PubMed · 849544
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I T Beck. 1977-04-09. Diarrhea.. https://pubmed.ncbi.nlm.nih.gov/849544/
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Enterocytozoon bieneusi is a globally distributed zoonotic enteric pathogen that remains largely overlooked in routine diarrheal disease surveillance. Although previous studies in Shanghai, China, have reported elevated prevalence in diarrheal populations, case-control data from suburban areas at the peri‑urban interface and the strength of the association between E. bieneusi infection and chronic diarrhea in non-immunocompromised individuals remain poorly characterized. We performed a hospital-based case-control study in suburban Shanghai, enrolling 286 diarrheal outpatients without documented immunodeficiency and 138 asymptomatic controls frequency-matched for age and sex. Fecal specimens were collected and subjected to genomic DNA extraction. E. bieneusi was detected via nested PCR amplification of the ribosomal internal transcribed spacer (ITS) region. Factors associated with infection were identified using multivariate logistic regression. Genotypic diversity and zoonotic potential were assessed by Sanger sequencing and phylogenetic analysis. The overall prevalence of E. bieneusi was 12.2% (35/286) in diarrheal patients, significantly higher than the 2.2% (3/138) observed in asymptomatic controls (P < 0.001). E. bieneusi positivity was independently associated with chronic/persistent diarrhea (adjusted odds ratio = 2.63, 95% confidence interval: 1.25-5.54, P = 0.011). Fourteen distinct ITS genotypes were identified, comprising five known genotypes (D, EbpD, SHW7, Henan-III, and CHG5) and nine novel genotypes (designated SHH2 to SHH10). Thirteen genotypes clustered within Group 1, and one genotype (CHG5) fell within Group 2, two phylogenetic groups that contain genotypes with documented zoonotic potential in global surveillance. E. bieneusi was detected at a relatively high prevalence among diarrheal patients in suburban Shanghai, and its detection was associated with chronic/persistent diarrhea. The predominance of zoonotic genotypes and the identification of nine novel Group 1 genotypes indicate phylogenetic similarity to known zoonotic lineages and warrant further investigation of local zoonotic transmission; no animal or environmental samples were analyzed in this study. These findings suggest that E. bieneusi testing may be considered as part of the differential diagnosis for patients with unexplained chronic/persistent diarrhea and highlight the need for One Health surveillance in the surveyed area.
Diarrhoea is a problem, not only of the developing world, but also of the Western world. However, the economic implications of diarrhoeal diseases are particularly evident in the poorer countries. The most common worldwide cause of diarrhoea is intestinal infection and infants, pre-school children, the elderly, and those with congenital or acquired immunodeficiency run a high risk of contracting such infections. Diarrhoeal disease can be classified into three major clinical syndromes: acute watery diarrhoea, bloody diarrhoea, and persistent diarrhoea. A number of different micro-organisms can cause infectious diarrhoea, depending on the clinical setting. The development of oral rehydration solution has provided a simple approach to rehydration and maintenance of hydration in patients with acute watery diarrhoea, and has been implemented worldwide under the auspices of the World Health Organization. However, rehydration does not treat the diarrhoea itself, which will persist until the infection resolves. Since the drugs currently used for the treatment of diarrhoea, such as the opiate agents and antibiotics, have limitations, the search continues for a drug that acts predominantly on secretory pathways without affecting gastrointestinal motility. Novel therapeutic approaches include 5-HT(2) and 5-HT(3) receptor antagonists, calcium-calmodulin antagonists, and sigma-receptor agonists. Another approach has concentrated on the antisecretory role of the neurotransmitter, enkephalin, and has resulted in the development of the enkephalinase inhibitor, racecadotril. This drug has true antisecretory activity, and has demonstrated good efficacy and tolerability in clinical trials.
Microbial balance is an important factor in the maintenance of intestinal homeostasis, and yogurt or fermented milk supplementation has been proposed to control diarrheal diseases. A number of studies using animal models and clinical studies in humans have confirmed the beneficial effect of such fermented products in case of lactose intolerance, viral diarrhea or antibiotics-associated diarrhea. The mechanisms by which lactic acid bacteria exert their effects are multiple. Bacterial lactase improves the absorption of lactose, but fermented products slow down the intestinal transit facilitating the action of residual intestinal lactase. The transient passage of lactic acid bacteria in the digestive tract may represent a microbial barrier against the development of pathogenic bacteria, probably due to the release of compounds contributing to the maintenance of colonization resistance to pathogens. The beneficial effects are mainly described in the presence of live bacteria, but inactivated bacteria may also present preventive or curative capacities in diarrheal diseases. Moreover, lactic acid bacteria has been described as reinforcing the non-specific immune defence but also specific immunity, particularly the secretory immune system mediated by secretory IgA or IgM in response to particulate infectious antigens and perhaps to soluble food antigens. Other possible mechanisms include the trophic effect on the intestinal layer, and a down-regulatory activity in cow's milk allergy as well as anti-inflammatory effects have also been suggested.