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1.
Medicine (Baltimore) ; 100(11): e25138, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725995

RESUMEN

BACKGROUND: Gastrointestinal complications and malnutrition are common problems that affect postoperative rehabilitation and survival of patients with esophageal cancer. Evidence has shown that probiotics have a positive effect on improving gastrointestinal complications and nutritional status of patients with esophageal cancer after surgery, but there is a lack of prospective studies on this topic. We designed this prospective randomized controlled trial to evaluate the effects of probiotics on gastrointestinal complications and nutritional status in patients with postoperative esophageal cancer. METHODS: This is a prospective, randomized, double-blind, placebo-controlled trial. It was approved by the Clinical Research Ethics Committee of our hospital. 192 patients will be randomly divided into probiotics group and the placebo group in a 1:1 ratio. After operation, probiotics and placebo will be given orally for 8 weeks. The indexes of nutritional status and incidence of digestive tract complications will be recorded and the data will be analyzed by SPSS 18.0 software. DISCUSSION: This study will evaluate the effect of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer. The results of this study will provide clinical basis for the use of probiotics in postoperative treatment of esophageal cancer. TRIAL REGISTRATION: OSF Registration number: D DOI 10.17605/OSF.IO/QHW86.


Asunto(s)
Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Enfermedades Gastrointestinales/terapia , Desnutrición/terapia , Complicaciones Posoperatorias , Probióticos/uso terapéutico , Adulto , Método Doble Ciego , Neoplasias Esofágicas/microbiología , Femenino , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/microbiología , Humanos , Masculino , Desnutrición/etiología , Desnutrición/microbiología , Persona de Mediana Edad , Estado Nutricional , Periodo Posoperatorio , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
2.
J Med Case Rep ; 15(1): 60, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557941

RESUMEN

BACKGROUND: To investigate the potential beneficial effect of fecal microbiota transplantation (FMT) on gastrointestinal symptoms, gut dysbiosis and immune status in discharged COVID-19 patients. CASE PRESENTATION: A total of 11 COVID-19 patients were recruited in April, 2020, about one month on average after they were discharged from the hospital. All subjects received FMT for 4 consecutive days by oral capsule administrations with 10 capsules for each day. In total, 5 out of 11 patients reported to be suffered from gastrointestinal symptoms, which were improved after FMT. After FMT, alterations of B cells were observed, which was characterized as decreased naive B cell (P = 0.012) and increased memory B cells (P = 0.001) and non-switched B cells (P = 0.012).The microbial community richness indicated by operational taxonomic units number, observed species and Chao1 estimator was marginally increased after FMT. Gut microbiome composition of discharged COVID-19 patients differed from that of the general population at both phylum and genera level, which was characterized with a lower proportion of Firmicutes (41.0%) and Actinobacteria (4.0%), higher proportion of Bacteroidetes (42.9%) and Proteobacteria (9.2%). FMT can partially restore the gut dysbiosis by increasing the relative abundance of Actinobacteria (15.0%) and reducing Proteobacteria (2.8%) at the phylum level. At the genera level, Bifidobacterium and Faecalibacterium had significantly increased after FMT. CONCLUSIONS: After FMT, altered peripheral lymphocyte subset, restored gut microbiota and alleviated gastrointestinal disorders were observe, suggesting that FMT may serve as a potential therapeutic and rehabilitative intervention for the COVID-19.


Asunto(s)
Subgrupos de Linfocitos B , Disbiosis/terapia , Trasplante de Microbiota Fecal , Enfermedades Gastrointestinales/terapia , Microbioma Gastrointestinal , Anciano , Bacteroidetes , Bifidobacterium , Disbiosis/microbiología , Faecalibacterium , Femenino , Enfermedades Gastrointestinales/microbiología , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente , Proteobacteria , Adulto Joven
3.
Am J Chin Med ; 49(2): 237-268, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33622213

RESUMEN

Intestinal flora is essential for maintaining host health and plays a unique role in transforming Traditional Chinese Medicine (TCM). TCM, as a bodyguard, has saved countless lives and maintained human health in the long history, especially in this COVID-19 pandemic. Pains of diseases have been removed from the effective TCM therapy, such as TCM preparation, moxibustion, and acupuncture. With the development of life science and technology, the wisdom and foresight of TCM has been more displayed. Furthermore, TCM has been also inherited and developed in innovation to better realize the modernization and globalization. Nowadays, intestinal flora transforming TCM and TCM targeted intestinal flora treating diseases have been important findings in life science. More and more TCM researches showed the significance of intestinal flora. Intestinal flora is also a way to study TCM to elucidate the profound theory of TCM. Processing, compatibility, and properties of TCM are well demonstrated by intestinal flora. Thus, it is no doubt that intestinal flora is a core in TCM study. The interaction between intestinal flora and TCM is so crucial for host health. Therefore, it is necessary to sum up the latest results in time. This paper systematically depicted the profile of TCM and the importance of intestinal flora in host. What is more, we comprehensively summarized and discussed the latest progress of the interplay between TCM and intestinal flora to better reveal the core connotation of TCM.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Disbiosis/microbiología , Microbioma Gastrointestinal , Medicina China Tradicional , Enfermedades Autoinmunes/microbiología , Enfermedades Autoinmunes/terapia , Enfermedades Cardiovasculares/microbiología , Enfermedades Cardiovasculares/terapia , Diabetes Mellitus/microbiología , Diabetes Mellitus/terapia , Electroacupuntura , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/terapia , Humanos , Enfermedades Metabólicas/microbiología , Enfermedades Metabólicas/terapia , Neoplasias/microbiología , Neoplasias/terapia , Enfermedad del Hígado Graso no Alcohólico/microbiología , Enfermedad del Hígado Graso no Alcohólico/terapia , Obesidad/microbiología , Obesidad/terapia , Insuficiencia Renal Crónica/microbiología , Insuficiencia Renal Crónica/terapia
4.
Front Cell Infect Microbiol ; 10: 575559, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33363049

RESUMEN

The current COVID-19 pandemic is a great challenge for worldwide researchers in the human microbiota area because the mechanisms and long-term effects of the infection at the GI level are not yet deeply understood. In the current review, scientific literature including original research articles, clinical studies, epidemiological reports, and review-type articles concerning human intestinal infection with SARS-CoV-2 and the possible consequences on the microbiota were reviewed. Moreover, the following aspects pertaining to COVID-19 have also been discussed: transmission, resistance in the human body, the impact of nutritional status in relation to the intestinal microbiota, and the impact of comorbid metabolic disorders such as inflammatory bowel disease (IBS), obesity, and type two diabetes (T2D). The articles investigated show that health, age, and nutritional status are associated with specific communities of bacterial species in the gut, which could influence the clinical course of COVID-19 infection. Fecal microbiota alterations were associated with fecal concentrations of SARS-CoV-2 and COVID-19 severity. Patients suffering from metabolic and gastrointestinal (GI) disorders are thought to be at a moderate-to-high risk of infection with SARS-CoV-2, indicating the direct implication of gut dysbiosis in COVID-19 severity. However, additional efforts are required to identify the initial GI symptoms of COVID-19 for possible early intervention.


Asunto(s)
/microbiología , Disbiosis/etiología , Microbioma Gastrointestinal , Pandemias , /fisiología , Animales , /epidemiología , Comorbilidad , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/microbiología , Reservorios de Enfermedades/virología , Enterocitos/patología , Enterocitos/virología , Heces/microbiología , Heces/virología , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/microbiología , Humanos , Síndrome del Colon Irritable/epidemiología , Síndrome del Colon Irritable/microbiología , Síndrome Metabólico/epidemiología , Síndrome Metabólico/microbiología , Obesidad/epidemiología , Obesidad/microbiología , Factores de Riesgo , /patogenicidad
5.
Eur Rev Med Pharmacol Sci ; 24(20): 10853-10859, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33155247

RESUMEN

OBJECTIVE: The aim of this review paper was to discuss the gut microbiota-related aspects of COVID-19 patients. We presented the faecal-oral transmission of SARS-CoV-2, gut microbiota imbalance, and fecal microbiota transplantation as a hidden source of this virus. MATERIALS AND METHODS: We analyzed the available literature (PubMed, Embase, Google Scholar databases) regarding COVID-19 and gut microbiota related aspects. RESULTS: The gastrointestinal symptoms, such as nausea, vomiting, diarrhea, abdominal discomfort/pain, may occur in these patients. Notably, these symptoms may contribute to the severity of COVID-19. Recent several studies have revealed a new SARS-CoV-2 transmission possibility, opening a fresh view on COVID-19. It is observed the possibility of SARS-CoV-2 transmission via faecal-oral route. Fecal microbiota transplantation may be a hidden source of SARS-CoV-2. Additionally, the pharmacological treatment of COVID-19 and other factors may significantly alter the composition of gut microbiota. Among others, loss of bacterial diversity, the decrease of commensal microbes as well as the increase of opportunistic pathogens are observed. CONCLUSIONS: The alterations of gut microbiota in COVID-19 patients consequently may lead to the development of gut dysbiosis-related diseases even after recovery from COVID-19. Therefore, it is recommended to screen stool samples taken from recovered patients at least 35 days after clearance of virus from respiratory tract. Before 35 days period, SARS-CoV-2 may still be detected in feces. It is also recommended to screen the composition as well as the activity of gut microbiota to assess its balance. In the case of gut dysbiosis, there should be introduced an appropriate method of its modulation. Additionally, all the fecal samples which are prepared for fecal microbiota transplantation should be tested for SARS-CoV-2 to provide protection for its recipients.


Asunto(s)
Infecciones por Coronavirus/microbiología , Enfermedades Gastrointestinales/microbiología , Tracto Gastrointestinal/microbiología , Neumonía Viral/microbiología , Diarrea/virología , Heces/virología , Enfermedades Gastrointestinales/virología , Microbioma Gastrointestinal , Tracto Gastrointestinal/virología , Humanos , Pandemias , Índice de Severidad de la Enfermedad , Vómitos/virología
6.
Epidemiol Infect ; 148: e206, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-32867880

RESUMEN

Enterotoxigenic Escherichia coli (ETEC) is a well-established cause of traveller's diarrhoea and occasional domestic foodborne illness outbreaks in the USA. Although ETEC are not detected by conventional stool culture methods used in clinical laboratories, syndromic culture-independent diagnostic tests (CIDTs) capable of detecting ETEC have become increasingly prevalent in the last decade. This study describes the epidemiology of ETEC infections reported to the Minnesota Department of Health (MDH) during 2016-2017. ETEC-positive stool specimens were submitted to MDH to confirm the presence of ETEC DNA by polymerase chain reaction (PCR). Cases were interviewed to ascertain illness and exposures. Contemporaneous Salmonella cases were used as a comparison group in a case-case comparison analysis of risk factors. Of 222 ETEC-positive specimens received by MDH, 108 (49%) were concordant by PCR. ETEC was the sixth most frequently reported bacterial enteric pathogen among a subset of CIDT-positive specimens. Sixty-nine (64%) laboratory-confirmed cases had an additional pathogen codetected with ETEC, including enteroaggregative E. coli (n = 40) and enteropathogenic E. coli (n = 39). Although travel is a risk factor for ETEC infection, only 43% of cases travelled internationally, providing evidence for ETEC as an underestimated source of domestically acquired enteric illness in the USA.


Asunto(s)
Escherichia coli Enterotoxigénica , Infecciones por Escherichia coli/epidemiología , Vigilancia de la Población , Femenino , Enfermedades Transmitidas por los Alimentos/epidemiología , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/microbiología , Humanos , Masculino , Minnesota/epidemiología , Reacción en Cadena de la Polimerasa Multiplex/métodos , Estudios Retrospectivos , Estaciones del Año
8.
Transl Res ; 226: 57-69, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32827705

RESUMEN

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the greatest worldwide pandemic since the 1918 flu. The consequences of the coronavirus disease 2019 (COVID-19) are devastating and represent the current major public health issue across the globe. At the onset, SARS-CoV-2 primarily attacks the respiratory system as it represents the main point of entry in the host, but it also can affect multiple organs. Although most of the patients do not present symptoms or are mildly symptomatic, some people infected with SARS-CoV-2 that experience more severe multiorgan dysfunction. The severity of COVID-19 is typically combined with a set of comorbidities such as hypertension, diabetes, obesity, and/or advanced age that seriously exacerbates the consequences of the infection. Also, SARS-CoV-2 can cause gastrointestinal symptoms, such as vomiting, diarrhea, or abdominal pain during the early phases of the disease. Intestinal dysfunction induces changes in intestinal microbes, and an increase in inflammatory cytokines. Thus, diagnosing gastrointestinal symptoms that precede respiratory problems during COVID-19 may be necessary for improved early detection and treatment. Uncovering the composition of the microbiota and its metabolic products in the context of COVID-19 can help determine novel biomarkers of the disease and help identify new therapeutic targets. Elucidating changes to the microbiome as reliable biomarkers in the context of COVID-19 represent an overlooked piece of the disease puzzle and requires further investigation.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Enfermedades Gastrointestinales/etiología , Microbioma Gastrointestinal , Neumonía Viral/complicaciones , Comorbilidad , Enfermedades Gastrointestinales/microbiología , Humanos , Pandemias
9.
BMC Infect Dis ; 20(1): 479, 2020 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-32631331

RESUMEN

BACKGROUND: The study aimed to assess whether gastrointestinal (GI) symptoms at admission are associated with increased short-term mortality in patients with invasive pneumococcal disease (IPD). METHODS: We included all patients with IPD at Aker University Hospital in Oslo, Norway, from 1993 to 2008. Clinical data were registered. Survival data were retrieved from official registries. We used Cox regression and Kaplan-Meier curve to compare mortality within 28 days of admission in patients with and without GI symptoms. RESULTS: Four hundred sixteen patients were included. Of these, 108 patients (26%) presented with GI symptoms, and 47 patients (11%) with GI symptoms only. Patients with GI symptoms were younger (p < 0.001) and had less cardiovascular disease (p < 0.001), pulmonary disease (p = 0.048), and cancer (p = 0.035) and received appropriate antibiotic treatment later. After adjusting for risk factors, we found an increased hazard ratio of 2.28 (95% CI 1.31-3.97) in patients presenting with GI symptoms. In patients with GI symptoms only there was an increased hazard ratio of 2.24 (95% CI 1.20-4.19) in univariate analysis, which increased to 4.20 (95% CI 2.11-8.39) after multivariate adjustment. Fewer patients with GI symptoms only received antibiotics upon admission. CONCLUSIONS: A large proportion of IPD patients present with GI symptoms only or in combination with other symptoms. GI symptoms in IPD are associated with increased short-term mortality.


Asunto(s)
Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/microbiología , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/mortalidad , Streptococcus pneumoniae/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Comorbilidad , Femenino , Enfermedades Gastrointestinales/tratamiento farmacológico , Hospitalización , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Infecciones Neumocócicas/tratamiento farmacológico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Streptococcus pneumoniae/aislamiento & purificación , Resultado del Tratamiento , Adulto Joven
10.
PLoS Negl Trop Dis ; 14(6): e0008387, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32574158

RESUMEN

Environmental enteric dysfunction (EED) is characterized by diffuse villous atrophy of the small bowel. EED is strongly associated with stunting, a major public health problem linked to increased childhood morbidity and mortality. EED and subsequent stunting of linear growth are surmised to have microbial origins. To interrogate this relationship, we defined the comprehensive virome (eukaryotic virus and bacteriophage) and bacterial microbiome of a longitudinal cohort of rural Malawian children with extensive metadata and intestinal permeability testing at each time point. We found thirty bacterial taxa differentially associated with linear growth. We detected many eukaryotic viruses. Neither the total number of eukaryotic families nor a specific viral family was statistically associated with improved linear growth. We identified 3 differentially abundant bacteriophage among growth velocities. Interestingly, there was a positive correlation between bacteria and bacteriophage richness in children with subsequent adequate/moderate growth which children with subsequent poor growth lacked. This suggests that a disruption in the equilibrium between bacteria and bacteriophage communities might be associated with subsequent poor growth. Future studies of EED and stunting should include the evaluation of viral communities in addition to bacterial microbiota to understand the complete microbial ecology of these poorly understood entities.


Asunto(s)
Bacterias/clasificación , Bacteriófagos/clasificación , Microbioma Gastrointestinal , Tracto Gastrointestinal/microbiología , Tracto Gastrointestinal/virología , Trastornos del Crecimiento/microbiología , Trastornos del Crecimiento/virología , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/virología , Bacteriófagos/genética , Bacteriófagos/crecimiento & desarrollo , Bacteriófagos/aislamiento & purificación , Preescolar , Femenino , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/virología , Humanos , Lactante , Intestino Delgado/microbiología , Intestino Delgado/virología , Malaui , Masculino , Viabilidad Microbiana , Permeabilidad , ARN Ribosómico 16S
11.
J Med Microbiol ; 69(7): 932-943, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32530393

RESUMEN

Introduction. Diarrhoeagenic Escherichia coli (DEC) are difficult to distinguish from non-pathogenic commensal E. coli using traditional culture methods. The implementation of PCR targeting specific virulence genes characteristic of the five DEC pathotypes, has improved the detection of DEC in faecal specimens from patients with symptoms of gastrointestinal disease.Aim. Antimicrobial resistance (AMR) profiles of 660 strains of DEC isolated between 2015 and 2017 from UK travellers reporting symptoms of gastrointestinal disease were reviewed to look for evidence of emerging AMR associated with travellers' diarrhoea.Methodology. All isolates of DEC were sequenced, and sequence type, serotype, pathotype markers and AMR profiles were derived from the genome data.Results. A travel history was provided for 54.1 % (357/660) of cases, of which 77.0 % (275/357) reported travel outside the UK within 7 days of onset of symptoms, and 23.0 % (82/357) reported no travel in that time frame. Of the 660 strains of DEC in this study, 265 (40.2 %) samples were identified as EAEC, 48 (7.3 %) as EIEC, 61 (9.2 %) were ETEC and 286 (43.3 %) were EPEC. EPEC caused the highest percentage of infections in children (40.6 %) whilst the highest proportion of cases reporting recent travel were infected with ETEC (86.1 %). There were 390/660 (59.0 %) isolates resistant to at least one antimicrobial on the panel tested (EIEC, 81.3 %; ETEC, n=65.6 %; EAEC, n=73.2 %; EPEC, 40.9 %) and 265/660 (40.2 %) were multidrug-resistant (EIEC, 33.3 %; ETEC, 32.8 %; EAEC, 56.2 %; EPEC, 28.0 %). Genes conferring resistance to the beta-lactams and fluroquinolones were highest in the EAEC pathotype, 56.6 and 60.7%, respectively.Conclusions. Increasing MDR, along with resistance to the fluroquinolones and the third-generation cephalosporins, in DEC causing travellers' diarrhoea provides further evidence for the need to restrict the use of antimicrobial agents and continuous monitoring.


Asunto(s)
Farmacorresistencia Bacteriana/genética , Disentería/genética , Escherichia coli/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Niño , Preescolar , Diarrea/patología , Farmacorresistencia Bacteriana/efectos de los fármacos , Disentería/epidemiología , Disentería/microbiología , Escherichia coli/aislamiento & purificación , Escherichia coli/patogenicidad , Infecciones por Escherichia coli/genética , Heces/microbiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/genética , Enfermedades Gastrointestinales/microbiología , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Viaje , Reino Unido , Virulencia/efectos de los fármacos
12.
Artículo en Inglés | MEDLINE | ID: mdl-32349313

RESUMEN

Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising non-invasive alternative. The objectives of this research were to compare salivary antibody levels in children to enteric infections and biomarkers of environmental enteric dysfunction (EED). We collected saliva samples from children aged one to six years enrolled in a sanitation trial in Maputo, Mozambique, and characterized salivary secretory immunoglobulin A (SIgA) concentrations with enzyme-linked immunosorbent assays. We used multilevel linear models to analyze cross-sectional associations between salivary SIgA and the number of concurrent enteric pathogen infections, as well as EED biomarkers in matched stool samples. Median salivary SIgA concentrations in this study population were 54 µg/mL (inter-quartile range (IQR): 34, 85 µg/mL), and SIgA levels were similar between children of different ages. SIgA was lower in children experiencing a higher number of concurrent infections -0.04 log µg/mL (95% confidence interval (CI): -0.08 to -0.005 log µg/mL), but was not associated with any of the included EED biomarkers. Contrary to evidence from high-income countries that suggests salivary SIgA increases rapidly with age in young children, the high prevalence of enteric infections may have led to a suppression of immunological development in this study sample and could in part explain the similar SIgA levels between children of different ages.


Asunto(s)
Salud Ambiental , Enfermedades Gastrointestinales , Inmunoglobulina A Secretora , Infecciones , Biomarcadores/análisis , Preescolar , Estudios Transversales , Biomarcadores Ambientales , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/microbiología , Humanos , Inmunoglobulina A Secretora/análisis , Lactante , Infecciones/diagnóstico , Masculino , Mozambique , Complejo Represivo Polycomb 2 , Saliva/química
13.
Inflamm Bowel Dis ; 26(8): e89-e91, 2020 07 17.
Artículo en Inglés | MEDLINE | ID: mdl-32440692

RESUMEN

Severe Acute Respiratory Syndrome Coronavirus-2 (SAR-CoV-2) has been shown to invade brain tissue. Based on the evolutionary similarity with SARS-CoV, researchers propose that SARS-CoV-2 can invade the olfactory bulb and gastrointestinal (GI) system through angiotensin-converting enzyme 2. However, how SARS-CoV-2 causes neurological or GI symptoms is not clear. Many suggested intestinal and neural inflammations, caused by viral invasion, as the most likely reason for the GI and neurological symptoms; however, the patients with coronavirus disease 2019 (COVID-19) without neurological or GI symptoms indicate that this is not the case. The gut-brain axis could explain the reason for why some with COVID-19 do not have these symptoms. COVID-19 patients mostly show respiratory distress first, then diarrhea, anorexia, stroke, or loss of consciousness comes into view. Obviously, GI invasion is a mechanical process that begins with oral invasion and, therefore, most probably exists before the brain invasion, as indicated in case reports. However, when the GI tract is invaded, the virus may enter the central nervous system through vascular and lymphatic systems or the vagal nerve. SARS-CoV-2 can infect leukocytes and migrate with them into the brain, or the viral particles can be directly transported across the blood-brain barrier to the brain. Also, more recent research has revealed that SARS-CoV-2 can invade the peripheral lymphatic vessels connecting with the glymphatic system of the brain. The temporal correlation between neurological and gastrointestinal symptoms suggests the lymph vessels around the GI tract, the vascular system, or the gut-brain axis (enteric nervous system) as the most likely entry route for SARS-CoV-2 to the brain.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Sistema Nervioso Entérico/fisiopatología , Enfermedades Gastrointestinales/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/microbiología , Salud Global , Humanos , Masculino , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Neuropéptidos , Oligopéptidos , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Prevalencia , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/terapia , Índice de Severidad de la Enfermedad
14.
Aliment Pharmacol Ther ; 52(1): 155-167, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32412673

RESUMEN

BACKGROUND: Small intestinal bacterial overgrowth may play a role in gastrointestinal and non-gastrointestinal diseases. AIMS: To use quantitative polymerase chain reaction (qPCR) to determine and compare bacterial loads of duodenal biopsies in asymptomatic controls, and patients with functional gastrointestinal disorders (FGIDs) and inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD). To define effects of gastric acid inhibition on bacterial load, explore links of bacterial load and gastrointestinal symptoms in response to a standardised nutrient challenge and compare bacterial load with glucose breath test results. METHODS: In 237 patients (63 controls, 84 FGID and 90 IBD), we collected mucosal samples under aseptic conditions during endoscopy extracted and total DNA. Bacterial load metric was calculated utilising qPCR measurements of the bacterial 16S rRNA gene, normalised to human beta-actin expression. Standard glucose breath test and nutrient challenge test were performed. RESULTS: The duodenal microbial load was higher in patients with FGID (0.22 ± 0.03) than controls (0.07 ± 0.05; P = 0.007) and patients with UC (0.01 ± 0.05) or CD (0.02 ± 0.09), (P = 0.0001). While patients treated with proton pump inhibitors (PPI) had significantly higher bacterial loads than non-users (P < 0.05), this did not explain differences between patient groups and controls. Bacterial load was significantly (r = 0.21, P < 0.016) associated with the symptom response to standardised nutrient challenge test. Methane, but not hydrogen values on glucose breath test were associated with bacterial load measured utilising qPCR. CONCLUSIONS: Utilising qPCR, a diagnosis of FGID and treatment with PPI were independently associated with increased bacterial loads. Increased bacterial loads are associated with an augmented symptom response to a standardised nutrient challenge.


Asunto(s)
Duodeno/microbiología , Enfermedades Gastrointestinales/microbiología , Enfermedades Inflamatorias del Intestino/microbiología , Adulto , Anciano , Bacterias/genética , Bacterias/aislamiento & purificación , Carga Bacteriana , Biopsia , Pruebas Respiratorias/métodos , Femenino , Enfermedades Gastrointestinales/metabolismo , Glucosa/metabolismo , Humanos , Enfermedades Inflamatorias del Intestino/metabolismo , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , ARN Ribosómico 16S/genética
15.
Am J Surg Pathol ; 44(9): 1251-1258, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32301754

RESUMEN

Malakoplakia is an inflammatory process related to defective macrophage response to bacterial infection. To further characterize the clinicopathologic manifestations of gastrointestinal malakoplakia, 26 cases were identified from 6 institutions. Hematoxylin and eosin-stained slides and available stains were reviewed, and pertinent clinicopathologic features analyzed. Sixteen patients were women (62%). Mean patient age was 64 (range: 24 to 83). Sites included the colorectum (n=23), appendix (n=1), and stomach (n=2). Clinical indications for tissue procurement included screening (n=14), tumor resection (n=5), diarrhea (n=1), adenoma surveillance (n=1), ulcerative colitis flare (n=1), abdominal pain (n=1), and appendicitis (1). All cases featured histiocytes with abundant, pale, eosinophilic cytoplasm focally containing Michaelis-Gutmann bodies. The process frequently involved the mucosa (n=19), with architectural distortion in 13 cases. Lymphoid aggregates were present in 18 cases, which were prominent or obscuring in 11 (all colon biopsies) and provoked concern for lymphoma in 2. Associated findings included adenocarcinoma (n=5), adenoma (n=2), gastric hyperplastic polyps (n=1), chemical gastritis (n=1), collagenous colitis (n=1), and active chronic colitis (n=2). In cases with available stains, Michaelis-Gutman bodies were highlighted by Periodic Acid-Schiff with diastase, Von Kossa, and iron stains. Although 2 cases were positive for Tropheryma whipplei antibody, no T. whipplei transcripts were detected on real-time polymerase chain reaction. All patients with available follow-up are alive and well with no additional instances of malakoplakia. Malakoplakia of the gastrointestinal tract is a benign, incidental finding. Although histologic features in the stomach and colon resections are similar to those at other sites, exuberant lymphocytic response in colon biopsies and immunoreactivity with T. whippleii antibody may provoke initial confusion and lead to unnecessary time and resource investment.


Asunto(s)
Enfermedades Gastrointestinales/patología , Tracto Gastrointestinal/patología , Hallazgos Incidentales , Malacoplasia , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Femenino , Mucosa Gástrica/patología , Enfermedades Gastrointestinales/microbiología , Tracto Gastrointestinal/microbiología , Humanos , Mucosa Intestinal/patología , Masculino , Persona de Mediana Edad , Pronóstico , Tropheryma/genética , Estados Unidos , Adulto Joven
16.
Hum Genet ; 139(5): 593-604, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32152699

RESUMEN

Gastrointestinal infections can be life threatening, but not much is known about the host's genetic contribution to susceptibility to gastrointestinal infections or the latter's association with psychiatric disorders. We utilized iPSYCH, a genotyped population-based sample of individuals born between 1981 and 2005 comprising 65,534 unrelated Danish individuals (45,889 diagnosed with mental disorders and 19,645 controls from a random population sample) in which all individuals were linked utilizing nationwide population-based registers to estimate the genetic contribution to susceptibility to gastrointestinal infections, identify genetic variants associated with gastrointestinal infections, and examine the link between gastrointestinal infections and psychiatric and neurodevelopmental disorders. The SNP heritability of susceptibility to gastrointestinal infections ranged from 3.7% to 6.4% on the liability scale. Significant correlations were found between gastrointestinal infections and the combined group of mental disorders (OR = 2.09; 95% CI: 1.82-2.4, P = 1.87 × 10-25). Correlations with autism spectrum disorder, attention deficit hyperactivity disorder, and depression were also significant. We identified a genome-wide significant locus associated with susceptibility to gastrointestinal infections (OR = 1.13; 95% CI: 1.08-1.18, P = 2.9 × 10-8), where the top SNP was an eQTL for the ABO gene. The risk allele was associated with reduced ABO expression, providing, for the first time, genetic evidence to support previous studies linking the O blood group to gastrointestinal infections. This study also highlights the importance of integrative work in genetics, psychiatry, infection, and epidemiology on the road to translational medicine.


Asunto(s)
Enfermedades Gastrointestinales/epidemiología , Marcadores Genéticos , Predisposición Genética a la Enfermedad , Trastornos Mentales/fisiopatología , Trastornos del Neurodesarrollo/fisiopatología , Estudios de Casos y Controles , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Enfermedades Gastrointestinales/genética , Enfermedades Gastrointestinales/microbiología , Estudio de Asociación del Genoma Completo , Genotipo , Humanos , Incidencia , Masculino , Polimorfismo de Nucleótido Simple , Sitios de Carácter Cuantitativo
17.
Infection ; 48(3): 471-475, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32128685

RESUMEN

BACKGROUND: While Campylobacter jejuni represents the most common cause of bacterial gastroenteritis, Yersinia pseudotuberculosis infections are very rarely diagnosed in adults. CASE: We report on a previously healthy patient who presented several times at our hospital with fever, Guillain-Barré syndrome, recurrent abdominal symptoms and distinct mesenteric lymphadenopathy, respectively. This complicated and diagnostically challenging course of disease was caused by a C. jejuni and Y. pseudotuberculosis coinfection. Antibiotic treatment with doxycycline was effective. CONCLUSION: Broad serology testing was crucial to discover that two concomitant infections were causing the symptoms. This case demonstrates that when a clinical picture is not fully explained by one known infection, another infection with the same underlying risk factor has to be considered, hence "a horse and a zebra".


Asunto(s)
Infecciones por Campylobacter/diagnóstico , Coinfección/diagnóstico , Enfermedades Gastrointestinales/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Infecciones por Yersinia pseudotuberculosis/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Infecciones por Campylobacter/diagnóstico por imagen , Infecciones por Campylobacter/tratamiento farmacológico , Infecciones por Campylobacter/microbiología , Campylobacter jejuni/aislamiento & purificación , Coinfección/diagnóstico por imagen , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Doxiciclina/uso terapéutico , Fiebre/microbiología , Enfermedades Gastrointestinales/diagnóstico por imagen , Enfermedades Gastrointestinales/tratamiento farmacológico , Enfermedades Gastrointestinales/microbiología , Alemania , Síndrome de Guillain-Barré/diagnóstico por imagen , Síndrome de Guillain-Barré/microbiología , Humanos , Linfadenopatía/diagnóstico , Linfadenopatía/microbiología , Masculino , Recurrencia , Resultado del Tratamiento , Yersinia pseudotuberculosis/aislamiento & purificación , Infecciones por Yersinia pseudotuberculosis/diagnóstico por imagen , Infecciones por Yersinia pseudotuberculosis/tratamiento farmacológico , Infecciones por Yersinia pseudotuberculosis/microbiología
19.
J Pediatr ; 218: 157-165.e3, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32089179

RESUMEN

OBJECTIVES: To evaluate whether the implementation of a multiplex gastrointestinal pathogen panel (GIP) was associated with changes in Clostridioides difficile (C difficile) testing and detection rates. STUDY DESIGN: We conducted an observational study using interrupted time series analysis and included pediatric patients with testing capable of detecting C difficile. From 2013 to 2015 ("conventional diagnostic era"), stool testing included C difficile-selective polymerase chain reaction and other pathogen-specific tests. From 2015 to 2017 ("GIP era"), C difficile polymerase chain reaction was available along with the GIP, which detected 22 pathogens including C difficile, and replaced the need for additional tests. Outcomes included C difficile testing and detection rates in ambulatory, emergency department, and inpatient settings. RESULTS: There were 6841 tests performed and 1214 C difficile positive results. Across the 3 settings, GIP era had significantly higher C difficile testing (1.7-2.3 times higher) and C difficile detection rates (1.9-3.4 times higher) compared with conventional diagnostic era. After adjusting for the number of tests performed, detection rates were no longer significantly different. Of C difficile positive GIPs, 31% were coinfected with another organism. With GIP testing, patients 1 year of age had a significantly higher C difficile percent positivity than 2-year-old (P = .02) and 3- to 18-year-old children (P < .01). Younger children with C difficile were more likely to be coinfected (P < .01). CONCLUSIONS: Introducing a multiplex panel led to increased C difficile testing, which resulted in increased C difficile detection rates and potential identification and treatment of colonized patients. This highlights an important target for diagnostic stewardship and the challenges associated with multiplex testing.


Asunto(s)
/aislamiento & purificación , Diarrea/microbiología , Heces/microbiología , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/microbiología , Adolescente , Niño , Preescolar , Diarrea/diagnóstico , Femenino , Humanos , Incidencia , Masculino , Reacción en Cadena de la Polimerasa Multiplex , Reacción en Cadena de la Polimerasa , Prevalencia
20.
Dig Dis Sci ; 65(3): 818-828, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32056091

RESUMEN

While there are numerous medical comorbidities associated with ASD, gastrointestinal (GI) issues have a significant impact on quality of life for these individuals. Recent findings continue to support the relationship between the gut microbiome and both GI symptoms and behavior, but the heterogeneity within the autism spectrum requires in-depth clinical characterization of these clinical cohorts. Large, diverse, well-controlled studies in this area of research are still needed. Although there is still much to discover about the brain-gut-microbiome axis in ASD, microbially mediated therapies, specifically probiotics and fecal microbiota transplantation have shown promise in the treatment of GI symptoms in ASD, with potential benefit to the core behavioral symptoms of ASD as well. Future research and clinical trials must increasingly consider complex phenotypes in ASD in stratification of large datasets as well as in design of inclusion criteria for individual therapeutic interventions.


Asunto(s)
Trastorno del Espectro Autista/microbiología , Encéfalo/microbiología , Enfermedades Gastrointestinales/microbiología , Microbioma Gastrointestinal , Tracto Gastrointestinal/microbiología , Animales , Trastorno del Espectro Autista/psicología , Trastorno del Espectro Autista/terapia , Encéfalo/fisiología , Trasplante de Microbiota Fecal/tendencias , Enfermedades Gastrointestinales/psicología , Enfermedades Gastrointestinales/terapia , Microbioma Gastrointestinal/fisiología , Tracto Gastrointestinal/fisiología , Humanos , Probióticos/administración & dosificación
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