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PubMed2004

Outcome of cats with diarrhea and Tritrichomonas foetus infection.

OBJECTIVE: To determine the long-term outcome of cats infected with Tritrichomonas foetus and identify treatment and management strategies influencing resolution of infection or associated diarrhea. DESIGN: Prospective study. SAMPLE POPULATION: 26 cats with T. foetus-associated diarrhea at least 22 months prior to the study. PROCEDURE: A standardized survey regarding clinical course and management was administered to owners of cats with T. foetus infection and associated diarrhea. Fecal samples were obtained from each cat; the presence of T. foetus was assessed via microscopic examination of smears, culture in commercial media, and polymerase chain reaction amplification of T. foetus rDNA involving species-specific primers. RESULTS: Survey responses were obtained from owners of all 26 cats. Twenty-three cats had complete resolution of diarrhea a median of 9 months after onset. Analysis of fecal samples obtained from 22 cats revealed persistent T. foetus infection in 12, with a median of 39 months after resolution of diarrhea. History of implementation of a dietary change, treatment with paromomycin, or higher numbers of cats in the household was associated with significantly longer duration of time to resolution of diarrhea. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested chronic T. foetus-associated diarrhea in most cats is likely to resolve spontaneously within 2 years of onset. Chronic infection with T. foetus (without clinical signs) after resolution of diarrhea appears to be common. Although often temporarily effective in decreasing severity of diarrhea, attempts to treat cats with T. foetus infection may result in prolongation of time to resolution of diarrhea.

Animals↗
PubMed2004

Acute diarrhea during army field exercise in southern China.

AIM: During emergency period, infectious diseases can be a major threat to military forces. During field training in southern China, diarrhea is the main cause of nonbattle injury. To evaluate the causes of and risk factors for diarrhea in emergency period, we collected clinical and epidemiological data from the People's Liberation Army (PLA) during field training in southern China. METHODS: From September 25 to October 2 1997, 2636 military personnel were investigated. Fecal sample cultures for lapactic pathogens were obtained from 103 military personnel with diarrhea. In addition, a questionnaire was administered to 103 cases and 206 controls to evaluate the association between illness and potential risk factors. At the same time, another questionnaire of 1:4 case-case control was administered to 22 severe cases (each severe case paired 4 mild cases). RESULTS: The training troop's diarrhea incidence rate was significantly higher than that of garrison. The diarrhea incidence rate of officers was significantly lower than that of soldiers. A lapactic pathogen was identified in 63.1% (65/103) of the troops with diarrhea. Enterotoxigenic Escherichia coli (35.0%) and plesiomona shigelloides (16.5%) were the most common bacterial pathogens. All bacterial isolates were sensitive to norfloxacin and ceftazidine. However, almost all of them were resistant to sulfamethoxazole, trimethoprim-sulfamethoxazole, oxytetracycline, doxycycline, furazolidone, ampicillin and cloromycetin to a different degree. Risk factors associated with diarrhea included drinking raw water, eating outside, contacting diarrhea patients, lacking sanitation, depression, lacking sleep, which were established by multiple-factor logistic regression analysis. In addition, the unit incidence rate was associated with the density of flies and the average daily boiled water available by regression and discriminate analysis. CONCLUSION: A series of risk factors are associated with the incidence rate of diarrhea. Our results may provide a useful basis for prevention and cure of diarrhea in emergency period of PLA.

Acute Disease↗
PubMed2005

The assessment and management of cancer treatment-related diarrhea.

Cancer treatment-induced diarrhea affects a high percentage of patients with cancer that receive chemotherapy or radiation treatment. Widely used criteria for measuring treatment-induced diarrhea, such as the National Cancer Institute Common Toxicity Criteria, do not account for important characteristics of treatment-induced diarrhea. These characteristics include the assessment of the duration of the diarrhea, coexisting symptoms, abdominal cramping, or the presence of nocturnal diarrhea. Until recently, there were no universally accepted guidelines for the management of diarrhea. An expert panel developed guidelines with recommendations regarding assessment of the patient and treatment. These guidelines stress the importance of a thorough assessment of the patient, and treatment based upon severity of symptoms. By employing these guidelines, the aggressive management of diarrhea may impact the overall morbidity of this symptom. Education regarding the importance of diarrhea is essential. Patients who are informed will better understand their role in managing this side effect and when to contact their health care provider with emergent symptoms. Early recognition and management of diarrhea will be essential to improve control of diarrhea, and in turn will positively impact patients' quality of life.

Antidiarrheals↗
PubMedDate not supplied

Intractable diarrhea in hyperthyroidism: management with beta-adrenergic blockade.

OBJECTIVE: To describe a patient with intractable diarrhea and thyrotoxic Graves' disease, for whom b-adrenergic blockade ultimately proved to be effective therapy for the diarrhea, and to review the types of hyperthyroidism-associated diarrhea. METHODS: We present the clinical course of a young man with a prolonged siege of diarrhea that proved elusive to diagnostic inquiries and resistant to all means of management until its endocrine basis was discovered. Control of such cases with b-adrenergic blockade is discussed, as are the pathophysiologic bases of intestinal hypermotility in hyperthyroidism. RESULTS: A 26-year-old man with Down syndrome, and no prior gastrointestinal disorder, had insidious, chronic, constant diarrhea, which was associated with loss of 14 kg during a 5-month period. Numerous laboratory and imaging studies and endoscopic examinations failed to disclose the cause of the diarrhea. Furthermore, a broad range of antibiotics and other empiric remedies failed to control the problem. No other symptoms of hyperthyroidism were reported, but when the endocrinopathy was suspected and identified, the diarrhea was promptly controlled by treatment with propranolol. In patients with hyperthyroidism, two types of diarrheal disorders have been described-secretory diarrhea and steatorrhea; bile acid malabsorption may have a role in either of these settings. CONCLUSION: In addition to its capacity for blocking the peripheral effects of thyroid hormone on the heart and central nervous system, b-adrenergic blockade is effective in slowing intestinal transit time and ameliorating the uncommon diarrhea associated with hyperthyroidism. Thyroid hormone in excess, among its other possible effects on the gastrointestinal tract, may exert a stimulatory effect by means of intermediary sympathetic activation, as it does with the heart. Thus, sympathetic blockade can mimic the salutary effects on the gastrointestinal tract conventionally brought about by direct antithyroid therapy, and well before the hyperthyroid state per se is eliminated. The current patient illustrates the value of considering hyperthyroidism in the differential diagnosis of diarrhea of unknown cause.

Adrenergic beta-Antagonists↗
PubMed1999

Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil.

To determine potential, long-term deficits associated with early childhood diarrhea and parasitic infections, we studied the physical fitness (by the Harvard Step Test) and cognitive function (by standardized tests noted below) of 26 children who had complete surveillance for diarrhea in their first 2 years of life and who had continued surveillance until 6-9 years of age in a poor urban community (favela) in Fortaleza in northeast Brazil. Early childhood diarrhea at 0-2 years of age correlated with reduced fitness by the Harvard Step Test at 6-9 years of age (P = 0.03) even after controlling for anthropometric and muscle area effects, anemia, intestinal helminths, Giardia infections, respiratory illnesses, and socioeconomic variables. Early childhood cryptosporidial infections (6 with diarrhea and 3 without diarrhea) were also associated with reduced fitness at 6-9 year of age, even when controlling for current nutritional status. Early diarrhea did not correlate with activity scores (P = 0.697), and early diarrhea remained significantly correlated with fitness scores (P = 0.035) after controlling for activity scores. Early diarrhea burdens also correlated in pilot studies with impaired cognitive function using a McCarthy Draw-A-Design (P = 0.01; P = 0.017 when controlling for early helminth infections), Wechsler Intelligence Scale for Children coding tasks (P = 0.031), and backward digit span tests (P = 0.045). These findings document for the first time a potentially substantial impact of early childhood diarrhea and cryptosporidial infections on subsequent functional status. If confirmed, these findings have major implications for calculations of global disability adjusted life years and for the importance and potential cost effectiveness of targeted interventions for early childhood diarrhea.

Animals↗
PubMed1998

Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding.

BACKGROUND: Clostridium difficile is the most common infectious cause of nosocomial diarrhea, but its role in diarrhea associated with tube feeding has not been rigorously investigated. OBJECTIVE: To determine the incidence of C. difficile acquisition and C. difficile-associated diarrhea in tube-fed and non-tube-fed patients. DESIGN: Prospective cohort study. SETTING: A university-affiliated Veterans Affairs Medical Center. PATIENTS: 76 consecutive hospitalized, tube-fed patients and 76 hospitalized, non-tube-fed patients. The two cohorts were matched for age, unit location, duration of hospitalization before surveillance, and severity of illness. MEASUREMENTS: Incidence of C. difficile acquisition, incidence of C. difficile-associated diarrhea, and C. difficile restriction endonuclease analysis typing results. RESULTS: More tube-fed patients than non-tube-fed patients acquired C. difficile (15 of 76 patients [20%] compared with 6 of 76 patients [8%]; P=0.03) and developed C. difficile-associated diarrhea (7 of 76 patients [9%] compared with 1 of 76 patients [1%]; P=0.03). The mean proportion (+/-SD) of surveillance days with diarrhea was greater for tube-fed patients after the development of C. difficile-associated diarrhea than for tube-fed patients without this diarrhea (0.68+/-0.4 compared with 0.22+/-0.2 [95% CI for the mean difference, 0.08 to 0.84]). Postpyloric tube feeding (odds ratio, 3.14 [CI, 1.008 to 9.77]) and duration of surveillance (odds ratio, 1.08 [CI, 1.0009 to 1.16]) were risk factors for the acquisition of C. difficile. Nineteen restriction endonuclease analysis types of C. difficile were identified from 20 patients. CONCLUSIONS: Hospitalized, tube-fed patients, especially those receiving postpyloric tube feeding, are at greater risk for the acquisition of C. difficile and the development of C. difficile-associated diarrhea than are hospitalized, non-tube-fed patients. Clinicians should test for C. difficile in tube-fed patients with diarrhea.

Aged↗
PubMed1999

Chronic diarrhea in tropics.

Diarrheal diseases continue to be very frequent in the tropics. Upto 40% of mortality associated with diarrheal diseases is associated with prolonged episodes of diarrhea and accompanying malnutrition. Prolonged diarrheal episodes can basically be divided into three main types: a) acute onset prolonged diarrhea or persistent diarrhea; b) insidious onset chronic diarrhea and c) recurrent diarrhea. Epidemiology, risk factors, etiological factors, gut pathophysiology and management of persistent diarrhea has been extensively reviewed in the article. Chronic diarrhea in tropics has entirely different etiological considerations than those observed in Western countries. Most of these factors are associated with poor sanitary and living conditions and gastrointestinal infections. Celiac disease is also identified as an important cause of chronic diarrhea in Indian settings. Chronic diarrhea needs to be differentiated from chronic non specific diarrhea wherein no adverse nutritional effects are seen in the patient.

Child↗
PubMed1990

[Effects of stimulation available at home and of mother-child interaction on the presence and duration of diarrhea in young infants].

The relationship between two key factors involved in infant care and the frequency and duration of diarrhea, was search for in a cohort of rural infants followed-up from birth onwards. The specific questions asked were if the profile of mother-infant interaction, and the total score on home stimulation available to the infant were associated with the presence or absence of diarrhea, and with its total duration, expressed as the percentage of days with diarrhea over the number of days of age, in each semester of the first year of life of the infants. Frequency an duration of diarrhea, mother-infant interaction, and scores on home stimulation available to the infant showed no difference between baby-boys and baby-girls. The behavior of mothers of infants with diarrhea was not significantly different than the behavior exhibited by mothers of infants without diarrhea; even in the scales related to "quantity of physical contact with the infant", "type of physical contact with the infant", "response to infant's needs", and "sensitivity toward the infant". Similarly, neither the quality nor quantity of home stimulation showed association with the presence of diarrhea. Finally, none of the two microenvironmental attributes influenced the duration of diarrhea in either semester of the life of the infant. Although diarrhea is one of the most frequent antecedents of severe clinical malnutrition and in the latter both mother-infant interaction and home stimulation play a prominent role in the evolution from second degree to third clinical degree malnutrition, it seems important than those factors have a minimal influence in relation to diarrhea during the first year of life.

Diarrhea, Infantile↗
PubMed1994

Evidence for the involvement of 5-hydroxytryptamine 4 receptors in 5-hydroxytryptophan-induced diarrhea in mice.

The objective of this study was to characterize the receptor(s) to 5-HT mediating 5-HTP-induced diarrhea in mice. The severity of diarrhea in mice was assessed using an arbitary scoring scale ranging from 0 (normal stools) to 3 (watery diarrhea). Administration of 5-HTP (1-30 mg/kg i.p.) produced a dose-dependent increase in diarrhea score (ED50, 1.47 mg/kg i.p.). 5-HTP (10 mg/kg i.p.)-induced diarrhea was unaffected by atropine (3 mg/kg i.p.) but was completely abolished by the aromatic L-amino acid decarboxylase inhibitor benserazide (10 mg/kg i.p.). Pretreatment (5 min before 5-HTP) with DAU 6285, a marginally selective 5-HT4 receptor antagonist, significantly inhibited 5-HTP-induced diarrhea (ID50, 0.58 mg/kg i.p.). Pretreatment (5 min before 5-HTP) with GR 113808 or SB 204070, two highly selective 5-HT4 antagonists, significantly inhibited 5-HTP-induced diarrhea with ID50 estimates of 0.31 and 0.003 mg/kg i.p., respectively. The maximal inhibition produced by DAU 6285, GR 113808 and SB 204070 was 63%, 68% and 36%, respectively. Neither GR 113808 (1 and 3 mg/kg i.p.) nor SB 204070 (0.1 and 1 mg/kg i.p.) had any effect on 16,16-dimethyl prostaglandin E2 (30 micrograms/kg i.p.)-induced diarrhea in mice. DAU 6285 significantly inhibited 16,16-dimethyl prostaglandin E2-induced diarrhea at the highest dose (3 mg/kg i.p.). Pretreatment (30 min before 5-HTP) with methysergide (0.1-3 mg/kg i.p.), metergoline (0.01-0.1 mg/kg i.p.), ketanserin (0.01-1 mg/kg i.p.), YM 060 (0.01-0.1 mg/kg i.p.) or ondansetron (0.01-3 mg/kg i.p.) had no significant effects on 5-HTP-induced diarrhea.(ABSTRACT TRUNCATED AT 250 WORDS)

5-Hydroxytryptophan↗
PubMedDate not supplied

Diarrhea associated with nasogastric feedings.

PURPOSE/OBJECTIVES: To determine the difference in the incidence of diarrhea among subjects given one of three formulas with varying fiber concentrations administered by nasogastric (NG) tube, variables affecting incidence of diarrhea, discomforts other than diarrhea associated with NG tube feedings, and effects of changing from continuous to interval feedings on incidence of diarrhea and discomforts. DESIGN: Prospective, double-blind, randomized study. SETTING: Midwestern tertiary care center otolaryngology nursing unit. SAMPLE: Eighty randomized subjects who were 18 years or older, English-speaking, and undergoing head and neck cancer surgery that required an NG tube postoperatively and who had no gastrointestinal (GI) illness within two weeks prior to surgery. METHODS: Subjects received continuous administration of formula containing no fiber, 7 gms/L of fiber, or 14 gms/L of fiber until they reached the caloric intake goal and then were advanced to interval feedings. Patients' medical records provided past medical history and information on medication administration. A bedside flow sheet was used for documenting incidence of diarrhea and other GI discomforts. MAIN RESEARCH VARIABLES: Amount of fiber in the formula administered, patient's genders and prior food aversions, and antibiotics' effect on diarrhea and other GI discomforts. FINDINGS: Multiple logistic regression showed significant odds ratios (ORs) for developing diarrhea in female subjects (OR = 7.96), subjects who had prior food aversions (OR = 2.67), and subjects receiving broad spectrum antibiotics (OR = 3.22). Diarrhea was four times more likely to occur in males who received fiber-free formula. Of all subjects, 70% experienced GI discomforts with continuous feedings, and 50% experienced discomforts when advanced to interval feedings. CONCLUSIONS: Fiber formulas reduced the incidence of diarrhea in male subjects but not in female subjects. Antibiotics' effect on diarrhea paralleled the findings of other studies. IMPLICATIONS FOR NURSING PRACTICE: Use formulas with fiber for males. Liquid stools do not require interruption of tube feeding; GI discomforts warrant interruption. Interval feeding schedules require monitoring similar to continuous feeding schedules.

Antibiotic Prophylaxis↗
PubMed1996

Risk factors associated with development of diarrhea in horses after celiotomy for colic: 190 cases (1990-1994).

OBJECTIVE: To determine the incidence of the risk factors for developing diarrhea in horses after celiotomy for colic. DESIGN: Retrospective cohort study. ANIMALS: 357 adult horses that had celiotomy for colic at the teaching hospital between Jan 1, 1990 and Sep 1, 1994. PROCEDURE: Medical records of horses that had celiotomy for colic were reviewed to abstract information regarding development of diarrhea, signalment, history, and treatment. RESULTS: In horses that had celiotomy for colic, the incidence of diarrhea was 53.2% (190/357). Using multiple logistic regression, horses with a disorder of the large intestine were approximately twice as likely to develop diarrhea after celiotomy as horses that had surgery for other types of intestinal lesions (P < 0.001). Even after accounting for the effects of large intestinal surgery, horses that also had an enterotomy were approximately 1.5 times as likely to develop diarrhea (P = 0.042). Diarrhea in horses associated with duration > 2 days, isolation of Salmonella spp from feces, or leukopenia was categorized as being severe. Incidence of severe diarrhea was 27.5% (98/357). Using multiple logistic regression, horses that had surgery of the large intestine were approximately 2.5 times as likely to develop severe diarrhea after celiotomy as horses that had surgery for other types of intestinal lesions (P = 0.006). In horses that had celiotomy for colic, those that were fed grass hay were approximately half as likely to develop severe diarrhea as were horses that were not fed grass hay (P = 0.018). CLINICAL IMPLICATIONS: Although the risk factors identified for the development of diarrhea are not alterable, knowledge of them will enable clinicians to better advise clients and to better prepare for medical management of horses after surgery.

Animal Feed↗
PubMed1998

A reliable, practical, and economical protocol for inducing diarrhea and severe dehydration in the neonatal calf.

Fifteen healthy, colostrum-fed, male dairy calves, aged 2 to 7 d were used in a study to develop a diarrhea protocol for neonatal calves that is reliable, practical, and economical. After instrumentation and recording baseline data, diarrhea and dehydration were induced by administering milk replacer [16.5 mL/kg of body weight (BW), PO], sucrose (2 g/kg in a 20% aqueous solution, p.o.), spironolactone and hydrochlorothiazide (1 mg/kg, PO) every 8 h, and furosemide (2 mg/kg, i.m., q6h). Calves were administered sucrose and diuretic agents for 48 h to induce diarrhea and severe dehydration. Clinical changes after 48 h were severe watery diarrhea, severe depression, and marked dehydration (mean, 14% BW loss). Cardiac output, stroke volume, mean central venous pressure, plasma volume, thiocyanate space, blood pH and bicarbonate concentration, base excess, serum chloride concentration, and fetlock temperature were decreased. Plasma lactate concentration, hematocrit, and serum potassium, creatinine, phosphorus, total protein and albumin concentrations were increased. This non-infectious calf diarrhea protocol has a 100% response rate, while providing a consistent and predictable hypovolemic state with diarrhea that reflects most of the clinicopathologic changes observed in osmotic/maldigestive diarrhea caused by infection with rotavirus, coronavirus or cryptosporidia. Limitations of the protocol, when compared to infectious diarrhea models, include failure to induce a severe metabolic acidosis, absence of hyponatremia, renal instead of enteric loss of chloride, renal as well as enteric loss of free water, absence of profound clinical depression and suspected differences in the morphologic and functional effect on intestinal epithelium. Despite these differences, the sucrose/diuretic protocol should be useful in the initial screening of new treatment modalities for calf diarrhea. To confirm their efficacy, the most effective treatment methods should then be examined in calves with naturally-acquired diarrhea.

Animals↗
PubMed1995

Epidemiologic Observations on Diarrhea Developing in U.S. and Mexican Students Living in Guadalajara, Mexico.

Background: A previous study suggested that U.S. students who lived in Mexico for 1 year had a risk of diarrhea intermediate between the rate for newly arrived U.S. students and Mexican students; however, the study was not controlled for changes of risky behavior over time. Methods: An analysis of acute diarrhea occurring among U.S. and Mexican student groups living in Guadalajara, Mexico was conducted to explore the association of diarrhea developing during selected 28-day periods with length of residence, season, and risk factors such as locations of food consumption, consumption of tap water, unsafe ice, alcohol, and antibiotics. Results: Compared to U.S. and Mexican student groups, newly arrived U.S. college students in July had the highest rate of diarrhea (55%), highest enteropathogen isolation rate (46%), and most consumption of alcohol and antibiotics; they also ate most frequently at restaurants and in Mexican family homes. Compared to a 34% rate of diarrhea among newly arrived U.S. medical students in August, the rate was only 6% among established medical students in January. This drop in attack rate was attended by less tap water and unsafe ice consumption by established students in January compared to the habits of newly arrived students in January or August when risky behavior was otherwise similar among these groups. The role of tap water and unsafe ice in the acquisition of wintertime diarrhea is further supported by the relatively high 29% rate of diarrhea among U.S. medical students newly arrived in January, who also consumed more tap water and ice than established students in January. Enterotoxigenic E. coli disease was observed only during the summer months; whereas, Campylobacter jejuni disease and disease associated with no detected pathogen were more common in winter. Conclusions: These data imply that wintertime diarrhea in Guadalajara is more likely than summertime diarrhea to be waterborne and to be caused by agents such as viruses or previously unrecognized enteropathogens that were not assessed in this study. Among Mexican students who had the highest frequency of tap water consumption and eating from vendors, the low rates of diarrhea in summer (3%) and winter (5%) imply that they enjoy a substantial degree of immunity. Further study will be necessary to understand the role that immunity (or its loss during summer vacation back in the United States) might play in additionally accounting for observed differences in attack rates between newly arrived students and those who had lived for a period of time in Mexico. (J Travel Med 2:6-10, 1995)

Journal Article↗
PubMed1992

Persistent diarrhea in northeast Brazil: etiologies and interactions with malnutrition.

With the improved control of acute diarrheal illness mortality with oral rehydration therapy, persistent diarrhea is now emerging as a major cause of childhood mortality in tropical developing areas like the impoverished populations in Brazil's Northeast. "Graveyard surveillance" in the rural community of Guaiuba in northeastern Brazil revealed fully half of the 70% diarrhea mortality was due to persistent diarrheal illnesses. Furthermore, 11% of 14 or more diarrheal illnesses per child per year in an urban slum in Fortaleza persisted beyond 14 days, a definition that clearly identified the high risk children for heavy diarrhea burdens. Not only did heavy diarrhea burdens ablate the key "catch-up" growth seen in severely malnourished children and in children following previous diarrheal illnesses, but malnutrition significantly predisposed children to a greater incidence and duration of diarrhea as well as a greater incidence of persistent diarrhea. Etiologic studies of 37 children presenting with persistent diarrhea to Hospital das Clinicas in Fortaleza revealed that Cryptosporidium (in 13%) and enteroadherent E. coli (36% with aggregative, 29% with diffuse and 13% with localized adherence to HEp-2 cells) were the predominant potential pathogens found in the stool or upper small bowel. These findings suggest that persistent diarrhea is emerging as an important health problem in Brazil's Northeast, that it identifies a high risk child for heavy diarrhea burdens, that important interactions occur with malnutrition and that Cryptosporidium and enteroadherent E. coli warrant further study as potential etiologies of this major cause of morbidity and mortality.

Animals↗
PubMed2000

Diarrhea-associated hospitalizations among children in Hawaii.

OBJECTIVE: To estimate the burden of diarrhea-associated hospitalizations among children in Hawaii. DESIGN: Retrospective analysis of hospital discharge records. PATIENTS: Children from 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the hospital discharge record in Hawaii. SETTING: Acute care hospitals in the state of Hawaii, 1994 through 1997. RESULTS: During 1994-1997, 2288 children (11.3% of all hospitalizations for children < 5 years of age) had a diarrhea-associated diagnosis listed at hospital discharge. The average annual incidence (per 10,000 children) of diarrhea-associated hospitalizations was 62.3; the incidence was higher for children < 1 year (101.6) than for those 1 through 4 years of age (52.7). Rates for Hawaii were lower than national rates during 1993 through 1995 (US annual rate of 89 per 10,000 children). The median length of hospital stay was 2 days for diarrhea-associated hospitalizations, and 3 days for hospitalizations specifically associated with rotavirus-related diarrhea. Diarrhea-associated hospitalizations were highest during the period December through June. CONCLUSIONS: Diarrhea is an important cause of hospitalization among children in Hawaii, where approximately 1 in 32 children may be hospitalized by 5 years of age. The age-specific and temporal trends reported here are consistent with those previously described for rotavirus-associated hospitalizations, suggesting that this pathogen is a major contributor to the overall morbidity from diarrhea.

Child, Preschool↗
PubMed2002

The evolution of bovine viral diarrhea: a review.

The economic importance of bovine viral diarrhea is increasing with the emergence of seemingly more virulent viruses, as evidenced by outbreaks of hemorrhagic syndrome and severe acute bovine viral diarrhea beginning in the 1980s and 1990s. It appears that evolutionary changes in bovine viral diarrhea virus were responsible for these outbreaks. The genetic properties of the classical bovine viral diarrhea virus that contribute to the basis of current diagnostic tests, vaccines, and our understanding of pathogenic mechanisms are now being reevaluated because of these "new" virus strains. This shift in virulence has confounded both nomenclature and the significance of current bovine viral diarrhea virus categorization. The purpose of this review is to summarize our current understanding of bovine viral diarrhea virus with a chronological review of prevailing scientific tenets and practices as described in clinical and scientific North American veterinary journals and textbooks. The first part of this review describes how we have arrived at our current understanding of the viruses, the diseases, and their nomenclature. The second part of the review deals with current concepts in virology and how these concepts may both explain and predict bovine viral diarrhea virus pathogenesis. By reviewing how knowledge of bovine viral diarrhea has evolved and the theories of how the virus itself is able to evolve, the interpretation of diagnostic tests are more effectively utilized in the control and treatment of bovine viral diarrhea virus associated disease.

Animals↗
PubMed1990

[Risk factors for acute infantile diarrhea in a rural community in Chiapas, Mexico. A strategy for intervention].

A community-based, case-control study was conducted during the summer peak season for diarrhea in the highlands of Chiapas, Mexico, to identify risk and protective factors associated with acute diarrhea in children less than 6 years of age. To estimate the diarrheal morbidity rate, the community was divided into 13 sectors, each of about 20 households. A resident (volunteer mother) made daily visits to every household in her sector to identify new cases of diarrhea. During 3 weeks of surveillance, 63 children with diarrhea and 48 control children were identified. The diarrheal attack rate during this period for children less than 6 years of age was 30%. Analysis of 29 neighborhood-matched case-control pairs showed that children with diarrhea were more likely than their controls to have had a mother with diarrhea in the 2 weeks preceding the onset of the child's diarrhea (P less than 0.05; relative risk = 10). The association of childhood diarrhea with maternal diarrhea may serve as a focus for more detailed studies as well as an intervention that may be appropriate and effective for this community.

Adult↗
PubMed1990

Diarrhea as a presenting symptom of hepatocellular carcinoma.

The clinical manifestations of hepatocellular carcinoma (HCC) are highly nonspecific since they usually mimic those of hepatic cirrhosis, which frequently underlies this neoplasm. The fact that some HCC patients present with severe diarrhea, an unusual symptom in liver cirrhosis, prompted us to determine the prevalence of diarrhea in a series of 23 consecutive HCC patients and compare it with that of a control group formed by cirrhotic patients without HCC, matched by age, sex, and etiology of the liver disease. All the patients were interviewed about the existence of diarrhea (defined as the presence of three or more loose stools per day appearing over three or more days) in the three months prior to admission. Both groups of patients were similar in regards to the degree of liver failure and presence of diarrhea-favoring factors. By contrast, diarrhea was significantly more frequent among HCC cases than among cirrhotics without HCC (47.8% vs 8.7%, P less than 0.005). HCC patients with diarrhea exhibited higher alkaline phosphatase and bilirubin levels and worse liver function, assessed by the Child-Pugh's classification, than patients without diarrhea. However, neither tumor size, vascular invasion, or the degree of tumor differentiation were significantly different between these two groups of HCC patients. These results show that diarrhea is a frequent manifestation of HCC in patients with cirrhosis. Therefore, the development of HCC in these patients should be suspected upon the appearance of diarrhea.

Adult↗