Severe congenital diarrhea secondary to tufting enteropathy. case report

ABSTRACT Introduction: Tufting enteropathy is a rare cause of congenital diarrhea in neonates. It is characterized by the abnormal distribution of epithelial adhesion molecules, which causes enterocytes to shed into the lumen, forming the characteristic tufts. Case summary: A 15-day-old female neonate was taken by her parents to the emergency department of a tertiary care hospital due to diarrheal stools she had been experiencing since birth. The patient presented with dehydration, abnormal weight loss, metabolic acidosis, and acute kidney failure. She received treatment with alizapride, loperamide, zinc sulfate, and probiotics, but after 75 days of treatment she was still symptomatic. An upper tract endoscopy and colonoscopy were performed, finding flattening of the villi and lymphoid cells in the lamina propria. However, the symptoms persisted, and she died at the age of ten months. A post-mortem exome sequencing reported tufting enteropathy. Conclusions. When congenital diarrhea is present, tufting enteropathy should be considered. An early molecular study would allow to evaluate the possibility of performing an intestinal transplant or modifying the treatment to meet the patient's palliative care needs.

RESUMEN Introducción. La enteropatía en penacho es una causa rara de diarrea congénita en neonatos; esta se caracteriza por una alteración de la adhesión epitelial que ocasiona desprendimiento de enterocitos hacia el lumen y, en consecuencia, forma los característicos penachos. Se describe el caso de una paciente con esta patología. Presentación del caso. Neonata de 15 días de vida, quien fue llevada por sus padres al servicio de urgencias de un hospital de tercer nivel debido a que desde su nacimiento tuvo deposiciones diarreicas y a causa de esto presentó deshidratación, pérdida de peso, acidosis metabólica e insuficiencia renal aguda. La paciente recibió manejo con alizaprida, loperamida, sulfato de zinc y probióticos, pero a los 75 días de tratamiento continuaba sintomática. Se le practicó una endoscopia de vías digestivas y una colonoscopia que mostraron aplanamiento de las vellosidades e infiltrado de células linfoides en la lámina propia. Los síntomas continuaron y la menor falleció a los 10 meses de nacida. El resultado del exoma post mortem reportó enteropatía en penacho. Conclusiones. Ante la presencia de diarrea congénita, se debe sospechar de una enteropatía en penacho y considerar el estudio molecular temprano, pues este permite evaluar la posibilidad de realizar un trasplante intestinal o modificar el tratamiento según las necesidades de cuidado paliativo del paciente.

Alergia alimentar não IgE mediada: proctocolite induzida por proteínas alimentares ­ Atualização / Non-IgE mediated food allergy: food protein-induced allergic proctocolitis ­ An update

Nas últimas décadas observa-se aumento na prevalência mundial de alergia alimentar, que já acomete aproximadamente 6% das crianças, atribuído à interação entre fatores genéticos, ambientais e alterações na resposta imunológica e pode envolver reações mediadas por IgE, não mediadas e mistas. As formas não IgE mediadas decorrem de reação de hipersensibilidade tardia, mediada por linfócitos T e afetam prioritariamente o trato gastrointestinal, como a Síndrome da enterocolite induzida por proteína alimentar (FPIES), Síndrome da proctocolite alérgica induzida por proteína alimentar (FPIAP), Síndrome da enteropatia induzida por proteína alimentar (FPE) e doença celíaca. As características destas reações podem ser diferenciadas por sua apresentação clínica, gravidade, idade de início e história natural. Entre as reações alérgicas aos alimentos não IgE mediadas, a proctocolite alérgica é a mais frequente. Geralmente ocorre no primeiro ano de vida e apresenta excelente prognóstico. Embora costume ter um curso benigno, traz grande preocupação aos cuidadores por frequentemente cursar com quadro de hematoquezia exigindo diagnóstico diferencial adequado. O conhecimento e manejo da proctocolite alérgica é de suma importância para a prática médica em Alergia e Imunologia. Seu diagnóstico é baseado na história clínica seguindo-se dieta de exclusão, especialmente do leite de vaca, com subsequente provocação oral, que geralmente pode ser realizada no domicílio. O diagnóstico preciso é importante, para se evitar dietas de exclusão desnecessárias. Nesta revisão foram utilizados artigos publicados nos últimos anos, com busca realizada através da base PubMed envolvendo revisões, diagnóstico e tratamento de alergias não IgE mediadas, com foco em proctocolite alérgica.

An increase in the worldwide prevalence of food allergies has been observed in the past decades, currently affecting 6% of children. This increase has been associated with the interaction between genetic, environmental, and immune response factors and can be observed in IgE, non-IgE, and mixed mediated reactions. Non-IgE mediated food allergies result from delayed-type hypersensitivity and mostly affect the gastrointestinal tract, such as food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), food protein-induced enteropathy (FPE), and celiac disease. These reactions can be differentiated by their clinical presentation, severity, age at onset, and natural history. Among non-IgE-mediated allergic reactions to food, allergic proctocolitis is the most frequent. It usually develops in the first year of life and has excellent prognosis. Although it has a benign course, allergic proctocolitis is challenging for health care professionals because it often presents with hematochezia, requiring an accurate differential diagnosis. Knowledge and management of allergic proctocolitis is of paramount importance for medical practice in allergy and immunology. Its diagnosis is based on clinical history followed by elimination diet, especially cow's milk, with subsequent oral food challenge, which may usually be performed at home. Accurate diagnosis is important to avoid unnecessary elimination diets. For this review, PubMed database was searched for recently published literature reviews and studies on the diagnosis and treatment of non- IgE mediated allergies, with a focus on allergic proctocolitis.

The clinical research progress of Tuina in the treatment of in fantile's diarrhea / 国际中医中药杂志

It was found that there were various forms of massage treatment of infantile diarrhea, mainly including patterns differenciation massage, school massage, special manipulation massage and comprehensive therapy. All of them had showed curative effect, with points mainly including large intestine, spleen meridian, abdomen, umbilicus, Guiwei acupoint and Qijiegu parts. The wind cold diarrhea was treated with pushing three passes, kneading Wailaogong acupoint; dampness heat diarrhea with Qing Tian He Shui massage, regularing six Fu-organs massage; dyspepsia diarrhea with clearing stomach meridian, kneading Banmen acupoint and Zusanli (ST 36); spleen deficiency diarrhea with Qihai (CV 6), and Baihui (GV 20). However, there are still some problems, such as few literature research, few mechanism study, and inconsistent evaluation criteria.

Análisis de la tendencia de la mortalidad por enfermedad diarreica aguda en el Perú y sus regiones, 1986-2015 / Trend analysis of acute diarrheal disease mortality in Peru and regions, 1986-2015

RESUMEN Introducción. La incidencia de las enfermedades diarreicas agudas (EDA) se ha mantenido relativamente constante en las tres últimas décadas; mientras que, la mortalidad ha disminuido principalmente por la terapia de rehidratación oral y a mejora en las condiciones de vida. Sin embargo, la letalidad es mayor en los países más pobres, razón por la cual todavía es considerado un problema de salud pública. Objetivo. Analizar la tendencia de la mortalidad por EDA en menores de 5 años en el Perú y sus regiones, en el periodo 1986-2015. Métodos. Se realizó un estudio observacional, analítico, de tendencias de la mortalidad por EDA en los niños menores de 5 años en el periodo 1986-2015, basado en datos secundarios, a nivel nacional y regional, a través del análisis de regresión segmentada de modelos del tipo Log-Lineal utilizando el programa Joinpoint del Instituto Nacional de Cáncer de Estados Unidos. Resultados. Perú presentó una reducción en la tasa específica de mortalidad por EDA (1986-1990: 243,3 y 2011-2015: 15,3). En el análisis de tendencia si bien todas las regiones mostraron una tendencia descendente, solo en 12 permaneció constante durante todo el periodo, 9 presentaron una tendencia estacionaria, 2 ascendente y en 2 la reducción se desaceleró en el último tramo. Conclusiones. A nivel nacional, la mortalidad por EDA en menores de 5 años tuvo una tendencia descendente, siendo no constante en diferentes momentos del periodo 1986-2015. En todas las regiones la tendencia fue descendente hasta el año 2000, luego se observan comportamientos diferentes.

ABSTRACT Introduction. The incidence of acute diarrheal diseases (ADD) has remained relatively constant in the last three decades, whereas mortality has decreased mainly due to oral rehydration therapy and to improvements in living conditions. However, fatality is higher in poorer countries, which it is still considered a public health problem. Objective. To analyze the ADD mortality trend in children under 5 years old in Peru and its regions, in the period 1986-2015. Methods. An observational, analytical study of trends in ADD mortality in children under 5 years old in the period 1986-2015, based on secondary data, was conducted at national and regional level through segmented regression analysis of Log-Linear models using the Joinpoint program of the National Cancer Institute of the United States. Results. Peru had a reduction in the specific ADD mortality rate (1986-1990: 243.3 and 2011-2015: 15.3). In the trend analysis although all regions showed a downward trend, only in 12 remained constant throughout the period, 9 had a stationary trend, 2 upward and in 2 the reduction slowed in the last stretch. Conclusions. At national level, ADD mortality in children under 5 years old had a downward trend, although it was not constant at different times during the 1986-2015 period. In all regions, the trend was downward until 2000, then different behaviors were observed.

Caracterização de Escherichia coli enteroagregativa entre crianças com diarreia na Amazônia ocidental brasileira / Characterization of enteroaggregative escherichia coli among diarrheal childrenin western brazilian amazon

ABSTRACT BACKGROUND: Enteroaggregative Escherichia coli (EAEC) is one of the main acute and chronic diarrhea causes both in children and adults, mainly in developing countries. OBJECTIVE: The aim of the present study is to characterize EAEC strains isolated from faecal samples and to identify genes potentially contributing to virulence, biofilm production and antimicrobial resistance in children admitted to a pediatric hospital in Porto Velho, Rondônia State. METHODS: The total of 1,625 E. coli specimens were isolated from 591 children in the age group 6 years or younger who were hospitalized in Cosme and Damião Children Hospital in Porto Velho, between February 2010 and February 2012, with acute gastroenteritis. Colonies suggestive of E. coli were subjected to polymerase chain reaction testing in order to identify the virulence factors. The in vitro adhesion assays using HEp-2 adherence were tests. Biofilm detection through spectrophotometry and antimicrobial susceptibility tests were conducted in the disk diffusion method. RESULTS: The mentioned study examined 591 stool samples from children with diarrhea. Diarrheogenic E. coli was found in 27.4% (162/591) of the children. EAEC was the diarreagenic E. coli most frequently associated with diarrhea 52.4% (85/162), which was followed by enteropathogenic E. coli 43.8% (71/162), enterotoxigenic E. coli 2.4% (4/162), and enterohemorrhagic E. coli 1.2% (2/162). The aggR gene was detected in 63.5% (54/85) of EAEC isolates; moreover, statistically significant correlation was observed among typical EAEC (aggR) and aatA (P<0.0001), irp2 (P=0.0357) and shf (P=0.0328). It was recorded that 69% (59/85) of the 85 analyzed EAEC strains were biofilm producers; 73% (43/59) of the biofilm producers carried the aggR gene versus 42.3% (11/26) of non-producers (P=0.0135). In addition, there was association between the aatA gene and biofilm production; 61% (36/59) of the samples presented producer strains, versus 19.2% (5/26) of non-producers (P<0.0004). Antibiotic sensitivity test evidenced that most EAEC were ampicillin 70.6% (60/85), sulfamethoxazole 60% (51/85), tetracycline 44.7% (38/85) and cefotaxime 22.4% (19/85) resistant. CONCLUSION: As far as it is known, the present study is pioneer in Northern Brazil to investigate EAEC virulence factors and to show the antimicrobial susceptibility of EAEC strains isolated from children with diarrhea.

RESUMO CONTEXTO: A Escherichia coli enteroagregativa (EAEC) é um dos principais agentes causadores de diarreia aguda e crônica em crianças e adultos, principalmente em países em desenvolvimento. OBJETIVO: Caracterizar cepas de EAEC isoladas de amostras fecais e identificar genes que potencialmente contribuem para a virulência, produção de biofilme e resistência antimicrobiana em crianças internadas em um hospital pediátrico em Porto Velho, Rondônia. MÉTODOS: Um total de 1.625 cepas de E. coli foram isolados de 591 crianças com gastroenterite aguda na faixa etária de 6 anos que foram internadas no Hospital Infantil Cosme e Damião na cidade de Porto Velho, entre fevereiro de 2010 e fevereiro de 2012. Colônias sugestivas de E. coli foram submetidas a reação em cadeia da polimerase para identificação de fatores de virulência. O ensaio de adesão in vitro foi desenvolvido com célula HEp-2. A detecção de biofilme foi realizada através do teste de espectrofotometria e os testes de susceptibilidade aos antimicrobiana foram realizados através do método de difusão em disco. RESULTADOS: A E. coli diarreiogênica foi encontrada em 27,4% (162/591) das crianças e a EAEC foi a E. coli diarreiogênica mais frequentemente associada à diarreia com 52,4% (85/162), seguida pela E. coli enteropatogênica 43,8% (71/162), E. coli enterotoxigênica 2,4% (4/162) e E. coli enterohemorrágica 1,2% (2/162). O gene aggR foi detectado em 63,5% (54/85) dos isolados de EAEC com correlação estatisticamente significante entre esse gene com os genes aatA (P<0,0001), irp2 (P=0,0357) e shf (P=0,0328). Neste estudo 69% (59/85) das cepas de EAEC eram produtoras de biofilme, destas 73% (43/59) possuíam o gene aggR, ao passo que entre as não produtoras 42,3% (11/26) possuíam o gene (P=0,0135). Essa associação também foi observada com o gene aatA, presente em 61% (36/59) das cepas produtoras e em 19,2% (5/26) das não produtoras (P<0,0004). O teste de sensibilidade aos antibimicrobianos evidenciou que a maioria das EAEC eram resistentes a ampicilina 70,6% (60/85), ao sulfametoxazol 60% (51/85), a tetraciclina 44,7% (38/85) e a cefotaxima 22,4% (19/85). CONCLUSÃO: Este é o primeiro estudo no Norte do Brasil sobre a investigação dos fatores de virulência de EAEC mostrando a susceptibilidade antimicrobiana de cepas de EAEC isoladas de crianças com diarreia.

Epidemiología sociocultural de los padecimientos gastrointestinales en niños y niñas del pueblo Nasa, Colombia / Socio-cultural epidemiology of gastrointestinal illness in children of the Nasa people, Colombia

Resumen Introducción: Los padecimientos gastrointestinales son frecuentes en la población indígena, generando diversas interpretaciones y tratamientos. Objetivo: Construir un perfil epidemiológico sociocultural de la enfermedad diarreica en niños Nasas menores de un año. Materiales y métodos: Método mixto e interdisciplinario que trianguló herramientas cuantitativas y cualitativas, y que orientó la caracterización sociocultural de este pueblo, la descripción estadística sobre la presencia y distribución de dicha enfermedad, y el quehacer etnográfico alrededor de su diagnóstico, interpretación y atención. Resultados: El 98.5% de esta población vive en la zona rural y no tiene acceso a saneamiento básico. En los seis meses de investigación se presentaron 349 casos de esta enfermedad en 306 infantes menores de un año, y su incidencia es mayor en las zonas con menor presencia de instituciones estatales. Los diagnósticos los realizan principalmente las madres a partir de elementos específicos: características de las deposiciones, y de situaciones contextuales: incidentes ambientales, sociales y culturales. Las principales causas reconocidas por las cuidadoras son de origen biológico: parásitos (23%) y malnutrición (21%), además de síndromes de filiación cultural: susto (15%), mal viento (8%) y lastimadura (7%). Las estrategias de atención indicaron un pluralismo médico con predominio de la autoatención. La biomedicina es la opción principal cuando las mamás ven comprometida la vida de los infantes. Conclusiones: La enfermedad diarreica entre los Nasas tiene elevada presencia, y es el reflejo de una vida precarizada, dinamizado en un territorio rural excluido y colmado de simbolizaciones.

Abstract Introduction: Gastrointestinal illness are frequent in the indigenous population, generating different interpretations and treatments. Objective: To construct a Socio-cultural epidemiological profile of diarrheal disease in Nasa children under one year of age. Materials and methods: Mixed and interdisciplinary method that triangulated quantitative and qualitative tools, which guide the sociocultural characterization of this people, the statistical description of the presence and distribution of this disease, and the ethnographic work around its diagnosis, interpretation and care. Results: 98.5% of this population live rural areas and do not have access to basic sanitation. During the six months of research, 349 cases of this disease were presented at 306 infants under one year, and its incidence is higher in areas with less presence of State institutions. The diagnoses are mainly made by the mothers based on specific elements: characteristics of the depositions, and contextual situations: environmental, social and cultural incidents. The main causes recognized by the caregivers are of biological origin: parasites (23%) and malnutrition (21%), also syndromes of cultural affiliation: fright (15%), bad wind (8%) and injury (7%). Care strategies indicated a medical pluralism with a predominance of self-care. Biomedicine is the main option when moms see the lives of the infants compromised. Conclusions: Diarrheal disease among the Nasas has a high presence, and it is a reflection of a precarious life, invigorated in a rural territory excluded and filled with symbolizations.

Enteropatógenos predominantes en diarreas agudas y variables asociadas en niños atendidos en el Hospital Regional Lambayeque, Perú / Predominant enteropathogens in acute diarrhea and associated variables in children at the Lambayeque Regional Hospital, Peru

Objetivo: Determinar el tipo y frecuencia de enteropatógenos predominantes en diarreas agudas y sus características asociadas en niños atendidos en el Hospital Regional Lambayeque (HRL) - Perú. Materiales y métodos: Se realizó un estudio analítico transversal entre marzo y mayo del 2015 en 70 muestras fecales. Las muestras se estudiaron mediante coprocultivo e inmunocromatografía para la detección de bacterias y virus enteropatógenos respectivamente. Mientras que los enteroparásitos se buscaron mediante examen microscópico directo, tinción de Kinyoun y ELISA para coproantígenos (Entamoeba histolytica, Giardia lamblia y Cryptosporidium spp.). Asimismo se realizó conteo de leucocitos y pruebas químicas (Benedict, Thevenon y Sudan III) para el estudio funcional de la enfermedad diarreica. Resultados: En el 48,6% de muestras se detectó la etiología infecciosa de la diarrea, siendo predominante la causa parasitaria (25,8%), seguida de la bacteriana (17,1%) y viral (5,8%). Los enteropatógenos más frecuentes fueron G. lamblia (18,6%) y Salmonella Enteritidis (10,0%). Se observó asociación entre la cantidad de leucocitos mayor a 100 con la etiología bacteriana (p=0,027), mientras que un número menor de 10 por campo (p=0,002) y el Sudan III positivo (p=0,003) con la etiología parasitaria. Conclusiones: En más de la mitad de muestras (51,4%) no se demostró etiología infecciosa de la diarrea, mientras que Giardia lamblia fue la más frecuente causa de diarrea en la población estudiada. No obstante, es necesaria la implementación de técnicas más sensibles y específicas para la detección de un rango mayor de enteropatógenos con el que se mejore el diagnóstico y tratamiento de la enfermedad

Objective: To determine the type and frequency of predominant enteropathogens in acute diarrhea and their associated characteristics in children treated at Hospital Regional Lambayeque (HRL) - Peru. Materials and methods: A cross-sectional analytical study was carried out in 70 fecal samples between March and May 2015. These samples were studied by coproculture and immunochromatography for the detection of enteropathogenic bacteria and viruses, respectively, while enteroparasites were sought by direct microscopic examination, Kinyoun staining method and ELISA for the detection of coproantigens (Entamoeba histolytica, Giardia lamblia and Cryptosporidium spp). Leukocyte count and chemical tests (Benedict, Thevenon and Sudan III) were also performed for the functional study of the diarrheal disease. Results: In 48.6% of the samples, the infectious etiology of diarrhea was detected, prevailing the parasitic cause (25.8%), followed by the bacterial (17.1%) and viral (5.8%) ones. The most common enteropathogens were G. lamblia (18.6%) and Salmonella enteritidis (10.0%). An association between greater than 100 fecal leukocytes per field and the bacterial etiology (p=0.027) was observed, while less than 10 fecal leukocytes per field (p=0.002) and a positive Sudam III test (p=0.003) were associated with the parasitic etiology. Conclusions: In more than half of the samples (51.4%) the infectious etiology of diarrhea could not be proven, whereas Giardia lamblia was the most frequent cause of diarrhea in the studied population. However, it is necessary to implement more sensitive and specific techniques for the detection of a greater range of enteropathogens with which to improve the diagnosis and treatment of the disease

Clinical Study on Mingmen Eight Array Massage Combined with Compound Lysine Hydrochloride and Zinc Gluconic Granules for Treatment of Infantile Diarrhea / 中国中医药信息杂志

Objective To observe the clinical efficacy of the Mingmen eight array massage combined with compound lysine hydrochloride and zinc gluconate granules for the treatment of infantile diarrhea. Methods Totally 120 children with diarrhea met the inclusion criteria were divided into the treatment group, Western medicine group, and general massage group by random number table method, 40 cases in each group. All 3 groups were given dietary guidance and did moderate exercise. Western medicine group was administered orally for compound lysine hydrochloride and zinc gluconate granules, two bags per day for the aged 1–10, three bags per day for the aged >10. Treatment group was given the Mingmen eight array massage therapy based on Western medicine. General massage group received conventional massage therapy based on Western medicine, with four weeks as treatment course. 3 groups of patients were observed before and after treatment for salivary amylase, blood zinc value, urine D-xylose absorption and excretion test, TCM symptom score, and clinical efficacy were evaluated. Results There was statistical significance in the salivary amylase, blood zinc value, and urinary D-xylose absorption and excretion rate between before and after t reatment(P<0.05); after treatment, treatment group showed higher salivary amylase, blood zinc value, and urinary D- xylose absorption and excretion rate than the Western medicine group and general massage group (P<0.05); scores of diarrhea, loose stool, lassitude, lusterless complexion, and appetite reduction decreased compared with before treatment (P<0.05); after treatment, all integrals of treatment group were lower than Western medicine group and general massage group (P<0.05). The total effective rates of the treatment group, Western medicine group and general massage group were 92.50％ (37/40), 72.50％ (29/40), and 75％ (30/40) respectively. There was statistical significance among the three groups (P<0.05). Conclusion Mingmen eight array massage combined with compound lysine hydrochloride and zinc gluconic granules can effectively alleviate the clinical symptoms of patients with infantile diarrhea, and improve the level of laboratory parameters.

Application of epidemic dynamics model in isolating hospital-acquired rotavirus infection / 中国感染控制杂志

Objective To establish an epidemic dynamics model of the transmission and prevention strategies of rotavirus infection in hospital.Methods Rotavirus SEIR model based on different isolation measures was constructed using epidemic dynamics method, the effectiveness of isolation measures was evaluated.Results Supposing that all patients were isolated, isolation measures were taken on the 3rd day of transmission, there were 4.3 cases of infection on the 5th day of transmission, peaked on the 7th day(n=6.4), until the 14th day of transmission, the number of infected persons fell to 3.4 cases.If isolation measures were taken on the 2nd day of transmission, the infected persons reached 4.0 on the 6th day, and reduced to 3.2 cases on the 8th day.If isolation measures were taken on the 1st day of transmission, the infected persons reached 2.4 at most, healthcare-associated infection would not occur.Early isolation can effectively prevent the outbreak of rotavirus infection, the later the isolation, the more the infection occurs and the longer the outbreak lasts.Conclusion Rotavirus infection can easily break out in hospital, early discovery and early isolation of rotavirus infected child is the effective measure to avoid rotavirus infection outbreak in hospital.

Diversity of group A rotavirus genes detected in the Triângulo Mineiro region, Minas Gerais, Brazil

ABSTRACT Group A rotaviruses are the main causative agent of infantile gastroenteritis. The segmented nature of the viral genome allows reassortment of genome segments, which can generate genetic variants. In this study, we characterized the diversity of the VP7, VP4 (VP8*), VP6, NSP4, and NSP5 genes of the rotaviruses that circulated from 2005 to 2011 in the Triângulo Mineiro (TM) region of Brazil. Samples with genotypes G2 (sublineages IVa-1 and IVa-3), G1 (sublineage I-A), G9 (lineage III), G12 (lineages II and III), G8 (lineage II), G3 (lineage III), P[4] (sublineages IVa and IVb), P[8] (sublineages P[8]-3.6, P[8]-3.3, and P[8]-3.1), I2 (lineage VII), E2 (lineages VI, XII, and X), and H2 (lineage III) were identified. The associations found in the samples were G1, G9, or G12 with P[8]-I1-E1-H1; G2 or G8 with P[4]-I2-E2-H2; G12 with I3-E3-H6; and G3 with P[4]-I2-E3-H3 (previously unreported combination). Reassortment events in G2P[4] strains and an apparent pattern of temporal segregation within the lineages were observed. Five TM samples contained genes that exhibited high nucleotide and amino acid identities with strains of animal origin. The present study includes a period of pre- and post-introduction of rotavirus vaccination in all Brazilian territories, thereby serving as a basis for monitoring changes in the genetic constitution of rotaviruses. The results also contribute to the understanding of the diversity and evolution of rotaviruses in a global context.

Effect of lysine hydrochloride and zinc gluconate granules combined with montmorillonite powder and live combined bifidobacterium and lactobacillus granules in infantile diarrhea / 中国生化药物杂志

Objective To evaluate the effect of lysine hydrochloride and zinc gluconate granules combined with montmorillonite powder and live combined bifidobacterium and lactobacillus granules in the treatment of infantile diarrhea.Methods 80 cases of children with infantile diarrhea in our hospital from May 2014 to May 2016 were selected and randomly divided into the combined treatment group ( lysine hydrochloride and zinc gluconate granules combined with montmorillonite powder and live combined bifidobacterium and lactobacillus granules ) , and conventional treatment group ( montmorillonite powder and live combined bifidobacterium and lactobacillus granules ) two groups with 40 cases in each group, the clinical curative effects, adverse reactions, stool frequency recovery normal time, stool normal time, abdominal pain disappeared time, temperature recovery time, vomiting disappeared time of the two groups were statistically analyzed.Results The total treatment effective rate of the combined treatment group 97.5%(39/40) was significantly higher than the conventional treatment group 72.5% (29/40), the difference was statistically significant (P<0.05), the stool frequency recovery normal time, stool normal time, abdominal pain disappeared time, temperature recovery time, vomiting disappeared time were significantly shorter than the conventional treatment group, the difference was statistically significant (P<0.05).Conclusion The effect of lysine hydrochloride and zinc gluconate granules combined with montmorillonite powder and live combined bifidobacterium and lactobacillus granules in the treatment of infantile diarrhea is better than montmorillonite powder and live combined bifidobacterium and lactobacillus granules .

Changes in epidemiology of rotavirus in the Triângulo Mineiro region of Brazil: lack of two consecutive rotavirus seasons

Rotaviruses are the main cause of infantile acute diarrhea, and a monovalent (G1P[8]) vaccine against the virus was introduced into the Brazilian National Immunization Program for all infants in March 2006. The objectives of this study were to determine the rate and genotype distribution of rotavirus causing infantile diarrhea in the Triângulo Mineiro region of Brazil during 2011-2012 and to assess the impact of local vaccination. Fecal specimens were analyzed for detection and characterization of rotavirus using polyacrylamide gel electrophoresis, reverse transcription followed by polymerase chain reaction (PCR), and PCR-genotyping assays. Overall, rotavirus was diagnosed in 1.7% (6/348) of cases. Rotavirus positivity rates decreased 88% [95% confidence intervals (CI)=15.2, 98.3%; P=0.026] in 2011 and 78% (95%CI=30.6, 93.0%; P=0.007) in 2012 when compared with available data for baseline years (2005/2006) in Uberaba. In Uberlândia, reductions of 95.3% (95%CI=66.0, 99.4%; P=0.002) in 2011, and 94.2% (95%CI=56.4, 99.2%; P=0.004) in 2012 were also observed compared with data for 2008. The circulation of rotavirus G2P[4] strains decreased during the period under study, and strains related to the P[8] genotype reemerged in the region. This study showed a marked and sustained reduction of rotavirus-related cases, with a lack of rotavirus in the 2011 and 2012 seasons, suggesting a positive impact of the vaccination program.

Análise espacial de indicadores integrados de saúde e ambiente para morbimortalidade por diarreia infantil no Brasil, 2010 / Spatial analysis of integrated health and environmental indicators for morbidity and mortality due to infant diarrhea in Brazil, 2010 / Análisis espacial de indicadores integrados de salud y ambiente para la morbilidad y mortalidad por diarrea infantil en Brasil, 2010

O objetivo deste estudo é construir indicadores integrados de saúde e ambiente para diarreia em crianças menores de um ano no Brasil. Foi utilizado um desenho de estudo ecológico, com a aplicação do modelo teórico Geo Saúde, que inclui as dimensões: força motriz, pressão, estado do meio ambiente, exposição e efeito à saúde humana. No Brasil, a probabilidade de crianças menores de um ano serem hospitalizadas ou chegarem a óbito por doença diarreica aguda, nas microrregiões brasileiras, é maior naquelas localizadas nas regiões Norte e Nordeste. Na Região Norte, as internações e óbitos são mais de cinco vezes maiores que as das regiões Sudeste e Sul, respectivamente. A taxa de internação por diarreia infantil mostrou-se associada com o percentual da população sem coleta de lixo; a taxa de mortalidade com a razão de dependência e percentual de moradores sem coleta de lixo. Conclui-se que o saneamento básico persiste como problema socioambiental nas regiões Norte e Nordeste, e a redução da diarreia infantil depende de políticas públicas nesse setor.

The objective of this study was to construct integrated health and environmental indicators for diarrhea in infants (< 1 year of age) in Brazil. The authors used an ecological design, applying the Geo Health model, including the following dimensions: driving force, pressure, state of the environment, and exposure to human health effects. The likelihood of infant hospitalization or death from acute diarrheal disease is highest in the North and Northeast regions of Brazil. In the North, hospitalizations and deaths are five times more common than in the Southeast and South. The hospitalization rate for infant diarrhea was associated with the percentage of the population without garbage collection and the mortality rate with the dependency ratio and percentage of residents without garbage collection. The article concludes that sanitation is a persistent environmental problem in North and Northeast Brazil and that a reduction in infant diarrhea requires effective public policies in this area.

El objetivo de este estudio es la construcción de indicadores integrados de salud y ambiente para la diarrea en menores de un año en Brasil. Se utilizó un diseño de estudio ecológico, con la aplicación del modelo teórico Geo Salud, que incluye las dimensiones: fuerza motriz, presión, estado del medio ambiente y exposición a los efectos la salud humana. En Brasil, la probabilidad de que los menores de un año sean hospitalizados o mueran por enfermedad diarreica aguda llega a las microrregiones de Brasil y es mayor en las regiones Norte y Nordeste. En el Norte, las hospitalizaciones y las muertes son más cinco veces superiores en comparación con el Sureste y Sur, respectivamente. La tasa de hospitalización por diarrea infantil se asoció con el porcentaje de la población sin sistema de recolección de basura; la tasa de mortalidad con la relación de dependencia y el porcentaje de residentes sin recolección de basura. Se concluye que el saneamiento sigue siendo un problema ambiental en las regiones Norte y Nordeste, y la reducción de la diarrea infantil depende de las políticas públicas en este sector.

Observation of the curative effect of traditional Chinese medicine direction inductive therapeutical instrument combined with golden bifid in the treatment of infantile diarrhea / 中国基层医药

Objective To explore the effect of traditional Chinese medicine direction inductive therapeutical instrument combined with golden bifid in the treatment of infantile diarrhea .Methods 188 infants aged from 1 month to 3 years who suffered from acute diarrhea were randomly divided into the treatment group and the control group ,94 cases in each group .All the patients were treated with continued diet ,prevention and correct water and electrolyte bal-ance and other treatment ,the treatment group received traditional Chinese medicine direction inductive therapeutical instrument combined with oral golden bifid based on the above treatment .The time of temperature returned to normal , stop vomiting and diarrhea and stool frequency were recorded and analyzed .Results The time of symptoms disap-peared,obvious effective rate and total effective rate of the treatment group were better than those of the control group . Conclusion It is safe and effective to treat infantile diarrhea by traditional Chinese medicine direction inductive therapeutical instrument combined with golden bifid .

La criptosporidiosis en niños hospitalizados. Hospital Provincial Pediátrico "Pepe Portilla" / Cryptosporidiosis in hospitalized infants . "Pepe Portilla" Provincial Pediatric Hospital

Introducción: la Cryptosporidium ocasiona diarrea aguda, acuosa, no sanguinolenta y que puede acompañarse de anorexia , náusea s o vómitos y dolor abdominal. Objetivo: determinar la presencia de Cryptosporidium como causa de diarreas en los pacientes pediátricos de 1 mes a 2 años, ingresados en el Hospital Provincial Pediátrico "Pepe Portilla" de Pinar del Río durante el periodo de enero-diciembre de 2010. Material y Métodos: se realizó una investigación aplicada y descriptiva, de corte transversal. Se empleó el método porcentual para cuantificar los resultados. Se realizó el examen de heces coloreadas por la técnica de Ziehl-Neelsen modificada a 845 niños que conformaron el universo; la muestra la constituyeron 19 niños con heces positivos a Cryptosporidium. Resultados: el Cryptosporidium estuvo presente en el 2.3% (19) de los pacientes con diarrea aguda. Se reportaron más casos en los meses de julio y agosto, fueron más afectados el sexo masculino y los niños de 1-12 meses; la diarrea liquida fue la manifestación clínica que predominó. Unos 15 pacientes (79%) se alimentaban con lactancia artificial. No hervir el agua, la presencia de vectores y el hacinamiento, fueron los hábitos higiénicos deficientes encontrados en los hogares, más frecuentes en la zona urbana; el nivel de escolaridad de la persona a cargo del niño fue adecuado. Conclusiones. el Cryptosporidium forma parte de la etiología de las diarreas de los niños hospitalizados, las medidas preventivas aun son deficientes.

Introduction: cryptosporidiosis provokes acute, aqueous, non-bloody diarrheas that can be accompanied by anorexia, nausea or vomits with abdominal pain. Objective: to determine the presence of Cryptosporidium as a cause of diarrheas in pediatric patients from 1 to 2 months old hospitalized at "Pepe Portilla" Pediatric Hospital, Pinar del Rio during January-December 2010. Material and Methods: an applied, descriptive and cross-sectional research was carried out. Percentage method was used to quantify the results. Stained feces using modified Ziehl-Neelsen technique was applied to 845 infants that comprised the target group; the sample included 19 children with feces positive to Cryptosporidium. Results: cryptosporidium was present in 19 of the patients suffering from acute diarrhea (2.3%). The majority of the cases were reported on the months of July and August, male sex was the most affected as well as infants from 1-2 months old; aqueous diarrhea was the prevailing clinical manifestation. Fifteen (15) patients received bottle feeding. Not boiling the water, the presence of vectors and overcrowding conditions were the most deficient standards of hygiene found in these homes, most frequent in urban zones. The person taking care of infants showed an adequate educational level. Conclusions: cryptosporidium is part of the etiology of diarrheas in hospitalized infants, preventive measures are still insufficient.

Padrões de aleitamento materno exclusivo e internação por diarréia entre 1999 e 2008 em capitais brasileiras / Exclusive breastfeeding and diarrhea hospitalization patterns between 1999 and 2008 in Brazilian State Capitals

A prevalência do aleitamento materno tem aumentado nas duas últimas décadas como resultado das políticas públicas de incentivo a esta prática. Trata-se de estudo epidemiológico ecológico, com base em dados secundários das Capitais Brasileiras e Distrito Federal. As prevalências de aleitamento materno, a população de nascidos vivos e os casos de internação hospitalar por diarreias foram comparados entre os anos de 1999 e 2008. Foi utilizado o teste não-paramétrico de Spearman para correlacionar as variáveis. Foram estudados 1.329.618 nascidos vivos no período. O aumento da prevalência de aleitamento materno exclusivo em crianças com menos de 4 meses de vida teve correlação negativa com as taxas de internação por diarreias (r = -0,483, p = 0,014), sendo essa correlação mais forte para meninas (r = -0,521, p = 0,016) que para os meninos (r = -0,476, p = 0,008). O aumento da prevalência de aleitamento materno exclusivo entre 1999 e 2008 parece estar correlacionado com a diminuição das taxas de internação hospitalar por diarreias no mesmo período, corroborando a importância das políticas públicas de promoção, proteção e apoio do aleitamento materno.

The prevalence of breastfeeding has increased over the past two decades in Brazil, as a result of public breastfeeding policies. The scope of this paper is to analyze the correlation between the increase in the prevalence of breastfeeding and hospitalization rates due to diarrhea. It is an epidemiological ecological study, based on secondary data from Brazilian Capital Cities and the Federal District. The prevalence of breastfeeding, the number of live births, and cases of hospitalization due to diarrhea were compared for the years 1999 and 2008 and the Spearman non-parametric test was used to correlate the variables. During the period, 1,329,618 children under one year of age in 1999 and 2008 were studied. The increase in the prevalence of exclusive breastfeeding among children under 4 months old had a negative correlation with hospitalization rates due to diarrhea (Rho=-0.483, p=0.014). This correlation was stronger for girls (Rho=-0.521, p=0.008) than for boys (Rho=-0.476, p=0.016). The increase in the prevalence of breastfeeding between 1999 and 2008 appears to be correlated to a reduction in hospitalization rates due to diarrhea over the same period, corroborating the importance of public policies to protect, support and promote breastfeeding.

Impacto de um programa de atualização em alimentação infantil em unidades de saúde na prática do aleitamento materno e na ocorrência de morbidade / An infant feeding update program at healthcare centers and its impact on breastfeeding and morbidity

O objetivo deste estudo foi avaliar o impacto de um programa de atualização em alimentação infantil na prática do aleitamento materno exclusivo (AME), ocorrência de diarreia e de sintomas de morbidade respiratória. Ensaio de campo randomizado por conglomerados foi conduzido na cidade de Porto Alegre, Rio Grande do Sul, Brasil, com vinte unidades básicas de saúde (UBS). Profissionais de saúde receberam informações sobre os Dez Passos da Alimentação Saudável para Crianças Menores de Dois Anos de Idade. Foram avaliadas 619 crianças com idade entre 6-9 meses. Observou-se maior duração do AME (p = 0,02) no grupo intervenção, porém sem significância na prevalência de diarreia e sintomas de morbidade respiratória. Análises complementares mostraram que a duração do AME foi maior no grupo de crianças sem ocorrência de diarreia (p = 0,001) e sem sintomas de morbidades respiratórias (p =0,03). Tais resultados sugerem que a estratégia de atualização não foi suficiente para interferir na ocorrência de morbidades, contudo foi eficaz em aumentar o tempo de AME.

This study evaluated the impact of an infant feeding update program on exclusive breastfeeding and the incidence of diarrhea and respiratory illness in infants. A randomized cluster field study was conducted in the city of Porto Alegre, Rio Grande do Sul State, Brazil, with 20 healthcare centers. Health professionals received information on the Ten Steps to Healthy Feeding for Children up to Two Years of Age. We evaluated 619 infants 6-9 months of age. The results showed longer duration of exclusive breastfeeding (p = 0.02) in the intervention group but no significant differences in the incidence of diarrhea or respiratory symptoms. Complementary analyses showed that exclusive breastfeeding was longer in the group of children without the occurrence of diarrhea (p = 0.001) or respiratory symptoms (p = 0.03). The data suggest that the training was insufficient to affect incidence of illness, but that it was effective in extending exclusive breastfeeding.

Progress in the pathogenesis of rotavirus-associated disease / 国际儿科学杂志

Rotavirus is the most common pathogens of diarrheal diseases in children. Rotavirus infection lead to not only gastrointestinal symptoms but also a variety of extraintesu'nal manifestations. The pathogenesis of RV diarrhea and especially RV viremia is related to multiple factors. Rotavirus infectious diarrhea is related to the damaged cell intercellular connections,the non-structural protein 4, heat shock protein hsc70 and other factors. Pathogenesis of RV viremia may be related to the secretion of inflammatory mediators in vivo and expression of cytokines after RV infection.

Patogénesis molecular, epidemiología y diagnóstico de Escherichia coli enteropatógena / Molecular pathogenesis, epidemiology and diagnosis of enteropathogenic Escherichia coli

Escherichia coli enteropatógena (EPEC) es una de las principales causas de diarrea en niños menores de dos años en países en vías de desarrollo. La principal característica histopatológica de la infección es una lesión que induce la EPEC en el intestino conocida como la lesión A/E (adherencia y eliminación). Las bacterias se adhieren a los enterocitos y permiten la acumulación de la actina del citoesqueleto en la región apical de la célula, hasta formar una estructura de tipo "pedestal" y causar la eliminación de las microvellosidades intestinales. A pesar de que se conoce de modo detallado el proceso de formación de los pedestales de actina, aún no se ha esclarecido el mecanismo global de la diarrea que induce EPEC. La diarrea se ha vinculado con: a) la destrucción de las microvellosidades del enterocito, b) la salida masiva de iones hacia la luz intestinal y c) la secreción de alguna enterotoxina. En estudios realizados en países en vías de desarrollo se ha demostrado que EPEC es uno de los principales agentes participantes en la diarrea infantil, con elevadas tasas de morbilidad y mortalidad. El diagnóstico microbiológico de la infección se realiza con metodologías adicionales a las utilizadas con regularidad en el laboratorio de microbiología clínica, entre ellas las siguientes: a) serotipificación, b) ensayo de adherencia, c) prueba de FAS (tinción fluorescente para actina) y d) detección específica de genes que codifican a proteínas incluidas en la patogénesis, como el bfpA y eae. Un objetivo de esta revisión es actualizar los avances observados en la patogénesis molecular de la infección por EPEC, las metodologías para el diagnóstico microbiológico y la epidemiología en México y otros países en vías de desarrollo.

Enteropathogenic Escherichia coli (EPEC) is a leading cause of diarrhea in infants less than two years of age in developing countries. To induce diarrhea EPEC uses several virulence factors acting on a still unknown and mysterious mechanism. The hallmark of EPEC infection is a histological intestinal alteration known as the attaching and effacing (A/E) lesion. The bacterium attaches intimately to the enterocyte and induces assembly of cytoskeleton intracellular actin on the cellular surface. Rearrangements of the actin cytoskeleton form a pedestal-like structure where bacterium tightly cups the cells, leading to degeneration of brush border microvilli. Although the mechanism of EPEC-induced pedestal formation has been dissected in detail, the overall mechanism of diarrhea is still obscure. It is believed that EPEC-mediated secretory diarrhea is related to a) intestinal microvilli effacement, b) massive loss of intracellular ions into the intestinal milieu and c) secretion of an EPEC enterotoxin. Epidemiological studies conducted in developing countries have shown that EPEC is one of the main bacteria frequently isolated from children with diarrhea, causing high morbidity and mortality rates. The microbiological diagnosis of EPEC-induced disease is performed with analytic methodologies different from those used by the standard microbiology laboratory, the most relevant being: a) serotypification, b) the adherence assay, c) FAS test, and d) the specific detection of virulence-involved genes (bfpA and eae genes) using molecular biology techniques. The purpose of this review is to update the most recent findings regarding the molecular pathogenesis of EPEC, its epidemiology in Mexico as well as other developing countries, and also the developed methodology for the diagnosis of EPEC infection.

Plasma amino acid changes in acute infantile diarrhea.

During the acute phase of diarrhea, there was an increase in plasma level of phenylalanine while other plasma amino acids did not increase or decrease. The addition of amino acid in ORS was not justified during acute infantile diarrhea.