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

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.

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.

Cryptosporidium diagnosis in different groups of children and characterization of parasite species.

BACKGROUND: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. METHODS: Children's feces were analyzed by modified Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. RESULTS: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). CONCLUSIONS: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

Cryptosporidium diagnosis in different groups of children and characterization of parasite species

ABSTRACT Background: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. Methods: Children's feces were analyzed by modified Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. Results: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). Conclusions: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

Molecular characterization of group A rotavirus isolates obtained from hospitalized children in Salvador, Bahia, Brazil.

Rotavirus is a major cause of infectious diarrhea in infants and young children. The objective of this study was to characterize the genotypes of Human Rotavirus found in children hospitalized with acute diarrhea in the Pediatric Hospital Prof. Hosannah de Oliveira of the UFBA in Salvador, Bahia, Brazil, during the years of 1999, 2000 and 2002. Fecal samples were analyzed (n=358) by methods EIARA and SDS-PAGE for detection of Rotavirus. Positive samples of one or two of these methods (n=168) were submitted to RT-PCR and Multiplex-Nested PCR to determine genotypes G and P. A hundred sixty-eight (46.9%) samples were positive and 190 (53.1%) negative. Only 17 (4.7%) samples had divergent results. The distribution of genotypes G during the first year, showed that the genotype G9 was present in 96,8% of the analyzed samples, in the second year, it was responsible for 96% and in the third year, 88,1%. The characterization of genotypes P demonstrated that the genotype P1A[8] was the most outstanding in all years. In this study we discuss the benefit to control the genotypes of Rotavirus through the molecular characterization for the development of potential vaccines.

Molecular characterization of group A rotavirus isolates obtained from hospitalized children in Salvador, Bahia, Brazil

Rotavirus is a major cause of infectious diarrhea in infants and young children. The objective of this study was to characterize the genotypes of Human Rotavirus found in children hospitalized with acute diarrhea in the Pediatric Hospital Prof. Hosannah de Oliveira of the UFBA in Salvador, Bahia, Brazil, during the years of 1999, 2000 and 2002. Fecal samples were analyzed (n=358) by methods EIARA and SDS-PAGE for detection of Rotavirus. Positive samples of one or two of these methods (n=168) were submitted to RT-PCR and Multiplex-Nested PCR to determine genotypes G and P. A hundred sixty-eight (46.9 percent) samples were positive and 190 (53.1 percent) negative. Only 17 (4.7 percent) samples had divergent results. The distribution of genotypes G during the first year, showed that the genotype G9 was present in 96,8 percent of the analyzed samples, in the second year, it was responsible for 96 percent and in the third year, 88,1 percent. The characterization of genotypes P demonstrated that the genotype P1A[8] was the most outstanding in all years. In this study we discuss the benefit to control the genotypes of Rotavirus through the molecular characterization for the development of potential vaccines.

Estado nutricional de crianças índias do Alto Xingu em 1980 e 1992 e evoluçäo pondero-estatural entre o primeiro e o quarto anos de vida / Nutritional status of indigenous children from the Alto Xingu in 1980 and 1992 and follow-up of weight and height from the first through the fourth years of life

Os objetivos deste estudo realizado com a populaçäo infantil do Alto Xingu foram: (1) analisar a evoluçäo do peso e da estatura entre o primeiro e o quarto anos de vida, (2) comparar o estado nutricional em 1980 e 1992. Avaliaram-se o peso e a estatura de: (1) 81 crianças no primeiro e no quarto ano de vida; (2) 264 crianças avaliadas em 1980 e de 172 em 1992 (idade < 10 anos). As medianas dos escores Z das 81 crianças examinadas no primeiro e no quarto ano de vida revelaram: (1) diminuiçäo do peso para a idade (-0,12 no primeiro ano e -0,51 no quarto ano de vida; p = 0,002); (2) diminuiçäo do peso para a estatura (+1,31 e +0,08; p < 0,001); (3) aumento da estatura para a idade (-1,50 e -0,94, p < 0,001). Entre 1980 e 1992, observou-se: (1) manutençäo do peso para a idade (-0,61 em 1980 e -0,62 em 1992; p = 0,90); (2) manutençäo do peso para a estatura, (+0,27 e +0,34; p = 0,10); e (3) reduçäo da estatura para a idade (-1,04 e -1,22; p = 0,02). Entre o primeiro e quarto ano de vida observou-se reduçäo do déficit de estatura para a idade e do excesso de peso para a estatura. Entre 1980 e 1992, observou-se diminuiçäo da estatura para idade, indicando a necessidade de monitorizaçäo do estado nutricional desta comunidade

Terapia nutricional enteral na síndrome do intestino curto com fórmula infantil elementar / Enteral nutrition therapy in short bowel syndrome with infantile elemental diet

A Síndrome do Intestino Curto (SIC) se caracteriza por importante estado de má absorçäo de nutrientes, que resulta de uma reduçäo substancial do intestino delgado. Este estudo é um relato de caso de um paciente com SIC, com história de ampla rececçäo intestinal. Paciente do sexo masculino, 23 meses, negro, com desnutriçäo grave, peso de internaçäo 6460 g. Avia de acesso para a nutriçäo foi nasogástrica, sonda de polietileno, infusäo contínua e a dieta utilizada foi uma formula infantil elementar (NEOCATE). A oferta calórica inicial foi de 100 kcal/kg/dia e a propéica foi de 3,0 g/kg/dia, com evoluçäo dependente do ganho ponderal e da readaptaçäo intestinal, alcançando oferta calórica final de 200 kcal/kg/dia e protóica de 6 kcal/kg/dia. O paciente foi mantido em balanço metabólico, com acompanhamento diário de peso, ingestäo e perdas. Cuidados das lesöes infectadas nas ostomias, avaliaçäo nutricional bioquímica, antropométrica e clínica constante foram realizadas. Apesar do paciente ter sido encaminhado inicialmwente para Nutriçäo Parenteral Total (NPT), a via enteral foi utilizada com o uso de uma dieta elementar como última escolha antes da NPT. O paciente foi abordado com sucesso, exclusivamente com nutriçäo enteral. Apresentou curva enteral ascendente, com recuperaçäo do estado geral e nutricional, alcançando no quinquagésimo quarto DHI o peso de 8540 g, que possibilitou um teto cirúrgico necessário para a reconstruçäo do transito intestinal. Apesar do encaminhamento inadequado e do manejo inicial incorreto, o estabelecimento de uma terapia nutricional eficaz foi capaz de proporcionar a sobrevida de um paciente absolutamente viável.(au)