Frecuencia de parasitismo intestinal en niños con diarrea persistente en el Área Sanitaria Sur de Sevilla

RESUMEN Introducción: La diarrea persistente está incluida en una gran categoría denominada síndrome de diarrea crónica, problema relativamente común de consulta médica en la edad pediátrica. La importancia y prevalencia de la diarrea persistente de etiología parasitaria es poco conocida en España. Objetivo: Determinar la prevalencia de parasitismo intestinal en niños con síndrome de diarrea persistente, así como las características clínicas asociadas a la etiología parasitaria en el Área Sanitaria Sur de Sevilla (España). Métodos: Estudio retrospectivo y de corte transversal realizado en un año (mayo de 2017-mayo de 2018). Se incluyeron a pacientes en edad pediátrica que consultaban por cuadro diarreico superior a 2 semanas y/o dolor abdominal. El estudio de laboratorio incluyó la determinación de sustancias reductoras, leucocitos fecales y grasas, además del estudio de la etiología infecciosa (bacterias, virus o parásitos). Resultados: De los 777 niños incluidos, 406 (52,3 %) correspondían al sexo masculino y 37 (147,7 %) al sexo femenino, con edades entre 1 mes y 14 años (mediana= 6 años). La presencia de parásitos fue detectada en el 6,9 % (54/777) de las muestras. Cuando se estratificaron los resultados por tipo de parasito, se observó que el 24,1% (13 casos) correspondía a Giardia sp., 14,8 % (8 casos) a Cryptosporidium sp., 55,6 % (30 casos) a Blastocystis sp., 3,6 % (2 casos) a Dientamoeba sp. y 1,9 % (1 caso) a Endolimax sp. Conclusiones: Los resultados revelan un escenario en el que la prevalencia de parásitos con valor clínico demostrado fue del 2,7 %. Esto lleva a considerar la conveniencia de incluir el estudio de parásitos en una segunda fase, después de descartar otras condiciones clínicas más prevalentes en niños con diarrea persistente, además de limitar el estudio de parásitos a la detección de Giardia sp. y Cryptosporidium sp.

ABSTRACT Introduction: Persistent diarrhea belongs in a large category known as chronic diarrhea syndrome, a relatively common concern in children's medical consultation. The importance and prevalence of persistent diarrhea of parasitic etiology are not sufficiently known in Spain. Objective: Determine the prevalence of intestinal parasite infection in children with persistent diarrhea syndrome and the clinical characteristics associated to its parasitic etiology in Seville South Health Area (Spain). Methods: A cross-sectional retrospective study was conducted during one year (May 2017 to May 2018) of patients in pediatric ages who attended consultation for a diarrhea picture of more than two weeks' evolution and/or abdominal pain. Laboratory testing included determination of reducing substances, fecal leukocytes and fats, as well as of the causative agents of the infection (bacteria, viruses or parasites). Results: Of the 777 children included in the study, 406 (52.3%) were male and 37 (147.7%) were female; mean age was six years (1 month to 14 years). Parasites were detected in 6.9% (54/777) of the samples. Stratification of results by parasite type showed that 24.1% (13 cases) corresponded to Giardia sp., 14.8 % (8 cases) to Cryptosporidium sp., 55.6 % (30 cases) to Blastocystis sp., 3.6 % (2 cases) to Dientamoeba sp. y 1.9 % (1 case) to Endolimax sp. Conclusions: According to the results obtained, the prevalence of parasites with demonstrated clinical value is 2.7%. It is therefore advisable to include the study of parasites in a second stage, after ruling out other clinical conditions which are more prevalent in children with persistent diarrhea, and limit the study to the detection of Giardia sp. and Cryptosporidium sp.

Persistent diarrhea in living donors after donor hepatectomy: natural course and analysis of predisposing risk factors

Background: Diarrhea is a frequent but overlooked complication of living liver donation. Thus, this retrospective study aimed to report the natural course of diarrhea and examined predictors of persistent diarrhea after living donor hepatectomy.Methods: We enrolled 79 donors who underwent living donor hepatectomy between 2010 and 2015 at a single medical center and had diarrhea symptoms after hepatectomy. The Chinese version of the gastrointestinal quality of life index (GIQLI) was applied to evaluate the effect of diarrhea on quality of life.Results: The onset of diarrhea was post-donation 1.1±0.3 months. According to their duration of diarrhea, donors were further classified into two groups: the healed and the persistent diarrhea group, the ratio was 36 to 43 (45.6% versus 54.4%). A donor who followed a low-fat diet had a protective effect on persistent diarrhea (odds ratio [OR] =0.18, 95% confidence interval: 0.04-0.66). Compared to healed diarrhea donors, donors with persistent diarrhea had lower GIQLI scores in the domains of physical (2.3 versus 1.9) and social functions (2.5 versus 2.3). Receiver operating characteristic curves for the duration of diarrhea after liver donation indicated that a donor was likely to develop a persistent diarrhea status if the duration of the diarrhea reached 12.5 months.Conclusions: A donor not following a low-fat diet can be independently predictive for persistent diarrhea after living donor hepatectomy. Besides, a donor with persistent diarrhea after hepatectomy is more likely to report lower GIQLI scores in physical and social functions.

The relationship analysis between children with chronic persistent diarrhea and food intolerance test / 国际检验医学杂志

Objective To investigate and compare the level of food specific IgG antibody between children with chronic diarrhea and healthy children,analyze the correlation between chronic persistent diarrhea and food intolerance.Methods The research objective of 105 cases was obtained from in-patient children in Shenzhen children′s hospital diagnosed as chronic persistent diarrhea and 94 cases diagnosed not diarrhea as control group in the year of 2015.The level of fourteen food allergen specific IgG in serum was detected using enzyme-linked immunosorbent (ELISA) in 199 cases.Results Chronic persistent diarrhea was more observed in 0-1 years old of infants.The positive rate of 14 food allergen specific IgG in 105 cases of children with chronic persistent diarrhea in turn from high to low was milk,eggs,tomatoes,rice,wheat,cod,corn,beef,soybeans,chicken,pork,mushrooms,shrimp and crab;14 food allergen specific IgG in 94 cases of children not with diarrhea in turn from high to low was arranged as follows:milk,eggs,tomatoes,rice,wheat,soybeans,cod,corn,beef,crab,chicken,mushroom,shrimp and pork.Among them the level of milk,beef and soybeans in the comparison of the two groups was significantly different(P<0.05).Conclusion Food intolerance was one of the important factors caused chronic persistent diarrhea in children.Reasonable diet for children may be the effective treatment of chronic persistent diarrhea.

Diagnosis and treatment progress of children′s food allergy correlative persistent diarrhea / 中华实用儿科临床杂志

Food allergy ( FA ) often leads to protracted diarrhea and chronic diarrhea, which influence children′s nutrition and growth seriously and early diagnosis and treatment is particularly important. Its pathogenesis includes IgE mediated,not IgE mediated,and mix. Mainly manifestations include:food protein mediated rectum colitis, food proteins mediated enterocolitis syndrome,food proteins mediated bowel disease,and coeliac disease ( CD) . Diagnosis should be asked for details of the history. Diet avoidance and open food challenge tests help determine the diagnosis. Treatment mainly for suspicious foods to avoid,breastfeeding should be continue,mothers need to avoid food allergies, artificial feeding should be changed to extensively hydrolysed protein formula( eHF) or amino acid-based formula( AAF) feeding. Try not to use of antibiotics,and to give support therapy. Early diagnosis and treatment,correct nutritional gui-dance can prevent serious complications,reduce its incidence.

Diarreia persistente - a utilização de fórmulas sem lactose e os riscos de mortalidade quando não tratada / Persistent diarrhea: the use of lactose and the risk of death when not treated

Objetivo: Apresentar dados recentes em comparação com dados anteriores, sobre a diarreia persistente (DP), sua etiologia, fisiopatologia, manejo clínico, dietético e profilaxia. Fontes de pesquisa: Busca eletrônica de dados no MEDLINE e LILACS. Síntese dos dados: As condições socioeconômicas, a desnutrição, o desmame precoce e o baixo peso ao nascer constituem os principais fatores de risco para a DP. Vários são os possíveis agentes etiológicos envolvidos. O achado mais importante para a manutenção da DP é a lesão intestinal, levando a alterações na absorção e secreção. O tratamento deve ser voltado para o manejo dietético e prevenção da desnutrição, sendo que os antibióticos têm uso limitado. Conclusões: A melhora das condições de vida das populações, o incentivo ao aleitamento materno e o manejo adequado da dieta no episódio de DP devem fazer parte das estratégias para a diminuição da mortalidade da doença diarreica em crianças menores de cinco anos.

Clinical observation of early feeding tolerance to amino acid-based formula combined with rice oil in children with persistent diarrhea induced by cow's milk protein allergy / 中华临床营养杂志

Objective To evaluate the clinical effects of amino acid-based formulae (AAF) combined with rice oil in treating children with persistent diarrhea caused by cow's milk protein allergy (CMPA).Methods We selected 60 infants (6-12 months) with CMPA-induced persistent diarrhea treated in Tianjin Children's Hospital between April 2011 and December 2013 and divided them into control group (n =30) and observation group (n =30) with a random number table.The control group was given AAF treatment,while the observation group was given the combination treatment of AAF + rice oil The two groups were compared in terms of treatment efficiency,period before improvement of stools,antidiarrheal time,early adverse reactions (vomit,abdominal distension),and the period before disappearance of systemic symptoms (frequent crying).Results The effective rate was 89.3％ in the control group and 96.7％ in the observation group,with no statistically significant difference (P =0.267).Adverse reactions disappeared significantly earlier in the observation group than in the control group [abdominal distension:(7.2 ± 1.7) days vs.(9.4 ±2.3) days; vomit:(8.6 ±2.5) days vs.(12.5 ±2.0) days; frequent crying:(8.0 ± 1.6) days vs.(10.0 ± 2.1) days; all P =0.000].Conclusions AAF is the first choice to treat CMPA-induced diarrhea.Early use of AAF in combination with rice oil could achieve better feeding tolerance in infant with CMPA-induced diarrhea.

Escherichia coli enteroagregativa como agente provocador de diarreia persistente: modelo experimental utilizando microscopia óptica de luz / Enteroaggregative Escherichia coli as a cause of persistent diarrhea: an experimental model using light microscopy

OBJETIVO: Avaliar interações de amostras de Escherichia coli enteroagregativa com tecido intestinal humano, a fim de documentar potenciais alterações em diferentes regiões do trato digestivo. MÉTODOS: Amostras de Escherichia coli enteroagregativa isoladas das fezes de crianças com diarreia persistente e a amostra protótipo 042, isolada de uma criança com diarreia em Lima, no Peru (controle positivo), foram analisadas por microscopia óptica de luz após semeadura em cultura de orgão in vitro de fragmentos de mucosa ileal e colônica. Foram analisadas as interações entre as diferentes cepas de Escherichia coli enteroagregativa e as mucosas ileal e colônica. RESULTADOS: A análise por microscopia óptica de luz indicou associação destes micro-organismos com o epitélio, provocando alterações. As cepas estudadas aderiram a ambas as regiões avaliadas (intestino delgado distal e grosso) e causaram alterações, especialmente naquelas áreas onde interagiram diretamente com o epitélio. No íleo, algumas regiões mostraram internalização secundária. CONCLUSÕES: Esses agentes podem causar diarreia persistente por meio de alterações no intestino delgado, no qual ocorrem as funções digestivo-absortivas. As lesões inflamatórias descritas na mucosa colônica poderiam explicar a colite mostrada em algumas crianças infectadas por Escherichia coli enteroagregativa.

OBJECTIVE: To examine the interactions of Enteroaggregative Escherichia coli strains with small and large intestinal mucosa, in order to detect potential alterations in both regions of the digestive tract. METHODS: Enteroaggregative Escherichia coli strains, isolated from stools of infants with persistent diarrhea and the prototype strain 042 (O44:H18), isolated from a child with diarrhea in Lima, Peru (positive control), were analised by light microscopy after in vitro organ culture assay of ileal and colonic mucosa. The interactions between the different enteroaggregative Escherichia coli strains and the ileal and colonic mucosa were analysed. RESULTS: Light microscopy analysis suggested an association of enteroaggregative Escherichia coli strains with the epithelium, inducing alterations. These bacteria adhered to both small and large bowel mucosa. The enteroaggregative Escherichia coli strains induced alterations in those areas where they were directly interacting with the epithelium. In the ileum, some areas showed a secondary internalization. CONCLUSIONS: The enteroaggregative Escherichia coli strains could cause persistent diarrhea inducing alterations in the small intestinal structures, where the digestive-absorptive functions take place. Inflammatory lesions observed in colons could justify the colitis described in some children infected by enteroaggregative Escherichia coli.

OBJETIVO: Evaluar interacciones de muestras de Escherichia coli enteroagregativa (EAEC) con tejido intestinal humano, a fin de documentar potenciales alteraciones en distintas regiones del tracto digestivo (intestino delgado distal e intestino grueso) y definir, con eso, su rol en la persistencia del proceso diarreico. MÉTODOS: Muestras de EAEC aislada de las heces de niños con diarrea persistente y la muestra prototipo 042, aislada de un niño con diarrea en Lima, Perú (control positivo) fueron analizadas por microscopía óptica de luz (ML) después de siembra en cultura de órgano in vitro de fragmentos de mucosa ileal y del colon. Fueron analizadas las interacciones entra las distintas cepas de EAEC y las mucosas ileal y del colon. RESULTADOS: El análisis por ML indicó asociación de estos microorganismos con el epitelio, provocando alteraciones. Las cepas estudiadas adhirieron a ambas regiones evaluadas: intestino delgado distal y grueso y causaron alteraciones, especialmente en aquellas áreas donde interactuaron directamente con el epitelio. En el íleo, algunas regiones mostraron internalización secundaria. CONCLUSIÓN: Estos agentes pueden causar diarrea persistente mediante alteraciones en el intestino delgado, donde ocurren las funciones digestivo-absortibas. Las lesiones inflamatorias descritas en la mucosa del colon podrían explicar la colitis descrita en algunos niños infectados por EAEC.

Chronic and Persistent Diarrhea in Infants and Young Children: Status Statement.

Justification: Diarrhea that lasts for more than two weeks is a common cause of mortality and morbidity in infants and children. There is a need to update the information available on this subject in Indian context. Process: This review has analyzed the available published data on the subject with particular focus on developing countries. It has also outlined the current diagnostic and management practices in India based on the experience of the participants from major hospitals in different parts of the country. Objectives: Problem areas in both persistent and chronic diarrhea have been identified and remedial measures relevant to India are presented. Recommendations: Micronutrient supplementation, algorithm based diet regimens, and good supportive care are sufficient in most children above 6 months of age with persistent diarrhea. Paucity of diagnostic facilities limits evaluation of chronic diarrhea in most parts of the country and regional laboratories need to be set up urgently. Lack of awareness regarding cow’s milk protein allergy, celiac disease and immunodeficiency associated diarrhea is of particular concern.

Persistent diarrhea: Risk factors and outcome.

Objective. To identify risk factors associated with Persistent diarrhea (PD) and deaths due to PD. Methods. This prospective case control study included 60 children with PD (cases) and 60 children (controls) with acute diarrhoea (AD). Detailed history, examination and appropriate investigations were done for all children. Crude Odds ratio was calculated for each risk factor by univariate analysis and adjusted odds ratio was calculated by multivariate logistic regression. Results. Prior antibiotic use, steroid use, anemia, vitamin A deficiency, malnutrition, LRI, UTI, oral candidiasis, and hyponatremia, were statistically significant risk factors by univariate analysis. Prior antibiotic use, vitamin A deficiency, malnutrition and LRI were independently associated with PD by multivariate logistic regression analysis. The risk factors for mortality were stool frequency more than 10 times per day, severe malnutrition, oral candidiasis, hypoalbuminemia and HIV positivity. Conclusions. The presence of these risk factors should alert the clinician to take appropriate measures, to decrease the mortality.

Actualización terapéutica sobre diarrea persistente / Therapeutical updating on persistent diarrhea

Se realizó una revisión bibliográfica acerca de la diarrea persistente y su tratamiento, mediante la revisión tanto de bibliografía impresa actualizada como de publicaciones electrónicas, con el objetivo de brindar información sobre la entidad y la conducta a seguir una vez diagnosticada. Se exponen los pilares de tratamiento según los resultados más coincidentes en la literatura médica, así como las formas de prevención de las consecuencias del diagnóstico y tratamiento tardíos. Se enfatiza en la importancia de la lactancia materna, del adecuado equilibrio dietético-nutricional y de la eliminación de los factores de riesgo que pueden incidir en la aparición y persistencia de esta afección.

A bibliographic review was made on the persistent diarrhea and its treatment using the updated printed review and the electronic publications to give information on entity and behavior followed since that the diagnosis is made. Treatment pillars are showed according the more coincident results in medical literature, as well as the prevention ways of consequences from late diagnosis and treatment. Authors emphasize the significance of breastfeeding, the proper dietetic-nutritional balance, and the elimination of risk factor that may to have an impact on the appearance and persistence of this affection.

Diarrea persistente / Persistent diarrhea

En los países en vía de desarrollo, el ciclo desnutrición-mala absorción-diarrea persistente, es una de las principales causas de la mortalidad infantil. Con frecuencia se deben a infecciones entéricas. La evaluación del niño con diarrea persistente, comienza con ciertos estudios paraclínicos. El pronóstico de la diarrea persistente, ha mejorado con el uso de dietas enterales y de la nutrición parenteral.

In the world’s developing countries, the cycle of malnutrition, malabsorption, and persistent diarrhea is one of the leading causes of death in children. It is most often caused by an enteric infection. Evaluation of the patient with persistent diarrhea should start with certain screening studies. The prognosis for persistent diarrhea has been markedly improved through the use of enteral diets and parenteral nutrition.

Experiencia con pacientes hospitalizados en la Unidad de Capacitación para el Tratamiento de la Diarrea del Hospital San Vicente de Paúl, de Medellín / Experience with hospitalized children at a training unit for diarrhea treatment, in Medellín, Colombia

Entre 1988 y 1994 se atendieron 1.755 niños en la sala de hospitalización de la Unidad de Capacitación para el Tratamiento de la Diarrea, del Hospital Universitario San Vicente de Paúl, de Medellín; 1.022 (58.2 por ciento) fueron hombres y 733 (41.8 por ciento) mujeres; mil setenta y ocho eran menores de un año (61.4 por ciento) y 677 (38.6 por ciento) tenían más de un año. Eran desnutridos 888 (50.6 por ciento). Presentaban diarrea persistente 418 (23.8 por ciento); 1.056 (82.2 por ciento) diarrea acuosa, 213 (16.6 por ciento) diarrea disentérica y 16 (1.2 por ciento) solamente vómitos. Novecientos trece pacientes (52 por ciento) consultaron o estuvieron en la sala de hidratación oral y 276 (15.7 por ciento) habían estado hospitalizados por diarrea durante el último mes. Al ingreso 670 (38.2 por ciento) se encontraban hidratados, 151 (8.6 por ciento) tenían deshidratación grave y 934 (53.2 por ciento) presentaban otros grados de deshidratación. La bacteria más frecuentemente identificada fue Salmonella enteritidis (258 casos; 23.9 por ciento). Setecientos ochenta y seis pacientes (44.8 por ciento) recibieron los líquidos solamente por vía oral o por sonda nasogástrica y 969 (55.2 por ciento) por vía intravenosa. Al egreso 1.088 (62 por ciento) tuvieron el diagnóstico de diarrea aguda y 667 (38 por ciento) el de diarrea persistente. La mortalidad fue de 1.5 por ciento (27 pacientes)

We present the results of our experience in the in-patient treatment of children with diarrhea. Between 1988 and 1994,1.755 children werehospitalized for this purpose at the Training Unit for Diarrhea Treatment, Hospital San Vicente, in Medellín, Colombia; 1.022 (58.2%) were males and 733 (41.8%) females; 1.078 (61.4%) were younger than one year and 677 (38.6%) were above this age. Eight hundred and eighty eight (50.6%) were undernourished. At admission, persistent diarrhea was found in 418 (23.8%); stools were watery in 1.056 (82.2%) and dysenteric in 213 (16.6%); 16 patients had suffered only vomit. During the previous month, half of the patients (52%) had attended the oral rehydration unit and 276 (15.7%) had been hospitalized because of diarrhea. At admission 670 (38.2%) were hydrated, 151 (8.6%) had serious dehydration and 934 (53.2%) presented other degrees of dehydration. Salmonella enteritidis was the most frequently isolated bacteria (258 cases; 23.9%). Oral or nasogastric fluids were the only therapy in 786 patients (44.8%) while the remaining 969 (55.2%) received intravenous hydration. Final diagnosis was acute diarrhea in 1.088 patients (62%) and persistent diarrhea in 667 (38%); only 27 patients (1.5%) died