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1.
Gac. méd. Méx ; 157(1): 113-115, ene.-feb. 2021. tab
Article in Spanish | LILACS | ID: biblio-1279084

ABSTRACT

Resumen Introducción: Clostridioides difficile causa diarrea y colitis pseudomembranosa. Su diagnóstico se realiza con la detección de glutamato-deshidrogenasa (GDH) o las toxinas A y B y se confirma con pruebas de amplificación de ácidos nucleicos. Objetivo: Definir si la determinación de GDH es redundante a la de las toxinas. Métodos: Estudio observacional retrospectivo de muestras fecales de pacientes con sospecha de infección por Clostridioides difficile. Las toxinas y GDH se determinaron mediante inmunocromatografía. Se realizó una simulación bayesiana con los cocientes de probabilidad; se consideró significativo un valor de p < 0.05. Resultados: Se analizaron 329 resultados de GDH y toxinas A y B. Se encontró una prevalencia de infección de Clostridioides difficile de 18.2 %. La sensibilidad y especificidad de la prueba de GDH fue de 0.90 y 0.89, respectivamente. El cociente de probabilidad positivo fue de 8.9 y el negativo, de 0.11. Conclusiones: Un resultado negativo de GDH disminuye considerablemente la probabilidad de infección, pero no la descarta. La detección de toxinas de Clostridioides difficile puede ser necesaria en instituciones donde la amplificación de ácidos nucleicos no es económica o accesible.


Abstract Introduction: Clostridioides difficile causes diarrhea and pseudomembranous colitis. Its diagnosis is made with glutamate dehydrogenase (GDH) or toxins A and B detection and is confirmed with nucleic acid amplification tests. Objective: To define if GDH determination is redundant to that of toxins. Methods: Retrospective, observational study in diarrheal stools of patients with suspected Clostridioides difficile infection. Toxins and GDH were determined by immunochromatography. Bayesian simulation was performed with likelihood ratios; a p-value < 0.05 was regarded as significant. Results: 329 GDH and toxin A and B results were analyzed. Clostridioides difficile infection prevalence was 18.2 %. Sensitivity and specificity of the GDH test were 0.90 and 0.89, respectively. Positive likelihood ratio was 8.9, and negative was 0.11. Conclusions: A negative GDH result considerably reduces the probability of infection but does not rule it out. Clostridioides difficile toxins detection may be necessary in institutions where nucleic acid amplification is not affordable or accessible.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Bacterial Proteins/analysis , Bacterial Toxins/analysis , Clostridioides difficile , Clostridium Infections/diagnosis , Enterotoxins/analysis , Feces/chemistry , Biomarkers/analysis , Likelihood Functions , Prevalence , Retrospective Studies , Bayes Theorem , Sensitivity and Specificity , Clostridium Infections/epidemiology , Diarrhea/microbiology , Feces/enzymology , Glutamate Dehydrogenase/analysis
2.
Rev. chil. infectol ; 36(4): 536-540, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1042673

ABSTRACT

Resumen La infección por Clostridioides (previamente Clostridium) difficile se ha convertido en un problema de salud importante debido al aumento en su incidencia, gravedad y recurrencia. En este último escenario, una edad mayor de 65 años ha sido asociada a una evolución más desfavorable. Factores de riesgo como la presencia de una inmunidad alterada, co-morbilidades, malnutrición, polifarmacia y cambios en la microbiota intestinal explicarían este mayor riesgo a mayor edad. El trasplante de microbiota fecal (TMF) es una estrategia efectiva en el tratamiento de la infección recurrente por Clostridioides difficile cuando la terapia estándar fracasa. Guías publicadas recientemente sugieren que esta estrategia puede ser utilizada a partir de la segunda recurrencia. Sin embargo, escasos estudios han evaluado los resultados del TMF en pacientes mayores de 65 años y para nuestro conocimiento existe una escasa experiencia nacional en este grupo de pacientes. Presentamos dos casos de TMF en pacientes octogenarios con una infección recurrente por Clostridioides difficile, con una evolución satisfactoria a largo plazo.


Clostridioides (formerly Clostridium) difficile infection has become a major health problem due to the increase in its incidence, severity, and recurrence. In this last scenario, age over 65 has been associated with a more unfavorable evolution. Risk factors such as the presence of altered immunity, comorbidities, malnutrition, polypharmacy, and changes in the intestinal microbiota would explain this higher risk in this group of patients. On the other hand, fecal microbiota transplantation (FMT) is an effective strategy in the treatment of recurrent Clostridioides difficile infection when standard therapy fails. Recently published guidelines suggest that this strategy can be used from the second recurrence. However, few studies have evaluated the results of the FMT in patients over 65 years old, and for our knowledge, there is limited national experience in this group of patients. We present two cases of TMF in octogenarian patients with a recurrent infection due to Clostridioides difficile, with satisfactory recovery at the long term.


Subject(s)
Humans , Female , Aged, 80 and over , Clostridium Infections/therapy , Diarrhea/microbiology , Fecal Microbiota Transplantation , Recurrence
3.
Medicina (B.Aires) ; 79(4): 291-294, ago. 2019. graf, tab
Article in Spanish | LILACS | ID: biblio-1040525

ABSTRACT

La diarrea por Clostridium difficile es reconocida de manera creciente en pacientes hospitalizados y se asocia con alta mortalidad. La vancomicina por vía enteral es el tratamiento antibiótico recomendado para las diferentes formas, incluso las más graves. Sin embargo, un grupo pequeño de pacientes desarrolla formas refractarias a ese tratamiento y no existen esquemas antibióticos alternativos recomendados para estos casos. El trasplante de microbiota fecal ha demostrado ser exitoso en una serie de casos de diarrea grave asociada a este microorganismo. Presentamos un caso de diarrea refractaria por C. difficile que fue tratada con éxito con una infusión de microbiota fecal.


Clostridium difficile infection is an increasingly recognized cause of diarrhea in inpatients, frequently associated to high mortality. Vancomycin is the treatment of choice for all Clostridium difficile- associated diarrheas, with different degrees of severity. However, some patients develop refractory forms to that treatment and there are no alternative antibiotic schemes recommended for these cases. Fecal microbiota transplantation has been shown to be successful in a series of cases of severe diarrhea associated with this organism. We present a case of refractory C. difficile infection successfully treated with fecal microbiota transplantation.


Subject(s)
Humans , Female , Aged, 80 and over , Clostridioides difficile , Clostridium Infections/therapy , Diarrhea/therapy , Fecal Microbiota Transplantation , Treatment Outcome , Clostridium Infections/complications , Diarrhea/microbiology
4.
Arq. gastroenterol ; 55(4): 390-396, Oct.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-983850

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Biofilms/growth & development , Diarrhea/microbiology , Escherichia coli/isolation & purification , Escherichia coli/physiology , Escherichia coli Infections/microbiology , Virulence/genetics , Brazil/epidemiology , Microbial Sensitivity Tests , Polymerase Chain Reaction , Prevalence , Diarrhea/epidemiology , Escherichia coli/drug effects , Escherichia coli Infections/epidemiology , Feces/microbiology , Genes, Bacterial/genetics
5.
Braz. j. biol ; 78(4): 619-624, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-951603

ABSTRACT

Abstract Leaves and roots of Acanthospermum australe (Asteraceae) have been used in Brazilian folk medicine for the treatment of various ailments including diarrhea, skin diseases, blennorrhagia, dyspepsia, parasitic worms and malaria. The aim of study was to characterize the chemical profiles of the aqueous and hydroalcoholic extracts of leaves and roots of A. australe, and to evaluate their antimicrobial activities against diarrhea-inducing bacteria (Enterococcus faecalis, Shigella dysenteriae and Yersinia enterocolitica), as well as their cytotoxic properties. Aqueous leaf extracts were obtained by infusion, while aqueous root extracts were obtained by decoction. The hydroalcoholic leaf and root extracts were prepared by maceration in 90% ethanol for 3 days. Antimicrobial activity was assessed using standard techniques and cytotoxicity was evaluated using Chinese hamster ovary cells CHO-K1. Chemical analysis revealed the presence of tannins, flavonoids, saponins and phenolic compounds in the extracts. Although root extracts were not effective against E. faecalis, leaf extracts at concentrations of 20 mg/mL exhibited bactericidal activities against this microorganism. The hydroalcoholic root extract was unique in presenting a bactericidal effect against S. dysenteriae. None of the extracts showed bacteriostatic or bactericidal activities against Y. enterocolitica. The results presented herein demonstrate that the Gram-positive E. faecalis and the Gram-negative S. dysenteriae were susceptible to A. australe extracts, although bacteriostatic/bactericidal activities were only observed at concentrations considered too high for clinical application. Our results support the ethnopharmacological use of A. australe in the treatment of gastrointestinal disorders, particularly diarrhea caused by infectious bacteria, although further studies are required to determine the anti-diarrhea effects and the toxicities of the extracts in vivo.


Resumo Folhas e raízes de Acanthospermum australe (Asteraceae) têm sido usadas na medicina popular brasileira para o tratamento de várias doenças, incluindo diarreia, doenças de pele, blenorragia, dispepsia, vermes parasitas e malária. O objetivo deste estudo foi caracterizar os perfis químicos dos extratos aquosos e hidroalcoólicos das raízes e folhas de A. australe, e avaliar as suas atividades antimicrobianas contra as bactérias indutoras de diarreia (Enterococcus faecalis, Shigella dysenteriae e Yersinia enterocolitica), bem como sua citotoxicidade. Os extratos aquosos de folhas foram obtidos por infusão, enquanto que os extratos aquosos de raízes foram obtidos por decocção. Os extratos hidroalcoólicos de folhas e raízes foram preparados por maceração em etanol a 90% durante 3 dias. A atividade antimicrobiana foi avaliada utilizando técnicas padrão e a citotoxicidade foi avaliada utilizando células de ovário de hamster chinês CHO-K1. A análise química revelou a presença de taninos, flavonóides, saponinas e compostos fenólicos nos extratos. Apesar de extratos de raiz não foram eficazes contra E. faecalis, extratos de folhas em concentrações de 20 mg/mL apresentaram atividades bactericidas contra este microrganismo. O extrato hidroalcoólico de raiz foi o único a apresentar um efeito bactericida contra S. dysenteriae. Nenhum dos extratos apresentaram atividades bacteriostáticas ou bactericidas contra Y. enterocolitica. Os resultados apresentados demonstram que a bactéria Gram-positiva E. faecalis e a Gram-negativa S. dysenteriae foram suscetíveis aos extratos de A. australe, embora as atividades bacteriostáticos/bactericidas tenham sido apenas observados em concentrações consideradas elevadas para aplicação clínica. Os nossos resultados apoiam a utilização de etnofarmacológica de A. australe no tratamento de perturbações gastrointestinais, especialmente diarreia causadas por bactérias infecciosas, embora sejam necessários mais estudos para determinar os efeitos anti-diarreia e as toxicidades dos extratos in vivo.


Subject(s)
Shigella dysenteriae/drug effects , Yersinia enterocolitica/drug effects , Plant Extracts/pharmacology , Enterococcus faecalis/drug effects , Asteraceae/chemistry , Diarrhea/microbiology , Anti-Bacterial Agents/pharmacology , Plants, Medicinal , Brazil , Plant Extracts/chemistry , Microbial Sensitivity Tests , Toxicity Tests , Plant Roots/chemistry , Plant Leaves/chemistry , Medicine, Traditional
6.
Rev. chil. infectol ; 35(2): 213-215, abr. 2018. tab
Article in Spanish | LILACS | ID: biblio-1042645

ABSTRACT

Resumen Introducción: Campylobacter es un importante agente de diarrea en el ser humano. En Ecuador, la información sobre Campylobacter es escasa y no existen antecedentes de susceptibilidad antimicrobiana. Objetivo: Describir la prevalencia de Campylobacter en niños con diarrea y su comportamiento in vitro frente a cinco antimicrobianos. Método: Se estudiaron 253 niños entre siete meses y 9 años de edad, que consultaron por diarrea en dos hospitales de la ciudad de Loja. Se realizó cultivo de muestras fecales e identificación por pruebas fenotípicas y por RPC múltiple. La susceptibilidad antimicrobiana fue determinada por el método de difusión en disco. Resultados: Campylobacter fue diagnosticado en 16 (6,3%) de las muestras, aislándose C. jejuni en 13 (5,1%) y C. coli en 3 (1,2%). Todas las cepas fueron susceptibles a gentamicina y ampicilina/ ácido clavulánico, con baja resistencia a ampicilina y eritromicina y alta resistencia a ciprofloxacina.


Introduction: Campylobacter is an important agent of diarrhea in humans. In Ecuador, the information on Campylobacter is scarce and there are not antecedents about antimicrobial susceptibility. Objective: To describe Campylobacter prevalence in children with diarrhea and their behavior against five antimicrobials in vitro. Method: We studied 253 children with diarrhea aging 7 months to 9 years who consulted for diarrhea in two hospitals in the city of Loja. Fecal samples were cultured and identification by tests by phenotypic tests and multiplex PCR. Susceptibility to 5 antibiotics was determined by the disc-diffusion method. Results: Campylobacter was found in 16 (6.3%) children, being C. jejuni the most frequent one (5.1%), followed by C. coli (1.2%). All strains were susceptible to gentamicin and ampicillin/clavulanic acid, being found low resistance to ampicillin and erythromycin and high resistance to ciprofloxacin.


Subject(s)
Humans , Infant , Child, Preschool , Child , Campylobacter Infections/microbiology , Campylobacter Infections/epidemiology , Campylobacter jejuni/isolation & purification , Campylobacter jejuni/drug effects , Campylobacter coli/isolation & purification , Campylobacter coli/drug effects , Drug Resistance, Multiple, Bacterial , Diarrhea/microbiology , Anti-Bacterial Agents/pharmacology , Campylobacter Infections/drug therapy , Prevalence , Ecuador/epidemiology , Feces/microbiology , Anti-Bacterial Agents/classification
7.
Braz. j. microbiol ; 49(1): 177-183, Jan.-Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-889193

ABSTRACT

ABSTRACT The study was conducted to compare the specificity of immunological diagnostic methods used for the diagnosis of Cryptosporidium species capable of causing life-threatening infection in both immunosuppressed and immunocompetent patients. For the detection of Cryptosporidium species in 79 animals with diarrhoea, we used three Copro-antigen tests: RIDASCREEN® Cryptosporidium test, Cryptosporidium 2nd Generation (ELISA) and RIDA®QUICK Cryptosporidium. For immunoassays we used positive and negative samples detected by means of polymerase chain reaction and validated by sequencing and nested polymerase chain reaction to confirm the presence six different species of Cryptosporidium species. Prevalence of cryptosporidiosis in the entire group determined by enzyme immunoassay, enzyme linked immunosorbent assay, immuno-chromatographic test and polymerase chain reaction was 34.17%, 27.84%, 6.33% and 27.84%, respectively. Sensitivity of animal samples with enzyme immunoassay, enzyme linked immunosorbent assay, and immuno-chromatographic test was 63.6%, 40.9% and 22.7%, resp., when questionable samples were considered positive, whereas specificity of enzyme immunoassay, enzyme linked immunosorbent assay and immuno-chromatographic test was 75.9%, 78.9% and 100%, respectively. Positive predictive values and negative predictive values were different for all the tests. These differences results are controversial and therefore reliability and reproducibility of immunoassays as the only diagnostic method is questionable. The use of various Cryptosporidium species in diagnosis based on immunological testing and different results obtained by individual tests indicate potential differences in Copro-antigens produced by individual Cryptosporidium species.


Subject(s)
Animals , Immunologic Tests/methods , Cryptosporidiosis/microbiology , Cryptosporidium/isolation & purification , Diarrhea/veterinary , Immunologic Tests/economics , Immunologic Tests/veterinary , Sensitivity and Specificity , Cryptosporidiosis/diagnosis , Cryptosporidium/genetics , Cryptosporidium/immunology , Diarrhea/diagnosis , Diarrhea/microbiology
8.
Article in English | AIM, AIM | ID: biblio-1268541

ABSTRACT

Introduction: bacterial agents are among pathogens implicated to cause diarrhea in children resulting to huge mortality and morbidities. Bacterial etiologies causing diarrhea in children below five years are rarely investigated in Central Kenya, which would otherwise guide prescription and target health education.Methods: a cross-sectional study approach was applied on 163 randomly selected stool samples from children below five years who presented with diarrhea in Murang`a and Muriranja`s hospitals. The objective was to determine the bacterial agents of diarrhea. Enteric bacterial pathogens were cultured using appropriate media and identified. Statistical analyses were performed using STATA v.13. Chi-square or Fisher exact-test were used to check for evidence of relationship whenever applicable.Results: there were nearly equal distributions in gender 86 (52.8%) female vs. 77 (47.2%) male, majority (35.6%) aged between 0-12 months. Bacterial isolates were highly diverse in female than the male, children aged 49-60 months and least among those aged 0-12 months. A total of 188 bacterial isolates belonging to 11 genera were recovered. The predominant bacteria was nonpathogenic Escherichia coli 85 (45.2%), while 13 (6.9%) Escherichia coli were positive for virulence genes, including 8 (4.3%) positive for LT and STp Shiga-like or Enterotoxigenic Escherichia coli, 3 (1.6%) positive for eae and bfpA Enteropathogenic Escherichia coli and 2 (1.1%) positive for Enteroaggregative Escherichia coli gene. Others included: Salmonella 21 (11.2%), Pseudomonas 14 (7.4%), Shigella 14 (7.4%), Klebsiella 12 (6.4%), Aeromonas 8 (4.3%), Enterobacter 7 (3.7%), Proteus 8 (4.3%), Citrobactor 3 (1.6%), Yersinia 2 (1.1%) and Vibrio 1 (0.5%).Conclusion: salmonella was the major bacterial isolate and majority of the bacteria were statistically significant cause of diarrhea (p=0.001)


Subject(s)
Child, Preschool , Cross-Sectional Studies , Diarrhea/etiology , Diarrhea/microbiology , Diarrhea/parasitology , Enterobacteriaceae , Kenya , Virulence
9.
Gastroenterol. latinoam ; 29(supl.1): S63-S67, 2018. tab
Article in Spanish | LILACS | ID: biblio-1117866

ABSTRACT

The management of Clostridium difficile (CD) infection has changed in recent years. The latest clinical guidelines and systematic reviews suggest the use of vancomycin orally as the first line of treatment regardless the severity of the crisis (main difference compared to previous recommendations), this is due to changes in its epidemiology, the decrease in effectiveness and the increase of recurrences with the use of metronidazole, particularly in severe crisis. In addition, the use of new agents such as fidaxomicin has been approved. Fulminant crisis require an aggressive management combining oral treatment, enemas and intravenous therapy in addition to a collaborative management with the surgery team. With respect to recurrences, the use of vancomycin in pulses and with extended therapy schemes is suggested; fecal microbiota transplantation (FMT) is also an attractive therapy for patients with multiple recurrences. The following is a summary of the latest recommendations and available evidence regarding the management of CD infection in the most frequent situations, both in first crisis and in its recurrences.


El manejo de la infección por Clostridium difficile (CD) ha tenido modificaciones los últimos años. Las últimas guías clínicas y revisiones sistemáticas sugieren el uso de vancomicina vía oral como primera línea de tratamiento independiente de la severidad de la crisis (diferencia principal con recomendaciones previas), esto debido a cambios en su epidemiología, la disminución de la efectividad y al aumento de las recurrencias con el uso de metronidazol, particularmente en crisis severas. Además, han sido aprobados el uso de nuevos agentes como la fidaxomicina. Las crisis de carácter fulminante requieren un manejo agresivo combinando terapia oral, vía enemas e intravenosa, además de un manejo en conjunto con el equipo de cirugía. Respecto a las recurrencias se sugiere el uso de vancomicina en pulsos y con esquemas de terapia extendida siendo además, el trasplante de microbiota fecal (FMT) una terapia atractiva para pacientes con múltiples recurrencias. A continuación se resumen las últimas recomendaciones y evidencia disponible respecto del manejo de la infección por CD en las situaciones más frecuentes, tanto en la primera crisis como en sus recurrencias.


Subject(s)
Humans , Vancomycin/therapeutic use , Clostridium Infections/drug therapy , Diarrhea/drug therapy , Fidaxomicin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Recurrence , Vancomycin/administration & dosage , Clostridioides difficile/drug effects , Clostridium Infections/complications , Diarrhea/microbiology , Fecal Microbiota Transplantation , Fidaxomicin/administration & dosage , Rifaximin/therapeutic use , Metronidazole/therapeutic use , Anti-Bacterial Agents/administration & dosage
10.
Clin. biomed. res ; 38(1): 87-92, 2018.
Article in English | LILACS | ID: biblio-1022449

ABSTRACT

Introduction: The intestinal microbiota may undergo changes after solid organ transplantation. The purpose of this systematic review was to characterize the intestinal microbiota of patients undergoing solid organ transplantation. Methods: MEDLINE, EMBASE and Cochrane Library databases were searched from inception to July 21, 2017. Studies of patients undergoing solid organ transplantation that evaluated changes in intestinal microbiota composition and one of the following outcomes were included: post-transplant weight, new-onset diabetes after transplantation, delayed graft function, acute rejection, graft and patient survival, and post-transplant infections. Results: Out of 765 studies found in this search, two studies (86 patients) fulfilled inclusion criteria. Both studies assessed kidney transplantation recipients, and a reduction in bacterial species diversity after transplantation was observed. Changes in intestinal microbiota were associated with acute rejection in both studies. One study reported diarrhea and urinary infections, while the other one reported urinary and respiratory infections. None of them reported other outcomes of interest. Conclusion: Changes in intestinal microbiota were observed after kidney transplantation, and they were associated with higher incidence of acute rejection and infections in transplant recipients. However, data are still scarce and more studies are needed to evaluate if microbiota changes have an impact on post-transplant outcomes. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Kidney Transplantation/adverse effects , Transplants/microbiology , Gastrointestinal Microbiome , Respiratory Tract Infections/microbiology , Urinary Tract Infections/microbiology , Treatment Outcome , Diarrhea/microbiology , Graft Rejection
11.
Rev. chil. infectol ; 34(4): 359-364, ago. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899724

ABSTRACT

Resumen Introducción: Salmonella sp puede causar infecciones asintomáticas, gastroenteritis, bacteriemia e infecciones focales como meningitis y osteomielitis. Objetivo: Describir aspectos microbiológicos y clínicos de las infecciones por Salmonella spp en niños en un hospital de referencia pediátrico Centro Hospitalario Pereira Rossell. Montevideo Uruguay. Material y Métodos: Estudio descriptivo y retrospectivo de pacientes en quienes se aislara Salmonella spp en el período 1 de enero de 2005 al 31 de diciembre de 2010. Resultados: Se aisló Salmonella spp en 46 niños menores de 15 años. Dieciocho eran menores de 2 años y 5 niños menores de tres meses. 24% de los pacientes presentaba factores de riesgo (infección por VIH; enfermedad hemato-oncológica, desnutrición) y co-morbilidades (bajo peso al nacer y neumonía). No hubo fallecidos. Los serotipos más frecuentes fueron: Typhimurium y Enteritidis. La mayoría de las cepas eran sensibles a ampicilina y cefalosporinas de tercera generación. Discusión: La presentación clínica predominante fue diarrea con sangre, no se presentaron brotes. Basados en los perfiles de susceptibilidad antimicrobiana, se pueden mantener las recomendaciones hasta el momento sugeridas. Conclusiones: Se debe tener en cuenta la infección por Salmonella sp en niños febriles con riesgo de enfermedad bacteriana invasora, con o sin focalidad.


Background: Salmonella can cause asymptomatic infections, diarrhea, bacteremia and focal infections such as meningitis and osteomyelitis. Aim: To describe clinical and microbiological aspects of infections by Salmonella spp. in children in a pediatric referral hospital: Centro Hospitalario Pereira Rossell, in Montevideo, Uruguay. Materials and Methods: Descriptive and retrospective study of 46 patients, from which Salmonella spp was isolated between January 1, 2005 and December 31, 2010. Results: Salmonella spp was isolated in 46 children younger than 15 years old. 18 were below 2 years old and 5 children below three months. 24% of the children had risk factors, such as HIV infection, oncological diseases and malnutrition; low birth weight and pneumonia were associated conditions. No deaths were reported. The serotypes more frequently found were: Typhimurium and Enteritidis. Most of the strains were susceptible to ampicillin and third generation of cephalosporins. Discussion: Diarrhea with blood was the predominant clinical presentation, and there were no outbreaks. Typhimurium and Enteritidis were the most common serotypes. Based on the profiles of susceptibility antimicrobial, we could maintain the same recommendations until the moment suggested. Conclusions: we must consider the Salmonella infection in febrile children under risk of an invasive bacterial disease, with or without focal infection.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Salmonella Infections/microbiology , Salmonella enteritidis/isolation & purification , Salmonella Infections/epidemiology , Salmonella typhimurium/isolation & purification , Time Factors , Uruguay/epidemiology , Intensive Care Units, Pediatric , Comorbidity , HIV Infections/epidemiology , Retrospective Studies , Risk Factors , Diarrhea/microbiology , Diarrhea/epidemiology
12.
Rev. chil. infectol ; 34(4): 347-351, ago. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899722

ABSTRACT

Resumen Introducción: La infección por Cystoisospora belli es una de las causas más frecuentes de diarrea acuosa en pacientes con infección por VIH y ocasiona altas tasas de morbilidad y mortalidad. Métodos: Se realizó un estudio retrospectivo en pacientes infectados con VIH y diarrea por C. belli. Características clínicas y de laboratorio fueron recolectadas mediante el análisis de historias clínicas. Resultados: Se identificaron siete casos. Cuatro presentaron diarrea recurrente a pesar de recibir profilaxis secundaria con cotrimoxazol y tratamiento específico, dos de los cuales tuvieron buena respuesta viral e inmunológica al tratamiento anti-retroviral de gran actividad (TARGA) al momento del diagnóstico y tratamiento antiparasitario. Mientras que, los tres restantes no recibían profilaxis, tampoco TARGA (dos de ellos), pero respondieron bien al tratamiento. Conclusiones: C. belli es causa importante de diarrea en pacientes VIH con TARGA y profilaxis, pudiendo tener distinta evolución clínica. Sugerimos que la infección persistente puede ser debido al fallo farmacológico por causas intrínsecas o extrínsecas al parásito, o a defectos en la restauración del sistema inmune intestinal, o ambos.


Introduction: Cystoisospora belli infection is one of the most important causes of watery diarrhea in patients with HIV and causes high rates of morbidity and mortality. Methods: A retrospective study was conducted in patients with HIV and diarrhea by C. belli. Clinical and laboratory characteristics were collected by analyzing clinical records. Results: Four had recurrent diarrhea despite receiving secondary prophylaxis with cotrimoxazole and specific treatment, two of which had a good viral and immunological response to highly active antiretroviral therapy (HAART) at the time of diagnosis and antiparasitic treatment. While the remaining three did not receive prophylaxis, neither did HAART (two of them), but they responded well to treatment. Conclusions: C. belli is an important cause of diarrhea in HIV patients on HAART and prophylaxis, being able to have different clinical evolution. We suggest that persistent infection may be due to drug failure by intrinsic or extrinsic to the parasite causes, or to defects in restoration of the intestinal immune system, or both.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Coccidiosis/microbiology , AIDS-Related Opportunistic Infections/microbiology , Sarcocystidae/microbiology , Diarrhea/microbiology , Peru , HIV Infections/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Retrospective Studies , AIDS-Related Opportunistic Infections/complications , Antiretroviral Therapy, Highly Active , Diarrhea/etiology
13.
IBJ-Iranian Biomedical Journal. 2017; 21 (1): 40-47
in English | IMEMR | ID: emr-185666

ABSTRACT

Background: Diarrhea, caused by enteroaggregative Escherichia coli [EAEC], is an important infection leading toillness and death. Numerous virulent factors have been described in EAEC. However, their prevalence was highly variable among EAECs of distinct geographic locations. Studies have shown that dispersin [antiaggregation protein, aap] is one of the important and abundant virulent factors in EAEC. In this study, we aimed to determine the presence, conservation, and immunogenicity of aap gene in EAEC isolated from Iranian patients


Methods: PCR amplification of aap gene in the EAEC isolates was performed, and the aap gene was cloned in pBAD-gIIIA vector. The sequence of aap gene was analyzed using the ExPASy and BLAST tools. The expression of aap gene was performed in E. coli Top10, and expression confirmation was carried out by SDS-PAGE and Western-blot techniques. Rabbits were immunized with purified dispersin protein emulsified with Freund's adjuvant. Sera were collected and examined for antibody response. Finally, in vitro efficacy of dispersin and anti-dispersin was evaluated


Results: The results of PCR showed the presence of aap gene in all of the EAEC isolates with significant homology. Finally, the significant difference between the levels of IgG response in dispersin-injected rabbits and control group was observed


Conclusion: Our results were in accordance with other studies that reported the presence of dispersin in the EAEC isolates with high conservation and immunogenicity. Hence, dispersin could be a promising candidate for any probable prevention against EAEC infections


Subject(s)
Humans , Escherichia coli Infections , Sequence Homology , Prevalence , Virulence Factors , Diarrhea/microbiology
14.
Braz. j. microbiol ; 47(supl.1): 3-30, Oct.-Dec. 2016.
Article in English | LILACS | ID: biblio-839325

ABSTRACT

ABSTRACT Most Escherichia coli strains live harmlessly in the intestines and rarely cause disease in healthy individuals. Nonetheless, a number of pathogenic strains can cause diarrhea or extraintestinal diseases both in healthy and immunocompromised individuals. Diarrheal illnesses are a severe public health problem and a major cause of morbidity and mortality in infants and young children, especially in developing countries. E. coli strains that cause diarrhea have evolved by acquiring, through horizontal gene transfer, a particular set of characteristics that have successfully persisted in the host. According to the group of virulence determinants acquired, specific combinations were formed determining the currently known E. coli pathotypes, which are collectively known as diarrheagenic E. coli. In this review, we have gathered information on current definitions, serotypes, lineages, virulence mechanisms, epidemiology, and diagnosis of the major diarrheagenic E. coli pathotypes.


Subject(s)
Humans , Diarrhea/diagnosis , Diarrhea/microbiology , Escherichia coli/classification , Escherichia coli/physiology , Escherichia coli Infections/diagnosis , Escherichia coli Infections/microbiology , Prevalence , Virulence Factors/genetics , Diarrhea/epidemiology , Escherichia coli/pathogenicity , Escherichia coli Infections/epidemiology
15.
Rev. chil. infectol ; 33(4): 438-450, ago. 2016. ilus
Article in Spanish | LILACS | ID: biblio-830115

ABSTRACT

Acute diarrheal disease (ADD) is a global public health problem, especially in developing countries and is one of the causes of mortality in children under five. ADD etiologic agents include viruses, bacteria and parasites in that order. Escherichia coli bacteria it is classified as a major diarrheagenic agent and transmitted by consuming contaminated water or undercooked foods. This review compiled updates on information virulence factors and pathogenic mechanisms involved in adhesion and colonization of seven pathotypes of E. coli called enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), shigatoxigenic E. coli (STEC), enteroaggregative E. coli (EAEC) and diffusely-adherent E. coli (DAEC). A final pathotype, adherent-invasive E. coli (AIEC) associated with Crohn's disease was also reviewed. The diarrheagenic pathotypes of E. coli affect different population groups and knowledge of the molecular mechanisms involved in the interaction with the human is important to guide research towards the development of vaccines and new tools for diagnosis and control.


La enfermedad diarreica aguda (EDA) es un problema de salud pública mundial, especialmente en los países en vía de desarrollo y es una de las causas de mortalidad en niños bajo cinco años de edad. Los agentes etiológicos de EDA incluyen virus, bacterias y parásitos, en ese orden. Dentro de las bacterias, Escherichia coli está clasificada como uno de los principales agentes diarreagénicos y se trasmite por el consumo de agua y alimentos contaminados o mal cocidos. Esta revisión recopiló información actualizada sobre los factores de virulencia y los mecanismos de patogenicidad implicados en la adhesión y colonización de siete patotipos de E. coli denominados, E. coli enteropatógena (ECEP), E. coli enterotoxigénica (ECET), E. coli enteroinvasora (ECEI), E. coli shigatoxigénica (ECST), E. coli enteroagregativa (ECEA) y E. coli de adherencia difusa (ECAD). Un último patotipo, E. coli adherente invasor (ECAI) asociado a la enfermedad de Crohn también fue revisado. Los patotipos diarreagénicos de E. coli afectan a diferentes grupos poblacionales y el conocimiento de los mecanismos moleculares implicados en la interacción con el humano es importante para orientar las investigaciones hacia el desarrollo de vacunas o nuevas herramientas para su diagnóstico y control.


Subject(s)
Humans , Diarrhea/microbiology , Escherichia coli Infections/microbiology , Enteropathogenic Escherichia coli/pathogenicity , Virulence Factors , Diarrhea/virology , Enteropathogenic Escherichia coli/classification , Feces/microbiology
16.
J. coloproctol. (Rio J., Impr.) ; 36(1): 21-26, Jan.-Mar. 2016. tab, graf
Article in English | LILACS | ID: lil-780061

ABSTRACT

BACKGROUND: Colonoscopy is part of the current diagnostic armamentarium. However, in some patients with chronic diarrhea, a colonoscopy may show normal mucosa; in these cases, serial biopsies can provide important information for the diagnosis and treatment of patients. AIM: To analyze patients with chronic diarrhea having a macroscopically normal colonoscopy, by evaluating histological changes. METHODS: 30 patients with chronic diarrhea and normal colonoscopy were prospectively evaluated and submitted to serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: The sample of 30 patients showed a ratio of 18 men (60%) and 12 women (40%). On histological types, it was found that 13 patients (43.3%) had lymphoid hyperplasia, eosinophilic inflammation in 4 (13.3%), nonspecific inflammation in 4 (13.3%), regenerative changes in 3 (10%), lymphocytic colitis in 2 (6.6%) and changes consistent with Crohn's disease in 1 (3.3%). CONCLUSIONS: One can observe that even chronic diarrhea patients, without other associated factors, benefited from colonoscopy with biopsy, because it held the etiologic diagnosis in some cases as also excluded by histopathology. It was noticed that the frequency of patients with altered biopsy and less dragged diarrheal episodes (84.2%) was large, should consider their achievement.


INTRODUÇÃO: A colonoscopia faz parte do arsenal de diagnóstico atual. Porém, em alguns pacientes com diarreia crônica, a colonoscopia pode evidenciar mucosa normal; nesses casos biópsias seriadas podem trazer informações importantes para o diagnóstico e tratamento dos pacientes. OBJETIVO: Analisar pacientes com diarreia crônica submetidos à colonoscopia macroscopicamente normal, avaliando assim histologicamente as alterações. MÉTODOS: Análise prospectiva da histologia 30 pacientes com diarreia crônica e colonoscopias normais, submetidos a biópsias seriadas de íleo terminal, cólon ascendente e reto. RESULTADOS: A amostra de 30 pacientes mostrou uma proporção de 18 homens (60%) e 12 mulheres (40%). Sobre os tipos de alterações histológicas, foi verificado que 13 pacientes (43,3%) apresentaram hiperplasia linfóide, inflamação eosinofílica em 4 (13,3%), inflamação inespecífica em 4 (13,3%), alterações regenerativas em 3 (10%), colite linfocítica em 2 (6,6%) e alterações compatíveis com Doença de Crohn em 1 (3,3%). CONCLUSÕES: Observou-se que mesmo pacientes com diarreia crônica, sem outros fatores associados, beneficiaram-se da colonoscopia com biópsia, pois a mesma realizou o diagnóstico etiológico em alguns casos como também o excluiu através da histopatologia. Verificou-se que a frequência de pacientes com biópsia alterada e quadros diarreicos menos arrastados (84,2%) foi grande, devendo-se considerar a realização do exame.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Rectum/surgery , Crohn Disease/surgery , Pseudolymphoma , Colon, Ascending/surgery , Diarrhea/diagnosis , Diarrhea/pathology , Rectum/pathology , Crohn Disease/pathology , Colonoscopy , Colon, Ascending/pathology , Colitis, Lymphocytic , Diarrhea/microbiology , Inflammation
17.
Rev. chil. infectol ; 33(1): 98-118, feb. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-776967

ABSTRACT

Background: Clostridium dijfficile-associated diarrhea (CDAD) has become very important due to the increase in its incidence, severity, recurrence and the associated economic burden. Having a national consensus guideline is essential to improve its management. Objective: To build a multidisciplinary and evidence-based consensus in prevention, diagnosis and treatment of CDAD. Methods: We convened a panel of experts in the field of infectious diseases, gastroenterology, evidence-based medicine and consensus methodology. The panel conducted a structured review of published literature in CDAD evaluating evidence levels and recommendation degree according to the methodology proposed by the GRADE working-group. A modified three-round Delphi technique was used to reach a consensus among the experts. Results: A group of 16 experts was established, 12 of them answered 18 clinically relevant questions. The levels of agreement achieved by the panel of 16 experts were 79% in the first round and 100% in the second and third round. The main consensus recommendations in prevention are: restricting the use of proton-pump inhibitors, primary prophylaxis with probiotics in antibiotics users, education of health personnel, isolation for patients hospitalized with CDAD, and cleaning the rooms exposed to C. difficile with products based in chlorine or hydrogen peroxide. In the diagnosis: use of biology molecular-based techniques is preferred and if not available, glutamate dehydrogenase-based algorithms may be recommended. With regard to treatment: the use of oral metronidazole in mild-moderate CDAD and oral vancomycin in severe CDAD are recommended. Treat the first recurrence with the same antibiotics according to severity. In the case of second and subsequent recurrences consider prolonged therapy with vancomycin, rifaximin or fecal microbiota transplant. Conclusion: The first Chilean consensus on prevention, diagnosis and treatment of CDAD is presented, which is a major step in improving national standards in the management of this disease.


Introducción: La diarrea asociada a Clostridium difficile (DACD) ha adquirido gran relevancia debido al aumento en su incidencia, gravedad, capacidad de recurrencia y carga económica asociada. Contar con una guía de consenso local es fundamental para mejorar su manejo. Objetivo: Elaborar un consenso multidisciplinara y basado en la evidencia en la prevención, diagnóstico y tratamiento de la DACD. Métodos: Se convocó a un panel de expertos en el área de enfermedades infecciosas, gastroenterología, medicina basada en la evidencia y metodología de consenso. El panel realizó una revisión estructurada de la literatura científica publicada en DACD evaluando el nivel de la evidencia y recomendación utilizando el sistema GRADE. Una técnica de Delfi modificada de tres rondas fue utilizada para alcanzar un consenso entre los expertos. Resultados: Se estableció un grupo de 16 expertos, 12 de ellos respondieron 18 preguntas de relevancia clínica. Los niveles de acuerdo alcanzados por el panel de 16 expertos fueron de 79% en la primera ronda y 100% en la segunda y tercera ronda. Las principales recomendaciones en prevención son: restricción del uso de inhibidores de la bomba de protones, profilaxis primaria con probióticos en usuarios de antimicrobianos de corto plazo, educación del personal de salud, aislamiento de contacto en pacientes hospitalizados con DACD y aseo de las habitaciones expuestas a C. difficile con productos en base a cloro o peróxido de hidrógeno. En el diagnóstico se recomienda: el uso de técnicas basadas en biología molecular y como alternativa algoritmos en base a glutamato deshidrogenasa. Con respecto al tratamiento, se recomienda el uso de metronidazol oral en DACD leve-moderada y vancomicina oral en DACD grave. El tratamiento de la primera recurrencia es con los mismos antimicrobianos de acuerdo a la gravedad, considerando en la segunda recurrencia y posteriores terapia prolongada con vancomicina, rifaximina o trasplante de microbiota fecal. Conclusión: Se presenta el primer consenso chileno en prevención, diagnóstico y tratamiento de DACD, paso trascendental en mejorar los estándares locales en el manejo de esta enfermedad.


Subject(s)
Humans , Clostridioides difficile , Clostridium Infections , Diarrhea/microbiology , Chile , Consensus , Clostridium Infections/diagnosis , Clostridium Infections/drug therapy , Clostridium Infections/prevention & control
18.
Rev. chil. infectol ; 32(5): 523-529, oct. 2015. tab
Article in Spanish | LILACS | ID: lil-771619

ABSTRACT

Background: Clostridium difficile (CUj-associated disease (CDAD) and the role of the hypervirulent strain NAP1 have not been well characterized in Pediatrics. Aims: To describe clinical features of CDAD, and to estimate NAP1 frequency and association with disease severity in Pediatrics. Methods: Descriptive, transversal surveillance of diarrheal episodes in Chilean children, hospitalized between February 2012 and December 2013, positive for CD by molecular diagnosis. Results: A total of 66 episodes of diarrhea with identification of CD occurred thougout the study period in children between 1 month and 19 years of age of which 39% were younger than one year old. CD acquisition was predominantly nosocomial and the most common risk factors were: presence of comorbidities (98.6%), use of antibiotics (93.9%), proton pump inhibitors (84.8%), invasive mechanic ventilation (54.5%), feeding tube (48.5%) and immunosuppression (40.9%). Clinical course was mostly mild, but 12 cases presented an unfavorable course, of which 3/26 occurred in children less than one year. Only one case was positive for NAP1 and had a mild course. Conclusion: Diarrhea with identification of CD was present throughout all pediatric ages, including children less than one year old. Analytical and longitudinal studies are required to better characterize the pathogenic role of CD in this age group. CDAD occurred mostly in patients with risk factors, and the clinical course was predominantly mild.


Introducción: Aún no ha sido bien caracterizada la infección por Clostridium difficile ni el rol de la cepa hipervirulenta NAP1 en pediatría. Objetivos: Describir las características clínicas de la infección por C. difficile, la frecuencia de NAP1 y su asociación con gravedad en población pediátrica. Material y Método: Estudio transversal, descriptivo, de episodios de diarrea con identificación molecular de C. difficile en niños chilenos hospitalizados entre febrero de 2012 y diciembre de 2013. Resultados: Se estudiaron 66 episodios de diarrea por C. difficile, en niños entre 1 mes y 19 años, teniendo 39% menos de un año de edad. La adquisición fue predominantemente nosocomial. Los factores de riesgo más frecuentes fueron: co-morbilidades, uso de antimicrobianos, inhibidores de bomba de protones, ventilación mecánica invasora, sonda de alimentación e inmunosupresión. El curso clínico fue mayoritariamente benigno, con 12 casos de evolución desfavorable incluyendo lactantes bajo un año de edad. Un niño presentó la cepa NAP1, con un curso clínico leve. Discusión: En esta serie, la diarrea con identificación de C. difficile se presentó en niños de todas las edades, incluyendo aquellos bajo un año. Se necesitan estudios analíticos y longitudinales para determinar el rol patógeno en este último grupo etario. La infección afecta a niños con factores de riesgo y es de evolución predominantemente satisfactoria.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Young Adult , Clostridium Infections/epidemiology , Clostridioides difficile/isolation & purification , Cross Infection/epidemiology , Diarrhea/epidemiology , Cross-Sectional Studies , Chile/epidemiology , Clostridium Infections/microbiology , Cross Infection/microbiology , Diarrhea/microbiology , Risk Factors , Severity of Illness Index
19.
Rev. chil. infectol ; 32(5): 550-558, oct. 2015.
Article in Spanish | LILACS | ID: lil-771623

ABSTRACT

Introduction: Clostridium difficile is the most commonly isolated organism in antimicrobial and health care-associated diarrhea and is growing in relevance in community-acquired infections. It is a Gram-positive bacillus acquired via the fecal-oral route in the community and in hospital setting. Epidemiology: 0.6 to 2.1% worldwide incidence, mortality ~ 1-5%. Colonization: High rates of asymptomatic colonization in healthy people, 37% in children: its presence in stools is of controversial significance. Risk factors in children are prior exposure to antibiotics, recent hospitalization, immunosuppression or inflammatory bowel disease. Clinical manifestations: secondary to intestinal involvement due to toxin production, ranging from asymptomatic colonization to fulminant disease. Diagnosis: Clinical diagnostic criteria plus high sensitivity and specificity laboratory certification. Recommendations AAP (American Academy of Pediatrics): under 1 year, avoid routine study, only in Hirschsprung disease and/or nosocomial outbreak, 1-3 year, a (+) result suggests C. difficile associated diarrhea (CDAD) is possible, and in children older than 3 years interpretation is equal to adults. Management: antimicrobial suspension, oral metronidazole as first line in mild to moderate CDAD, and oral or enema vancomycin or associated with intravenous metronidazole only in severe cases. Duration 10 days. Prevention: Antimicrobial control programs and environmental management. Conclusion: Given the increasing complexity of pediatric patients it is important to deepen the knowledge on this microorganism and its clinical manifestations, as its incidence, morbidity and mortality are increasing.


Introducción: Clostridium difficile, microorganismo más común en diarrea asociada a antimicrobianos, a atención de salud y en aumento en la comunidad es un bacilo grampositivo adquirido vía fecal oral en la comunidad y en el ambiente hospitalario. Epidemiología: Incidencia mundial 0,6-2,1%, mortalidad~1-5%. Colonización: Alta colonización asintomática en personas sanas, niños 37%, su presencia en las deposiciones es controversial. Factores de riesgo en niños: exposición previa a antimicrobianos, hospitalización reciente, inmunosupresión o enfermedad inflamatoria intestinal. Clínica: Compromiso intestinal secundario a la producción de toxinas. Puede variar desde una colonización asintomática hasta enfermedad fulminante. Diagnóstico: La certificación diagnóstica requiere de un criterio clínico más laboratorio rápido, con elevada sensibilidad y especificidad. Recomendaciones de American Academy of Pediatrics son en lactantes bajo un año, evitar estudio rutinario, sólo enfermedad de Hirschprung y/o brote nosocomial, entre 1-3 años; un resultado (+) indica DACD posible y en mayores de 3 años los criterios son igual a adultos. Manejo: Suspensión de antimicrobianos, metronidazol ev como primera línea en niños con DACD leve a moderada y vancomicina oral, enema o asociada a metronidazol intravenoso sólo en casos graves. Duración 10 días. Prevención: Control de antimicrobianos y manejo ambiental. Conclusión: Dada la creciente complejidad de pacientes pediátricos, es importante profundizar sobre este microorganismo y el desarrollo de enfermedad, ya que su incidencia y morbi-mortalidad van en aumento.


Subject(s)
Child , Humans , Clostridioides difficile , Clostridium Infections/epidemiology , Diarrhea/epidemiology , Chile/epidemiology , Clostridium Infections/diagnosis , Clostridium Infections/drug therapy , Diarrhea/microbiology , Incidence , Risk Factors
20.
Rev. Méd. Clín. Condes ; 26(5): 676-686, sept. 2015. graf, tab
Article in Spanish | LILACS | ID: biblio-1128587

ABSTRACT

En este artículo se enfocará la diarrea aguda del adulto desde una perspectiva clínica, incorporando definiciones básicas de epidemiología, fisiopatología, enfrentamiento clínico, estudio cuando corresponda y tratamiento. Se presentarán nuevas herramientas diagnósticas basadas en biología molecular, de reciente introducción en clínica y que han significado un aporte en casos seleccionados. Además, se enfrentan situaciones especiales como la diarrea del viajero y de los pacientes inmunocomprometidos. La diarrea asociada a antibióticos se tratará en un artículo aparte.


In this article of acute diarrhea in adults, will present from a clinical perspective, including different basic definitions from epidemiology, pathophysiology, clinical approach, corresponding studies and treatment. It includes new diagnostic tools based on molecular biology, of recent use in medical practice, that have had a relevant effect in selected cases. It also includes special situations, such as traveler's diarrhea and immunosuppressed patients. We exclude from this article antibiotics-related diarrhea.


Subject(s)
Humans , Adult , Diarrhea/diagnosis , Diarrhea/therapy , Physical Examination , Acute Disease , Endoscopy, Gastrointestinal , Diarrhea/physiopathology , Diarrhea/microbiology , Diarrhea/epidemiology , Feces/microbiology , Medical History Taking
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