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Muzembo BA, Kitahara K, Ohno A, Khatiwada J, Dutta S, Miyoshi SI. Rapid diagnostic tests and loop-mediated isothermal amplification method for the detection of Shigella species: A systematic review and meta-analysis. J Infect Public Health 2024; 17:1065-1078. [PMID: 38705059 DOI: 10.1016/j.jiph.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
We meta-analyzed the diagnostic accuracy of rapid diagnostic tests (dipsticks) and loop-mediated isothermal amplification (LAMP) method to detect Shigella species. We searched MEDLINE, Embase, Web of Science and Google Scholar from inception to 2023 for studies reporting on the performance of Shigella dipstick and LAMP tests compared with culture or polymerase chain reaction (PCR). Our search identified 2618 studies, of which fourteen met the inclusion criteria for the systematic review. Ten studies covering 4056 tests (from twelve countries) were included in the meta-analysis. The overall pooled sensitivity and specificity were 98% (95% CI: 94-100) and 97% (95% CI: 92-99), respectively. Pooled sensitivity and specificity of dipsticks were 95% and 98%, respectively. In contrast, LAMP showed higher pooled sensitivity (100%) and diagnostic odds ratio (431752), but similar specificity (97%). LAMP and dipstick tests exhibited promising performance, suggesting that they could be useful for assisting in the diagnosis of shigellosis.
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Affiliation(s)
- Basilua Andre Muzembo
- Research Institute of Nursing Care for People and Community, University of Hyogo, Akashi, Japan; Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Kei Kitahara
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India
| | - Ayumu Ohno
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India
| | | | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Çınar Ç, Perone P, Tybur JM. Four studies yield limited evidence for prepared (disgust) learning via evaluative conditioning. Appetite 2024; 196:107256. [PMID: 38342314 DOI: 10.1016/j.appet.2024.107256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
Prepared learning accounts suggest that specialized learning mechanisms increase the retention of associations linked to ancestrally-prevalent threats. Few studies have investigated specialized aversion learning for pathogen threats. In four pre-registered studies (N's = 515, 495, 164, 175), we employed an evaluative conditioning procedure to test whether foods (versus non-foods) are more readily associated with negative content associated with pathogens than negative content not associated with pathogens. Participants saw negatively valenced (either pathogen-relevant or -irrelevant), neutral or positively-valenced stimuli paired with meats and plants (in Studies 1 and 2) and with meats and abstract shapes (in Studies 3 and 4). They then evaluated each stimulus explicitly via self-reports (Studies 1-4) and implicitly via an Affect Misattribution Procedure (Studies 3 and 4). Linear mixed models revealed general evaluative conditioning effects, but inconsistent evidence for specialized (implicit or explicit) learning for a food-pathogen association. However, results from a mega-analysis across studies revealed stronger conditioning effects for meats paired with pathogen-relevant negative stimuli than pathogen-irrelevant negative stimuli.
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Affiliation(s)
- Çağla Çınar
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Brain and Behavior, Amsterdam, the Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Paola Perone
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Brain and Behavior, Amsterdam, the Netherlands; TNO Human Performance, Netherlands Organization for Applied Scientific Research, the Netherlands
| | - Joshua M Tybur
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Brain and Behavior, Amsterdam, the Netherlands
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Çınar Ç, Perone P, Tybur JM. WITHDRAWN: Four studies Yield limited evidence for prepared (disgust) learning via evaluative conditioning. Appetite 2024; 193:107047. [PMID: 37769850 DOI: 10.1016/j.appet.2023.107047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/28/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Çağla Çınar
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Institute for Brain and Behavior, Amsterdam, Netherlands; University of Amsterdam, Amsterdam, Netherlands
| | - Paola Perone
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Institute for Brain and Behavior, Amsterdam, Netherlands
| | - Joshua M Tybur
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Institute for Brain and Behavior, Amsterdam, Netherlands
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Campodónico VL, Hanlon A, Mikula MW, Miller JA, Gherna M, Carroll KC, Simner PJ. A diagnostic stewardship approach to prevent unnecessary testing of an enteric bacterial molecular panel. Microbiol Spectr 2023; 11:e0294523. [PMID: 37902336 PMCID: PMC10715171 DOI: 10.1128/spectrum.02945-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
IMPORTANCE Testing for enteric bacterial pathogens in patients hospitalized for more than 3 days is almost always inappropriate. Our study validates the utility of the 3-day rule and the use of clinical decision support tools to decrease unnecessary testing of enteropathogenic bacteria other than C. difficile. Overriding the restriction was very low yield. Our study highlights the importance of diagnostic stewardship and further refines the criteria for allowing providers to override the restriction while monitoring the impact of the interventions.
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Affiliation(s)
- Victoria L. Campodónico
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann Hanlon
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael W. Mikula
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jo-Anne Miller
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Gherna
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen C. Carroll
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia J. Simner
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Terefe L, Nardos A, Debella A, Dereje B, Arega M, Abebe AG, Gemechu W, Woldekidan S. Antidiarrheal Activities of the Methanol Leaf Extracts of Olinia rochetiana (Oliniaceae) Against Castor Oil-Induced Diarrhea in Mice. J Exp Pharmacol 2023; 15:485-495. [PMID: 38026232 PMCID: PMC10676088 DOI: 10.2147/jep.s441555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Olinia rochetiana has been used traditionally to cure diarrheal disease. Therefore, this study aimed to investigate the acute toxicity and antidiarrheal effect of O. rochetiana leaf extracts. Methods Cold maceration was used to extract plant leaf powder with 80% methanol. The extract's antidiarrheal action was tested against a castor oil-induced diarrheal model, a charcoal meal test, and enteropooling tests at doses of 100, 200, and 400 mg/kg. Negative controls received the vehicle at 10 mL/kg, while positive controls received loperamide at 3 mg/kg. Results From the study, no apparent toxicity was observed when a single dose of 2000 mg/kg was administered. In the castor oil-induced model, the extract delayed the onset of diarrhea, reduced stool frequency, and decreased wet feces weight and number in a dose-dependent manner at 200 mg/kg (p < 0.05) and 400 mg/kg (p < 0.01). The percent reduction in moist feces at 100, 200, and 400 mg/kg was 54.2, 23.97, and 18.26%, respectively, indicating a significant dose-dependent decrease. In a charcoal meal test, the extracts at 200 and 400 mg/kg revealed a peristaltic index of 65 and 46%, respectively, with considerable inhibition of charcoal transport at 23 and 39%. The weight and volume of intestinal contents dropped significantly at a dose of 400 mg/kg (p < 0.01), which is 0.43 mg/kg, in the enteropooling test when compared with the tested dose. The computed in vivo antidiarrheal index revealed diarrheal inhibition values of 46.06 and 71.06% at 200 and 400 mg/kg, respectively. Conclusion In the current investigation, O. rochetiana showed significant antidiarrheal activity with no symptoms of toxicity in mice.
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Affiliation(s)
- Lidet Terefe
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aschalew Nardos
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Asfaw Debella
- Department of Traditional and Modern Medicine Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Beyene Dereje
- Department of Pharmacology, School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Melese Arega
- Department of Pharmacy, Pawi Health Sciences College, Pawi, Ethiopia
| | - Abiy Gelagle Abebe
- Department of Traditional and Modern Medicine Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Worku Gemechu
- Department of Traditional and Modern Medicine Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Samuel Woldekidan
- Department of Traditional and Modern Medicine Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Wang T, Wang G, Shan CX, Sun YQ, Ren X, Yu LJ, Wang YF, Lin SH, Zhang XA, Li H, Zhang CH, Geng MJ, Yang WZ, Wang LP, Liu W, Fang LQ. Comparative study on epidemiological and etiological characteristics of patients with acute diarrhea with febrile or non-febrile symptoms in China. Infect Dis Poverty 2023; 12:62. [PMID: 37403122 DOI: 10.1186/s40249-023-01108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/17/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Acute diarrhea with fever can potentially represent a more severe form of the disease compared to non-febrile diarrhea. This study was to investigate the epidemiological characteristics and enteric pathogen composition of febrile-diarrheal patients, and to explore factors including pathogens associated with fever by age group. METHODS A nationwide surveillance study of acute diarrheal patients of all ages was conducted in 217 sentinel hospitals from 31 provinces (autonomous regions or municipalities) in China between 2011 and 2020. Seventeen diarrhea-related pathogens, including seven viruses and ten bacteria, were investigated and their association with occurrence of fever symptoms was assessed using multivariate logistic analysis. RESULTS A total of 146,296 patients with acute diarrhea (18.6% with fever) were tested. Th diarrheal children below 5 years had the highest frequency of fever (24.2%), and related to significantly higher prevalence of viral enteropathogens (40.2%) as compared with other age groups (P < 0.001). Within each age group, the febrile-diarrheal patients were associated with a significantly higher prevalence of bacterial pathogens than afebrile-diarrheal patients (all P < 0.01). There was discrepancy when each pathogen was compared, i.e., nontyphoidal Salmonella (NTS) was overrepresented in febrile vs non-febrile patients of all age groups, while the febrile vs non-febrile difference for diarrheagenic Escherichia coli (DEC) was only significant for adult groups. The multivariate analysis revealed significant association between fever and infection with rotavirus A among children [odds ratio (OR) = 1.60], for DEC in adult groups (OR = 1.64), for NTS in both children (OR = 2.95) and adults (OR = 3.59). CONCLUSIONS There are significant discrepancy of the infected enteric pathogens in patients with acute diarrhea with fever between age groups, and it is valuable for priority detection of NTS and rotavirus A in patients with children < 5 years old and NTS and DEC in adult patients. The results may be useful in identifying dominant pathogen candidates for the application of diagnostic assays and prevention control.
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Affiliation(s)
- Tao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, Hubei, People's Republic of China
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China
| | - Gang Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China
| | - Chun-Xi Shan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China
| | - Yan-Qun Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China
- Nanjing Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Xiang Ren
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning On Infectious Disease, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Lin-Jie Yu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China
| | - Yi-Fei Wang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning On Infectious Disease, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Sheng-Hong Lin
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning On Infectious Disease, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China
| | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China
| | - Cui-Hong Zhang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning On Infectious Disease, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Meng-Jie Geng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning On Infectious Disease, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Wei-Zhong Yang
- Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Li-Ping Wang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning On Infectious Disease, Chinese Center for Disease Control and Prevention, No. 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
| | - Wei Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, Hubei, People's Republic of China.
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing, 100071, People's Republic of China.
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Köffer J, Frontzek A, Eigner U. Development and validation of a bacterial gastrointestinal multiplex RT-PCR assay for use on a fully automated molecular system. J Microbiol Methods 2023; 210:106754. [PMID: 37263528 DOI: 10.1016/j.mimet.2023.106754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
PCR-based enteric multiplex panels represent a rapid and reliable alternative to conventional "classical" phenotypic stool diagnostics. The aim of this study was to establish a laboratory-developed non-commercial multiplex Real-Time-PCR panel for the detection of the most important bacterial stool pathogens, Salmonella spp., Shigella spp., Yersinia enterocolitica/ pseudotuberculosis and Campylobacter jejuni/coli. on the "open" cobas omni Utility Channel (UC) of the cobas 6800 system (Roche). The aim was to replace the laborious phenotypical stool diagnostics with a high throughput Real-Time PCR method. The respective primers and probes were designed to cover conserved genomic regions of the pathogens and validated using Ultramer oligonucleotides, positive stool material and reference strains. To further validate the multiplex PCR-assay, the following parameters were evaluated: analytical-sensitivity and -specificity, cross-reactivity, linearity and inter- and intra-assay variance as well as limit of detection (LOD). In addition a retrospective analysis of culture positive and negative samples from daily routine was performed using 745 native stool samples. The Gastro assay was linear over a 5-log-unit and within the expected dynamic range with amplification efficiencies ranging from 94.6% to 120%. In addition, all targets showed excellent coefficients of repeatability (≤ 1.11%), intermediate precision (≤ 1.02%) and total variance (≤ 1.39%). In terms of analytical sensitivity the assay demonstrated detection limits ranging from 7.83 copies per reaction to 14.4 copies per reaction. The assay showed excellent agreement with culture methods (>95%) and a 100% sensitivity and specificity after resolution of discrepant results. The multiplex-PCR assay provides a comprehensive, rapid and sensitive alternative to conventional methods for the detection of the major bacterial stool pathogens in diagnostic laboratories.
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Affiliation(s)
| | - André Frontzek
- Roche Diagnostics (formerly, during study: Labor Stein, Mönchengladbach, Germany), Mannheim, Germany
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Anjum N, Hossain MS, Rahman MA, Rafi MKJ, Al Noman A, Afroze M, Saha S, Alelwani W, Tangpong J. Deciphering antidiarrheal effects of Meda pata (Litsea glutinosa (Lour.) C.B.Rob.) leaf extract in chemical-induced models of albino rats. JOURNAL OF ETHNOPHARMACOLOGY 2023; 308:116189. [PMID: 36791925 DOI: 10.1016/j.jep.2023.116189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Diarrhea is one of the leading causes of preventable death in developing countries, mainly caused by bacterial infections and traditional therapies are very common in diarrheal incidences. Meda Pata (Litsea glutionsa) has a long history of use as traditional medicine for diarrhea, dysentery, and spasm in Bangladesh, India, and some other Asian countries. AIM OF THE STUDY This research reports the antidiarrheal effects of Meda Pata (Litsea glutinosa leaf extract, LGLEx) in animal models. The work has been supported by in silico molecular docking study to verify the effects. MATERIALS AND METHODS The antidiarrheal effect of LGLEx was investigated in castor oil-induced diarrhea, magnesium sulfate-induced diarrhea, and gastrointestinal motility test models. Antidiarrheal effects were supported by a molecular docking study through an interaction between LGLEx's GC-MS analyzed imidazole-containing compounds and muscarinic acetylcholine receptor (PDB: 4U14) and 5-HT3 receptor (PDB: 5AIN). RESULTS LGLEx potentially reduced the diarrheal incidences in in vivo assays reducing gastrointestinal motility. The maximum diarrheal inhibition was obtained in the castor oil-induced model (62.63%) and and BaSO4-induced model (73.14%), which were statistically significant (P < 0.05) when compared to the reference drug loperamide. In the castor-oil and BaSO4-induced models, peristaltic movement was reduced by 25.96% and 32.17%, respectively. Biochemical markers particularly IgE, C-reactive proteins, and serum electrolytes were significantly (P < 0.0) restored in treated groups. A Molecular docking analysis revealed that two compounds (1-Ethyl-2-hydroxymethylimidazole and 1,6-Anhydro-beta-D-glucofuranose demonstrated the highest binding affinity with target receptors muscarinic acetylcholine receptor (PDB: 4U14) and 5-HT3 receptor (PDB: 5AIN) confirming their drug likeliness. The findings indicate a high potential antidiarrheal impact that warrants further investigation for its therapeutic application.
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Affiliation(s)
- Nazifa Anjum
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, 4331, Bangladesh.
| | - Md Saddam Hossain
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, 4331, Bangladesh.
| | - Md Atiar Rahman
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, 4331, Bangladesh; School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand.
| | - Md Khalid Juhani Rafi
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, 4331, Bangladesh.
| | - Abdullah Al Noman
- Department of Pharmacy, International Islamic University Chittagong, Kumira, Chittagong, 4318, Bangladesh.
| | - Mirola Afroze
- Bangladesh Reference Institute for Chemical Measurements (BRiCM), Dr. Kudrat-i-Khuda Road, Dhanmondi, Dhaka, Bangladesh.
| | - Srabonti Saha
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong, 4331, Bangladesh.
| | - Walla Alelwani
- Department of Biochemistry, College of Science, University of Jeddah, Jeddah, Saudi Arabia.
| | - Jitbanjong Tangpong
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand.
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Reddy A, Nwankwo N, Sekar A, Kumar A. An unusual cause of chronic diarrhea in a Middle-Aged adult: A diagnostic challenge. Clin Case Rep 2023; 11:e7357. [PMID: 37220509 PMCID: PMC10199814 DOI: 10.1002/ccr3.7357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
Diarrhea is a common symptom in medical practice that often gets overlooked. This article is intended to increase the awareness of physicians and other providers on a subtle but important cause of chronic diarrhea.
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Affiliation(s)
- Aswanth Reddy
- Department of Hematology and OncologyMercy ClinicFort SmithArkansasUSA
| | - Nkolika Nwankwo
- Department of Internal MedicineMercy ClinicFort SmithArkansasUSA
| | - Arjun Sekar
- Department of Nephrology, Rochester Regional HealthRGH Center for Kidney Disease and HypertensionRochesterNew YorkUSA
| | - Aswini Kumar
- Department of CardiologyMercy ClinicFort SmithArkansasUSA
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Teklemariam AD, Al-Hindi RR, Albiheyri RS, Alharbi MG, Alghamdi MA, Filimban AAR, Al Mutiri AS, Al-Alyani AM, Alseghayer MS, Almaneea AM, Albar AH, Khormi MA, Bhunia AK. Human Salmonellosis: A Continuous Global Threat in the Farm-to-Fork Food Safety Continuum. Foods 2023; 12:foods12091756. [PMID: 37174295 PMCID: PMC10178548 DOI: 10.3390/foods12091756] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Salmonella is one of the most common zoonotic foodborne pathogens and a worldwide public health threat. Salmonella enterica is the most pathogenic among Salmonella species, comprising over 2500 serovars. It causes typhoid fever and gastroenteritis, and the serovars responsible for the later disease are known as non-typhoidal Salmonella (NTS). Salmonella transmission to humans happens along the farm-to-fork continuum via contaminated animal- and plant-derived foods, including poultry, eggs, fish, pork, beef, vegetables, fruits, nuts, and flour. Several virulence factors have been recognized to play a vital role in attaching, invading, and evading the host defense system. These factors include capsule, adhesion proteins, flagella, plasmids, and type III secretion systems that are encoded on the Salmonella pathogenicity islands. The increased global prevalence of NTS serovars in recent years indicates that the control approaches centered on alleviating the food animals' contamination along the food chain have been unsuccessful. Moreover, the emergence of antibiotic-resistant Salmonella variants suggests a potential food safety crisis. This review summarizes the current state of the knowledge on the nomenclature, microbiological features, virulence factors, and the mechanism of antimicrobial resistance of Salmonella. Furthermore, it provides insights into the pathogenesis and epidemiology of Salmonella infections. The recent outbreaks of salmonellosis reported in different clinical settings and geographical regions, including Africa, the Middle East and North Africa, Latin America, Europe, and the USA in the farm-to-fork continuum, are also highlighted.
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Affiliation(s)
- Addisu D Teklemariam
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rashad R Al-Hindi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Raed S Albiheyri
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Centre of Excellence in Bionanoscience Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mona G Alharbi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mashail A Alghamdi
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Amani A R Filimban
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Abdullah S Al Mutiri
- Laboratory Department, Saudi Food and Drug Authority, Riyadh 12843, Saudi Arabia
| | - Abdullah M Al-Alyani
- Laboratory Department, Saudi Food and Drug Authority, Jeddah 22311, Saudi Arabia
| | - Mazen S Alseghayer
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Monitoring and Risk Assessment Department, Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Abdulaziz M Almaneea
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Monitoring and Risk Assessment Department, Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Abdulgader H Albar
- Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Microbiology and Medical Parasitology, Faculty of Medicine, Jeddah University, Jeddah 23218, Saudi Arabia
| | - Mohsen A Khormi
- Department of Biological Sciences, Faculty of Sciences, Jazan University, Jazan 82817, Saudi Arabia
| | - Arun K Bhunia
- Molecular Food Microbiology Laboratory, Department of Food Science, Purdue University, West Lafayette, IN 47907, USA
- Purdue Institute of Inflammation, Immunology, and Infectious Disease, Purdue University, West Lafayette, IN 47907, USA
- Purdue University Interdisciplinary Life Science Program (PULSe), West Lafayette, IN 47907, USA
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA
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11
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Akhter N, Alam M, Amin Khan MR, Sharmin S, Emon NU, Bakar Siddique MA, Hossain KH, Rahman MA. Therapeutic potentials of Adenostemma lavenia (L.) O.Kuntze evidenced into an array of pharmacological effects and ligand-receptor interactions. Heliyon 2023; 9:e15541. [PMID: 37151655 PMCID: PMC10161694 DOI: 10.1016/j.heliyon.2023.e15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/09/2023] Open
Abstract
This study constructed the phytochemical profiles of Adenostemma lavenia (L) methanol extract (MEAL) and investigated its anti-nociceptive, anti-diarrheal, antipyretic, thrombolytic and anthelmintic effects. The GC-MS characterized MEAL had undergone an in vivo antipyretic effect assayed on Swiss albino mice adopting the yeast-induced pyrexia model, antinociceptive activity tested following acetic acid-induced writhing and formalin-induced licking paw models, anti-diarrheal effect in castor oil-induced diarrhea, castor oil-induced enteropooling, and charcoal-induced intestinal transit tests, in vitro thrombolytic effect using clot-lysis model and anthelmintic effects assayed on Tubifex tubifex nematode. The MEAL biometabolites and associated proteins of target diseases were interacted with computational analysis. The MEAL showed a significant dose-dependent percentage of inhibition in acetic acid-induced writhing and formalin-induced paw licking displaying inhibition of 80.40% in acetic acid-induced writhing and 36.23% and 58.21% in the second phase of the formalin-induced model. The MEAL inhibition of 34.37%, 35.29%, and 42.95% in castor oil-induced diarrhea, castor oil-induced enteropooling, and charcoal-induced gastrointestinal motility, respectively. The MEAL significantly reduced yeast-induced pyrexia. Its biometabolites showed remarkable (-4.1 kcal/mol to 7.4 kcal/mol) binding affinity with the protein receptors. Caryophyllene and Cyclobarbital yielded the best binding scores in this research. Results suggest that pure compounds-based pharmacological investigations are necessary to affirm the therapeutic effects.
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Affiliation(s)
- Nahid Akhter
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chattogram 4318, Bangladesh
| | - Munsur Alam
- School of Health and Life Sciences, Department of Pharmaceutical Science, North South University, Dhaka 1229, Bangladesh
| | - Md Ruhul Amin Khan
- School of Health and Life Sciences, Department of Pharmaceutical Science, North South University, Dhaka 1229, Bangladesh
| | - Sanjida Sharmin
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chattogram 4318, Bangladesh
| | - Nazim Uddin Emon
- Department of Pharmacy, Faculty of Science and Engineering, International Islamic University Chittagong, Chattogram 4318, Bangladesh
| | - Md Abu Bakar Siddique
- Institute of National Analytical Research and Service (INARS), Bangladesh Council of Scientific and Industrial Research (BCSIR), Dhanmondi, Dhaka 1205, Bangladesh
| | - Kazi Helal Hossain
- Department of Neuroscience, Lerner Research Institute, 9620 Carnegie Avenue, Cleveland Clinic Cleveland, Ohio, USA
| | - Md Atiar Rahman
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand
- Department of Biochemistry and Molecular Biology, University of Chittagong, Chittagong 4331, Bangladesh
- Corresponding author. Department of Biochemistry & Molecular Biology, University of Chittagong, Chittagong, 4331, Bangladesh.
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12
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Hirose Y, Akashi Y, Sun Y, Notake S, Ueda A, Kato D, Muramatsu S, Ishikawa H, Suzuki H. Diagnostic performance of microscopic stool examination in Campylobacter infection performed by different medical specialties. J Gen Fam Med 2023; 24:102-109. [PMID: 36909784 PMCID: PMC10000277 DOI: 10.1002/jgf2.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/29/2022] [Accepted: 11/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Microscopic examination of stool samples can contribute to the early diagnosis of Campylobacter gastroenteritis. However, it is unclear whether the diagnostic performance is reliable when performed by physicians. Methods This prospective study included fresh stool samples collected from patients with gastroenteritis between August 2018 and March 2020. The samples were used for microscopic examination through Gram staining. Two physicians, a clinical laboratory technician, and microbiologists performed the examinations. In addition, antigen tests (QuickNavi-Campylobacter; Denka Co., Ltd.) were evaluated for the samples collected between May 2019 and March 2020. Infection with Campylobacter spp. was confirmed when stool cultures or polymerase chain reaction tests provided positive results. Results Microscopic examination was performed on 205 samples, of which 46 (22.4%) were positive for Campylobacter spp. For the microscopic examination, the sensitivity and specificity were 53.5% and 98.1% for physician A, 46.7% and 96.2% for physician B, 63.0% and 100% for the clinical laboratory technician, and 67.4% and 100% for microbiologists, respectively. The antigen testing was evaluated in 131 of the 205 samples and showed a sensitivity of 93.3% and specificity of 99.0%. Conclusions Microscopic examination of the stool samples showed high specificity. The sensitivity when the examinations were performed by the physicians was insufficient. The rapid antigen tests can reliably detect Campylobacter spp. in stool samples.
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Affiliation(s)
- Yumi Hirose
- Department of General Medicine and Primary Care Tsukuba Medical Center Hospital Tsukuba Japan
| | - Yusaku Akashi
- Division of Infectious Diseases, Department of Medicine Tsukuba Medical Center Hospital Tsukuba Japan.,Akashi Clinic of Internal Medicine Clinic Osaka Japan.,Department of Infectious Diseases, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Yu Sun
- Department of General Medicine and Primary Care Tsukuba Medical Center Hospital Tsukuba Japan.,Graduate School of Comprehensive Human Sciences University of Tsukuba Tsukuba Japan.,Health Services Research and Development Center University of Tsukuba Tsukuba Japan
| | - Shigeyuki Notake
- Department of Clinical Laboratory Tsukuba Medical Center Hospital Tsukuba Japan
| | - Atsuo Ueda
- Department of Clinical Laboratory Tsukuba Medical Center Hospital Tsukuba Japan
| | - Daisuke Kato
- Research & Development Division, Reagent R&D Department Gosen site, Denka Co., Ltd. Gosen Japan
| | - Shino Muramatsu
- Research & Development Division, Reagent R&D Department Gosen site, Denka Co., Ltd. Gosen Japan
| | - Hiroichi Ishikawa
- Department of Respiratory Medicine Tsukuba Medical Center Hospital Tsukuba Japan
| | - Hiromichi Suzuki
- Division of Infectious Diseases, Department of Medicine Tsukuba Medical Center Hospital Tsukuba Japan.,Department of Infectious Diseases, Faculty of Medicine University of Tsukuba Tsukuba Japan
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13
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Relationship between Diagnostic Method and Pathogen Detection, Healthcare Resource Use, and Cost in U.S. Adult Outpatients Treated for Acute Infectious Gastroenteritis. J Clin Microbiol 2023; 61:e0162822. [PMID: 36645308 PMCID: PMC9945572 DOI: 10.1128/jcm.01628-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A retrospective observational study was performed to assess the relationship between diagnostic method (traditional work-up [TW], multiplex PCR panel with < 12 target pathogens [PCR < 12], or multiplex PCR panel with ≥ 12 target pathogens [PCR12]), and diagnostic yield, health care resource use (HRU), and cost in adult outpatients visiting U.S. hospitals for acute infectious gastroenteritis (AGE). Using data from PINC AI Healthcare Database during January 1, 2016-June 30, 2021, we analyzed adult patients with an AGE diagnosis and stool testing performed during an outpatient visit. Detection rates for different pathogens were analyzed for those with microbiology data available. Among 36,787 patients, TW was most often performed (57.0%). PCR12 testing was more frequent in patients from large, urban, and teaching hospitals, compared to TW (all P < 0.01). PCR12 was associated with a higher mean index visit cost (by $97) but lower mean 30-day AGE-related follow-up cost (by $117) than TW. Patients with PCR12 had a lower 30-day AGE-related hospitalization risk than TW (1.7% versus 2.7% P < 0.01). Among the 8,451 patients with microbiology data, PCR12 was associated with fewer stool tests per patient (mean 1.61 versus 1.26), faster turnaround time (mean 6.3 versus 25.7 h) and lower likelihood of receiving in-hospital antibiotics (39.4% versus 47.1%, all P < 0.01) than TW. A higher percentage of patients with PCR12 had a target pathogen detected (73.1%) compared to PCR < 12 (63.6%) or TW (45.4%, P < 0.01). Thus, we found that large multiplex PCR panels were associated with lower 30-day AGE-related follow-up cost and risk of AGE-related hospitalization, and increased diagnostic yield compared to TW.
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14
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Qassadi FI, Zhu Z, Monaghan TM. Plant-Derived Products with Therapeutic Potential against Gastrointestinal Bacteria. Pathogens 2023; 12:pathogens12020333. [PMID: 36839605 PMCID: PMC9967904 DOI: 10.3390/pathogens12020333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
The rising burden of antimicrobial resistance and increasing infectious disease outbreaks, including the recent COVID-19 pandemic, has led to a growing demand for the development of natural products as a valuable source of leading medicinal compounds. There is a wide variety of active constituents found in plants, making them an excellent source of antimicrobial agents with therapeutic potential as alternatives or potentiators of antibiotics. The structural diversity of phytochemicals enables them to act through a variety of mechanisms, targeting multiple biochemical pathways, in contrast to traditional antimicrobials. Moreover, the bioactivity of the herbal extracts can be explained by various metabolites working in synergism, where hundreds to thousands of metabolites make up the extract. Although a vast amount of literature is available regarding the use of these herbal extracts against bacterial and viral infections, critical assessments of their quality are lacking. This review aims to explore the efficacy and antimicrobial effects of herbal extracts against clinically relevant gastrointestinal infections including pathogenic Escherichia coli, toxigenic Clostridioides difficile, Campylobacter and Salmonella species. The review will discuss research gaps and propose future approaches to the translational development of plant-derived products for drug discovery purposes for the treatment and prevention of gastrointestinal infectious diseases.
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Affiliation(s)
- Fatimah I. Qassadi
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
- Department of Pharmacognosy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Zheying Zhu
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK
| | - Tanya M. Monaghan
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham NG7 2RD, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
- Correspondence:
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15
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Afzal M, Hassan SS, Sohail S, Camps I, Khan Y, Basharat Z, Karim A, Aurongzeb M, Irfan M, Salman M, Morel CM. Genomic landscape of the emerging XDR Salmonella Typhi for mining druggable targets clpP, hisH, folP and gpmI and screening of novel TCM inhibitors, molecular docking and simulation analyses. BMC Microbiol 2023; 23:25. [PMID: 36681806 PMCID: PMC9860245 DOI: 10.1186/s12866-023-02756-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Typhoid fever is transmitted by ingestion of polluted water, contaminated food, and stool of typhoid-infected individuals, mostly in developing countries with poor hygienic environments. To find novel therapeutic targets and inhibitors, We employed a subtractive genomics strategy towards Salmonella Typhi and the complete genomes of eight strains were primarily subjected to the EDGAR tool to predict the core genome (n = 3207). Human non-homology (n = 2450) was followed by essential genes identification (n = 37). The STRING database predicted maximum protein-protein interactions, followed by cellular localization. The virulent/immunogenic ability of predicted genes were checked to differentiate drug and vaccine targets. Furthermore, the 3D models of the identified putative proteins encoded by the respective genes were constructed and subjected to druggability analyses where only "highly druggable" proteins were selected for molecular docking and simulation analyses. The putative targets ATP-dependent CLP protease proteolytic subunit, Imidazole glycerol phosphate synthase hisH, 7,8-dihydropteroate synthase folP and 2,3-bisphosphoglycerate-independent phosphoglycerate mutase gpmI were screened against a drug-like library (n = 12,000) and top hits were selected based on H-bonds, RMSD and energy scores. Finally, the ADMET properties for novel inhibitors ZINC19340748, ZINC09319798, ZINC00494142, ZINC32918650 were optimized followed by binding free energy (MM/PBSA) calculation for ligand-receptor complexes. The findings of this work are expected to aid in expediting the identification of novel protein targets and inhibitors in combating typhoid Salmonellosis, in addition to the already existing therapies.
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Affiliation(s)
- Muneeba Afzal
- Department of Health and Biological Sciences, Abasyn University Peshawar, Peshawar, KP 25000 Pakistan
| | - Syed Shah Hassan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
- Centre for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Building “Expansão”, 8th floor room 814, Av. Brasil 4036 - Manguinhos, Rio de Janeiro, RJ 21040-361 Brazil
- Jamil-Ur-Rehman Center for Genome Research, PCMD-ICCBS, University of Karachi, Karachi, Sindh 75270 Pakistan
| | - Saman Sohail
- Department of Chemistry, Islamia College Peshawar, Peshawar, KP 25000 Pakistan
| | - Ihosvany Camps
- Laboratório de Modelagem Computacional, LaModel, Instituto de Ciências Exatas - ICEx. Universidade Federal de Alfenas - UNIFAL-MG, Alfenas, Minas Gerais Brazil
- High Performance & Quantum Computing Labs, Waterloo, Canada
| | - Yasmin Khan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Zarrin Basharat
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Asad Karim
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Muhammad Aurongzeb
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Muhammad Irfan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270 Pakistan
| | - Muhammad Salman
- Department of Health and Biological Sciences, Abasyn University Peshawar, Peshawar, KP 25000 Pakistan
| | - Carlos M. Morel
- Centre for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Building “Expansão”, 8th floor room 814, Av. Brasil 4036 - Manguinhos, Rio de Janeiro, RJ 21040-361 Brazil
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16
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Antibiotic prescribing for acute gastroenteritis during ambulatory care visits-United States, 2006-2015. Infect Control Hosp Epidemiol 2022; 43:1880-1889. [PMID: 36017721 PMCID: PMC9753066 DOI: 10.1017/ice.2021.522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To describe national antibiotic prescribing for acute gastroenteritis (AGE). SETTING Ambulatory care. METHODS We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006-2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen. RESULTS We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%-15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%-36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%-26.4%), and penicillins (18.9%; 99% CI, 11.6%-26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%-12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%-13.8%), most commonly for Yersinia (46.7%; 95% CI, 21.4%-71.9%), Campylobacter (44.8%; 95% CI, 41.5%-48.1%), Shigella (39.7%; 95% CI, 35.9%-43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%-38.3%), and nontyphoidal Salmonella (31.7%; 95% CI, 29.5%-33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%-13.0%) of visits for viral gastroenteritis. CONCLUSIONS Overall, ∼13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings.
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Krzyżewska-Dudek E, Kotimaa J, Kapczyńska K, Rybka J, Meri S. Lipopolysaccharides and outer membrane proteins as main structures involved in complement evasion strategies of non-typhoidal Salmonella strains. Mol Immunol 2022; 150:67-77. [PMID: 35998438 DOI: 10.1016/j.molimm.2022.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/27/2022]
Abstract
Non-typhoidal Salmonella (NTS) infections pose a serious public health problem. In addition to the typical course of salmonellosis, an infection with Salmonella bacteria can often lead to parenteral infections and sepsis, which are particularly dangerous for children, the elderly and immunocompromised. Bacterial resistance to serum is a key virulence factor for the development of systemic infections. Salmonella, as an enterobacterial pathogen, has developed several mechanisms to escape and block the antibacterial effects of the complement system. In this review, we discuss the relevance of outer membrane polysaccharides to the complement evasion mechanisms of NTS strains. These include the influence of the overall length and density of the lipopolysaccharide molecules, modifications of the O-antigen lipopolysaccharide composition and the role of capsular polysaccharides in opsonization and protection of the outer membrane from the lytic action of complement. Additionally, we discuss specific outer membrane protein complement evasion mechanisms, such as recruitment of complement regulatory proteins, blocking assembly of late complement components to form the membrane attack complex and the proteolytic cleavage of complement proteins.
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Affiliation(s)
- E Krzyżewska-Dudek
- Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, and Diagnostic Center (HUSLAB), Helsinki University Hospital, 00290 Helsinki, Finland; Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - J Kotimaa
- Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, and Diagnostic Center (HUSLAB), Helsinki University Hospital, 00290 Helsinki, Finland
| | - K Kapczyńska
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - J Rybka
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - S Meri
- Department of Bacteriology and Immunology, Translational Immunology Research Program, University of Helsinki, and Diagnostic Center (HUSLAB), Helsinki University Hospital, 00290 Helsinki, Finland.
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Myojin S, Pak K, Sako M, Kobayashi T, Takahashi T, Sunagawa T, Tsuboi N, Ishikura K, Kubota M, Kubota M, Igarashi T, Morioka I, Miyairi I. Interventions for Shiga toxin-producing Escherichia coli gastroenteritis and risk of hemolytic uremic syndrome: A population-based matched case control study. PLoS One 2022; 17:e0263349. [PMID: 35120154 PMCID: PMC8815883 DOI: 10.1371/journal.pone.0263349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background The role of antibiotics in the treatment of Shiga toxin-producing Escherichia coli (STEC) infection is controversial. Objectives To evaluate the association between treatment (antibiotics, antidiarrheal agents, and probiotics) for STEC infection and hemolytic uremic syndrome (HUS) development. Patients and methods We performed a population-based matched case-control study using the data from the National Epidemiological Surveillance of Infectious Diseases (NESID) between January 1, 2017 and December 31, 2018. We identified all patients with STEC infection and HUS as cases and matched patients with STEC infection without HUS as controls, with a case-control a ratio of 1:5. Further medical information was obtained by a standardized questionnaire. Multivariable conditional logistic regression model was used. Results 7760 patients with STEC infection were registered in the NESID. 182 patients with HUS and 910 matched controls without HUS were selected. 90 patients with HUS (68 children and 22 adults) and 371 patients without HUS (266 children and 105 adults) were included in the main analysis. The matched ORs of any antibiotics and fosfomycin for HUS in children were 0.56 (95% CI 0.32–0.98), 0.58 (0.34–1.01). The matched ORs for HUS were 2.07 (1.07–4.03), 0.86 (0.46−1.61) in all ages treated with antidiarrheal agent and probiotics. Conclusions Antibiotics, especially fosfomycin, may prevent the development of HUS in children, while use of antidiarrheal agents should be avoided.
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Affiliation(s)
- Shota Myojin
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Kyongsun Pak
- Biostatistics Unit, Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mayumi Sako
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takuri Takahashi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norihiko Tsuboi
- Division of Critical Care Medicine, Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masaya Kubota
- Division of Neurology, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
- * E-mail:
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Aleksić E, Miljković-Selimović B, Tambur Z, Aleksić N, Biočanin V, Avramov S. Resistance to Antibiotics in Thermophilic Campylobacters. Front Med (Lausanne) 2021; 8:763434. [PMID: 34859016 PMCID: PMC8632019 DOI: 10.3389/fmed.2021.763434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022] Open
Abstract
Campylobacter jejuni (C. jejuni) is one of the most frequent causes of bacterial enterocolitis globally. The disease in human is usually self-limiting, but when complications arise antibiotic therapy is required at a time when resistance to antibiotics is increasing worldwide. Mechanisms of antibiotic resistance in bacteria are diverse depending on antibiotic type and usage and include: enzymatic destruction or drug inactivation; alteration of the target enzyme; alteration of cell membrane permeability; alteration of ribosome structure and alteration of the metabolic pathway(s). Resistance of Campylobacter spp. to antibiotics, especially fluoroquinolones is now a major public health problem in developed and developing countries. In this review the mechanisms of resistance to fluoroquinolones, macrolides, tetracycline, aminoglycoside and the role of integrons in resistance of Campylobacter (especially at the molecular level) are discussed, as well as the mechanisms of resistance to β-lactam antibiotics, sulphonamides and trimethoprim. Multiple drug resistance is an increasing problem for treatment of campylobacter infections and emergence of resistant strains and resistance are important One Health issues.
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Affiliation(s)
- Ema Aleksić
- Faculty of Stomatology Pancevo, University Business Academy in Novi Sad, Pančevo, Serbia
| | | | - Zoran Tambur
- Faculty of Stomatology Pancevo, University Business Academy in Novi Sad, Pančevo, Serbia
| | - Nikola Aleksić
- Faculty of Stomatology Pancevo, University Business Academy in Novi Sad, Pančevo, Serbia.,Institute for Cardiovascular Disease "Dedinje, "Belgrade, Serbia
| | - Vladimir Biočanin
- Faculty of Stomatology Pancevo, University Business Academy in Novi Sad, Pančevo, Serbia
| | - Stevan Avramov
- Faculty of Stomatology Pancevo, University Business Academy in Novi Sad, Pančevo, Serbia.,Institute for Biological Research "Siniša Stanković," University of Belgrade, Belgrade, Serbia
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Detection of potential enteric pathogens in children with severe acute gastroenteritis using the filmarray: Results from a three - years hospital-based survey in Northern Italy. Diagn Microbiol Infect Dis 2021; 102:115611. [PMID: 34953368 DOI: 10.1016/j.diagmicrobio.2021.115611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Acute gastroenteritis (AGE) are leading causes of morbidity and mortality in children. Therefore, rapid pathogens identification is needed. The AGE aetiology was investigated from 2018 to 2020 in 2,066 children in Parma (Italy) by FilmArray Gastrointestinal Panel and Enterovirus-targeting RT-PCR. Pathogens were detected in 1,162 (56.2%) stool samples from as many children; 798 (68.7%) were single and 364 (31.3%) mixed infections (68.7% vs 31.3%, P < 0.0001). Children aged 0-5 years showed the highest infection incidence (66.1%). The most frequent pathogens were Enteropathogenic Escherichia coli (EPEC; 19.14%), Clostridioides difficile (10.42%), Norovirus (10.36%), Enterovirus (9.44%), and Campylobacter (9.21%). EPEC, Campylobacter, enteroaggregative E. coli, Norovirus, and Rotavirus showed seasonality. The incidence of pathogens detected decreased between 2018 and 2020 (42.7% vs 20.8%, P < 0.0001), seemingly for the preventive measures imposed by the severe acute respiratory syndrome coronavirus-2 pandemic. A putative aetiology in half the children examined and an estimate of enteric pathogens epidemiology were assessed.
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Adeyemi OO, Alabi AS, Adeyemi OA, Talabi OT, Abidakun OM, Joel IY, Stonehouse NJ. Acute gastroenteritis and the usage pattern of antibiotics and traditional herbal medications for its management in a Nigerian community. PLoS One 2021; 16:e0257837. [PMID: 34607333 PMCID: PMC8490005 DOI: 10.1371/journal.pone.0257837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/12/2021] [Indexed: 11/23/2022] Open
Abstract
Acute gastroenteritis (AGE) is the highest cause of mortality worldwide in children under the age of 5 years, with the highest mortalities occurring in low-to-middle income countries. Treatment can involve use of unregulated herbal medication and antibiotics. A cross sectional study was carried out to investigate the use of antibiotics and traditional herbal medications in the management of AGE among Yòrùbá-speaking communities in Kwara State, Nigeria. Our findings suggest habitual use of antibiotics (54.6%) and herbal medication (42.5%) in the management of AGE with high levels of self-prescription of antibiotics (21.7%) and herbal medications (36.2%) within the community. Ethanolic extracts of selected herbal plants reported (i.e. Aristolochia ringens, Azadirachta indica, Chromolaena odorata, Etanda Africana, Ficus capensis, Ficus vogelii, Mangifera indica, Momordica charantia, Ocimum gratisimum, Senna alata, Sorghum bicolor and Vernonia amygdalina) were investigated for antibacterial properties, using bacteria known to be causative agents of AGE. Our findings showed that, with exception of Ficus vogelii, which enhanced bacterial growth, the plant extracts reported all showed some antibacterial activity. We further discuss our findings within a regulatory context, with the aim to guide the use of traditional and herbal medication in low-to medium income countries (LMICs) and reduce the potential risks associated with the development of antimicrobial resistance.
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Affiliation(s)
- Oluwapelumi Olufemi Adeyemi
- Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- School of Molecular and Cellular Biology and Astbury Centre for Structural Molecular Biology, Garstang Building, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
- * E-mail: (OOA); (NJS)
| | - Ade Stephen Alabi
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | | | - Olaoluwa Temitope Talabi
- Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | | | - Nicola J. Stonehouse
- School of Molecular and Cellular Biology and Astbury Centre for Structural Molecular Biology, Garstang Building, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
- * E-mail: (OOA); (NJS)
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22
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Emberland KE, Wensaas KA, Litleskare S, Iversen A, Hanevik K, Langeland N, Rortveit G. Clinical features of gastroenteritis during a large waterborne Campylobacter outbreak in Askøy, Norway. Infection 2021; 50:343-354. [PMID: 34215942 PMCID: PMC8942940 DOI: 10.1007/s15010-021-01652-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
Purpose Outbreaks of Campylobacter infection are common, but studies exploring the clinical features of acute illness in the outbreak setting are scarce in existing literature. The main purpose of the present study was to investigate the clinical features of self-reported acute illness in gastroenteritis cases during a large waterborne Campylobacter outbreak in Askøy municipality, Norway, in 2019. Methods A web-based self-administered questionnaire, and invitation to participate was sent by the municipality of Askøy as text message to mobile phones using the municipality’s warning system to the inhabitants during the ongoing outbreak. Results Out of 3624 participants, 749 (20.7%) were defined as cases, of which 177 (23.6%) reported severe gastroenteritis. The most common symptoms were loose stools (90.7%), abdominal pain (89.3%) and diarrhea (88.9%), whereas 63.8% reported fever, 50.2% joint pain and 14.2% bloody stools. Tiredness, a symptom non-specific to gastroenteritis, was the overall most common symptom (91.2%). Conclusion About one in four of the cases reported symptoms consistent with severe gastroenteritis. We found more joint pain and less bloody stools than reported in published studies of laboratory confirmed campylobacteriosis cases. Tiredness was common in the current study, although rarely described in previous literature of acute illness in the outbreak setting. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01652-3.
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Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.
| | - K-A Wensaas
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - S Litleskare
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - A Iversen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Community Medicine, Askøy municipality, Norway
| | - K Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - N Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - G Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
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23
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Dougherty B, Finley R, Marshall B, Dumoulin D, Pavletic A, Dow J, Hluchy T, Asplin R, Stone J. An analysis of antibiotic prescribing practices for enteric bacterial infections within FoodNet Canada sentinel sites. J Antimicrob Chemother 2021; 75:1061-1067. [PMID: 31960039 DOI: 10.1093/jac/dkz525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Understanding the current state of antibiotic treatment guidelines and prescribing practices for bacterial enteric infections is critical to inform antibiotic stewardship initiatives. This study aims to add to the current understanding through three objectives: (i) to identify and summarize published treatment guidelines for bacterial enteric infections; (ii) to describe observed antibiotic prescribing practices for bacterial enteric infections across three sentinel sites in Canada; and (iii) to assess concordance between observed antibiotic prescribing and treatment guidelines. METHODS An environmental scan of treatment guidelines for bacterial enteric infections was conducted and recommendations were collated. A descriptive analysis of cases of bacterial enteric illnesses captured in FoodNet Canada's sentinel site surveillance system between 2010 and 2018 was performed. Antibiotic-use data were self-reported by cases via an enhanced questionnaire. RESULTS Ten treatment guidelines were identified in the environmental scan. There was substantial variation between guidelines for both when to prescribe antibiotics and which antibiotics were recommended. Of the 5877 cases of laboratory-confirmed bacterial enteric illness in the three sites, 49% of cases reported having received an antibiotic prescription. Of particular significance was the finding that 21% of verotoxigenic Escherichia coli cases received a prescription. Of the 17 antibiotics recommended in the guidelines, 14 were used in practice. In addition to these, 18 other antibiotics not included in any of the guidelines reviewed were also prescribed. CONCLUSIONS Our study suggests that a substantial proportion of enteric bacterial infections in Canada are prescribed antibiotics. These findings highlight the need to standardize treatment guidelines for enteric illnesses and could be used to inform future stewardship programme development.
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Affiliation(s)
- Brendan Dougherty
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.,Centre for Food-borne, Environmental, and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Rita Finley
- Centre for Food-borne, Environmental, and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Barbara Marshall
- Centre for Food-borne, Environmental, and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Danielle Dumoulin
- Centre for Food-borne, Environmental, and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Amy Pavletic
- Middlesex-London Health Unit, London, Ontario, Canada
| | - Joanne Dow
- Middlesex-London Health Unit, London, Ontario, Canada
| | - Tara Hluchy
- Alberta Health Services, Calgary, Alberta, Canada
| | - Rod Asplin
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Jason Stone
- Fraser Health Authority, Surrey, British Columbia, Canada
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24
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Castany-Feixas M, Simo S, Garcia-Garcia S, Fernandez de Sevilla M, Launes C, Kalkgruber M, Gene A, Muñoz-Almagro C, Brotons P. Rapid molecular syndromic testing for aetiological diagnosis of gastrointestinal infections and targeted antimicrobial prescription: experience from a reference paediatric hospital in Spain. Eur J Clin Microbiol Infect Dis 2021; 40:2153-2160. [PMID: 33963926 PMCID: PMC8449766 DOI: 10.1007/s10096-021-04266-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
Aetiological diagnosis of gastrointestinal infections is challenging since a wide range of bacteria, parasites and viruses can be causal agents and derived clinical manifestations appear quite similar. Our aim was to evaluate contribution of the novel QIAstat-DxGastrointestinal Panel (GIP) to aetiological diagnosis of gastrointestinal infections and rational antimicrobial prescription in a reference paediatric hospital. Evaluation included comparison of diagnostic yield and agreement of results of QIAstat-Dx GIP and conventional microbiological methods. Parallel testing was performed on stool samples collected prospectively from children admitted to Sant Joan de Deu Barcelona Hospital (Spain) during the period February-March 2019. Influence of the panel test use on antimicrobial prescription was assessed using a pre-post study design. Eighty-six (68.8%) out of 125 specimens were positive by QIAstat-Dx GIP versus 44 (35.2%) positive by a composite of conventional methods (p<0.001). Global agreement of panel test results with rotavirus-adenovirus antigen detection (92.8%) and a two-step antigen/toxin and PCR-based algorithm for toxigenic Clostridioides difficile detection (87.5%) was greater than that with bacterial culture (76.0%) and parasite microscopic identification (64.3%). Panel test results orientated antimicrobial prescription changes in 18 (14.4%) patients, including antimicrobial start in 11 cases initially untreated, targeted antimicrobial prescription in 5 and discontinuation in 2 cases empirically treated. Results showed that QIAstat-Dx GIP significantly expanded aetiological diagnosis of gastrointestinal infections compared to conventional microbiological methods while orientating a more judicious use of antimicrobial drugs in hospitalised children.
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Affiliation(s)
| | - Silvia Simo
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
| | - Selene Garcia-Garcia
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariona Fernandez de Sevilla
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Cristian Launes
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | | | - Amadeu Gene
- University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain. .,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain. .,Universitat Internacional de Catalunya, Barcelona, Spain. .,University Hospital Sant Joan de Deu, P° Sant Joan de Déu, n° 2 08950 Esplugues, Barcelona, Spain.
| | - Pedro Brotons
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
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25
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Golfeyz S, Haviland A, Burger A. Things We Do for No Reason™: Ova and Parasite Testing in Patients With Acute Diarrhea Arising During Hospitalization. J Hosp Med 2021; 16:236-238. [PMID: 33734981 DOI: 10.12788/jhm.3498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/02/2020] [Indexed: 11/20/2022]
Abstract
Inspired by the ABIM Foundation’s Choosing Wisely® campaign, the “Things We Do for No Reason™” (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
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Affiliation(s)
- Shmuel Golfeyz
- Division of Gastroenterology and Hepatology, Maimonides Medical Center, Brooklyn, New York
| | - Adam Haviland
- Division of Infectious Diseases, Montefiore Hospital and Medical Center, Bronx, New York
| | - Alfred Burger
- Division of Hospital Medicine, Mount Sinai Beth Israel, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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26
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Multicenter evaluation of Verigene Enteric Pathogens Nucleic Acid Test for detection of gastrointestinal pathogens. Sci Rep 2021; 11:3033. [PMID: 33542335 PMCID: PMC7862589 DOI: 10.1038/s41598-021-82490-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/20/2021] [Indexed: 01/18/2023] Open
Abstract
We investigated the efficiency of the Verigene Enteric Pathogens Nucleic Acid Test (Verigene EP test), which is an automated microarray-based assay system that enables rapid and simultaneous genetic detection of gastrointestinal pathogens and toxins, including those in the Campylobacter Group, Salmonella species, Shigella species, the Vibrio Group, Yersinia enterocolitica, Shiga toxin 1 and 2, norovirus GI/GII, and rotavirus A. Three clinical laboratories evaluated the Verigene EP test, using 268 stool samples for bacterial and toxin genes and 167 samples for viral genes. Culture-based reference methods were used for the detection of bacteria and toxins, while a different molecular assay was used for viral detection. The overall concordance rate between the Verigene EP test and the reference methods for the 1940 assays was 99.0%. The overall sensitivity and specificity of the Verigene EP test were 97.0% and 99.3%, respectively. Of the 19 samples with discordant results, 13 samples were false positives and six were false negatives. The Verigene EP test simultaneously detected two targets in 11 samples; overall, the test demonstrated high efficiency in detecting crucial diarrheagenic pathogens, indicating its suitability for clinical practice.
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27
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Nycz BT, Pretty K, Gomez-Trujillo A, Sanchez B, Dominguez SR. Description of Enteropathic Escherichia coli Species in Pediatric Patients at a Quaternary Children's Hospital. J Pediatric Infect Dis Soc 2020; 9:573-579. [PMID: 31803928 DOI: 10.1093/jpids/piz081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/08/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND The epidemiology, demographics, clinical presentations, and outcomes associated with enteroaggregative Escherichia coli (EAEC), enteropathogenic E. coli (EPEC), and enterotoxigenic E. coli (ETEC) pathotypes in US children are not well understood. METHODS This study was a retrospective chart review of all pediatric patients with a stool sample submitted to the Children's Hospital Colorado clinical microbiology laboratory for testing with the BioFire FilmArray Gastrointestinal Pathogen Panel from October 2015 through October 2017. RESULTS During the study period, 5692 patient stool samples were submitted; 679 (13%) were positive for EAEC, EPEC, or ETEC. Of note, 163/232 (70%) patients with EAEC, 282/493 (57%) with EPEC, and 49/58 (85%) with ETEC had detection of at least 1 other pathogen. Of all E. coli-positive stool samples, only 158/679 (23%) were from low-risk patients who were singly infected with EAEC, EPEC, or ETEC. In this cohort, most cases were associated with acute diarrhea (50%), abdominal pain (61%), and/or cramping (49%) and presented without fever (14%), emesis (28%), or lethargy (7%). Thirteen (8%) of these 158 patients received antibiotics at the time of their initial presentation to care. Of the 145 patients who did not receive antibiotics at their initial visit, 23 (16%) returned to care due to persistence of symptoms. CONCLUSIONS Our results suggest that the majority of patients singly infected with EAEC, EPEC, or ETEC present with mild, self-limited, gastrointestinal (GI) complaints. Further research is needed to determine what role these pathogens might play in children who present with chronic or inflammatory GI symptoms.
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Affiliation(s)
- Bryan T Nycz
- Department of Pediatrics, Division of Infectious Diseases, Aurora, Colorado, USA
| | - Kristin Pretty
- Department of Pediatrics, Division of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Angel Gomez-Trujillo
- Department of Pediatrics, Division of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brenda Sanchez
- Department of Pediatrics, Division of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Samuel R Dominguez
- Department of Pediatrics, Division of Infectious Diseases, Aurora, Colorado, USA.,Department of Pediatrics, Division of Pathology and Laboratory Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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28
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Burjaq SZ, Abu-Romman SM. Prevalence and Antimicrobial Resistance of Salmonella spp. From Irrigation Water in Two Major Sources in Jordan. Curr Microbiol 2020; 77:3760-3766. [PMID: 32918569 DOI: 10.1007/s00284-020-02178-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
Irrigation water could be a direct source of pathogenic microorganisms that contaminates fresh produce and causes human diseases. In this study, we evaluated the prevalence of Salmonella spp. and its serotypes Typhimurium and Enteritidis, antimicrobial susceptibility and multidrug resistance (MDR) status, and seasonal variation, of Salmonella spp. in irrigation water of King Abdullah Canal (KAC) and Wadi Shueib (WS) in Jordan. The study results demonstrated that 32.2% (29/90) of irrigation water was contaminated with Salmonella spp. and the irrigation water of WS was found highly contaminated (62.1%) with Salmonella spp. compared to KAC (37.9%). In addition, higher prevalence of Salmonella were recorded in spring (33.3%) and summer (36.3%) seasons, compared to winter seasons. Among the contaminated irrigation water samples, prevalence of Salmonella Typhimurium serotype was found in (37.9%) (11/29) samples, while S. Enteritidis was absent. The most common antimicrobial resistance of Salmonella isolates was observed as tetracycline (11/29, 37.9%) and 6 (20.7%) Salmonella Typhimurium isolates were found multidrug resistance (MDR). Thus, this study results confirmed that the irrigation water was contaminated with pathogenic MDR Salmonella spp.
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Affiliation(s)
- Shereen Z Burjaq
- Department of Medical Analysis, Faculty of Science, Al-Balqa Applied University, P.O. Box 206, Salt, 19117, Jordan.
| | - Saeid M Abu-Romman
- Department of Biotechnology, Faculty of Agricultural Technology, Al-Balqa Applied University, Salt, Jordan
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29
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McMillan EA, Jackson CR, Frye JG. Transferable Plasmids of Salmonella enterica Associated With Antibiotic Resistance Genes. Front Microbiol 2020; 11:562181. [PMID: 33133037 PMCID: PMC7578388 DOI: 10.3389/fmicb.2020.562181] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022] Open
Abstract
Salmonella enterica is a common foodborne illness in the United States and globally. An increasing number of Salmonella infections are resistant to antibiotics, and many of the genes responsible for those resistances are carried by plasmids. Plasmids are important mediators of horizontal gene exchange, which could potentially increase the spread of antibiotic resistance (AR) genes. Twenty-eight different incompatibility groups of plasmids have been described in Enterobacteriaceae. Incompatibility groups differ in their accessory gene content, replication mechanisms, and their associations with Salmonella serotypes and animal sources. Plasmids also differ in their ability to conjugate or be mobilized, essential genes, and conditions required for transfer. It is important to understand the differences in gene content and transfer mechanisms to accurately determine the impact of plasmids on the dissemination and persistence of antibiotic resistance genes. This review will cover the most common plasmid incompatibility groups present in S. enterica with a focus on the transfer mechanisms and associated antibiotic resistance genes.
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Affiliation(s)
- Elizabeth A McMillan
- Bacterial Epidemiology and Antimicrobial Resistance Research Unit, U.S. National Poultry Research Center, Agricultural Research Service, U.S. Department of Agriculture, Athens, GA, United States
| | - Charlene R Jackson
- Bacterial Epidemiology and Antimicrobial Resistance Research Unit, U.S. National Poultry Research Center, Agricultural Research Service, U.S. Department of Agriculture, Athens, GA, United States
| | - Jonathan G Frye
- Bacterial Epidemiology and Antimicrobial Resistance Research Unit, U.S. National Poultry Research Center, Agricultural Research Service, U.S. Department of Agriculture, Athens, GA, United States
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30
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Ahn JS, Seo SI, Kim J, Kim T, Kang JG, Kim HS, Shin WG, Jang MK, Kim HY. Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea. World J Clin Cases 2020; 8:3708-3717. [PMID: 32953847 PMCID: PMC7479561 DOI: 10.12998/wjcc.v8.i17.3708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/04/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, stool multiplex polymerase chain reaction (PCR) tests have been developed for identifying diarrhea-causing bacterial pathogens. Furthermore, fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.
AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.
METHODS Overall, 400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital (January 2016 to December 2018). Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella, Campylobacter, Shigella, Escherichia coli O157:H7, Aeromonas, Vibrio, and Clostridium difficile. We reviewed clinical and laboratory findings using stool multiplex PCR.
RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture (49.2% vs 5.2%), with Campylobacter as the most common pathogen (54%). Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR (1124.5 ± 816.9 mg/kg vs 609 ± 713.2 mg/kg, P = 0.001). C-reactive protein (OR = 1.01, 95%CI: 1.001-1.027, P = 0.034) and sigmoidoscopy-detected colitis (OR = 4.76, 95%CI: 1.101-20.551, P = 0.037) were independent factors in stool PCR-based detection of bacterial pathogens. Sensitivity and specificity of calprotectin were evaluated to be 70.5% and 60.9%, respectively (adjusted cut-off value = 388 mg/kg).
CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture, and it is correlated with calprotectin expression. Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.
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Affiliation(s)
- Jae Sung Ahn
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul KS013, South Korea
| | - Taewan Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Jin Gu Kang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul KS013, South Korea
| | - Hyoung Su Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Myoung Kuk Jang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
| | - Hak Yang Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul KS013, South Korea
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon KS013, South Korea
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31
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Fraij O, Castro N, de Leon Castro LA, Brandt LJ. Stool cultures show a lack of impact in the management of acute gastroenteritis for hospitalized patients in the Bronx, New York. Gut Pathog 2020; 12:30. [PMID: 32582380 PMCID: PMC7310251 DOI: 10.1186/s13099-020-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Acute gastroenteritis (AGE) is diagnosed with a presentation of > 1
episode of vomiting and > 3 episodes of diarrhea in a 24-h period. Treatment is
supportive, however, in severe cases antibacterial treatment may be indicated. Stool
cultures can detect the responsible pathogenic bacteria and can guide antibiotic
treatment, however, the indication for and efficacy of stool cultures is debatable. This
study aimed to address the clinical utility of stool cultures in patients diagnosed with
AGE. Methods A retrospective, multicenter study was performed in patients admitted for
AGE from 2012 to 2014. Patient charts were obtained through hospital software using
ICD-9 codes for AGE. Inclusion criteria was a documented diagnosis of AGE, age of 18
years or older, symptoms of both upper GI symptoms of abdominal pain and/or nausea
and lower GI symptoms of diarrhea. Patients were classified into two main groups,
those in whom (1) stool culture was obtained and (2) those in whom stool culture was
not performed. Clinical features and outcomes were compared between groups. The
diagnostic yield of stool cultures was assessed. All analysis were conducted using the
Statistical Package for Social Science (SPSS).
Results Of 2479 patient charts reviewed, 342 met the above criteria for AGE. 119
patients (34.8%) had stool cultures collected and 223 (65.2%) did not. Demographics,
clinical features and serologic lab values are shown in Table 1. Of the 119 stool
cultures performed, only 4% (n = 5) yielded growth of pathogenic bacteria (2
Pseudomonas spp, 2 Campylobacter spp, 1 Salmonella spp). The group who
underwent stool culture had a higher percentage of patients with fevers (26% vs 13%,p < 0.003) and longer hospital length of stay (3.15 vs 2.28 days, p < 0.001) compared
to the group that did not undergo stool cultures.
Conclusion Stool cultures are commonly ordered when AGE is suspected. In our
cohort, stool culture had a very low yield of detecting an underlying pathogen. Although
patients who had stool cultures obtained were more likely to be febrile and to have a
longer length of hospital stay than were those who did not have stool cultures, for the
vast majority of patients, stool culture played little to no role in patient management.
Further studies are needed to which patients benefit most from undergoing stool
culture.
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Affiliation(s)
- Omar Fraij
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY USA
| | - Neva Castro
- New York City Health and Hospitals Corporation (HHC), New York, NY USA
| | | | - Lawrence J Brandt
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY USA
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Tieroshyn V, Moroz L, Prishliak O, Shostakovich-Koretska L, Kruglova O, Gordienko L. Colloidal Silicon Dioxide in Tablet form (Carbowhite) Efficacy in Patients with Acute Diarrhea: Results of Randomized, Double-Blind, Placebo-Controlled, Multi-Center Study. Sci Rep 2020; 10:6344. [PMID: 32286322 PMCID: PMC7156649 DOI: 10.1038/s41598-020-62386-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/10/2020] [Indexed: 01/30/2023] Open
Abstract
The acute diarrhea is a wide-spread disease. The prescription of enterosorbents is appropriate as a primary measure for the treatment of the acute diarrhea for effective prevention of the fluid and electrolyte loss, as well as method for symptom relief of the attack of the disease. Aim of the study - the antidiarrheal efficacy and safety study of high-dispersion silicon dioxide enterosorbent in tablet dosage form in patients with acute diarrhea. This was randomized, double-blind, placebo-controlled, 4-center study. Acute diarrhea was defined as three and more episodes of watery stool per day either during 48 hours or less before study entry in the patients having normal stool recently. It has been postulated that symptoms and signs of acute diarrhea have to be caused by direct infection of the gastrointestinal tract and did not associated with moderate-to-severe systemic states. 144 patients with established acute diarrhea were randomized into treatment group (enterosorbent "Carbowhite", n = 120) or placebo group. Date collection including severity diarrhea, systemic symptoms was performed at baseline and daily during 7 days. Stool examination and serological assay were performed at baseline. The primary end points were declared as time to complete recovery from acute diarrhea. It has been found that the use of the siliceous enterosorbent ("Carbowhite") allowed to reduce (p < 0.001) the treatment period averagely for 0.9 days (95% confidence interval 0.5-1.2 days) in comparison with placebo. Data of safety monitoring has revealed that both patient groups had negative stool culture, while initiation of antibiotic treatment was run more frequently in placebo group (8.3%) compared to investigational product group (4.1%, P = 0.044). The siliceous enterosorbent "Carbowhite" was well tolerated and reduced the recovery time of the acute episode of the diarrhea in the clinically significant form.
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Affiliation(s)
| | - Larisa Moroz
- Vinnytsya National Medical University named after M. I. Pirogov, Vinnytsya, Ukraine
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An Overview of the Molecular Methods in the Diagnosis of Gastrointestinal Infectious Diseases. Int J Microbiol 2020; 2020:8135724. [PMID: 32280346 PMCID: PMC7128059 DOI: 10.1155/2020/8135724] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/24/2020] [Accepted: 03/02/2020] [Indexed: 12/14/2022] Open
Abstract
Gastrointestinal infectious diseases are very common worldwide and an important cause of morbidity and mortality, particularly in infants in developing countries. Diarrhea and other intestinal infections are caused by a wide range of bacteria, viruses, protozoa, and parasites. Conventional diagnosis of these infections is performed by culture, microscopy, and antigen detection immunoassays. The traditional culture and microscopy procedures are time-consuming, lack sensitivity, and require special laboratory setup and well-trained staff. However, based on the advancement in the molecular diagnostics and with the introduction of commercially available tests, traditional diagnostic techniques have been continuously replaced by these newer rapid antigen detection and molecular-based methods. This review summarizes and discusses the availability, advantages, and disadvantages of molecular methods in the detection and identification of human gastrointestinal pathogens.
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Kwack WG, Lim YJ, Kwon KH, Chung JW, Oh JY. Outcomes and clinical relevance of stool multiplex bacterial polymerase chain reaction in patients with acute diarrhea: single center experience. Korean J Intern Med 2020; 35:300-309. [PMID: 30685964 PMCID: PMC7061005 DOI: 10.3904/kjim.2017.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Diagnostic stool multiplex polymerase chain reaction (PCR) testing has attracted considerable interest, because of its high sensitivity, short turnaround time, and ability to detect multiple organisms simultaneously. This study investigates the clinical usefulness of a stool multiplex bacterial PCR in patients with acute diarrhea. METHODS We retrospectively evaluated the stool multiplex bacterial PCR results, clinical parameters, and clinical courses of patients hospitalized because of acute diarrhea between August 2014 and November 2016. RESULTS A total of 725 patients (male, 372; mean age, 30.9 ± 29.3 years) underwent stool multiplex bacterial PCR. A total of 243 pathogens were detected in 226 patients. The detection rate of multiplex PCR testing was higher than that of stool culture (32.7% vs. 3.3%, p < 0.01). Severe symptoms of acute diarrhea (bloody diarrhea, frequent diarrhea) and prescribed empirical antibiotics were significantly more common in the positive multiplex PCR group (p = 0.02, p < 0.01, p < 0.01, respectively). However, mean durations of hospital stay were similar in the 2 groups according to the multiplex PCR results (p = 0.32). In addition, Campylobacter spp., which was the most commonly detected pathogen (97/243, 39.9%), was significantly associated with frequent diarrhea and prescribed empirical antibiotics (p < 0.01), but not with duration of hospital stay (p = 0.09). CONCLUSION We concluded that stool multiplex bacterial PCR might be a useful tool for identifying bacterial etiology in patients with acute diarrhea, especially in those with Campylobacter spp. infection.
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Affiliation(s)
- Won Gun Kwack
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Correspondence to Yun Jeong Lim, M.D. Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea Tel: +82-31-961-7133 Fax: +82-31-961-9339 E-mail:
| | - Ki Hwan Kwon
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jae Woo Chung
- Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin Young Oh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Affiliation(s)
- Henry J Binder
- Section of Digestive Diseases, Department of Internal Medicine, Yale University, PO Box 208019, New Haven, CT, 06520, USA.
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Abuzerr S, Nasseri S, Yunesian M, Hadi M, Zinszer K, Mahvi AH, Nabizadeh R, Abu Mustafa A, Mohammed SH. Water, sanitation, and hygiene risk factors of acute diarrhea among children under five years in the Gaza Strip. JOURNAL OF WATER, SANITATION AND HYGIENE FOR DEVELOPMENT 2019. [DOI: 10.2166/washdev.2019.072] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Abstract
This cross-sectional community household-based study aims to evaluate the water, sanitation, and hygiene facilities in the Gaza Strip and to investigate their associations with the occurrence of acute diarrhea among children under five years. A survey using a structured questionnaire was conducted on 1,857 households with an child under five years from August 2017 to June 2018. About 69.7% of heads of households reported a diarrheal episode among their children during the two months preceding the survey. Multivariable logistic regression showed that sewage water observed around the households was associated with an increased risk of acute diarrhea (AOR = 2.45; P < 0.001; 95% CI: 1.83–3.27). Nevertheless, the allocation of a special water tank for desalinated drinking water at home (AOR = 0.3; P = 0.02; 95% CI: 0.1–0.8), the connection of households to a closed sewerage system (AOR = 0.56; P < 0.001; 95% CI: 0.43–0.73), and handwashing practices before and after eating (AOR = 0.42; P = 0.003; 95% CI: 0.24–0.74 and AOR = 0.50; P = 0.03; 95% CI: 0.26–0.94, respectively), as well as using desalinated water sources for drinking purposes, were inversely associated with the incidence of acute diarrhea among children under five. Further improvements in the existing sewerage system and the intensification of sanitation and hygiene promotion programs at the household levels may reduce the risk of acute diarrhea among children under five years in the Gaza Strip.
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Affiliation(s)
- Samer Abuzerr
- Department of Environmental Health Engineering, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
- School of Public Health, Department of Social and Preventive Medicine, University of Montreal, Montréal, Canada
| | - Simin Nasseri
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, TUMS, Tehran, Iran
| | - Mahdi Hadi
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Kate Zinszer
- School of Public Health, Department of Social and Preventive Medicine, University of Montreal, Montréal, Canada
| | - Amir Hossein Mahvi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Water Quality Research (CWQR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayman Abu Mustafa
- Department of Research, Directorate General of Human Resources Development, Ministry of Health, Gaza Strip, Palestine
| | - Shimels Hussien Mohammed
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Homsi M, Singh B, Azawi M, Panchal A, Hauter N, Salafia C, Aron J. Antibiotic therapy in acute gastroenteritis: a single-center retrospective cohort study. Ann Gastroenterol 2019; 32:565-569. [PMID: 31700232 PMCID: PMC6826080 DOI: 10.20524/aog.2019.0422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/23/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Acute gastroenteritis (AGE) is a common reason for emergency department visits and hospitalizations. The role of antibiotics in AGE is unclear, as the current literature shows only a minor impact on the duration of symptoms and the overall clinical course. Our goal was to assess whether antibiotic therapy in patients with AGE affects the length of hospital stay (LOS). Methods: In a retrospective study, we evaluated 479 patients admitted to the hospital with a diagnosis of AGE. The study compared the 219 patients (46%) treated with antibiotics to the remainder treated with supportive therapy. The diagnosis of AGE was made either clinically or based on imaging findings. The primary outcome of this study was to compare the LOS in days between both groups. Results: Patients treated with antibiotics had a similar LOS to those treated with supportive therapy (2.62 vs. 2.66 days, P=0.77). Patients with presumed sepsis had a higher likelihood of receiving antibiotics compared to those without presumed sepsis (risk ratio 1.49, 62.5% vs. 41.95%; P<0.001). In this subgroup, patients who received antibiotics had a slightly shorter LOS than those who received only supportive therapy, but the difference was not statistically significant (2.09 vs. 2.54 days, P=0.69). Conclusion: We found no difference in the LOS for hospitalized patients with AGE treated with antibiotics when compared to supportive therapy. This calls into question the role of antibiotics in the management of AGE.
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Affiliation(s)
- Maher Homsi
- Department of Internal Medicine, Division of Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida (Maher Homsi)
| | - Bhanu Singh
- Internal Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center), New York (Bhanu Singh, Muaataz Azawi, Ankur Panchal, Nabeeh Hauter)
| | - Muaataz Azawi
- Internal Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center), New York (Bhanu Singh, Muaataz Azawi, Ankur Panchal, Nabeeh Hauter)
| | - Ankur Panchal
- Internal Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center), New York (Bhanu Singh, Muaataz Azawi, Ankur Panchal, Nabeeh Hauter)
| | - Nabeeh Hauter
- Internal Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center), New York (Bhanu Singh, Muaataz Azawi, Ankur Panchal, Nabeeh Hauter)
| | - Carolyn Salafia
- Internal Medicine, The Mount Sinai School of Medicine, New York (Carolyn Salafia)
| | - Joshua Aron
- Internal Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (Elmhurst Hospital Center), New York (Joshua Aron)
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Nakayama S, Hirashio S, Yorishima H, Doi T, Yoshida Y, Matsumoto M, Masaki T. Atypical reduction of plasma ADAMTS13 activity by a non-IgG-type inhibitor in a patient with hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli. CEN Case Rep 2019; 8:266-270. [DOI: 10.1007/s13730-019-00405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022] Open
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Kakoullis L, Papachristodoulou E, Chra P, Panos G. Shiga toxin-induced haemolytic uraemic syndrome and the role of antibiotics: a global overview. J Infect 2019; 79:75-94. [DOI: 10.1016/j.jinf.2019.05.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/21/2019] [Accepted: 05/25/2019] [Indexed: 11/17/2022]
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Wilson PB. 'I think I'm gonna hurl': A Narrative Review of the Causes of Nausea and Vomiting in Sport. Sports (Basel) 2019; 7:E162. [PMID: 31277403 PMCID: PMC6680692 DOI: 10.3390/sports7070162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/27/2022] Open
Abstract
Exercise-associated gastrointestinal (GI) distress can negatively impact athletic performance and interfere with exercise training. Although there are a few universal underlying causes of GI distress, each symptom often has its own unique triggers and, therefore, its own prevention and management strategies. One of the most troubling GI symptoms an athlete can experience during training and competition is nausea/vomiting. The prevalence of nausea varies with several factors, two of the most important being exercise intensity and duration. Relatively brief, high-intensity exercise (e.g., sprinting, tempo runs) and ultra-endurance exercise are both associated with more frequent and severe nausea. The potential causes of nausea in sport are numerous and can include catecholamine secretion, hypohydration, heat stress, hyponatremia, altitude exposure, excessive fluid/food consumption, hypertonic beverage intake, pre-exercise intake of fatty- or protein-rich foods (especially in close proximity to exercise), prolonged fasting, various supplements (caffeine, sodium bicarbonate, ketones), certain drugs (antibiotics, opioids), GI infections, and competition-related anxiety. Beyond directly addressing these aforementioned causes, antiemetic drugs (e.g., ondansetron) may also be useful for alleviating nausea in some competitive situations. Given the commonness of nausea in sport and its potential impact on exercise performance, athletes and sports medicine practitioners should be aware of the origins of nausea and strategies for dealing with this troublesome gut complaint.
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Affiliation(s)
- Patrick B Wilson
- Human Movement Sciences, Old Dominion University, Norfolk, VA 23529, USA.
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Park Y, Son M, Jekarl DW, Choi HY, Kim SY, Lee S. Clinical Significance of Inflammatory Biomarkers in Acute Pediatric Diarrhea. Pediatr Gastroenterol Hepatol Nutr 2019; 22:369-376. [PMID: 31338312 PMCID: PMC6629592 DOI: 10.5223/pghn.2019.22.4.369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/09/2018] [Accepted: 10/21/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the clinical significance of inflammatory biomarkers in acute infectious diarrhea among children. METHODS Clinical parameters including fever, bacterial and viral etiology based on stool culture and multiplex polymerase chain reaction, and nine biomarkers including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocytes in blood and calprotectin, lactoferrin, myeloperoxidase, polymorphonuclear elastase, leukocytes, and occult blood in feces were evaluated in children who were hospitalized due to acute diarrhea without underlying disease. RESULTS A total of 62 patients were included. Among these patients, 33 had fever, 18 showed bacterial infections, and 40 patients were infected with 43 viruses. Of all the biomarkers, CRP was significantly correlated with fever (p<0.001). CRP, ESR, calprotectin, lactoferrin, myeloperoxidase, fecal leukocytes, and occult blood were significantly associated with infection with bacterial pathogens (p<0.001, p=0.04, p=0.03, p=0.003, p=0.02, p=0.03, p=0.002, respectively). The combination of CRP and fecal lactoferrin at their best cut-off values (13.7 mg/L and 22.8 µg/mL, respectively) yielded a sensitivity of 72.2%, and a specificity of 95.5% for bacterial etiology compared with their individual use. CONCLUSION Blood CRP is a useful diagnostic marker for both fever and bacterial etiology in acute pediatric diarrhea. The combination of CRP and fecal lactoferrin yields better diagnostic capability for bacterial etiology than their use alone for acute diarrhea in children without underlying gastrointestinal disease.
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Affiliation(s)
- Yoonseon Park
- Department of Pediatrics, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Minji Son
- Department of Pediatrics, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Dong Wook Jekarl
- Department of Laboratory Medicine, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hyun Yoo Choi
- Department of Laboratory Medicine, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sang Yong Kim
- Department of Pediatrics, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seungok Lee
- Department of Laboratory Medicine, Incheon St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Incheon, Korea
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Affiliation(s)
- Alexis Guenette
- Division of Infectious Disease, University Health Network, University of Toronto, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada
| | - Shahid Husain
- Division of Infectious Disease, Multi-Organ Transplant Program, University Health Network, University of Toronto, 585 University Avenue, 11 PMB 138, Toronto, Ontario M5G 2N2, Canada.
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Ratnagiri R, Dutta P, Attawar S. Heart transplant in India: Gleneagles global experience. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2019. [DOI: 10.4103/jpcs.jpcs_19_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chatani M, Kishita M, Inatomi O, Takahashi K, Sugimoto M, Sonoda A, Kawahara M, Bamba S, Kito K, Kushima R, Andoh A. Severe Colitis with Portal Venous Gas Caused by Brachyspira pilosicoli Infection. Intern Med 2019; 58:3409-3413. [PMID: 31787630 PMCID: PMC6928490 DOI: 10.2169/internalmedicine.3254-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
We herein report a case of Brachyspira pilosicoli-caused severe colitis presenting with portal venous gas. A 75-year-old man was admitted because of a fever, severe abdominal pain and bloody diarrhea. He was negative for anti-HIV antibodies. He had been in close contact with a dog earlier. Abdominal computed tomography detected severe wall-thickening and fat-stranding of the entire colon accompanied by portal venous gas. A smear examination of his stool showed many Gram-negative spiral rods, suggesting intestinal spirochetosis. A polymerase chain reaction assay using stool samples detected an amplified band specific for B. pilosicoli. He responded well to antimicrobial agents including metronidazole.
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Affiliation(s)
- Motoharu Chatani
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Megumi Kishita
- Division of Clinical Laboratory Medicine, Shiga University of Medical Science, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Japan
| | | | | | - Ayano Sonoda
- Department of Medicine, Shiga University of Medical Science, Japan
| | | | - Shigeki Bamba
- Division of Nutrition, Shiga University of Medical Science, Japan
| | - Katsuyuki Kito
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Ryoji Kushima
- Division of Clinical Laboratory Medicine, Shiga University of Medical Science, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Japan
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Andersen AD, Nguyen DN, Langhorn L, Renes IB, van Elburg RM, Hartog A, Tims S, van de Looij Y, Sangild PT, Thymann T. Synbiotics Combined with Glutamine Stimulate Brain Development and the Immune System in Preterm Pigs. J Nutr 2019; 149:36-45. [PMID: 30608604 DOI: 10.1093/jn/nxy243] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023] Open
Abstract
Background Preterm infants are born with an immature gut, brain, and immune system, predisposing them to short- and long-term complications. Objective We hypothesized that a milk diet supplemented with pre- and probiotics (i.e. synbiotics) and glutamine would improve gut, brain, and immune maturation in preterm neonates, using preterm pigs as a model. Methods Preterm pigs (Landrace x Yorkshire x Duroc, n = 40, delivered by c-section at 90% of gestation) were reared individually until day 23 after birth under highly standardized conditions. Piglets in the intervention group (PPG, n = 20) were fed increasing volumes of bovine milk supplemented with prebiotics (short-chain galacto- and long chain fructo-oligosaccharides 9:1, 4-12 g/L), probiotics (Bifidobacterium breve M16-V, 3 × 109 CFU/d) and l-glutamine [0.15-0.30 g/(kg · d)], and compared with pigs fed bovine milk with added placebo compounds as control (CON, n = 20). Clinical, gastrointestinal, immunological, cognitive, and neurological endpoints were measured. Results The PPG pigs showed more diarrhea but weight gain, body composition, and gut parameters were similar between the groups. Cognitive performance, assessed in a T-maze, was significantly higher in PPG pigs (P < 0.01), whereas motor function and exploratory interest were similar between the groups. Using ex vivo diffusion imaging, the orientation dispersion index in brain cortical gray matter was 50% higher (P = 0.04), and fractional anisotropy value was 7% lower (P = 0.05) in PPG pigs compared with CON pigs, consistent with increased dendritic branching in PPG. In associative fibers, radial diffusivity was lower and fractional anisotropy was higher in PPG pigs compared with CON pigs (all P < 0.05), while measures in the internal capsule showed a tendency towards reduced radial diffusivity and mean diffusivity (both P = 0.09). On day 23 pigs in the PPG group showed higher blood leukocyte numbers (+43%), neutrophil counts (+100%), and phagocytic rates (+24%), relative to CON, all P < 0.05. Conclusion Preterm pigs supplemented with Bifidobacterium breve, galacto- and fructo-oligosaccharides, and l-glutamine showed enhanced neuronal and immunological development. The findings indicate the potential for targeted nutritional interventions after preterm birth, to support development of important systems such as immunity and brain.
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Affiliation(s)
- Anders D Andersen
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Denmark
| | - Duc Ninh Nguyen
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Denmark
| | - Louise Langhorn
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Denmark
| | - Ingrid B Renes
- Danone Nutricia Research, Utrecht, Netherlands.,Department of Pediatrics, Emma Children's Hospital AMC, Amsterdam, Netherlands
| | - Ruurd M van Elburg
- Danone Nutricia Research, Utrecht, Netherlands.,Department of Pediatrics, Emma Children's Hospital AMC, Amsterdam, Netherlands
| | - Anita Hartog
- Danone Nutricia Research, Utrecht, Netherlands.,Department of Pharmacology & Pathophysiology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
| | | | - Yohan van de Looij
- Division of Child Development & Growth, University Children's Hospital Geneva & Functional and Metabolic Imaging Laboratory, Lausanne, Switzerland
| | - Per T Sangild
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Denmark
| | - Thomas Thymann
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Denmark
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Valenzuela C, Legarraga P, Peña A, Arenas A, Berkowitz L, Ramírez G, Wozniak A, García P, Álvarez-Lobos M. Etiologic and clinical characterization of community acquired gastroenteritis in adult patients in a Chilean emergency room by the FilmArray GI panel. PLoS One 2018; 13:e0207850. [PMID: 30475924 PMCID: PMC6258233 DOI: 10.1371/journal.pone.0207850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/07/2018] [Indexed: 02/04/2023] Open
Abstract
Infectious diarrhea can be caused by a large number of microorganisms including bacteria virus and parasites. The clinical syndromic approach has been traditionally used to guide therapy. The aim of this study was to characterize the etiology of acute diarrhea by the FilmArray GI panel and to correlate it with its clinical presentation in an adult population presenting to the emergency room in a developing country. Material and Methods: Adult patients attending the ER due to acute diarrhea were selected. All patients included had a FilmArray GI panel performed and the clinical characteristics were recorded. Results: One hundred and ninety-nine patients were included. One hundred and eighteen (59.3%) were females. The mean age was 43 years old. Thirty three percent of the patients presented dysentery, 36.7% fever, 54.8% referred nauseas and 35.7% vomiting. Sixty three percent of the patients presented some degree of dehydration. In total, 221 microorganisms were detected of which 71.5% corresponded to bacteria (158/221), 19.9% to virus (44/221) and 8.6% to parasites (19/221). In 133 (67.0%) of 199 patients at least one microorganism was identified. Infections with more than one microorganism were detected in 27.1% of the patients. Polimicrobial infections were associated with a higher frequency of nausea (50.0% vs 32.0%, p 0.046), abdominal pain (87.0% vs 44.0%, p<0.0001) and travel history (20.0% vs 5.0%, p 0.0102). Bacterial infections occurred without a seasonal distribution with the exception of Salmonella sp whereas viral infections predominated during the autumn–winter months. Diarreicogenic E. coli were present in the context of a co-infection in more than 80.0% of the cases. Discussion: The use of multiplex panels has given us invaluable information regarding the epidemiology of acute diarrhea in adult. It highlighted the importance of polimicrobial infections and the frequency of diarreicogenic E. coli infections. Nevertheless, the lack of severity compared to monomicrobial infections and the usual association with other microorganisms in the latter make their clinical importance debatable.
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Affiliation(s)
- Carlos Valenzuela
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Paulette Legarraga
- Department of Clinical Laboratories, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arturo Peña
- Emergency Room, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alex Arenas
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Loni Berkowitz
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gigliola Ramírez
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aniela Wozniak
- Department of Clinical Laboratories, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricia García
- Department of Clinical Laboratories, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail: (MAL); (PG)
| | - Manuel Álvarez-Lobos
- Department of Gastroenterology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail: (MAL); (PG)
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Mekonnen GK, Mengistie B, Sahilu G, Mulat W, Kloos H. Caregivers' knowledge and attitudes about childhood diarrhea among refugee and host communities in Gambella Region, Ethiopia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:24. [PMID: 30466488 PMCID: PMC6249824 DOI: 10.1186/s41043-018-0156-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Maternal knowledge, attitudes, and practices related to hygiene, breastfeeding, sanitary food preparation, and appropriate weaning practices are potentially important determinants in the occurrence of diarrhea in children. However, few studies have been carried out about the knowledge and attitudes about childhood diarrhea among parents in refugee camps and host communities. OBJECTIVE This study aims at assessing the caregivers' knowledge and attitudes regarding acute diarrhea in under-five children among refugee and host communities in Gambella Region, Ethiopia. METHODOLOGY This cross-sectional study, employing multistage sampling, was carried out from September to December 2016. Data was collected by a questionnaire-based interview, and 1667 caregivers were included in this study. A composite knowledge score was calculated, and a five-point Likert type of attitude scale was developed to assess the attitudes of the caregivers towards childhood diarrhea. Appropriate descriptive statistics and logistic regression models were used. Odds ratios (ORs) are presented with their 95% confidence intervals (CIs), and all analyses were performed at the 5% significance level (p < 0.05). RESULT The study indicates that 633 (28.0%) of the caregivers had poor knowledge, while 393 (23.6%) of them had unfavorable attitudes towards childhood diarrhea. Knowledge of the caregivers was significantly associated with formal education (AOR, 1.3; 95% CI, 1.03-1.5) and health information obtained from a health care institution (AOR, 1.8; 95% CI, 1.28-2.3). Caregivers' knowledge is a single predictor of their attitude (p < 0.001), and Pearson's correlation coefficient revealed that there was a significant positive correlation (r = 0.2, p < 0.001) between knowledge and attitude scores. CONCLUSION The study indicates that significant numbers of caregivers had inadequate knowledge and unfavorable attitudes about diarrhea in under-five children. Designing and implementing an inclusive health education intervention focusing on uneducated child caregivers may be beneficial for improving knowledge and attitudes towards reducing the incidence of acute childhood diarrhea in the region.
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Affiliation(s)
- Getachew Kabew Mekonnen
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O. BOX. 150461, Addis Ababa, Ethiopia
- College of Health and Medical Sciences, Haramaya University, P.O. Box 1570, Harar, Ethiopia
| | - Bezatu Mengistie
- College of Health and Medical Sciences, Haramaya University, P.O. Box 1570, Harar, Ethiopia
| | - Geremew Sahilu
- Ethiopian Institute of Water Resources, Addis Ababa University, P.O. BOX. 150461, Addis Ababa, Ethiopia
| | - Worku Mulat
- Department of Civil and Environmental Engineering, University of Connecticut, Storrs, CT USA
| | - Helmut Kloos
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
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49
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Wang S, Yang F, Li D, Qin J, Hou W, Jiang L, Kong M, Wu Y, Zhang Y, Zhao F, Fang Y, Miao Y, Xu L, Chen J, Bao Z, Olszewski MA, Zhao H, Zhang Y. Clinical application of a multiplex genetic pathogen detection system remaps the aetiology of diarrhoeal infections in Shanghai. Gut Pathog 2018; 10:37. [PMID: 30214488 PMCID: PMC6134694 DOI: 10.1186/s13099-018-0264-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/27/2018] [Indexed: 01/25/2023] Open
Abstract
Background Culture-based diagnostic methods cannot achieve rapid and precise diagnoses for the identification of multiple diarrhoeal pathogens (DPs). A high-throughput multiplex genetic detection system (HMGS) was adapted and evaluated for the simultaneous identification and differentiation of infectious DPs and a broad analysis of DP infection aetiology. Results DP-HMGS was highly sensitive and specific for DP detection compared with culture-based techniques and was similar to singleplex real-time PCR. The uniform level of sensitivity of DP-HMGS for all DPs allowed us to remap the aetiology of acute diarrhoeal infections in Shanghai, correcting incidences of massively underdiagnosed DP species with accuracy approaching that of sequencing-based methods. The most frequent DPs were enteropathogenic Escherichia coli, rotavirus and Campylobacter jejuni. DP-HMGS detected two additional causes of infectious diarrhoea that were previously missed by routine culture-based methods: enterohemorrhagic E. coli and Yersinia enterocolitica. We demonstrated the age dependence of specific DP distributions, especially the distributions of rotavirus, intestinal adenovirus and Clostridium difficile in paediatric patients as well as those of dominant bacterial infections in adults, with a distinct “top 3” pattern for each age group. Finally, the multiplexing capability and high sensitivity of DP-HMGS allowed the detection of infections co-induced by multiple pathogens (approximately 1/3 of the cases), with some DPs preferentially co-occurring as infectious agents. Conclusions DP-HMGS has been shown to be a rapid, specific, sensitive and appropriate method for the simultaneous screening/detection of polymicrobial DP infections in faecal specimens. Widespread use of DP-HMGS is likely to advance routine diagnostic and clinical studies on the aetiology of acute diarrhoea. Electronic supplementary material The online version of this article (10.1186/s13099-018-0264-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiwen Wang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Feng Yang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Dong Li
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Juanxiu Qin
- 5Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200135 China
| | - Weiwei Hou
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Lian Jiang
- 4Department of Clinical Laboratory, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065 China
| | - Mimi Kong
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yong Wu
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Yuchen Zhang
- 6Ningbo HEALTH Gene Technologies Co., Ltd., Ningbo, China
| | - Fuju Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yi Fang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yingxin Miao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Lingli Xu
- Shanghai ABSciex Analytical Instrument Trading Co., Ltd., Shanghai, China
| | - Jie Chen
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China.,8Department of Gastroenterology, Gerontology Institute of Shanghai, Affiliated with Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China
| | - Michal A Olszewski
- 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System and Research Service, VA Ann Arbor Health Systems, Ann Arbor, MI USA
| | - Hu Zhao
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
| | - Yanmei Zhang
- 1Department of Laboratory Medicine, Huadong Hospital, Affiliated with Fudan University, Shanghai, 200040 China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, 200040 China.,3Research Center on Aging and Medicine, Fudan University, Shanghai, 200040 China
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Zhao Y, Tang J. Staphylococcal enterotoxin M causes intestine dysfunction via activating inflammation. J Food Saf 2018. [DOI: 10.1111/jfs.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yanying Zhao
- College of Life Science and Technology; Southwest Minzu University (Southwest University for Nationalities); Chengdu China
| | - Junni Tang
- College of Life Science and Technology; Southwest Minzu University (Southwest University for Nationalities); Chengdu China
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