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2.
Zhonghua Nei Ke Za Zhi ; 59(1): 82-85, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887844

RESUMO

A 43-year-old male presented with elevated serum creatinine for 4 years and developed abdominal pain for 3 days. He started peritoneal dialysis 2 months ago. Dialysis-related peritonitis was ruled out and acute gastroenteritis was diagnosed. The patient was administrated with ertapenem 500 mg/d. An acute mental abnormality developed 3 days later. After excluded organic encephalopathy, ertapenem was discontinued for the suspicion of antibiotic-related encephalopathy. The frequency of peritoneal dialysis was increased to accelerate the clearance of antibiotics. However, the metal abnormality became even more severe. Then a diagnosis of Wernick-Korsakoff syndrome was considered. After the administration of high dose vitamin B(1), the mental disorder dramatically relieved. Vitamin B(1) 30 mg/d is maintained during peritoneal dialysis and the mental disorder does not relapse.


Assuntos
Dor Abdominal/etiologia , Síndrome de Korsakoff/tratamento farmacológico , Diálise Peritoneal , Insuficiência Renal/terapia , Tiamina/administração & dosagem , Encefalopatia de Wernicke/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Ertapenem/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Síndrome de Korsakoff/diagnóstico , Masculino , Transtornos Mentais , Peritonite , Insuficiência Renal/complicações , Resultado do Tratamento , Encefalopatia de Wernicke/diagnóstico
3.
BMC Infect Dis ; 19(1): 1018, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791267

RESUMO

BACKGROUND: Although, India has made steady progress in reducing deaths in children younger than 5 years, the proportional mortality accounted by diarrhoeal diseases still remains high. The present hospital based cross sectional study was carried out to understand the prevalence of various bacterial pathogens associated with the diarrhoea cases in under 5 years age group. METHODS: During, 1st September, 2015 to 30th November 2017, all the childhood diarrhoea cases (≤5 yrs) of SCB Medical College in Odisha, India were included in the study. Stool samples were collected and processed for the isolation of causative bacterial pathogen and the isolated bacterial pathogens were subjected to antibiotic sensitivity testing, molecular analysis of drug resistance. Clinical and demographic data were collected and analyzed. RESULTS: Three hundred twenty patients were enrolled in the study during the study period from whom 82 bacterial isolates were obtained indicating a proportional causality of 25.6% for bacterial diarrhoea among children in this region. Entero toxigenic E.coli (ETEC) accounted for majority of the cases and and more than 50% of the strains were found to be multi-drug resistant (resistant to more than 3 class of antibiotics). More than 50% of the strains were resistant to current choice of treatment like ciprofloxacin, ofloxacin and ceftriaxone and 2.4% being resistant to Imipenem. ESBL production was also observed in some of the strains and one isolate harboured the NDM-1 gene. Fluoroquinolone resistance was found to be linked with multiple mutations in the QRDR region followed by PMQR determinants. CONCLUSION: The current study, to the best of our knowledge is first of its kind which demonstrated the etiology of bacterial diarrhoea in children less than 5 years old and identified diarrheogenic E. coli as the predominant enteropathogen in Odisha. Majority of the isolates being multi-drug resistance calls for a continuous surveillance system in the region which will be helpfulin identifying emerging resistance pattern and for developing suitable intervention stategies.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Diarreia/diagnóstico , Diarreia/etiologia , Resistência Microbiana a Medicamentos/genética , Tipagem Molecular/métodos , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Pré-Escolar , Ciprofloxacino/uso terapêutico , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Fluoroquinolonas/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Técnicas de Diagnóstico Molecular/métodos , Prevalência , Centros de Atenção Terciária
4.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31694979

RESUMO

BACKGROUND: Ondansetron is an effective antiemetic employed to prevent vomiting in children with gastroenteritis in high-income countries; data from low- and middle-income countries are sparse. METHODS: We conducted a randomized, double-blind, placebo-controlled superiority trial in 2 pediatric emergency departments in Pakistan. Dehydrated children aged 6 to 60 months with ≥1 diarrheal (ie, loose or liquid) stool and ≥1 vomiting episode within the preceding 4 hours were eligible to participate. Participants received a single weight-based dose of oral ondansetron (8-15 kg: 2 mg; >15 kg: 4 mg) or identical placebo. The primary outcome was intravenous administration of ≥20 mL/kg over 4 hours of an isotonic fluid within 72 hours of random assignment. RESULTS: All 918 (100%) randomly assigned children completed follow-up. Intravenous rehydration was administered to 14.7% (68 of 462) and 19.5% (89 of 456) of those administered ondansetron and placebo, respectively (difference: -4.8%; 95% confidence interval [CI], -9.7% to 0.0%). In multivariable logistic regression analysis adjusted for other antiemetic agents, antibiotics, zinc, and the number of vomiting episodes in the preceding 24 hours, children administered ondansetron had lower odds of the primary outcome (odds ratio: 0.70; 95% CI, 0.49 to 1.00). Fewer children in the ondansetron, relative to the placebo group vomited during the observation period (difference: -12.9%; 95% CI, -18.0% to -7.8%). The median number of vomiting episodes (P < .001) was lower in the ondansetron group. CONCLUSIONS: Among children with gastroenteritis-associated vomiting and dehydration, oral ondansetron administration reduced vomiting and intravenous rehydration use. Ondansetron use may be considered to promote oral rehydration therapy success among dehydrated children in low- and middle-income countries.


Assuntos
Antieméticos/administração & dosagem , Desidratação/tratamento farmacológico , Desidratação/epidemiologia , Serviço Hospitalar de Emergência , Ondansetron/administração & dosagem , Administração Oral , Pré-Escolar , Desidratação/diagnóstico , Método Duplo-Cego , Feminino , Hidratação/métodos , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Humanos , Lactente , Masculino , Paquistão/epidemiologia
5.
Eur J Clin Microbiol Infect Dis ; 38(12): 2371-2379, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31502119

RESUMO

Little is known about the epidemiology and severity of gastroenteritis among children treated at home. We sought to compare illness severity and etiology between children brought for emergency department (ED) care to those managed at home (i.e., community). Prospective cohort study of children enrolled between December 2014 and December 2016 in two pediatric EDs in Alberta, Canada along with children treated at home after telephone triage (i.e., community). Primary outcomes were maximal frequency of vomiting and diarrhea in the 24-h pre-enrollment period; secondary outcomes included etiologic pathogens, dehydration severity, future healthcare visits, and treatments provided. A total of 1613 patients (1317 ED, 296 community) were enrolled. Median maximal frequency of vomiting was higher in the ED cohort (5 (3, 10) vs. 5 (2, 8); P < 0.001). Proportion of children with diarrhea and its 24-h median frequency were lower in the ED cohort (61.3 vs. 82.8% and 2 (0, 6) vs. 4 (1, 7); P < 0.001, respectively). In regression analysis, the ED cohort had a higher maximum number of vomiting episodes pre-enrollment (incident rate ratio (IRR) 1.25; 95% CI 1.12, 1.40) while the community cohort had higher maximal 24-h period diarrheal episodes (IRR 1.20; 95% CI 1.01, 1.43). Norovirus was identified more frequently in the community cohort (36.8% vs. 23.6%; P < 0.001). Children treated in the ED have a greater number of vomiting episodes; those treated at home have more diarrheal episodes. Norovirus is more common among children treated symptomatically at home and thus may represent a greater burden of disease than previously thought.


Assuntos
Serviço Hospitalar de Emergência , Gastroenterite/epidemiologia , Gastroenterite/terapia , Autocuidado , Doença Aguda , Alberta/epidemiologia , Infecções por Caliciviridae/epidemiologia , Canadá/epidemiologia , Pré-Escolar , Desidratação/epidemiologia , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/terapia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/patologia , Hospitais Pediátricos , Humanos , Lactente , Masculino , Norovirus/isolamento & purificação , Estudos Prospectivos , Telefone , Triagem , Vômito/diagnóstico , Vômito/epidemiologia , Vômito/terapia
6.
Acta Virol ; 63(3): 328-332, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31507200

RESUMO

Acute gastroenteritis (AGE) is one of the most frequently occuring illnesses in children and adults worldwide. In February 2017, two AGE outbreaks occurred in two adjacent schools in Huzhou city, Zhenjiang province of China. We detected high percentages of recombinant norovirus GII.P16/GII.2 in one school and chicken anemia virus (CAV) in another school using next generation sequencing (NGS) and specific PCR. The results highlight the importance of continuous surveillance of GII.P16/GII.2, and suggest the need of further studies on whether CAV causes AGE. Keywords: acute gastroenteritis; norovirus; chicken anemia virus; Huzhou; School.


Assuntos
Infecções por Caliciviridae , Vírus da Anemia da Galinha , Surtos de Doenças , Gastroenterite , Norovirus , Infecções por Caliciviridae/diagnóstico , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Criança , China/epidemiologia , Infecções por Circoviridae/epidemiologia , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Prevalência
8.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 895-899, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484250

RESUMO

Objective: To conduct a viral pathogen surveillance program on pediatric inpatients less than five years old with acute gastroenteritis in Shanghai and to better understand the pathogenic spectrum and molecular features in the target population, for setting up programs on control, prevention, medication and vaccine applications of the diseases. Methods: Fecal samples were collected from inpatients less than 5 years old who were admitted to a pediatric hospital for having acute gastroenteritis. Information related to demographic, clinical and epidemiological features of the patients was also collected. Laboratory assays including ELISA, real-time PCR and nested PCR, were performed to detect the presence of pathogens as rotavirus, calicivirus, astrovirus and adenovirus. Results: A total of 1 018 samples were collected (male 671 and 347 female), with the positive detection rate as 40.57% which peaked from autumn till winter, annually. Calicivirus and rotavirus A presented with the highest detection rates (24.75% and 13.95% respectively). The lowest detection rate was found in the 0-6 month-olds (32.20%). 65% of the patients with positive virus had received antibiotic treatment prior to the hospitalization. However, no statistically significant difference was seen, regarding the rates of antibiotic medication in the virus positive or negative populations (P>0.05). Data from the Rotavirus genotype analysis revealed that G9P[8] genotype was the predominant strain, and causing majority of rotavirus infections in all the age groups. Conclusions: Among the inpatients under 5 years of age in Shanghai, the positive detection rate for Calicivirus was higher than that for rotavirus group A, suggesting the necessity to carefully monitor the changes regarding the pathogenic spectrum and subtypes of the virus. Antibiotics should also be attentively administered, together with the development of suitable vaccine.


Assuntos
Caliciviridae/isolamento & purificação , Fezes/virologia , Gastroenterite/virologia , Pacientes Internados/estatística & dados numéricos , Infecções por Rotavirus/diagnóstico , Rotavirus/isolamento & purificação , Doença Aguda , Pré-Escolar , China/epidemiologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Humanos , Lactente , Masculino , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologia
9.
Intervirology ; 62(3-4): 164-168, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487720

RESUMO

Despite the significant medical advances which have taken place in the last decades, acute diarrhoea cases remain a public health issue of major significance, with gastroenteritis agents being associated with severe symptoms in adults and high morbidity in infants and children. Regarding rotaviruses, while children are the predominant victims of rotavirus infection, adults (often caretakers or parents of these children) may experience the same symptoms of fever, vomiting, and non-bloody diarrhoea. Three different routine schemes for the detection of rotaviruses in archived stool samples were evaluated in terms of diagnostic performance. A total of 640 archived stool samples were included in the study. The samples were screened with three different techniques: a commercial rapid immunochromatographic test, a modified in-house conventional one-step reverse-transcription polymerase chain reaction (PCR) screen protocol, and a com-mer-cial one-step real-time PCR kit. Technical aspects and considerations are discussed.


Assuntos
Testes Diagnósticos de Rotina/métodos , Imunoensaio/métodos , Infecções por Rotavirus/diagnóstico , Rotavirus/isolamento & purificação , Diarreia/diagnóstico , Diarreia/virologia , Fezes/virologia , Gastroenterite/diagnóstico , Gastroenterite/virologia , Grécia , Humanos , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Rotavirus/imunologia , Sensibilidade e Especificidade , Centros de Atenção Terciária
10.
Diagn Microbiol Infect Dis ; 95(3): 114862, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31375249

RESUMO

Transport media are recommended to improve the sensitivity of fecal culture, but there are limited published data comparing bacterial viability in feces stored with or without transport media. In this study, recovery of bacteria from culture-positive feces after 7 days of storage was assessed under the following conditions: without transport media (w/oTM); with FecalSwab™ Transport and Preservation Medium (FSTM); and with modified Cary-Blair (mCB). All Shiga toxin-producing E. coli (STEC) positive specimens (n = 23) and ≥97.5% of Salmonella-positive specimens (n = 40) remained positive under all conditions. Campylobacter (n = 41) was isolated from 82.9% of feces stored in mCB, 68.4% in FSTM, and 70.7% w/oTM; Shigella (n = 14) 85.7%, 78.6%, and 78.6%; and Yersinia (n = 16) 93.8%, 87.5%, and 81.3%, respectively (P = 0.076, Cochran's Q). Transport media were not required for STEC or Salmonella. mCB may be better than w/oTM or FSTM for other pathogens, but an evaluation with a larger number of specimens is required.


Assuntos
Técnicas Bacteriológicas/métodos , Fezes/microbiologia , Viabilidade Microbiana , Manejo de Espécimes/métodos , Bactérias/isolamento & purificação , Técnicas Bacteriológicas/instrumentação , Meios de Cultura , Gastroenterite/diagnóstico , Humanos , Manejo de Espécimes/instrumentação
11.
BMC Infect Dis ; 19(1): 595, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288749

RESUMO

BACKGROUND: Noroviruses (NVs) are an important cause of acute gastroenteritis (AGE) worldwide. There are limited data on the prevalence and molecular characterization of NVs in children in Hohhot, China. METHODS: Between January 2012 and December 2017, 1863 stool samples were collected at Maternal and Child Health Hospital in Hohhot. All samples were screened for NVs by real-time reverse transcription polymerase chain reaction (real-time RT-PCR). RESULTS: NVs were detected in 24.15% of these inpatient cases, ranging from 12.78 to 32.92% in different years. NV was detected throughout the year, with a peak in winter. Based on sequence analysis of the partial VP1 gene, the 306 identified NV strains were divided into six genotypes: GII.3 (71.24%), GII.4 (23.53%), and GII.2, GII.5, GII.6, and GII.13 (total 5.23%). Based on further sequence analysis of the RNA-dependent RNA polymerase (RdRp), GII.P12/GII.3, GII.Pe/GII.4, and GII.P4/GII.4 were identified as predominant genotypes, accounting for 92.6% of genotyped strains. The median age of the children with NV infection was 8.0 (range 0-59) months. However, children infected with GII.3 were younger (median 7.0 months) than GII.4-positive patients (median 10.0 months). CONCLUSION: NV contributed greatly to AGE among hospitalized children in Hohhot in China. Continuous surveillance is important for understanding the local prevalence and characterization of NV.


Assuntos
Infecções por Caliciviridae/diagnóstico , Gastroenterite/diagnóstico , Norovirus/genética , Doença Aguda , Infecções por Caliciviridae/epidemiologia , Criança Hospitalizada , Pré-Escolar , China/epidemiologia , Fezes/virologia , Feminino , Gastroenterite/epidemiologia , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Norovirus/classificação , Norovirus/isolamento & purificação , Filogenia , Prevalência , RNA Viral/isolamento & purificação , RNA Viral/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Estações do Ano
12.
BMC Infect Dis ; 19(1): 592, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286917

RESUMO

BACKGROUND: Norovirus (NoV) is recognized as a leading cause of acute gastroenteritis (AGE) outbreaks in settings globally. Studies have shown that employees played an important role in the transmission mode during some NoV outbreaks. This study aimed to investigate the prevalence of NoV infection and duration of NoV shedding among employees during NoV outbreaks, as well as factors affecting shedding duration. METHODS: Specimens and epidemiological data were collected from employees who were suspected of being involved in the transmission or with AGE symptoms during NoV outbreaks in Xuhui District, Shanghai, from 2015 to 2017. Specimens were detected using real-time RT-PCR to determine whether or not employees had become infected with NoV. Specimens were collected every 3-7 days from NoV-infected employees until specimens became negative for NoV. RESULTS: A total of 421 employees were sampled from 49 NoV outbreaks, and nearly 90% of them (377/421) were asymptomatic. Symptomatic employees showed significantly higher prevalence of NoV infection than asymptomatic ones (70.5% vs. 17.0%, P < 0.01). The average duration of NoV shedding was 6.9 days (95% confidence interval: 6.1-7.7 days) among 88 NoV-infected individuals, and was significantly longer in symptomatic individuals than in asymptomatic ones (9.8 days vs. 5.6 days, P < 0.01). In Cox proportional-hazards model, after adjusting age and gender, symptoms was the only factor associated with duration of NoV shedding. CONCLUSIONS: Compared with asymptomatic employees, symptomatic employees had higher prevalence of NoV infection and longer durations of NoV shedding. Since NoV shedding duration among NoV-infected employees tends to be longer than their isolation time during outbreaks, reinforcement of hygiene practices among these employees is especially necessary to reduce the risk of virus secondary transmissions after their return to work.


Assuntos
Infecções por Caliciviridae , Surtos de Doenças/estatística & dados numéricos , Gastroenterite , Norovirus/genética , Adulto , Canal Anal/virologia , Infecções Assintomáticas/epidemiologia , Infecções por Caliciviridae/diagnóstico , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , China/epidemiologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , RNA Viral/análise , RNA Viral/genética , Reação em Cadeia da Polimerase em Tempo Real
13.
Eur J Clin Microbiol Infect Dis ; 38(11): 2103-2112, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31352670

RESUMO

In acute gastroenteritis (AGE), identification of the infectious agent is important for patient management. Since symptoms do not reliably identify the agent, microbiological diagnostics are important. Conventional methods lack sensitivity and often take days. Multiplex PCR panels offer fast and sensitive alternatives. Our aim was to assess the performance of the new QIAstat Gastrointestinal Panel (GIP) detecting 24 different gastroenteric pathogens from stool in Cary-Blair transport medium (Adenovirus F 40/41, Astrovirus, Norovirus GI/GII, Rotavirus A, Sapovirus, Campylobacter spp., Clostridium difficile, Plesiomonas shigelloides, Salmonella spp., Vibrio cholera, Vibrio parahaemolyticus, Vibrio vulnificus, Yersinia enterocolitica, enteroaggregative Escherichia coli, enteropathogenic E. coli, enterotoxigenic E. coli, Shiga-toxin-producing E. coli (stx1 and stx2) (including specific detection of E. coli O157), Shigella spp./enteroinvasive E. coli, Cryptosporidium spp., Cyclospora cayetanensis, Entamoeba histolytica and Giardia lamblia). We tested both prospective (n = 163) and retrospective (n = 222) stool samples sent for routine diagnostics by the QIAstat GIP comparing it to the FDA-approved BioFire FilmArray GIP. Seegene Allplex GIP was used for discrepancy testing. After discrepancy testing, QIAstat GIP detected 447 of 455 pathogens (98.2%, 95% confidence interval (CI) 96.6-99.1%). There were eight false positive detections. Multiple pathogens were detected in 32.5% of positive samples. The QIAstat GIP detected a large range of AGE pathogens with a high sensitivity. It offers an easy-to-use system for GI pathogen detection in stool within 70 min. An advantage of the QIAstat is the availability of cycle threshold (CT) values to aid in interpretation of results.


Assuntos
Bactérias/isolamento & purificação , Gastroenterite/diagnóstico , Técnicas de Diagnóstico Molecular/normas , Parasitos/isolamento & purificação , Vírus/isolamento & purificação , Doença Aguda , Adolescente , Adulto , Idoso , Animais , Bactérias/classificação , Criança , Pré-Escolar , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Parasitos/classificação , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Vírus/classificação , Adulto Jovem
14.
MEDICC Rev ; 21(4): 40, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31242152

RESUMO

As a nurse and doctoral candidate, I learned from my research in and about Cuba that the country has an international reputation for having an excellent health system, providing universal care for its citizens, with major indicators-such as life expectancy-rivaling those of industrialized countries, including the USA. Little did I know that I would be accessing this health care system myself.


Assuntos
Assistência à Saúde , Gastroenterite/terapia , Doença Aguda , Cuba , Assistência à Saúde/métodos , Feminino , Gastroenterite/diagnóstico , Humanos , Qualidade da Assistência à Saúde , Estados Unidos/etnologia
15.
Iran J Kidney Dis ; 13(3): 139-150, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31209187

RESUMO

Shiga toxin induced Escherichia Coli (STEC) is associated with chronic kidney disease or neurologic disability. The aim of this study is to determine the prevalence of STEC identified in human studies in Iran. Search engines of PubMed, EMBASE, OVID, SCOPUS, Web of Science, Google Scholar, IranMedex, MagIran, SID and ganj.irandoc were used. All human studies with stool or rectal swap samples evaluated for STEC and the outcome of HUS in Iran, which had been published between 1985 and 2017, were included. Chi-square and I2 statistic tests were applied to assess between-studies heterogeneity. Pooled prevalence and odd ratio were calculated using random effect models. A total of 30 articles containing 23379 samples were included for the final analysis. The design of study was cross sectional in 16, case control in 13 and one was cohort. The pooled prevalence of STEC was 7% (95% CI, 5 - 11; I2 = 98.3%). In subgroup analysis, the pooled prevalence was 8% (95% CI, 4 - 13; I2 = 97.55%) in children but 4% (95% CI, 2 - 7; I2 = 97.66%) in adults. The odds of patients with diarrhea having had STEC were 7.06 times the odds of healthy subjects (pooled OR = 7.06, 95% CI: 3.66-13.61). Patients with bloody diarrhea less likely to have positive STEC than patients with non-bloody diarrhea (pooled OR = 0.33, 95% CI: 0.10-1.02). STEC was prevalent in diarrheic patients and the rate increased in recent years. The highest contamination was seen in East-South of Iran. Public health intervention is mandatory to eliminate it effectively.


Assuntos
Infecções por Escherichia coli/epidemiologia , Gastroenterite/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Escherichia coli Shiga Toxigênica/isolamento & purificação , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/microbiologia , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/microbiologia , Fezes/microbiologia , Gastroenterite/diagnóstico , Gastroenterite/microbiologia , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Irã (Geográfico)/epidemiologia , Prevalência
16.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31171587

RESUMO

BACKGROUND: Overuse of laboratory testing contributes substantially to health care waste, downstream resource use, and patient harm. Understanding patterns of variation in hospital-level testing across common inpatient diagnoses could identify outliers and inform waste-reduction efforts. METHODS: We conducted a multicenter retrospective cohort study of pediatric inpatients at 41 children's hospitals using administrative data from 2010 to 2016. Initial electrolyte testing was defined as testing occurring within the first 2 days of an encounter, and repeat testing was defined as subsequent testing within an encounter in which initial testing occurred. To examine if testing rates correlated across diagnoses at the hospital level, we compared risk-adjusted rates for gastroenteritis with a weighted average of risk-adjusted rates in other diagnosis cohorts. For each diagnosis, linear regression was performed to compare initial and subsequent testing. RESULTS: In 497 719 patient encounters, wide variation was observed across hospitals in adjusted, initial, and repeat testing rates. Hospital-specific rates of testing in gastroenteritis were moderately to strongly correlated with the weighted average of testing in other conditions (initial: r = 0.63; repeat r = 0.83). Within diagnoses, higher hospital-level initial testing rates were associated with significantly increased rates of subsequent testing for all diagnoses except gastroenteritis. CONCLUSIONS: Among children's hospitals, rates of initial and repeat electrolyte testing vary widely across 8 common inpatient diagnoses. For most diagnoses, hospital-level rates of initial testing were associated with rates of subsequent testing. Consistent rates of testing across multiple diagnoses suggest that hospital-level factors, such as institutional culture, may influence decisions for electrolyte testing.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Eletrólitos/análise , Laboratórios Hospitalares/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Técnicas de Laboratório Clínico/economia , Feminino , Gastroenterite/diagnóstico , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Laboratórios Hospitalares/economia , Masculino , Utilização de Procedimentos e Técnicas , Melhoria de Qualidade , Estudos Retrospectivos , Procedimentos Desnecessários/economia
17.
Seizure ; 70: 20-24, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31238195

RESUMO

PURPOSE: The aim of the present study was to compare the clinical features of campylobacter-associated benign convulsions with mild gastroenteritis (BCWG) with rotavirus-associated BCWG in China. METHODS: The medical records of BCWG patients admitted to Children's Hospital of Jiangxi Province in China between January 2015 and January 2017 were reviewed in this retrospective study. RESULTS: Ultimately, 318 patients were diagnosed with BCWG. Two hundred and two cases were tested for Campylobacter jejuni antigen, and seven (3.47%) were positive. A total of 248 cases were tested for rotavirus antigen, and 44 (17.74%) were positive. Campylobacter-associated BCWG occurred in summer and autumn. In contrast, rotavirus-associated BCWG mainly occurred in winter. In the campylobacter-associated BCWG group, five patients (71.43%) had two or more seizures. In one patient(14.29%), the seizure occurred on the first day of gastroenteritis; three patients (42.86%) had seizures on the second day, and three (42.86%) had seizures on the third day or later. Thirteen seizures were observed in the campylobacter-associated BCWG group; of these, 11 (84.62%) lasted less than 5 min, and 11 (84.62%) were generalized seizures. Phenobarbital (5 mg/kg/time) was effective in all 6 cases (100%) in which it was used. Other than the different seasonal distributions, the clinical features of campylobacter-associated BCWG and rotavirus-associated BCWG may be similar. CONCLUSIONS: Campylobacter is one of the pathogens responsible for BCWG, especially in summer and autumn. Other than the different seasonal distributions, the clinical features of campylobacter-associated BCWG and rotavirus-associated BCWG may be similar.


Assuntos
Infecções por Campylobacter/complicações , Gastroenterite/complicações , Infecções por Rotavirus/complicações , Convulsões/etiologia , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/terapia , Diagnóstico Diferencial , Feminino , Seguimentos , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/terapia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/terapia , Estações do Ano , Convulsões/diagnóstico , Convulsões/epidemiologia , Convulsões/terapia
18.
Semin Diagn Pathol ; 36(3): 187-192, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036328

RESUMO

Knowledge of the pathogenic roles of certain bacterial agents in gastroenteritis has been growing over the past few decades. With the increasing use of multiplex molecular-based syndromic stool pathogen panels, the roles of Plesiomonas shigelloides and some of the diarrheagenic pathotypes of Escherichia coli (enterotoxigenic E. coli [ETEC], enteropathogenic E. coli [EPEC], enteroinvasive E. coli [EIEC], and enteroaggregative E. coli [EAEC]) have been better understood. Although not currently targeted on Food and Drug Administration (FDA)-cleared commercial multiplex stool panels, Aeromonas has also emerged as a possible cause of bacterial gastroenteritis. The clinical presentation, pathophysiology, and diagnostic approaches to these pathogens in stool specimens are reviewed. Variability in inclusion of these pathogens on multiplex molecular panels and difficulties in detection by stool culture techniques utilized by clinical microbiology laboratories have contributed to an unclear understanding of the pathogenic role of several of these pathogens. Nonetheless, most evidence points towards a clear pathogenic role for P. shigelloides and ETEC, and possibly EPEC and EIEC. The contribution of Aeromonas spp. and EAEC to bacterial gastroenteritis has not been fully established. Further studies of pathogenicity of these pathogens are needed.


Assuntos
Aeromonas/isolamento & purificação , Infecções Bacterianas/patologia , Doenças Transmissíveis Emergentes/patologia , Diarreia/patologia , Escherichia coli/isolamento & purificação , Gastroenterite/patologia , Plesiomonas/isolamento & purificação , Infecções Bacterianas/diagnóstico , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/microbiologia , Diarreia/diagnóstico , Diarreia/microbiologia , Fezes/microbiologia , Gastroenterite/diagnóstico , Gastroenterite/microbiologia , Humanos
19.
Virol J ; 16(1): 64, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092258

RESUMO

BACKGROUND: Acute gastroenteritis (AGE) due to group A rotavirus (RVA) agent is one of the major causes of hospitalization in paediatric age. The G3P[8] RVA genotype has been usually considered as one of the major human genotypes, largely circulating in Asia, but showing low detection rates in the European countries. In recent years, the G3P[8] RVAs emerged also in Europe as a predominant genotype and the viral strains detected revealed high similarities with equine-like G3P[8] RVA strains, resulting in a new variant circulating in humans and able to cause AGE in the paediatric population. CASE PRESENTATION: An 8-year-old boy was admitted to the Emergency Room because he had suffered from severe diarrhoea, vomiting, and high fever over the previous two days. Severe dehydration was evident based on low serum concentrations of potassium and sodium, low glycaemia, and pre-renal failure (creatinine 2.48 mg/dL, urea 133 mg/dL). Immunological tests were within normal range. Enzyme immunoassay for the detection of RV was positive, and a sample of faeces was collected in order to perform the molecular characterization of the viral strain. The phylogenetic trees revealed relatedness between the VP7 and VP4 genes of the G3P[8] RVA Italian strain (namely PG2) and those belonging to recent G3P[8] RVAs detected worldwide. The G3 VP7 belonged to the G3-I lineage and shared the highest nucleotide sequence identity (99.8%) with the equine-like G3 previously identified in other countries. The P [8] VP4 revealed a similar clustering pattern to that observed for the VP7. In addition, the molecular characterization of the 11 gene segments of strain PG2 revealed a G3-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2 genomic constellation. CONCLUSIONS: This case shows the first detection in Italy of a reassortant G3P[8] RVA associated with a severe AGE, which is unusual in a school-age child without any known severe underlying problems. The findings reported in this paper highlight the importance of continuously monitoring the RVA strains circulating in paediatric age in order to detect novel viral variants able to spread in the general population.


Assuntos
Gastroenterite/virologia , Genótipo , Vírus Reordenados/genética , Infecções por Rotavirus/diagnóstico , Rotavirus/genética , Criança , Diarreia/virologia , Fezes/virologia , Gastroenterite/diagnóstico , Gastroenterite/terapia , Genoma Viral , Humanos , Infusões Intravenosas , Itália , Masculino , Vírus Reordenados/isolamento & purificação , Rotavirus/isolamento & purificação , Infecções por Rotavirus/terapia , Análise de Sequência de DNA
20.
BMC Infect Dis ; 19(1): 400, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072305

RESUMO

BACKGROUND: Older adults are vulnerable to hospitalization or death from norovirus infection, but the actual disease burden remains unknown. Therefore, we conducted a nationwide survey to estimate the number of inpatients with norovirus gastroenteritis and associated deaths among Japanese older adults. METHODS: We performed a nationwide two-step query targeting 4184 hospital departments selected from 17,575 departments using stratified random sampling according to the number of beds. We asked each department to complete a mail-back questionnaire on the annual numbers of inpatients with infectious gastroenteritis and associated deaths between administrative years 2012 and 2014, and the implementation status of norovirus infection testing. In a second query, we investigated the annual number of inpatients with norovirus gastroenteritis and associated deaths in departments that had reported infectious gastroenteritis inpatients in the first query. Clinical information was collected for inpatients with norovirus gastroenteritis in administrative year 2014. RESULTS: Norovirus testing for patients hospitalized for acute gastroenteritis was routinely conducted in 16% of the responding departments. Although half the departments responded that some acute gastroenteritis inpatients received such testing but others did not. In this situation, numbers of inpatients with norovirus gastroenteritis in Japan were estimated as 31,800 (95% CI: 25,700-37,900) in administrative year 2012, 21,600 (95% CI: 17,700-25,500) in administrative year 2013, and 15,700 (95% CI: 12,900-18,500) in administrative year 2014. The estimated number of associated deaths was approximately 600 in each administrative year. Factors associated with death included higher age, living in long-term care facilities, underlying illnesses such as chronic respiratory diseases, and complications such as aspiration pneumonia. CONCLUSIONS: The actual number of norovirus inpatient would be higher than the estimated here due to the low rate of routinely implemented norovirus testing. Considering Japan's rapidly aging society and the disease burden of norovirus infection among Japanese older adults, it is important to protect this high-risk population from norovirus infection.


Assuntos
Infecções por Caliciviridae/diagnóstico , Gastroenterite/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Infecções por Caliciviridae/complicações , Infecções por Caliciviridae/virologia , Feminino , Gastroenterite/epidemiologia , Gastroenterite/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Norovirus/isolamento & purificação , Fatores de Risco , Análise de Sobrevida
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