Spatiotemporal distribution of climate-sensitive disease incidences in ethiopia: a longitudinal retrospective analysis of Malaria, Meningitis, Cholera, Dysentery, Leishmaniasis and Dengue fever between 2010 and 2022/2023

BACKGROUND

Understanding the temporal and geographic distribution of disease incidences is crucial for effective public health planning and intervention strategies. This study presents a comprehensive analysis of the spatiotemporal distribution of disease incidences in Ethiopia, focusing on six major diseases: Malaria, Meningitis, Cholera and Dysentery, over the period from 2010 to 2022, whereas Dengue Fever and Leishmaniasis from 2018 to 2023.

METHODS

Using data from Ethiopian public health institute: public health emergency management (PHEM), and Ministry of Health, we examined the occurrence and spread of each disease across different regions of Ethiopia. Spatial mapping and time series analysis were employed to identify hotspots, trends, and seasonal variations in disease incidence.

RESULTS

The findings reveal distinct patterns for each disease, with varying cases and temporal dynamics. Monthly wise, Malaria exhibits a cyclical pattern with a peak during the rainy and humid season, while Dysentery, Meningitis and Cholera displays intermittent incidences. Dysentery cases show a consistent presence throughout the years, while Meningitis remains relatively low in frequency but poses a potential threat due to its severity. Dengue fever predominantly occurs in the eastern parts of Ethiopia. A significant surge in reported incident cases occurred during the years 2010 to 2013, primarily concentrated in the Amhara, Sidama, Oromia, Dire Dawa, and Benishangul-Gumuz regions.

CONCLUSIONS

This study helps to a better understanding of disease epidemiology in Ethiopia and can serve as a foundation for evidence-based decision-making in disease prevention and control. By recognizing the patterns and seasonal changes associated with each disease, health authorities can implement proactive measures to mitigate the impact of outbreaks and safeguard public health in the region.

Vaccine value profile for Shigella

Shigella is the leading bacterial cause of diarrhoea and the second leading cause of diarrhoeal mortality among all ages. It also exhibits increasing levels of antibiotic resistance. The greatest burden is among children under five in low- and middle-income countries (LMICs). As such, a priority strategic goal of the World Health Organization (WHO) is the development of a safe, effective and affordable vaccine to reduce morbidity and mortality from Shigella-attributable dysentery and diarrhea, including long term outcomes associated with chronic inflammation and growth faltering, in children under 5 years of age in LMICs. In addition, a safe and effective Shigella vaccine is of potential interest to travellers and military both to prevent acute disease and rarer, long-term sequelae. An effective Shigella vaccine is also anticipated to reduce antibiotic use and thereby help diminish further emergence of enteric pathogens resistant to antimicrobials. The most advanced vaccine candidates are multivalent, parenteral formulations in Phase 2 and Phase 3 clinical studies. They rely on O-antigen-polysaccharide protein conjugate technologies or, alternatively, outer membrane vesicles expressing penta-acylated lipopolysaccharide that has been detoxified. Other parenteral and oral formulations, many delivering a broader array of Shigella antigens, are at earlier stages of clinical development. These formulations are being assessed in alignment with the WHO Preferred Product Characteristics, which call for a 1 to 2 dose primary immunization series given during the first 12 months of life, ideally starting at 6 months of age. This 'Vaccine Value Profile' (VVP) for Shigella is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, government agencies and multi-lateral organizations. All contributors have extensive expertise on various elements of the Shigella VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.

Diagnostic value of serum procalcitonin and C-reactive protein in discriminating between bacterial and nonbacterial colitis: a retrospective study

BACKGROUND

Differentiating between bacterial and nonbacterial colitis remains a challenge. We aimed to evaluate the value of serum procalcitonin (PCT) and C-reactive protein (CRP) in differentiating between bacterial and nonbacterial colitis.

METHODS

Adult patients with three or more episodes of watery diarrhea and colitis symptoms within 14 days of a hospital visit were eligible for this study. The patients' stool pathogen polymerase chain reaction (PCR) testing results, serum PCT levels, and serum CRP levels were analyzed retrospectively. Patients were divided into bacterial and nonbacterial colitis groups according to their PCR. The laboratory data were compared between the two groups. The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic accuracy.

RESULTS

In total, 636 patients were included; 186 in the bacterial colitis group and 450 in the nonbacterial colitis group. In the bacterial colitis group, Clostridium perfringens was the commonest pathogen (n=70), followed by Clostridium difficile toxin B (n=60). The AUC for PCT and CRP was 0.557 and 0.567, respectively, indicating poor discrimination. The sensitivity and specificity for diagnosing bacterial colitis were 54.8% and 52.6% for PCT, and 52.2% and 54.2% for CRP, respectively. Combining PCT and CRP measurements did not increase the discrimination performance (AUC, 0.522; 95% confidence interval, 0.474-0.571).

CONCLUSION

Neither PCT nor CRP helped discriminate bacterial colitis from nonbacterial colitis.

Shigellosis in Southeast Asia: A systematic review and meta-analysis

BACKGROUND

Southeast Asia is attractive for tourism. Unfortunately, travelers to this region are at risk of becoming infected with Shigella. We conducted a meta-analysis to provide updates on Shigella prevalence in Southeast Asia, along with their serogroups and serotypes.

METHODS

We conducted a systematic search using PubMed, EMBASE, and Web of Science for peer-reviewed studies from 2000 to November 2022. We selected studies that detected Shigella in stools by culture or polymerase chain reaction (PCR). Two reviewers extracted the data using a standardized form and performed quality assessments using the Joanna Briggs Institute checklist. The random effects model was used to estimate the pooled prevalence of Shigella.

RESULTS

During our search, we identified 4376 studies. 29 studies (from six Southeast Asian countries) were included in the systematic review, 21 each in the meta-analysis of the prevalence of Shigella (Sample size: 109545) and the prevalence of Shigella serogroups. The pooled prevalence of Shigella was 4% (95% CI: 4-5%) among diarrhea cases. Shigella sonnei was the most abundant serogroup in Thailand (74%) and Vietnam (57%), whereas Shigella flexneri was dominant in Indonesia (72%) and Cambodia (71%). Shigella dysenteriae and Shigella boydii were uncommon (pooled prevalence of 1% each). The pooled prevalence of Shigella was 5% (95% CI: 4-6%) in children aged <5 years. The pooled prevalence showed a decreasing trend comparing data collected between 2000-2013 (5%; 95% CI: 4-6%) and between 2014-2022 (3%; 95% CI: 2-4%). Shigella prevalence was 6% in studies that included participants with mixed pathogens versus 3% in those without. Shigella flexneri serotype 2a was the most frequently isolated (33%), followed by 3a (21%), 1b (10%), 2b (3%), and 6 (3%).

CONCLUSIONS

This study provides compelling evidence for the development of effective Shigella vaccines for residents of endemic regions and travellers to these areas.

Shigella-Controlled Human Infection Models: Current and Future Perspectives

Shigella-controlled human infection models (CHIMs) are an invaluable tool utilized by the vaccine community to combat one of the leading global causes of infectious diarrhea, which affects infants, children and adults regardless of socioeconomic status. The impact of shigellosis disproportionately affects children in low- and middle-income countries (LMICs) resulting in cognitive and physical stunting, perpetuating a cycle that must be halted. Shigella-CHIMs not only facilitate the early evaluation of enteric countermeasures and up-selection of the most promising products but also provide insight into mechanisms of infection and immunity that are not possible utilizing animal models or in vitro systems. The greater understanding of shigellosis obtained in CHIMs builds and empowers the development of new generation solutions to global health issues which are unattainable in the conventional laboratory and clinical settings. Therefore, refining, mining and expansion of safe and reproducible infection models hold the potential to create effective means to end diarrheal disease and associated co-morbidities associated with Shigella infection.

Postinfection Irritable Bowel Syndrome

Following acute gastroenteritis (AGE) due to bacteria, viruses, or protozoa, a subset of patients develop new onset Rome criteria positive irritable bowel syndrome (IBS), called postinfection IBS (PI-IBS). The pooled prevalence of PI-IBS following AGE was 11.5%. PI-IBS is the best natural model that suggests that a subset of patients with IBS may have an organic basis. Several factors are associated with a greater risk of development of PI-IBS following AGE including female sex, younger age, smoking, severity of AGE, abdominal pain, bleeding per rectum, treatment with antibiotics, anxiety, depression, somatization, neuroticism, recent adverse life events, hypochondriasis, extroversion, negative illness beliefs, history of stress, sleep disturbance, and family history of functional gastrointestinal disorders (FGIDs), currently called disorder of gut-brain interaction. Most patients with PI-IBS present with either diarrhea-predominant IBS or the mixed subtype of IBS, and overlap with other FGIDs, such as functional dyspepsia is common. The drugs used to treat non-constipation IBS may also be useful in PI-IBS treatment. Since randomized controlled trials on the efficacy of drugs to treat PI-IBS are rare, more studies are needed on this issue.

Antibacterial and antishigellosis activity of Xylopia staudtii (engl. & diels), Annonaceae

ETHNOPHARMACOLOGICAL RELEVANCE

Xylopia staudtii is a medicinal plant which fruits are traditionally used in western Cameroon as a spice in the preparation of soups known for their abdominal cramp relieving properties. Often identified as Xylopia africana, its bark is used in the treatment of dysentery in Mont Cameroun localities. This plant could therefore contain active ingredients against intestinal pathogens, including Shigella spp, which are responsible of the deathly dysenteric diarrhoea.

AIM OF THE STUDY

This study aims to assess the efficacy of the hydroethanolic extract from Xylopia staudtii bark in immunodepressed mice infected with Shigella flexneri.

MATERIALS AND METHODS

Qualitative detection of compounds in the crude extract was done using UPLC-DAD-(HR) ESI-MS analysis in an attempt to link the activity to the chemical composition. The MIC and the MBC of the extract was determined using broth dilution method. Shigellosis was induced by intraperitoneal administration of Shigella flexneri to immunodepressed mice pretreated with streptomycin. These infected mice were then treated with the extract (100, 200 and 400 mg/kg), and reference substances (ciprofloxacin and saline). During the 9 days of treatment, animal morphology, fecal pathology and deaths were recorded. At the end of the treatment period, blood and organs were collected from any surviving animals for hematological, biochemical and histopathological analyses.

RESULTS

The extract was found to be significantly active, with a bactericidal effect against Shigella and a bacteriostatic effect against Escherichia coli. It was able to reduce and stop the faecal pathology caused by the infection in mice, as well as the rate of deaths which was brought to zero (0) in animal treated at 400 mg/kg. The bacteria load in faeces was reduced by 100% in animal treated at 400 mg/kg. Xylopia staudtii extract elicited anti-inflammatory properties by reducing MPO activity and Lcn2 intestinal level. It also prevents damages in the intestinal tissue and the shortening of colon which characterise Shigella infection. The serum level of ASAT, ALAT, bilirubin, urea and creatinine in animals treated with the extract was similar to those of normal animal used in the study. These activities of the plant may be due at least in part to the presence of ent-kauran type diterpens such as kaurenoic acid identified in the extract.

CONCLUSION

These findings support the usage of Xylopia staudtii as an antimicrobial against bacillary dysentery, making this plant a potential candidate for the formulation of an improved standardized traditional medicine.

Edwardsiella ictaluri, an unusual cause of bacteraemia in a Nigerian child with acute bloody diarrhoea

Enteric septicaemia of catfish was first detected in 1976 as an economically significant disease associated with commercial catfish production. Initially, Edwardsiella ictaluri was a host specific pathogen of catfish species but has also been reported from other hosts other than the catfish such as the zebrafish. E. ictaluri has not been isolated in humans hence it is not a zoonotic infection. There has been no previous report of isolation of this organism in humans. This was a case report of a 5 year old boy who presented with fever, vomiting, passage of bloody stool of 6 days and abdominal pain of a day duration. In the case of this 5 year old boy who presented with features of dysentery, blood culture using BACTEC™ grew E. ictaluri. E. ictaluri may be a pathogen which can infect humans just like another closely related species, Edwardsiella tarda. Although, E. ictaluri has not been reported in humans, could this be the first case? Non availability of diagnostic technique appropriate for its diagnosis may explain the rare incidence of the organism in humans, hence many cases would have been treated without isolating the organism.

Overt hematochezia : A rare gastrointestinal presentation in patients with corona virus disease 2019

World health care systems are affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and its associated disease, coronavirus disease 2019 (COVID-19). This new human pathogen mostly affects the respiratory system, but various extrapulmonary pathologies have been reported in the literature. It seems that the gastrointestinal system is one of the target organs for SARS-CoV- 2. Diarrhea as a long-term bowel symptom is not rare, although its occurrence is not as high as that of fever and cough.

Comparative analysis of fecal microbiota composition diversity in Tibetan piglets suffering from diarrheagenic Escherichia coli (DEC)

This study was ascertained to investigate the adverse effects of pathogenic E. coli on gut microbiota of Tibetan piglets with history of yellow and white dysentery. For this purpose, a total of 18 fecal samples were collected from infected and healthy Tibetan piglets for 16S rRNA gene amplification and sequencing of V3-V4 region. Results showed that Firmicutes, Bacteroidia Fusobacteriota, Proteobacteria and Actinobacteriota were the predominant bacteria in Tibetan piglets at the level of phylum classification. Results on classification at family level showed that Lactobacillus, Bacteroidota, Fusobacteriota and Enterobacteriaceae were the dominant bacteria. Results on classification of bacteria at phylum level compared with normal piglets indicated that Bacteroidota, Actinobacteriota, Euryarchaota and Spirochaetota in fecal microbial community in Tibetan piglets showing yellow dysenteric and diarrhea group were significantly decreased (P ≤ 0.05). Compared with the feces of healthy Tibetan piglets, the abundance of Escherichia-Shigella, Lactobacillus and Enterococcus increased significantly in feces of Tibetan piglets having yellow dysentery and white dysentery. Moreover, results exhibited that the Proteobacteria and Fusobacteriota were significantly increased (P ≤ 0.05) suggesting dominant microbial community. Results revealed that E. coli induced different pathological alterations in intestine including damage to intestinal epithelial cells, infiltration of inflammatory cells, presence of red blood cells in spaces of tissues, hemorrhages and necrosis of intestinal villi in piglets with history of yellow dysentery. This study for the first time reported the composition, characteristics, and differences of the fecal microflora diversity of Tibetan piglets with yellow and white dysentery in Qinghai-Tibet Plateau, which can provide a suitable support for effective control of diarrhoeal disease in these animals.

Association between floods and the risk of dysentery in China: a meta-analysis

The association between floods and the risk of dysentery remain controversial. Therefore, we performed a meta-analysis to clarify this relationship. A literature search was performed in PubMed, Web of science, and Embase for relevant articles published up to November 2019. Random-effects model was used to pool relative risks with 95% confidence intervals. The sensitivity analysis was carried out to evaluate the stability of the results. Publication bias was estimated using Egger's test. Eleven studies from 10 articles evaluated the association between floods and the risk of dysentery in China. The pooled RR (95% CI) of dysentery for the flooded time versus non-flooded period was 1.48 (95% CI: 1.14-1.91). Significant association was found in subgroup analysis stratified by dysentery styles [dysentery: 1.61 (95% CI: 1.34-1.93) and bacillary dysentery: 1.46 (95% CI: 1.06-2.01)]. The pooled RR (95%CI) of sensitivity analysis for dysentery was 1.26 (95% CI: 1.05-1.52). No significant publication bias was found in our meta-analysis. This meta-analysis confirms that floods have significantly increased the risk of dysentery in China. Our findings will provide more evidence to reduce negative health outcomes of floods in China.

Traditional Chinese medicines differentially modulate the gut microbiota based on their nature (Yao-Xing)

BACKGROUND

Property theory is a unique principle guiding traditional Chinese medicine (TCM) that classifies various TCMs into four natures (hot, warm, cool, and cold) to reflect their medical actions on the human body. Despite successful application for thousands of years, characterizing the nature of medical TCMs by modern physiological indicators remains a challenge.

PURPOSE

In this study, we investigated the potential relationship between the nature of TCMs and their modulation of the gut microbiota.

STUDY DESIGN

We selected twelve TCMs with hot, warm, cool, or cold natures that possess antidiarrheal effects. Their aqueous extracts were orally administered to C57BL/6 mice at a clinical dose for 4 weeks. The gut microbiota was measured by 16S rRNA-based metagenomics, and the correlation between microbial composition/function and TCM nature was analyzed.

RESULTS

Antidiarrheal TCMs with different natures showed distinct impacts on the gut microbiota. Hot-natured TCMs had no influence on the gut microbiota, warm-natured TCMs had a moderate influence, cool-natured TCMs had a strong influence, and cold-natured TCMs substantially changed the structure of the gut microbial community. The abundance of Anaerotruncus, Tyzzerella and Ruminiclostridium steadily increased, while that of Ruminococcaceae_UCG-010, Parasutterella and Bifidobacterium continuously decreased as the herbal nature turned from cold to hot. Microbiome functional prediction for Cluster of Orthologous Groups (COG) of proteins and Kyoto Encyclopedia of Genes and Genomes (KEGG) categories showed that colder TCMs imposed a stronger influence on microbial functional repertoires. Specifically, the abundance of ABC transporters, key bacterial proteins involved in nutrient absorption and drug resistance, was gradually decreased by colder TCMs.

CONCLUSION

Our results demonstrated that the nature of TCMs could be reflected by their modulation of gut microbes. Cold TCMs may exert their antidiarrheal effects, at least partially, by modulating the gut microbiota, while hot TCMs may alleviate dysentery in other ways.

Laboratory-based surveillance of Shigella spp. from human clinical cases in Colombia, 1997-2018

INTRODUCTION

Shigellosis is endemic in low-and middle-income countries, causing approximately 125 million episodes of diarrhea and leading to approximately 160 .000 deaths annually one-third of which is associated with children.

OBJECTIVE

To describe the characteristics and antimicrobial resistance profiles of Shigella species recovered in Colombia from 1997 to 2018.

MATERIALS AND METHODS

We received isolates from laboratories in 29 Colombian departments. We serotyped with specific antiserum and determined antimicrobial resistance and minimal inhibitory concentrations for ten antibiotics with Kirby-Bauer tests following the Clinical and Laboratory Standards Institute recommendations.

RESULTS

We analyzed 5,251 isolates of Shigella spp., most of them obtained from stools (96.4%); 2,511 (47.8%) were from children under five years of age. The two most common species were S. sonnei (55.1%) and S. flexneri (41.7%). The highest resistance rate was that of tetracycline (88.1%) followed by trimethoprim-sulfamethoxazole (79.3%) and ampicillin (65.5%); 50.8% of isolates were resistant to chloramphenicol, 43.6% to amoxicillin/clavulanic acid, and less than 1% to cefotaxime, ceftazidime, gentamicin, and ciprofloxacin. In S. sonnei, the most common resistance profile corresponded to trimethoprim-sulfamethoxazole (92%) whereas in S. flexneri the most common antibiotic profiles were multidrug resistance.

CONCLUSIONS

In Colombia, children under five years are affected by all Shigella species. These findings should guide funders and public health officials to make evidence based decisions for protection and prevention measures. The antimicrobial resistance characteristics found in this study underline the importance of combating the dissemination of the most frequently isolated species, S. sonnei and S. flexneri.

In vitro growth-inhibitory effects of Portulaca oleracea L. formulation on intestinal pathogens

Introduction

Empirical evidence suggests that Portulaca oleracea L. treats enteric infections, including dysentery, cholera, and acute infectious gastroenteritis.

Aim

The aim of this study is to clarify the growth-inhibitory effects of Portulaca oleracea L. extract against 56 strains of intestinal pathogens.

Methodology

‘Gogyo-so-cha (GSC)’ was used as the P. oleracea L. formulation. A growth curve analysis was used to measure the growth-inhibitory effects of GSC, and Shiga toxin induction was measured using the latex agglutination test.

Results

GSC demonstrated strong bactericidal effects against Shigella dysenteriae and Vibrio cholerae strains from various isolates. GSC demonstrated weak or no bactericidal effects against intestinal commensal bacteria, including Enterococcus spp. and Escherichia coli. GSC did not induce Shigella toxins.

Conclusion

GSC significantly inhibited the growth of intestinal pathogens, including S. dysenteriae and V. cholerae, without adversely affecting the intestinal flora, supporting the usage of GSC in traditional Chinese medicine. Taken together, GSC would be of immense value in the developing world, where diarrhoeal infectious diseases continue to pose a major health risk.

Dysentery as the only presentation of COVID-19 in a child: a case report

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has caused irreparable damage to society, and the damage continues. Pediatricians are confronted with COVID-19 in a variety of presentations, which may lead to delayed diagnosis and treatment. Early diagnosis of the disease plays an important role in preventing transmission of the virus in the community.

Case presentation

Here we report a 27-month-old previously healthy Iranian female child who presented with fever and bloody diarrhea, diagnosed with COVID-19 based on contact history, exclusion of enteric bacterial pathogens and parasites, and positive stool and nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction (RT-PCR) tests. The patient had viral shedding for more than a month.

Conclusions

The pediatric population usually does not present with typical clinical features of COVID-19, which are respiratory involvement. Dysentery may be the only presentation of this disease, and long-term isolation should be considered, as the viral shedding may last for more than a month.

[Spatio-temporal dynamics of bacillary dysentery outbreaks in Democratic Republic of the Congo, 1999-2013]

PROBLEM STATEMENT

From 1999 to 2013 in the Democratic RC, monitoring of bacillary dysentery in bloody diarrhea revealed an average rate of attack in 620 out of 100,000 inhabitants. Within the study period, biological confirmation was available in less than 1% of cases. A dozen dysentery outbreaks were confirmed in laboratories as shigellosis. In this study, our objective is to improve dysentery surveillance.

METHODS

A descriptive method based on epidemiological and biological data was applied, and a literature review was included.

RESULTS

According to historical research, the first dysentery epidemics occurred in the Mayombe Region in the early 1920s. Spatial dynamics show that the eastern part of the country experienced the highest number of attacks. Time series of bloody diarrhea in the country have revealed a decrease since 2005. No seasonality was found.

CONCLUSION

Shigellosis outbreaks have become rare and of low magnitude. Our results suggest a need for further exploration of the causes and determinants of high incidences of bloody diarrhea. Present-day diminution of shigellosis outbreaks calls for research into explanatory factors.

Testing the waters: Syndemic gastrointestinal distress in Lambaréné, Gabon, 1926-1932

This paper argues that a cluster of pathogens, hazardous labor conditions, and environmental constraints rendered chronic gastrointestinal distress fatal for African laborers living near Lambaréné, Gabon during the 1920s. Application of syndemic theory and epidemiological methods on patient records at Hospital Schweitzer, the central hospital of the region, explain how a seemingly simple diagnosis of chronic gastrointestinal distress belied a complex web of worsening biological and social outcomes for laborers in the tropical forests of central Gabon. An analysis of the syndemic suffering of GI patients reveals how the dysentery pathogen became tied to the peaks and valleys of the colonial economy, and in particular, the colonial extraction of tropical hardwoods. These processes culminated in the summer of 1929 when the highest number of timber exports coincided with the deadliest months of dysentery outbreak for the patient population at Hospital Schweitzer. This case study proposes syndemics as an effective theoretical framework to research historical precedents of the entanglement of people, pathogens, and illness.

High rate of resistance to ceftriaxone and azithromycin among Shigella spp. isolates at three children's referral hospitals in Northeast Iran

Acute dysentery is a prevalent case of hospital admission in developing countries, whose most common cause is believed to be Shigella species. Treatment failure employing oral or intravenous antibiotics is an increasing problem among children with dysentery. This is a prospective descriptive study that aims to find the antibiotic resistance pattern of Shigella spp. isolates from children with acute diarrhea in three children's referral hospitals in Mashhad, northeast-Iran. Between February 2018 to September 2019, a total of 233 stool samples were collected from children with inflammatory diarrhea. Shigella spp. were identified by culture and biochemical standard tests. Moreover, polyvalent Shigella antisera were used for serogrouping. The antibiotic susceptibility was performed by disk diffusion method. During the 9-month study period, a total of 94 non-duplicate clinical Shigella spp. were identified by culture and biochemical tests. Based on slide agglutination with appropriate group-specific polyvalent antisera, Shigella sonnei (70.2%) was found to be the most prevalent Shigella spp. followed by S. flexeneri (23.4%), S. dysentery (1%). Among isolates, S. boydii was not detected and five isolates (5.3%) were nonserotypable isolates. The resistance rate of Shigella spp. to azithromycin, ceftriaxone, ciprofloxacin, co-trimoxazole, nalidixic acid, gentamicin, amoxicillin, ampicillin, doxycycline and cefixime was 25.5%, 43.6%, 3.8%, 82.9%, 15.9%, 26.6%, 40.4%, 57.4%, 41.4%, 22.3%, respectively. The results revealed that the resistance of Shigella spp. to the three most commonly utilized antibiotics (azithromycin, ceftriaxone and, cefixime) is too high to recommend them as empirical therapy for children with acute dysentery in this city.

Impact of climate change on dysentery: Scientific evidences, uncertainty, modeling and projections

Dysentery is water-borne and food-borne infectious disease and its incidence is sensitive to climate change. Although the impact of climate change on dysentery is being studied in specific areas, a systematic review is lacking. We searched the worldwide literature using three sets of keywords and six databases. We identified and selected 98 studies during 1866-2019 and reviewed the relevant findings. Climate change, including long-term variations in factors, such as temperature, precipitation, and humidity, and short-term variations in extreme weather events, such as floods and drought, mostly had a harmful impact on dysentery incidence. However, some uncertainty over the exact effects of climate factors exists, specifically in the different indexes for the same climate factor, various determinant indexes for different dysentery burdens, and divergent effects for different population groups. These complicate the accurate quantification of such impacts. We generalized two types of methods: sensitivity analysis, used to detect the sensitivity of dysentery to climate change, including Pearson's and Spearman's correlations; and mathematical models, which quantify the impact of climate on dysentery, and include models that examine the associations (including negative binomial regression models) and quantify correlations (including single generalized additive models and mixed models). Projection studies mostly predict disease risks, and some predict disease incidence based on climate models under RCP 4.5. Since some geographic heterogeneity exists in the climate-dysentery relationship, modeling and projection of dysentery incidence on a national or global scale remain challenging. The reviewed results have implications for the present and future. Current research should be extended to select appropriate and robust climate-dysentery models, reasonable disease burden measure, and appropriate climate models and scenarios. We recommend future studies focus on qualitative investigation of the mechanism involved in the impact of climate on dysentery, and accurate projection of dysentery incidence, aided by advancing accuracy of extreme weather forecasting.

Astringent drugs for bleedings and diarrhoea: The history of Cynomorium coccineum (Maltese Mushroom)

ETHNOPHARMACOLOGICAL RELEVANCE

The botanical identity of the ancient vernacular cynomorium does not correspond to the modern scientific genus while it is not clear how many species of hipocistis (Cytinus sp.) were differentiated by the ancient physicians and whether Cynomorium coccineum was subsumed. The early history of therapeutic uses related to the herbal drugs derived from these parasitic taxa is therefore not easily accessible. Cynomorium coccineum became an important pharmaceutical commodity after the Siege of Malta but its importance decreased in the 18th century and now is considered obsolete.

MATERIAL AND METHODS

We compare the morphological, ecological and therapeutic information of Cynomorium and other parasitizing plant taxa across the past 2000 years and contextualize their uses with the pharmacological properties of their principal metabolites focusing on the raise and fall of C. coccineum as a medicine.

RESULTS

The therapeutic uses of C. coccineum, the Maltese mushroom, seem to become clearly traceable since the Canon of Medicine by Avicenna. Styptic and astringent drugs such as Cynomorium, Cytinus but also gall apples and many others have been selected for their protein-linking capacity leading to the formation of a protective layer on the mucous membranes, which can be used to reduce the secretion of water and electrolytes in case of diarrhoea, dysentery and external bleedings. Whether C. coccineum is effective as a systemically applied anti-haemorrhagic drug is questionable.

CONCLUSION

It appears that the vernacular cynomorium of the ancients corresponds to an edible Orobanche sp. while it remains doubtful whether the vernacular hipocistis was next to Cytinus sp. also applied to C. coccineum as evidence of C. coccineum parasitizing Cistus sp. is scarce. The isolation of gallic acid used as a styptic and the increasing availability of chemical styptics in the 18th century together with the availability of effective alternative anti-diarrhoeic drugs with a more reliable supply very probably led to the decline of the importance of the Maltese mushroom in pharmacy during the 18th century. The effectiveness of gallic acid as a systemic anti-haemorrhagic remains uncertain.

Acute diarrhea with blood: diagnosis and drug treatment

OBJECTIVE

To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy.

SOURCES OF DATA

A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review.

SYNTHESIS OF DATA

Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines.

CONCLUSIONS

Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost-effective preventative measure in future.

Intestinal Parasites in an Ottoman Period Latrine from Acre (Israel) Dating to the Early 1800s CE

The aim of this study is to determine the species of parasites that affected the inhabitants of the city of Acre on the coast of the eastern Mediterranean during the Ottoman Period. This is the first archaeological study of parasites in the Ottoman Empire. We analysed sediment from a latrine dating to the early 1800s for the presence of helminth eggs and protozoan parasites which caused dysentery. The samples were examined using light microscopy and enzyme-linked immunosorbent assay (ELISA) kits. We found evidence for roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), fish tapeworm (Dibothriocephalus sp.), Taenia tapeworm (Taenia sp.), lancet liver fluke (Dicrocoelium dendriticum), and the protozoa Giardia duodenalis and Entamoeba histolytica. The parasite taxa recovered demonstrate the breadth of species present in this coastal city. We consider the effect of Ottoman Period diet, culture, trade and sanitation upon risk of parasitism in this community living 200 years ago.

Epidemiological characteristics of bacillary dysentery from 2009 to 2016 and its incidence prediction model based on meteorological factors

Background

This study aimed to analyse the epidemiological characteristics of bacillary dysentery (BD) caused by Shigella in Chongqing, China, and to establish incidence prediction models based on the correlation between meteorological factors and BD, thus providing a scientific basis for the prevention and control of BD.

Methods

In this study, descriptive methods were employed to investigate the epidemiological distribution of BD. The Boruta algorithm was used to estimate the correlation between meteorological factors and BD incidence. The genetic algorithm (GA) combined with support vector regression (SVR) was used to establish the prediction models for BD incidence.

Results

In total, 68,855 cases of BD were included. The incidence declined from 36.312/100,000 to 23.613/100,000, with an obvious seasonal peak from May to October. Males were more predisposed to the infection than females (the ratio was 1.118:1). Children < 5 years old comprised the highest incidence (295.892/100,000) among all age categories, and pre-education children comprised the highest proportion (34,658 cases, 50.335%) among all occupational categories. Eight important meteorological factors, including the highest temperature, average temperature, average air pressure, precipitation and sunshine, were correlated with the monthly incidence of BD. The obtained mean absolute percent error (MAPE), mean squared error (MSE) and squared correlation coefficient (R²) of GA_SVR_MONTH values were 0.087, 0.101 and 0.922, respectively.

Conclusion

From 2009 to 2016, BD incidence in Chongqing was still high, especially in the main urban areas and among the male and pre-education children populations. Eight meteorological factors, including temperature, air pressure, precipitation and sunshine, were the most important correlative feature sets of BD incidence. Moreover, BD incidence prediction models based on meteorological factors had better prediction accuracies. The findings in this study could provide a panorama of BD in Chongqing and offer a useful approach for predicting the incidence of infectious disease. Furthermore, this information could be used to improve current interventions and public health planning.

Epidemiological characteristics and strategies for the prevention of diarrheal disease in indigenous children: A scoping review

AIM

The aim of the present scoping review was to map the scientific evidence about diarrheal disease in indigenous children and the strategies that can be used to prevent it.

METHODS

The subject headings were indigenous population; child; diarrhea; dysentery; epidemiology; and prevention, primary; also the following keywords characteristic, epidemiologic study; and children. The databases consulted were Latin American and Caribbean Health Sciences Literature, MEDLINE via the US National Library of Medicine/National Institutes of Health, and Web of Science. Initially, 268 studies were identified, and after being screened using the eligibility criteria, six were selected. Finally, via reference tracking, five more were identified. The final sample was made up of eleven articles.

RESULTS

The results confirmed higher mortality rates due to diarrheal disease among indigenous children who are socially disadvantaged and living in poor hygienic and basic sanitation conditions. Among the primary prevention strategies are basic sanitation, health education better hygiene habits, animal control, breastfeeding, supplementing the diet with zinc, vitamins, and the rotavirus vaccine. The preventive strategies included the use of oral rehydration solutions, adequate nutrition, prescribed antimicrobials, and intravenous fluid replacement with glycaemic and electrolyte correction in severe cases.

CONCLUSION

In conclusion, public policies regarding the indigenous population and cross-cultural care should be strengthened. The present study confirmed that, at a global level, there is a lack of publications studying this issue.

Inappropriate use of antibiotics for childhood diarrhea case management - Kenya, 2009-2016

BACKGROUND

Antibiotics are essential to treat for many childhood bacterial infections; however inappropriate antibiotic use contributes to antimicrobial resistance. For childhood diarrhea, empiric antibiotic use is recommended for dysentery (bloody diarrhea) for which first-line therapy is ciprofloxacin. We assessed inappropriate antibiotic prescription for childhood diarrhea in two primary healthcare facilities in Kenya.

METHODS

We analyzed data from the Kenya Population Based Infectious Disease Surveillance system in Asembo (rural, malaria-endemic) and Kibera (urban slum, non-malaria-endemic). We examined records of children aged 2-59 months with diarrhea (≥3 loose stools in 24 h) presenting for care from August 21, 2009 to May 3, 2016, excluding visits with non-diarrheal indications for antibiotics. We examined the frequency of antibiotic over-prescription (antibiotic prescription for non-dysentery), under-prescription (no antibiotic prescription for dysentery), and inappropriate antibiotic selection (non-recommended antibiotic). We examined factors associated with over-prescription and under-prescription using multivariate logistic regression with generalized estimating equations.

RESULTS

Of 2808 clinic visits with diarrhea in Asembo, 2685 (95.6%) were non-dysentery visits and antibiotic over-prescription occurred in 52.5%. Of 4697 clinic visits with diarrhea in Kibera, 4518 (96.2%) were non-dysentery and antibiotic over-prescription occurred in 20.0%. Antibiotic under-prescription was noted in 26.8 and 73.7% of dysentery cases in Asembo and Kibera, respectively. Ciprofloxacin was used for 11% of dysentery visits in Asembo and 0% in Kibera. Factors associated with over- and under-prescription varied by site. In Asembo a discharge diagnosis of gastroenteritis was associated with over-prescription (adjusted odds ratio [aOR]:8.23, 95% confidence interval [95%CI]: 3.68-18.4), while malaria diagnosis was negatively associated with antibiotic over-prescription (aOR 0.37, 95%CI: 0.25-0.54) but positively associated with antibiotic under-prescription (aOR: 1.82, 95%CI: 1.05-3.13). In Kibera, over-prescription was more common among visits with concurrent signs of respiratory infection (difficulty breathing; aOR: 3.97, 95%CI: 1.28-12.30, cough: aOR: 1.42, 95%CI: 1.06-1.90) and less common among children aged < 1 year (aOR: 0.82, 95%CI: 0.71-0.94).

CONCLUSIONS

Inappropriate antibiotic prescription was common in childhood diarrhea management and efforts are needed to promote rational antibiotic use. Interventions to improve antibiotic use for diarrhea should consider the influence of malaria diagnosis on clinical decision-making and address both over-prescription, under-prescription, and inappropriate antibiotic selection.

Prescription of Antibiotics for Adults with Acute Infectious Diarrhea in Korea: A Population-based Study

Background

Acute infectious diarrhea (AID) is a commonly observed condition globally. Several studies recommend against the use of empiric antibiotic therapy for AID, except in some cases of travelers' diarrhea. However, many physicians prescribe antimicrobial agents for AID. We aimed to determine the rate of antibiotic use and the associated prescription patterns among adults with AID.

Materials and Methods

This population-based, retrospective epidemiological study was performed using Korean National Health Insurance claims data from 2016 to 2017. The study population comprised adults (age ≥18 years) who had visited clinics with AID-related complaints. Exclusion criteria were the presence of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and other non-infectious forms of colitis. Patients who underwent surgery during admission were also excluded.

Results

The study population comprised 1,613,057 adult patients with AID (767,606 [47.6%] men). Young patients (age 18 – 39 years) accounted for 870,239 (54.0%) of the study population. Overall, 752,536 (46.7%) cases received antibiotic prescriptions. The rate of antibiotic administration tended to be higher among elderly patients (age ≥65 years) than among younger patients (49.5% vs. 46.4%, P <0.001). The antibiotics most frequently prescribed in both monotherapy and combination regimens were fluoroquinolones (29.8%), rifaximin (26.8%), second-generation cephalosporins (9.2%), third-generation cephalosporins (7.3%), trimethoprim/sulfamethoxazole (5.5%), and β-lactam/β-lactamase inhibitors (5.3%). Patients who visited tertiary care hospitals had lower rates of antibiotic therapy (n = 14,131, 41.8%) than did those visiting private clinics (n = 532,951, 47.1%). In total, 56,275 (62.3%) admitted patients received antibiotic therapy, whereas outpatients had lower rates of antibiotic prescription (n = 694,204, 46.0%).

Conclusion

This study revealed differences between the antibiotics used to treat AID in Korea and those recommended by the guidelines for AID treatment. Multifaceted efforts are necessary to strengthen physicians' adherence to published guidelines.

Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence

BACKGROUND

Shigella remains the primary cause of diarrhoea in paediatric patients worldwide and accounts for up to 40,000 deaths per year. Current guidelines for the treatment of shigellosis are based on data which are over a decade old. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for shigellosis in children is necessary, taking into account susceptibility patterns, cost and the risk of adverse events.

METHODS

A systematic review of the current published literature on the treatment of shigella dysentery was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

RESULTS

The initial search produced 131 results, of which nine studies met the inclusion criteria. The quality of the studies was assessed as per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. International guidelines were also reviewed. There is a lack of current research regarding the clinical treatment of shigellosis in paediatric and adult patients, despite rising antimicrobial resistance worldwide. In particular, there is a lack of studies assessing the non-susceptibility of community-acquired strains, with almost all published research pertaining to microbiological data from hospital-based settings.

DISCUSSION

Current WHO guidelines support the use of fluoroquinolones (first-line), β-lactams (second-line) and cephalosporins (second-line) which accords with currently available evidence and other international guidelines, and there is no strong evidence for changing this guidance. Azithromycin is appropriate as a second-line therapy in regions where the rate of non-susceptibility of ciprofloxacin is known to be high, and research suggests that, from a cardiac point of view, azithromycin is safer than other macrolide antibiotics. Cefixime is also a reasonable alternative, although its use must be weighed against the risk of dissemination of extended-spectrum β-lactamase-producing organisms.

The Role of Probiotics in the Treatment of Dysentery: a Randomized Double-Blind Clinical Trial

Diarrhea is considered as an important cause of morbidity and mortality, even though one of the main reasons of death following diarrhea is initiated by dysentery. In recent years, the consumption of probiotics has been proposed for the treatment of infectious diarrhea. Despite most of the studies on probiotics have focused on acute watery diarrhea, few studies in the field of dysentery have found beneficial effects of probiotics. This study is a randomized double-blind clinical trial. The patients were randomly placed into control and case groups. In the intervention group, the patients received probiotics in the form of Kidilact® sachet, which contained high amounts of 7-strain friendly bacteria strains of Lactobacillus casei, Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus bulgaricus, Bifidobacterium infantis, Bifidobacterium breve, and Streptococcus thermophiles. On the other hand, the patients in the control group received placebo sachets on a daily basis for 5 days. It is notable that the treatment protocol of acute dysentery was done on both groups. The results of this study showed significant differences in the duration of blood in diarrhea between probiotic consumers (2.62 days) and the control group (3.16 days) (P value = 0.05). Additionally, significant differences in the average length of hospitalization in probiotic consumers (3.16 days) and control (3.66 days), (P value = 0.02) could be claimed that the consumption of probiotics is effective in reducing the duration of dysentery and diarrhea. The results of this study suggest that the use of probiotics can be effective in reducing the duration of blood in diarrhea. This study was also recorded in the Iran center of clinical trials registration database (IRCT2014060617985N1).

Identification of potential drug targets and inhibitor of the pathogenic bacteria Shigella flexneri 2a through the subtractive genomic approach

Shigella flexneri 2a is one of the most pathogenic bacteria among the Shigella spp., which is responsible for dysentery and causes masses of deaths throughout the world per year. A proper identification of the potential drug targets and inhibitors is crucial for the treatment of the shigellosis due to their emerging multidrug resistance (MDR) patterns. In this study, a systematic subtractive approach was implemented for the identification of novel therapeutic targets of S. flexneri 2a (301) through genome-wide metabolic pathway analysis of the essential genes and proteins. Ligand-based virtual screening and ADMET analyses were also made for the identification of potential inhibitors as well. Initially, we found 70 essential unique proteins as novel targets. After subsequent prioritization, finally we got six unique targets as the potential therapeutic targets and their three-dimensional models were built thereafter. Aspartate-β-semialdehyde dehydrogenase (ASD), was the most potent target among them and used for docking analysis through ligand-based virtual screening. The compound 3 (PubChem CID: 11319750) suited well as the best inhibitor of the ASD through ADMET and enzyme inhibition capacity analysis. To end, we hope that our proposed therapeutic targets and its inhibitors might give some breakthrough to treat shigellosis efficiently in in vitro.

Intestinal parasites from the 2nd-5th century AD latrine in the Roman Baths at Sagalassos (Turkey)

The aim of this research was to determine the species of intestinal parasite present in a Roman Imperial period population in Asia Minor, and to use this information to improve our understanding of health in the eastern Mediterranean region in Roman times. We analyzed five samples from the latrines of the Roman bath complex at Sagalassos, Turkey. Fecal biomarker analysis using 5β-stanols has indicated the feces were of human origin. The eggs of roundworm (Ascaris) were identified in all five samples using microscopy, and the cysts of the protozoan Giardia duodenalis (which causes dysentery) were identified multiple times in one sample using ELISA. The positive G. duodenalis result at Sagalassos is particularly important as it represents the earliest reliable evidence for this parasite in the Old World (i.e. outside the Americas). As both these species of parasite are spread through the contamination of food and water by fecal material, their presence implies that Roman sanitation technologies such as latrines and public baths did not break the cycle of reinfection in this population. We then discuss the evidence for roundworm in the writings of the Roman physician Galen, who came from Pergamon, another town in western Asia Minor.

Role of antimicrobials in the treatment of adult patients presenting to the emergency department with acute gastroenteritis - A mini review

BACKGROUND & OBJECTIVE

Acute gastroenteritis is generally considered a self-limiting illness that does not require the use of antibiotics. However, many emergency departments in the country frequently prescribe antibiotics to patients presenting with diarrhoea. This review attempts to determine whether this practice is reasonable. Our objective was to determine the role of antimicrobials in the empiric management of acute gastroenteritis.

METHODS

The online data base "PubMed", as well as the World Wide Web, were searched for relevant articles (RCTs, Reviews, Prospective studies, etc.) with key words such as "gastroenteritis AND antibiotics", "Management AND gastroenteritis", "Treatment AND diarrhoea" etc. and covered the years 1960-2016. Fifty articles were studied, of which 43 were chosen on the basis of relevance for qualitative assessment.

RESULTS

The articles reviewed for this paper suggest that antimicrobial therapy is not appropriate for the majority of cases of (uncomplicated) gastroenteritis, as risks (antibiotic-associated diarrhoea, hypersensitivity reactions, etc.) outweigh benefits. However, there are instances where antibiotics are clearly indicated. Further, it is noted that there have not been any recent trials to clarify the role of antimicrobials in adult diarrhoeal illness.

CONCLUSIONS

The focus in management of patients presenting with diarrhoea in the Emergency Department should be on rehydration and that only certain patients, such as those with fever or dysentery, or those with an impaired immune response should receive empiric antimicrobial therapy. More studies are needed to determine in what instances antimicrobials are of greatest benefit, so that adverse effects of rampant antibiotic prescription can be curtailed.

Identification of weather variables sensitive to dysentery in disease-affected county of China

Climate change mainly refers to long-term change in weather variables, and it has significant impact on sustainability and spread of infectious diseases. Among three leading infectious diseases in China, dysentery is exclusively sensitive to climate change. Previous researches on weather variables and dysentery mainly focus on determining correlation between dysentery incidence and weather variables. However, the contribution of each variable to dysentery incidence has been rarely clarified. Therefore, we chose a typical county in epidemic of dysentery as the study area. Based on data of dysentery incidence, weather variables (monthly mean temperature, precipitation, wind speed, relative humidity, absolute humidity, maximum temperature, and minimum temperature) and lagged analysis, we used principal component analysis (PCA) and classification and regression trees (CART) to examine the relationships between the incidence of dysentery and weather variables. Principal component analysis showed that temperature, precipitation, and humidity played a key role in determining transmission of dysentery. We further selected weather variables including minimum temperature, precipitation, and relative humidity based on results of PCA, and used CART to clarify contributions of these three weather variables to dysentery incidence. We found when minimum temperature was at a high level, the high incidence of dysentery occurred if relative humidity or precipitation was at a high level. We compared our results with other studies on dysentery incidence and meteorological factors in areas both in China and abroad, and good agreement has been achieved. Yet, some differences remain for three reasons: not identifying all key weather variables, climate condition difference caused by local factors, and human factors that also affect dysentery incidence. This study hopes to shed light on potential early warnings for dysentery transmission as climate change occurs, and provide a theoretical basis for the control and prevention of dysentery.

Long-term Clinical Course of Post-infectious Irritable Bowel Syndrome After Shigellosis: A 10-year Follow-up Study

Background/Aims

A limited number of studies are available regarding the long-term natural history of post-infectious irritable bowel syndrome (PI-IBS). We aimed to investigate the long-term clinical course of PI-IBS.

Methods

A prospective cohort study was conducted from a 2001 shigellosis outbreak in a Korean hospital with about 2000 employees. A cohort of 124 hospital employees who were infected by Shigella sonnei due to contaminated food in the cafeteria, and 105 sex- and age-matched, non-infected, controls were serially followed for their bowel symptoms by questionnaire surveys for 10 years.

Results

The Shigella-infected cohort showed significantly higher odds ratio for irritable bowel syndrome (IBS) at 1-year (11.90; 95% CI, 1.49–95.58) and 3-year (3.93; 95% CI, 1.20–12.86) follow-up, compared to their controls. However, corresponding odds ratio for PI-IBS was not significantly increased at 5-year (1.88; 95% CI, 0.64–5.54) and 8-year (1.87; 95% CI, 0.62–5.19) follow-up. At 10-year follow-up survey, the prevalence of IBS was similar for the Shigella-infected cohort and their controls (23.3% versus 19.7%, P = 0.703). Risk factors which were independently associated with PI-IBS among the Shigella-infected cohort included younger age, previous history of functional bowel disorder, and longer duration of diarrhea at baseline.

Conclusions

Patients who were infected by Shigella sonnei experienced significantly increased risk of IBS until 3 years after shigellosis, and modestly increased risk until 8 years, but showed similar risk of IBS with uninfected controls at 10 years post-infection. PI-IBS is quite a chronic disorder, and follows a long-term natural course.

Small Intestinal Infections

Small intestinal infections are extremely common worldwide. They may be bacterial, viral, or parasitic in etiology. Most are foodborne or waterborne, with specific etiologies differing by region and with diverse pathophysiologies. Very young, very old, and immune-deficient individuals are the most vulnerable to morbidity or mortality from small intestinal infections. There have been significant advances in diagnostic sophistication with the development and early application of molecular diagnostic assays, though these tests have not become mainstream. The lack of rapid diagnoses combined with the self-limited nature of small intestinal infections has hampered the development of specific and effective treatments other than oral rehydration. Antibiotics are not indicated in the absence of an etiologic diagnosis, and not at all in the case of some infections.

Multi drug resistance and Extended Spectrum Beta Lactamases in clinical isolates of Shigella: A study from New Delhi, India

BACKGROUND

Shigella is an important cause of gastroenteritis in local Indian population, as well as of traveler's diarrhea in the international visitors to India. These patients often require appropriate antimicrobial therapy; however, rapid development of antimicrobial resistance poses a major hurdle in achieving this goal.

METHOD

A prospective study was conducted during 2009-12 in New Delhi, India, including 6339 stool samples from gastroenteritis patients. 121 Shigella strains were identified on the basis of colony morphology, biochemical reactions, serotyping and ipaH gene based PCR. Antimicrobial susceptibility testing by disc diffusion, MIC determination by Vitek(®) 2 and phenotypic tests for ESBL/AmpC production were done.

RESULTS

Nineteen percent strains (23/121) were found to be resistant to third generation cephalosporins and all were phenotypically confirmed to be ESBL producers; one strain was positive for AmpC. ESBL producing strains were also found to be significantly more resistant (p < 0.05) to several other antimicrobials agents in comparison to ESBL non-producers, [ampicillin (100% vs. 62.2%), ampicillin/sulbactam (100% vs. 30.6%), cotrimoxazole (100% vs. 77.6%), ciprofloxacin (87.0% vs. 49.0%), ofloxacin (87.0% vs. 52.0%) and gentamicin (30.4% vs. 7.1%)]. Multidrug resistance was seen in 76% strains.

CONCLUSIONS

Inappropriate use of antimicrobial agents puts high selection pressure on the higher-end antibiotics. Multi-drug resistance and high rates of ESBL production by Shigella is a matter of concern for the local population as well as international travelers. Therefore, better national level antimicrobial management programs are the priority needs.

Trends of reported foodborne diseases at the Ridge Hospital, Accra, Ghana: a retrospective review of routine data from 2009-2013

Background

There are over 250 foodborne diseases and are of growing public health concern worldwide. The distribution of these diseases varies from one locality to the other. Foodborne diseases come about as a result of ingestion of food contaminated with microorganisms or chemicals. The most common clinical presentation of foodborne disease takes the form of gastrointestinal symptoms; although other systems of the body can also be affected and represents a considerable burden of disability as well as mortality. The current study was carried out with the aim of describing the trends and patterns of foodborne diseases reported at the Ridge Hospital in Accra, Ghana to serve as the first step towards understanding the profile of foodborne diseases in Accra. The study could then serve as a guide in the establishment of a sentinel site or surveillance system for foodborne diseases.

Methods

A retrospective review of routine data kept on patients who visited the Ridge Hospital from January 2009 to December 2013 was conducted to describe the trends and patterns of foodborne diseases reported at the facility. All available health records were reviewed and data on foodborne diseases extracted and analysed by age group, sex, season and geographical location within the catchment area of the hospital.

Results

The review showed significant variation in the annual reported cases of foodborne diseases [2009 = 11.5 % (118/1058); 2010 = 2.30 % (22/956); 2011 = 17.45 % (608/3485); 2012 = 7.98 % (498/6315) and 2013 = 2.56 % (345/13458)] p < 0.05. Significant seasonal variations were also observed [early dry season = 10.2 % (322/3142); late dry season = 24.4 % (909/3728); early wet season = 4.3 % (107/2494); late wet season = 6.3 % (256/4094). There were monthly variations also during the period (p < 0.001) except for the year 2010 (p = 0.428). The highest prevalence was reported during the late dry season (February–April). The most affected age group was those aged between 15 and 34 years who had significantly more infections in 2012 and 2013 than the other age groups (p < 0.001). Overall many more males than females reported of food borne diseases (p < 0.001).

Conclusion

The commonly reported foodborne diseases at the Ridge Hospital were: typhoid fever, dysentery, cholera and viral hepatitis. These diseases were found to be very seasonal with peaks at the onset of the rainy season.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1472-8) contains supplementary material, which is available to authorized users.

True Prevalence of Shigellosis in Indian Children with Acute Gastroenteritis: Have We Been Missing the Diagnosis?

BACKGROUND

Shigella is responsible for high morbidity and mortality among children, yet its true prevalence remains inconclusive. The aim of this study was to determine the actual prevalence of Shigella infection in childhood diarrhea and dysentery cases and assess the applicability of ipaH gene PCR in Indian settings.

METHODS

This study was conducted at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India during 2011-12. A total of 385 children (207 with diarrhea, 118 with dysentery, and 60 matched controls) were enrolled. Stool samples were cultured, and the suspected colonies were analyzed using biochemical reactions and serotyping. Antimicrobial susceptibility testing was done using disc diffusion method. ipaH-gene PCR was performed directly on stool samples collected from 180 randomly selected patients (60 from each group).

RESULTS

Shigella was isolated using conventional culture methods in 8.2% (95% CI: 5.1%, 12.8%), 33.1% (95% CI: 25.2%, 42.0%), and 0% in the diarrhea, dysentery and control cases, respectively. High resistance was seen towards co-trimoxazole, nalidixic acid, fluoroquinolones, doxycycline and several beta-lactams drugs. Actual prevalence of shigellosis was determined using ipaH gene PCR to be 18.3% (95% CI: 10.4% - 30.1%) diarrhea cases and 56.7% (95% CI: 44.1, 68.4%) dysentery cases. One (1.7%, 95% CI: 0.01%, 9.7%) control specimen also yielded positive result in PCR.

CONCLUSIONS

Correct diagnosis of shigellosis is essential to start antimicrobial therapy in selected cases. The prevalence of Shigella / EIEC infection in children is much higher than previously estimated. Despite its high costs and other limitations, we recommend the use of ipaH-gene PCR as a routine tool in the management of childhood acute gastroenteritis cases.

Lythrum salicaria L.-Underestimated medicinal plant from European traditional medicine. A review

ETHNOPHARMACOLOGICAL RELEVANCE

Purple loosestrife-Lythrum salicaria L. is a herbaceous perennial plant belonging to the Lythraceae family. It has been used for centuries in European traditional medicine. Despite Lythri herba being a pharmacopoeial plant material (Ph. Eur.), L. salicaria popularity as a medicinal plant has recently declined. The aim of the paper is to recall a traditional and historical use of L. salicaria and juxtapose it with comprehensive view on the current knowledge about its chemical composition and documented biological activities in order to bring back the interest into this valuable plant and indicate reasonable directions of future research and possible applications.

MATERIALS AND METHODS

Systematic survey of historical and ethnopharmacological literature was carried out using sources of European and American libraries. Pharmacological and phytochemical literature research was performed using Scopus, PubMed, Web of Science and Reaxys databases.

RESULTS

The review of historical sources from ancient times till 20th century revealed an outstanding position of L. salicaria in traditional medicine. The main applications indicated were gastrointestinal tract ailments (mainly dysentery and diarrhea) as well as different skin and mucosa affections. The current phytochemical studies have shown that polyphenols (C-glucosidic ellagitannins and C-glucosidic flavonoids) as well as heteropolysaccharides are dominating constituents, which probably determine the observed pharmacological effects. The extracts and some isolated compounds were shown to possess antidiarrheal, antimicrobial, anti-oxidant, anti-inflammatory and anti-diabetic activities.

CONCLUSIONS

The intrinsic literature overview conclusively demonstrates that L. salicaria L. used to be considered as an exceptionally effective remedy in European traditional medicine. Despite its unquestionable important position from unknown reasons its popularity has been weakened during the past few decades. Unfortunately the contemporary pharmacological research is still insufficient to support its thoroughly described traditional uses. The necessity of complex studies regarding modes of action, which would directly refer to L. salicaria main traditional applications-gastrointestinal tract ailments, is strongly underlined.

Drug Resistance in the Microaerophilic Parasite Giardia lamblia

The microaerophilic parasite Giardia lamblia is a causative agent of dysentery affecting hundreds of millions of people around the globe every year. The symptoms of the disease, commonly referred to as giardiasis, are diarrhea, nausea, and malabsorption. Treatment of giardiasis is exclusively based on chemotherapy with antigiardial drugs, including metronidazole, albendazole, and nitazoxanide. In this review, all drugs currently used in the treatment of Giardia infections are discussed with a special emphasis on treatment failure and drug resistance.

Human Parasites in Medieval Europe: Lifestyle, Sanitation and Medical Treatment

Parasites have been infecting humans throughout our evolution. However, not all people suffered with the same species or to the same intensity throughout this time. Our changing way of life has altered the suitability of humans to infection by each type of parasite. This analysis focuses upon the evidence for parasites from archaeological excavations at medieval sites across Europe. Comparison between the patterns of infection in the medieval period allows us to see how changes in sanitation, herding animals, growing and fertilizing crops, the fishing industry, food preparation and migration all affected human susceptibility to different parasites. We go on to explore how ectoparasites may have spread infectious bacterial diseases, and also consider what medieval medical practitioners thought of parasites and how they tried to treat them. While modern research has shown the use of a toilet decreases the risk of contracting certain intestinal parasites, the evidence for past societies presented here suggests that the invention of latrines had no observable beneficial effects upon intestinal health. This may be because toilets were not sufficiently ubiquitous until the last century, or that the use of fresh human faeces for manuring crops still ensured those parasite species were easily able to reinfect the population.