Other bacterial diarrhoeas

Single Dose Treatments in Tropical Infectious Diarrhoea

Single dose treatments have the important advantages of simple administration, excellent compliance, short-lived side effects (if any) and short period of drug pressure. However, drugs used for single dose treatments must possess important characteristics, namely, long half-life, effective concentration in tissues over a long period, and low toxicity. In tropical medicine, such drugs are an important advance in the treatment of malaria (mefloquine and halofantrine), schistosomiasis (praziquantel and metrifonate), filariasis (ivermectin), and genitourinary tract and intestinal infections.

Intestinal infections are one of the most frequent problems in tropical medicine. While a large number of cases of diarrhoea are of viral (rotavirus) or bacterial (Salmonella, Escherichia coli) origin, necessitating only oral rehydration, some are of parasitological origin (Giardia, Entamoeba histolytica, Strongyloides, Trichuris, Schistosoma) and can be cured by a single dose treatment (tinidazole, secnidazole, ivermectin, albendazole, praziquantel). Secnidazole is the nitroimidazole with the longest half-life and is, therefore, used in single dose treatments for Giardia, acute intestinal amoebiasis and E. histolytica cyst carriers. Single dose treatments of most intestinal parasites will be a major advance in the management of tropical infectious diarrhoea. In the next decade, opportunistic intestinal infections (Cryptosporidium, Isospora, Enterocytozoon) in AIDS patients that are refractory to treatment could be the major problem.

Evidence for a rapid, direct effect on epithelial monolayer integrity and transepithelial transport in response to Salmonella invasion

In cultured monolayers of high-resistance Madin-Darby Canine Kidney (MDCK) cells, infection with Salmonella typhimurium SL1344 resulted in a dose- and time-dependent increase in transepithelial conductance (Gt) and short-circuit current (Isc). There was a direct linear relationship between the S. typhimurium-induced increments in Isc and Gt suggesting that this early change in epithelial parameters is, in part, the result of a cellular conductance change most probably at the apical membrane. An additional wild-type S. typhimurium strain, SR11, and an invasion-deficient isogenic mutant SB111 carrying a non-polar mutation in invA were used to confirm that the S. typhimurium-induced change in epithelial electrical parameters is directly linked to the invasion process. The S. typhimurium-induced change in epithelial electrical parameters was markedly attenuated in Na+-free choline medium. Addition of piretanide (10(-4) M, basal side) failed to affect the increased epithelial conductance and Isc after a 40-min incubation with S. typhimurium. NPPB (5x10(-4) M) added to the apical medium reduced the S. typhimurium-stimulated Isc by 28%, but Gt was not significantly reduced. It is unlikely that the S. typhimurium-induced Isc is due to Cl- secretion. Staining of S. typhimurium-infected MDCK I monolayers with TRITC-phalloidin revealed marked alterations of F-actin; diffuse intracellular accumulations of F-actin corresponding to the presence of invading bacteria were observed by 15 min. After 60 min, prominent extrusions of the apical membrane corresponding to previously described "membrane ruffles" were noted. Marked accumulations of perijunctional F-actin in infected cells corresponded to contraction of the perijunctional actin ring at the apical pole. In adjacent cells marked distortion and stretch of the apical surface was evident. The invasion-deficient invA mutant SB111 failed to induce these morphological changes. These data demonstrate that S. typhimurium invasion induces increased transcellular conductance which does not result from stimulation of Cl- secretion but instead appears to be predominantly due to increased Na+ permeability. The increased membrane conductance is coincident with increased transepithelial inulin permeability indicating that the increment in Gt has an additional "paracellular" component. The S. typhimurium-induced alterations in epithelial parameters may be related to "membrane ruffling" and/or to the accompanying changes in cell shape.