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Martins AS, Santos SA, Lisboa CADS, Barros TF, Ribeiro TCM, Da Costa-Ribeiro H, Mattos ÂPD, Almeida Mendes PSD, Mendes CMC, Souza EL, Moreno Amor AL, Soares NM, Aquino Teixeira MC. Infectious etiology and indicators of malabsorption or intestinal injury in childhood diarrhea. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:80-91. [PMID: 38648349 DOI: 10.7705/biomedica.6913] [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: 02/19/2023] [Accepted: 02/20/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease. OBJECTIVE To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity. MATERIALS AND METHODS The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests. RESULTS We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method. CONCLUSIONS Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.
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Affiliation(s)
- Adson Santos Martins
- Programa de Pós-Graduação em Farmácia, Universidade Federal da Bahia, Salvador, Brasil
| | - Samara Alves Santos
- Programa de Pós-Graduação em Farmácia, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Tânia Fraga Barros
- Programa de Pós-Graduação em Farmácia, Universidade Federal da Bahia, Salvador, Brasil; Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Hugo Da Costa-Ribeiro
- Hospital Universitário Professor Edgard Santos - HUPES, Universidade Federal da Bahia, Salvador, Brasi
| | - Ângela Peixoto de Mattos
- Hospital Universitário Professor Edgard Santos - HUPES, Universidade Federal da BahiaHospital Universitário Professor Edgard Santos - HUPES, Universidade Federal da Bahia, Salvador, Brasi
| | | | | | - Edna Lúcia Souza
- aculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brasil
| | - Ana Lúcia Moreno Amor
- Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, Brasil
| | - Neci Matos Soares
- Programa de Pós-Graduação em Farmácia, Universidade Federal da Bahia, Salvador, Brasil; Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil
| | - Márcia Cristina Aquino Teixeira
- Programa de Pós-Graduação em Farmácia, Universidade Federal da Bahia, Salvador, Brasil; Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil
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Tsegaye H, Demelash A, Aklilu D, Girma B. Determinants of pediatrics emergency mortality at comprehensive specialized hospitals of South nation nationalities and people region, Ethiopia, 2022: unmatched case-control study. BMC Pediatr 2023; 23:192. [PMID: 37085755 PMCID: PMC10120093 DOI: 10.1186/s12887-023-04011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Globally, child mortality is remaining high, especially in sub-Saharan African countries like Ethiopia. Mortality which happens within 24 hours of admission is preventable. However, in Ethiopia little is known regarding pediatric emergency mortality. Therefore, this study was aimed to identify determinants of pediatric emergency mortality at compressive specialized hospitals found in South Nation Nationalities and people region, Southern Ethiopia. METHODS A facility-based unmatched case-control study was conducted on 344 children (115 cases and 229 controls) at comprehensive specialized hospitals of South Nation Nationalities and people region, Ethiopia. The data collection checklist was checked for its consistency. Data were entered and cleaned for missed values by using Epi Data3.1, then exported to Stata version 14.1 for analysis. Logistic regression was done to identify the significant determinants for pediatric emergency mortality. Finally, AORs at 95% CI and P-value < 0.05 were used to declare statistical significance. RESULT A total of 344 charts were reviewed, of which 333 (97%) (112 cases and 221 controls) charts fulfilled the inclusion criteria.. In multivariable analysis, delayed diagnosis and treatment [AOR = 2.088, 95% of CI (1.128, 3.864)], acute respiratory distress syndrome [AOR = 2.804, 95% of CI (1.487, 5.250)], dehydration [AOR = 3.323, 95% of CI (1.260, 8.761)], meningitis [AOR = 5.282, 95% of CI (2.707, 10.310)], sepsis [AOR = 4.224, 95% of CI (2.220, 8.040)], accidental injury [AOR = 3.603, 95% of CI (1.877, 6.916)] and duration of sign/symptoms [AOR = 5.481, 95% of CI (2.457, 12.230)] were significantly associated with pediatric emergency mortality. CONCLUSION In the current study, delayed diagnosis and treatment, acute respiratory distress syndrome, dehydration, sepsis, meningitis, accidental injury and duration of signs/symptoms were significantly associated with pediatric emergency mortality. Healthcare professionals should identify and treat patients early at an emergency department and provide attention to patients with the above diseases. Furthermore, quality care should be provided.
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Affiliation(s)
| | - Alebachew Demelash
- Department of Pediatrics and Child Health Nursing, School of Midwifery and Nursing, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Dawit Aklilu
- Department of Pediatrics and Child Health Nursing, School of Midwifery and Nursing, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Bekahegn Girma
- Department of Nursing, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia.
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Silva HGDS, Franzolin MR, dos Anjos GF, Barbosa AS, dos Santos LF, Miranda KF, Marques RM, de Souza MCL, Piazza RMF, Domingos MDO. O55 Polysaccharides Are Good Antigen Targets for the Formulation of Vaccines against O55 STEC and Capsulated aEPEC Strains. Pathogens 2022; 11:pathogens11080895. [PMID: 36015015 PMCID: PMC9414270 DOI: 10.3390/pathogens11080895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
The serogroup O55 of E. coli is composed of strains whose mechanisms of virulence are different from each other. Since the O55 polysaccharides are present in all E. coli O55 strains, and so are the polymers that compose the capsule of O55 atypical enteropathogenic E. coli (aEPEC), it was investigated whether anti-O55 antibodies were able to help the innate immune system to eliminate capsulated aEPEC and Shiga toxin-producing E. coli (STEC) belonging to the serogroup O55. The results demonstrate that the capsule of EPEC was able to inhibit the deposition of C3b on the bacterial surface and, as a consequence, their lysis by the alternative pathway of the complement system. However, in the presence of antibodies, the ability of the complement to lyse these pathogens was restored. It was also observed that macrophages were able to ingest EPEC and STEC, but they were only able to kill the ingested pathogens in the presence of antibodies. Anti-O55 antibodies were also able to inhibit aEPEC and STEC O55 adherence to human epithelial cells. In summary, the results demonstrated that the O55 polysaccharides have the potential to induce an effective humoral immune response against STEC and EPEC, indicating that they are good antigen targets to be used in vaccine formulations against these pathogens.
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Affiliation(s)
| | - Marcia Regina Franzolin
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
| | - Geovana Ferreira dos Anjos
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
| | - Angela Silva Barbosa
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
| | - Luis Fernando dos Santos
- Centro de Bacteriologia, Núcleo de Doenças Entéricas, Instituto Adolfo Lutz, Avenida Dr. Arnaldo, 355, São Paulo CEP 01246-000, SP, Brazil
| | - Kaique Ferrari Miranda
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
| | - Ronaldo Maciel Marques
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
| | - Matilde Costa Lima de Souza
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
| | - Roxane Maria Fontes Piazza
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
| | - Marta de Oliveira Domingos
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo CEP 05503-900, SP, Brazil
- Correspondence: ; Tel.: +55-11-2627-9708
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Huang Z, He Z, Wei Z, Wang W, Li Z, Xia X, Qin D, Zhang L, Guo J, Li J, Diao B, Zhan Z, Zhang J, Zeng M, Kan B. Correlation Between Prevalence of Selected Enteropathogens and Diarrhea in Children: A Case-Control Study in China. Open Forum Infect Dis 2021; 8:ofab445. [PMID: 34631918 PMCID: PMC8496764 DOI: 10.1093/ofid/ofab445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The application of nucleic acid detection methods improves the ability of laboratories to detect diarrheal pathogens, but it also poses new challenges for the interpretation of results. It is often difficult to attribute a diarrhea episode to the detected pathogens. Here we investigated the prevalence of 19 enteropathogens among diarrheal and nondiarrheal children and provided support for understanding the clinical significance of the pathogens. METHODS A total of 710 fecal samples were collected from children under 5 years old in 2 different regions of China from May 2017 to March 2018, comprising 383 mild to moderate diarrheal cases and 327 nondiarrheal controls. The enteropathogens were detected using real-time polymerase chain reaction (PCR) or real-time reverse transcription PCR (RT-PCR). RESULTS Enteropathogens were detected in 68.9% of cases and 41.3% of controls. Rotavirus A (adjusted OR [aOR], 9.91; 95% CI, 4.99-19.67), norovirus GI and GII (aOR, 3.82; 95% CI, 2.12-6.89), and Campylobacter jejuni (aOR, 20.12; 95% CI, 2.57-157.38) were significantly associated with diarrhea (P < .05). Adenovirus, norovirus GII, rotavirus A, and enteroaggregative Escherichia coli (pCVD432) gave lower cycle threshold (Ct) values in cases than in controls (P < .05). Rotavirus A and norovirus GII were associated with diarrhea when the Ct values were ≤30 and ≤25, respectively. CONCLUSIONS The types and loads of enteropathogens are likely to influence the interpretation of the clinical significance of positive results.
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Affiliation(s)
- Zheng Huang
- Shanghai Changning District Center for Disease Control and Prevention, Shanghai, China
| | - Zixiang He
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, China
| | - Zhongqiu Wei
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Wei Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenpeng Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xin Xia
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, China
| | - Di Qin
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, China
| | - Ling Zhang
- Shanghai Changning District Center for Disease Control and Prevention, Shanghai, China
| | - Jiayin Guo
- Shanghai Changning District Center for Disease Control and Prevention, Shanghai, China
| | - Jie Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Baowei Diao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhifei Zhan
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, China
| | - Jingyun Zhang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zeng
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Biao Kan
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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