Traitement médicamenteux des diarrhées aiguëis du nourrisson et de l'enfant

Characteristics of Rotavirus, ETEC, and Vibrio Cholerae Among Under 2-year Children Attending an Urban Diarrheal Disease Hospital in Bangladesh

Background

Information on comparative clinical and host characteristics of under-2 children with watery diarrhea caused by rotavirus, Enterotoxigenic Escherichia coli (ETEC), and Vibrio cholerae as single pathogens is lacking. We sought to investigate the sociodemographic, clinical, and host characteristics of under-2 children hospitalized due to these pathogens.

Methodology

We conducted a hospital-based case-control study using the icddr,b Diarrheal Diseases Surveillance System. Children of either sex, <2 years with diarrhea, who attended the hospital during 2014 to 2018, constituted the study population. Stool specimens having a single pathogen like rotavirus, ETEC, or Vibrio cholerae constituted the cases and stool specimens having no detectable common enteropathogens comprised the controls. Multinomial logistic regression analysis was done where control was the reference group.

Results

A total of 14 889 patients were enrolled, 6939 of whom were under-2 children, and 5245 (76%) constituted our study population. Among them 48% (n = 2532), 3% (n = 148) and 1% (n = 49) had rotavirus, ETEC, and Vibrio cholera, respectively. A control group (diarrhea without these 3 or Shigella, Salmonella, Aeromonas) accounted for 48% (n = 2516). In multinomial regression model, children with rotavirus (adjusted odds ratio [aOR], 1.36; 95% confidence interval [95% CI], 1.19-1.55) less often presented with dehydrating diarrhea compared to those with ETEC (aOR, 1.54; 95% CI, 1.05-2.26) and cholera (aOR, 2.25; 95% CI, 1.11-4.57). Rotavirus diarrhea was associated (aOR, 1.25; 95% CI, 1.07-1.46) with those who received antimicrobials prior to hospital admission and protectively associated with drinking tap water (aOR, 0.84; 95% CI, 0.73-0.95); however, ETEC diarrhea had protective association (aOR, 0.62; 95% CI, 0.43-0.92) with children who received antimicrobials prior to hospital admission and was associated with drinking tap water (aOR, 1.78; 95% CI, 1.19-2.66). Use of intravenous fluid was associated with cholera (aOR, 10.36; 95% CI, 4.85-22.16) and had protective association with rotavirus episodes (aOR, 0.64; 95% CI, 0.45-0.91).

Conclusions

Clinical presentations and host characteristics of rotavirus, ETEC, and Vibrio cholerae diarrhea differed from each other and the information may be helpful for clinicians for better understanding and proper management of these children.

Changing characteristics of rotavirus diarrhea in children younger than five years in urban Bangladesh

Background

Childhood rotavirus diarrhea is still one of the major public health challenges. The present study aimed to determine changing characteristics of rotavirus diarrhea in under-5 children at two periods of time.

Methods

We enrolled 5,357 under-5 children with rotavirus positive in two different time periods; i) 1993-1997 (n = 2,493), and ii) 2008–2012 (n = 2,864) considering beginning and ending of two decades. These children were enrolled in the urban Dhaka Hospital of icddr,b.

Results

Overall, proportion of rotavirus was about 25% in 1993–97, which was 42% in 2008–12 (68% rise; p<0.001). Significant higher proportion of children were stunted [38% vs. 22%; aOR-1.33 (95% CI-1.09-1.62)], had vomiting [87% vs. 74%; aOR-2.58 (95% CI-2.02-3.28)], fever [10% vs. 8%; aOR-1.31 (95% CI-0.96-1.78)], family members >5 [38% vs. 35%; aOR-1.32 (95% CI-1.10-1.58)] required more intravenous fluid [9% vs. 3%; aOR-4.93 (95% CI-3.19-7.63)], had higher co-infection with Shigella [3% vs. 1%; aOR-3.36 (95% CI-1.61-7.03)], Vibrio cholerae [4% vs. 1%; aOR-3.70 (95% CI-2.12-6.46)]; and ETEC [13% vs. 7%; aOR-2.21 (95% CI-1.65-2.97)]; however, significantly lower proportion of them used sanitary toilets [54% vs. 78%; aOR-0.66 (95% CI-0.54-0.80)], boiled drinking water [16% vs. 38%; aOR-0.60 (95% CI-0.48-0.74)], used antimicrobial at home [63% vs. 82%; aOR-0.56 (95% CI-0.46-0.69)] and had some or severe dehydration [18% vs. 34%; aOR-0.15 (95% CI-0.12-0.20)] in 1^st observation period compared to that of 2^nd.

Conclusion

Proportion of episodes of under-5 rotavirus diarrhea increased over the period. Concomitant changes in host, socio-demographic and clinical characteristics, and co-infections were also observed. Thus, vaccination campaign which is prevailing in private sector should also be introduced in public sector.

The use of oral rehydration salt in managing children under 5 y old with diarrhea in the Gambia: knowledge, attitude, and practice

OBJECTIVE

Diarrhea is a leading cause of mortality in children under the age of 5 y in developing countries. To our knowledge, no other studies have investigated the management of diarrhea in the Gambia. The aim of this study was to assess maternal knowledge, attitude, and practice in the causes, prevention, and management of diarrhea in children under the age of 5 y in the Gambia.

METHODS

Four hundred mothers with children who have diarrhea and are under the age of 5 y were randomly recruited. Data were collected using structured questionnaires, including demographic information, knowledge about diarrhea, attitude toward the management of diarrhea, and practice for the prevention and management of diarrhea. χ(2) and Student's t tests were used for the descriptive and quantitative analysis, respectively. Simple and multiple linear regressions were used to determine the association between the variables. A P-value < 0.05 was considered statistically significant.

RESULTS

The mean of maternal knowledge (K), attitude (A), practice (P), and knowledge-attitude-practice sum (KAP) scores were 14.4, 6.3, 13.2, and 33.9, respectively. The mean of knowledge scores were significantly higher in mothers who responded positively for germs (13.4 versus 12.6) and dirty hands (13.7 versus 13.0) as causes of diarrhea. Mothers with education had significantly higher knowledge (14.7 versus 14.2) and attitude scores (6.6 versus 6.1) in management of diarrhea. However, the study found a low use rate (4%) of oral rehydration solution in practice. Multiple linear regression analysis revealed that maternal age was positively associated with practice (β = 0.061) and KAP scores (β = 0.102). The number of children in the family was positively correlated with attitude scores (β = 0.408). Socioeconomic status was positively associated with attitude (β = 0.549), practice (β = 0.841), and KAP scores (β = 1.887).

CONCLUSIONS

The mothers have high knowledge scores in the management of diarrhea; however, use of oral rehydration solution is low among children with diarrhea under the age of 5 y in the Gambia. Higher maternal age and socioeconomic status are correlated with higher practice and KAP scores.

[Management of acute diarrhea in children]

Diarrhea in childhood is very frequent (two episodes/year/children less of 5 years), rarely fatale (mostly mild) and not requiring additional exploration. But it can justify a hospitalization in case of dehydration (delay of care) or risk of dehydration. It is mainly of viral origin (rotavirus +++) and it has for main complication dehydration. Diagnosis and evaluation of the dehydration, in percentage of loss of weight, must be fast and lead (drive) to a premature correction of hypovolumic shock (or to an accurate fluid management). Main treatment is oral rehydration solutions (ORS), which considerably upset the morbi-mortality, associated with a premature refeeding. Breast-feeding must not be interrupted. Symptomatic treatments and especially antibiotics are not recommended. In case of failure of the rehydration by ORS, alternative is nasogastric tube or intraveinous infusion. Prevention includes essentially the respect of hygienic rules and antirotavirus vaccine.

Profile of travel-associated illness in children, Zürich, Switzerland

BACKGROUND

The number of families traveling with their children to their country of origin and/or to tropical destinations has increased in Switzerland and includes a changing profile and multinational range of patients. Defining the profile of reported travel-associated illnesses will help to improve the prevention and treatment of such illnesses in children.

METHODS

This study includes children aged up to 16 years who sought medical advice for a presumed travel-related illness at the emergency room of the University of Zürich Children's Hospital during the period July 2007 to December 2008.

RESULTS

We analyzed data on 328 children (58.8% male, mean age: 4.62 y) who presented with travel-associated illness. Our analysis included 155 traditional (mainly tourist) travelers, 162 children who were visiting friends and relatives (VFR), and 11 immigrants. Some 11% were hospitalized. No deaths occurred. The main conditions recorded were diarrheal illness (39%), respiratory (28.7%) and febrile/systemic illness (13.4%). With increasing age, the proportion of children with diarrheal disease increased, while the proportion with respiratory illness declined. There were significant associations between geographic area of exposure and the profile of travel-related disease (p < 0.001). Among 36 children with more serious diseases requiring hospitalization, 12 (3.7% overall) presented with potentially serious diseases: malaria (n = 2), Salmonella typhi (n = 3), Salmonella paratyphi (n = 2), meningococcal meningitis (n = 1), tuberculosis (n = 2), visceral leishmania (n = 1), and hepatitis A (n = 1). Eleven of the 12 children presenting with these potentially serious illnesses were VFR or immigrant children.

CONCLUSION

The main diagnoses for ill-returned Zürich children who presented for emergency care were diarrhea, respiratory, and febrile/systemic illness. A broad spectrum of morbidity was seen including meningococcal meningitis, malaria, tuberculosis, typhoid fever, leishmania, and hepatitis A. Diagnoses varied between geographic regions visited, and VFR child travelers constituted a large proportion of sick-returned children presenting for emergency care.

Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis

BACKGROUND

Racecadotril is an antidiarrhoeal drug with intestinal antisecretory mechanism of action.

AIM

To assess racecadotril efficacy as an adjunct to oral rehydration solution, against oral rehydration solution alone or with placebo in childhood acute gastroenteritis.

METHODS

Individual patient data meta-analysis following multilevel mixed models testing the significance of the treatment effect adjusted for baseline covariates.

RESULTS

Nine randomised clinical trials (n=1384) were identified with raw data. Baseline dehydration level and Rotavirus were found as two essential predictors influencing the outcomes. The proportion of recovered patients was higher in racecadotril groups compared with placebo, Hazard Ratio HR=2.04, 95% CI (1.85; 2.32), p<0.001. For inpatient studies, the ratio of mean stool output racecadotril/placebo was 0.59 (0.51; 0.74), p<0.001. For outpatient studies, the ratio of the mean number of diarrhoeic stools racecadotril/placebo was 0.63 (0.51; 0.74), p<0.001.

CONCLUSION

Dehydration level and Rotavirus at baseline are essential adjustments to compare treatments. As an adjunct to oral rehydration solution, racecadotril has a clinically relevant effect in reducing diarrhoea (duration, stool output and stool number), irrespective of baseline conditions (dehydration, Rotavirus or age), treatment conditions (inpatient or outpatient studies) or cultural environment.