Seasonal pattern of enterotoxigenic Escherichia coli (ETEC) in children under three years of age

Children aged one month to three years from Yangon Children Hospital were studied. A total of 923 cases of diarrhoea and 932 cases of control were included in this study. The total isolation rate of ETEC was 232 cases (25.2 percent) and 55 casea (5.9 percent) from diarrhoea and control cases respectively. In the diarrhoea group, out of 232 cases of ETEC, 43 cases (4.7 percent) were STLT, 134 cases (14.5 percent) were ST and 55 cases (6.0 percent) were LT. In the control group, out of 55 cases of ETEC, 6 cases (0.6 percent) were STLT, 21 cases (2.3 percent) were ST and 28 cases (3.0 percent) were LT. Although ETEC was found in children all the year round, the incidence rate was higher during the months of February to July with the highest peak of 47.0 percent in June. ETEC occurred in the control cases with the maximum isolation rate of 16 percent in June.

Relationship between serogroups and enterotoxin production of Escherichia coli from children with diarrhoea

It has been reported that the enterotoxigenic Escherichia coli could be serotyped in various countries and some serotypes were restricted to each area. Thus a study was conducted on 2522 Escherichia coli isolates from 501 diarrhoeal cases and 374 control cases from the Intakaw survey. Enterotoxigenic strains were isolated from 91 cases of diarrhoea and from 29 control cases. It was found that the serogroups 0126 and 0114 were associated with heat-stable (ST) and heat-labile (LT) toxin producing isolates respectively. 027 and 06 serogroups showed a correlation with ST alone and STLT producers respectively. Though the other serogroups sought were 01, 026, 0119, 0159, 0127, 0128, 0148 and 0159, it was notedthat only 60 percent of the enterotoxigenic E. clli could be serogrouped. The serotyping of flagella was also done and different patterns including H8, H12, H19, H21, H32, H38, H49 and H51 were observed.

Intestinal permeability in Myanmar children: Results from a field study

The differential urinary excretion of lactulose and L-rhamnose after a standard oral dose has been employed as an index of mucosal injury and its feasibility and practicability tested under field conditions. 110 children who were assessed for malnutrition also had intestinal permeability analysis. Weight-for-age were all used as indicators of malnutrition. Moderately malnourished children (75 percent weight-for-age) had significantly greater lactulose/L-rhamnose ratios (p < 0.05) than those children with normal nutrition (90 percent weight-for-afe) (0.1495 + 0.0134 vs 0.1132 + 0.0109). No significant differences were found between the differential sugar ratios of those children who had chronic (90 percent length-for-age) or acute (80 percent weight-for-height) malnutrition and those children who were normally nourished according to these classifications.

Changes in serum aldosterone levels in response to malnutrition and diarrhoea

The study included 31 children (age 1 to 5 years) who were hospitalized for malnutrition, malnutrition with diarrhoea and acute diarrhoea of less than 48 hrs duration. The controls, consisted of 6 children from the same locality as patients, were apparently healthy and in the same age group. Serum chloride tend to increase in the patients and the increase was more pronounced in the group suffering from both malnutrition and diarrhoea. On the other hand, serum potassium tend to decrease and the decreases were significant in the groups having malnutrition. Serum aldosterone levels were raised in all the three groups of patients namely malnutrition, diarrhoea and malnutrition associated diarrhoea when compared with the control. The increase was still observed even after exclusion of the subjects whose ages lied within the first 1 year of the life for whom the serum aldosterone levels were found to have a sharp rise.

Effect of cholera toxin on intestinal lysosomal enzymes in the suckling rat

Lysosomal function, namely lysosomal enzyme activities and lysosomal membrane integrities were investigated in suckling rats which received cholera toxin intragastrically and in shamoperated controls suing two typical Lysosomal enzymes, acid phosphatase and cathepsin D. It was found that the maximal specific activities of both the enzymes were decreased in the infected group when compared with the control suggesting a reduction in the ability of intracellular digestion by lysosome. On the other hand, the value of the ratio between maximal and basal activity (an expression of the degree of retention of enzyme by lysosome or lysosomal membrane stability ) of acid phosphatase was significantly increased suggesting lesser extent of leakage of the enzyme into cytoplasm when compared with the control. However, there was no difference in the lysosomal membrane stability when measured in terms of cathepsin D. This discrepancy between the two enzymes was explained by their latencies.

Detection of pathogenic of bacteria in children with diarrhoea

86 children ranging from one to three years old with diarrhoea from Yangon Children's Hospital and respective controls were included in this study. Isolation rates of major pathogens responsible for acute diarrhoea in children were Enterotoxigenic Escherichia coli (EPEC) 8.1 per cent , Salmonella 1.2 per cent, Shigella sonnei 1.2 per cent, Plesiomonas 1.2 per cent and vibrios 1.2 per cent. In the control group the prevalence was found to be ETEC 9.3 per cent, EPEC 7.0 per cent, Salmonella 12.0 per cent , S. sonnei 1.2 per cent, Plesiomonas 7.0 per cent and vibrios 1.2 per cent. The total pathogen isolated from diarrhoea and control cases were 46.5 per cent and 38.4 per cent respectively. It was also noted that Salmonella and Plesiomonas isolation rates were higher in the control group.

Effect of acute diarrhoea on the bioavailability of chloroquine in Myanmar subjects

Considering the possibility of altered bioavailability of during acute diarrhoea, there is a need to determine the therapeutic status of chloroquine as an antimalarial prophylactic during an attack of acute diarrhoea and to develop a reasonable basis for dose adjustment if necessary, in such clinical situations. Chloroquine 300 mg base was administered orally to 16 adult diarrhoeal patients from the Infectious Disease Hospital, Yangon and 12 healthy non-diarrhoeal volunteers. The drug serum levels at various time intervals up to 96 hours were analysed fluorometrically and the pharmacokinetic profile studied. Acute diarrhoea was found to decrease the rate, but did not alter the extent of absorption of chloroquine. Since the overall bioavailability of chloroquine remains unchanged, it was concluded that if there is no vomiting, dosage adjustment is not necessary in acute diarrhoea.

Effect of enterotoxingenic Escherichia coli heat labile toxin on intestinal enzymes in rat

Differential study of the maker enzyme level for intracellular organelles in intestinal mucosa and muscularis layer following E. coli labile toxin (LT) administration to rat revealed that there were no changes in the enzyme levels in mucosa but some changes (a degree of acid phophatase and an increase of proteinase) in muscularis layer. The results suggest that the LT, being a high molecular weight toxin, may not be easily invaginated into intestinal epithelial cells and interact with the subcellular particles. The changes in the enzyme activities observed in the muscularis layer could be the abnormal metabolic consequences of prolonged hypersecretion produced by LT.

Endotoxin in jejunal fluid of patients with acute watery diarrhoea due to vibrio cholera EL tor infection

Jejunal fluids were collected from ten adults with cholera (stool culture for Vibrio cholera El for positive) and ten adults with non-cholera watery diarrhoea admitted to Infectious Diseases Hospital. By limulus amoebocyte lysate gelation test using chloroform extraction, "endotoxin" (lipopolysaccharide) was detected in half of patients with cholera and none of patients with noncholera diarrhoea. Patients in whose jejunal fluids endotoxin was detected were older, had smaller body weights, purged less diarrhoeal stools, fewer motions and for a shorter duration, vomitted 1.36 litres on the average, and required less intravenous and oral rehydration fluids than cholera patients without detectable "endotoxin" in their jejunal fluids. These findings suggest that presence of "endotoxin" of V. cholera El Tor in the gut lumen did not cause more severe diarrhoea.

Clinal trials of "Glycine-ORS" versus "standard-ORS" in neonatal gastroenteritis

34 male newborns over 2.5 kg admitted for watery diarrhoea were entered into a randomized, double-blind clinical trial of glycine-ORS versus standard-ORS (UNICEF). Babies on glycine-ORS were able to consume about 60 ml more than their counterparts on standard-ORS, and had less frequent diarrhoeal motions. The rate of recovery from dehydration (as demonstrated by reduction in haematocrits) were almost, identical. None died, and none needed intravenous rehydration.

Seasonal variation in acute diarrhoea in children in two village communities in Burma

639 under-five children at Htaukkyant villages in 1979-80, and over 700 under five children at Intakaw villages in 1982-83, were followed up by daily diarrhoea surveillance and monthly anthropometry for a duration of one year. There was a definite seasonality for acute diarrhoea, the incidence rates during the monsoon months being significantly higher than those during the winter months. Bacterial agents, especially enterotoxigenic Escherichia coli, were the most common pathogens for acute diarrhoea during monsoon, and rotavirus was the most common pathogen detected during winter. Presumably, because of the cytopathic effect of rotavirus, children who developed diarrhoea during winter had smaller gain in body weights per month than those who developed diarrhoea during monsoon (being most commonly associated with enterotoxigenic Escherichia coli).