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1.
Georgian Med News ; (311): 120-125, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33814404

RESUMEN

The aim of the work - to determine the pathogenetic role of carbohydrate malabsorption syndrome in severity and duration of rotavirus infection symptoms in early aged children. The study included 60 breastfed children aged 1-24 months with rotavirus infection. The severity and duration of the main symptoms of rotavirus gastroenteritis were analyzed depending on the dynamic changes in laboratory parameters of carbohydrate malabsorption syndrome: the total amount of reducing carbohydrates in feces, lactose and glucose in feces, which were determined on II-III, V, VII and X days of the disease. To determine the total amount of reducing sugars in the coprofiltrates, the Benedict's test was used, the lactose in the feces was determined using the Malfatti's test, and the glucose was determined by the Glucophane test systems (Erba Lachema). It was found that the syndrome of carbohydrate malabsorption had the maximum pathogenetic effect on the severity of rotavirus diarrhea after the fifth day of the disease mainly due to lactase deficiency. Starting from the seventh day of rotavirus infection, with an increase in the level of carbohydrates in the feces by 0,5%, the frequency of liquid stools increases by 1 time per day. The prognostic sign of long-term diarrheal syndrome (≥9 days) is the total level of reducing sugars in the feces ≥1% on the fifth day of illness. If the result of the Benedict's test increases by 0,4% in this term, the duration of diarrhea increases by 1 day. When the level of carbohydrates in the stool ≥ 0,75% on the tenth day of the disease the risk of residual effects on discharge from the hospital (such as unstable stools 2-3 times a day, meteorism and flatulence) increases.


Asunto(s)
Diarrea Infantil , Síndromes de Malabsorción , Infecciones por Rotavirus , Rotavirus , Adolescente , Adulto , Anciano , Carbohidratos , Niño , Preescolar , Diarrea/diagnóstico , Diarrea/epidemiología , Heces , Femenino , Humanos , Lactante , Síndromes de Malabsorción/complicaciones , Síndromes de Malabsorción/diagnóstico , Infecciones por Rotavirus/complicaciones , Infecciones por Rotavirus/diagnóstico , Adulto Joven
2.
Mayo Clin Proc ; 96(3): 563-576, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33673910

RESUMEN

OBJECTIVE: To explore the natural history of chronic unexplained gastrointestinal (GI) symptoms and to determine the longitudinal trends of prevalence during a 20-year period in a single US community. METHODS: Between January 1, 1990, and December 31, 2009, valid self-report questionnaires of GI symptoms were mailed to randomly selected cohorts of a community. The study used respondents who answered questions on 1 or more of 3 surveys (initial, 1990-1992; second, 2003-2004; and third, 2008-2009). The trends of prevalence of GI symptoms over time were analyzed in responders who completed 3 surveys, and the natural history or transition was evaluated. RESULTS: The overall prevalence of major symptom groupings including gastroesophageal reflux disease was consistent among residents in a community on 3 survey time points (1990-1992, 2003-2004, and 2008-2009). The transitions of GI symptoms were common in 228 patients who responded to all 3 surveys; only 29% had the same symptom category in 3 surveys; otherwise, symptoms changed over time, resolving, recurring, or transitioning to another disorder. Observed proportions of symptom transitions were significantly different from expected during 20 years (P<.001). Higher non-GI somatic symptom scores were significantly associated with both symptom transitions (odds ratio, 3.9; 95% CI, 1.38 to 10.77) and having sustained symptoms (odds ratio, 12.7; 95% CI, 4.62 to 34.90). CONCLUSION: The overall population prevalence of chronic unexplained GI symptoms is stable, but in individuals, transitions seem to be the rule. As these various GI syndromes appear to be so intimately interconnected, the common underlying pathogenesis may account for a major subgroup of chronic unexplained GI disorders.


Asunto(s)
Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/epidemiología , Índice de Severidad de la Enfermedad , Adulto , Estreñimiento/diagnóstico , Estreñimiento/epidemiología , Diarrea/diagnóstico , Diarrea/epidemiología , Femenino , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/epidemiología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios
3.
Medicine (Baltimore) ; 100(11): e24897, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725961

RESUMEN

ABSTRACT: The prevalence of children exhibiting coronavirus disease 2019 (COVID-19) with digestive system involvement remains unknown. Therefore, we aimed to quantify the impact of COVID-19 on the digestive system of children.In this meta-analysis, we searched PubMed, Embase, and Web of Science from January 1, 2020, to June 31, 2020. We also searched for COVID-19 publications in specific journals for more comprehensive results. We included studies that reported the epidemiological and clinical characteristics of COVID-19, and we excluded duplicate publications, reviews, animal studies, case reports, publications without the full text, studies with incomplete information, and studies from which data extraction was impossible.We conducted a meta-analysis of the incidence of gastrointestinal symptoms and changes in liver function involving 19 studies. The pooled prevalence of diarrhea was 10% (95% CI: 7-14; I2  = 84%), that of nausea or vomiting was 7% (95% CI: 5-11; I2  = 77%), and that of abdominal pain was 4% (95% CI: 2-9; I2  = 79%). In addition, the pooled incidence of increased alanine aminotransferase was 8% (95% CI: 5-15; I2  = 46%), and the pooled incidence of increased AST was 15% (95% CI: 9-26; I2  = 66%). The pooled rate of recovery was 97% (95% CI: 94-100; I2  = 86%), and the pooled rate of death, which was 1% (95% CI: 1-4; I2  = 48%), was much smaller than the recovery rate.Our research shows that digestive system symptoms and function in children with COVID-19 are not uncommon. More attention should be paid to this unique group of patients.


Asunto(s)
/epidemiología , Enfermedades del Sistema Digestivo/epidemiología , Dolor Abdominal/epidemiología , Adolescente , Niño , Preescolar , Diarrea/epidemiología , Sistema Digestivo/fisiopatología , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Hepatopatías/epidemiología , Masculino , Náusea/epidemiología , Prevalencia , Vómitos/epidemiología
4.
Eur J Gastroenterol Hepatol ; 33(5): 691-694, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33787540

RESUMEN

BACKGROUND: Infection due to severe acute respiratory syndrome coronavirus 2 is typically associated with a respiratory syndrome, but gastrointestinal symptoms have been described in early reports from China. However, data from European centres are scarce. OBJECTIVES: We aimed to characterise the gastrointestinal manifestations of patients with coronavirus disease 2019 (COVID-19) and their disease course. METHODS: Patients admitted at our centre between March and April 2020 with diagnosis of COVID-19 were included. Asymptomatic patients or those without symptom information were excluded. Clinical features, laboratory data and disease severity (mechanical ventilation, intensive care admission or death) were analysed. RESULTS: Two-hundred one patients were included (median age 71 years; 56.2% male). Digestive symptoms were reported by 60 (29.9%) patients during the disease course, being part of the disease presentation in 34 (16.9%). The most frequent were diarrhoea in 36 patients (17.9%). Patients with gastrointestinal symptoms were younger (P = 0.032), had higher haemoglobin levels (P = 0.002) and lower C-reactive protein (P = 0.045) and potassium levels (P = 0.004). Patients with digestive symptoms had less severe disease (28.3 vs. 44.0%; P = 0.038). Regarding liver damage, aspartate aminotransferase (AST) was elevated in 65.2% of patients and alanine aminotransferase (ALT) in 62.7%, but these patients did not present a more severe disease (elevated AST P = 0.062; elevated ALT P = 0.276). CONCLUSION: A significant portion of COVID-19 patients have digestive symptoms, mostly at presentation. This should be taken into account in order to keep a high level of suspicion to reach an early diagnosis and setup infection control measures to control the transmission rate. This subgroup of patients appears to have a less severe disease course.


Asunto(s)
/fisiopatología , Diarrea/fisiopatología , Vómitos/fisiopatología , Dolor Abdominal/epidemiología , Dolor Abdominal/metabolismo , Dolor Abdominal/fisiopatología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Ageusia/epidemiología , Ageusia/metabolismo , Ageusia/fisiopatología , Alanina Transaminasa/metabolismo , Aspartato Aminotransferasas/metabolismo , Proteína C-Reactiva/metabolismo , Diarrea/epidemiología , Diarrea/metabolismo , Femenino , Hemoglobinas/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Náusea/epidemiología , Náusea/metabolismo , Náusea/fisiopatología , Portugal/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Vómitos/epidemiología , Vómitos/metabolismo , Adulto Joven
5.
BMJ Glob Health ; 6(3)2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33758014

RESUMEN

We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN's aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.


Asunto(s)
Servicios de Salud del Niño/normas , Prestación de Atención de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Investigación sobre Servicios de Salud , Mejoramiento de la Calidad , /epidemiología , Niño , Preescolar , Países en Desarrollo , Diarrea/epidemiología , Diarrea/prevención & control , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Malaria/epidemiología , Malaria/prevención & control , Pandemias , Neumonía/epidemiología , Neumonía/prevención & control
7.
BMC Infect Dis ; 21(1): 201, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33622284

RESUMEN

BACKGROUND: In Mozambique, infection by intestinal parasites is reported all over the country. However, infection in children with diarrhoea is mostly focused in the southern region of Mozambique. This work aims to determine the frequency and potential risk factors for infection by Cryptosporidium spp., Giardia lamblia, and Entamoeba histolytica in children under-five years hospitalized with diarrhoea in Hospital Central de Nampula, northern Mozambique. METHODS: A cross-sectional hospital-based surveillance was conducted between March 2015 and January 2018 in children admitted with diarrhoea in Hospital Central de Nampula. Sociodemographic information was obtained through semi-structured interviews applied to the children's caregivers. A single stool sample was collected from each child to detect antigens from Cryptosporidium spp., G. lamblia, and E. histolytica using an immune-enzymatic technique. Crude and adjusted odds ratios (with 95% Confidence Intervals) were obtained by logistic regression models to identify factors associated with infection by Cryptosporidium spp. and G. lamblia. RESULTS: The median age and interquartile intervals of our sample population was 12 months (8-20). Intestinal protozoa were detected in 21.4% (59/276). Cryptosporidium spp. was the most common protozoa (13.9% - 38/274), followed by G. lamblia (9.1% - 25/274) and E. histolytica (0.4% - 1/275). Children with illiterate caregiver's (p-value = 0.042) and undernourished (p-value = 0.011) were more likely to be infected by Cryptosporidium spp. G. lamblia was more common in children living in households with more than four members (p-value = 0.039). E. histolytica was detected in an eleven month's child, co-infected with Cryptosporidium spp. and undernourished. CONCLUSION: Cryptosporidium spp. and Giardia lamblia were the most common pathogenic intestinal protozoa detected in children with diarrhoea hospitalized in the Hospital Central de Nampula. Our findings obtained highlight the importance of exploring the caregiver's education level, children's nutritional status for infections with Cryptosporidium spp., and living conditions, namely crowded households for infections with G. lamblia in children younger than five years.


Asunto(s)
Diarrea/epidemiología , Diarrea/parasitología , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/parasitología , Áreas de Pobreza , Preescolar , Coinfección/epidemiología , Coinfección/parasitología , Estudios Transversales , Heces/parasitología , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Mozambique/epidemiología , Factores de Riesgo
8.
J Anim Sci ; 99(1)2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33528019

RESUMEN

Trehalose, a nonreducing disaccharide consisting of d-glucose with α,α-1,1 linkage, was evaluated as a functional material to improve the gut environment in preweaned calves. In experiment 1, 173 calves were divided into two groups; the trehalose group was fed trehalose at 30 g/animal/d with milk replacer during the suckling period, and the control group was fed nonsupplemented milk replacer. Medication frequency was lower in the trehalose group (P < 0.05). In experiment 2, calves (n = 20) were divided into two groups (control group [n = 10] and trehalose group [n = 10]) based on their body weight and reared under the same feeding regimens as in experiment 1. Fresh feces were collected from individual animals at the beginning of the trial (average age 11 d), 3 wk after trehalose feeding (experimental day 22), and 1 d before weaning, and the fecal score was recorded daily. Fecal samples were analyzed for fermentation parameters and microbiota. The fecal score was significantly lower in the trehalose group than in the control group in the early stage (at an age of 14 to 18 d; P < 0.05) of the suckling period. Calves fed trehalose tended to have a higher proportion of fecal butyrate on day 22 than calves in the control group (P = 0.08). Population sizes of Clostridium spp. were significantly lower (P = 0.036), whereas those of Dialister spp. and Eubacterium spp. tended to be higher in the feces of calves in the trehalose group on day 22 (P = 0.060 and P = 0.083). These observations indicate that trehalose feeding modulated the gut environment and partially contributed to the reduction in medication frequency observed in experiment 1.


Asunto(s)
Enfermedades de los Bovinos/epidemiología , Diarrea/veterinaria , Heces/microbiología , Microbiota , Leche , Trehalosa/administración & dosificación , Alimentación Animal/análisis , Animales , Peso Corporal , Bovinos , Diarrea/epidemiología , Dieta/veterinaria , Suplementos Dietéticos , Incidencia , Destete
9.
Viruses ; 13(2)2021 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-33530573

RESUMEN

Sapovirus is a common cause of acute gastroenteritis in all age groups. Sapovirus infections are seldom investigated in Spain, and its epidemiology in the country is not well known. The use of molecular diagnostic procedures has allowed a more frequent detection of sapoviruses in patients with diarrhea. A total of 2545 stool samples from patients with acute gastroenteritis attended from June 2018 to February 2020 at the Clinic University Hospital in Valencia, Spain, were analyzed by reverse transcription (RT) and real-time multiplex PCR (RT-PCR) to investigate the etiology of enteric infections. Sapovirus was the second enteric virus detected with a positive rate of 8%, behind norovirus (12.2%) and ahead of rotavirus (7.1%), astrovirus (4.9%) and enteric adenoviruses (2.9%). Most sapovirus infections occurred in infants and young children under 3 years of age (74%) with the highest prevalence in autumn and early winter. Coinfections were found in 25% of the patients with sapovirus diarrhea, mainly with other enteric viruses. Genotyping demonstrated the circulation of seven different genotypes during the study period, with a predominance of genotypes GI.1, GI.2, and GII.1. Phylogenetic analysis showed that genogroup GII strains form a cluster separated from genogroup GI and GV, being genotype GV.1 strains related to genotype GI.1 and GI.2 strains.


Asunto(s)
Infecciones por Caliciviridae/epidemiología , Infecciones por Caliciviridae/virología , Gastroenteritis/epidemiología , Gastroenteritis/virología , Sapovirus/genética , Factores de Edad , Infecciones por Caliciviridae/diagnóstico , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/virología , Diarrea/diagnóstico , Diarrea/epidemiología , Diarrea/virología , Femenino , Gastroenteritis/diagnóstico , Variación Genética , Genotipo , Humanos , Masculino , Epidemiología Molecular , Reacción en Cadena de la Polimerasa Multiplex , Filogenia , Prevalencia , ARN Viral/genética , Sapovirus/clasificación , Sapovirus/aislamiento & purificación , Estaciones del Año , España/epidemiología
10.
PLoS One ; 16(2): e0246190, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33592019

RESUMEN

BACKGROUND AND OBJECTIVES: With the increase in the number of COVID-19 infections, the global health apparatus is facing insufficient resources. The main objective of the current study is to provide additional data regarding the clinical characteristics of the patients diagnosed with COVID-19, and in particular to analyze the factors associated with disease severity, lack of improvement, and mortality. METHODS: 102 studies were included in the present meta-analysis, all of which were published before September 24, 2020. The studies were found by searching a number of databases, including Scopus, MEDLINE, Web of Science, and Embase. We performed a thorough search from early February until September 24. The selected papers were evaluated and analyzed using Stata software application version 14. RESULTS: Ultimately, 102 papers were selected for this meta- analysis, covering 121,437 infected patients. The mean age of the patients was 58.42 years. The results indicate a prevalence of 79.26% for fever (95% CI: 74.98-83.26; I2 = 97.35%), 60.70% for cough (95% CI: 56.91-64.43; I2 = 94.98%), 33.21% for fatigue or myalgia (95% CI: 28.86-37.70; I2 = 96.12%), 31.30% for dyspnea (95% CI: 26.14-36.69; I2 = 97.67%), and 10.65% for diarrhea (95% CI: 8.26-13.27; I2 = 94.20%). The prevalence for the most common comorbidities was 28.30% for hypertension (95% CI: 23.66-33.18; I2 = 99.58%), 14.29% for diabetes (95% CI: 11.88-16.87; I2 = 99.10%), 12.30% for cardiovascular diseases (95% CI: 9.59-15.27; I2 = 99.33%), and 5.19% for chronic kidney disease (95% CI: 3.95-6.58; I2 = 96.42%). CONCLUSIONS: We evaluated the prevalence of some of the most important comorbidities in COVID-19 patients, indicating that some underlying disorders, including hypertension, diabetes, cardiovascular diseases, and chronic kidney disease, can be considered as risk factors for patients with COVID-19 infection. Furthermore, the results show that an elderly male with underlying diseases is more likely to have severe COVID-19.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Tos/epidemiología , Diabetes Mellitus/epidemiología , Diarrea/epidemiología , Fiebre/epidemiología , Insuficiencia Renal Crónica/epidemiología , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias
11.
Infect Dis (Lond) ; 53(5): 348-360, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33583306

RESUMEN

AIM: Diarrhoea is a relatively common manifestation of coronavirus disease (COVID-19), but there is no systematic review which comprehensively describes it beyond its incidence and impact on prognosis. This study aims to provide a detailed systematic review of diarrhoea in adults with COVID-19. METHODS: A PUBMED and Scopus search (until 7 September 2020) was performed. Studies that were limited to describing incidence of diarrhoea and its effect on prognosis were excluded. RESULTS: Twenty-six papers including 7860 patients with COVID-19 were subjected to synthesis. Mean duration of diarrhoea was 4.2 (3.6-4.9) days (range 1-16 days), whereas mean bowel movement count was 4.6 (3.8-5.3) and maximum was 20 per day. Diarrhoea started on an average 5.1 (3.8-6.5) days after disease onset but was the first manifestation in 4.3% patients. Stool occult blood was detected in 6.8% of patients with diarrhoea, while 53.3% cases had watery diarrhoea. Patients with diarrhoea also had elevated faecal calprotectin. Viral genome in faeces was detected more often in patients with diarrhoea and most often in patients without respiratory symptoms. Fever, myalgia and respiratory symptoms were observed with the same incidence in patients with and without diarrhoea. Similarly, there were no differences noted in complete blood count and most inflammation biomarkers between patients with and without diarrhoea. However, nausea, vomiting abdominal pain, sneezing and headache were more common in patients with diarrhoea. Diarrhoea was the main manifestation of COVID-19 in 6.1% of cases and this form of the disease had specific features. CONCLUSIONS: Diarrhoea in COVID-19 needs further investigation.


Asunto(s)
/epidemiología , Diarrea/epidemiología , Adulto , Humanos , Incidencia
12.
BMC Infect Dis ; 21(1): 54, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33435906

RESUMEN

BACKGROUND: An outbreak of acute gastroenteritis occurred in a kindergarten located Shenzhen City on March 4, 2018. We were invited to investigate to the risk factors associated with this outbreak. METHODS: We conducted retrospective cohort-studies on three different groups of subjects in order to figure out the difference of incidence of acute gastroenteritis among subjects of different activities on March 2: group one consisted of people who attended the Lantern festival activities; group two consisted of children and employees who ate breakfast and bread provided by the kindergarten; and groups three consisted of children and employees who did not eat breakfast or bread provided by the kindergarten. Fecal, anal swabs, dishware swabs and hand swabs specimens were collected in the study. Bacteria known to cause acute gastroenteritis were cultured. Viruses associated with acute gastroenteritis were tested using real-time PCR. Capsid gene fragment of 557 bp of norovirus was amplified and sequenced. The phylogenetic tree was constructed with MEGA 7.0 using neighbor-joining method based on capsid gene fragment of norovirus. RESULTS: A total of 143 suspected cases were identified in this outbreak. Diarrhea happened more often in adults than in children while emesis and bellyache were more frequently found in children than in adults. Higher AGE incidence was observed in group 2, children and employees who had breakfast in the kindergarten on March 2, as well as in group 3, and among employees who eating bread involved in breakfast provided on March 2. Five anal swab specimens were positive for norovirus. All noroviruses belongs to group II.3 and have an identity more than 99%. CONCLUSION: A chef, as an asymptomatic carrier with norovirus, was the infectious resource in this outbreak. He contaminated breakfast food provided on March 2. Although morning check is implemented in kindergartens of China, employees are often excluded in morning check. Our finding highlights the importance of morning check covering employees and periodical training for cooks.


Asunto(s)
Desayuno , Infecciones por Caliciviridae/epidemiología , Portador Sano/virología , Brotes de Enfermedades , Manipulación de Alimentos , Gastroenteritis/epidemiología , Norovirus/genética , Escuelas de Párvulos , Adulto , Infecciones por Caliciviridae/diagnóstico , Infecciones por Caliciviridae/prevención & control , Infecciones por Caliciviridae/virología , Niño , Preescolar , China/epidemiología , Diarrea/epidemiología , Diarrea/virología , Heces/virología , Femenino , Microbiología de Alimentos/métodos , Gastroenteritis/diagnóstico , Gastroenteritis/prevención & control , Gastroenteritis/virología , Humanos , Incidencia , Masculino , Filogenia , Cuarentena/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Factores de Riesgo , Vómitos/epidemiología , Vómitos/virología
13.
Cir Pediatr ; 34(1): 3-8, 2021 Jan 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33507637

RESUMEN

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.


Asunto(s)
Abdomen Agudo/diagnóstico , Dolor Abdominal/etiología , /diagnóstico , Abdomen Agudo/cirugía , Abdomen Agudo/virología , Dolor Abdominal/virología , Adolescente , Apendicitis/diagnóstico , Niño , Preescolar , Diarrea/epidemiología , Diarrea/etiología , Femenino , Fiebre/epidemiología , Fiebre/etiología , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Peritonitis/diagnóstico , Estudios Retrospectivos , Vómitos/epidemiología , Vómitos/etiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-33466953

RESUMEN

Diarrhea is a leading cause of death among children under five (U5) in Lao People's Democratic Republic (PDR). This study assessed the association between the presence of household hand-washing facilities with water and soap and diarrhea episodes among children U5 in Lao PDR. Data from the Lao Social Indicator Survey II were used. The outcome variable was diarrhea episodes in the two weeks preceding the survey. The main predictor variable was the presence of household hand-washing facilities with or without water and/or soap. Mixed-effect logistic regression analysis was used to assess the association, controlling for clustering, and other predictor variables. Of the 8640 households surveyed with 11,404 children, 49.1% possessed hand-washing facilities with both water and soap and 34.7% possessed hand-washing facilities with water alone. Children whose households possessed hand-washing facilities with water alone were significantly more likely to have a diarrhea episode compared to children whose households possessed hand-washing facilities with both water and soap (8.1% vs. 5.9%; odds ratio, 1.49; 95% confidence interval, 1.22-1.81). The association remained significant even after adjusting for other predictors. The absence of soap in hand-washing facilities was associated with higher odds of having a diarrhea episode among children U5 in Lao PDR.


Asunto(s)
Jabones , Agua , Niño , Preescolar , Estudios Transversales , Diarrea/epidemiología , Humanos , Incidencia , Laos/epidemiología
15.
BMC Infect Dis ; 21(1): 9, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407180

RESUMEN

BACKGROUND: To determine the prevalence of enteric infections in Aboriginal children aged 0-2 years using conventional and molecular diagnostic techniques and to explore associations between the presence of pathogens and child growth. METHODS: Cross-sectional analysis of Aboriginal children (n = 62) residing in a remote community in Northern Australia, conducted from July 24th - October 30th 2017. Stool samples were analysed for organisms by microscopy (directly in the field and following fixation and storage in sodium-acetate formalin), and by qualitative PCR for viruses, bacteria and parasites and serology for Strongyloides-specific IgG. Child growth (height and weight) was measured and z scores calculated according to WHO growth standards. RESULTS: Nearly 60% of children had evidence for at least one enteric pathogen in their stool (37/62). The highest burden of infection was with adenovirus/sapovirus (22.9%), followed by astrovirus (9.8%) and Cryptosporidium hominis/parvum (8.2%). Non-pathogenic organisms were detected in 22.5% of children. Ten percent of children had diarrhea at the time of stool collection. Infection with two or more pathogens was negatively associated with height for age z scores (- 1.34, 95% CI - 2.61 to - 0.07), as was carriage of the non-pathogen Blastocystis hominis (- 2.05, 95% CI - 3.55 to - 0.54). CONCLUSIONS: Infants and toddlers living in this remote Northern Australian Aboriginal community had a high burden of enteric pathogens and non-pathogens. The association between carriage of pathogens/non-pathogens with impaired child growth in the critical first 1000 days of life has implications for healthy child growth and development and warrants further investigation. These findings have relevance for many other First Nations Communities that face many of the same challenges with regard to poverty, infections, and malnutrition.


Asunto(s)
Infecciones por Adenovirus Humanos/epidemiología , Adenovirus Humanos/genética , Infecciones por Astroviridae/epidemiología , Infecciones por Caliciviridae/epidemiología , Criptosporidiosis/epidemiología , Cryptosporidium/genética , Gastroenteritis/epidemiología , Mamastrovirus/genética , Sapovirus/genética , Infecciones por Adenovirus Humanos/virología , Adenovirus Humanos/aislamiento & purificación , Animales , Infecciones por Astroviridae/virología , Australia/epidemiología , Infecciones por Caliciviridae/virología , Preescolar , Estudios Transversales , Criptosporidiosis/parasitología , Cryptosporidium/aislamiento & purificación , Diarrea/epidemiología , Diarrea/parasitología , Diarrea/virología , Heces/parasitología , Heces/virología , Femenino , Gastroenteritis/parasitología , Gastroenteritis/virología , Humanos , Lactante , Recién Nacido , Masculino , Mamastrovirus/aislamiento & purificación , Grupo de Ascendencia Oceánica , Reacción en Cadena de la Polimerasa/métodos , Prevalencia , Sapovirus/aislamiento & purificación
16.
BMC Infect Dis ; 21(1): 7, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407198

RESUMEN

BACKGROUND: Little is known about the etiology of childhood diarrhea in the United Arab Emirates (UAE) especially after the introduction of rotavirus vaccines. This study aimed to identify gastrointestinal pathogens in children with diarrhea (cases) and the carriage rate of these pathogens in asymptomatic children (controls). METHODS: Stool samples were collected from 203 cases and 73 controls who presented to two major hospitals in Al Ain city, UAE. Samples were analyzed with Allplex™ Gastrointestinal Full Panel Assay for common entero-pathogens. The association between diarrhea and the isolated pathogens was calculated in a multivariate logistic regression model. The adjusted attributable fractions (aAFs) were calculated for all pathogens significantly associated with cases. RESULTS: At least one pathogen was identified in 87 samples (42.8%) from cases and 17 (23.3%) from controls (P < 0.001). Rotavirus, norovirus GII and adenovirus were significantly more prevalent in cases. Their aAFs with 95% ci are 0.95 (0.64, 1.00) for rotavirus, 0.86 (0.38, 0.97) for norovirus GII and 0.84 (0.29, 0.96) for adenovirus. None of the 13 bacteria tested for were more commonly found in the cases than in controls. Cryptosporidium spp. were more significantly detected in cases than in controls. Co-infections occurred in 27.9% of the children. Viruses and parasites were significantly more likely to occur together only in the cases. CONCLUSIONS: Multiplex PCR revealed high positivity rates in both cases and controls which demand a cautious interpretation. Rotavirus remains the main childhood diarrhea pathogen in UAE. Effective strategies are needed to better control rotavirus and other causative pathogens.


Asunto(s)
Infecciones por Adenovirus Humanos/epidemiología , Adenovirus Humanos/genética , Infecciones por Caliciviridae/epidemiología , Coinfección/epidemiología , Criptosporidiosis/epidemiología , Cryptosporidium/genética , Diarrea/epidemiología , Norovirus/genética , Infecciones por Rotavirus/epidemiología , Rotavirus/genética , Infecciones por Adenovirus Humanos/virología , Adenovirus Humanos/aislamiento & purificación , Animales , Infecciones por Caliciviridae/virología , Estudios de Casos y Controles , Preescolar , Coinfección/parasitología , Coinfección/virología , Criptosporidiosis/parasitología , Cryptosporidium/aislamiento & purificación , Diarrea/parasitología , Diarrea/virología , Heces/parasitología , Heces/virología , Femenino , Humanos , Lactante , Masculino , Reacción en Cadena de la Polimerasa Multiplex/métodos , Norovirus/aislamiento & purificación , Rotavirus/aislamiento & purificación , Infecciones por Rotavirus/virología , Vacunas contra Rotavirus , Emiratos Árabes Unidos/epidemiología
17.
BMC Infect Dis ; 21(1): 18, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407207

RESUMEN

BACKGROUND: Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique. METHODS: The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR). RESULTS: Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed. CONCLUSIONS: The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Diarrea/epidemiología , Desnutrición/epidemiología , Infecciones por Rotavirus/epidemiología , Rotavirus/inmunología , Animales , Lactancia Materna , Preescolar , Comorbilidad , Estudios Transversales , Diarrea/virología , Composición Familiar , Heces/virología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Mozambique/epidemiología , Prevalencia , Factores de Riesgo , Infecciones por Rotavirus/prevención & control , Infecciones por Rotavirus/virología , Vacunas contra Rotavirus/uso terapéutico
18.
BMC Infect Dis ; 21(1): 109, 2021 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-33485326

RESUMEN

BACKGROUND: Diarrhoea is a common cause of mortality and morbidity in children under five years old. In Kenya, it has a 21% case fatality with Enteropathogenic E. coli, Campylobacter jejuni, Shigella spp. and Salmonella spp. accounting for 50-60% of the cases. Sulphonamides, tetracycline, ampicillin and trimethoprim/sulfamethoxazole are typically used in the treatment of diarrhoeal diseases but have become ineffective in the face of emerging antimicrobial resistance. The objective of this study was to evaluate the prevalence and antimicrobial susceptibility of Campylobacter jejuni and Shigella species in children under five years of age presenting with diarrhoea at Kapsabet County Referral Hospital in Kenya. METHODS: Faecal samples were collected from 139 children admitted with diarrhoea. Each sample was examined macroscopically for colour, texture, and presence of extraneous material. The samples were then cultured for bacterial growth. Observed bacterial growth was isolated and identified by a series of biochemical tests. Resistance patterns were also evaluated using the Kirby - Bauer Disk diffusion method. The chi - square test and Pearson Correlation Coefficient were used to establish statistical significance. RESULTS: Approximately 33.1% of the total faecal samples tested were positive for enteric pathogens. Shigella spp. demonstrated resistance to erythromycin (91.7%), doxycyclin (83.3%), ampicillin (82.1%), cotrimoxazole (73.1%), minocycline (66.7%) and cefuroxime (54.2%). Campylobacter jejuni also exhibited resistance to erythromycin (87.5%), doxycyclin (75%), ampicillin (73.7%), cotrimoxazole (73.3%) and minocycline (68.8%). CONCLUSIONS: The resistance patterns of Shigella spp. and Campylobacter jejuni reported in this study necessitates the need for a comprehensive multiregional investigation to evaluate the geographical prevalence and antimicrobial resistance distributions of these microorganisms. These findings also support the need for the discovery and development of effective therapeutic alternatives. TRIAL REGISTRATION: Retrospectively registered. Certificate No. 00762.


Asunto(s)
Antibacterianos/farmacología , Campylobacter jejuni/efectos de los fármacos , Diarrea/microbiología , Farmacorresistencia Bacteriana Múltiple , Shigella/efectos de los fármacos , Antibacterianos/uso terapéutico , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/microbiología , Campylobacter jejuni/aislamiento & purificación , Niño , Preescolar , Diarrea/epidemiología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Disentería Bacilar/epidemiología , Disentería Bacilar/microbiología , Heces/microbiología , Femenino , Hospitales , Humanos , Lactante , Kenia/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Shigella/aislamiento & purificación
19.
PLoS One ; 15(12): e0244214, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33362236

RESUMEN

BACKGROUND: Following an influx of an estimated 742,000 Rohingya refugees in Bangladesh, Médecins sans Frontières (MSF) established an active indicator-based Community Based Surveillance (CBS) in 13 sub-camps in Cox's Bazar in August 2017. Its objective was to detect epidemic prone diseases early for rapid response. We describe the surveillance, alert and response in place from epidemiological week 20 (12 May 2019) until 44 (2 November 2019). METHODS: Suspected cases were identified through passive health facility surveillance and active indicator-based CBS. CBS-teams conducted active case finding for suspected cases of acute watery diarrhea (AWD), acute jaundice syndrome (AJS), acute flaccid paralysis (AFP), dengue, diphtheria, measles and meningitis. We evaluate the following surveillance system attributes: usefulness, Positive Predictive Value (PPV), timeliness, simplicity, flexibility, acceptability, representativeness and stability. RESULTS: Between epidemiological weeks 20 and 44, an average of 97,340 households were included in the CBS per surveillance cycle. Household coverage reached over 85%. Twenty-one RDT positive cholera cases and two clusters of AWD were identified by the CBS and health facility surveillance that triggered the response mechanism within 12 hours. The PPV of the CBS varied per disease between 41.7%-100%. The CBS required 354 full-time staff in 10 different roles. The CBS was sufficiently flexible to integrate dengue surveillance. The CBS was representative of the population in the catchment area due to its exhaustive character and high household coverage. All households consented to CBS participation, showing acceptability. DISCUSSION: The CBS allowed for timely response but was resource intensive. Disease trends identified by the health facility surveillance and suspected diseases trends identified by CBS were similar, which might indicate limited additional value of the CBS in a dense and stable setting such as Cox's Bazar. Instead, a passive community-event-based surveillance mechanism combined with health facility-based surveillance could be more appropriate.


Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Indicadores de Salud , Vigilancia en Salud Pública/métodos , Campos de Refugiados/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Bangladesh , Dengue/epidemiología , Diarrea/epidemiología , Humanos , Sarampión/epidemiología , Meningitis/epidemiología , Mianmar , Campos de Refugiados/normas , Sociedades Médicas
20.
PLoS One ; 15(12): e0244100, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33347474

RESUMEN

BACKGROUND: Rotavirus vaccine (RV) and pneumococcal vaccine (PCV) decrease diarrheal and respiratory disease incidence and severity, but there are few data about the effects of these vaccines among HIV-exposed uninfected (HEU) children. METHODS: We recorded RV and PCV vaccination history in a placebo-controlled trial that studied the need for cotrimoxazole among HEU infants in Botswana (the Mpepu Study). We categorized infants by enrollment before or after the simultaneous April 2012 introduction of RV and PCV, and compared diagnoses of diarrhea and pneumonia (grade 3/4), hospitalizations, and deaths from both disease conditions through the 12-month study visit by vaccine era/status across two sites (a city and a village) by Kaplan-Meier estimates. RESULTS: Two thousand six hundred and thirty-five HEU infants were included in this secondary analysis, of these 1689 (64%) were enrolled in Gaborone (344 pre-vaccine, 1345 vaccine) and 946 (36%) in Molepolole (209 pre-vaccine, 737 vaccine). We observed substantial reduction in hazard of hospitalization or death for reason of diarrhea and pneumonia in the vaccine era versus the pre-vaccine era in Molepolole (hazard ratio, HR = 0.44, 95% confidence interval, CI = 0.28, 0.71) with smaller reduction in Gaborone (HR = 0.91, 95% CI = 0.57, 1.45). Similar downward trends were observed for diagnoses of diarrhea and pneumonia separately during the vaccine versus pre-vaccine era. CONCLUSIONS: Although temporal confounding cannot be excluded, significant declines in the burden of diarrheal and respiratory illness were observed among HEU children in Botswana following the introduction of RV and PCV. RV and PCV may maximally benefit HEU children in rural areas with higher disease burden.


Asunto(s)
Diarrea/epidemiología , Infecciones por VIH/epidemiología , Vacunas Neumococicas/administración & dosificación , Neumonía Neumocócica/epidemiología , Neumonía Viral/epidemiología , Vacunas contra Rotavirus/administración & dosificación , Vacunas Conjugadas/administración & dosificación , Botswana/epidemiología , Niño , Preescolar , Diarrea/prevención & control , Femenino , Hospitalización , Humanos , Lactante , Neumonía Neumocócica/prevención & control , Neumonía Viral/prevención & control
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