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1.
BMC Infect Dis ; 21(1): 9, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407180

RESUMO

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.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Adenovírus Humanos/genética , Infecções por Astroviridae/epidemiologia , Infecções por Caliciviridae/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Gastroenterite/epidemiologia , Mamastrovirus/genética , Sapovirus/genética , Infecções por Adenovirus Humanos/virologia , Adenovírus Humanos/isolamento & purificação , Animais , Infecções por Astroviridae/virologia , Austrália/epidemiologia , Infecções por Caliciviridae/virologia , Pré-Escolar , Estudos Transversais , Criptosporidiose/parasitologia , Cryptosporidium/isolamento & purificação , Diarreia/epidemiologia , Diarreia/parasitologia , Diarreia/virologia , Fezes/parasitologia , Fezes/virologia , Feminino , Gastroenterite/parasitologia , Gastroenterite/virologia , Humanos , Lactente , Recém-Nascido , Masculino , Mamastrovirus/isolamento & purificação , Grupo com Ancestrais Oceânicos , Reação em Cadeia da Polimerase/métodos , Prevalência , Sapovirus/isolamento & purificação
2.
BMC Infect Dis ; 21(1): 7, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407198

RESUMO

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.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Adenovírus Humanos/genética , Infecções por Caliciviridae/epidemiologia , Coinfecção/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Diarreia/epidemiologia , Norovirus/genética , Infecções por Rotavirus/epidemiologia , Rotavirus/genética , Infecções por Adenovirus Humanos/virologia , Adenovírus Humanos/isolamento & purificação , Animais , Infecções por Caliciviridae/virologia , Estudos de Casos e Controles , Pré-Escolar , Coinfecção/parasitologia , Coinfecção/virologia , Criptosporidiose/parasitologia , Cryptosporidium/isolamento & purificação , Diarreia/parasitologia , Diarreia/virologia , Fezes/parasitologia , Fezes/virologia , Feminino , Humanos , Lactente , Masculino , Reação em Cadeia da Polimerase Multiplex/métodos , Norovirus/isolamento & purificação , Rotavirus/isolamento & purificação , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus , Emirados Árabes Unidos/epidemiologia
3.
BMC Infect Dis ; 21(1): 18, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407207

RESUMO

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.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Diarreia/epidemiologia , Desnutrição/epidemiologia , Infecções por Rotavirus/epidemiologia , Rotavirus/imunologia , Animais , Aleitamento Materno , Pré-Escolar , Comorbidade , Estudos Transversais , Diarreia/virologia , Características da Família , Fezes/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique/epidemiologia , Prevalência , Fatores de Risco , Infecções por Rotavirus/prevenção & controle , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/uso terapêutico
4.
Medicine (Baltimore) ; 99(42): e22748, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080738

RESUMO

To compare clinical features and outcomes between early and late onset of neonatal bacterial meningitis (NBM).Patients were allocated in 2 groups: early onset neonatal bacterial meningitis (ENBM) and late onset neonatal bacterial meningitis (LNBM). Data analysis includes asphyxia at birth, premature rupture of membranes (PROM), amnionitis, amniotic fluid contamination, maternal age, clinical manifestations of the patients, laboratory findings, radiological results, complications related to meningitis, duration of hospitalization and therapeutic effect.There was no difference in gender, birth weight, gestational age, and incidence of asphyxia between 2 groups. The incidence of PROM, chorioamnionitis and amniotic fluid contamination, proportion of small-for-gestational-age infants, convulsions, intracranial hemorrhage, hyperbilirubinemia, and the protein level of cerebrospinal fluid in ENBM group were higher than that in LNBM group (P < .05); the proportion of fever, elevated C-reaction protein and the abnormal of platelet counts in LNBM group was higher than that in ENBM group (P < .05). There was no difference in the incidence of complications and hospitalization time between 2 groups. The rate of effective treatment in LNBM group was significantly higher than that in ENBM group (P < .05).Patients with conditions of amniotic fluid contamination, chorioamnionitis, small-for-gestational-age and PROM might be more prone to develop ENBM and ENBM had worse outcomes than LNBM.


Assuntos
Meningites Bacterianas/epidemiologia , Adulto , Líquido Amniótico , Proteína C-Reativa/análise , Proteínas do Líquido Cefalorraquidiano/análise , China/epidemiologia , Corioamnionite/epidemiologia , Diarreia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Hemorragias Intracranianas/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Contagem de Plaquetas , Gravidez , Complicações na Gravidez/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões/epidemiologia , Nascimento a Termo
5.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(10): 1104-1110, 2020 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-33115197

RESUMO

Objective: To understand the epidemiological characteristics and clinical features of rotavirus-, norovirus-, adenovirus-and astrovirus-associ ated acute gastroenteritis in children under 5 years old in Beijing from Octorber, 2015 to March, 2017. Methods: In the intestinal clinic of 6 hospitals in 6 districts of Beijing, information and stool samples of the first 30 patients with acute gastroenteritis who are under the age of 5 years are collected monthly.Rotavirus, norovirus, adenovirus and astrovirus are identified by PCR.Descriptive epidemiological method was used to describe the epidemiological characteristics of diarrhea caused by rotavirus, norovirus, adenovirus and astrovirus in Beijing. One-way analysis of variance was used to analyze the Vesikari clinical severity score of of acute gastroenteritis caused by each virus. Unconditional logistic regression analysis was used to analysis the associated factors of clinical features. Results: Of the 2 052 samples, 709 (34.6%) were non-mixed infections: the positive rate of rotavirus, norovirus, adenovirus and astrovirus were 20.0%, 7.5%, 4.2% and 2.9%, respectively. A total of 135 cases (6.6%) were mixed infection. The mean and standard deviation of Vesikari clinical severity score was 8.0±3.1 for rotavirus associated acute gastroenteritis, which was significantly higher than norovirus (6.4±2.4, P<0.001), adenovirus (6.2±2.1, P<0.001) and astrovirus (6.1±2.0, P<0.001). The comparison of clinical features showed that compared with astrovirus, the children under 5 years old infected with rotavirus were more likely to have a diarrhea ≥5 days (OR=3.334), have vomiting ≥3 times within one day (OR=8.788), have vomiting≥1 day (OR=3.963), have a Vesikari clinical severity score ≥11 severe cases (OR=13.194). Norovirus infected cases were prone to have vomiting≥3 times in 1 day (OR=5.710).Adenovirus infected cases were prone to have a diarrhea≥5 days (OR=2.616). When using rotavirus as a reference, children under 5 years of age were less likely to develop fever≥38.4 ℃ after infection with norovirus (OR=0.397) or adenovirus (OR=0.280). Conclusions: The results of this study showed that the characteristics of acute gastroenteritis caused by different viruses are different. The clinical symptoms caused by rotavirus are more serious. Children under 24 months of age are at high risk of rotavirus infection. Effective preventive measures such as vaccination should be taken as soon as possible.


Assuntos
Infecções por Astroviridae , Infecções por Caliciviridae , Gastroenterite , Infecções por Rotavirus , Rotavirus , Infecções por Astroviridae/epidemiologia , Infecções por Caliciviridae/epidemiologia , Criança , Pré-Escolar , Diarreia/epidemiologia , Fezes , Gastroenterite/epidemiologia , Humanos , Lactente , Infecções por Rotavirus/epidemiologia
6.
Sci Rep ; 10(1): 17846, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082472

RESUMO

In order to understand the clinical manifestations and incidence of gastrointestinal symptoms of coronavirus disease (COVID-19) in children and discuss the importance of fecal nucleic acid testing.We retrospectively analyzed studies on gastrointestinal symptoms and fecal nucleic acid detection in pediatric COVID-19 patients from January 1, 2020 to August 10, 2020, including prospective clinical studies and case reports. The results of fecal nucleic acid detection were analyzed systematically. Stata12.0 software was used for meta-analysis.The results showed that the most common gastrointestinal symptoms in children with COVID-19 were vomiting and diarrhea, with a total incidence of 17.7% (95% Cl 13.9-21.5%). However, the prevalence of gastrointestinal symptoms in other countries (21.1%, 95% CI 16.5-25.7%) was higher compared to China (12.9%, 95% CI 8-17.7%). In Wuhan, the pooled prevalence was much higher (41.3%, 95% CI 3.2-79.4%) compared to areas outside Wuhan in China (7.1%, 95% CI 4.0-10.3%). The positive rate of fecal nucleic acid testing in COVID-19 children was relatively high at 85.8% (91/106). Additionally, 71.2% (52/73) were still positive for fecal nucleic acid after respiratory tract specimens turned negative. One and two weeks after the respiratory tract specimens turned nucleic acid-negative, 45.2% (33/73) and 34.2% (25/73) patients, respectively, remained fecal nucleic acid-positive. The longest interval between the respiratory tract specimens turning negative and fecal specimens turning negative exceeded 70 days. Conclusions and relevance: gastrointestinal symptoms in pediatric COVID-19 are relatively common. Attention should be paid to the detection of fecal nucleic acids in children. Fecal nucleic acid-negative status should be considered as one of the desegregation standards.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Fezes/virologia , Gastroenteropatias/diagnóstico , Pneumonia Viral/diagnóstico , Betacoronavirus/isolamento & purificação , Criança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diarreia/complicações , Diarreia/diagnóstico , Diarreia/epidemiologia , Gastroenteropatias/complicações , Gastroenteropatias/epidemiologia , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prevalência , Prognóstico , RNA Viral/metabolismo
7.
Arch Virol ; 165(12): 3011-3015, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33025200

RESUMO

The hemagglutinin-esterase (HE) protein of betacoronavirus lineage A is a secondary receptor in the infection process and is involved in the emergence of new betacoronavirus genotypes with altered host specificity and tissue tropism. We previously reported a novel recombinant bovine coronavirus (BCoV) strain that was circulating in dairy cattle in China, but this virus was not successfully isolated, and the genetic characteristics of BCoV are still largely unknown. In this study, 20 diarrheic faecal samples were collected from a farm in Liaoning province that had an outbreak of calf diarrhea (≤ 3 months of age) in November 2018, and all of the samples tested positive for BCoV by RT-PCR. In addition, a BCoV strain with a recombinant HE (designated as SWUN/A1/2018) and another BCoV strain with a recombinant HE containing an insertion (designated as SWUN/A10/2018) were successfully isolated in cell culture (TCID50: 104.25/mL and 104.73/mL, respectively). Unexpectedly, we identified the emergence of a novel BCoV variant characterized by a 12-nt bovine gene insertion in the receptor-binding domain in a natural recombinant HE gene, suggesting a novel evolutionary pattern in BCoV.


Assuntos
Doenças dos Bovinos/epidemiologia , Infecções por Coronavirus/veterinária , Coronavirus Bovino/genética , Diarreia/veterinária , Hemaglutininas Virais/genética , RNA Viral/genética , Proteínas Virais de Fusão/genética , Animais , Bovinos , Doenças dos Bovinos/patologia , Doenças dos Bovinos/virologia , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Coronavirus Bovino/classificação , Coronavirus Bovino/isolamento & purificação , Diarreia/epidemiologia , Diarreia/patologia , Diarreia/virologia , Evolução Molecular , Fezes/virologia , Expressão Gênica , Genótipo , Modelos Moleculares , Mutagênese Insercional , Filogenia , Estrutura Secundária de Proteína , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA
8.
BMC Infect Dis ; 20(1): 741, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33036564

RESUMO

BACKGROUND: Cholera remains a major global health challenge. Uvira, in the Democratic Republic of the Congo (DRC), has had endemic cholera since the 1970's and has been implicated as a possible point of origin for national outbreaks. A previous study among this population, reported a case confirmation rate of 40% by rapid diagnostic test (RDT) among patients at the Uvira Cholera Treatment Centre (CTC). This study considers the prevalence and diversity of 15 enteric pathogens in suspected cholera cases seeking treatment at the Uvira CTC. METHODS: We used the Luminex xTAG® multiplex PCR to test for 15 enteric pathogens, including toxigenic strains of V. cholerae in rectal swabs preserved on Whatman FTA Elute cards. Results were interpreted on MAGPIX® and analyzed on the xTAG® Data Analysis Software. Prevalence of enteric pathogens were calculated and pathogen diversity was modelled with a Poisson regression. RESULTS: Among 269 enrolled CTC patients, PCR detected the presence of toxigenic Vibrio cholerae in 38% (103/269) of the patients, which were considered to be cholera cases. These strains were detected as the sole pathogen in 36% (37/103) of these cases. Almost half (45%) of all study participants carried multiple enteric pathogens (two or more). Enterotoxigenic Escherichia coli (36%) and Cryptosporidium (28%) were the other most common pathogens identified amongst all participants. No pathogen was detected in 16.4% of study participants. Mean number of pathogens was highest amongst boys and girls aged 1-15 years and lowest in women aged 16-81 years. Ninety-three percent of toxigenic V. cholerae strains detected by PCR were found in patients having tested positive for V. cholerae O1 by RDT. CONCLUSIONS: Our study supports previous results from DRC and other cholera endemic areas in sub-Sahara Africa with less than half of CTC admissions positive for cholera by PCR. More research is required to determine the causes of severe acute diarrhea in these low-resource, endemic areas to optimize treatment measures. TRIAL REGISTRATION: This study is part of the impact evaluation study entitled: "Impact Evaluation of Urban Water Supply Improvements on Cholera and Other Diarrheal Diseases in Uvira, Democratic Republic of Congo" registered on 10 October 2016 at clinicaltrials.gov Identification number: NCT02928341 .


Assuntos
Cólera/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Diarreia/epidemiologia , Surtos de Doenças , Escherichia coli Enterotoxigênica/genética , Infecções por Escherichia coli/epidemiologia , Vibrio cholerae/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Cólera/microbiologia , Criptosporidiose/parasitologia , República Democrática do Congo/epidemiologia , Testes Diagnósticos de Rotina , Diarreia/microbiologia , Doenças Endêmicas , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Prevalência , Microbiologia da Água , Adulto Jovem
9.
Wei Sheng Yan Jiu ; 49(5): 724-730, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33070812

RESUMO

OBJECTIVE: To identify the relationship between fever and diarrhea 2-week prevalence and Yingyangbao(YYB) effective consumption among infants and young children. METHODS: A total of 2952 infants and young children aged from 6 to 24 month in 10 impoverished counties of Henan province were selected by multi-stage random sampling between June and September 2017. To acquire 2-week prevalence information of infants and young children, their caregivers were investigated by self-made questionnaire. The structural equation model was utilized in multi-factor analysis. RESULTS: After adjusting potential confounders, YYB effective consumption reduced2-week prevalence of fever(ß=-0. 279, P=0. 001) and diarrhea(ß=-0. 182, P=0. 042) among infants and young children. Nutrition knowledge and YYB benefit cognition of caregivers reduced2-week prevalence of fever(γ=-0. 002, 95%CI-0. 004~-0. 001, P=0. 003) and diarrhea(γ=-0. 001, 95%CI-0. 003~0. 000, P=0. 049) indirectly through chain mediation path of "nutrition knowledge-YYB benfit cognition-YYB effective consumption-fever/diarrheal". CONCLUSION: YYB effective consumption can reduce 2-week prevalence of fever and diarrhea among infants and young children. Nutrition knowledge and YYB benefit cognition can improve YYB effective consumption and thus reduce 2-week prevalence of fever and diarrhea indirectly.


Assuntos
Suplementos Nutricionais , População Rural , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/prevenção & controle , Alimentos Fortificados , Humanos , Lactente , Prevalência
10.
Rev Saude Publica ; 54: 90, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33027343

RESUMO

OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.


Assuntos
Diarreia/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Lactente , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
11.
BMC Infect Dis ; 20(1): 659, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894092

RESUMO

BACKGROUND: Diarrheagenic Escherichia coli (DEC) are among the leading pathogens associated with endemic diarrhea in low income countries. Yet, few epidemiological studies have focused the contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC) and diffusely adherent E. coli (DAEC). METHODS: We assessed the contribution of EHEC, EIEC and DAEC isolated from stool samples from a case-control study conducted in children aged < 5 years in Southern Mozambique between December 2007 and November 2012. The isolates were screened by conventional PCR targeting stx1 and stx2 (EHEC), ial and ipaH (EIEC), and daaE (DAEC) genes. RESULTS: We analyzed 297 samples from cases with less-severe diarrhea (LSD) matched to 297 controls, and 89 samples from cases with moderate-to-severe diarrhea (MSD) matched to 222 controls, collected between November 3, 2011 and November 2, 2012. DEC were more common among LSD cases (2.7%, [8/297] of cases vs. 1.3% [4/297] of controls; p = 0.243]) than in MSD cases (0%, [0/89] of cases vs. 0.4%, [1/222] of controls; p = 1.000). Detailed analysis revealed low frequency of EHEC, DAEC or EIEC and no association with diarrhea in all age strata. Although the low frequency, EIEC was predominant in LSD cases aged 24-59 months (4.1% for cases vs. 0% for controls), followed by DAEC in similar frequency for cases and controls in infants (1.9%) and lastly EHEC from one control. Analysis of a subset of samples from previous period (December 10, 2007 and October 31, 2011) showed high frequency of DEC in controls compared to MSD cases (16.2%, [25/154] vs. 11.9%, [14/118], p = 0.383, respectively). Among these, DAEC predominated, being detected in 7.7% of cases vs. 17.6% of controls aged 24-59 months, followed by EIEC in 7.7% of cases vs. 5.9% of controls for the same age category, although no association was observed. EHEC was detected in one sample from cases and two from controls. CONCLUSIONS: Our data suggests that although EHEC, DAEC and EIEC are less frequent in endemic diarrhea in rural Mozambique, attention should be given to their transmission dynamics (e.g. the role on sporadic or epidemic diarrhea) considering that the role of asymptomatic individuals as source of dissemination remains unknown.


Assuntos
Diarreia/epidemiologia , Escherichia coli Êntero-Hemorrágica/genética , Infecções por Escherichia coli/epidemiologia , Saúde da População Rural , Estudos de Casos e Controles , Pré-Escolar , Diarreia/microbiologia , Doenças Endêmicas , Escherichia coli Êntero-Hemorrágica/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Fezes/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , População Rural
12.
Appl Environ Microbiol ; 86(23)2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-32948526

RESUMO

This study aimed to characterize in silico enterotoxigenic Escherichia coli F4- and F18-positive isolates (n = 90) causing swine postweaning diarrhea, including pathogenic potential, phylogenetic relationship, antimicrobial and biocide resistance, prophage content, and metal tolerance rates. F4 strains belonged mostly to the O149 and O6 serogroups and ST100 and ST48 sequence types (STs). F18 strains were mainly assigned to the O8 and O147 serogroups and ST10, ST23, and ST42. The highest rates of antimicrobial resistance were found against streptomycin, sulfamethoxazole, tetracycline, trimethoprim, and ampicillin. No resistance was found toward ciprofloxacin, cefotaxime, ceftiofur, and colistin. Genes conferring tolerance to copper (showing the highest diversity), cadmium, silver, and zinc were predicted in all genomes. Enterotoxin genes (ltcA, 100% F4, 62% F18; astA, 100% F4, 38.1% F18; sta, 18.8% F4, 38.1% F18; stb, 100% F4, 76.2% F18) and fimbria-encoding genes typed as F4ac and F18ac were detected in all strains, in addition to up to 16 other virulence genes in individual strains. Phage analysis predicted between 7 and 20 different prophage regions in each strain. A highly diverse variety of plasmids was found; IncFII, IncFIB, and IncFIC were prevalent among F4 isolates, while IncI1 and IncX1 were dominant among F18 strains. Interestingly, F4 isolates from the early 1990s belonged to the same clonal group detected for most of the F4 strains from 2018 to 2019 (ONT:H10-A-ST100-CH27-0). The small number of single-nucleotide polymorphism differences between the oldest and recent F4 ST100 isolates suggests a relatively stable genome. Overall, the isolates analyzed in this study showed remarkably different genetic traits depending on the fimbria type.IMPORTANCE Diarrhea in the postweaning period due to enterotoxigenic E. coli (ETEC) is an economically relevant disease in pig production worldwide. In Denmark, prevention is mainly achieved by zinc oxide administration (to be discontinued by 2022). In addition, a breeding program has been implemented that aims to reduce the prevalence of this illness. Treatment with antimicrobials contributes to the problem of antimicrobial resistance (AMR) development. As a novelty, this study aims to deeply understand the genetic population structure and variation among diarrhea-associated isolates by whole-genome sequencing characterization. ST100-F4ac is the dominant clonal group circulating in Danish herds and showed high similarity to ETEC ST100 isolates from China, the United States, and Spain. High rates of AMR and high diversity of virulence genes were detected. The characterization of diarrhea-related ETEC is important for understanding the disease epidemiology and pathogenesis and for implementation of new strategies aiming to reduce the impact of the disease in pig production.


Assuntos
Diarreia/veterinária , Escherichia coli Enterotoxigênica/genética , Infecções por Escherichia coli/veterinária , Genoma Bacteriano , Doenças dos Suínos/epidemiologia , Animais , Dinamarca/epidemiologia , Diarreia/epidemiologia , Diarreia/microbiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Filogenia , Suínos , Doenças dos Suínos/microbiologia
13.
Am J Trop Med Hyg ; 103(5): 1855-1863, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32959765

RESUMO

U.S. military personnel must be ready to deploy to locations worldwide, including environments with heightened risk of infectious disease. Diarrheal illnesses continue to be among the most significant infectious disease threats to operational capability. To better prevent, detect, and respond to these threats and improve synchronization across the Department of Defense (DoD) overseas laboratory network, a multisite Global Travelers' Diarrhea protocol was implemented with standardized case definitions and harmonized laboratory methods to identify enteric pathogens. Harmonized laboratory procedures for detection of Norovirus (NoV), enterotoxigenic Escherichia coli (ETEC), enteroaggregative E. coli, Shiga toxin-producing E. coli, enteropathogenic E. coli, Salmonella enterica, Shigella/enteroinvasive E. coli, and Campylobacter jejuni have been implemented at six DoD laboratories with surveillance sites in Egypt, Honduras, Peru, Nepal, Thailand, and Kenya. Samples from individuals traveling from wealthy to poorer countries were collected between June 2012 and May 2018, and of samples with all variables of interest available (n = 410), most participants enrolled were students (46%), tourists (26%), U.S. military personnel (13%), or other unspecified travelers (11%). One or more pathogens were detected in 59% of samples tested. Of samples tested, the most commonly detected pathogens were NoV (24%), ETEC (16%), and C. jejuni (14%), suggesting that NoV plays a larger role in travelers' diarrhea than has previously been described. Harmonized data collection and methods will ensure identification and characterization of enteric pathogens are consistent across the DoD laboratory network, ultimately resulting in more comparable data for global assessments, preventive measures, and treatment recommendations.


Assuntos
Infecções por Caliciviridae/epidemiologia , Diarreia/epidemiologia , Gastroenteropatias/epidemiologia , Militares , Viagem , Diarreia/etiologia , Gastroenteropatias/etiologia , Humanos , Norovirus , Estados Unidos
14.
Arch Virol ; 165(12): 2883-2889, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32892248

RESUMO

In order to understand the prevalence and genetic diversity of porcine deltacoronavirus (PDCoV) in diarrhoeal pigs in Sichuan province, 634 clinical samples were collected from individual pigs with diarrhoea in 13 regions of Sichuan province, China, from January 2017 and June 2019. The detection results showed that the infection rate of PDCoV was relatively low in diarrhoeal pigs, 13.25% (84/634), but the infection rate of PEDV (porcine epidemic diarrhea virus) was high, 32.18% (204/634). Coinfection with PEDV was common (55.95%, 47/84) in PDCoV-infected diarrhoeal pigs. Additionally, the chance of PDCoV infection was 2.77 times higher in suckling piglets than in sows, and about 3.30 times higher in spring and winter than in summer. PDCoV/PEDV coinfection was 75% less likely in sows than in suckling piglets. The complete genomes of four Sichuan PDCoV strains were sequenced and analysed. There were some insertion-deletion signatures in the whole genome sequences of four strains, including a 6-nt deletion in the non-structural gene 2 region, a 9-nt insertion in the non-structural gene 3 region, a 3-nt deletion in the S gene region, and a distinguishing 11-nt deletion in the 3'UTR region. Phylogenetic analysis based on complete genome sequences revealed that the PDCoV Sichuan strains were closely related to other Chinese PDCoV reference strains; however, phylogenetic analysis based on S gene sequences showed that the CH/SC/2019 strain clustered in a large clade with strains from the USA, Japan, and Korea. These data advance our understanding of the genetic diversity and evolutionary characteristics of PDCoV in China and may contribute to vaccine development.


Assuntos
Infecções por Coronavirus/veterinária , Diarreia/veterinária , Genoma Viral , Vírus da Diarreia Epidêmica Suína/fisiologia , Doenças dos Suínos/epidemiologia , Animais , China , Coinfecção/veterinária , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diarreia/epidemiologia , Diarreia/virologia , Fezes/virologia , Filogenia , Vírus da Diarreia Epidêmica Suína/genética , Prevalência , Sus scrofa/virologia , Suínos , Doenças dos Suínos/virologia , Sequenciamento Completo do Genoma
15.
Korean J Intern Med ; 35(6): 1261-1269, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32872734

RESUMO

BACKGROUND/AIMS: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea. METHODS: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed. RESULTS: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality. CONCLUSION: Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.


Assuntos
Infecções por Coronavirus/complicações , Diarreia/virologia , Pneumonia Viral/complicações , Adulto , Idoso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Diarreia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prevalência , Radiografia Torácica , República da Coreia/epidemiologia , Estudos Retrospectivos , Choque Séptico/virologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-32963886

RESUMO

Diarrhoeal diseases are among the leading causes of morbidity and mortality in the Western Pacific Region. However, data on the major causes of infectious diarrhoea are limited in many countries within the Region, including Papua New Guinea. In 2013-2014, we conducted surveillance for acute diarrhoeal illness in four provinces in Papua New Guinea. One rural health clinic from each province participated in the surveillance activity. Samples were sent to central laboratories and batch analysed for bacterial and viral gastrointestinal pathogens that are commonly associated with diarrhoea. Across the four sites, the most commonly detected pathogens were Shigella spp., Campylobacter spp. and rotavirus. In this paper, we report the results of the surveillance activity and the challenges that we faced. The lessons learnt may be applicable to other parts of the Region with a similar socioeconomic status.


Assuntos
Diarreia/epidemiologia , Monitoramento Epidemiológico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diarreia/microbiologia , Diarreia/virologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Papua Nova Guiné/epidemiologia , Adulto Jovem
17.
Afr J Prim Health Care Fam Med ; 12(1): e1-e11, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32896151

RESUMO

BACKGROUND: Diarrhoea remains a public health problem and an important cause of morbidity and mortality amongst children, mainly in low- and middle-income countries. In Namibia, the national prevalence of diarrhoea was 17%; it was responsible for 5% of all deaths in children under 5 years old and is the second leading cause of death. AIM: The purpose of this study was to assess the epidemiology and factors associated with acute diarrhoea amongst children less than 5 years of age in Engela district in the Ohangwena region, Namibia. SETTING: The study was conducted in Ohangwena Region in Namibia which extends east to west along the borders of the southern part of Angola. METHODS: A cross-sectional study was conducted. A structured questionnaire was administered through face-to-face interviews. Descriptive statistics were used to describe the socio-demographic and epidemiological data of diarrhoea and logistic regression analysis was used to determine the factors associated with the prevalence of diarrhoea. RESULTS: The study found a prevalence of 23.8% for diarrhoea in the 2 weeks period preceding the survey amongst children aged under 5 years. The prevalence of diarrhoea was statistically significantly associated with children (p 0.05). The strongest predictor of the prevalence of diarrhoea was the residential area 'informal settlement', with an odds ratio of 36.42. This implies that children living in the informal settlement are 36.42 times at risk of contracting diarrhoea as compared to those living in other residential areas. CONCLUSION: epidemiology; factors; diarrhoea; under-5 years children; Engela district; Ohangwena region; Namibia.


Assuntos
Diarreia/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Namíbia/epidemiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos
18.
J Korean Med Sci ; 35(37): e333, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32959547

RESUMO

BACKGROUND: There is limited information on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who are asymptomatic or have mild symptoms. METHODS: We performed a retrospective case series of patients with COVID-19 enrolled from February 22 to March 26, 2020. Forty cases of COVID-19 were confirmed using real-time reverse-transcription polymerase chain reaction among patients who underwent screening tests and were consecutively hospitalized at Ulsan University Hospital, Ulsan, Korea. The final follow-up date was May 19, 2020. All COVID-19 cases in Ulsan were included. Demographic and epidemiological information, comorbidities, clinical signs and symptoms, laboratory and radiologic findings, medications, treatments, outcomes, and main durations of patients with COVID-19 were compared according to supplemental oxygen requirement. RESULTS: Forty patients were included (median age, 30 years; interquartile range [IQR], 25-57 years; 58% female). Six (15%) patients required supplemental oxygen. The prevalence of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was 5% and that of presymptomatic infection was 13%. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea were the screening criteria for diagnosing symptomatic and presymptomatic SARS-CoV-2 infections. Sputum production, chest discomfort, a large number of symptoms, abnormal procalcitonin and C-reactive protein levels, and abnormal chest X-ray or chest computed tomography findings were more common in patients requiring supplemental oxygen than in those not requiring supplemental oxygen. Overall mortality rate was 3% (1/40). Four patients (10%) were readmitted after testing positive by reverse-transcription polymerase chain reaction again. Incubation period was 5 days (IQR, 4-6 days), and the duration of viral shedding was 21 days (IQR, 14-28 days; maximum, 51 days). CONCLUSION: The prevalence of asymptomatic SARS-CoV-2 infection was 5%, which is much lower than that previously reported. This finding suggests that careful interviews and follow-ups should be performed to identify SARS-CoV-2 infections. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea are adequate screening criteria for covering all symptoms of SARS-CoV-2 infection. Further evaluation is required to create representative screening criteria for COVID-19.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus , Comorbidade , Tosse/epidemiologia , Diarreia/epidemiologia , Feminino , Febre/epidemiologia , Hospitalização , Humanos , Coreia (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/epidemiologia , Pandemias , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Avaliação de Sintomas , Resultado do Tratamento
19.
BMC Public Health ; 20(1): 1241, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32799826

RESUMO

BACKGROUND: Providing universal access to safe water, sanitation and hygiene (WASH) in remote Nepal remains challenging. We investigated WASH conditions and their association with children's nutritional status, intestinal parasitic infections and diarrhoea. METHODS: Data was collected through a cross-sectional survey of 1427 households, including questionnaires, observations, stool analysis, anthropometry, water quality measurements, and assessment of clinical signs of nutritional deficiencies. RESULTS: We found 55.5% of children were undernourished, 63.9% had clinical signs of nutritional deficiencies, 51.1% had intestinal parasitic infections and 52.2% had diarrhoea. Multivariate mixed logistic regression analysis revealed a statistically significant negative association between undernutrition and socio-economic level, with adjusted odds ratios (AOR) of 0.70 (95%-CI = 0.43-1.11) and 0.43 (95%-CI = 0.25-0.75) for high and intermediate levels compared to the lowest level. Undernutrition was negatively associated with regular deworming of children (AOR = 0.44, 95% CI = 0.20-0.94), food supplements (AOR = 0.57, 95% CI = 0.38-0.84), household's own food production (AOR = 0.67, 95% CI = 0.46-0.97) and personal hygiene (AOR = 0.83, 95% CI = 0.51-1.35). Nutritional deficiency was negatively associated with handwashing after cleaning a baby's bottom (AOR = 0.60, 95% CI = 0.40-0.92) and cleanliness of caregiver's hands (AOR = 0.61, 95% CI = 0.41-0.89) and positively associated with keeping animals inside the house overnight (AOR = 1.71, 95% CI = 1.17-2.51) and the presence of total coliforms in the drinking water source (AOR = 10.44, 95% CI = 1.61-67.4). Diarrhoea was positively associated with intermittent water supply (AOR = 2.72, 95% CI = 1.18-6.31) and the presence of a mud floor (AOR = 2.29, 95% CI = 1.20-4.37) and negatively associated with cleanliness of the toilet (AOR = 0.68, 95% CI = 0.47-0.98), and the cleanliness of children's hands (AOR = 0.62, 95% CI = 0.40-0.96). CONCLUSIONS: Our study found, more than half of the survey children were in a critical health condition. Results suggest that child health improvements are dependent on multiple public health improvements, including providing better nutrition, promoting adequate hygiene behaviour, such as handwashing, keeping the latrines clean, keeping the household environment free from animal faeces and assuring a reliable supply of safe water.


Assuntos
Diarreia/epidemiologia , Higiene , Enteropatias Parasitárias/epidemiologia , Estado Nutricional , Saúde da População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Adulto , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Nepal/epidemiologia
20.
Am J Trop Med Hyg ; 103(4): 1735-1741, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32830641

RESUMO

We conducted a comparative cross-sectional study to examine the potential effects of a community-led total sanitation (CLTS) intervention on sanitation and hygiene in Pallisa district in Uganda. Quantitative data were collected from households using a semi-structured questionnaire and an observation checklist, entered and analyzed using univariate, bivariate, and multivariate analyses. Overall, knowledge on sanitation and hygiene was significantly higher (64.5%; 129/200) among households in the CLTS intervention than among those in the nonintervention subcounties (54.0%; 108/200) (P = 0.033). Latrine quality was rated as fair in a majority (73.3%; 143/195) of the CLTS intervention households compared with 50.8% (93/183) in the non-CLTS households (P < 0.001). Latrine cleanliness was rated as good in more than a half (51.3%; 100/195) of households in the intervention area, whereas only 13.7% (25/183) for the nonintervention area (P < 0.001). In this study, 35.0% (70/200) of the households in the intervention subcounty had attained open defecation-free (ODF) status compared with only 6.0% (12/200) in the nonintervention subcounty (P < 0.001). Level of knowledge on hygiene and sanitation (adjusted odd ratio [AOR]: 2.23; 95% CI: 1.24-4.03) and CLTS status (AOR: 8.89; 95% CI: 4.26-18.56) were significantly associated with achievement of ODF status in the multivariate analysis. The mean cases of diarrhea were significantly lower in CLTS implementing (subcounty (0.42 [SD ± 1.03]) than in the non-CLTS implementing subcounty (0.98 [SD ± 1.39]; t = -4.6; P < 0.001). Sanitation and hygiene outcomes were better in the CLTS intervention subcounty than in the non-CLTS intervention subcounty, suggesting that scaling up CLTS could reduce ODF and the burden of diarrheal diseases.


Assuntos
Diarreia/epidemiologia , Higiene , Saneamento , Adolescente , Adulto , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Toaletes , Uganda/epidemiologia , Adulto Jovem
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