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1.
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.
Zhongguo Zhong Yao Za Zhi ; 44(14): 2914-2925, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31602833

RESUMO

To systematically review the efficacy and safety of Huoxiang Zhengqi Pills combined with Western medicine in the treatment of acute gastroenteritis. Four Chinese databases( CNKI,VIP,Wan Fang,Sino Med) and three English databases( Cochrane Library,Medline,EMbase) were systematically and comprehensively searched from the database establishment to April 2019 to collect the randomized controlled trials( RCTs) about the treatment of acute gastroenteritis with Huoxiang Zhengqi Pills combined with Western medicine. Two investigators independently performed literature screening,data extraction and bias risk assessment. Rev Man 5. 3 software was used for data analysis. A total of 316 articles were retrieved and finally 44 studies were included in this study,involving 4153 patients. The overall quality of the included studies was generally low. Meta-analysis results showed that in the total clinical effective rate,Huoxiang Zhengqi Pills combined with conventional treatment or norfloxacin tablets was superior to conventional treatment or norfloxacin tablets alone. In terms of the time for improving clinical symptoms,Huoxiang Zhengqi Pills combined with conventional treatment or norfloxacin tablets could better relieve fever than conventional treatment or norfloxacin tablets alone. In terms of incidence of adverse reactions,there was no statistical difference between Huoxiang Zhengqi Pills combined with conventional treatment and conventional treatment alone. Other outcome measures were affected by various factors( such as inclusion of only 1 study or excessive heterogeneity among studies) and could not be concluded. Due to the limitations of the quality and quantity of included studies,this conclusion still needs to be verified by more high quality researches.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Gastroenterite/tratamento farmacológico , Humanos , Norfloxacino/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
6.
Bull Soc Pathol Exot ; 112(1): 12-13, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31225731

RESUMO

Srongyloidiasis can sometimes be a source of diagnostic wandering in a patient with an autoimmune disease living in a tropical environment, despite systematic deworming with albendazole (400 mg/day/3 days), prior to the starting of a corticotherapy. We report an observation of a febrile gastroenteritis complicated by signs of intra and extracellular dehydration, in a 37-year-old lupus patient, including duodenal biopsies, and stool parasitology, which led to the diagnosis of strongyloidiasis effectively treated by ivermectin per os (two doses) of 200 micrograms/kg, once every 2 weeks apart), following failure of a first 5-days course of albendazole (400 mg/day).


Assuntos
Gastroenterite/parasitologia , Lúpus Eritematoso Cutâneo/complicações , Estrongiloidíase/complicações , Corticosteroides/uso terapêutico , Adulto , Albendazol/uso terapêutico , Antiparasitários/uso terapêutico , Biópsia , Duodeno/parasitologia , Duodeno/patologia , Fezes/parasitologia , Feminino , Febre , Gabão , Gastroenterite/tratamento farmacológico , Humanos , Ivermectina/uso terapêutico , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico
7.
Artigo em Inglês | MEDLINE | ID: mdl-31083597

RESUMO

Shiga toxin-producing Escherichia Coli (STEC) infections routinely run as a common gastroenteritis, but in many cases they may evolve towards hemolytic uremic syndrome (HUS). HUS is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Gut microorganisms have a fundamental impact on human physiology, because they modulate normal intestinal functions and play a pivotal role in influencing the local and systemic immune responses. Despite surveillance established in many countries and major progresses in the understanding of STEC-HUS mechanisms, no specific treatment is currently available. Targeting the gut microbiota could represent a new potential therapeutic strategy in STEC infection. In this paper, we reviewed the current knowledge about microbiota characteristics of patients with STEC infections, as well as in vitro and in vivo evidence of probiotic supplementation in managing STEC gastroenteritis and in HUS onset prevention.


Assuntos
Infecções por Escherichia coli/tratamento farmacológico , Gastroenterite/tratamento farmacológico , Microbioma Gastrointestinal , Síndrome Hemolítico-Urêmica/tratamento farmacológico , Probióticos/uso terapêutico , Escherichia coli Shiga Toxigênica/fisiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Gastroenterite/complicações , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Incidência
8.
Microb Drug Resist ; 25(8): 1191-1198, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31120391

RESUMO

Objectives: The primary aim of this study was to investigate the presence of antibiotic resistance genes (ARGs) and plasmid replicon types for 75 multidrug-resistant (MDR) Salmonella Enteritidis isolates from children with gastroenteritis. We also evaluated the association among biofilm formation, in vitro invasion capacity, and antibiotic resistance phenotypes. Materials and Methods: Twenty-two ARGs and 18 different plasmid incompatibility types were investigated using polymerase chain reaction (PCR) and DNA sequencing. In vitro invasion capacity of S. Enteritidis isolates possessing different antibiotic resistance patterns was assessed using the Caco2 human intestinal epithelial cell line and biofilm formation was performed in a 96-well polystyrene well format using crystal violet detection. Results: The presence of plasmid-mediated quinolone resistance genes and ß-lactamase genes was established using PCR amplification. All the tested S. Enteritidis isolates that were fluoroquinolone resistant possessed gyrA mutations and 50% also possessed mutations in parC. MDR S. Enteritidis isolates containing three (29/75) or four (21/75) plasmid replicon types were predominant and 71/75 carried both FIIs and FIC replicon-type plasmids. MDR isolates were strong or moderate biofilm producers and a significant positive association (p < 0.05) between antibiotic resistance and biomass of biofilms was observed in the strains assayed. A ceftiofur-resistant strain was significantly more invasive (p < 0.01) than the other isolates. Conclusions: We observed a high incidence of ARGs and diversity of plasmids in S. Enteritidis isolates from children. Biofilm formation and invasion capacity highlight a significant hazard to public health.


Assuntos
Biofilmes/crescimento & desenvolvimento , Farmacorresistência Bacteriana Múltipla/genética , Gastroenterite/microbiologia , Plasmídeos/genética , Infecções por Salmonella/microbiologia , Salmonella enteritidis/crescimento & desenvolvimento , Salmonella enteritidis/genética , Antibacterianos/uso terapêutico , Biofilmes/efeitos dos fármacos , Células CACO-2 , Linhagem Celular Tumoral , Criança , Células Epiteliais/microbiologia , Gastroenterite/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana/métodos , Quinolonas/uso terapêutico , Infecções por Salmonella/tratamento farmacológico , Salmonella enteritidis/efeitos dos fármacos , beta-Lactamases/genética
9.
Microb Drug Resist ; 25(7): 1080-1086, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31021299

RESUMO

Aims: To determine the prevalence and the antibiotic resistance patterns of Campylobacter jejuni isolated from pediatric diarrhea patients in central Iran. Materials and Methods: Stool specimens (n = 230) were investigated using a modified Gram stain, two specific culture media, and C. jejuni-specific PCR. Antibiotic resistance profiles and relevant resistance genes were determined. Genetic relationships among a selection of the isolates were studied by Fla typing. Results: Out of the 230 diarrhea samples, 48 (20.8%) cases of C. jejuni were identified using modified Gram stain, 45 (19.5%) using the culture media, and 76 (33%) cases were identified using PCR. The highest antibiotic resistance rates were observed in 37 (82.2%) strains against tetracycline, in 32 (71.1%) against ciprofloxacin, and in 31 (68.8%) against erythromycin. Twenty (44.4%) isolates were resistant to ciprofloxacin and erythromycin simultaneously. Genotypic investigations found 36 (97.3%) strains carrying the tet (o) gene, 31 (96.8%) harboring the cmeB gene, 22 (68.7%) strains with the gyrA6 gene, 20 (64.5%) strains containing a 23S rRNA mutation, and 21 (65.6%) strains with the qnrS gene. Fla typing of a random subset of 14 strains revealed 11 different types showing the genomic diversity of the isolates. Strains sharing the same Fla type could be easily distinguished by their resistance gene profile. Conclusions: This is the first study to demonstrate that genetically diverse quinolone-macrolide-resistant C. jejuni is an important cause of gastroenteritis in children from central Iran. Pediatricians should consider these resistance features once the antibiotic prescription is necessary for prevention of possible complications, especially in those under 5 years of age. Of note, most cases of Campylobacter diarrhea are self-limiting and antibiotics should only be prescribed in those cases where severe complications evolve.


Assuntos
Infecções por Campylobacter/microbiologia , Campylobacter jejuni/efeitos dos fármacos , Campylobacter jejuni/isolamento & purificação , Farmacorresistência Bacteriana/genética , Gastroenterite/microbiologia , Macrolídeos/uso terapêutico , Quinolonas/uso terapêutico , Antibacterianos/uso terapêutico , Infecções por Campylobacter/tratamento farmacológico , Campylobacter jejuni/genética , Criança , Pré-Escolar , Ciprofloxacino/uso terapêutico , Estudos Transversais , DNA Bacteriano/genética , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Eritromicina/uso terapêutico , Feminino , Flagelina/genética , Gastroenterite/tratamento farmacológico , Genótipo , Humanos , Lactente , Irã (Geográfico) , Masculino , Testes de Sensibilidade Microbiana/métodos , RNA Ribossômico 23S/genética , Tetraciclina/uso terapêutico
10.
Am J Gastroenterol ; 114(6): 984-994, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31008735

RESUMO

OBJECTIVES: The literature related to eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC) is limited. We aimed to characterize rates of diagnosis, clinical features, and initial treatments for patients with EG, EGE, and EC. METHODS: In this retrospective study, data were collected from 6 centers in the Consortium of Eosinophilic Gastrointestinal Researchers from 2005 to 2016. We analyzed demographics, time trends in diagnosis, medical history, presenting symptoms, disease overlap, and initial treatment patterns/responses. RESULTS: Of 373 subjects (317 children and 56 adults), 38% had EG, 33% EGE, and 29% EC. Rates of diagnosis of all diseases increased over time. There was no male predominance, and the majority of subjects had atopy. Presenting symptoms were similar between diseases with nausea/vomiting and abdominal pain, the most common. One hundred fifty-four subjects (41%) had eosinophilic inflammation outside of their primary disease location with the esophagus the second most common gastrointestinal (GI) segment involved. Multisite inflammation was more common in children than in adults (68% vs 37%; P < 0.001). Initial treatment patterns varied highly between centers. One hundred-nine subjects (29%) had follow-up within 6 months, and the majority had clinical, endoscopic, and histologic improvements. CONCLUSIONS: In this cohort, EG, EGE, and EC were diagnosed more frequently over time, and inflammation of GI segments outside the primary disease site co-occurrence of atopy was common with a lack of male predominance. Symptoms were similar between diseases, and initial treatment strategies were highly variable. Future investigation should assess the cause of the increased prevalence of eosinophilic GI disorders and prospectively assess outcomes to establish treatment algorithms.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colite/epidemiologia , Enterite/epidemiologia , Eosinofilia/epidemiologia , Eosinófilos/patologia , Gastrite/epidemiologia , Gastroenterite/epidemiologia , Fármacos Gastrointestinais/uso terapêutico , Mucosa Intestinal/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Colite/diagnóstico , Colite/tratamento farmacológico , Comorbidade/tendências , Enterite/diagnóstico , Enterite/tratamento farmacológico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Feminino , Seguimentos , Previsões , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
11.
BMC Infect Dis ; 19(1): 158, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764764

RESUMO

BACKGROUND: Clinical characteristics (taxonomy, virulence genes and antimicrobial resistance ) of Aeromonas in isolated from extra-intestinal and intestinal infections were investigated to describe epidemiology, associated virulence factors and optimal therapy options. METHODS: Clinical samples (n = 115) of Aeromonas were collected from a general hospital in Beijing between the period 2015 and 2017. Taxonomy was investigate by Multilocus phylogenetic analysis (MLPA), 10 putative virulence factors by use of polymerase chain reaction (PCR) and antimicrobial resistance to 15 antibiotics by use of the microbroth dilution method. RESULTS: The most common species of Aeromonas detected in samples of intestinal tract included; A. caviae (43.9%), A. veronii (35.7%), and A. dhakensis (12.2%). Prevalent species of Aeromonas collected from extra-intestinal infections included; A. hydrophila (29.4%), A. caviae (29.4%), and A. dhakensis (23.5%). A. hydrophila were detected in 1% of stool samples and 29.4% (5/17) of extra-intestinal infections. A. hydrophila strains in extra-intestinal infections were related to malignancy. The most common medical conditions among patients with Aeromonas infections included malignancy and liver-transplant related cholecystitis. Multiple drug resistance (MDR) was prevalent in extra-intestinal isolates (82.3%, 14/17) and was greater than the prevalence in intestinal isolates (30.6%, 30/98) (P < 0.05). Resistant rates of extra-intestinal isolates were 70.6, 35.3, 23.5 and 5.9% for ceftriaxone, ciprofloxacin, gentamicin and imipenem, respectively, and were higher than found in previous studies. Despite differences in the number and type of virulence genes among samples of Aeromonas, no significant correlation was found between invasion and virulent genes in intestinal or extra-intestinal infections. CONCLUSIONS: Overall results of this study support a role for Aeromonas spp. as a potential causative infectious agent of gastroenteritis, and malignancy, liver cirrhosis, post liver transplantation in immunocompromised patients. A. hydrophila was more prevalent in samples of extra-intestinal infections when compared to samples of intestinal infections, and was especially prominent in samples of patients presenting with malignancy. Aeromonas isolates from extra-intestinal samples had high rates of drug resistance but 3rd generation cephalosporins, fluoroquinolones and aminoglycosides remain as options to treat severe diarrhea. However, increasing MDR of extra-intestinal infection samples warrants monitoring.


Assuntos
Aeromonas/classificação , Aeromonas/isolamento & purificação , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/microbiologia , Enteropatias/microbiologia , Infecções Intra-Abdominais/microbiologia , Fatores de Virulência/genética , Adolescente , Adulto , Aeromonas/efeitos dos fármacos , Aeromonas/genética , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , China/epidemiologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Feminino , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Enteropatias/tratamento farmacológico , Enteropatias/epidemiologia , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Filogenia , Prevalência , Virulência/genética , Adulto Jovem
12.
Viruses ; 11(2)2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30791582

RESUMO

Viral gastroenteritis is an important cause of morbidity and mortality worldwide, being particularly severe for children under the age of five. The most common viral agents of gastroenteritis are noroviruses, rotaviruses, sapoviruses, astroviruses and adenoviruses, however, no specific antiviral treatment exists today against any of these pathogens. We here discuss the feasibility of developing a broad-spectrum antiviral treatment against these diarrhea-causing viruses. This review focuses on the viral polymerase as an antiviral target, as this is the most conserved viral protein among the diverse viral families to which these viruses belong to. We describe the functional and structural similarities of the different viral polymerases, the antiviral effect of reported polymerase inhibitors and highlight common features that might be exploited in an attempt of designing such pan-polymerase inhibitor.


Assuntos
Antivirais/isolamento & purificação , Diarreia/tratamento farmacológico , Diarreia/virologia , Gastroenterite/tratamento farmacológico , Gastroenterite/virologia , RNA Replicase/metabolismo , Infecções por Adenovirus Humanos/tratamento farmacológico , Animais , Antivirais/uso terapêutico , Vírus de DNA/efeitos dos fármacos , Vírus de DNA/enzimologia , Humanos , Norovirus/efeitos dos fármacos , Norovirus/enzimologia , Inibidores da Síntese de Ácido Nucleico/isolamento & purificação , Inibidores da Síntese de Ácido Nucleico/uso terapêutico , Vírus de RNA/efeitos dos fármacos , Vírus de RNA/enzimologia , Rotavirus/efeitos dos fármacos , Rotavirus/enzimologia , Infecções por Rotavirus/tratamento farmacológico
13.
J Antimicrob Chemother ; 74(1): 207-213, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285243

RESUMO

Background: Gastroenteritis (GE) is a frequent reason for consultating a general practitioner. Yet little is known about antibiotic prescribing in primary care patients with GE. In this study, we quantified empirical and targeted antibiotic treatment of GE, compliance with recommendations from primary care clinical practice guidelines (CPGs) and the degree of antimicrobial resistance in patients receiving diagnostic faeces testing (DFT). Methods: We performed a cohort study using routine care data of 160 general practitioners, including electronic patient records from 2013 to 2014. GE episodes were extracted and linked to microbiological laboratory records to retrieve results of DFT. For each episode, data on patient characteristics, DFT results including antimicrobial resistance testing, and antibiotic prescriptions were collected. Results: We identified 13217 GE episodes. Antibiotic treatment was prescribed in 1163 (8.8%) episodes, most frequently with metronidazole (n = 646, 4.9%), azithromycin (n = 254, 1.9%) or ciprofloxacin (n = 184, 1.4%). Treatment was empirical for 641 (5%) GE episodes, of which 30% (n = 191) followed the CPG-recommended antibiotic choice. Targeted treatment following DFT results was prescribed for 537 GE episodes (4%), of which 99% (n = 529) followed CPG recommendations. Non-susceptibility to first- or second-choice antibiotics was demonstrated in three Salmonella isolates (9%-13% of all isolates) and one Campylobacter isolate (1%). Conclusions: Antibiotic treatment of GE in primary care is relatively infrequent, with 1 in 11 episodes treated. Empirical treatment was more frequent compared with targeted treatment and mostly with non-CPG-recommended antibiotics. However, treatment based upon DFT results followed CPG recommendations.


Assuntos
Antibacterianos/uso terapêutico , Gastroenterite/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Clin Microbiol Infect ; 25(4): 454-461, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29964235

RESUMO

OBJECTIVES: To evaluate the relationship between individual bacterial and viral pathogens and disease severity. METHODS: Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). RESULTS: Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. CONCLUSIONS: In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.


Assuntos
Adenoviridae/isolamento & purificação , Gastroenterite , Norovirus/isolamento & purificação , Rotavirus/isolamento & purificação , Salmonella/isolamento & purificação , Adolescente , Adulto , Canadá , Criança , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Gastroenterite/microbiologia , Humanos , Lactente , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
16.
Curr Opin Pharmacol ; 43: 81-86, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30218940

RESUMO

The evolving policies regarding the use of therapeutic Cannabis have steadily increased the public interest in its use as a complementary and alternative medicine in several disorders, including inflammatory bowel disease. Endocannabinoids represent both an appealing therapeutic strategy and a captivating scientific dilemma. Results from clinical trials have to be carefully interpreted owing to possible reporting-biases related to cannabinoids psychotropic effects. Moreover, discriminating between symptomatic improvement and the real gain on the underlying inflammatory process is often challenging. This review summarizes the advances and latest discovery in this ever-changing field of investigation, highlighting the main limitations in the current use of these drugs in clinical practice and the possible future perspectives to overcome these flaws.


Assuntos
Anti-Inflamatórios/uso terapêutico , Agonistas de Receptores de Canabinoides/uso terapêutico , Endocanabinoides/uso terapêutico , Gastroenterite/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Trato Gastrointestinal/efeitos dos fármacos , Receptores de Canabinoides/efeitos dos fármacos , Animais , Anti-Inflamatórios/efeitos adversos , Agonistas de Receptores de Canabinoides/efeitos adversos , Endocanabinoides/efeitos adversos , Endocanabinoides/metabolismo , Gastroenterite/diagnóstico , Gastroenterite/metabolismo , Gastroenterite/fisiopatologia , Fármacos Gastrointestinais/efeitos adversos , Trato Gastrointestinal/metabolismo , Trato Gastrointestinal/fisiopatologia , Humanos , Ligantes , Receptores de Canabinoides/metabolismo , Fatores de Risco , Transdução de Sinais/efeitos dos fármacos , Resultado do Tratamento
17.
J Travel Med ; 25(1)2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30169854

RESUMO

The first case of Shigella-associated acalculous cholecystitis is described. A 27-year-old woman presented to hospital with diarrhoea and acute acalculous cholecystitis one day after return to Australia from Vietnam. Her feces culture grew multi-drug resistant ESBL-producing Shigella sonnei and she improved with antimicrobial therapy and intravenous fluids.


Assuntos
Colecistite Acalculosa/microbiologia , Farmacorresistência Bacteriana Múltipla , Gastroenterite/microbiologia , Trato Gastrointestinal/microbiologia , Colecistite Acalculosa/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Austrália , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Gastroenterite/tratamento farmacológico , Humanos , Shigella sonnei/efeitos dos fármacos , Shigella sonnei/isolamento & purificação , Viagem , Vietnã
18.
Artigo em Inglês | MEDLINE | ID: mdl-30104275

RESUMO

Norovirus is the main cause of viral gastroenteritis worldwide. Although norovirus gastroenteritis is self-limiting in immunocompetent individuals, chronic infections with debilitating and life-threatening complications occur in immunocompromised patients. Nitazoxanide (NTZ) has been used empirically in the clinic and has demonstrated effectiveness against norovirus gastroenteritis. In this study, we aimed at uncovering the antiviral potential and mechanisms of action of NTZ and its active metabolite, tizoxanide (TIZ), using a human norovirus (HuNV) replicon. NTZ and TIZ, collectively referred to as thiazolides (TZD), potently inhibited replication of HuNV and a norovirus surrogate, feline calicivirus. Mechanistic studies revealed that TZD activated cellular antiviral response and stimulated the expression of a subset of interferon-stimulated genes (ISGs), particularly interferon regulatory factor 1 (IRF-1), not only in a Huh7 cell-based HuNV replicon, but also in naive Huh7 and Caco-2 cells and novel human intestinal organoids. Overexpression of exogenous IRF-1 inhibited HuNV replication, whereas knockdown of IRF-1 largely attenuated the antiviral activity of TZD, suggesting that IRF-1 mediated TZD inhibition of HuNV. By using a Janus kinase (JAK) inhibitor, CP-690550, and a STAT1 knockout approach, we found that TZD induced antiviral response independently of the classical JAK-signal transducers and activators of transcription (JAK-STAT) pathway. Furthermore, TZD and ribavirin synergized to inhibit HuNV replication and completely depleted the replicons from host cells after long-term treatment. In summary, our results demonstrated that TZD combated HuNV replication through activation of cellular antiviral response, in particular by inducing a prominent antiviral effector, IRF-1. NTZ monotherapy or combination with ribavirin represent promising options for treating norovirus gastroenteritis, especially in immunocompromised patients.


Assuntos
Antivirais/farmacologia , Norovirus/efeitos dos fármacos , Ribavirina/farmacologia , Tiazóis/farmacologia , Replicação Viral/efeitos dos fármacos , Células CACO-2 , Infecções por Caliciviridae/tratamento farmacológico , Infecções por Caliciviridae/metabolismo , Infecções por Caliciviridae/virologia , Linhagem Celular , Linhagem Celular Tumoral , Sinergismo Farmacológico , Gastroenterite/tratamento farmacológico , Gastroenterite/metabolismo , Gastroenterite/virologia , Células HEK293 , Humanos , Fator Regulador 1 de Interferon/metabolismo , Intestinos/virologia , Janus Quinases/metabolismo , Organoides/efeitos dos fármacos , Organoides/metabolismo , Organoides/virologia , Replicon/efeitos dos fármacos , Fator de Transcrição STAT1/metabolismo
19.
Vet Parasitol ; 258: 79-87, 2018 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30105983

RESUMO

Ovine parasitic gastroenteritis is a complex disease routinely treated using anthelmintics. Although many different strongyle species may contribute to parasitic gastroenteritis, not all are equally pathogenic: in temperate regions, the primary pathogen is Teladorsagia circumcincta. In this study we investigated benzimidazole and ivermectin resistance on a commercial sheep farm in southeast Scotland. We assessed the impact of species diversity on the diagnosis of resistance using the faecal egg count reduction test and in vitro bioassays, and correlated the results with the frequency of benzimidazole resistance-associated genotypes measured in the T. circumcincta population by pyrosequencing of the ß-tubulin isotype-1 gene. Faecal egg count reduction test results showed efficacies of 65% for albendazole and 77% for ivermectin, indicating moderate resistance levels on the farm. However, PCR speciation of the same populations pre- and post-treatment revealed that removal of susceptible species had masked the presence of a highly resistant population of T. circumcincta. Less than 25% of individuals in the pre-treatment populations were T. circumcincta, the remainder consisting of Cooperia curticei, Chabertia ovina, Oesophagostomum venulosum and Trichostrongylus spp. In contrast, post-treatment with albendazole or ivermectin, the majority (88% and 100% respectively) of the populations consisted of T. circumcincta. The egg hatch test for benzimidazole resistance and the larval development test for ivermectin resistance were carried out using eggs obtained from the same populations and the results were broadly consistent with the faecal egg count reduction test. Thirty individual T. circumcincta from each sampling time point were assessed for benzimidazole resistance by pyrosequencing, revealing a high frequency and diversity of resistance-associated mutations, including within the population sampled post-ivermectin treatment. These results highlight the potential diversity of parasite species present on UK farms, and their importance in the diagnosis of anthelmintic resistance. On this particular farm, we demonstrate the presence of a highly dual-resistant population of T. circumcincta, which was strongly selected by treatment with either benzimidazoles or ivermectin, while other potentially less pathogenic species were removed.


Assuntos
Anti-Helmínticos/farmacologia , Resistência a Medicamentos , Gastroenterite/veterinária , Doenças dos Ovinos/parasitologia , Trichostrongyloidea/efeitos dos fármacos , Tricostrongiloidíase/veterinária , Animais , Anti-Helmínticos/uso terapêutico , Benzimidazóis/farmacologia , Benzimidazóis/uso terapêutico , Bioensaio , Fazendas , Fezes/parasitologia , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Gastroenterite/parasitologia , Variação Genética , Ivermectina/farmacologia , Ivermectina/uso terapêutico , Contagem de Ovos de Parasitas/métodos , Reação em Cadeia da Polimerase/métodos , Ovinos , Doenças dos Ovinos/tratamento farmacológico , Doenças dos Ovinos/epidemiologia , Trichostrongyloidea/genética , Trichostrongyloidea/patogenicidade , Tricostrongiloidíase/tratamento farmacológico , Tricostrongiloidíase/epidemiologia , Tricostrongiloidíase/parasitologia , Reino Unido/epidemiologia
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