Management of acute infectious diarrhea for children living in resource-limited settings.

Acute infectious gastroenteritis continues to be a leading cause of morbidity and mortality in children below 5 years of age, with the majority of deaths concentrated in 35 'low income' countries. In these countries the under five years of age mortality rates reach 100 per 1000 live births, of which a significant proportion are associated with acute diarrhea. Rotavirus, cryptosporidium, Shigella spp and enterotoxigenic Escherichia coli are the main pathogens causing disease in these settings, although other bacteria and parasites can cause moderate to severe disease in different regions and situations. Treatment of children in these setting should be focused on appropriate rehydration, early hospitalization of severely malnourished children, zinc supplementation, and in specific situations, antimicrobials should be considered. The rationale for antimicrobial use should be based on the potential benefits based on published literature and the opportunity for use. This review provides a pathogen-specific update on the potential benefits of antimicrobials and suggests an empirical management approach for children suffering an acute watery or bloody diarrhea in a resource-limited region.

Hyperimmune bovine colostrum for treatment of GI infections: a review and update on Clostridium difficile.

Hyperimmune bovine colostrum (HBC), produced by vaccination of a cow during gestation, is rich in targeted immunoglobulins, and can be used to treat a variety of diseases. The published history of HBC use for treating gastrointestinal infections in humans has developed over the past several decades and demonstrates the promise of this type of therapeutic for GI infectious disease. HBC, or purified derivative products, have been used successfully for treatment or prevention of cryptosporidiosis, shigellosis, rotavirus, enterotoxigenic E. coli, and C. difficile infection (CDI). Given the positive results of previous studies using HBC for treatment of CDI, we have produced HBC with antibodies against the two most important virulence factors of C. difficile, TcdA and TcdB, using a novel recombinant vaccine. Our preliminary results demonstrate efficacy of the HBC product for treatment of CDI in the gnotobiotic piglet model, and warrant more thorough investigation. HBC may provide an effective treatment alternative to antibiotics, which can spare the normal gut microflora, and reduce rates of recurrence and antibiotic resistance.

Bovine colostrums: a review of clinical uses.

Bovine colostrums are the "early" milk produced by cows during the first several days post-parturition. This "early" milk has a nutrient profile and immunological composition that differs substantially from "mature" milk. Included in the nutrient profile are higher amounts of immunoglobulins, growth factors, cytokines, and nucleosides than are found in milk. Bovine colostrums are also rich in oligosaccharides, antimicrobials, and immune-regulating factors. Available evidence suggests a beneficial effect of supplementation of bovine colostrums in improving body composition, aspects of athletic performance, diarrhea in persons with immune-deficiency syndromes, NSAID-induced gastrointestinal disturbances, and aspects of the acute phase response that occurs secondary to surgery. Specific hyperimmune bovine colostrums, produced to have high neutralizing titer activity against Cryptosporidia, H. pylori, measles, rotavirus, and Shigella sp., appear to have clinical utility in conditions associated with these infectious organisms.

[Kaopectate in the combined treatment of patients with intestinal infections]. / Kaopektat v kompleksnom lechenii bol'nykh kishechnymi infektsiiami.

The paper presents results of multiple-modality treatment of patients with acute intestinal infections with making use of the drug preparation Kaopectate incorporating activated attapulgite which is a natural mixture of hydrates of magnesium silicate and silicate of alumina. The above drug has been shown to be endowed with a antidiarrheal and detoxifying activities.

Diarreia causada por Shigella: aspectos clinicos e terapeuticos / Diarrhea caused by Shigella: clinical and therapeutical aspects

Os autores estudaram diarreias graves causadas por Shigella sp que foram atendidas no Servico de Emergencias do Hospital Universtario da USP durante tres anos. Esse agente foi isolado de 65 casos de diarreia aguda que corresponderam a 3,1 por cento dos casos graves e 22,3 por cento dos quadros clinicos de disenteria. A S.flexneri foi a mais isolada, seguida pela S.sonnei, na proporcao de 3:1...

[Analysis of 7843 outpatients with diarrhoea].

7843 outpatients with diarrhoea registered at clinical units of villages, townships and counties were analysed in August 20-30, 1988. Among those, 3129 (39.9%) cases were children under 5 years of age, and 18 (0.23%) with cholera, 2222 (28.33%) with dysentery, 122 (1.56%) with typhoid or paratyphoid fever and 5479 (69.88%) with other diarrhoea diagnosed by clinical symptoms. It was shown that the mediate or severe, mild and no dehydration was 5.37%, 26.97% and 66.66% respectively, and that the use rate of antibiotics, I.V. infusion, ORS and Chinese Herbs was 88.94%, 19.32%, 27.64% and 15.86% respectively. The conclusion elucidated that the high proportion of seeking medical services within 24 hours and few cases of mediate or severe dehydration were one of the reasons why there was low case-fatality of diarrhoea in China.