Gastroenteritis eosinofílica: aspectos clínicos e imagenológicos de una entidad poco frecuente, reporte de caso / Eosinophilic gastroenteritis: clinical aspects and imagenological features of an infrequent entity, case report

Eosinophil-associated diseases constitute a group of pathologies where eosinophils play an important role. Among them, eosinophilic gastroenteritis is a rare entity. Few demographic data exist in the literature, with an estimated prevalence of 28-30/100,000. The symptoms presented by patients mainly depend on the affected segment of the gastrointestinal tract and the layer infiltrated by eosinophils. We report a 22-year-old male patient with a one-month history of diarrhea, with mucus and occasionally hematic striae. Initial laboratory tests showed leukocytosis with eosinophilia, and imaging studies showed extensive involvement of the gastrointestinal tract characterized by diffuse concentric parietal thickening and submucosal edema associated with ascites. Upper endoscopy and biopsy confirmed the presence of foci of infiltration by eosinophils. The patient was treated with corticosteroids and a lactose and wheat free diet, with a favorable evolution, without relapse after stopping corticosteroid treatment.

Las enfermedades asociadas a eosinófilos constituyen un grupo de patologías en que el aumento de los eosinófilos presenta un rol fundamental, encontrándose entre ellas la gastroenteritis eosinofílica, entidad poco frecuente. En la literatura existen pocos datos demográficos, con una prevalencia estimada entre 28-30 /100.000 habitantes. Los síntomas dependen principalmente del segmento afectado del tracto gastrointestinal y de la capa de la pared infiltrada por eosinófilos. Se presenta el caso clínico de un paciente masculino de 22 años con cuadro de diarrea de un mes de evolución, asociado a mucosidad y ocasionalmente estrías hemáticas. El estudio de laboratorio inicial mostró leucocitosis con eosinofilia, realizándose estudios de imágenes que demuestran extenso compromiso del tubo digestivo caracterizado por engrosamiento parietal difuso concéntrico y edema submucoso del estómago como también de asas de intestino delgado, asociado a ascitis. La endoscopia digestiva alta y biopsia confirmaron la presencia de focos de infiltración por eosinófilos. El paciente fue tratado con corticoides y dieta con restricción de lactosa y trigo, con evolución favorable, sin recaída tras la suspensión del tratamiento corticoidal

Detection of Diarrheagenic Escherichia coli in Bovine Meat in the Northern Region of Paraná State, Brazil

Abstract Ground bovine meat is commonly consumed by the population of Brazil. However, it constitutes an excellent medium for the multiplication of microorganisms due to available nutrients and handling practices prior to consumption. Here, we examined 100 samples of ground beef for the presence of diarrheagenic Escherichia coli (DEC) pathotypes by PCR, and characterized isolates by analyzing their adherence to HEp-2 cells, serotype, antimicrobial susceptibility, and phylogeny. Enteroaggregative E. coli was detected in five (5%) meat samples, Shiga toxin-producing E. coli in three (3%), and atypical enteropathogenic E. coli in two (2%). According to the phylogeny, six isolates (60%) were classified in group A, two (20%) in group B1, and two (20%) in group E. The detected serotypes were O3:H2, O93:H9, O93:H46, O105ab:H7, O152:H8, O156:H10, and O175:H7. The antimicrobial susceptibility testing showed that one sample (10%) was resistant to ampicillin, two (20%) to sulfamethoxazole-trimethoprim, and two (20%) to cephalothin. Based on these results, bovine ground meat for human consumption can serve as a reservoir of DEC, which emphasizes the importance of appropriate hygienic-sanitary conditions during handling at every stage from slaughter to table.

Síndrome diarreico por rotavirus en niños menores de 5 años inmunizados y no de la ciudad de Maracaibo, estado Zulia, Venezuela / Diarrheic syndrome due to rotavirus in immunized and non-immunized children under 5, in the city of Maracaibo, state of Zulia, Venezuela

La diarrea aguda es la causa más común de morbi-mortalidad infantil, donde el Rotavirus es uno de los principales agentes involucrados en las diarreas severas en niños menores de 5 años. El presente estudio tiene como objetivo determinar la presencia de rotavirus en una población infantil con cuadros diarreicos, vacunados y no vacunados que acuden a observación pediátrica del Hospital de Niños y Hospital Universitario de Maracaibo, estado Zulia en el período de Abril 2011 hasta Abril 2012, para ello se recolectaron 100 muestras de heces y para el diagnóstico se utilizó la técnica de Aglutinación Directa en partículas de Látex. Resultaron positivos un 43,6% (24/55) de niños no vacunados y 33,3% (10/30) de niños vacunados afectando principalmente a los menores de 1 año con predominio del sexo masculino con un 65,9% sobre el sexo femenino con 40%, la diarrea por el agente viral estudiado representó casi la mitad de las hospitalizaciones por gastroenteritis, encontrándose una diferencia estadística significativa de p= 0.027 en el numero de evacuaciones del cuarto día, entre niños no vacunados (5) y vacunados (3). Los resultados de esta investigación muestran la circulación de rotavirus en niños vacunados y no vacunados, es por ello importante considerar que el presente reporte tiene como fin último alertar a la comunidad médica a considerar en todo niño con gastroenteritis la posibilidad de que se trate de un cuadro por RV.

Acute diarrhea is the most common cause of morbidity and mortality in infants, where rotavirus is one of the main agents involved in severe diarrhea for children under five years. The present study aims to determine the presence of rotavirus in a vaccinated and unvaccinated pediatric population with acute diarrhea that came to the Children’s Hospital and the University Hospital of Maracaibo, State of Zulia, for observation from April 2011 to April 2012. One-hundred stool samples were collected and direct agglutination of latex particles was used for diagnosis. 43.6% of the unvaccinated children were positive (24/55) as were 33.3% (10/30) of the vaccinated children. Principally, children under 1 year were affected, predominantly males with 65.9% and females with 40%. Diarrhea due to the viral agent under study accounted for nearly half the hospitalizations for gastroenteritis. A statistically significant difference of p = 0.027 was found between the number of evacuations on the fourth day in unvaccinated (5) and vaccinated (3) children. Results of this research show rotavirus circulating in vaccinated and unvaccinated children. Therefore, the purpose of this report is to alert the medical community to consider that every child with gastroenteritis could possibly have RV.

Gastroenterite eosinofílica em criança, levando à desnutrição / Eosinophilic gastroenteritis and children with malnutrition

A gastroenterite eosinofílica é uma afecção caracterizada pela infiltração maciça de eosinófilos no trato gastrointestinal. Foi descrita pela primeira vez por Kaijser em 1937 e pode acometer qualquer área do trato gastrointestinal. A causa e o mecanismo de infiltração de eosinófilos são ainda desconhecidos. A apresentação pode variar, dependendo da localização, assim como da profundidade e da extensão do acometimento, e geralmente tem curso crônico. É uma doença relativamente rara, que afeta predominantemente adultos jovens do sexo masculino. (AU)

Eosinophilic gastroenteritis is a condition with extensive infiltration of eosinophils in the gastrointestinal tract. It was first described by Kaijser en 1937 and can affect any part of gastrointestinal tract. The cause and the real way for infiltration are unknown. Presentation may vary depending on location as well as depth and extent of bowel wall involvement and usually runs a chronic relapsing course. It is a rare disease that affects mainly young adult men. (AU)

Eosinophilic gastrointestinal disorders

Eosinophilic gastrointestinal disorders are rare inflammatory diseases of unknown origin defined as disorders that selectively affect the gastrointestinal tract with eosinophil-rich inflammation in the absence of known causes for eosinophilia [eg, drug reactions, parasitic infections, and malignancy]. Eosinophil levels fluctuate, predating presentation by years and may be absent at presentation. Allergic mechanism has been suggested in at least a subset of patients. Indeed, increased total IgE and food-specific IgE levels have been detected in the majority of patients. A majority of patients have positive skin test responses to a variety of food antigens but do not have typical anaphylactic reactions, which is consistent with a delayed-type of food hypersensitivity syndrome. A male preponderance in the third to fifth decades of life has been reported. 25% have a history of atopy. Presentation may vary from a single organ affected by eosinophilic infiltrate to that of multisystem involvement. The gastric antrum and proximal small bowel are the most affected sites, commonly presenting with obstruction. Frank ulceration and haemorrhage are unusual. Symptoms are non-specific with nausea, vomiting, dyspepsia, abdominal pain, and weight loss. Approximately 80% have symptoms for several years before diagnosis. Eosinophilic gastroenteritis can present with protein-losing enteropathy. Serosal inflammation is the most likely cause of the exudative ascites. Biliary obstruction is a rare presentation of eosinophilic gastroenteritis. Presentation can mimic malignancy. Ultrasound, computed tomography and contrast studies may show nonspecific features of thickened mucosa and bowel wall. The histology is characteristic with mucosal oedema, a dense eosinophilic infiltrate, muscle bundle hypertrophy, and fibrosis. The submucosa is most commonly affected and full thickness biopsies may be needed for diagnosis. Treatments are often unsatisfactory, and long-term outcomes are uncertain. Prednisolone 20-40 mg per day remains an empirical treatment. Elimination diets and sodium cromoglycate are successful in rare cases where the causative antigen is isolated. Drugs such as montelukast, ketotifen, suplatast tosilate, mycophenolate mofetil, and alternative Chinese medicines have been advocated but are generally not successful. Spontaneous resolution may occur. It is hoped that a better understanding of the pathogenesis and treatment of EG will emerge by combining holistic clinical and research approaches involving experts in the fields of allergy, gastroenterology, nutrition, and pathology

[Eosinophilic gastroenteritis with clinical manifestations of small bowel obstruction: a case report]

Eosinophilic gastroenteritis is a rare disease with eosinophilic infiltration of the wall of the gastrointestinal tract, especially in stomach and small bowel. The etiology of the disease is unknown. A 61 year man was admitted because of epigastric pain for 10 days with burning quality with an increase after each meal. Laboratory tests showed mild leukocytosis with 5% eosinophilia, mildly elevated ESR and CRP and serum IgE at upper normal limit. Increased mucosal thickness was shown in posterior gastric wall and the descending part of duodenum seemed narrow with thick irregular wall. CT scan and esophago-gastro-duedenoscopy revealed gastric distention and erythema in D1 region with luminal narrowing. Pathology report from D1, showed inflammatory infiltration with eosinophilia in lamina propria. The patient was treated with oral prednisolone. All complaints and manifestations disappeared soon after treatment and the radiologic studies showed normal image

Frecuencia de rotavirus y adenovirus entre octubre 2005-agosto 2006 en el Instituto Médico La Floresta: Caracas-Venezuela / Frequency of rotavirus and adenovirus from october 2005-august 2006 at the Instituto Medico La Floresta: Caracas-Venezuela

La gastroenteritis clásica por rotavirus y adenovirus ocurre principalmente en niños entre 6 y 24 meses, pero es común en todos los grupos etarios, incluyendo adultos. Generalmente, los adultos han sido infectados, como lo demuestra la presión de anticuerpos séricos, sin embargo, no están protegidos contra nuevos episodios. Determinar la frecuencia de infección por rotavirus y adenovirus en el Instituto Médico La Florestas (IMLF), octubre 2005-agosto 2006. Estudio descriptivo, retrospectivo de datos obtenidos de la detección de rota/ adenovirus en heces por técnica inmunocromatografía del IMFL. Se procesaron 465 muestras de heces para rotavirus y adenovirus en todos los grupos etarios. De éstas, 162 (34,84 por ciento) muestras fueron positivas para ambos virus y sólo en 52 (32,10 por ciento) fue posible precisar si provenían de adultos o niños. En los niños, la frecuencia fue 80,77 por ciento, más elevada para adenovirus 42,31 por ciento, que para rotavirus 38,64 por ciento. En los adultos, fue 19,23 por ciento; con 13,46 por ciento y 5,77 por ciento para rotavirus y adenovirus respectivamente. La coinfección por ambos virus se encontró en 6 casos (11,54 por ciento. La infección por rotavirus, suele ser más leve en adultos; sin embargo, han sido reportadas muertes; y puede ser severa en inmunocomprometidos como lo reportado en esta casuística con shock hipolémico en un paciente trasplantado renal e insufiencia renal aguda y, trombocitopenia, cilindruria y proteinuria en un paicente adulto infectado por VIH. La afectación familiar con un niño como caso índice se reporta en dos grupos de familias. La infección por rotavirus y adenovirus se debe considerar como diagnóstico diferencial en pacientes adultos con diarrea independientemente de su condición inmunológica. Se reporta la casuística en un grupo pequeño de un centro privado. Se recomienda vigilancia epidemiológica nacional a todo nivel para conocer la frecuencia a mayor escala en todos los grupos etarios.

Avaliação quantitativa do risco de doença, causada por Vibrio arahaemolyticus, associado ao consumo de ostras (Crassostrea brasiliana) cruas cultivadas e comercializadas no Estado de São Paulo / Quantitative risk assessment of illness, caused by Vibrio parahaemolyticus, associated with the consumption of raw oysters (Crassostrea brasiliana) farmed and commercialized in the State of São Paulo

Vibrio parahaemolyticus (Vp) é uma bactéria naturalmente presente em regiões estuarinas, sendo a principal causa de gastrenterite de origem bacteriana associada a pescados, principalmente ostras cruas. Nesta pesquisa, foi desenvolvida uma avaliação quantitativa de risco para avaliar a probabilidade de Vp causar doença após o consumo de ostra crua, produzida e comercializada no Estado de São Paulo. O estudo incluiu a identificação e caracterização do perigo, a avaliação da exposição e a caracterização do risco. Um modelo matemático foi desenvolvido. Este modelo leva em consideração o comportamento de Vp em ostras na cadeia produtiva, em cada estação do ano, além da relação entre a dose de Vp ingerida e a probabilidade de desenvolver a doença. A avaliação da exposição foi desenvolvida em três etapas: cultivo, pós-coleta e consumo. Na etapa de cultivo foram considerados os fatores que influenciam a prevalência e o número de Vp em ostras no momento da coleta. Na etapa pós-coleta, foram descritas as práticas da indústria e foram considerados os fatores associados ao processamento, transporte e manipulação. Já na etapa de consumo foram considerados os fatores como a quantidade de ostras consumidas por porção, o peso médio por ostra consumida e a população de Vp patogênico no momento do consumo. O resultado do modelo quantitativo da avaliação da exposição foi, então, integrado ao modelo dose-resposta, Beta-Poisson, para se obter uma estimativa do risco. Esta estimativa expressa o impacto da exposição humana a Vp, sobre a saúde pública, associada ao consumo de ostras. A simulação de Monte Carlo foi utilizada para avaliar o efeito da variabilidade e incerteza das variáveis do modelo sobre a estimativa do risco. O modelo prediz uma probabilidade de ocorrência de doença de 4,6x10-4, por porção de ostra, consumida ao longo do ano. As variáveis que possuem maior influência sobre o risco de ocorrência de doença são a população de Vp em ostras no cultivo, a temperatura de transporte das ostras até o varejo e a porcentagem de Vp patogênico em ostra, no momento do seu consumo. O modelo evidencia que uma das maneiras de reduzir o risco de ocorrência de doença seria intervir nas condições de transporte de ostras até o varejo por meio da sua refrigeração. Com o modelo é possível identificar fatores e simular cenários para avaliar o comportamento de V. parahaemolytícus como um perigo microbiológico, ao longo da cadeia produtiva de ostra até o momento do seu consumo. Também é possível avaliar o impacto de medidas de intervenção na cadeia produtiva. As suposições adotadas limitam a aplicabilidade do modelo. Portanto, é necessário que o modelo seja validado, particularmente com relação ao número de casos de doença causados por Vp, cujos dados de vigilância epidemiológica inexistem no Brasil

Vibrio parahaemolyticus (Vp) is naturally present in estuarine regions and is the main cause of gastroenteritis associated with the consumption of bivalve molluscan shellfish, specially raw oysters. In this research, a quantitative risk assessment was developed to evaluate the probability of Vp causing disease after consumption of raw oyster, produced and commercialized in the state of Sao Paulo. The study included the identification and characterization of the hazard, exposure assessment and risk characterization. A mathematical model was developed. This model takes into account the behavior of Vp in oysters in the productive chain, for each season of the year, besides the relationship between the number of cells of Vp ingested and the probability of developing the disease. The exposure assessment was done in three steps: farming, after harvesting and consumption. At the farming step, the factors that influence the prevalence and the population of Vp at the time of harvesting were considered. At the after harvesting step, the factors associated with transportation, handling and processing were considered. At the consumption step, factors related to the amount of oysters and the average weight per oyster consumed and the density of pathogenic Vp at the time of consumption were considered. Then, the quantitative model of exposure assessment was integrated to the dose-response model, BetaPoisson, in order to obtain a risk estimate. This calculation expresses the impact of the human exposure to Vp associated with the consumption of oysters on public health. The Monte Carlo simulation was used to evaluate the effect of variability and uncertainty of variables of the model in the risk estimation. The model predicts a probability of occurrence of the disease of 4,6x10-4 per serving of oyster consumed during one year. The variables showing the greatest influence on the risk of occurrence of disease are the density of Vp in oyster in the farming step, the temperature during transportation of oysters to the retail market and the percentage of pathogenic Vp strains in oysters,' at the moment of consumption. The model indicates that the use of refrigeration during transportation of oysters to retail could reduce the risk of disease. The model allows the identification of factors and the simulation of scenarios in order to evaluate the behavior of V. parahaemolyticus, as a microbiologícal hazard, in the productive chain of oyster to the consumption. It is also possible to evaluate the impact of intervention measures in the productive chain. The assumptions Iimit the application of the model. Therefore, it is necessary to validate the model, particularly in relation to the number of cases of dísease caused by V. parahaemolyticus of which the data on epidemiologic surveillance do not exist in Brazil

study of the kap of physicians regarding oral rehydration therapy in Basrah

This survey was carried out to study the knowledge, attitudes and practice of physicians regarding ORT. The study included 124 doctors working in Basrah city. All doctors surveyed reported that they prescribed ORT for acute diarrhoea, 60% recommended continued feeding during the illness. However, ORT alone was recommended by 42% of physicians, and by 58% in combination with other medications. All the surveyed physicians generally advised continuation of breast feeding, 32% recommended stopping of all solids and 8% advised mothers to withhold all types of food for 24-48 hours

relation between bacterial gastroenteritis and urinary tract infection in early childhood

200 cases of suspected bacterial gastroenteritis were the subject of this study for the various bacterial species involved in the pathogenesis of gastroenteritis, detection of cases with significant bacteriuria, correlation between the organisms found in the stools and urine and between the occurrence of U.T.I. and the state of nutrition and hydration of the same cases. Blood cultures were done in some cases as well. Pathogenic organisms were isolated from stools in 76% of gastroenteritis cases [E. Coli 26%, Shigella dysenteriae 24%, Klebsiella aeruginosae 7%, Klebsiella ozaenae 5%, Proteus mirabilis 3%, Proteus vulgaris 1%, Pseudomonas aeruginosa 2% and Staph. Aureus 2%]. Bacteriological examination of urine showed that 16% of all cases had significant bacterial count. E. coli was isolated in 75% of cases, Klebsiella aeruginosa in 18% and Proteus mirabilis in 6.2%. Serotyping of E. Coli strains isolated from both urine and stools showed that combined urinary tract infection and gastroenteritis, were caused by the same serotypes in 18 cases. Klebsiella and Proteus, isolated from the stools and urine, had the same biochemical reaction shown by APII-20E test. Dehydration and/or malnutrition significantly enhanced the occurrence of U.T.I. in the studied cases, either through the ascending route mainly or blood-borne through the intestinal mucosa. 8 cases [16%] out of 50 presented with bacteremia. E. Coli serotype O86B7 was isolated from 3 cases of blood culture. This serotype was the same as that isolated from urine and stools. Klebsiella and Proteus, isolated from the blood, had the same biochemical reaction as those isolated from urine and stools. Thus, it is advisable to perform a bacteriological culture of urine in cases of gastroenteritis, especially those complicated with dehydration and/or malnutrition

Avances recientes en vacunas contra enteropatógenos / Recent advances in vaccines against enteropatogens

La mayor parte de los agentes infecciosos que afectan el tracto gastrointestinal, ya sean bacterias, virus o protozoarios, causan el sídrome clínico de diarrea, siendo el grupo etáreo menor de cinco años el más afectado por este padecimiento. A efecto de disminuir la morbilidad por esta causa, se han venido desarrollando diversas investigaciones y métodos para crear vacunas que combatan a los agentes que provocan las enfermedades gastrointestinales; aunque la generación de vacunas, es un proceso complejo que implica el desarrollo de: La biotecnología, inmunología, ingeniería genética, computación, química de proteínas y otras. Gracias a la biotecnología se ha logrado la síntesis de antígenos que inducen "protección", y la técnica de anticuerpos monoclonales que ha permitido definir los epítopos específicos protectores que forman parte de un antígeno proteíco en la superficie de un agente microbiano. Actualmente se están realizando investigaciones para la obtención de vacunas contra microorganismos enteropatógenos, siendo considerados como más padecimientos mas relevantes: Gastroenteritis causa por rotavirus, diarrea causada por escherichia Coli, shigelosis o disenteria bacilar causada por shigella; fiebre tifoidea causada por salmonella typhi, amibiasis provocada por Entamoeba histolytica. Sin embargo, el control de los padecimientos señalados no sólo dependen del desarrollo de vacunas, sino también de aspectos importantes tales como el mojoramiento de la infraestructura sanitaria, el saneamiento básico, habitos higiénicos y manejo adecuado de alimentos

Role of the human rotavirus in childhood diarrhea

The human rotavirus [HRV] was detected by the enzyme-linked-immunosorbent assay [ELISA] in stool samples of 34[23%] of 150 infants and young children below three years of age hospitalized for the management of acute gastroenteritis at Al- Yarmouk Teaching Hospital, Baghdad, over a nine-month period [February through October, 1985]. The HRV was found to be the most important agent associated with diarrhoea in this study. Five of the rotavirus-positive patient had associated bacterial enteropathogens

Septicemia e gastrenterite em crianças internadas: estudo clínico e anatomapatológico / Septicemia and gastroenteritis in hospitalized children: clinical and anatomopathological study

Os autores realizaram uma análise retrospectiva de 20 pacientes de idades entre cinco dias e sete anos, que foram necropsiados no Serviço de Patologia Infantil do HUAP e que tiveram diagnóstico histológico de gastroenterite e septicemia. Foram divididos em dois grupos: o primeiro, constituído por 11 crianças que adquiriram diarréia na comunidade e depois foram internadas e o segundo, por nove pacientes cuja infecçäo intestinal foi adquirida no hospital. Só foi possível determinar o agente etiológico em sete casos (E. coli em três, Klebsiella pneumoniae em um, Pseudomonas aeruginosa em um e Staphylococcus aureus em dois). Entre os achados anatomopatológicos, além da enterocolite, o achado mais comum foi pneumonia bacteriana. Concluíram que a septicemia conseqüente à infecçäo hospitalar ocorreu em 12 casos (60%), sendo três do grupo 1 e nove do grupo 2. A grande maioria dos pacientes foi medicada com associaçäo de antibióticos. Näo observaram diferenças significativas em relaçäo à gravidade das complicaçöes entre os dois grupos, através do exame anatomopatológico. Teriam sido evitados muitos desses casos se fossem observadas as regras contra infecçäo hospitalar