Diarrhea as the Initial Presentation in a Patient With HIV Diagnosed With Hodgkin's Lymphoma.

Hodgkin's lymphoma (HL) is a form of cancer that involves abnormal lymphocyte proliferation which affects the lymphatic system. Patients with HIV are at increased risk of developing HL, despite the introduction of combination antiretroviral therapy. The most common presentation of HL is painless lymphadenopathy with classic constitutional symptoms in advanced disease. Here we discuss a 39-year-old female with a history of HIV on emtricitabine/tenofovir and dolutegravir who presented with four days of worsening diarrhea along with fevers and chills. She had a similar presentation at a nearby hospital four months prior. After initial concern for gastrointestinal infection, an extensive infectious workup was conducted and was negative. After complaints of sore throat and increased confusion during the hospital stay, a CT Chest and Neck revealed diffuse lymphadenopathy. Severely elevated ferritin levels raised concern for secondary hemophagocytic lymphohistiocytosis and prompted expedited ultrasound-guided cervical lymph node (LN) core biopsy and bone marrow biopsy. Ultrasound-guided core biopsy of the LN showed classical Hodgkin's lymphoma of mixed cellularity. The patient was started on doxorubicin, vinblastine, and dacarbazine + nivolumab. This is a case of a patient with HIV who presented with chronic diarrhea of unidentifiable origin and was ultimately diagnosed with classical Hodgkin's lymphoma during her hospitalization and highlights the importance of maintaining lymphoproliferative diseases on the differential in patients with HIV and gastrointestinal symptoms.

Promising clinical and immunological efficacy of Bacillus clausii spore probiotics for supportive treatment of persistent diarrhea in children.

Persistent diarrhea is a severe gastroenteric disease with relatively high risk of pediatric mortality in developing countries. We conducted a randomized, double-blind, controlled clinical trial to evaluate the efficacy of liquid-form Bacillus clausii spore probiotics (LiveSpo CLAUSY; 2 billion CFU/5 mL ampoule) at high dosages of 4-6 ampoules a day in supporting treatment of children with persistent diarrhea. Our findings showed that B. clausii spores significantly improved treatment outcomes, resulting in a 2-day shorter recovery period (p < 0.05) and a 1.5-1.6 folds greater efficacy in reducing diarrhea symptoms, such as high frequency of bowel movement of ≥ 3 stools a day, presence of fecal mucus, and diapered infant stool scale types 4-5B. LiveSpo CLAUSY supportive treatment achieved 3 days (p < 0.0001) faster recovery from diarrhea disease, with 1.6-fold improved treatment efficacy. At day 5 of treatment, a significant decrease in blood levels of pro-inflammatory cytokines TNF-α, IL-17, and IL-23 by 3.24% (p = 0.0409), 29.76% (p = 0.0001), and 10.87% (p = 0.0036), respectively, was observed in the Clausy group. Simultaneously, there was a significant 37.97% decrease (p = 0.0326) in the excreted IgA in stool at day 5 in the Clausy group. Overall, the clinical study demonstrates the efficacy of B. clausii spores (LiveSpo CLAUSY) as an effective symptomatic treatment and immunomodulatory agent for persistent diarrhea in children.Trial registration: NCT05812820.

Microscopic Colitis in a Young Male: Unveiling the Rarity.

In recent decades, microscopic colitis (MC) has become increasingly recognized as a common contributor to diarrhea and lower gastrointestinal symptoms, particularly among the older demographic. The condition is distinguished by persistent diarrhea with loose watery stools, and endoscopic examination is typically normal with characteristic histopathologic findings. MC is rarely seen under 30 years of age and is less common in males. Our case highlights an exceedingly uncommon clinical setting as it involves a young male who was diagnosed with collagenous colitis. The diagnosis of MC can easily be missed by physicians during initial evaluation. Specifically in irritable bowel syndrome patients with diarrhea predominant symptoms, a colonoscopy should be performed and biopsies should be taken from the entire colon to rule out MC.

Whipple's Disease: A Case Report.

Whipple's disease (WD) is caused by Tropheryma whipplei, frequently found in lamina propria's macrophages in the small intestine. It is a rare and chronic systemic infection, and the principal clinical manifestations are diarrhea, weight loss, abdominal pain, and arthralgia. The diagnosis is difficult mainly because of its rarity and should be considered in patients with arthralgias, diarrhea, abdominal pain, and weight loss after more common conditions have been excluded. The laboratory diagnosis is established by a duodenal biopsy. The treatment involves 14 days of intravenous antibiotics with good penetration in the cerebrospinal fluid (i.e., ceftriaxone) and one-year treatment with oral co-trimoxazole. Early diagnosis and proper treatment are crucial because it improves the prognosis. We report the case of a 58-year-old female with skin hyperpigmentation, loss of appetite and weight (16% of body weight in three months), nausea, upper abdominal pain, and diarrhea. Esophagogastroduodenoscopy and colonoscopy were performed to obtain biopsy samples, which, together with laboratory tests and microbiological studies, led to a diagnosis of Whipple's disease.

The Overlooked Agent: Cytomegalovirus Colitis in an Immunocompetent Patient.

Cytomegalovirus (CMV) colitis is usually associated with immunosuppressed patients, which by the classic definition are individuals who have immunosuppressed associated conditions (human immunodeficiency virus [HIV], oncology diseases, inflammatory bowel disease, transplant patients) or who are submitted to immunosuppressing therapies (for instance, corticosteroids, chemotherapeutic agents or immunomodulation therapies). In immunocompetent patients, this diagnosis tends to be often missed, leading to a delay in initiating proper management. We present a case of a 91-year-old woman that was diagnosed with CMV colitis without any identified formal immunocompromising factors. We intend to highlight the need to review the definition of an immunosuppressed individual and emphasize that CMV colitis should be considered in the differential diagnosis, especially in elderly patients and those with underlying conditions that can possibly affect their immune status, since prompt diagnosis and treatment are essential and influence the prognosis.

Vasoactive Intestinal Peptide Tumor as the Cause of Persistent Diarrhea: A Diagnostic Challenge.

Although chronic diarrhea is frequent, some of its causes are rare, namely, neuroendocrine tumors (NETs). Due to their rarity and non-specific symptoms, such as diarrhea, they are often underdiagnosed. An 80-year-old woman presented to the emergency department due to emesis and watery diarrhea. Blood tests showed acute kidney injury, hypokalemia, and metabolic acidosis. An abdominal computed tomography revealed a 51 mm pancreatic lesion. An endoscopic ultrasound-guided biopsy raised the hypothesis of a NET. The patient refused surgery and was lost to follow-up. At the eighth hospitalization, 11 months later, the suspicion of a vasoactive intestinal peptide tumor (VIPoma) was raised and confirmed by assessing the vasoactive intestinal peptide (VIP) levels (>100 pmol/L). Octreotide was started with the resolution of the symptoms. 68Ga-DOTANOC positron emission tomography/computed tomography excluded metastatic disease. After six months of octreotide therapy, the tumor shrunk 13 mm in maximum diameter. At the last follow-up, one year later, she remained asymptomatic. The delayed diagnosis of VIPoma led to multiple life-threatening episodes. This case highlights the importance of considering all potential differential diagnoses of common symptoms such as diarrhea. Although VIPomas are rare, clinicians should be aware of this entity and suspect this diagnosis in patients with chronic diarrhea with a poor response to standard antidiarrheal agents. Somatostatin analogs should be promptly prescribed for symptom control and tumor progression prevention in patients who refuse surgery or have unresectable tumors. Tumor shrinkage might also be observed in these cases.

Mycophenolate Mofetil-Induced Cytomegalovirus Colitis in a Patient With Polymyositis.

As the rate of autoimmune conditions and cancers is increasing in the United States, a larger number of patients are being managed with immunosuppressive medications. Diarrhea is a common problem in immunocompromised patients. A feared complication of immunosuppression is infection with opportunistic pathogens. Cytomegalovirus is an opportunistic infection that can cause infection in a variety of different organ systems, including affecting the gastrointestinal system. Severe infection is most commonly seen as a complication of acquired immunodeficiency syndrome (AIDS), organ transplant, hematological malignancy, or cancer therapy. This case report describes a case of cytomegalovirus colitis in an immunosuppressed patient following mycophenolate mofetil (CellCept) therapy.

Frecuencia de parasitismo intestinal en niños con diarrea persistente en el Área Sanitaria Sur de Sevilla

RESUMEN Introducción: La diarrea persistente está incluida en una gran categoría denominada síndrome de diarrea crónica, problema relativamente común de consulta médica en la edad pediátrica. La importancia y prevalencia de la diarrea persistente de etiología parasitaria es poco conocida en España. Objetivo: Determinar la prevalencia de parasitismo intestinal en niños con síndrome de diarrea persistente, así como las características clínicas asociadas a la etiología parasitaria en el Área Sanitaria Sur de Sevilla (España). Métodos: Estudio retrospectivo y de corte transversal realizado en un año (mayo de 2017-mayo de 2018). Se incluyeron a pacientes en edad pediátrica que consultaban por cuadro diarreico superior a 2 semanas y/o dolor abdominal. El estudio de laboratorio incluyó la determinación de sustancias reductoras, leucocitos fecales y grasas, además del estudio de la etiología infecciosa (bacterias, virus o parásitos). Resultados: De los 777 niños incluidos, 406 (52,3 %) correspondían al sexo masculino y 37 (147,7 %) al sexo femenino, con edades entre 1 mes y 14 años (mediana= 6 años). La presencia de parásitos fue detectada en el 6,9 % (54/777) de las muestras. Cuando se estratificaron los resultados por tipo de parasito, se observó que el 24,1% (13 casos) correspondía a Giardia sp., 14,8 % (8 casos) a Cryptosporidium sp., 55,6 % (30 casos) a Blastocystis sp., 3,6 % (2 casos) a Dientamoeba sp. y 1,9 % (1 caso) a Endolimax sp. Conclusiones: Los resultados revelan un escenario en el que la prevalencia de parásitos con valor clínico demostrado fue del 2,7 %. Esto lleva a considerar la conveniencia de incluir el estudio de parásitos en una segunda fase, después de descartar otras condiciones clínicas más prevalentes en niños con diarrea persistente, además de limitar el estudio de parásitos a la detección de Giardia sp. y Cryptosporidium sp.

ABSTRACT Introduction: Persistent diarrhea belongs in a large category known as chronic diarrhea syndrome, a relatively common concern in children's medical consultation. The importance and prevalence of persistent diarrhea of parasitic etiology are not sufficiently known in Spain. Objective: Determine the prevalence of intestinal parasite infection in children with persistent diarrhea syndrome and the clinical characteristics associated to its parasitic etiology in Seville South Health Area (Spain). Methods: A cross-sectional retrospective study was conducted during one year (May 2017 to May 2018) of patients in pediatric ages who attended consultation for a diarrhea picture of more than two weeks' evolution and/or abdominal pain. Laboratory testing included determination of reducing substances, fecal leukocytes and fats, as well as of the causative agents of the infection (bacteria, viruses or parasites). Results: Of the 777 children included in the study, 406 (52.3%) were male and 37 (147.7%) were female; mean age was six years (1 month to 14 years). Parasites were detected in 6.9% (54/777) of the samples. Stratification of results by parasite type showed that 24.1% (13 cases) corresponded to Giardia sp., 14.8 % (8 cases) to Cryptosporidium sp., 55.6 % (30 cases) to Blastocystis sp., 3.6 % (2 cases) to Dientamoeba sp. y 1.9 % (1 case) to Endolimax sp. Conclusions: According to the results obtained, the prevalence of parasites with demonstrated clinical value is 2.7%. It is therefore advisable to include the study of parasites in a second stage, after ruling out other clinical conditions which are more prevalent in children with persistent diarrhea, and limit the study to the detection of Giardia sp. and Cryptosporidium sp.

Risk Factors and Outcomes of Hospital Acquired Pneumonia in Young Bangladeshi Children.

Hospital acquired pneumonia (HAP) is common and often associated with high mortality in children aged five or less. We sought to evaluate the risk factors and outcome of HAP in such children. We compared demographic, clinical, and laboratory characteristics in children <5 years using a case control design during the period of August 2013 and December 2017, where children with HAP were constituted as cases (n = 281) and twice as many randomly selected children without HAP were constituted as controls (n = 562). HAP was defined as a child developing a new episode of pneumonia both clinically and radiologically after at least 48 h of hospitalization. A total of 4101 children were treated during the study period. The mortality was significantly higher among the cases than the controls (8% vs. 4%, p = 0.014). In multivariate logistic regression analysis, after adjusting for potential confounders, it was found that persistent diarrhea (95% CI = 1.32-5.79; p = 0.007), severe acute malnutrition (95% CI = 1.46-3.27; p < 0.001), bacteremia (95% CI = 1.16-3.49; p = 0.013), and prolonged hospitalization of >5 days (95% CI = 3.01-8.02; p < 0.001) were identified as independent risk factors for HAP. Early identification of these risk factors and their prompt management may help to reduce HAP-related fatal consequences, especially in resource limited settings.

Frequency of Cryptosporidiosis in Children having Persistent Diarrhea.

OBJECTIVE: Globally childhood diarrheal diseases continue to be the second leading cause of death. Cryptosporidium spp are important intestinal parasites that cause diarrhea in humans and animals particularly in developing countries. This investigation was carried out to find out the frequency of cryptosporidiosis in children presenting with persistent diarrhea. METHODS: Two hundred stool samples were collected in this descriptive cross-sectional study conducted at Microbiology Department, Combined Military Hospital, Lahore Pakistan between the months of July to Dec 2014. Children aged five years to 12 years who presented with persistent diarrhea were included in the study. Stool specimens were processed using the modified acid-fast staining method, and microscopically examined for Cryptosporidium infection. RESULTS: The average age of study participants was 7.95 with a standard deviation of 2.21 years. Among the participants 66% were males whereas 34% were females. Twenty eight percent had presence of oocysts in stool samples. CONCLUSIONS: The frequency of Cryptosporidiosis among children with persistent diarrhea was 28%. This high frequency indicates that this population is uniquely susceptible to infection. It also highlights the need for education about hygiene, accurate diagnosis, and treatment of Cryptosporidiosis. There is also a need for additional studies regarding the occurrence of this pathogen.

GC-MS and metabolomics analysis of amino acids, glucose and urinary metabolic pathways and characteristics in children with spleen-deficiency diarrhea.

Diarrhea is a disease, and patients must have bowel movements at least three times per day. This condition may last for several days and may cause dehydration due to fluid loss. Spleen-deficiency makes a person more vulnerable to some infectious diseases. Persistent diarrhea due to spleen-deficiency may affect amino acids and glucose metabolic pathways, and urinary metabolic characteristics. For this purpose, this research was carried out to investigate the pathogenesis and changes of metabolic profiling in urine samples that come from 3 months to 3 years old children with persistent diarrhea due to Spleen-deficiency were analyzed by metabolomics methods based on gas chromatography and mass spectrometry (GC-MS). The urine samples were collected and divided into normal children group (NC group, n=30), persistent diarrhea group (PD group, n=30)．The endogenous metabolites in urine were obtained by GC-MS. Principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) was used to analyze the data．The results were analyzed by one-way analysis of variance and Fold change．Finally，there was a significant difference between the normal group and the diarrhea group, and the significant metabolites, glutamic acid, serine，phenylalanine, histidine, and et al. were identified between two groups. The metabolism of glycine, serine and threonine, arginine and proline, glutathione and pentose phosphate were involved. The result demonstrated that amino acid metabolism and glucose metabolism were the main metabolic pathways and responsible for persistent diarrhea due to Spleen-deficiency.

The application research of xTAG GPP multiplex PCR in the diagnosis of persistent and chronic diarrhea in children.

BACKGROUND: Persistent and chronic diarrhea is difficult to treat, and infection is still the main cause. In this study, we investigate the application value of xTAG gastrointestinal pathogen panel (xTAG GPP) multiplex PCR in the early diagnosis of persistent and chronic diarrhea in children and to understand the epidemiology of intestinal diarrhea pathogens. METHODS: One hundred ninety-nine specimens were collected from Nanjing Children's Hospital Affiliated to Nanjing Medical University (Nanjing, China). We compared the xTAG GPP multiplex PCR assay with traditional methods (culture, rapid enzyme immunoassay chromatography, and microscopic examination) and performed a statistical analysis. RESULTS: The positive rate of the xTAG GPP multiplex PCR assay of diarrhea specimens from 199 patients was 72.86% (145/199). The virus detection rate was 48.7%, and rotavirus A was the most common organism detected (34.67%), concentrated in winter, and was common in children. The second most common organism detected was norovirus GI/GII (20.6%). The positive rate of this bacteria was 40.2%, and Campylobacter (22.11%, 44/199) was most frequently detected. C. difficile toxins A/B and Salmonella was detected in 44 and 17 samples, respectively. Infections with Shigella occurred 4 times, and E. coli O157 was only detected once. Three samples were parasitic (1.51%), two samples were positive for Entamoeba histolytica, and one was positive for Cryptosporidium. Adenovirus 40/41, STEC, ETEC, Giardia, Yersinia enterocolitica and Vibrio cholerae were not detected. In total, 86 (43.2%) infected specimens with a single pathogen were detected. There were 59 coinfections (29.65% of the samples) of viruses and/or bacteria and/or parasites. Coinfections involved 49 double infections (24.62%), 9 triple infections (4.52%) and 1 quadruple infections (0.5%). Norovirus GI/GII was found to have the highest involvement, with 32 coinfections (16.08%). CONCLUSION: The xTAG GPP multiplex PCR assay is simple, sensitive, and specific and can be used as a quick way to diagnose persistent and chronic diarrhea in children.

Efficacy of a Green Banana-Mixed Diet in the Management of Persistent Diarrhea: Protocol for an Open-Labeled, Randomized Controlled Trial.

BACKGROUND: Diarrhea is the second-leading cause of death in children under 5 years of age. In low- and middle-income countries, 3%-20% of acute diarrheal episodes become persistent diarrhea (PD) (ie, duration ≥14 days), which results in 36%-56% of all diarrheal deaths. In Bangladesh, PD causes >25% of diarrhea-related deaths. Commensal gut microbiota dysbiosis is increasingly recognized in the pathogenesis of PD. Hospital-based management of PD requires a hospital stay, which increases the risk of infection and hospital costs. The higher cost of treatment and high case-fatality rates reiterate PD as an important public health problem. At the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), for the last two decades, a consensus-based guideline has been followed for PD. Observation has revealed that green banana helps in the resolution of diarrhea. However, no larger prospective study has been conducted to evaluate the efficacy of green banana in the management of PD among children older than 6 months of age. OBJECTIVE: Our objective is to assess the efficacy of full-strength rice suji (semolina) with and without green banana compared to three-quarter-strength rice suji in the management of PD in children aged 6-36 months at the Dhaka Hospital of the icddr,b. METHODS: This open-labeled, randomized controlled study aims to enroll a total of 145 children with PD who have not been improving on a diet of milk suji. Children will be randomized into three different diet-specific groups: full-strength rice suji containing green banana, full-strength rice suji alone, and three-quarter-strength rice suji. The primary outcome is the percentage of children who recovered from diarrhea by day 5. RESULTS: Recruitment and data collection began in December 2017 and were completed in November 2019. Results are expected by April 2020. CONCLUSIONS: This study is expected to provide insights into the incorporation of green banana into the dietary management of PD. This would be the first study to investigate the role of microbiota and metabolomics in the pathogenesis of PD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03366740; https://clinicaltrials.gov/ct2/show/NCT03366740. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15759.

Antibiotic resistance profiling of pathogenic Enterobacteriaceae from Cluj-Napoca, Romania.

INTRODUCTION: Members of the family Enterobacteriaceae are commonly identified in the clinical laboratory, being responsible for a substantial range of infections. This study aimed to investigate phenotypic and genotypic resistance traits in pathogenic Enterobacteriaceae isolated from outpatients in Cluj-Napoca, Romania. METHODS: Pathogenic Enterobacteriaceae were isolated from urinary tract infections, wound infections and persistent diarrhea in a private laboratory from Cluj-Napoca, Romania. Bacterial strains were biochemically identified and subjected to antimicrobial susceptibility testing by disk diffusion. The carriage of antibiotic resistance genes and of class 1 integron were assessed by PCR. RESULTS: E. coli and Enterobacter spp. were the most prevalent pathogens. High levels of resistance were observed against folate pathway inhibitors (74%), fluoroquinolones (49%) and penicillins (44%). The incidence of carbapenem resistance was 3%. The strains displaying phenotypic resistance were able to produce ß-lactamase enzymes encoded by bla TEM, bla TEM-1, bla SHV-1 and bla CTX-M, aminoglycoside modifying enzymes due to the carriage of aac(3)-IIIa, aac(6')-II and aac(6')-Ie-aph(2"), to possess fluoroquinolones resistance due to qnrS DNA gyrase protection proteins and resistance to folate pathway inhibitors due to dihydropteroate synthases encoded by sul1, sul2 and sul3 genes. The high frequency of intI1 integrase was associated to sulphonamide resistance (r=0.48; p<0.001) and also to fluoroquinolone resistance (r=0.27; p=0.011), but no significant associations in the co-occurrence of specific antibiotic resistance genes and intI1 were found in pathogenic Enterobacteriaceae. CONCLUSIONS: An important proportion of pathogenic Enterobacteriaceae were multidrug resistant, due to a wide diversity of mechanisms encoding genetic resistance.

Negative Impact of Prolonged Antibiotics or Persistent Diarrhea on Vitamin K1 Levels in 2-24 Weeks aged Egyptian Infants.

BACKGROUND: To evaluate the hazard of prolonged antibiotic therapy and/or persistent diarrhea on vitamin K1 (VK1) level and bleeding profile in infants (2-24 weeks). METHODS: A one-year case-control study, conducted at Ain Shams University, Egypt. 338 infants (2-24 weeks) were recruited and divided into 3 groups (1:1:3 ratios); group A (n=67) patients who received antibiotics for ≥10 days, group B (n=67) who had persistent diarrhea ≥ 14 days and group C (n=204) age- and gender- matched infants who had not either received antibiotics nor had diarrhea. All subjected to clinical assessment, bleeding history and had their complete blood count (CBC), PT and PTT, liver transaminases and VK1 level assayed. RESULTS: There was a significant increase in frequency of VKDB (vitamin K deficiency bleeding) and abnormal bleeding profile in cases than control group. There was significant negative correlation between VK1 level and duration of diarrhea, length of antibiotics used and bleeding profile. Antibiotic usage has hazardous effect on VK1 level in those with diarrhea; more patients were receiving antibiotic in those with persistent diarrhea and VKDB (N=55) than those with persistent diarrhea and normal VK1 (N=12). The longer duration of antibiotic therapy the lower level of VK1. Combining cephalosporin/penicillin therapy and/or diarrhea, in particular, had an impact on VK1 level. CONCLUSION: VKDB, a preventable cause of life-threatening hemorrhage, is still a major health problem in Egyptian infants, where persistent diarrhea and misuse of antibiotics are prevalent, necessitate a booster dose of VK in those high risk infants.

Review: chronic and persistent diarrhea with a focus in the returning traveler.

BACKGROUND: Travelers' diarrhea is a common malady afflicting up to 50% of travelers after a 2-week travel period. An appreciable percentage of these cases will become persistent or chronic. We summarized the published literature reporting persistent/chronic diarrhea in travelers elucidating current understanding of disease incidence, etiology and regional variability. METHODS: We searched electronic databases (Medline, Embase, and Cochrane database of clinical trials) from 1990 to 2015 using the following terms: "chronic or persistent diarrh* and (returning) travel* or enteropathogen, GeoSentinel, and travel-associated infection. Included studies published in the English language on adult returning travelers (duration < 3-months) reporting denominator data. Point estimates and standard 95% confidence intervals were calculated for incidence using a random-effects model. Study incidence heterogeneity rates were assessed using x2 heterogeneity statistics, graphically represented with Forest plots. RESULTS: We identified 19 studies meeting the inclusion criteria (all published after 1999). 18 studies reported upon the incidence of persistent/chronic diarrhea as a syndromic diagnosis in returning travelers; one study reported adequate denominator data from which to assess pathogen specific etiology. Giardiasis comprise an appreicaible percentage of infectious mediated persistent/chronic diarrhea in returning travelers. The overall estimate of persistent/chronic diarrhea incidence was 6% (0.05-0.07) in 321,454, travelers; with significant heterogeniety observed across regions. The total number of regional travelers, and point estimates for incidence (95% CI) for Latin American, African, and Asian travelers were [15816 (0.09 [0.07-0.11]), 42290 (0.06 [0.05-0.07]), and 27433 (0.07 [0.06-0.09])] respectively. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Persistent/chronic diarrhea ranked fourth as a syndromic diagnosis in all regions. CONCLUSIONS: Persistent/Chronic diarrhea is a leading syndromic diagnosis in returning travelers across all regions. The 6% incidence [proportionate morbidity (PM) of 60] observed in over >300,000 global travelers is comparable to prior estimates. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Giardiasis comprises an appreciabile percentatge of travel-associated infectious mediated persistent/chronic diarrhea. There's a dearth of published data characterizing the incidence of specific enteropathogenic etiologies for persistent/chronic diarrhea in returning travelers.

The relationship analysis between children with chronic persistent diarrhea and food intolerance test / 国际检验医学杂志

Objective To investigate and compare the level of food specific IgG antibody between children with chronic diarrhea and healthy children,analyze the correlation between chronic persistent diarrhea and food intolerance.Methods The research objective of 105 cases was obtained from in-patient children in Shenzhen children′s hospital diagnosed as chronic persistent diarrhea and 94 cases diagnosed not diarrhea as control group in the year of 2015.The level of fourteen food allergen specific IgG in serum was detected using enzyme-linked immunosorbent (ELISA) in 199 cases.Results Chronic persistent diarrhea was more observed in 0-1 years old of infants.The positive rate of 14 food allergen specific IgG in 105 cases of children with chronic persistent diarrhea in turn from high to low was milk,eggs,tomatoes,rice,wheat,cod,corn,beef,soybeans,chicken,pork,mushrooms,shrimp and crab;14 food allergen specific IgG in 94 cases of children not with diarrhea in turn from high to low was arranged as follows:milk,eggs,tomatoes,rice,wheat,soybeans,cod,corn,beef,crab,chicken,mushroom,shrimp and pork.Among them the level of milk,beef and soybeans in the comparison of the two groups was significantly different(P<0.05).Conclusion Food intolerance was one of the important factors caused chronic persistent diarrhea in children.Reasonable diet for children may be the effective treatment of chronic persistent diarrhea.

Vitamin A deficiency impacts the structural segregation of gut microbiota in children with persistent diarrhea.

To investigate whether gut microbiota is associated with vitamin A nutritional levels in children with persistent diarrhea, a total of 59 pediatric patients with persistent diarrhea aged 1-12 months were selected from the Department of Gastroenterology at the Children's Hospital of Chongqing Medical University, China. Subjects were hospitalized and divided into VA-deficient (n = 30) and VA-normal (n = 29) groups according to their venous serum retinol levels. Fecal samples from all 59 subjects were collected immediately after admission and analyzed by Illumina MiSeq for 16S rRNA genes to characterize the overall microbiota of the samples. The gut microbiota of the VA-deficient and VA-normal groups were compared using a bioinformatic statistical approach. The Shannon index (p = 0.02), Simpson index (p = 0.01) and component diagram data indicated significantly lower diversity in the VA-deficient than the VA-normal group. A metagenome analysis (LEfSe) and a differentially abundant features approach using Metastats revealed that Escherichia coli and Clostridium butyricum were the key phylotypes of the VA-normal group, while Enterococcus predominated the VA-deficient group. In conclusion, the diversity of gut microbiota and the key phylotypes are significantly different in children with persistent diarrhea at different VA nutritional levels.

Effect of vitamin A and Zn supplementation on indices of vitamin A status, haemoglobin level and defecation of children with persistent diarrhea.

To investigate the effect of vitamin A and Zn supplementation on vitamin A status, haemoglobin level and defecation of children with persistent diarrhea, a total of 160 paediatric patients were randomly assigned to one of four intervention groups: daily supplementation of 1,500 IU VA for 14 days; daily Zn supplementation for 14 days; daily supplementation with both VA and Zn for 14 days; no supplementation. One hundred twenty-seven children with persistent diarrhea finished intervention (33 were lost to follow-up). Among the 127 children, 41 (32.28%) had anaemia, 104 (81.89%) had a VA deficiency and 38 (29.92%) had an iron insufficiency. Supplementation with VA or VA + Zn enhanced the serum VA levels and ameliorated anaemia. Supplementation with Zn and VA + Zn for 5 days significantly improved defecation, where the VA + Zn treatment resulted in superior outcomes. After 14 days of intervention, the total effectiveness rates were 93.94%, 96.77% and 96.67% in the three groups, significantly greater than that of the non-supplementation group (72.73%). These results indicate that single VA or concurrent VA + Zn supplementation can improve vitamin A status, haemoglobin level and defecation. However, concurrent VA + Zn supplementation is the optimal option and can shorten the duration of persistent diarrhea and markedly improve nutritional status. (www.clinicaltrials.gov registration number: ChiCTR-IOR-14005498).

Management of children with prolonged diarrhea.

Prolonged diarrhea is usually defined as acute-onset diarrhea lasting 7 days or more, but less than 14 days. Its trend has been declining in recent years because of improvement in the management of acute diarrhea, which represents the ideal strategy to prevent prolonged diarrhea. The pathogenesis of prolonged diarrhea is multifactorial and essentially based on persistent mucosal damage due to specific infections or sequential infections with different pathogens, host-related factors including micronutrient and/or vitamin deficiency, undernutrition and immunodeficiency, high mucosal permeability due to previous infectious processes and nutrient deficiency with consequential malabsorption, and microbiota disruption. Infections seem to play a major role in causing prolonged diarrhea in both developing and developed areas. However, single etiologic pathogens have not been identified, and the pattern of agents varies according to settings, host risk factors, and previous use of antibiotics and other drugs. The management of prolonged diarrhea is complex. Because of the wide etiologic spectrum, diagnostic algorithms should take into consideration the age of the patient, clinical and epidemiological factors, and the nutritional status and should always include a search for enteric pathogens. Often, expensive laboratory evaluations are of little benefit in guiding therapy, and an empirical approach may be effective in the majority of cases. The presence or absence of weight loss is crucial for driving the initial management of prolonged diarrhea. If there is no weight loss, generally there is no need for further evaluation. If weight loss is present, empiric anti-infectious therapy or elimination diet may be considered once specific etiologies have been excluded.