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Neupane R, Bhathena M, Das G, Long E, Beard J, Solomon H, Simon JL, Nisar YB, MacLeod WB, Hamer DH. Antibiotic resistance trends for common bacterial aetiologies of childhood diarrhoea in low- and middle-income countries: A systematic review. J Glob Health 2023; 13:04060. [PMID: 37475599 PMCID: PMC10359834 DOI: 10.7189/jogh.13.04060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Diarrhoea is the second most common cause of death among children under the age of five worldwide. The World Health Organization (WHO) recommends treating diarrhoea with oral rehydration therapy, intravenous fluids for severe dehydration, and zinc supplements. Antibiotics are only recommended to treat acute, invasive diarrhoea. Rising antibiotic resistance has led to a decrease in the effectiveness of treatments for diarrhoea. Methods A systematic literature review in PubMed, Web of Science, and EMBASE was conducted to identify articles relevant to antibiotic-resistant childhood diarrhoea. Articles in English published between 1990 to 2020 that described antibiotic resistance patterns of common pathogens causing childhood diarrhoea in low- and middle-income countries were included. The studies were limited to papers that categorized children as 0-5 years or 0-10 years old. The proportion of isolates with resistance to major classes of antibiotics stratified by major WHO global regions and time was determined. Results Quantitative data were extracted from 44 articles that met screening criteria; most focused on children under five years. Escherichia coli isolates had relatively high resistance rates to ampicillin and tetracycline in the African (AFR), American (AMR), and Eastern Mediterranean Regions (EMR). There was moderate to high resistance to ampicillin and third generation cephalosporins among Salmonella spp in the AFR, EMR, and the Western Pacific Region (WPR). Resistance rates for ampicillin, co-trimoxazole, and chloramphenicol for Shigella in the AFR started at an alarmingly high rate ( ~ 90%) in 2006 and fluctuated over time. There were limited antibiotic resistance data for Aeromonas, Yersinia, and V. cholerae. The 161 isolates of Campylobacter analysed showed initially low rates of fluoroquinolone resistance with high rates of resistance in recent years, especially in the Southeast Asian Region. Conclusions Resistance to inexpensive antibiotics for treatment of invasive diarrhoea in children under ten years is widespread (although data on 6- to 10-year-old children are limited), and resistance rates to fluoroquinolones and later-generation cephalosporins are increasing. A strong regional surveillance system is needed to carefully monitor trends in antibiotic resistance, future studies should include school-aged children, and interventions are needed to reduce inappropriate use of antibiotics for the treatment of community-acquired, non-invasive diarrhoea. Registration This systematic review was registered in Prospero (registration number CRD42020204004) in August 2020.
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Affiliation(s)
- Raghavee Neupane
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Myra Bhathena
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Gopika Das
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Long
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Beard
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Hiwote Solomon
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jon L Simon
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Yasir B Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Emerging Infectious Diseases Policy and Research, Boston University, Boston, Massachusetts, USA
- National Emerging Infectious Disease Laboratory, Boston University, Boston, Massachusetts, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Mabika RM, Liabagui SLO, Mounioko F, Souza A, Yala JF. Evaluation of the bioresistance profile of enterobacteria isolated from faeces of children with diarrhoea in the town of Koula-Moutou, Gabon: prospective study. Pan Afr Med J 2022; 43:63. [PMID: 36523289 PMCID: PMC9733464 DOI: 10.11604/pamj.2022.43.63.25276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/04/2022] [Indexed: 06/17/2023] Open
Abstract
Introduction the emergence and expansion of multidrug resistance in Enterobacteriaceae responsible for various infections are increasing in the world. This study was designed to determine the phenotypic profiles of the resistance of enterobacteria strains isolated from the faeces of children with diarrhoeal diseases and to classify them according to the type of resistance. Methods screening was carried out on 98 isolates divided into 2 groups: opportunistic pathogens and strict enteropathogens. Their sensitivity to 13 antibiotics was evaluated by the Mueller Hinton agar medium diffusion method. Results a strong resistance to different classes of β-lactams was found in the strains, 74.0% (n=45) and 83.3% (n=31) for opportunists and enteropathogens, respectively. These strains were completely resistant to doxycycline and erythromycin (100%; n=98) for both types of bacteria. Opportunists and enteropathogens were 95.1% (n=58) and 94.6% (n=35) resistant to gentamicin, and 31.1% (n=19) and 35.1% (n=13) resistant to chloramphenicol, respectively. Similarly, the total resistance of strains was observed with ofloxacin and amounted to 98.4% (n=60) and 96.7% with levofloxacin and norfloxacin, respectively. The analysis of β-lactam resistance phenotypes revealed a dominance of the carbapenemase-producing strains (28.6%; n=28). However, 24.3% (n=9) of enteropathogens were pan-resistant versus 19.7% (n=12) for opportunists. Conclusion the results of this study indicate a worryingly high level of antibiotic resistance in enterobacteria which might tend towards total resistance.
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Affiliation(s)
- Rolande Mabika Mabika
- Laboratory of Molecular and Cellular Biology, Microbiology Team, Agrobiology Research Unit, Masuku University of Science and Technology, BP 067 Franceville, Gabon
| | - Sandrine Lydie Oyegue Liabagui
- Laboratory of Research in Immunology, Parasitology and Microbiology, Regional Doctoral School of Central Africa in Tropical Infectiology, Masuku University of Science and Technology, Franceville, Gabon
| | - Franck Mounioko
- Vector Ecology Laboratory, Tropical Ecology Research Institute, Libreville, Gabon
| | - Alain Souza
- Laboratory of Molecular and Cellular Biology, Microbiology Team, Agrobiology Research Unit, Masuku University of Science and Technology, BP 067 Franceville, Gabon
| | - Jean Fabrice Yala
- Laboratory of Molecular and Cellular Biology, Microbiology Team, Agrobiology Research Unit, Masuku University of Science and Technology, BP 067 Franceville, Gabon
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Gholkar MS, Li JV, Daswani PG, Tetali P, Birdi TJ. 1H nuclear magnetic resonance-based metabolite profiling of guava leaf extract: an attempt to develop a prototype for standardization of plant extracts. BMC Complement Med Ther 2021; 21:95. [PMID: 33736648 PMCID: PMC7977270 DOI: 10.1186/s12906-021-03221-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/19/2021] [Indexed: 01/17/2023] Open
Abstract
Background Herbal medicines are fast gaining popularity. However, their acceptability by modern practitioners is low which is often due to lack of standardization. Several approaches towards standardization of herbals have been employed. The current study attempted to recognize key peaks from 1H NMR spectra which together would comprise of a spectral fingerprint relating to efficacy of Psidium guajava (guava) leaf extract as an antidiarrhoeal when a number of unidentified active principles are involved. Methods Ninety samples of guava leaves were collected from three locations over three seasons. Hydroalcoholic (water and ethanol, 50:50) extracts of these samples were prepared and their 1H NMR spectra were acquired. Spectra were also obtained for quercetin, ferulic acid and gallic acid as standards. Eight bioassays reflecting different stages of diarrhoeal pathogenesis were undertaken and based on pre-decided cut-offs, the extracts were classified as ‘good’ or ‘poor’ extracts. The bioactivity data was then correlated with the 1H NMR profiles using Regression or Orthogonal Partial Least Square-Discriminant Analysis (OPLS-DA). Results OPLS-DA showed seasonal and regional segregation of extracts. Significant models were established for seven bioassays, namely those for anti-bacterial activity against Shigella flexneri and Vibrio cholerae, adherence of E. coli, invasion of E. coli and S. flexneri and production and binding of toxin produced by V. cholerae. It was observed that none of the extracts were good or bad across all the bioassays. The spectral analysis showed multiple peaks correlating with a particular activity. Based on NMR and LC-MS/MS, it was noted that the extracts contained quercetin, ferulic acid and gallic acid. However, they did not correlate with the peaks that segregated extracts with good and poor activity. Conclusions The current study identified key peaks in 1H NMR spectra contributing to the anti-diarrhoeal activity of guava leaf extracts. The approach of using spectral fingerprinting employed in the present study can thus be used as a prototype towards standardization of plant extracts with respect to efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03221-5.
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Affiliation(s)
- Manasi S Gholkar
- Department of Medicinal Plants, The Foundation for Medical Research, Dr. Kantilal J. Sheth Memorial Building, 84-A, R.G, Thadani Marg, Worli, Mumbai - 400018, MAHARASHTRA, India
| | - Jia V Li
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Poonam G Daswani
- Department of Medicinal Plants, The Foundation for Medical Research, Dr. Kantilal J. Sheth Memorial Building, 84-A, R.G, Thadani Marg, Worli, Mumbai - 400018, MAHARASHTRA, India
| | - P Tetali
- Presently Freelance Consultant & Formerly Scientist at Naoroji Godrej Centre for Plant Research (NGCPR), Shirwal, Maharashtra, India
| | - Tannaz J Birdi
- Department of Medicinal Plants, The Foundation for Medical Research, Dr. Kantilal J. Sheth Memorial Building, 84-A, R.G, Thadani Marg, Worli, Mumbai - 400018, MAHARASHTRA, India.
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Daswani P, Muthuraman V, Macaden R, Dias M, Birdi T. Effect of Psidium guajava (guava) L. Leaf Decoction on Antibiotic-resistant Clinical Diarrhoeagenic Isolates of Shigella spp. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2020. [DOI: 10.34172/ijep.2020.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Although shigellosis is self-limiting, antibiotics are recommended to minimize the severity of symptoms and reduce mortality rates. However, due to the increasing reports of antibiotic resistance, alternative approaches are needed to combat shigellosis. Interest for research on medicinal plants has increased in recent years, and hence, they can be explored to treat this infectious diarrhoea. Objective: To study the effect of Psidium guajava L. (guava) leaf decoction (GLD) on the antibiotic-resistant clinical isolates of Shigella spp. Materials and Methods: A total of 43 isolated Shigella spp. from diarrhoeal patients were used in this study. The effect of GLD on the bacterial viability was initially assessed. The isolates were divided into two categories: sensitive and resistant to GLD. For sensitive isolates, antibacterial activity of GLD was evaluated while for resistant strains, the ability of GLD for reducing the bacterial invasion of the HEp-2 cell line underwent an investigation. Results: Among the 43 Shigella isolates, GLD affected the growth of 23 strains. The invasion of 9 strains from the 20 remaining resistant isolates was unaffected. Although the number of isolates was less, the data suggested that isolates belonging to S. flexneri serogroup were more sensitive to GLD in comparison with other spp (i.e., sonnei, boydii, and dysenteriae). Conclusion: The results of this study revealed the efficacy of GLD against drug-resistant Shigella spp. and thus could be considered for the treatment of diarrhoea. GLD can be a cost-effective alternative to antibiotics.
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Affiliation(s)
- Poonam Daswani
- Department of Medicinal Plants,The Foundation for Medical Research, Mumbai, India
| | | | - Ragini Macaden
- Divison of Infectious Diseases, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
| | - Mary Dias
- Divison of Infectious Diseases, St. John’s Research Institute, St. John’s Medical College, Bengaluru, India
| | - Tannaz Birdi
- Department of Medicinal Plants,The Foundation for Medical Research, Mumbai, India
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Houattongkham S, Yamamoto E, Sithivong N, Inthaphatha S, Kariya T, Saw YM, Vongduangchanh A, Keosavanh O, Hamajima N. Etiologic agents of acute diarrhea in sentinel surveillance sites in Vientiane Capital, Lao People's Democratic Republic, 2012-2015. Eur J Clin Microbiol Infect Dis 2020; 39:1115-1122. [PMID: 31993879 DOI: 10.1007/s10096-020-03827-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/21/2020] [Indexed: 10/23/2022]
Abstract
This study aims to identify the pathogens of diarrhea in Vientiane Capital, Lao People's Democratic Republic (Lao PDR). The data of 2482 patients who visited eight health facilities due to diarrhea in 2012-2015 were retrospectively reviewed. Stool or rectal swabs collected from all patients were tested for bacteria. Children who were under 5 years old were additionally tested for rotavirus. Of 2482 cases, 1566 cases were under 5 years old, and at least one enteropathogen was detected in 475 cases (19.1%). Salmonella species was the most commonly detected bacterial pathogen. Enteropathogenic Escherichia coli (EPEC) and Salmonella species was the major pathogen in the dry season and the wet season, respectively. Eighty-seven patients tested positive for multiple bacteria. Rotavirus was detected in 291 children under 5 years old (32.4%), mostly from October to April. The major bacteria of coinfection with rotavirus were EPEC followed by Salmonella species. Salmonella species was the predominant bacterial pathogen of diarrhea of all ages, and rotavirus was the predominant pathogen among children under 5 years old. Further studies examining other types of pathogens for diarrhea and the introduction of a rotavirus vaccine for children are needed in Lao PDR.
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Affiliation(s)
- Souphatsone Houattongkham
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Epidemiology Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Noikaseumsy Sithivong
- Laboratory Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Arounnapha Vongduangchanh
- Laboratory Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Onechanh Keosavanh
- Epidemiology Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR.,Laboratory Section, Bacteriology Unit, National Center for Laboratory and Epidemiology, Km 3 Thadeau Road, Ban Thaphalarnxay, Sisathanack district, Vientiane Capital, Lao PDR
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Moharana SS, Panda RK, Dash M, Chayani N, Bokade P, Pati S, Bhattacharya D. Etiology of childhood diarrhoea among under five children and molecular analysis of antibiotic resistance in isolated enteric bacterial pathogens from a tertiary care hospital, Eastern Odisha, India. BMC Infect Dis 2019; 19:1018. [PMID: 31791267 PMCID: PMC6889523 DOI: 10.1186/s12879-019-4501-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 09/24/2019] [Indexed: 01/03/2023] Open
Abstract
Background Although, India has made steady progress in reducing deaths in children younger than 5 years, the proportional mortality accounted by diarrhoeal diseases still remains high. The present hospital based cross sectional study was carried out to understand the prevalence of various bacterial pathogens associated with the diarrhoea cases in under 5 years age group. Methods During, 1st September, 2015 to 30th November 2017, all the childhood diarrhoea cases (≤5 yrs) of SCB Medical College in Odisha, India were included in the study. Stool samples were collected and processed for the isolation of causative bacterial pathogen and the isolated bacterial pathogens were subjected to antibiotic sensitivity testing, molecular analysis of drug resistance. Clinical and demographic data were collected and analyzed. Results Three hundred twenty patients were enrolled in the study during the study period from whom 82 bacterial isolates were obtained indicating a proportional causality of 25.6% for bacterial diarrhoea among children in this region. Entero toxigenic E.coli (ETEC) accounted for majority of the cases and and more than 50% of the strains were found to be multi-drug resistant (resistant to more than 3 class of antibiotics). More than 50% of the strains were resistant to current choice of treatment like ciprofloxacin, ofloxacin and ceftriaxone and 2.4% being resistant to Imipenem. ESBL production was also observed in some of the strains and one isolate harboured the NDM-1 gene. Fluoroquinolone resistance was found to be linked with multiple mutations in the QRDR region followed by PMQR determinants. Conclusion The current study, to the best of our knowledge is first of its kind which demonstrated the etiology of bacterial diarrhoea in children less than 5 years old and identified diarrheogenic E. coli as the predominant enteropathogen in Odisha. Majority of the isolates being multi-drug resistance calls for a continuous surveillance system in the region which will be helpfulin identifying emerging resistance pattern and for developing suitable intervention stategies.
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Affiliation(s)
- Sonam S Moharana
- Dept. of Microbiology, SCB Medical College (Govt. of Odisha), Manglabag, Cuttack, Odisha, 753007, India
| | - Rakesh K Panda
- Dept. of Microbiology, SCB Medical College (Govt. of Odisha), Manglabag, Cuttack, Odisha, 753007, India
| | - Muktikesh Dash
- Dept. of Microbiology, SCB Medical College (Govt. of Odisha), Manglabag, Cuttack, Odisha, 753007, India
| | - Nirupama Chayani
- Dept. of Microbiology, SCB Medical College (Govt. of Odisha), Manglabag, Cuttack, Odisha, 753007, India
| | - Priyanka Bokade
- Dept. of Bacteriology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Reserch, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Sanghamitra Pati
- Dept. of Bacteriology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Reserch, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India
| | - Debdutta Bhattacharya
- Dept. of Bacteriology & One Health, ICMR-Regional Medical Research Centre (Dept. of Health Reserch, Ministry of Health & Family Welfare, Govt. of India), Chandrasekharpur, Bhubaneswar, 751023, India.
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Sadiq A, Bokhari H, Noreen Z, Asghar RM, Bostan N. Magnitude of Rotavirus A and Campylobacter jejuni infections in children with diarrhea in Twin cities of Rawalpindi and Islamabad, Pakistan. BMC Infect Dis 2019; 19:978. [PMID: 31752744 PMCID: PMC6868847 DOI: 10.1186/s12879-019-4575-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/16/2019] [Indexed: 03/10/2023] Open
Abstract
Background Acute diarrhea is a leading cause of morbidity and mortality in children particularly in developing countries of Asia and Africa. The present study was conducted to detect the two most important pathogens, rotavirus and Campylobacter Jejuni in children suffering with diarrhea in Rawalpindi and Islamabad, Pakistan in 2014. The clinical and epidemiological aspects of the disease were also investigated. Methods A total of 500 stool samples were collected from children presented with clinical signs and symptoms of acute diarrhea. The samples were initially screened for the presence of rotavirus A (RVA) via ELISA (Enzyme-linked immunosorbent assay) and RT-PCR (Reverse Transcriptase PCR) and then were analysed for C. jejuni by using species specific PCR assay. Results The detection rate of RVA was 26.4% (132/500) while, Campylobacter was detected in 52% (260/500) of samples with C. jejuni accounted for 48.2% (241/500) of all study cases. Co-infection of C. jejuni with RVA was identified in 21.8% of all cases. Children with RVA and C. jejuni co-infection showed a higher probability (p = 0.01) to be dehydrated. A significant association (p = 0.02) was found between C. jejuni positive status and fever in children. The median age of children with both RVA and C. jejuni infection was 6–11 months. The RVA detection rate was high in winter months of the year while, C. jejuni infections were documented high in summer over 1 year study period. Conclusions The overall results have demonstrated the high prevalence of C. jejuni in Rawalpindi, Islamabad, Pakistan in 2014. The results of present study will not only help to calculate disease burden caused by C. jejuni and rotavirus but also will provide critical information to health authorities in planning public health care strategies against these pathogens.
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Affiliation(s)
- Asma Sadiq
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan
| | - Habib Bokhari
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan.
| | - Zobia Noreen
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan
| | | | - Nazish Bostan
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan.
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Zelelie TZ, Gebreyes DS, Tilahun AT, Craddock HA, Gishen NZ. Enteropathogens in Under-Five Children with Diarrhea in Health Facilities of Debre Berhan Town, North Shoa, Ethiopia. Ethiop J Health Sci 2019; 29:203-214. [PMID: 31011268 PMCID: PMC6460452 DOI: 10.4314/ejhs.v29i2.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Diarrheal disease is a major cause of mortality and morbidity for under-five children in Ethiopia. The purpose of this study was to investigate the behavioral and socioeconomic risk factors, etiology, and drug susceptibility of bacteria isolated from under-five children with acute diarrhea who were treated at Debre Berhan Referral Hospital or Health Center in Ethiopia. Methods A health facility based cross-sectional study design was used to investigate enteropathogens from 163 under-five children with acute diarrhea. After obtaining written consent from parents or guardians, data were collected using a standardized questionnaire. Freshly passed stool samples were collected for microbiological tests for bacteria and parasites. The chi-square test was used for assessing the relationships of variables. Results Enteropathogens were detected among 55.8% (91/163) participants. There was a 46%(75/163) bacterial culture positivity rate and a 9.8%(16/163) prevalence of parasites. The isolated enteropathogens were Escherchia coli, Klebsiella specie, Proteus species, Salmonella species, Shigella species, Enterobacter species, Giardia lamblia, Enteameba histolytica, Ascaris lumbricoides, Trichuris trichiura and Hymnoleps nana. Level of antimicrobial resistance of bacterial isolates ranged from 0 to 87.2%. Poor hand washing and poor cleaning of feeding utensils showed significant association with the presence of enteropathogens. Conclusion Bacterial enteropathogens with drug resistance were observed in this study. Continuous health education and promotion about diarrheal disease for mothers/caretakers and regular surveillance of entropathogenes are recommended to reduce under-five mortality.
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Affiliation(s)
- Tizazu Zenebe Zelelie
- Department of Medicine, Medical Microbiology Unit, Debre Berhan University, Ethiopia
| | | | | | | | - Nigus Zegeye Gishen
- Department of Medicine, Medical Microbiology Unit, Debre Berhan University, Ethiopia
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Bae JY, Lee DH, Ko KO, Lim JW, Cheon EJ, Song YH, Yoon JM. Clinical manifestation of Campylobacter enteritis in children. KOREAN JOURNAL OF PEDIATRICS 2018; 61:84-89. [PMID: 29628968 PMCID: PMC5876509 DOI: 10.3345/kjp.2018.61.3.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/08/2017] [Accepted: 10/23/2017] [Indexed: 11/27/2022]
Abstract
Purpose Timely antibiotic therapy in selected cases of diarrhea associated with bacterial infections can reduce the duration and severity of illness and prevent complications. The availability of a predictive index before identification of causative bacteria would aid in the choice of a therapeutic agent. Methods The study included patients admitted to the pediatrics unit at Konyang University Hospital for acute inflammatory diarrhea from August 1, 2015 to July 31, 2016 who underwent multiplex polymerase chain reaction testing. Of 248 patients, 83 had positive results. The clinical symptoms and blood test results were examined in 61 patients with Campylobacter spp. (25 patients), Salmonella spp. (18 patients), and Clostridium perfringens (18 patients) infections. The mean age of the 61 patients (male:femal=31:30) was 84.0±54.8 months, and the mean hospital stay was 4.6±1.7 days. Results There were no statistical differences in sex, age, clinical symptoms, or signs. Patients with Campylobacter infection were significantly older (P=0.00). C-reactive protein (CRP) levels in patients with Campylobacter infection were higher than those in the other 2 groups, at 9.6±6.1 mg/dL. The results of receiver-operating characteristic curve analysis showed that the cutoff age was ≥103.5 months (sensitivity, 72%; specificity, 86%) and the CRP cutoff level was ≥4.55 mg/dL (sensitivity, 80%; specificity, 69%). Conclusion Age (≥103.5 months) and higher CRP level (≥4.55 mg/dL) were good predictors of Campylobacter enterocolitis. If neither criterion was met, Campylobacter enterocolitis was unlikely (negative predictive value 97.2%). When both criteria were met, Campylobacter enterocolitis was highly likely.
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Affiliation(s)
- Joon Yeol Bae
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Dong Hyuk Lee
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Ok Ko
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Jeong Cheon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hwa Song
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University College of Medicine, Daejeon, Korea
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Duong VT, Tuyen HT, Van Minh P, Campbell JI, Phuc HL, Nhu TDH, Tu LTP, Chau TTH, Nhi LTQ, Hung NT, Ngoc NM, Huong NTT, Vi LL, Thompson CN, Thwaites GE, de Alwis R, Baker S. No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting. Clin Infect Dis 2018; 66:504-511. [PMID: 29029149 PMCID: PMC5850041 DOI: 10.1093/cid/cix844] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022] Open
Abstract
Background Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR). Methods We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome. Results Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases. Conclusions In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea.
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Affiliation(s)
- Vu Thuy Duong
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Children’s Hospital 1, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - Pham Van Minh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - James I Campbell
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | | | - Tran Do Hoang Nhu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - Le Thi Phuong Tu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Tran Thi Hong Chau
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - Le Thi Quynh Nhi
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | - Lu Lan Vi
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Corinne N Thompson
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
| | - Guy E Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
| | - Ruklanthi de Alwis
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
- The Department of Medicine, University of Cambridge, United Kingdom
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11
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Mbuthia OW, Mathenge SG, Oyaro MO, Ng'ayo MO. Etiology and pathogenicity of bacterial isolates: a cross sectional study among diarrheal children below five years in central regions of Kenya. Pan Afr Med J 2018; 31:88. [PMID: 31011389 PMCID: PMC6462152 DOI: 10.11604/pamj.2018.31.88.15644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/20/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education. METHODS A cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable. RESULTS There were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%). CONCLUSION Salmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001).
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Affiliation(s)
| | | | - Micah Ongeri Oyaro
- Human Pathology Department, Immunology Unit, University of Nairobi, Nairobi Kenya
| | - Musa Otieno Ng'ayo
- Centre of Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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12
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Ashie GK, Mutocheluh M, Owusu M, Kwofie TB, Akonor S, Narkwa PW, Nguah SB, Dogbe J. Microbial pathogens associated with acute childhood diarrhoea in Kumasi, Ghana. BMC Res Notes 2017; 10:264. [PMID: 28693616 PMCID: PMC5504554 DOI: 10.1186/s13104-017-2578-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background Diarrhoeal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in sub-Saharan Africa. This case–control study was conducted to investigate the bacterial, viral and parasitic pathogens associated with acute diarrhoea among children attending three health facilities in Kumasi, Ghana. Methods Stool specimens were collected from 240 children under 5 years of age visiting hospitals in Kumasi, Ghana due to acute diarrhoea and from 107 healthy controls of similar age. Both intestinal and malaria parasites were diagnosed by microscopy whereas rota- and adenoviruses were identified by stool antigen immunochromatograhic testing. Bacterial enteropathogens were detected by conventional culture techniques. Results Of all subjects, 23 (6.6%) were positive for malaria parasitaemia, 139 (40.1%) had at least one bacterial agent in their stool and 25 (7.2%) had ova or parasites. Subjects infected with malaria had the highest odds of having diarrhoea [12.0 (95% CI 1.56, 92.35)] followed by those with rotaviruses [4.4 (95% CI 2.05, 9.47)] and bacterial infection [4.99 (95% CI 1.45, 17.17)]. Conclusion In conclusion, this study was unique as it looked at the three groups of pathogens (parasites, viruses and bacteria) that cause acute diarrhoea in children in the Kumasi metropolis of Ghana. This study has shown for the first time since 2004 that malaria parasitaemia, rotavirus and bacterial infections still remain common pathogens associated with acute childhood diarrhoea in the Kumasi metropolis of Ghana.
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Affiliation(s)
- Gilbert Kotei Ashie
- Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohamed Mutocheluh
- Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Michael Owusu
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Theophilus Benjamine Kwofie
- Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Akonor
- Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Patrick Williams Narkwa
- Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Blay Nguah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joslin Dogbe
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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13
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Shrivastava AK, Kumar S, Mohakud NK, Suar M, Sahu PS. Multiple etiologies of infectious diarrhea and concurrent infections in a pediatric outpatient-based screening study in Odisha, India. Gut Pathog 2017; 9:16. [PMID: 28400860 PMCID: PMC5387278 DOI: 10.1186/s13099-017-0166-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 03/27/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are multiple etiologies responsible for infectious gastroenteritis causing acute diarrhea which are often under diagnosed. Also acute diarrhea is one of the major causes of morbidity and mortality among children less than 5 years of age. METHODS In our study, fecal samples (n = 130) were collected from children (<5 years) presenting with symptoms of acute diarrhea. Samples were screened for viral, bacterial, and parasitic etiologies. Rotavirus and Adenovirus were screened by immunochromatographic tests. Diarrheagenic Escherichia coli (EPEC, EHEC, STEC, EAEC, O157, O111), Shigella spp., Salmonella spp., Vibrio cholera, Cryptosporidium spp., and Giardia spp. were detected by gene-specific polymerase chain reaction. RESULTS Escherichia coli was detected to be the major etiological agent (30.07%) followed by Rotavirus (26.15%), Shigella (23.84%), Adenovirus (4.61%), Cryptosporidium (3.07%), and Giardia (0.77%). Concurrent infections with two or more pathogens were observed in 44 of 130 (33.84%) cases with a predominant incidence particularly in <2-year-old children (65.90%) compared to children of 2-5 years age group (34.09%). An overall result showed significantly higher detection rates among children with diarrhea in both combinations of two as well as three infections concurrently (p = 0.004915 and 0.03917, respectively). CONCLUSION Suspecting possible multiple infectious etiologies and diagnosis of the right causative agent(s) can aid in a better pharmacological management of acute childhood diarrhea. It is hypothesized that in cases with concurrent infections the etiological agents might be complementing each other's strategies of pathogenesis resulting in severe diarrhea that could be studied better in experimental infections.
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Affiliation(s)
- Arpit Kumar Shrivastava
- Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India
| | - Subrat Kumar
- Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India
| | - Nirmal Kumar Mohakud
- Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha 751024 India
| | - Mrutyunjay Suar
- Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India
| | - Priyadarshi Soumyaranjan Sahu
- Infection Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha 751024 India.,Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha 751024 India.,Divisions of Pathology, School of Medicine, International Medical University, 57000 Kuala Lumpur, Malaysia
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14
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Kim Y, Kim HJ, Lim S, Bae KS, Han SB, Jeong DC, Kang JH, Shin GJ, Lee GD, Park YJ. Community-acquired Escherichia coli Enteritis in Korean Children: The Clinical Application of a Stool Polymerase Chain Reaction Assay. Infect Chemother 2017; 49:275-281. [PMID: 29299895 PMCID: PMC5754338 DOI: 10.3947/ic.2017.49.4.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/28/2017] [Indexed: 01/31/2023] Open
Abstract
Background Although Escherichia coli is a common cause of bacterial enteritis in Korea, reports on community-acquired E. coli enteritis in Korean children are scarce. This study aimed to determine the clinical characteristics and pathotype distribution of community-acquired E. coli enteritis diagnosed by a multiplex polymerase chain reaction (PCR) assay in Korean children. Materials and Methods The medical records of children aged 18 years or less who were diagnosed with acute gastroenteritis by the attending physician between 2013 and 2016 were retrospectively reviewed. The clinical characteristics of children diagnosed with E. coli enteritis were investigated and compared with those diagnosed with Salmonella enteritis. E. coli and Salmonella infections were diagnosed by a stool PCR assay. Results Among 279 children, in whom PCR assays for E. coli and Salmonella spp. were performed, Salmonella enteritis and E. coli enteritis were diagnosed in 43 (15.4%) and 39 (14.0%) children, respectively. Among the 39 children with E. coli enteritis, enteropathogenic E. coli (n=21, 53.8%) and enteroaggregative E. coli (n=15, 38.4%) were the most common causative agents. Empirical antibiotics were administered to 33 (84.6%) children. A total of 31 (79.5%) children developed fever, and 25 (80.6%) of them had the fever for 3 days or less, which resolved a median of 1 day (range 0-3 days) after hospitalization. The most frequent gastrointestinal symptom was diarrhea (n=36, 92.3%). Significantly more children with E. coli enteritis were aged 2 years or less as compared with those with Salmonella enteritis (41.0% vs. 21.9%, P = 0.021). Children with Salmonella enteritis more frequently complained of fever (97.7% vs. 79.5%, P = 0.012), abdominal pain (90.7% vs. 64.1%, P = 0.004), and hematochezia (46.5% vs. 10.3%, P <0.001) than those with E. coli enteritis. Erythrocyte sedimentation rate and C-reactive protein levels were significantly higher in children with Salmonella enteritis than those with E. coli enteritis (P <0.001). Conclusion Enteropathogenic E. coli was the most frequent pathotype in Korean children with E. coli enteritis that caused mild clinical symptoms. A stool PCR assay for E. coli may be useful for epidemiological purpose and for an early diagnosis of E. coli enteritis.
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Affiliation(s)
- Youie Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Jin Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sooyeon Lim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kil Seong Bae
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Beom Han
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Dae Chul Jeong
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Vaccine Bio Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gook Jae Shin
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gun Dong Lee
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Joon Park
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Clinical and Laboratory Characteristics of Pediatric Campylobacter spp. Acute Gastroenteritis. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.35730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Qu M, Lv B, Zhang X, Yan H, Huang Y, Qian H, Pang B, Jia L, Kan B, Wang Q. Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhea in Beijing, China (2010-2014). Gut Pathog 2016; 8:31. [PMID: 27303446 PMCID: PMC4906916 DOI: 10.1186/s13099-016-0116-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/03/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diarrhea is one of the main causes of morbidity and mortality among children less than 5 years of age worldwide, and its causes vary by region. This study aimed to determine the etiologic spectrum, prevalent characteristics and antimicrobial resistance patterns of common enteropathogenic bacteria from diarrheagenic children in Beijing, the capital of China. METHODS Stool samples were collected from 2524 outpatients who were aged 0-5 years in Beijing, China during 2010-2014. Microbiological methods, real-time PCR and antimicrobial susceptibility test were used to identify the bacterial causes and antimicrobial resistance patterns in the isolates. RESULTS Of the 2524 patients screened, we identified the causes of 269 cases (10.7 %) as follows: diarrheagenic Escherichia coli (4.6 %), Salmonella (4.3 %), Shigella (1.4 %) and Vibrio parahaemolyticus (0.4 %). Atypical EPEC, Salmonella enteritidis, Shigella sonnei and serotype O3:K6 were the most common serogroups or serotypes of the four etiological bacteria. The prevalence of pathogens was correlated with age, season and clinical symptoms. The highest proportion of all causative bacteria was found in children aged 3-5 years and in summer. The clinical symptoms associated with specific bacterial infection, such as fever; abdominal pain; vomiting; and watery, mucus, and bloody stool, were observed frequently in diarrheal patients. Salmonella showed moderate rates of resistance (40-60 %) to ampicillin, nalidixic acid, streptomycin and sulfisoxazole. Resistance to at least three antimicrobials was found in 50 % of isolates. Of the top three serotypes in Salmonella, high-level antimicrobial resistance to single and multiple antibiotics was more common among Salmonella typhimurium and Salmonella 1, 4, [5], 12:i:- than among S. enteritidis. More than 90 % of Shigella isolates showed more alarming resistance to most antibiotics, with a widened spectrum compared to Salmonella. CONCLUSION Constant antibiotic surveillance is warranted because the bacteria were highly resistant to various antimicrobials. Our study contributes to the strengthening of the existing surveillance system and provides aid for effective prevention and control strategies for childhood diarrhea.
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Affiliation(s)
- Mei Qu
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
| | - Bing Lv
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
| | - Xin Zhang
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
| | - Hanqiu Yan
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
| | - Ying Huang
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
| | - Haikun Qian
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
| | - Bo Pang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, 102206 People's Republic of China
| | - Lei Jia
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
| | - Biao Kan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, 102206 People's Republic of China
| | - Quanyi Wang
- Department of Infectious and Endemic Diseases Control, Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, No. 16 He Ping Li Middle Street, Beijing, 100013 People's Republic of China
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Abstract
Diarrheal diseases remain a leading cause of global childhood mortality and morbidity. Several recent epidemiological studies highlight the rate of diarrheal diseases in different parts of the world and draw attention to the impact on childhood growth and survival. Despite the well-documented global burden of diarrheal diseases, currently there are no combination diarrheal vaccines, only licensed vaccines for rotavirus and cholera, and Salmonella typhi-based vaccines for typhoid fever. The recognition of the impact of diarrheal episodes on infant growth, as seen in resource-poor countries, has spurred action from governmental and non-governmental agencies to accelerate research toward affordable and effective vaccines against diarrheal diseases. Both travelers and children in endemic countries will benefit from a combination diarrheal vaccine, but it can be argued that the greater proportion of any positive impact will be on the public health status of the latter. The history of combination pediatric vaccines indicate that monovalent or single disease vaccines are typically licensed first prior to formulation in a combination vaccine, and that the combinations themselves undergo periodic revision in response to need for improvement in safety or potential for wider coverage of important pediatric pathogens. Nevertheless combination pediatric vaccines have proven to be an effective tool in limiting or eradicating communicable childhood diseases worldwide. The landscape of diarrheal vaccine candidates indicates that there now several in active development that offer options for potential testing of combinations to combat those bacterial and viral pathogens responsible for the heaviest disease burden—rotavirus, ETEC, Shigella, Campylobacter, V. cholera and Salmonella.
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Affiliation(s)
- Malabi M Venkatesan
- a Bacterial Diseases Branch; Walter Reed Army Institute of Research ; Silver Spring , MD , USA
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18
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Prediction of Intra-Species Protein-Protein Interactions in Enteropathogens Facilitating Systems Biology Study. PLoS One 2015; 10:e0145648. [PMID: 26717407 PMCID: PMC4699205 DOI: 10.1371/journal.pone.0145648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
Protein-protein interactions in Escherichia coli (E. coli) has been studied extensively using high throughput methods such as tandem affinity purification followed by mass spectrometry and yeast two-hybrid method. This can in turn be used to understand the mechanisms of bacterial cellular processes. However, experimental characterization of such huge amount of interactions data is not available for other important enteropathogens. Here, we propose a support vector machine (SVM)-based prediction model using the known PPIs data of E. coli that can be used to predict PPIs in other enteropathogens, such as Vibrio cholerae, Salmonella Typhi, Shigella flexneri and Yersinia entrocolitica. Different features such as domain-domain association (DDA), network topology, and sequence information were used in developing the SVM model. The proposed model using DDA, degree and amino acid composition features has achieved an accuracy of 82% and 62% on 5-fold cross validation and blind E. coli datasets, respectively. The predicted interactions were validated by Gene Ontology (GO) semantic similarity measure and String PPIs database (experimental PPIs only). Finally, we have developed a user-friendly webserver named EnPPIpred to predict intra-species PPIs in enteropathogens, which will be of great help for the experimental biologists. The webserver EnPPIpred is freely available at http://bicresources.jcbose.ac.in/ssaha4/EnPPIpred/.
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19
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Li LL, Liu N, Humphries EM, Yu JM, Li S, Lindsay BR, Stine OC, Duan ZJ. Aetiology of diarrhoeal disease and evaluation of viral-bacterial coinfection in children under 5 years old in China: a matched case-control study. Clin Microbiol Infect 2015; 22:381.e9-381.e16. [PMID: 26724990 PMCID: PMC4865875 DOI: 10.1016/j.cmi.2015.12.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/10/2015] [Accepted: 12/18/2015] [Indexed: 01/21/2023]
Abstract
Globally, diarrhoeal diseases are the second leading cause of death among children under 5 years old. Few case-control studies on the aetiology of diarrhoea have been conducted in China. A case-control study on 922 children under 5 years old who presented with diarrhoea and individually matched controls was conducted in China between May 2011 and January 2013. Quantitative PCR was used to analyze stool samples for 10 diarrhoeal pathogens. Potential enteric pathogens were detected in 377 (81.8%) of 461 children with diarrhoea and 215 controls (46.6%, p <0.001). Rotavirus, norovirus GII, Shigella and adenovirus were qualitatively associated with diarrhoea. Using receiver operating characteristic curves, the optimal cutoff threshold for defining a symptomatic individual was 72, 5840, and 10(4) copies per reaction for rotavirus (odds ratio 259), norovirus GII (odds ratio 10.6) and Shigella (odds ratio 5.1). The attributable fractions were 0.18 for rotavirus, 0.08 for norovirus GII, 0.01 for Shigella and 0.04 for adenovirus. Coinfections between pathogens were common. Two pairs, rotavirus and adenovirus, and norovirus GII and Salmonella were positively associated. The co-occurrence of rotavirus and sapovirus, astrovirus, enterotoxigenic Escherichia coli or Campylobacter jejuni only occurred in children with disease. Coinfection was not correlated with clinical symptoms. Quantitative data are critical. Our results indicate that increased pathogen loads increase the OR between diarrhoea and rotavirus, norovirus GII and Shigella. Coinfections with rotavirus and norovirus GII are common and occur in a nonrandom distribution. Despite testing for ten diarrhoeal pathogens, over two-thirds of cases do not have a recognized attributable cause.
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Affiliation(s)
- L L Li
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - N Liu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - E M Humphries
- University of Maryland, School of Medicine, Baltimore, MD, USA
| | - J M Yu
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China
| | - S Li
- University of Maryland, School of Medicine, Baltimore, MD, USA
| | - B R Lindsay
- University of Maryland, School of Medicine, Baltimore, MD, USA; Merck & Co. Inc., North Wales, PA, USA
| | - O C Stine
- University of Maryland, School of Medicine, Baltimore, MD, USA.
| | - Z J Duan
- National Institute for Viral Disease Control and Prevention, China CDC, Beijing, China.
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Wang X, Wang J, Sun H, Xia S, Duan R, Liang J, Xiao Y, Qiu H, Shan G, Jing H. Etiology of Childhood Infectious Diarrhea in a Developed Region of China: Compared to Childhood Diarrhea in a Developing Region and Adult Diarrhea in a Developed Region. PLoS One 2015; 10:e0142136. [PMID: 26528820 PMCID: PMC4631449 DOI: 10.1371/journal.pone.0142136] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/16/2015] [Indexed: 01/22/2023] Open
Abstract
In China, great differences in economy, social characteristics and hygiene exist between developing and developed regions. A comparative study of infectious diarrhea between two regions was needed. Three groups of diarrheal patients were collected: children ≤5 year-olds from Beijing (developed region) and Henan Province (developing region), and adults over 18 year-olds from Beijing. A questionnaire was used to survey and feces samples were examined for 16 enteropathogens. We enrolled 1422 children and 1047 adults from developed region and 755 children from developing region. Virus positive rates were 32.98% for children and 23.67% for adults in developed region. The most prevalent pathogen for children was rotavirus whereas for adults was norovirus. Bacterial isolation rates were 13.92% for children from developed region, while 29.14% for children from the developing regions. For the greatest difference, Shigella accounted for 50.79% and was the dominant pathogen in the developing region, whereas in the developed region it was only 1.45%. There was no significant relationship between the local levels of development with diarrheogenic Escherichia coli (DEC) categories. But it was seen the notable differences between the population with different age: enteropathogenic E.coli (EPEC) and enteroaggregative E.coli (EAggEC) were the primary classes of DEC in children from both regions, whereas it was enterotoxigenic E.coli (ETEC) in adults. The symptoms of Shigella and Salmonella infection, such as bloody stools, white blood cells (WBC) and red blood cells (RBC) positivity and fever were similar in children, which may lead to the misidentification. Yersinia enterocolitica and shiga toxin-producing E.coli (STEC) infections were firstly reported in Beijing. There was a large difference in etiology of bacterial diarrhea between children in developing and developed regions of China.
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Affiliation(s)
- Xin Wang
- Institute of Basic Medicine Science, Chinese Academy of Medicine Sciences, School of Basic Medicine, Peking Union Medicine College, Beijing, China
- National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Jing Wang
- Department of Infectious Disease, Dongcheng Centre for Disease Control and Prevention, Beijing, China
| | - Hao Sun
- Department of Infectious Disease, Dongcheng Centre for Disease Control and Prevention, Beijing, China
| | - Shengli Xia
- Department of Infectious Disease, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, China
| | - Ran Duan
- National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Junrong Liang
- National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yuchun Xiao
- National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Haiyan Qiu
- National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Guangliang Shan
- Institute of Basic Medicine Science, Chinese Academy of Medicine Sciences, School of Basic Medicine, Peking Union Medicine College, Beijing, China
- * E-mail: (HJ); (GS)
| | - Huaiqi Jing
- National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
- * E-mail: (HJ); (GS)
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