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At least 19 recordsLinked to original sources
PubMed1990

The incidence of viral-associated diarrhea after admission to a pediatric hospital.

For determination of the incidence of viral-associated diarrhea after admission to a pediatric hospital, all patients admitted to general pediatrics, cardiology, and neurosurgery wards without diarrhea between January 1 and July 31, 1985 were followed 5 days per week for presence of diarrhea, etiologic agent, and possible risk factors. A total of 1,530 patients were followed for 3,642 days. Of these patients, 69 developed 80 nosocomial diarrhea episodes after 72 hours in hospital for a nosocomial diarrhea rate of 4.5 infected children per 100 admissions. Of 358 patients with an infected roommate, 37 (10.3%) developed nosocomial diarrhea. Etiologic agents recognized included rotavirus (43%), calicivirus (16%), astrovirus (14%), minreovirus (12%), adenovirus (8%), Salmonella sp. (4%), and parvo/picornavirus (3%). The nosocomial diarrhea rate by age was: 0-11 months, 8.8%; 12-35 months, 3.6%; and 36 months or more, 0.6%. The rate by length of stay was: 3-7 days, 8.4%; 8-14 days, 10.4%; 15-21 days, 7.9%; and 22 days or more, 8.8%, and by number of roommates/1,000 patient-days it was: 0-1, 15.7; 2 to 3, 27.7; and 4 or more, 45.2. Patients who acquired diarrhea were more likely to be diapered (9.6% vs. 1.8%, p less than 0.001). Playroom use was not significantly different in the two groups. A total of 64 patients developed diarrhea within 72 hours of admission (community diarrhea rate = 4.2). Nosocomial viral-associated diarrhea is almost exclusively a disease of diapered children less than age 36 months and occurs at any time during hospital stay. It is more common in multibed rooms, but does occur in single-bed rooms.

Age Factors↗
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↗
PubMed1990

Is "Campylobacter upsaliensis" an unrecognised cause of human diarrhoea?

For 3 years a filtration system for the isolation of "new" campylobacter was included in the culture protocol of 15,185 stool specimens. "C upsaliensis" was isolated in 99 patients, C jejuni subsp doylei in 4, and C hyointestinalis in 2. "C upsaliensis" was the only organism isolated in 83 patients. Clinical information was available for 77 out of these 83 patients. 92% of the patients had diarrhoea; vomiting and fever were rare (14% and 7%, respectively); the onset was mostly sudden; and the symptoms usually lasted for less than a week. Gross or occult blood was present in a quarter of cases and neutrophils were detected in faecal smears in about a fifth. "C upsaliensis" may be an unrecognised and frequent cause of diarrhoea in man, and selective isolation media should be combined with non-selective isolation systems.

Adult↗
PubMed1991

Salmonella and Shigella gastroenteritis at a public teaching hospital in Nairobi, Kenya.

OBJECTIVE: To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species. DESIGN: Prospective 6-month survey. SETTING: Tertiary care center in a developing country. PATIENTS: Pediatric and adult patients admitted with the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea. OUTCOME MEASURES: Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea. RESULTS: Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission. CONCLUSIONS: Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country. Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation.

Adult↗
PubMedDate not supplied

Diarrhea in developed and developing countries: magnitude, special settings, and etiologies.

Diarrheal diseases are major causes of morbidity, with attack rates ranging from two to 12 or more illnesses per person per year in developed and developing countries. In addition, diarrheal illnesses account for an estimated 12,600 deaths each day in children in Asia, Africa, and Latin America. The causes of diarrhea include a wide array of viruses, bacteria, and parasites, many of which have been recognized only in the last decade or two. While enterotoxigenic Escherichia coli and rotaviruses predominate in developing areas, Norwalk-like viruses, Campylobacter jejuni, and cytotoxigenic Clostridium difficile are seen with increasing frequency in developed areas; and Shigella, Salmonella, Cryptosporidium species, and Giardia lamblia are found throughout the world. The rational management of infectious diarrhea requires the highly selective use of laboratory tests for these varied etiologic agents, depending on the clinical and epidemiologic setting. The purpose of this review is to provide an overview of the magnitude, special settings, and etiologies of diarrhea endemic to developed and developing countries. This information permits a practical approach to the diagnosis and management of common diarrheal illnesses in different settings.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Diarrheal disease in Cambodian children at a camp in Thailand.

The etiology of acute diarrhea (less than or equal to 3 days duration) and persistent diarrhea (greater than or equal to 14 days duration) was determined in Cambodian children under age 5 years in a refugee camp on the Thai-Cambodian border between May and October 1989; potential risk factors associated with persistent diarrhea were examined in an age-matched case-control study. Specimens collected from children and environmental sources were examined by standard microbiologic methods; Escherichia coli isolates were examined for hybridization with specific DNA probes and in tissue culture adherence assays. The same bacterial, viral, or parasitic agents were identified in 79 children with persistent diarrhea and in 408 children with acute diarrhea. Only one of nine children with persistent diarrhea excreted the same organism, Cryptosporidium, for that extended period. The most important risk factors identified for developing persistent diarrhea were living with other young children (odds ratio (OR) = 2.0, 95% confidence interval (Cl) 1.2-3.4) and being undernourished (OR = 2.6, 95% Cl 1.2-5.7). Persistent diarrhea in children in this camp was associated with several different agents rather than persistent infections with a single organism.

Cambodia↗
PubMed1989

Faecal mycobacteria and their relationship to HIV-related enteritis in Lusaka, Zambia.

The prevalence of infection with mycobacteria, both typical and atypical, is increasing along with prevalence of infection with HIV. Patients with pulmonary tuberculosis (PTB) and patients with chronic diarrhoea are forming a growing proportion of the patient population in hospitals in central Africa. To investigate the possibility that mycobacteria may be responsible for some of the HIV-related enteropathy seen in Lusaka, we studied 89 patients in four different diagnostic groups, clinically, by Mantoux test and by microscopy and culture of stool specimens for mycobacteria. In the HIV-positive group with chronic diarrhoea (n = 31), two patients were found to have mycobacteria on faecal smear and three were culture positive while of the 15 HIV-negative controls, three were smear positive and three were culture positive. Of the 15 patients with proven PTB, three had positive faecal smears but none were culture positive. In the fourth group of 24 patients with suspected PTB, seven were smear positive and five, culture positive. Only in this last group was there some correlation between smear results and culture results. Although this last finding is difficult to explain, it appears that there is no correlation between the symptom of chronic diarrhoea and the presence of mycobacteria in the stool. We conclude that mycobacteria do not play a significant role in the pathogenesis of HIV-related enteropathy in Lusaka.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Would control of childhood infectious diseases reduce malnutrition?

Infectious diseases and especially diarrheal diseases have been noted to have an adverse effect on the growth of underprivileged children in developing countries. Diarrheal diseases have been estimated to account for 10-80% of growth retardation in the first few years of life, with the magnitude of effect possibly modified by other factors, such as the adequacy and source of dietary intake, treatment and feeding practices during and following illness and the opportunity for catch-up growth after illness. In the only study in which infectious diseases and routine dietary intake have been evaluated simultaneously, inadequate dietary intake rather than infectious diseases, was found to have the predominant role in growth faltering. Although reduction in infectious diseases is desirable for many reasons, the relative feasibility and cost of this approach to improve nutritional status must be compared with more direct nutrition interventions.

Child↗
PubMed1992

Frequency of isolation of Cryptosporidium oocysts in Ethiopian children with acute diarrhoeal disease.

Stool specimens from one hundred children with acute diarrhoeal disease seen at the Gondar College of Medical Sciences Hospital, north-western Ethiopia were prospectively screened for the presence of oocysts of Cryptosporidium species. The study was conducted between June 1989 and January 1990. Nine out of one hundred specimens were positive for oocysts of Cryptosporidium. This study has demonstrated the presence of this parasite in the study region. A well desgned case control study is recommended to elucidate its clinical manifestations and association with malnutrition.

Animals↗
PubMedDate not supplied

[Prevalence of cryptosporidiosis in diarrheic syndrome in HIV positive patients].

During the period February 1987-June 1988, we examined 542 stool samples of 271 HIV positive patients both with and without full-blown AIDS. One hundred patients with either acute or chronic diarrhea and 180 patients without diarrhea were studied. The stool samples were examined for the presence of Cryptosporidium sp., other protozoa, helmints, and pathogenic enterobacteria. We found a prevalence of 14.3% of Cryptosporidium sp. in patients with full-blown disease and diarrhea. We encountered no Cryptosporidium sp. among asymptomatic patients. The occurrence of diarrhea was significantly associated with a CD4/CD8 ratio lower than 0.4, with the finding of Cryptosporidium sp. in the stools, being a CDC group IV, and with a positive stool culture for pathogenic enterobacteria. The diarrhea caused by Cryptosporidium sp. could not be distinguished, on clinical grounds, from diarrhea caused by other etiologic agents.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Multidrug resistant epidemic shigellosis in a village in west Bengal, 1984.

An out break of acute bacillary dysentery in a village called Dhamasin in Hooghly district of West Bengal was investigated during March 1984. Forty seven percent of families were affected. A total of 91 cases and 2 deaths occurred amongst 937 people giving an over all attack rate of 9.7% and a case fatality rate of 2.2 percent. Highest attack rate (22.7%) was observed in below one year age group. Multiple drug resistant Shigella dysentery type 1 strains were isolated for the first time from 6 out of 22 cases sampled at the domiciliary level. The organism was never isolated earlier during last ten years of surveillance in the infectious Diseases Hospital, Calcutta. Identification of nature of this outbreak and it's causative agent helped to realise the potentiality of extensive spread and paved the way for further investigations. Public health authorities were buffled as the rapid spread of the disease throughout the entire state of West Bengal could not be contained in spite of instituting all probable control measures on war footing.

Acute Disease↗
PubMedDate not supplied

Etiological agents of diarrhoea.

Two decades of research have established newer pathogens and techniques in establishing several organisms of diarrhoeal diseases as aetiological agents. It is now possible to detect an agent in 80% of the situation of diarrhoea in a standard laboratory. The brief review describes the list of pathogens, their diagnostic techniques with short description on clinical and epidemiological status.

Bacterial Infections↗