de la diarrea en niños y evaluar algunos marcadores fecales asociados con la integridad intestinal. Materiales y métodos. Se estudiaron 45 niños con enfermedad diarreica, en los cuales se evaluaron la presencia de enteropatógenos y los marcadores de malabsorción. Se analizaron las muestras fecales de 76 niños, mediante las pruebas de esteatocrito tradicional y esteatocrito ácido, para la cuantificación de la grasa. Resultados. Se observó diarrea aguda en el 80 % de los niños y diarrea persistente en el 20 %. De los individuos con diarrea, el 40 % fue positivo para enteropatógenos; los más diagnosticados fueron rotavirus (13,3 %) y Giardia duodenalis (11,1 %). Entre los pacientes infectados, la sangre oculta fue más evidente en aquellos portadores de bacterias patógenas (40 %) o enterovirus (40%), mientras que la esteatorrea se observó en infecciones por el protozoo G. duodenalis (35,7 %). Los niños con diarrea excretaron significativamente más lípidos en las heces que aquellos sin diarrea, según lo determinado por los métodos de esteatocrito tradicional (p<0,0003) y esteatocrito ácido (p<0,0001). Conclusiones. La diarrea infantil puede provocar deficiencias graves de nutrientes. La esteatorrea es distintiva de la malabsorción intestinal y puede detectarse mediante la estimación del esteatocrito ácido. Esta prueba podría utilizarse de forma rutinaria como una herramienta de laboratorio para la evaluación semicuantitativa de la malabsorción de grasas en niños con diarrea.

Factores de riesgo de enfermedad diarreica aguda en niños menores de un año

Introducción: las enfermedades diarreicas agudas son una causa importante de morbilidad y mortalidad de la población infantil a nivel mundial y en países en vías de desarrollo. Objetivo: identificar los factores de riesgo asociados a la diarrea aguda en niños menores de un año del municipio Bayamo. Métodos: se realizó un estudio observacional analítico de casos y controles, en niños menores de 1 años pertenecientes al municipio Bayamo, que ingresaron con enfermedad diarreica aguda en el Hospital Provincial Pediátrico Docente "General Milanés" en el año 2022. La muestra constituida por 246 pacientes, 82 casos y 164 controles. Se realizó el análisis univariado y multivariado: la razón de productos cruzados y el Chi cuadrado, con una confiabilidad del 95% y una probabilidad menor de 0.05. Resultados: en el análisis univariado la no lactancia materna exclusiva hasta los 6 meses fue el factor de mayor significación estadística (OR 20,695, IC 7,360-58,188 P=0,000), seguido de la desnutrición (OR 10,503 IC 3,322-33,213 P=0,000), uso previo de antimicrobiano (OR 7,798 IC 2,803-21,684 P=0,000. En el análisis multivariado el factor que mostró mayor independencia fue la no lactancia materna exclusiva hasta los 6 meses. Conclusiones: la no lactancia materna hasta los 6 meses de edad resultó ser el factor de mayor riesgo para desarrollar una enfermedad diarreica aguda, seguido de la desnutrición y uso previo de antimicrobiano.

SUMMARY Introduction: acute diarrheal diseases (ADD) are an important cause of morbidity and mortality in children worldwide and in developing countries. Objective: to identify the risk factors associated with acute diarrhea in children under one year of age in the Bayamo municipality. Methods: an analytical observational study of cases and controls was carried out in children under 1 year of age belonging to the Bayamo municipality, who were admitted with acute diarrheal disease to the "General Milanés" Provincial Pediatric Teaching Hospital in 2022. The sample was made up of 246 patients, 82 cases and 164 controls. The univariate and multivariate analysis was performed: the cross-product ratio (Odd Ratio) and the Chi square, with a reliability of 95% and a probability of less than 0.05. Results: in the univariate analysis, non-exclusive breastfeeding up to 6 months was the factor with the greatest statistical significance (OR 20.695, CI 7.360-58.188 P=0.000), followed by malnutrition (OR 10.503 CI 3.322-33.213 P=0.000). previous use of antimicrobial (OR 7.798 CI 2.803-21.684 P=0.000. In the multivariate analysis, the factor that showed greater independence was not exclusive breastfeeding up to 6 months. Conclusions: Non-breastfeeding until 6 months of age turned out to be the highest risk factor for developing an acute diarrheal disease, followed by malnutrition and previous use of antimicrobials.

Introdução: as doenças diarreicas agudas são uma importante causa de morbidade e mortalidade em crianças em todo o mundo e em países em desenvolvimento. Objetivo: identificar os fatores de risco associados à diarreia aguda em crianças menores de um ano de idade no município de Bayamo. Métodos: foi realizado um estudo observacional, analítico, caso-controle em crianças menores de 1 ano de idade pertencentes ao município de Bayamo, que foram admitidas com doença diarreica aguda no Hospital Universitário Pediátrico Provincial "General Milanés" em 2022. A amostra foi composta por 246 pacientes, 82 casos e 164 controles. Foram realizadas análises univariada e multivariada: a razão de produtos cruzados e o Qui-quadrado, com confiabilidade de 95% e probabilidade menor que 0,05. Resultados: na análise univariada, o aleitamento materno não exclusivo até os 6 meses de idade foi o fator estatisticamente mais significativo (OR 20,695, IC 7,360-58,188, P=0,000), seguido de desnutrição (OR 10,503, IC 3,322-33,213, P=0,000), uso prévio de antimicrobianos (OR, 7,798, IC 2,803-21,684, P=0,000. Na análise multivariada, o fator que apresentou maior independência foi o aleitamento materno não exclusivo até os 6 meses. Conclusões: não amamentar até os 6 meses de idade foi o maior fator de risco para o desenvolvimento de doença diarreica aguda, seguido de desnutrição e uso prévio de antimicrobianos.

Campylobacter diarrhea in children in South Asia: A systematic review

Background: Campylobacter spp. are one of the commonest causes of diarrhea in children under five and in resource poor settings also lead to malabsorption and stunting. The purpose of this systematic review was to understand the burden of Campylobacter spp. associated diarrhea among children in the South Asian countries. Methods: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Databases were searched with defined keywords for publications from the years 1998–2018. Data on proportion of positive samples was extracted to compare the rates of Campylobacter infection among children (under the age of 19) from different study populations. Results: Of the 359 publications screened, 27 eligible articles were included in this systematic review and categorized based on study design. In 8 case-control studies, Campylobacter spp. was detected more frequently among diarrheal cases (range, 3.2–17.4%) than non-diarrheal cases (0–13%). Although there were variations in the study population, overall, children under the age of two years experienced Campylobacter diarrhea more often than older children. Most studies reported stool culture as the method used to detect Campylobacter spp. however retesting using PCR-based methods significantly increased detection rates. Limited data were available on Campylobacter species. In 4 studies that provided species data, C. jejuni (3.2–11.2%) was shown to be the most common species, followed by C. coli. Conclusion: In South Asia, Campylobacter spp. are one of the most common bacterial diarrheal pathogens affecting children but there is a paucity of data on species, risk factors and attributable sources. Although a few studies were available, the epidemiology of campylobacteriosis remains uncertain. To understand the true burden and sources of infection, more detailed studies are needed collecting data from human, animal and environmental sources and using both culture and genomic tools.

Determinantes de riesgo relacionados con la enfermedad diarreica aguda en niños menores de 5 años en una zona rural de Huánuco, Perú

Introducción: La enfermedad diarreica aguda sigue siendo uno de los problemas de salud pública a nivel mundial que afecta principalmente a países subdesarrollados. Objetivo fue identificar los determinantes de riesgo relacionados con esta dolencia en niños menores de 5 años de la localidad de Huancapata, Ambo, Huánuco, durante el 2019. Metodología: Se realizó un estudio observacional y transversal, con diseño correlacional. La muestra fueron 101 madres de niños menores de 5 años, seleccionadas probabilísticamente. Se aplicó una guía de entrevista de las características generales, un cuestionario de determinantes de riesgo y una ficha de valoración clínica de la EDA. El análisis inferencial se realizó con la prueba de chi cuadrado, el odds ratio (OR) con sus intervalos de confianza al 95 % y con un p < 0,05. Resultados: Se halló que los determinantes hábitos de higiene: insumos inadecuados para el lavado de manos (X2 = 3,631; OR = 2,2 y p = 0,046) y la falta de higiene de los juguetes del niño (X2 = 5,683; OR = 3, 127 y p = 0,014) resultaron ser estadísticamente significativos como determinantes relacionados con la EDA. Discusión: Los insumos inadecuados para el lavado de manos y la falta de lavado de los juguetes del niño, fueron los determinantes de riesgo relacionados con la EDA en los niños en estudio.

Summary Introduction: Acute diarrheal disease continues to be one of the world's health problems that mainly affects underdeveloped countries. The objective is to identify the risk determinants related to this ailment in children under 5 years of age in the town of Huancapata, Ambo, Huánuco, during 2019. Methodology: An observational and cross-sectional study was carried out, with a correlational design. The sample consisted of 101 mothers of children under 5 years of age, selected probabilistically. An interview guide of the general characteristics, a questionnaire of risk determinants and a clinical evaluation form of ADD were applied. The inferential analysis was performed with the chi square test, the odds ratio (OR) with its 95% confidence intervals and with a p <0.05. Results: It was found that the determining hygiene habits: inadequate supplies for hand washing (X2 = 3,631; OR = 2.2 and p = 0.046) and the lack of hygiene of the child's toys (X2 = 5.683; OR = 3, 127 and p = 0.014) were found to be statistically significant as determinants related to ADD. Discussion: Inadequate supplies for hand washing and lack of washing of children's toys were the risk determinants related to ADD in the children in the study.

Introdução: A doença diarreica aguda continua sendo um dos problemas de saúde mundial que afeta, principalmente, os países subdesenvolvidos. O objetivo é identificar os determinantes de risco relacionados com esta doença em crianças menores de 5 anos da localidade de Huancapata, Ambo, Huánuco, durante o ano de 2019. Metodologia: Realizou-se um estudo observacional é transversal, com desenho correlacionar. A amostra foi de 101 mães de crianças menores de 5 anos, selecionadas probabilisticamente. Foram aplicados uma guia de entrevista das características gerais, um questionário de determinantes de risco é uma ficha de avaliação clínica da DDA. A análise inferencial foi realizada com o teste de qui quadrado, o Odds Ratio ( OR) com seus intervalos de confiança de 95% e p < 0,05. Resultados: Constatou-se que os hábitos de higiene determinantes: insumos inadequados para a lavagem das mãos (X2=3,631; OR= 2,2 ep = 0,046) e a falta de higiene dos brinquedos da criança (X2=5,683; OR= 3,127 ep = 0,014), foram considerados, estatisticamente, significativos como determinantes relacionados com a DDA. Discussão: Suprimentos inadequados para a lavagem das mãos e a falta de lavagem dos brinquedos das crianças foram os determinantes de risco relacionados com a DDA nas crianças em estudo.

Probióticos y prebióticos: rol en la terapéutica de la enfermedad diarreica aguda infantil / Probiotics and prebiotics: its role in childhood acute diarrheal disease therapy

RESUMEN: La enfermedad diarreica aguda infantil (EDAI), constituye un problema de salud pública, representando la 2ª causa de morbimortalidad infantil en menores de 5 años, en el Ecuador. La hidratación oral y parenteral en los niños hospitalizados bajo normas de administración de conformidad con el grado de deshidratación y pérdida de peso, así como medidas preventivas como la vacunación obligatoria contra el rotavirus, han contribuido a disminuir, pero no a solucionar este problema de salud infantil. Múltiples factores contribuyen para que no se resuelva: socioeconómicos, educacionales, el destete temprano y malas prácticas alimenticias, entre otros. Últimos estudios han propuesto la utilización de probióticos que contribuyan a disminuir el problema sugieriendo el usode Saccharomyces boulardii (SB), asociado a un prebiótico; lo que permitiría acortar el tiempo de tratamiento de una EDAI; por lo que la simbiosis entre SB y un prebiótico denominado fructooligosacárido (FOS), podría ser una alternativa para reducir costos y complicaciones. Una alternativa para medir el curso clínico de una EDAI en infantes es la escala BITTS, de reciente creación y fácil aplicación por clínicos. El objetivo de este manuscrito fue resumir la evidencia existente respecto del rol de losprobióticos y prebióticos en la terapéutica de de la EDAI.

SUMMARY: In Ecuador childhood acute diarrheal disease (CADD) constitutes a serious public health problem, representing the 2nd cause of infant morbidity and mortality in children under 5 years of age. Oral and parenteral hydration in hospitalized children, with standard treatments according to their degree of dehydration and weight loss, as well as preventive measures such as mandatory vaccination against rotavirus, have contributed to a decrease. Nevertheless, this childhood disease has still not been resolved. There are multiple contributing factors involved that prevent complete eradication of the disease Among these are socio-economic problems, education, early weaning and poor feeding practices, all of which continue to affect infants. Recent studies have proposed the use of probiotics that help reduce the problem and it has been suggested that Saccharomyces boulardii (SB), associated with a prebiotic, would reduce the treatment time of an CADD. Therefore, the symbiosis between the SB probiotic and a prebiotic called fructo- oligosaccharide (FOS) could be an alternative to reduce complications and reduce costs. An alternative to measure the clinical course of an CADD in infants is the BITTS scale, which was recently created and can easily be applied by clinicians. The aim of this manuscript was to summarize the existing evidence regarding the role of PROBIOTICS and prebiotics in the treatment of CADD.

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those >6 months of age and 10mg/day in those <6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value <0.05 was considered statistically significant.Results: The mean age was 19.49'14.41 months. The compliance to complete 14-day zinc therapy was 62.14%.' The mean number of days zinc was taken was 11.28'3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Características sociodemográficas y clínico-epidemiológicas de los pacientes adultos ingresados por diarrea del viajero en la Clínica Internacional Trinidad, 2015-2017 / Sociodemographic and clinical-epidemiological characteristics of patients admitted for traveler's diarrhea to Trinidad International Clinic, 2015-2017

Introducción: La diarrea del viajero es causa frecuente de hospitalización en turistas internacionales. Objetivo: Describir las características sociodemográficas y clínico-epidemiológicas de los pacientes adultos ingresados por diarrea del viajero en la Clínica Internacional de Trinidad durante los años 2015 al 2017. Métodos: Estudio descriptivo de los 699 pacientes adultos con diarrea del viajero que requirieron de ingreso en el periodo de estudio. Se revisaron sus historias clínicas para analizar la frecuencia en que estuvieron presentes algunas variables sociodemográficas y clínico-epidemiológicas. Para analizar los datos se utilizó la estadística descriptiva con distribución de frecuencias y porcentajes. Resultados: El grupo etario entre 19 y 40 años tuvo un 60,52 por ciento de pacientes afectados; el 58,23 por ciento en el sexo femenino, con una incidencia mayor en los meses de julio (12,88 por ciento) y febrero (12,44 por ciento). Los viajeros procedentes de países europeos representaron el 76,97 por ciento ; el 74,96 por ciento se hospedó en casas particulares. El 1,85 por ciento de los afectados presentaba antecedentes de enfermedad gastrointestinal; el 76,11 por ciento requirió de 1 a 6 h de observación, con deshidratación leve (59,66 por ciento) y moderada (21,75 por ciento). El vómito y las náuseas se presentaron en el 58,37 por ciento de los pacientes y en el 60,73 por ciento la causa no fue precisada. Conclusiones: Las variables sociodemográficas y clínico-epidemiológicas seleccionadas permitieron describir características de los pacientes adultos ingresados por diarrea del viajero. Se recomienda profundizar en el estudio para contribuir a su prevención y optimizar la atención(AU)

Introduction: Traveler's diarrhea is a frequent cause of hospitalization of international tourists. Objective: Describe the sociodemographic and clinical-epidemiological characteristics of adult patients admitted for traveler's diarrhea to Trinidad International Clinic in the period 2015-2017. Methods: A descriptive study was conducted of the 699 adult patients with traveler's diarrhea who required hospitalization in the study period. The patients' medical records were reviewed to analyze the frequency of some sociodemographic and clinical-epidemiological variables. Data analysis was based on descriptive statistics with frequency and percentage distribution. Results: 60.52 percent of the patients affected were in the 19-40 years age group, 58.23 percent were female, and the highest incidence was observed in the months of July (12.88 percent) and February (12.4 4 percent ). Travelers from European countries represented 76.97 percent, and 74.96 percent were staying in private dwellings. Of the patients affected, 1.85 percent had a history of gastrointestinal disease; 76.11percent required 1-6 hours of observation; dehydration was mild in 59.66 percent and moderate in 21.75 percent. Vomiting and nausea were present in 58.37 percent of the patients; in 60.73 percent the cause was not determined. Conclusions: The sociodemographic and clinical-epidemiological variables selected made it possible to characterize the adult patients admitted for traveler's diarrhea. Further research is recommended to contribute to the prevention this disease. Further research is recommended to contribute to the prevention this disease and optimize care(AU)

Prevalencia de patógenos causantes de enfermedad diarreica aguda en el área Metropolitana de Asunción y Central

Introducción: Las enfermedades diarreicas agudas (EDA) constituyen un problema de salud pública y son una de las causas más importantes de mortalidad y morbilidad en niños a nivel mundial. Objetivo: Determinar la prevalencia de enteropatógenos causantes de EDA en el área metropolitana de Asunción y Central. Materiales y métodos: Se realizó un estudio observacional, descriptivo de corte transverso. Se analizaron 743 muestras de heces diarreicas, en las cuales se investigó la presencia de Salmonella spp., Shigella spp., Campylobacter spp., Escherichia coli diarreigénicas y Rotavirus, utilizando técnicas de referencia. Resultados: En el 31,2% (232/743) de las muestras fue posible identificar al menos uno de los patógenos entéricos investigados, siendo las E. coli diarreigénicas fueron las bacterias identificadas con mayor frecuencia, seguido por Rotavirus, Campylobacter spp., Shigella spp. y en último lugar, Salmonella spp. Conclusión: La población más afectada corresponde a niños menores de 5 años. El principal patógeno identificado como agente causal de diarreas fueron las E. coli diarreigénicas en primer lugar, seguido por Rotavirus, Campylobacter spp., Shigella spp. y Salmonella spp. En algunas muestras se detectaron más de un patógeno entérico, encontrando incluso casos de coinfección con hasta cuatro patógenos diferentes.

Introduction: Acute diarrheal diseases (ADD) constitute a public health problem and are one of the most important causes of mortality and morbidity in children worldwide. Objective: To determine the prevalence of enteropathogens causing ADD in the metropolitan area of ​​Asunción and Central. Materials and methods: An observational, descriptive cross-sectional study was conducted. 743 samples of diarrheic feces were analyzed, in which the presence of Salmonella spp., Shigella spp., Campylobacter spp., Escherichia coli diarreigenic and Rotavirus was investigated, using reference techniques. Results: In 31.2% (232/743) of the samples it was possible to identify at least one of the enteric pathogens investigated, being the diarrhenetic E. coli were the most frequently identified bacteria, followed by Rotavirus, Campylobacter spp., Shigella spp. and lastly, Salmonella spp. Conclusion: The most affected population corresponds to children under 5 years of age. The main pathogen identified as the causative agent of diarrhea was diarrigenic E. coli, followed by Rotavirus, Campylobacter spp., Shigella spp. and Salmonella spp. In some samples more than one enteric pathogen was detected, even finding cases of coinfection with up to four different pathogens.

Electrolyte disturbance in rotaviral diarrhea and other acute diarrheal diseases in children under 5 years

Background: Acute diarrheal disease is one of the most common cause of mortality and morbidity in under 5 children. Rotavirus is one of the important cause of diarrhea in under 5. This study was done to know the electrolyte disturbance in under 5 children with diarrhea.Methods: A prospective observational study was conducted in Masonic Medical Centre for Children, Coimbatore on children aged less than 5 years with acute diarrhea with moderate and severe dehydration.Results: Total 220 children are included in study, among them 66(58.9%) had rotavirus infection. Among 220 cases of diarrhea 14.09% (31/220) had hypernatremia, 2.72% (6/220) had hyponatremia, 4.54% (10/220) had hyperkalemia and 9.09% (20/220) had hypokalemia. Among 66 cases of rotavirus diarrhea, 27.27% (18/66) had hypernatremia, 4.5% (3/66) had hyponatremia and 25.75% (17/66) had hypokalemia.Conclusions: Hypernatremia is the most common electrolyte disturbance in acute diarrheal diseases and most frequently seen in rotavirus diarrhea. In most of the situation, there is unavailability of laboratory or time lag in obtaining reports. Hence prediction of electrolyte disturbance and management is more important in diarrheal disease.

Detección molecular de Escherichia coli diarreogénica en pacientes pediátricos con síndrome diarreico agudo en Paraguay / Molecular detection of diarrheogenic Escherichia coli in pediatric patients with acute diarrheal syndrome in Paraguay

La Escherichia coli diarreogénica (ECD) se ha clasificado con base en criterios clínicos, epidemiológicos y moleculares en cinco grupos, cada uno con factores de virulencia específicos. El objetivo fue determinar la prevalencia de ECD en pacientes pediátricos con enfermedad diarreica aguda del Laboratorio Central de Salud Publica en el periodo 2012- 2015. Se procesaron muestras de heces con síndrome diarreico agudo, provenientes de pacientes pediátricos, en los cuales se buscó algún gen de virulencia ECD utilizando métodos convencionales de siembra y screening molecular, mediante PCR múltiple con cebadores diseñados específicamente para amplificar los genes de virulencia elt, est, eae, stx, ipaH y aggR. Del total de muestras analizadas, 13% (180/1379) de las muestras presentó algún factor de virulencia compatible con algún patotipo ECD con mayor predominio en niños de 1 a 3 años. La frecuencia de los distintos patotipos fue la siguiente: 61 (34%) ETEC, 40 (22%) EAEC, 41 (23%) EPEC, 27 (15%) EIEC, 7 (4%) STEC y 3 (2%) ETEC/EAEC, 1 (0.5%) ETEC/EAEC/EIEC. El porcentaje de E. coli diarreogénicas detectado tiene similitud con lo reportado en otros países de la región, lo que nos indica que estos patógenos son parte importante de la etiología de la enfermedad diarreica aguda infecciosa en la población infantil en nuestro país. Se debe destacar que para el diagnóstico de las diferentes categorías ECD, es necesario disponer de un procedimiento diagnóstico específico dirigido a la detección de los factores de virulencia utilizando métodos moleculares o métodos inmunológicos.

Diarrheagenic Escherichia coli (DEC) has been classified based on clinical, epidemiological and molecular criteria in five groups, each with specific virulence factors. The objective was to determine the prevalence of DEC in pediatric patients with acute diarrheal disease of the Central Laboratory of Public Health in the 2012-2015 period. A total of 1447 fecal samples of acute diarrheal syndrome from pediatric patients were processed in which a DEC virulence gene was searched using conventional screening and molecular screening methods with multiple PCR primers specifically designed to amplify virulence genes, st, lt, eae, stx, ipaH and aggR. From the total of analyzed samples, 13% (180/1379) of the samples presented some virulence factor compatible with a DEC pathogen type with greater predominance in children from 1 to 3 years. The frequency of the different pathogen types was as follows: 61 (34%) ETEC, 40 (22%) EAEC, 41 (23%) EPEC, 27 (15%) EIEC, 7 (4%) STEC and 3 (2% ETEC/EAEC, 1 (0.5%) ETEC/EAEC/EIEC. The percentage of DEC detected is similar to that reported in other countries of the region, which indicates that these pathogens are an important part of the etiology of acute infectious diarrheal disease in children in our country. It should be noted that for the diagnosis of different DEC categories, it is necessary to have a specific diagnostic procedure aimed at the detection of virulence factors using molecular methods or immunodiagnostic methods.

Enfermedad diarreica aguda por rotavirus en pacientes ingresados en un servicio de gastroenterología pediátrica / Acute diarrheal disease caused by rotavirus in patients admitted in a pediatric gastroenterology service

Se realizó un estudio descriptivo, prospectivo y transversal de 72 pacientes menores de 18 meses de edad con enfermedad diarreica aguda por rotavirus de tipo A, quienes fueron ingresados en el Servicio de Gastroenterología del Hospital Infantil Docente Sur "Dr. Antonio María Béguez César" de Santiago de Cuba, durante el período comprendido de marzo del 2012 a diciembre del 2013, con vistas a caracterizarles según algunas variables clínicas, epidemiológicas y terapéuticas. En el análisis estadístico se aplicaron el cálculo porcentual y la prueba de la Χ² (con un nivel de significación igual a 0,05), que revelaron un predominio del grupo etario de 12-18 meses, de los estilos de vida regular y malo, así como de la procedencia rural y la lactancia artificial. Asimismo fueron más frecuentes el cuadro sintomático de diarrea, vómito y fiebre, y la complicación deficiencia transitoria de la enzima lactasa.

A descriptive, prospective and cross-sectional study of 72 patients younger than 18 months of age with acute diarrheal disease caused by type A rotavirus who were admitted in the Gastroenterology Service of "Dr. Antonio María Béguez Caesar" Southern Teaching Pediatric Hospital in Santiago de Cuba was carried out, during the period of March, 2012 to December, 2013, with the aim characterizing them according to some clinical, epidemic and therapeutic variables. In the statistical analysis the percentage calculation and the Chi square test were applied (with a significance level similar to 0,05), that revealed a prevalence of the age group 12-18 months, of the lifestyles middle and poor, as well as of the rural origin and artificial nursing. Also the symptomatic pattern of diarrhea, vomit and fever, and the complication of transitory deficiency of the enzyme lactase were most frequent.

The role of human adenoviruses type 41 in acute diarrheal disease in Minas Gerais after rotavirus vaccination

Abstract Human adenovirus species F (HAdV-F) type 40 and 41 are commonly associated with acute diarrheal disease (ADD) across the world. Despite being the largest state in southeastern Brazil and having the second largest number of inhabitants, there is no information in the State of Minas Gerais regarding the role of HAdV-F in the etiology of ADD. This study was performed to determine the prevalence, to verify the epidemiological aspects of infection, and to characterize the strains of human adenoviruses (HAdV) detected. A total of 377 diarrheal fecal samples were obtained between January 2007 and August 2011 from inpatient and outpatient children of age ranging from 0 to 12 years. All samples were previously tested for rotavirus, norovirus, and astrovirus, and 314 of 377 were negative. The viral DNA was extracted, amplified using the polymerase chain reaction and the HAdV-positive samples were sequenced and phylogenetically analyzed. Statistical analyses were performed using the Chi-square test (p < 0.05), considering two conditions: the total of samples tested (377) and the total of negative samples for the remaining viruses tested (314). The overall prevalence of HAdV was 12.47% (47/377); and in 76.60% (36/47) of the positive samples, this virus was the only infectious agent detected. The phylogenetic analysis of partial sequences of 32 positive samples revealed that they all clustered with the HAdV-F type 41. The statistical analysis showed that there was no correlation between the onset of the HAdV infection and the origin of the samples (inpatients or outpatients) in the two conditions tested: the total of samples tested (p = 0.598) and the total of negative samples for the remaining viruses tested (p = 0.614). There was a significant association in the occurrence of infection in children aged 0–12 months for the condition 1 (p = 0.030) as well as condition 2 (p = 0.019). The occurrence of infections due to HAdV did not coincide with a pattern of seasonal distribution. These data indicate the significant involvement of HAdV-F type 41 in the etiology of ADD in Minas Gerais, which demonstrates the importance of other viral agents in the development of the disease after the introduction of rotavirus vaccine immunization.

Pacientes ingresados a causa de enfermedad diarreica aguda según tipo de lactancia / Patients hospitalized due to acute diarrheal disease according to nursing type

Se realizó un estudio descriptivo y transversal de 71 lactantes menores de 7 meses, ingresados en el Servicio de Enfermedades Diarreicas Agudas del Hospital Infantil Docente Sur "Dr. Antonio María Béguez César" de Santiago de Cuba durante 2013, a fin de caracterizarles según variables clinicoepidemiológicas de interés. En la serie predominaron la lactancia artificial (32,4 %), los pacientes con género de vida regular (62,0 %), el estado nutricional eutrófico (63,3 %) y la diarrea osmótica (59,1 %); también se observó que las madres menores de 25 años fueron las de mayor frecuencia en cuanto al abandono de la lactancia materna. Se concluye que la práctica inapropiada de dicha lactancia estuvo acorde con algunas variables desfavorables como el género de vida y la edad materna.

A descriptive and cross-sectional study of 71 nursing infants younger than 7 months, admitted to the acute diarhreal disease service of "Dr. Antonio María Béguez César" Southern Teaching Children Hospital in Santiago de Cuba was carried out during 2013, in order to characterize them according to the clinical epidemiological variable of interest. In the series the bottle feeding (32.4%), the patients with regular life gender (62.0%), the eutrophic nutritional state (63.3%) and the osmotic diarrhea (59.1%) prevailed; it was also observed that mothers younger than 25 years were the ones stopping breast feeding earlier. It was concluded that the inappropriate practice of this nursing was in agreement with some unfavorable variables as life gender and maternal age.

Análisis estadístico de la enfermedad diarreica aguda en pacientes atendidos en servicio de urgencias durante el 2012-2013 / Statistical analysis of acute diarrheal disease in patients cared for at emergency services, 2012-2013

INTRODUCCIÓN: la enfermedad diarreica aguda se considera un problema de salud y obedece a múltiples etiologías. OBJETIVO: describir el análisis estadístico de la enfermedad diarreica aguda en pacientes atendidos en servicio de urgencias en el Hospital "Celia Sánchez Manduley" en el período 2012-2013. MÉTODOS: se realizó un estudio descriptivo retrospectivo. El universo estuvo compuesto por todos los casos vistos en el servicio de medicina interna. La muestra la constituyeron los pacientes que fueron vistos con diagnóstico de enfermedad diarreica aguda, desde junio 2012 hasta diciembre 2013. RESULTADOS: el municipio Manzanillo en los dos años, es el que mayor cantidad de casos aporta. A partir del mes de junio los casos de enfermedad diarreica aguda comienzan a aumentar. El Índice Ocupacional es alto. El número de fallecidos es ínfimo. CONCLUSIONES: en la atención primaria de salud, del municipio Manzanillo, fallan las acciones preventivas para evitar la aparición de la enfermedad diarreica aguda, de todos los casos vistos, más de la mitad ingresan. Se hace necesario una sala dotada de 23 camas para atender los pacientes con esta enfermedad, a pesar de todas las dificultades en el servicio, el rápido actuar de los profesionales, la comunidad y el gobierno disminuye el número probable de fallecidos.

INTRODUCTION: acute diarrheal disease is considered to be a health problem with many possible etiologies. OBJECTIVE: describe the statistical analysis of acute diarrheal disease in patients cared for at the emergency service of "Celia Sánchez Manduley" hospital in the period 2012-2013. METHODS: a retrospective descriptive study was conducted. The study universe was composed of all the patients attending the internal medicine service. The sample was formed by the patients diagnosed with acute diarrheal disease from June 2012 to December 2013. RESULTS: the municipality of Manzanillo contributed the largest number of cases in the two years. As of the month of June, the number of acute diarrheal disease cases started to rise. The occupancy index was high. The number of fatal cases was minimum. CONCLUSIONS: primary health care actions aimed at preventing acute diarrheal disease are deficient in the municipality of Manzanillo. More than half of the cases examined are admitted to hospital. A ward with 23 beds is required for the care of patients with this disease. Despite all the difficulties in the service, the number of probable deaths remains low thanks to the fast response of professionals, the community and the government.

Enfermedad diarreica aguda por Escherichia coli enteropatógenas en Colombia / Acute diarrheal disease caused by enteropathogenic Escherichia coli in Colombia

Intestinal Escherichia coli pathogens are leading causes of acute diarrheal disease in children less than 5 years in Latin America, Africa and Asia and a leading cause of death in children living in poorest communities in Africa and South East Asia. Studies on the role of E. coli pathogens in childhood diarrhea in Colombia and other countries in Latin America are limited due to the lack of detection assays in clinical laboratories at the main urban medical centers. Recent studies report that enterotoxigenic E. coli is the most common E. coli pathogens associated with diarrhea in children less than 5 years of age. Other E. coli pathotypes have been detected in children with diarrhea including enteropathogenic, enteroaggregative, shiga-toxin producing and diffusely adherent E. coli. It was also found that meat and vegetables at retail stores are contaminated with Shiga-toxin producing E. coli and enteroaggregative E. coli, suggesting that food products are involved in transmission and infection of the susceptible host. More studies are necessary to evaluate the mechanisms of transmission, the impact on the epidemiology of diarrheal disease, and management strategies and prevention of these pathogens affecting the pediatric population in Colombia.

Las cepas de E. coli enteropatógenas son causas importantes de la enfermedad diarreica aguda (EDA) en niños bajo 5 años de edad en América Latina, África y Asia y están asociadas a alta mortalidad en niños en las comunidades más pobres de África y el Sudeste Asiático. Estudios sobre el papel de las variedades de E. coli entero-patógenas en la EDA infantil en Colombia y otros países de América Latina son limitados debido a la carencia de ensayos para detección de estos patógenos en los laboratorios clínicos de centros de salud. Estudios recientes han reportado la detección de E. coli enteropatógenas en Colombia, siendo E. coli enterotoxigénica la cepa más frecuentemente asociada a diarrea en niños bajo 5 años. Otros patógenos detectados en estos pacientes incluyen E. coli enteroagregativa, enteropatógena "clásica", productora de toxina Shiga, y de adherencia difusa. Con base en estudios que reportan la presencia de E. coli productora de toxina Shiga y E. coli enteroagregativa en carnes y vegetales en supermercados, se cree que productos alimentarios contaminados contribuyen a la transmisión de estos patógenos y a la infección del hospedero susceptible. Más estudios son necesarios para evaluar los mecanismos de transmisión, el impacto en la epidemiologia de la EDA, y las pautas de manejo y prevención de estos patógenos que afectan la población pediátrica en Colombia.

Evaluación de la vigilancia microbiológica del cólera / Evaluation of cholera microbiological surveillance

Introducción: el cólera constituye una enfermedad infecciosa, por lo que desde hace más de 40 años ha sido objeto de vigilancia en Cuba. La razón de ser de la vigilancia es la obtención de información, su procesamiento, análisis y elaboración de recomendaciones para la acción oportuna. Objetivo: evaluar la vigilancia microbiológica del cólera en el Centro Provincial de Higiene y Epidemiología de La Habana. Método: se realizó un estudio descriptivo transversal de evaluación táctica en el período del I de octubre al I8 de noviembre del año 20I2. El universo lo constituyeron la Vicedirección de Higiene y Epidemiología y la Vicedirección de Microbiología con sus 22 laboratorios. Se seleccionó una muestra no aleatoria, por conveniencia, que quedó integrada por el jefe de departamento de la unidad de análisis y tendencias de salud, el jefe del programa de control de enfermedades de transmisión digestiva, el vicedirector de microbiología y el personal que se encontraba presente en los laboratorios de agua y de enterobacterias. Se aplicó la metodología de la evaluación rápida propuesta por la Dra. Fariñas, visitándose en un período de 2 días, el laboratorio provincial de microbiología. Resultados: se identificaron brechas existente entre lo que estaba orientado para realizar ante todo paciente sospechosos o confirmado de cólera por parte del laboratorio de microbiología y lo que en realidad se estaba realizando. Conclusiones: las acciones de vigilancia microbiológica del cólera en el Centro Provincial de Higiene y Epidemiología fueron evaluadas de medianamente útil. Estructura medianamente suficiente. Proceso aceptable e impacto satisfactorio...

Background: cholera is an infectious disease, so for more than 40 years it has been under surveillance in Cuba. The reason for monitoring cholera in Cuba is to obtain information, processing, analysis, and development of recommendations for appropriate action. Objective: to evaluate cholera microbiological surveillance in Havana Center of Hygiene and Epidemiology. Method: a descriptive cross-sectional study of tactical assessment was conducted from October to 1st November I8th, 20I2. The universe was formed by vice-direction of Hygiene and Epidemiology and vice-direction of Microbiology with its 22 laboratories. A non-random sample of convenience was chosen. it was composed of the head of the department of the unit for analysis and health trends, the program chief for controlling digestive transmission disease, the deputy director of microbiology and the staff who was present in water laboratories and Enterobacteriaceae. A rapid assessment methodology proposed by Dr. Farinas was applied, visiting the provincial microbiology laboratory over a period of 2 days. Results: existing gaps were identified between what was primarily instructed for a suspected or confirmed case of cholera by the microbiology laboratory and what actually was taking place. Conclusions: cholera microbiological surveillance actions were evaluated fairly useful in Havana Center of Hygiene and Epidemiology, as reasonably sufficient structure, good enough process, and satisfactory impact...

Evaluación de la vigilancia del cólera en el policlínico Héroes del Moncada / Evaluation of cholera surveillance at Heroes of Moncada polyclinic

Introducción: la evaluación está concebida como la actividad que permite emitir un juicio de valor. El cólera constituye una enfermedad infecciosa conocida desde tiempos inmemoriales, por lo que desde hace más de 40 años ha sido objeto de vigilancia en Cuba. Múltiples y complejas variables han sido las responsables de la entrada del Vibrio cholerae en el país, condicionando la aparición en el territorio nacional de diversos brotes. Objetivo: evaluar la vigilancia del cólera en el policlínico Héroes del Moncada del municipio Plaza de la Revolución, en el período de octubre-noviembre de 2012. Método: se realizó un estudio descriptivo, transversal, de evaluación táctica. El universo estuvo conformado por: 26 médicos de consultorios de médico de familia, un vicedirector de Higiene y Epidemiología, 3 técnicas de laboratorios, dos de estadísticas y 3 técnicos de Higiene del área. Se seleccionó una muestra por conveniencia que representó el 20 por ciento del universo. Se aplicó la metodología de la evaluación rápida propuesta por la Dra. Teresa Fariñas, visitándose en un período de 2 días un total de 5 consultorios del policlínico. Además se recogió información retrospectiva del mes de octubre y primera quincena de noviembre. Resultados: se identificaron brechas entre lo que estaba orientado vigilar por los médicos y enfermeras de la familia ante todo caso que solicitara atención médica por padecer de una enfermedad diarreica aguda y lo que en realidad se estaba realizando. Conclusiones: la valoración de la vigilancia del cólera en nuestro estudio fue evaluada de medianamente satisfactoria, al calificarse como no útil, con una calidad medianamente aceptable y unos resultados satisfactorios...

evaluation is conceived as the activity that allows a judgment of value. Cholera is an infectious disease known since ancient times, so for more than 40 years it has been under surveillance in Cuba. Multiple and complex variables have been responsible for the entry of Vibrio cholerae in Cuba, conditioning the emergence of several outbreaks on the national territory. Objective: to assess cholera surveillance at Heroes of Moncada polyclinic in Plaza Township, Havana from October to November 2012. Method: a tactical, descriptive, cross-sectional study assessment was performed. The universe consisted of 26 medical practices, a principal assistant of Hygiene and Epidemiology, 3 laboratory technicians, 2 of statistics technicians, and 3 hygiene technicians from this area. A convenience sample was selected representing 20 percent of the universe. The rapid assessment methodology proposed by Dr. Teresa Fariñas was applied, visiting 5 medical practices of this area over a total period of two days. Further background information from October and first half of November was collected. Results: gaps were identified between what was primarily instructed to control by family physicians and nurses in case of health care due to acute diarrheal disease and what actually was taking place. Conclusions: the evaluation of cholera surveillance in our study was assessed fairly satisfactory, by being scored as unuseful, with a fairly acceptable quality and satisfactory results...

Surveillance and analysis on diarrheal disease pathogen spectrum among children under 5 years old in Pudong New Area of Shanghai City / 上海预防医学

[Objective] To investigate the pathogen spectrum and characteristics of diarrheal disea-ses among children under five and to provide the basis for prevention and control measures . [ Methods] From February 2012 to January 2013, a total of 619 cases from 2 sentinel hospitals were collected for case survey .From them were collected stool specimens for detection of enteric pathogenic bacteria and virus nu-cleic acids. [Results] The virus detection rate was norovirus (11.95%), rotavirus(7.27%), enteric adenovirus(2.91%), saporovirus(1.45%) and astrovirus(0.97%).The bacteria detection rate was E. coli(5.65%), nontyphoidal salmonella (2.42%), campylobacter (0.81%), aeromonas hydrophila (0.65%),shigella(0.48%) and yersinia enterocolitica (0.32%).The virus detection rate was 27.70%from August to next March, which showed higher than that of other months (18.48%) (χ2 =7.18,P <0.05).The bacteria detection rate was 15.34%from April to October, showing higher than the rate of oth-er months(3.15%)(χ2 =31.22,P<0.05). [Conclusion] Norovirus is the main pathogen for viral diarrheal diseases in children under five and E .coli is the main pathogen of bacterial diarrheal diseases . All study results suggested that summer and autumn should be as the focus time in prevention and control of bacterial diarrhea , while those of viral diarrhea should cover the whole year .

Características epidemiológicas y clinicoterapéuticas en pacientes ingresados a causa de enfermedad diarreica persistente / Clinical therapeutic and epidemiological characteristics in patients admitted due to persistent diarrheal disease

Se realizó un estudio descriptivo, longitudinal y prospectivo de 62 lactantes con enfermedad diarreica persistente, ingresados en el Servicio de Enfermedades Diarreicas Agudas del Hospital Infantil Docente Sur de Santiago de Cuba, de enero a diciembre del 2010, con vistas a caracterizarles según algunas variables epidemiológicas, clínicas y terapéuticas. La mayoría de los integrantes de la serie eran del sexo masculino (66,1 %), procedían de áreas rurales (53,2 %), y presentaban género de vida regular (51,7 %) y antecedentes de un episodio diarreico (53,2 %). Asimismo, el uso de antimicrobianos previo al ingreso resultó elevado (74,1 %), con prevalencia del metronidazol (32,2 %), la complicación más frecuente fue el déficit enzimático de disacaridasas (67,7 %) y la totalidad de los pacientes no recibió lactancia materna exclusiva, lo cual pudo contribuir al incremento de la frecuencia de la afección.

A descriptive, longitudinal and prospective study was conducted in 62 infants with persistent diarrheal disease, admitted to the Department for Acute Diarrheal Diseases of Southern Teaching Children Hospital in Santiago de Cuba from January to December 2010 to characterize them according to some epidemiological, clinical and therapeutic variables. Most members of the series were males (66.1%), they were from rural areas (53.2%), and had regular living conditions (51.7%) and history of diarrhea (53.2%). Also, the use of antimicrobials before admission was high (74.1%), with prevalence of metronidazole (32.2%), the most frequent complication was the disaccharidase deficiency (67.7%) and the total of the patients did not receive exclusive breastfeeding, which could contribute to increasing the frequency of the condition.

Modificación de conocimientos sobre enfermedades diarreicas agudas en escolares de la Secundaria Básica “Francisco Maceo Osorio” / Modification to knowledge of acute diarrheal diseases in schoolchildren of “Francisco Maceo Osorio” Junior High School

Se realizó una intervención educativa cuasiexperimental en 60 estudiantes de séptimo grado de la Secundaria Básica Urbana "Francisco Maceo Osorio" de Santiago de Cuba, desde noviembre de 2010 hasta febrero de 2011, con vistas a modificar sus conocimientos sobre las enfermedades diarreicas agudas. Se aplicó un cuestionario que incluía determinados aspectos sobre la afección, cuyas respuestas fueron evaluadas en ese momento y 3 meses después de varias sesiones de trabajo, donde se utilizaron técnicas participativas para intercambiar informaciones y amenizar la actividad. Se utilizaron la frecuencia absoluta y el porcentaje como medidas de resumen para variables cualitativas y se aplicó la prueba de McNemar, con nivel de significación de 95 %. Antes del estudio 85,0 % tenían conocimientos inadecuados sobre el tema, lo cual estuvo relacionado con las insuficientes actividades de promoción y prevención que se efectuaban en el centro; comportamiento que fue variado satisfactoriamente después de este (93,3 %). La acción educativa demostró ser eficaz, de manera que esta experiencia podría extenderse a otros centros escolares del territorio.

A quasi-experimental educational intervention was performed in 60 seventh graders of "Francisco Maceo Osorio" Urban Junior High School in Santiago de Cuba, from November 2010 to February 2011, with the purpose of modifying their knowledge of acute diarrheal diseases. A questionnaire was used, which included some aspects on the disease, and their answers were evaluated at that moment and 3 months after several working sessions, where participative techniques were used to exchange information and to make the activity more enjoyable. Absolute frequency and percentage were used as summary measures for qualitative variates and the McNemar test was applied with 95 % significance. Before the study 85.0 % of them had inadequate knowledge of the topic, which was related to the insufficient promotion and prevention activities, but this behavior was successfully changed after that (93.3 %). The educational action proved to be effective, so that this experience could be extended to other schools in the territory.