Bacterial gastroenteritis

The effects of climate variability and seasonal influence on diarrhoeal disease in the tropical city-state of Singapore - A time-series analysis

BACKGROUND

Diarrhoeal disease is common and imposes substantial health and economic burdens across the globe, especially in the African and Southeast Asian regions. Besides causing high mortality and morbidity, diarrhoeal disease has also been associated with growth and cognitive shortfalls in children in low-resource settings. Extreme weather events brought about by climate change may increase diarrhoeal disease and impact vulnerable populations in countries regardless of levels of development. We examined the seasonal and climatic influences of acute diarrhoeal disease reports in Singapore, a city-state located in Southeast Asia.

METHODS

We used a time-series analysis, adjusting for time-varying potential confounders in a negative binomial regression model and fitting fractional polynomials to investigate the relationship between climatic factors (temperature, relative humidity and rainfall) and reported diarrhoeal disease.

RESULTS

We included 1,798,198 reports of diarrhoeal disease from 2005 to 2018. We observed annual trimodal peaks in the number of reports. Every 10% increase in relative humidity in the present week was positively associated with an increase in reports one week later [Incidence Rate Ratio (IRR): 1.030, 95% CI 1.004-1.057] and negatively associated with a decrease in reports six weeks later (IRR: 0.979, 95% CI 0.961-0.997). We observed effect modification of relative humidity on the risk of diarrhoeal disease in the first calendar quarter (January to March). There was weak evidence of a delayed effect of ambient air temperature on reports of diarrhoeal disease one week later (IRR: 1.013, 95% CI 0.998-1.027). No threshold effects of climatic factors were observed. Each week of school holidays was associated with a 14.4% reduction in diarrhoeal disease reports (IRR: 0.856, 95% CI: 0.840 to 0.871). Public holidays were associated with a reduction in reports in the same week and an increase a week later.

CONCLUSIONS

Diarrhoeal disease is highly seasonal and is associated with climate variability. Food safety and primary healthcare resource mitigation could be timed in anticipation of seasonal and climate driven increases in disease reports.

Kalanchoe brasiliensis Cambess., a Promising Natural Source of Antioxidant and Antibiotic Agents against Multidrug-Resistant Pathogens for the Treatment of Salmonella Gastroenteritis

Kalanchoe brasiliensis Cambess. is a native Brazilian plant popularly known as “saião”, and the juice of its fresh leaves is traditionally used to treat several disorders, including inflammatory and infectious processes such as dysentery. The goals of this study were to characterize the phytochemical composition and investigate the antioxidant activity, the antibiotic effect, and the mode of action against Salmonella of the hydroethanolic extracts from K. brasiliensis leaves collected in the summer and spring Brazilian seasons. These extracts had their chemical composition established by high-performance liquid chromatography with diode-array detection. Total phenolic and flavonoid contents were spectrophotometrically determined. 2,2-Diphenyl-1-picryl-hydrazyl radical scavenging, phosphomolybdenum reducing power and β-carotene bleaching assays were carried out to evaluate the antioxidant capacity. Antibiotic potential was assessed by minimal inhibitory concentration against 8 bacterial ATCC® and 5 methicillin-resistant Staphylococcus aureus and 5 Salmonella clinical strains. The mode of action was investigated by time-kill, bacterial cell viability, and leakage of compounds absorbing at 280 nm assays against Salmonella. Chromatographic profile and UV spectrum analyses suggested the significant presence of flavonoid type patuletin and eupafolin derivatives, and no difference between both periods of collection was noted. Significant amounts of total phenolic and flavonoid contents and a promising antioxidant capacity were observed. Hydroethanolic extracts (70%, summer and spring) were the most active against the tested Gram-positive and Gram-negative bacterial strains, showing the bacteriostatic action of 5000 μg/mL. Time-kill data demonstrated that these extracts were able to reduce the Salmonella growth rate. Cell number was reduced with release of the bacterial content. Together, these results suggest that K. brasiliensis is a natural source of antioxidant and antibacterial agents that can be applied in the research and development of new antibiotics for the treatment of Salmonella gastroenteritis because they are able to interfere in the Salmonella growth, probably due to cell membrane damage.

Characterization of essential oil from Ocimum gratissimum leaves: Antibacterial and mode of action against selected gastroenteritis pathogens

Essential oil of fresh leaves of Ocimum gratissimum (OGEO) was water-steam distilled and analyzed by GC-MS. Thirty-seven compounds were identified, with eugenol (55.6%) as the major component followed by cis-ocimene (13.9%), γ-muurolene (11.6%), (Z,E)-α-farnesene (5.6%), α-trans-bergamotene (4.1%), and β-caryophyllene (2.7%). Antimicrobial activity of OGEO was tested against four gastroenteritis pathogens (Staphylococcus aureus, Escherichia coli, Salmonella Typhimurium, and Shigella flexneri). OGEO exhibited antibacterial effect, with MICs of 1-2 mg ml^-1, against the tested species. OGEO also displayed rapid killing effect within 5 s at four times of MIC against both E. coli and S. Typhimurium. Various assays were performed to investigate the mode of action of the oil. OGEO increased the permeability of microbial cell membrane as evidenced by LIVE/DEAD BacLight assay. Analyses of the release of absorbing materials at 260 nm, protein leakage, SDS-PAGE, and SEM strongly suggested the disruptive action of the oil on the cytoplasmic membrane of the tested microorganisms. Results revealed that the antibacterial property of OGEO could be due to membrane disruption.

Prevalence, risk factors and antimicrobial resistance of Salmonella diarrhoeal infection among children in Thi-Qar Governorate, Iraq

We conducted a hospital-based cross-sectional study among children aged <5 years in Thi-Qar Governorate, south-eastern Iraq, in order to examine the prevalence, risk factors and antimicrobial resistance associated with gastroenteritis caused by Salmonella infection. From 320 diarrhoea cases enrolled between March and August 2016, 33 (10·3%, 95% confidence interval (CI) 8·4-12·4) cases were stool culture-positive for non-typhoidal Salmonella enterica. The most commonly identified serovar was Typhimurium (54%). Multivariable logistic regression analysis indicated that the odds of Salmonella infection in children from households supplied by pipe water was 4·7 (95% CI 1·6-13·9) times higher compared with those supplied with reverse osmosis treated water. Similarly, children from households with domestic animals were found to have a higher odds (OR 10·5; 95% CI 3·8-28·4) of being Salmonella stool culture-positive. The likelihood of Salmonella infection was higher (OR 3·9; 95% CI 1·0-6·4) among children belonging to caregiver with primary vs. tertiary education levels. Lower odds (OR 0·4; 95% CI 0·1-0·9) of Salmonella infection were associated with children exclusively breast fed as compared with those exclusively bottle fed. Salmonella infection was three times lower (95% CI 0·1-0·7) in children belonging to caregiver who reported always washing hands after cleaning children following defecation, vs. those belonging to caregivers who did not wash hands. The antimicrobial resistance profile by disc diffusion revealed that non-susceptibility to tetracycline (78·8%), azithromycin (66·7%) and ciprofloxacin (57·6%) were the most commonly seen, and 84·9% of Salmonella isolates were classified as multi-drug resistant. This is the first study on prevalence and antimicrobial resistance of Salmonella infection among children in this setting. This work provides specific epidemiological data which are crucial to understand and combat paediatric diarrhoea in Iraq.

Case-control study of diarrheal disease etiology in individuals over 5 years in southwest China

Background

Acute diarrhea is one of the major public health problems worldwide. Most of studies on acute diarrhea have been made on infants aged below 5 years and few efforts have been made to identify the etiological agents of acute diarrhea in people over five, especially in China.

Methods

271 diarrhea cases and 149 healthy controls over 5 years were recruited from four participating hospitals between June 2014 and July 2015. Each stool specimen was collected to detect a series of enteric pathogens, involving five viruses (Rotavirus group A, RVA; Norovirus, NoV; Sapovirus, SaV; Astrovirus, As; and Adenovirus, Ad), seven bacteria (diarrheagenic Escherichia coli, DEC; non-typhoidal Salmonella, NTS; Shigella spp.; Vibrio cholera; Vibrio parahaemolyticus; Aeromonas spp.; and Plesiomonas spp.) and three protozoa (Cryptosporidium spp., Giardia lamblia, G. lamblia, and Blastocystis hominis, B. hominis). Standard microbiological and molecular methods were applied to detect these pathogens. Data was analyzed using Chi square, Fisher-exact tests and logistic regressions.

Results

The prevalence of at least one enteric pathogen was detected in 29.2% (79/271) acute diarrhea cases and in 12.1% (18/149) in healthy controls (p < 0.0001). Enteric viral infections (14.4%) were the most common in patients suffering from acute diarrhea, followed by bacteria (13.7%) and intestinal protozoa (4.8%). DEC (12.5%) was the most common causative agent in diarrhea cases, followed by NoV GII (10.0%), RVA (7.4%) and B. hominis (4.8%). The prevalence of co-infection was statistically higher (p = 0.0059) in the case group (7.7%) than in the healthy control (1.3%). RVA–NoV GII (3.0%) was the most common co-infection in symptomatic cases.

Conclusions

DEC was the most predominant pathogen in diarrhea cases, but it was largely overlooked because the lack of laboratory capacities. Because of the high prevalence of co-infections, it is recommended the urgent development of alternative laboratory methods to assess polymicrobial infections. Such methodological improvements will result in a better prevention and treatment strategies to control diarrhea illness in China.

Electronic supplementary material

The online version of this article (doi:10.1186/s13099-016-0141-1) contains supplementary material, which is available to authorized users.

Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhea in Beijing, China (2010-2014)

BACKGROUND

Diarrhea is one of the main causes of morbidity and mortality among children less than 5 years of age worldwide, and its causes vary by region. This study aimed to determine the etiologic spectrum, prevalent characteristics and antimicrobial resistance patterns of common enteropathogenic bacteria from diarrheagenic children in Beijing, the capital of China.

METHODS

Stool samples were collected from 2524 outpatients who were aged 0-5 years in Beijing, China during 2010-2014. Microbiological methods, real-time PCR and antimicrobial susceptibility test were used to identify the bacterial causes and antimicrobial resistance patterns in the isolates.

RESULTS

Of the 2524 patients screened, we identified the causes of 269 cases (10.7 %) as follows: diarrheagenic Escherichia coli (4.6 %), Salmonella (4.3 %), Shigella (1.4 %) and Vibrio parahaemolyticus (0.4 %). Atypical EPEC, Salmonella enteritidis, Shigella sonnei and serotype O3:K6 were the most common serogroups or serotypes of the four etiological bacteria. The prevalence of pathogens was correlated with age, season and clinical symptoms. The highest proportion of all causative bacteria was found in children aged 3-5 years and in summer. The clinical symptoms associated with specific bacterial infection, such as fever; abdominal pain; vomiting; and watery, mucus, and bloody stool, were observed frequently in diarrheal patients. Salmonella showed moderate rates of resistance (40-60 %) to ampicillin, nalidixic acid, streptomycin and sulfisoxazole. Resistance to at least three antimicrobials was found in 50 % of isolates. Of the top three serotypes in Salmonella, high-level antimicrobial resistance to single and multiple antibiotics was more common among Salmonella typhimurium and Salmonella 1, 4, [5], 12:i:- than among S. enteritidis. More than 90 % of Shigella isolates showed more alarming resistance to most antibiotics, with a widened spectrum compared to Salmonella.

CONCLUSION

Constant antibiotic surveillance is warranted because the bacteria were highly resistant to various antimicrobials. Our study contributes to the strengthening of the existing surveillance system and provides aid for effective prevention and control strategies for childhood diarrhea.

Determination of the cytotoxic activity of Campylobacter strains isolated from bovine and swine carcasses in north-eastern Poland

The study was carried out to determine the cytotoxin production by Campylobacter spp. isolated from slaughtered cattle and swine in north-eastern Poland. In total three commercial slaughterhouses were sampled during one year. Carcass swabs were taken to detect the level of Campylobacter spp. contamination. Campylobacter spp. was found in 50 (34%) out of 147 swine carcasses examined. PCR analysis revealed 4 (8%) isolates to be C. jejuni, and 46 (92%) to be C. coli. From a total of 373 bovine carcasses, Campylobacter spp. were isolated from 49 (13.1%) samples. The results regarding the occurrence of cdt genes associated with cytotoxicity indicated that 100% of C. jejuni and 67.4% C. coli obtained from pigs had all three cdtA, cdtB and cdtC genes. In case of C. jejuni strains isolated from cattle all cdt genes were confirmed in 93.9% isolates. The isolates possessesing all cdt genes had higher cytotoxic activity against cell lines used. The isolates both from cattle and swine were characterized by the highest cytotoxicity against HeLa cells. The values obtained reached 80.8% for C. jejuni isolates from cattle and 76.2% for C. jejuni and 69.0% for C. coli isolates from swine. High prevalence of cytotoxicity in Campylobacter spp. indicates a significant epidemiological role of this pathogen in human infections.

The impact of phosphorus on the immune system and the intestinal microbiota with special focus on the pig

There is increasing interest in dietary ingredients that are appropriate to support digestive and immune functions, but also maintain a stable microbial ecosystem in the gastrointestinal tract (GIT), particularly in weaned pigs. P is an essential nutrient for both microbes and their host, as it is involved, for example, in bone formation, energy metabolism, cellular signalling and stabilisation of cell membranes. Non-ruminant animals have limited access to phytate, the main storage form of P in plant seeds. The release of P bound to phytate requires phytase activity of plant or microbial origin, resulting in the formation of variable phosphorylated inositol phosphates (InsPs). The present review focuses on interactions between variations in dietary P supply, the immune system of the host, and the intestinal microbial ecosystem. Although results on the interaction between P and the immune system are inconsistent, several studies in different species have shown a positive impact of dietary P and phytase addition on the adaptive immune response. Recent studies with pigs suggest that P supply may influence intestinal microbial composition and activity. Individual InsPs or phosphate may also affect properties of pathogenic micro-organisms, such as metabolism or virulence. In conclusion, P may be considered as part of an integrated approach to support immune functions and maintain a stable microbial ecosystem in the GIT, thereby providing a barrier against potential pathogens. Within this regard, differences in phytate-P content and intrinsic phytase activity of plant feedstuffs, as well as the formation of individual InsPs, have to be taken into account.

Etiology of diarrhea among children under the age five in China: Results from a five-year surveillance

OBJECTIVES

Diarrhea is a leading cause of morbidity and mortality for children, although sparse data is available on the etiology of diarrhea in China. This study was conducted to determine main causes that underlie childhood diarrhea and related diseases.

METHOD

Surveillance data for diarrhea was collected from 213 participating hospitals between 2009 and 2013. These stool specimens, from children aged 0-59 months, were then analyzed for a panel of etiological agents consisting of 5 viruses, 8 bacteria and 3 protozoa. The proportion of children who tested positive for each pathogen was calculated and seasonal patterns for major organisms were determined.

RESULTS

Pathogens were identified in 44.6% of the 32,189 samples from children with diarrhea. The most commonly detected pathogens were rotavirus (29.7% of cases), norovirus (11.8%), Diarrheagenic Escherichia coli (DEC; 5.0%), adenovirus (4.8%), non-typhoidal Salmonella (NTS; 4.3%), and Shigella spp. (3.6%). A strong seasonal pattern was observed for these organisms, including rotavirus (winter), norovirus (autumn), and DEC, NTS, and Shigella (summer).

CONCLUSION

A wide range of enteropathogens were detected in this five-year surveillance study; rotavirus and norovirus were most common among children under the age five. These findings should serve as robust evidence for public health entities when planning and developing national intervention programs in China.