Tendencia de los egresos hospitalarios por enfermedades infecciosas intestinales en niños en Argentina, 2005-2013 / Trends in hospital discharges for intestinal infectious disease in infants in Argentina, 2005-2013

Introducción. La diarrea aguda es uno de los problemas de salud pública más serios en los países en desarrollo por asociarse, generalmente, a condiciones de vida desfavorables. El objetivo de este trabajo es analizar la tendencia de los egresos hospitalarios por enfermedades infecciosas intestinales de los menores de 5 años en establecimientos oficiales del subsector público de Argentina en el período 2005-2013. Población y métodos. Se realizó un estudio ecológico de series temporales con datos provenientes de la Dirección de Estadísticas e Información en Salud, a nivel nacional y regional. Se calcularon las tasas de egresos específicas y se analizó el comportamiento estacional y la tendencia del evento. Resultados. En Argentina, se registraron 2 521 729 egresos en menores de 5 años, de los cuales el 9,0% presentó diagnóstico de enfermedad infecciosa intestinal. Los menores de 1 año representaron la tercera parte de las internaciones y el análisis de estacionalidad reveló dos picos anuales (verano e invierno). Globalmente, se observó una tendencia de tipo decreciente, con un leve aumento en el período 2007-2009. Las regiones del Noroeste y Noreste Argentino presentaron tasas de hasta 3-4 veces mayores que la región Pampeana. Conclusiones. Los egresos hospitalarios por enfermedades infecciosas intestinales en el subsector público representan alrededor del 10% del total de los egresos en los menores de 5 años. Este evento presenta un patrón estacional, con una tendencia levemente decreciente en los últimos años, a pesar de no distribuirse en forma homogénea en las diversas regiones.

Introduction. Acute diarrhea is one of the most serious public health problems in developing countries because it is generally associated with unfavorable living conditions. The objective of this study was to analyze trends in hospital discharges for intestinal infectious disease in children under age 5 recorded in official public hospitals from Argentina in the 2005-2013period. Population and methods. This was an ecological, time-series study based on data provided by the Health Statistics and Information Department, at a national and regional level. Specific hospital discharge rates were estimated, and seasonal behavior and trends were analyzed in relation to this event. Results. In Argentina, 2 521 729patients under age 5 were discharged in this period; of these, 9.0% were diagnosed with intestinal infectious disease. Children under age 1 accounted for a third of hospitalizations; two annual peaks (summer and winter) were observed in the seasonality analysis. Overall, a downward trend was observed, with a mild increase in the 2007-2009 period. Rates were up to 3 or 4 times higher in Northwest and Northeast Argentina than in the Pampa region. Conclusions. Hospital discharges for intestinal infectious disease in the public subsector account for approximately 10% of all discharges of children under age 5. This event shows a seasonal pattern, with a slightly downward trend over the past years in spite of its heterogeneous distribution across the different Argentine regions.

Enteropathogensddetected in a daycare center, sutheastern Brazil: bacteria, viirus, and parasite research / Enteropatógenos detectados em crianças de creche no Sudeste do Brasil: pesquisa de bactérias, vírus e parasitos

Introduction: The objective of this study was to determine the prevalence and etiological profile of enteropathogens in children from a daycare center. Methods: From October 2010 to February 2011 stool samples from 100 children enrolled in a government daycare center in the municipality of São José do Rio Preto, in the state of São Paulo, were collected and analyzed. Results: A total of 246 bacteria were isolated in 99% of the fecal samples; 129 were in the diarrheal group and 117 in the non-diarrheal group. Seventy-three strains of Escherichia coli were isolated, 19 of Enterobacter, one of Alcaligenes and one of Proteus. There were 14 cases of mixed colonization with Enterobacter and E. coli. Norovirus and Astrovirus were detected in children with clinical signs suggestive of diarrhea. These viruses were detected exclusively among children residing in urban areas. All fecal samples were negative for the presence of the rotavirus species A and C. The presence of Giardia lamblia, Entamoeba coli, Endolimax nana and hookworm was observed. A significant association was found between food consumption outside home and daycare center and the presence of intestinal parasites. Conclusions: For children of this daycare center, intestinal infection due to pathogens does not seem to have contributed to the occurrence of diarrhea or other intestinal symptoms. The observed differences may be due to the wide diversity of geographical, social and economic characteristics and the climate of Brazil, all of which have been reported as critical factors in the modulation of the frequency of different enteropathogens.

Introdução: O objetivo deste estudo foi determinar a prevalência e o perfil etiológico de enteropatógenos em crianças de uma creche. Métodos: No período de outubro de 2010 a fevereiro de 2011 foram coletadas e analisadas amostras de fezes de 100 crianças matriculadas em creche do governo no município de São José do Rio Preto, Estado de São Paulo. Resultados: Um total de 246 bactérias foram isoladas em 99% das amostras de fezes; 129 eram diarreicas e 117 não-diarreicas. Foram isoladas setenta e três cepas de Escherichia coli, 19 de Enterobacter, uma de Alcaligenes e uma de Proteus. Foram detectados 14 casos de colonização mista com Enterobacter e de E. coli. Norovírus e Astrovirus foram detectados em crianças com sinais clínicos sugestivos de diarréia. Estes vírus foram detectados exclusivamente entre as crianças residentes em áreas urbanas. Todas as amostras fecais foram negativas para a presença das espécies de rotavírus A e C. Foi observada a presença de Giardia lamblia, Entamoeba coli, Endolimax nana e ancilostomídeos. Foi encontrada associação significativa entre o consumo de alimentos fora do centro da casa e creche e a presença de parasitos intestinais. Conclusões: Para as crianças desta creche, a infecção intestinal por patógenos não parece ter contribuido para a ocorrência de diarreia ou outros sintomas intestinais. As diferenças observadas podem ser atribuídas à grande diversidade de características geográficas, sociais e econômicas e o clima do Brasil, as quais tem sido relatadas como fatores críticos para a modulação da frequência de diferentes enteropatógenos.

Review on Gastric Mucosal Microbiota Profiling Differences in Patients with Chronic Gastritis, Intestinal Metaplasia, and Gastric Cancer / 대한소화기학회지

No abstract available.

Espiroquetosis intestinal humana: serie clínica y revisión de la literatura / Human intestinal spirochetosis: clinical series and literature review

Introduction: Human intestinal spirochetosis (HIE) is defined as colonization by spirochetes of the large intestine. Is associated with chronic diarrhea. The incidence and prevalence ranges from 0.4% to 12%. Objective: To determine the prevalence of HIE in the Salvador's Hospital, between 2003 and 2008 in patients with a history of chronic diarrhea and without abnormalities in colonoscopy, in 2 separate groups: patients with and without a history of HIV infection. Material and Methods: Retrospective morphology evaluation of the large bowel endoscopic biopsies to the selected groups. Results: We reviewed 115 biopsies, 98 were from HIV-negative and 17 HIV from positive patients. Two cases of intestinal spirochetosis were detected, both HIV negative, with a prevalence of 1.7%. Comment: The prevalence of HIE is similar to that reported in Western countries. Population studies are needed to determine the real epidemiological impact in our environment.

Introducción: La espiroquetosis intestinal humana (EIH) se define como la colonización del intestino grueso por espiroquetas. Se asocia a diarrea crónica. Su incidencia y prevalencia van desde 0,4 a 12% Objetivo: Determinar la prevalencia de EIH en el Hospital Del Salvador, de Santiago, Chile, entre los años 2003 y 2008, en pacientes con antecedentes clínicos de diarrea crónica y colonoscopia sin hallazgos patológicos, separados en dos grupos: pacientes con y sin antecedentes de infección por VIH. Material y Método: Evaluación morfológica retrospectiva de las biopsias endoscópicas de intestino grueso de los grupos seleccionados. Resultados: Se revisaron 115 biopsias, 98 correspondieron a pacientes sin infección por VIH y 17 a pacientes seropositivos para VIH. Se detectaron dos casos de espiroquetosis intestinal, ambos en pacientes sin infección por VIH, con una prevalencia de 1,7 %. Comentario: La prevalencia de EIH es similar a la publicada en países occidentales. Se requieren estudios poblacionales para determinar el real impacto epidemiológico en nuestro medio.

Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs?

OBJECTIVE: Immunosuppressed patients are at risk of microsporidiosis, and this parasitosis has an increased rate of dissemination in this population. Our objective was to evaluate the presence of microsporidiosis and other intestinal parasites in rheumatic disease patients undergoing anti-tumor necrosis factor/disease-modifying anti-rheumatic drug treatment. METHODS: Ninety-eight patients (47 with rheumatoid arthritis, 31 with ankylosing spondylitis and 11 with psoriatic arthritis) and 92 healthy control patients were enrolled in the study. Three stool samples and cultures were collected from each subject. RESULTS: The frequency of microsporidia was significantly higher in rheumatic disease patients than in control subjects (36 vs. 4 percent, respectively; p<0.0001), as well as in those with rheumatic diseases (32 vs. 4 percent, respectively; p<0.0001), ankylosing spondylitis (45 vs. 4 percent, respectively; p<0.0001) and psoriatic arthritis (40 vs. 4 percent, respectively; p<0.0001), despite a similar social-economic class distribution in both the patient and control groups (p = 0.1153). Of note, concomitant fecal leukocytes were observed in the majority of the microsporidia-positive patients (79.5 percent). Approximately 80 percent of the patients had gastrointestinal symptoms, such as diarrhea (26 percent), abdominal pain (31 percent) and weight loss (5 percent), although the frequencies of these symptoms were comparable in patients with and without this infection (p>0.05). Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis disease activity parameters were comparable in both groups (p>0.05). The duration of anti-tumor necrosis factor/disease-modifying anti-rheumatic drugs and glucocorticoid use were also similar in both groups. CONCLUSION: We have documented that microsporidiosis with intestinal mucosa disruption is frequent in patients undergoing concomitant anti-tumor necrosis factor/disease-modifying anti-rheumatic drug therapy. Impaired host defenses due to the combination of the underlying disease and the immunosuppressive therapy is the most likely explanation for this finding, and this increased susceptibility reinforces the need for the investigation of microsporidia and implementation of treatment strategies in this population.

Disbiose intestinal: [revisão] / Disbiosis intestinal: [revisión] / Intestinal dysbiosis: [review]

A nutrição clínica funcional é uma forma contemporânea de abordar a ciência da nutrição e tem como propósito avaliar a interação do organismo com o alimento e o processo da nutrição. É preciso nutrir o organismo com o alimento e o processo da nutrição. É preciso nutrir o organismo adequadamente, isto é, orientar a ingestão adequada de alimentos, em quantidade e qualidade, afim de que ele receba todos os nutrientes essenciais ao seu bom funcionamento e ainda garantir que estes alimentos sejam bem digeridos, absorvidos e utilizados. Este processo é fundamental para determinar o melhor estado físico, mental e emocional. A nutrição funcional leva em consideração a importância da integridade fisiológica e funcional do trato gastrintestinal (TGI). Dentro da avaliação do processo alimentar, a absorção dos nutrientes pode ser alterada por sintomas de má absorção, interação entre os nutrientes, alteração da permeabilidade intestinal e pela disbiose intestinal. O acúmulo de maus-tratos com a função intestinal afeta o equilíbrio da microbiota intestinal., fazendo com que as bactérias nocivas aumentem, causando a disbiose. Entre as possíveis causas da dibiose estão a idade, o estresse, a disponibilidade de material fermentável, a má digestão, o tempo de trânsito intestinal, o pH intestinal e o estado imunológico do hospedeiro. O tratamento da disbiose abrange duas linhas, uma dietética, por meio da ingestão de alimentos que beneficiam a constituição da microbiota intestinal, e outra usando medicamentos. O objetivo deste trabalho é realizar uma revisão bibliográfica sobre disbiose intestinal e sobre as condutas terapêuticas que têm sido adotadas para prevenir e tratar este distúrbio.

La nutrición clínica funcional es una forma contemporánea de hacer frente a la ciencia de la nutrición y está diseñado para evaluar la interacción del organismo para procesar los alimentos y la nutrición. Es necesario para nutrir el cuerpo con los alimentos y el proceso de la nutrición. Que necesita para nutrir adecuadamente el cuerpo, es decir, realizar un consumo adecuado de alimentos en cantidad y calidad, para que reciba todos los nutrientes esenciales para su buen funcionamiento y aún así asegurar que estos alimentos sean bien digeridos, absorbidos y utilizados. Este proceso es crítico para determinar el mejor estado físico, mental y emocional. La alimentación funcional se tiene en cuenta la importancia de la integridad fisiológica y funcional del tracto gastrointestinal (GI). Dentro de la evaluación de los alimentos, la absorción de nutrientes puede verse afectada por los síntomas de mala absorción, la interacción entre los nutrientes, cambios en la permeabilidad intestinal y disbiosis intestinal. La acumulación de malos tratos con la función intestinal afecta el equilibrio de la flora intestinal., Para que las bacterias nocivas crecen, causando disbiosis. Entre las posibles causas de dibiose son la edad, el estrés, la disponibilidad de material fermentable, mala digestión, tiempo de tránsito intestinal, el pH y el estado inmune intestinal del huésped. El tratamiento de la disbiosis incluir dos líneas, una dieta, comiendo los alimentos que se benefician del establecimiento de la microbiota intestinal, y el uso de otras drogas. El objetivo de este estudio fue revisar la literatura sobre disbiosis intestinal y sobre los procedimientos terapéuticos que se han adoptado para prevenir y tratar este trastorno.

The functional clinical nutrition is a contemporary form of addressing the science of nutrition and is designed to assess the interaction of the organism to process food and nutrition. You need to nourish the body with food and nutrition process. You need to properly nourish the body, that is, conduct an adequate intake of food in quantity and quality, so that he receives all the nutrients essential for its proper functioning and still ensure that these foods are well digested, absorbed and utilized. This process is critical in determining the best physical, mental and emotional. Nutrition functional takes into account the importance of physiological and functional integrity of the gastrointestinal tract (GI) tract. Within the evaluation of the food, the absorption of nutrients can be affected by symptoms of malabsorption, interaction between nutrients, changes in intestinal permeability and intestinal dysbiosis. The accumulation of ill-treatment with the bowel function affects the balance of intestinal flora., So that harmful bacteria grow, causing dysbiosis. Among the possible causes of dibiose are age, stress, availability of fermentable material, poor digestion, intestinal transit time, pH and the intestinal immune status of the host. Treatment of dysbiosis include two lines, a diet, by eating foods that benefit the establishment of the intestinal microbiota, and using other drugs. The objective of this study was to review the literature on intestinal dysbiosis and on therapeutic procedures that have been adopted to prevent and treat this disorder.

Prevalence of intestinal microsporidiosis in Human Immunodeficiency Virus-infected patients with diarrhea in major United States cities

To determine the prevalence of intestinal microsporidiosis in HIV-infected patients, we performed a prospective study of HIV-infected patients with diarrheal illnesses in three US hospitals and examined an observational database of HIV-infected patients in 10 US cities. Among 737 specimens from the three hospitals, results were positive for 11 (prevalence 1.5 percent); seven (64 percent) acquired HIV through male-to-male sexual contact, two (18 percent) through male-to-male sexual contact and injection drug use, and one (9 percent) through heterosexual contact; one (9 percent) had an undetermined mode of transmission. Median CD4 count within six months of diagnosis of microsporidiosis was 33 cells/µL (range 3 to 319 cells/µL). For the national observational database (n = 24,098), the overall prevalence of microsporidiosis was 0.16 percent. Prevalence of microsporidiosis among HIV-infected patients with diarrheal disease is low, and microsporidiosis is most often diagnosed in patients with very low CD4+ cell counts. Testing for microsporidia appears to be indicated, especially for patients with very low CD4+ cell counts.

Para determinar a prevalência de microsporidiose intestinal em pacientes infectados pelo HIV foi realizado um estudo prospectivo em três hospitais dos Estados Unidos da América do Norte (EUA) e analizada uma base de dados nacional composta de dados coletados de pacientes infectados pelo HIV em 10 cidades dos EUA. De um total de 737 amostras de fezes de pacientes infectados pelo HIV que apresentavam diarréia, amostras de 11 pacientes (prevalência de 1,5 por cento) foram positivas para microsporídios. Todos os positivos eram do sexo masculino e, entre eles, sete (64 por cento) pacientes adquiriram a infecção pelo HIV através de relação homossexual, dois (18 por cento) através de relação sexual e drogas injetáveis e um (9 por cento) através de contato heterosexual, enquanto que em um paciente o modo de transmissão do HIV não foi determinado. A contagem média de linfócitos CD4 realizada até seis meses do diagnóstico de microsporidiose foi de 33 células/microlitro (3 a 319 células/microlitro). A análise da base de dados nacional (n = 24.098) mostrou uma prevalência de microsporidiose de 0,16 por cento. A prevalência de microsporidiose em pacientes HIV-positivos com diarréia é baixa. Entretando, como a microsporidiose é mais frequentemente diagnosticada em pacientes com contagens de CD4 muito baixas, a indicação de pesquisa de microsporídios é justificada, especialmente para estes pacientes.

Sobrecrecimiento bacteriano intestinal / Small intestinal bacterial overgrowth. An update

Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions.

Case report: intestinal anthrax in a 4-year old boy

Anthrax is a highly dangerous disease that results in death in the absence of prompt diagnosis and treatment. Intestinal form of this disease is rare but fatal. This report presents a 4-year old boy with abdominal pain, vomiting, distension and poor general condition. He was taken to the operating theatre with the diagnosis of peritonitis; right hemicolectomy was performed because of ileo-cecal invagination and perforation. Four hours later the patient died of septic shock. His laboratory studies revealed the diagnosis of anthrax. We have discussed the epidemiological aspects of the disease and emphasized the importance of immediate diagnosis and treatment

Hepatic and small bowel mucormycosis after chemotherapy in a patient with acute lymphocytic leukemia

Mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin B and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin B therapy.

Virulence factors of aeromonads--an emerging food borne pathogen problem.

Aeromonas spp. possess a number of virulence properties which are considered responsible for intestinal and extra-intestinal infections in human beings and also for a wide variety of infections in animals. The paper discusses current status of colonization and toxic factors of Aeromonas spp., especially in relation to food and biochemical markers. Future research needs are also identified.

Variación temporal de genotipos y serogrupos de E coli enterohemorrágicos aislados en niños chilenos con infecciones intestinales o síndrome hemolítico urémico / Temporal variation of genotypes and serogroups of enterohemorrhagic E coli isolated from chilean children with intestinal infections or hemolytic-uremic syndrome

Thirty six strains isolated from chilean children with hemolytic-uremic syndrome (8 obtained in 1988-1989, 15 obtained in 1990-1993 and 13 obtained in 1995-1996), 33 strains from asymptomatic children, obtained in similar periods and 30 strains from children with bloody diarrhea, obtained in 1995-1996 were studied. Virulence factors were investigated with a colony hybridization technique using probes that identify virulence genes. Serotypes were identified with commercial antisera. Both SLTI and SLTII genes predominated in strains obtained from children with hemolytic uremic syndrome in 1988-1989 and 1995-1996 and SLTI gene predominated in strains obtained in 1990-1993. Similar temporal variations in virulence genes of strains obtained from asymptomatic children were observed. SLTI/SLTII pattern predominated in strains obtained from children bloody diarrhea and the frequency of 0157 serogroup was lower, compared to strains obtained from children with hemolytic uremic syndrome. There was a temporal variation in toxigenic genotypes of enterohemorrhagic E coli strains, but no association between these genotypes and the risk for hemolitic uremic syndrome was observed

Entomoftoromicose intestinal: relato de caso / Intestinal entomophthoromycosis: a case report

A case of intestinal entomophthoramycosis caused by Entomophthorales in a man with 19 years-old, farmer and without associated disease. The patient was submitted to a intestinal resection and diagnosis was carried through after analysis of the surgical specimen. After a review of the literature, the clinical evolution, clinico-pathologic features, difficulties in diagnosis and treatment are discussed.

Detection of Chamydia psittaci in enteric subclinical infections in adult sheep, through cell culture isolation

Con excepción de México, la clamidiasis en ovinos es una entidad bien determinada en países donde se desarrolla la ovinocultura. A fin de determinar la presencia de Chlamydia psittaci en hatos ovinos en nuestro país, 10 explotaciones de 5 diferentes áreas del altiplano fueron muestreadas, colectándose un total de 267 muestras viables de heces de hembras adultas en SPG (92 de ellas se obtuvieron en un segundo muestreo efectuado en 5 explotaciones elegidas al azar). Las muestras fueron procesadas e inoculadas en células L-929 con medio Iscove's suplementado, realizándose la identificación de las inclusiones intracitoplasmáticas características mediante tinción de Giemsa, e inmunofluorescencia indirecta en muestras sospechosas. Se obtuvo 92.88 por ciento de aislamientos sin observarse diferencias significativas entre los diferentes hatos analizados ni entre los dos muestreos efectuados. Es necesario, en consecuencia, realizar estudios que conduzcan a la identificación del posible papel patógeno de C. psittaci en nuestros ovinos

Colonización bacteriana anormal del intestino delgado alto en escolares de nivel socioeconómico alto y bajo / Abnormal bacterial colonization of the upper small intestine among school-age children of high and low socioeconomic level

La contaminación microbiológica del ambiente produce enteropatía ambiental crónica, caracterizada por cambios morfofuncionales en el intestino delgado. En 311 escolares, 155 de NSE-A y 156 NSE-B, se evaluó la contaminacion bacteriana midiendo H2 en el aire espirado, en muestras en ayunas y cada 15 minutos, durante 240 min, después de ingerir 150mg.kg de lactulosa. Una encuesta de salud incluyó información acerca de la ingesta de medicamentos y alimentos, consumo de alcohol o tabaco e intolerancia a alimentos. En 30 por ciento de los niños el nivel basal de excreción de H2 excedia 10 ppm. En 18,1 por ciento del NSE-A y 4,5 por ciento del NSE-b (p<0,0001) los máximos de excreción de H2 superaron 20 ppm en los primeros 90 min. Se detectó cúspide colónica (> 20 ppm) en 78,7 por ciento del NSE-A y 40,4 por ciento del NSE-B (p<0,0000). En 18,7 por ciento y 48,7 por ciento del NSE-A y NSE-B, respectivamente, las curvas fueron planas (nivel basal <10 ppm y aumentos posteriores < 20ppm). La enteropatía ambiental crónica ya está presente en escolares. La menor excresión de H2 en el nivel socioeconómico bajo podría explicarse con efectos relacionados con la dieta