RESUMEN
BACKGROUND: Environmental enteric dysfunction (EED) is an enigmatic disorder of the small intestine that is postulated to play a role in childhood undernutrition, a pressing global health problem. Defining the incidence of this disorder, its pathophysiological features, and its contribution to impaired linear and ponderal growth has been hampered by the difficulty in directly sampling the small intestinal mucosa and microbial community (microbiota). METHODS: In this study, among 110 young children (mean age, 18 months) with linear growth stunting who were living in an urban slum in Dhaka, Bangladesh, and had not benefited from a nutritional intervention, we performed endoscopy in 80 children who had biopsy-confirmed EED and available plasma and duodenal samples. We quantified the levels of 4077 plasma proteins and 2619 proteins in duodenal biopsy samples obtained from these children. The levels of bacterial strains in microbiota recovered from duodenal aspirate from each child were determined with the use of culture-independent methods. In addition, we obtained 21 plasma samples and 27 fecal samples from age-matched healthy children living in the same area. Young germ-free mice that had been fed a Bangladeshi diet were colonized with bacterial strains cultured from the duodenal aspirates. RESULTS: Of the bacterial strains that were obtained from the children, the absolute levels of a shared group of 14 taxa (which are not typically classified as enteropathogens) were negatively correlated with linear growth (length-for-age z score, r = -0.49; P = 0.003) and positively correlated with duodenal proteins involved in immunoinflammatory responses. The representation of these 14 duodenal taxa in fecal microbiota was significantly different from that in samples obtained from healthy children (P<0.001 by permutational multivariate analysis of variance). Enteropathy of the small intestine developed in gnotobiotic mice that had been colonized with cultured duodenal strains obtained from children with EED. CONCLUSIONS: These results provide support for a causal relationship between growth stunting and components of the small intestinal microbiota and enteropathy and offer a rationale for developing therapies that target these microbial contributions to EED. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02812615.).
Asunto(s)
Duodeno/microbiología , Microbioma Gastrointestinal , Trastornos del Crecimiento/microbiología , Trastornos de la Nutrición del Lactante/complicaciones , Animales , Bacterias/aislamiento & purificación , Bangladesh , Duodenoscopía , Duodeno/patología , Enfermedades Ambientales/complicaciones , Heces/microbiología , Femenino , Vida Libre de Gérmenes , Crecimiento , Trastornos del Crecimiento/etiología , Humanos , Lactante , Enfermedades Inflamatorias del Intestino/complicaciones , Factor I del Crecimiento Similar a la Insulina/análisis , Enfermedades Intestinales/complicaciones , Masculino , Ratones , Ratones Endogámicos C57BL , Análisis Multivariante , Proteínas Asociadas a Pancreatitis/análisis , Proteoma/análisisRESUMEN
This paper details the phenotypic, genotypic, and antibiotic sensitivity patterns of 88 Vibrio cholerae strains from Zimbabwe. Of the 88 strains, 83 were classified as "altered El Tor" and 5 as "hybrid El Tor" strains. All of the strains were susceptible to tetracycline, doxycycline, ciprofloxacin, and azithromycin by disc diffusion, but susceptibility to tetracycline and azithromycin diminished when observed using the MIC method.
Asunto(s)
Antibacterianos/farmacología , Cólera/epidemiología , Cólera/microbiología , Vibrio cholerae/efectos de los fármacos , Vibrio cholerae/genética , Técnicas de Tipificación Bacteriana , Análisis por Conglomerados , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Tipificación Molecular , Vibrio cholerae/aislamiento & purificación , Zimbabwe/epidemiologíaAsunto(s)
Antibacterianos/uso terapéutico , Cólera/epidemiología , Cólera/terapia , Brotes de Enfermedades , Fluidoterapia/métodos , Saneamiento/normas , Vibrio cholerae O1/aislamiento & purificación , Abastecimiento de Agua , Administración Oral , Antibacterianos/administración & dosificación , Región del Caribe/epidemiología , Cólera/diagnóstico , Cólera/mortalidad , Cólera/transmisión , Brotes de Enfermedades/estadística & datos numéricos , Doxiciclina/uso terapéutico , Esquema de Medicación , Eritromicina/uso terapéutico , Salud Global , Haití/epidemiología , Humanos , Infusiones Intravenosas , América Latina/epidemiología , Pandemias/estadística & datos numéricos , Salud Pública/normas , Salud Pública/estadística & datos numéricos , Soluciones para Rehidratación/administración & dosificación , Tetraciclina/uso terapéutico , Abastecimiento de Agua/normas , Organización Mundial de la SaludRESUMEN
A case of typhus fever is presented. On admission, the clinical diagnosis was typhoid fever. Forty-eight hours after admission, the presence of subconjunctival haemorrhage, malena, and jaundice raised the possibility of a different aetiology, the two most likely differentials being dengue and typhus. Finally, a co-infection of typhoid and typhus was discovered. This uncommon clinical scenario should be taken into account in the management of patients with high fever on admission being treated as a case of typhoid fever.