Hospitalizaciones por diarrea con sangre en un centro pediátrico de referencia en Uruguay / Hospitalizations due to bloody diarrhea in a pediatric reference center in Uruguay / Internações por diarreia sanguinolenta em um centro de referência pediátrica no Uruguai

Introducción: La diarrea con sangre es un motivo frecuente de admisión hospitalaria en niños, con gastroenteritis aguda; en la mayoría de los casos se tratan de infecciones leves y autolimitadas, pero pueden producirse complicaciones graves. Objetivos: Describir la etiología y características clínico- evolutivas de los niños menores de 15 años hospitalizados por diarrea con sangre en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell entre los años 2012- 2023. Materiales y métodos: Estudio retrospectivo mediante revisión de historias y registros de laboratorio. Variables: demográficas, estado nutricional, hidratación, motivos de hospitalización, ingreso unidades de cuidados intensivos (UCI), enteropatógenos, tratamientos, evolución. Resultados: Se incluyeron 229 niños, mediana de edad de 8 meses; sexo masculino 61%; eutróficos 88%, bien hidratados 55%, con comorbilidades 11%, prematurez 6,5%. El motivo de hospitalización fue diarrea con sangre/disentería sin otro síntoma 45%. Se solicitó coprovirológico/coprocultivo en 98% y detección por técnicas de ácidos nucleicos en materia fecal 5,2%. Se identificó al menos un agente patógeno en 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecciones en 12%. Se indicaron antibióticos a 86%; ceftriaxona 62%, azitromicina 35%. Ingresaron a UCI 6,5% (15), presentaron complicaciones 10/14, fallo renal agudo 5 y alteraciones del medio interno 3. La mayoría presentó buena evolución. Conclusiones: La diarrea con sangre/disentería continúa siendo una causa importante de hospitalización afectando en su mayoría a niños sanos menores de 5 años. Los patógenos detectados con mayor frecuencia fueron bacterias principalmente Shigella sp., Salmonella sp. y E coli diarreogénicas. Se reportó alta prescripción de antibióticos, cumpliendo en la mayoría de los casos con las recomendaciones.

Introduction: Bloody diarrhea is a common reason for hospital admission in children with acute gastroenteritis; In most cases these are mild and self-limiting infections, but serious complications can occur. Goals: To describe the etiology and clinical-evolutionary characteristics of children under 15 years of age hospitalized for bloody diarrhea at the Pediatric Hospital, Centro Hospitalario Pereira Rossell between the years 2012-2023. Materials and methods: Retrospective study through review of histories and laboratory records. Variables: demographics, nutritional status, hydration, reason for hospitalization, intensive care unit (ICU) admission, enteropathogens, treatments, evolution. Results: 229 children were included, median age 8 months; male sex 61%; eutrophic 88%, well hydrated 55%, with comorbidities 11%, prematurity 6.5%. The reason for hospitalization was bloody diarrhea/dysentery without other symptoms 45%. Coprovirological/coproculture was requested in 98% and detection by nucleic acid techniques in fecal matter was requested in 5,2%. At least one pathogenic agent was identified in 34,3%: Shigella sp. 38%; Salmonella sp 19,5%; coinfections in 12%. Antibiotics were indicated for 86%; ceftriaxone 62%, azithromycin 35%. Were admitted to the ICU 6,5% (15), 10/14 had complications, 5 had acute kidney failure and 3 had alterations in the internal environment. The majority had a good evolution. Conclusions: Bloody diarrhea/dysentery continues to be an important cause of hospitalization, affecting mostly healthy children under 5 years of age. The most frequently detected pathogens were bacteria, mainly Shigella sp., Salmonella sp. and diarrheagenic E coli. High prescription of antibiotics was reported, complying in most cases with the recommendations.

Introdução: A diarreia com sangue é um motivo comum de internação hospitalar em crianças com gastroenterite aguda; Na maioria dos casos, estas são infecções leves e autolimitadas, mas podem ocorrer complicações graves. Metas: Descrever a etiologia e as características clínico-evolutivas de crianças menores de 15 anos internadas por diarreia sanguinolenta no Hospital Pediátrico Centro Hospitalario Pereira Rossell entre os anos de 2012-2023. Materiais e métodos: Estudo retrospectivo por meio de revisão de histórias e registros laboratoriais. Variáveis: dados demográficos, estado nutricional, hidratação, motivo da internação, internação em unidade de terapia intensiva (UTI), enteropatógenos, tratamentos, evolução. Resultados: foram incluídas 229 crianças, mediana de idade 8 meses; sexo masculino 61%; eutrófico 88%, bem hidratado 55%, com comorbidades 11%, prematuridade 6,5%. O motivo da internação foi diarreia sanguinolenta/disenteria sem outros sintomas 45%. O estudo coprovirologico/coprocultivo foi solicitado em 98% e a detecção por técnicas de ácidos nucleicos em matéria fecal foi solicitada em 5,2%. Pelo menos um agente patogênico foi identificado em 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecções em 12%. Os antibióticos foram indicados para 86%; ceftriaxona 62%, azitromicina 35%. Foram internados em UTI 6,5% (15), 10/14 apresentaram complicações, 5 tiveram insuficiência renal aguda e 3 apresentaram alterações no meio interno, a maioria teve boa evolução. Conclusões: A diarreia/disenteria com sangue continua a ser uma causa importante de hospitalização, afetando sobretudo crianças saudáveis ​​com menos de 5 anos de idade. Os patógenos mais frequentemente detectados foram bactérias, principalmente Shigella sp., Salmonella sp. e E. coli diarreiogênica. Foi relatada elevada prescrição de antibióticos, cumprindo na maioria dos casos as recomendações.

Influence of early use of antimicrobial on the health and performance of Holstein calves in the first month of life / Influência do uso precoce de antimicrobiano na sanidade de bezerras holandesas no primeiro mês de vida

The early use of antimicrobial therapy has been introduced in many farms to prevent diarrhea and respiratory disease in young calves; however, there is controversy about whether this practice has a beneficial effect on the health of these animals. This study evaluated the influence of the early use of antimicrobials on the health and performance of neonatal Holstein calves. Twenty-six Holstein calves were screened and divided into two groups, according to the administration (ATB+), or not (ATB-) of tulathromycin (2.5mg/kg, subcutaneously) within the first 12 hours of life. Calves were evaluated by general clinical examination, fecal score, respiratory score, and external palpation of the umbilical region, besides fecal output of dry matter. Anemia was determined by using an automatic system and, also, using a commercial kit for iron dosage. Diarrhea was diagnosed by a centrifuge-flotation technique using a sugar solution (Cryptosporidium) and multiplex semi-nested RT-PCR (rotavirus/coronavirus). The performance of the calves was estimated by Daily Weight Gain (DWG). The young dairy calves were evaluated within 12 hours of birth (≤12h) and at 3-5th (D3-5), 7-9th (D7-9), 13-15th (D13-15), 20-23rd (D20-23), and 27-30th (D27-30) days of life. No difference was noted between the ATB+ and ATB- groups concerning heart rate, respiratory frequency, and rectal temperature. Erythrogram showed a higher frequency of anemia in ATB- group (P=0.016) at the D3-5 check-up; lower values of serum iron were also observed simultaneously (P=0.051). Thirteen cases of respiratory disease were detected during this study; however, no significant difference was observed between the groups in this regard. The frequency of diarrhea (fecal score 2-3) was high in both groups, peaking at D13-D15. No differences were noted between the groups regarding the frequency of diarrhea when considering the dry fecal matter. The predominant etiological agent for diarrhea was Cryptosporidium spp.. The DWG was similar between groups, with maximum weight reduction on D13-15. The administration of tulathromycin in prophylactic dose (2.5mg/kg) at birth decreased the frequency of anemia but did not influence weight gain or the prevalence of diarrhea.(AU)

O uso precoce de antimicrobianos tem sido adotado em muitas fazendas para profilaxia das diarreias e doença respiratória em bezerras, no entanto existem controvérsias sobre os beneficios desta prática na saúde desses animais. Esta pesquisa avaliou a influência do uso precoce de antimicrobiano na sanidade e desempenho de bezerras holandesas recém-nascidas. Para tanto foram selecionadas 26 bezerras Holandesas distribuídas de acordo com a aplicação (ATB+) ou não (ATB-) de tulatromicina (2,5mg/Kg) por via subcutânea até 12h de vida. As bezerras foram examinadas por meio de exame clínico geral, escore fecal, escore respiratório e palpação externa da região umbilical, além da matéria seca fecal. A presença de anemias foi determinada pelo eritrograma utilizando sistema automático e além da dosagem de ferro utilizando kit comercial. O diagnóstico etiológico das diarreias foi investigado por meio da técnica de flutuação em solução saturada de sacarose (Cryptosporidium) e multiplex semi-nested RT-PCR (rotavírus/coronavírus). O desempenho das bezerras foi estimado pelo ganho de peso. As bezerras foram avaliadas até doze horas após o nascimento (≤12h); 3-5º (D3-5); 7-9º (D7-9); 13-15º (D13-15); 20-23º (D20-23); e 27-30º dias de vida (D27-30). Não foram encontradas diferenças entre os grupos ATB+ e ATB- em relação à frequência cardíaca, frequência respiratória e temperatura retal. O eritrograma revelou maior frequência de anemias no grupo ATB- (P=0,016) no D3-5. Neste momento também foram observados menores valores de ferro sérico (P=0,051). Foram detectados treze casos de doença respiratória durante o estudo, no entanto não foi possível detectar diferença entre os grupos. A frequência de diarreias (escore fecal 2 e 3) foi alta em ambos os grupos, observando-se pico no D13-15 (ATB+=92,3%; ATB-=92,3%). Não observamos diferenças entre os grupos em relação a frequência de diarreia considerando-se a matéria seca fecal. O agente etiológico predominante nas diarreias foi o Cryptosporidium. O ganho de peso diário foi igual entre grupos, com intensa redução no GPD no D13-15. A administração de tulatromicina na dose profilática (2,5mg/Kg) ao nascimento diminuiu a frequência de anemias e não influenciou no ganho de peso e prevalência de diarreias.(AU)

Diarrea aguda infecciosa: ¿qué debe saber un gastroenterólogo?, ¿cómo mejoramos el diagnóstico etiológico? / Acute infectious diarrhea: what should a gastroenterologist know? how do we improve the etiological diagnosis?

Acute infectious diarrhea is still a major public health problem, both in developing and developed countries, causing morbidity, mortality and high costs. Acute diarrhea particularly affects people in extrema age ranges, travelers and immunosuppressed individuals. Traditional microbiological study, based on cultures, direct microscope analysis, and antigen tests show poor performance, due to low sensitivity and specificity, slowness and the diversity of bacteria, viruses and parasites that complicate getting the results. New molecular techniques based on multiple polymerase chain reaction (PCR) kits allow for the identification, in few hours and simultaneously, of many agents, such as bacteria, viruses and parasites, with high sensitivity and specificity; which will probably transform etiological diagnosis of acute diarrhea

La diarrea aguda infecciosa continúa siendo un problema de salud pública tanto en países en vías de desarrollo como en países desarrollados, causando morbi-mortalidad y grandes gastos económicos. Las diarreas agudas son especialmente importantes en personas con edades extremas, viajeros e inmunodeprimidos. El estudio microbiológico tradicional basado en cultivos, análisis microscópico directo y pruebas de antígenos tiene un rendimiento pobre, dado por su baja sensibilidad y especificidad, lentitud y la gran diversidad de bacterias, virus y parásitos que dificultan la obtención de resultados. Las nuevas técnicas de diagnóstico molecular basadas en kits de reacción de polimerasa en cadena (PCR) múltiple permiten identificar en pocas horas y en forma simultánea una gran cantidad de agentes, tanto bacterias, virus, como parásitos, con alta sensibilidad y especificidad, lo que probablemente transformará el diagnóstico etiológico de las diarreas agudas.

Diarrea crónica como manifestación inicial de un ganglioneuroblastoma / Chronic diarrhea as the initial manifestation of a ganglioneuroblastoma

Resumen: El neuroblastoma es un tumor maligno del sistema nervioso simpático periférico con presentación y curso clínico heterogéneo. Es el tercer tumor pediátrico más frecuente y el 90% de los casos se diagnostica antes de los 5 años. Los síntomas más comunes se deben a la compresión por la masa tumoral o al dolor óseo causado por la metástasis. La diarrea como síntoma principal es rara por lo que es difícil de diagnosticar en la etapa temprana de la enfermedad. Se presenta el caso clínico de una paciente de 2 años en la que luego de 8 meses de estudio por diarrea crónica se diagnóstica ganglioneuroblastoma secretor de VIP. Se debe plantear como diagnóstico diferencial en los pacientes menores de 3 años con diarrea crónica intratable luego de haber descartado otras etiologías.

Summary: Neuroblastoma is a malignant tumor of the peripheral sympathetic nervous system with heterogeneous clinical presentation and course. It is the third most frequent pediatric tumor and in 90% of cases it is diagnosed before 5 years of age. The most typical symptoms result from the tumor compression or bone pain caused by methastasis. Diarrhea as the main symptom is unusual, and thus it is hard to diagnose in early stages of the disease. We report the case of a 2-year-old patient who, after 8 months of study for chronic diarrhea was diagnosed with VIP-secreting ganglioneuroblastoma. It is necessary for this condition to be considered as a differential diagnosis in patients younger than 3 years old with chronic diarrhea with no evolution, after other etiologies are ruled out.

Campylobacter spp como causa de disentería: opciones diagnósticas: A propósito de dos casos clínicos / Campylobacter spp as a cause of dysentery: diagnostic options: Presentation of two clinical cases

En los últimos años se ha observado un aumento en la incidencia de Campylobacter spp (CSSP) como agente de diarrea, enteritis y disentería. Constituye una zoonosis así como una enfermedad trasmitida por alimentos. El diagnóstico de GEA por CSPP se realiza por identificación del agente etiológico en las heces del paciente. El objetivo de la siguiente observación es presentar dos casos clínicos de GEA en niños con diagnóstico etiológico de colitis causada probablemente por Campylobacter spp mediante la utilización de examen directo de materia fecal. El cultivo de la bacteria es el gold standard; en Uruguay sólo está disponible con fines de investigación. El método más fácil de poner en práctica en los laboratorios clínicos es la tinción y observación directa con un Gram modificado el cual sumado a la clínica, permite un diagnóstico con alto grado de presunción. En ambos pacientes el resultado motivó la instauración de un tratamiento antibiótico específico que determinó una buena evolución.

In recent years an increase in the incidence of Campylobacter spp (CSSP) as the agent of diarrhea, enteritis and dysentery was observed. It constitutes a zoonosis, as well as a food transmitted disease. Diagnosis of acute gastroenteritis by CSPP is done by identifying the etiological agent on the patients’ feces. The objective of the following observation is to present two clinical cases of acute gastroenteritis in children with an etiological diagnosis of colitis, probably caused by Campylobacter spp by means of a direct study of the stool. Culture of the bacteria is the gold standard, although in Uruguay it is only available for research purposes. The easiest method to put into practice in the clinical laboratories is staining and the direct observation with a modified Gram, which, together with the clinical examination, enables diagnosis with a high degree of presumption. In both patients, the result caused the adoption of a specific antibiotic, which determined a good evolution.

Efecto de la combinación de bases nutritivas con el inhibidor sobre la recuperación de salmonelas / Effect of combining nutrient bases and inhibitor on recovery of Salmonella

INTRODUCCIÓN: las salmonelas son las causantes más frecuentes de enfermedades transmitidas por alimentos a nivel mundial. El caldo selenito cistina es un medio de enriquecimiento selectivo utilizado para la recuperación de especies de salmonelas en muestras de alimentos, aguas, heces y otros materiales de importancia sanitaria. OBJETIVO: evaluar la combinación de bases nutritivas obtenidas por métodos originales con el selenito de sodio para garantizar la adecuada recuperación de especies de salmonelas en el caldo selenito cistina. MÉTODOS: se realizó un estudio comparativo con diferentes bases nutritivas, que evaluó la promoción de crecimiento bacteriano de seis cepas de Salmonella y Shigella. Se prepararon dos variantes y se inocularon los microorganismos seleccionados a una concentración aproximada de 3 × 108 unidades formadoras de colonia por mililitro. El incremento de la biomasa se determinó a través de la medición de la absorbancia en un espectrofotómetro a 640 nanómetros cada una hora. Se comparó el comportamiento del medio caldo selenito cistina formulado por ingredientes con el caldo selenito cistina de Merck frente a los microorganismos de interés. Se determinó productividad y selectividad del medio de cultivo. RESULTADOS: la variante que contiene la mezcla de bases nutritivas (peptona bacteriológica Z, peptona de soya e hidrolizado enzimático de caseína) facilitó una mejor recuperación de las cepas ensayadas, mostró diferencias significativas (p< 0,05) con respecto a la variante que contiene solo hidrolizado enzimático de caseína. El medio experimental que contenía la mezcla de bases nutritivas con el selenito de sodio, mostró una recuperación de Salmonella a bajas concentraciones, similar al de referencia e inhibió mejor Escherichia coli a bajas concentraciones. A altas concentraciones ninguno de los dos medios pudo inhibir el crecimiento de E. coli. La productividad para ambos medios, resultó satisfactoria en el intervalo de 0,1 a 1, al igual que la selectividad con un valor aproximado de 3. CONCLUSIONES: la combinación de bases nutritivas originales con el selenito de sodio permitió una adecuada recuperación de las especies de salmonelas.

INTRODUCTION: Salmonella are the most common causes of food-borne disease worldwide. Selenite cystine broth is a selective enrichment medium used for the recovery of Salmonella species in samples of food, water, feces and other materials of clinical importance. OBJECTIVE: Evaluate the combination of nutrition bases obtained by original methods and sodium selenite to ensure appropriate recovery of Salmonella species in selenite cystine broth. METHODS: A comparative study was conducted with various nutrition bases to evaluate the fostering of bacterial growth in six strains of Salmonella and Shigella. Two variants were prepared and the microorganisms selected were inoculated at an approximate concentration of 3 × 108 colony-forming units per milliliter. Absorbance was measured with a 640 nanometer spectrophotometer every hour to determine biomass increase. Behavior of the selenite cystine broth medium formulated by ingredients was compared with that of Merck cystine selenite broth in the presence of the microorganisms of interest. Determination was performed of the productivity and selectivity of the culture medium. RESULTS: The variant containing the mixture of nutrient bases (bacteriological peptone Z, soybean peptone and casein enzymatic hydrolysate) facilitated better recovery of the strains tested, with significant differences (p< 0.05) with respect to the variant containing casein enzymatic hydrolysate alone. The experimental medium containing the mixture of nutrient bases and sodium selenite displayed Salmonella recovery at low concentrations in a manner similar to the reference medium and inhibited Escherichia coli more efficiently at low concentrations. At high concentrations neither medium was able to inhibit the growth of E. coli. Productivity was satisfactory in both media, ranging between 0.1 and 1, and so was selectivity, which reached an approximate value of 3. CONCLUSIONS: The combination of original nutrition bases and sodium selenite allowed appropriate recovery of Salmonella species.

Establishment of Blastocystis hominis in-vitro Culture Using Fecal Samples from Infants in Slum Area of Mirpur, Dhaka, Bangladesh.

Introduction: Blastocystis hominis (B. hominis) is an obligate anaerobic protozoan found in the human large intestine, and is the most common eukaryotic organism reported in human fecal samples. Method: Multiple stool samples from 460 children (53.9% male and 46.07% female) were collected and examined for the presence of Blastocystis hominis in Parasitology Laboratory of International Centre for Diarrhoeal Diseases Research, Bangladesh during the period of 9th January to 28th December, 2011. Among them, 255 were diarrheal patients (56.47% male and 43.53% female). Direct microscopy was done for each of the samples and each sample was cultured in vitro for 48 hours and observed again for the presence of the pathogen. Th e aim of the study was to develop a sustainable technique to identify the pathogen. Results: In culture, several morphological forms were observed. Th rough microscopy, various morphological forms were clearly observed. Within 5679 tested samples, 795 samples (0.14%) were positive for B. hominis. As multiple forms were observed in the same sample, the most prevalent was cyst (0.125%) whereas least prevalent was granular (0.0072%). Th e highest percentage for all the morphological forms was observed in age group 25-36 months. In direct microscopy from fresh samples, children from 37-48 months showed the highest percentage (22.9%) of infection (p=0.000). In culture, the same age group showed the most infection rate (p=0.000). Among the diff erent morphological forms observed in culture, the highest prevalence of cyst was in age group 37-48 months (p=0.000). Th e highest prevalence of vacuolar form(5.7%) was observed in the same age group (p=0.015). In contrast, the amoeboid forms were mostly observed in children of 25-36 months (p=0.002).Th e children aged in between 37 to 48 months are at the most risk of the infection. Conclusion: Th e sensitivity of direct microscopy was found only 38.46% in respect to in-vitro culture which strongly suggests that in-vitro culture is the gold standard for the diagnosis of this parasite.

Bacterial Etiology of Diarrhoeal Diseases in Children Under 5 Years Old in Ombadda Hospital - Sudan

Abstract:This study was conducted in Ombadda hospital in order to isolate and identify the bacterial aetiology of diarrhoea in children under 5years of age and determine their antibiograms. Stool specimens were collected from children seeking treatment at Ombadda and Omdurman paediatric hospitals from April to September 2008. The stool specimens were cultured on conventional media; and the isolates were identified by biochemical tests; and confirmed by serology. Enteropathogenic E.coli (EPEC) was the predominant isolate (42.11); followed by Salmonella paratyphi B (31.58);Salmonella typhi (10.53) V. cholerae (10.53) and Shigella flexneri(5.26). The enteric bacterial pathogens were susceptible to cefuroxime and ceftriaxone.V.cholerae was susceptible to amoxicillin.This study showed high proportion of bacterial diarrhoea among children less than five years old. The most common causative agent is EPEC which is not part of routine investigation of stool culture in all of the laboratories in Sudan

Comparative study between PCR and microscopic examination in diagnosing Entamoeba histolytica

Differentiation between E. histolytica and non pathogenic species as Entamoeba dispar, which are morphologically identical species, is essential for rapid treatment decision, precaution of the invasive disease and public health. This study evaluated the real time PCR for detection of intestinal amoebiasis in comparison with microscopic examination. Stool samples were obtained from symptomatic 40 patients from outpatient clinic of Benha University Hospitals and Benha Educational Hospital. Twenty suffered from dysentery and 20 cases were not suffering dysentery. In addition 10 stool samples of other parasitic infection as Giardia lamblia and Cryptospordium parvum were examined by direct smear, iodine stained smear, formol ether concentration technique and real time PCR for detection of E. histolytica DNA. Formol ether concentration technique showed that 20 [40%] samples were positive for E. histolytica but real time PCR showed 26 [52%] positivity. All samples positive by microscopy were also positive by PCR and additional 6 PCR positive cases. There was no cross reaction with other parasites as G. lamblia and C. parvum

Etiología bacteriana de la diarrea aguda en pacientes pediátricos / Bacterial etiology of acute diarrhea in pediatric patients

La diarrea aguda es una causa importante de morbilidad y mortalidad en países en desarrollo. Sólo requiere tratamiento antimicrobiano en situaciones puntuales y el uso adecuado de los mismos depende del conocimiento previo de la epidemiología local. Para conocer estos parámetros se estudiaron en forma retrospectiva los resultados bacteriológicos de 7.075 muestras de materia fecal de niños ambulatorios hasta 15 años, en el período 2001-2003, atendidos en el Hospital de Niños de La Plata. Se aislaron 1.221 bacterias enteropatógenas (17,26%). Los patógenos identificados por métodos estándar fueron: Shigella flexneri(27%), Shigella sonnei(21,2%), Campylobacterspp. (30,1%), Aeromonas spp.(9,4%), Salmonella spp. (5,4%), Escheríchia coli enteropatógena (5,7%), Escheríchia coli enteroinvasiva (0,9%) y Escheríchia coliO157 (0,4%). No se aislaron cepas de Shigella dysenteriae, Shigella boydii ni Yersinia spp. Las cepas de Shigella flexneri presentaron una alta resistencia: ampicilina (92,4%, 89,2% y 91,9%), cotrimoxazol (51,5%, 50% y 44,4%) y cloranfenicol (73,8%, 85,9% y 79,2%) en 2001, 2002 y 2003, respectivamente. En el caso de Shigella sonnei, la resistencia a ampicilina fue menor (39,4%, 20,6% y 12,9%), la resistencia a cotrimoxazol fue similar (60,6%, 54,3% y 38,7%) y para cloranfenicol mucho menor aún (6%, 2,9% y 3,3%) en los mismos años. No se aislaron cepas resistentes a ciprofloxacina, nitrofuranos ni cefalosporinas de tercera generación en el período de estudio.

Acute diarrhea is an important cause of morbidity and mortality in developing countries, and in some cases, it requires antimicrobial therapy .The use of antibiotics needs a previous knowledge of local epidemiology. In order to know these parameters, the result of enteropathogenic bacteria isolated from 7.075 fecal samples from ambulatory patients up to 15 years old, assisted at the Hospital de Niños de La Plata from 2001 to 2003 was retrospectively studied. A total of 1,221 enteropathogenic bacteria were isolated (17.26%). The pathogens identified by standard methods were Shigella flexneri (27%), Shigella sonnei (21.2%), Campylobacter spp.(30.1%), Aeromonas spp.(9.4%), Salmonella spp. (5.4%), enteropathogenic Escherichia coli ( 5.7% ), enteroinvasive Escherichia coli (0.9%) and Escherichia coli 0157 (0.4%). Strains from Shigella dysenteriae, Shigella boydii and Yersinia spp were not isolated in this study. Shigella flexneri strains were resistant to ampicillin (92.4%, 89.2%, 91.9%), cotrimoxazole (51.5%, 50%, 44%) and chloramphenicol (73.8%, 85.9%, 79.2%) for 2001, 2002 and 2003 respectively. Shigella sonnei strains were resistant to ampicillin (39.4%, 20.6%,12.9%), cotrimoxazole (60.6%, 54.3% 38.7%) and chloramphenicol (6%, 2.9%, 3.3%) for each year. Strains resistant to ciprofloxacin, nitrofurans and third generation cephalosporins were not isolated.

[Shigella spp frequency, serotyping and antibiotic resistance pattern in acute diarrheic patients in Zanjan Shahid Beheshti hospital, during 2003-2007]

Gastroenteritis is one of the most important diseases in the world. This disease is more critical among children, people with immune deficiency and the sufferers from mal-nutrition. Shigella spp. as the most important cause of dysentery, causes much mortality around the world. Increasing antibiotic resistance is one of the major health problems. This research aimed to study the pattern of antibiotic resistance of Shigella spp. In Zanjan Shahid Beheshti Hospital. Shigella spp. was isolated from stool samples of diarrheic patients during 2003-2007 using common microbioloyic methods. They were examined for serotyping and antibiogram using disc diffusion method. Shigella spp were found in 134 out of 682 [19.6%] diarrheic stool samples. They comprised of 53% males and 47% females. The highest number of positive samples was found in August and the lowest number was seen in March. The shigella species isolated from 134 positive cultures, identified as sh.flexeneri [62.7%], sh.boydii [20.1%] and sh.dysenteriae [17.2%]. In the antibiogram, ciprofloxacin was the most sensitive antibiotic [88.8%] and Ampicillin showed the highest resistance [100%]. Due to irregular use of antibiotics and increasing antibiotic resistance to Shigella species it can be suggested that some of antibiotics can be omitted from the list of drug choice

importance of Escherichia coli 0157:H7 in foodborn infection

Enterohemorrhagic Escherichia coli O157: H7 is one of the most important causes of bloody diarrhea. This bacterium is able to make bloody diarrhea or Hemorrhagic Colitis [HC] through verotoxin or shigatoxin production, and in acute forms it may lead to Hemolytic Uremic Syndrome [HUS] or Thrombotic Thrombocytopenic Purpurea [TTP]. Contamination with E. coli O157:H7 usually happens after consumption of animal products especially undercooked meats. The most important reservoir of this bacterium is beef and consumption of undercooked ground beef, especially in children younger than 10 years old, is the most common reason of food infection by this bacterium. Two important biochemical characteristics for detection of E. coli O157: H7 are lack of sorbitol fermentation and absence of glucuronidase. In order to control food infection with this bacterium, foods must be cooked thoroughly until reaching the temperature of at least 68.3°C, in the center

Use of vaccine trials to estimate burden of disease.

Vaccine trials, the most informative way of determining the efficacy of a vaccine, can also provide valuable information about the burden of disease. The burden of Haemophilus influenzae type b (Hib) remains a major barrier to the use of Hib vaccines, especially in Asia. Recent studies in Indonesia and Bangladesh have used vaccine-trial designs, with known effective vaccines, to estimate the vaccine-preventable burden of Hib disease in those communities. New vaccines against pneumonia and diarrhoeal diseases are usually directed at only one of various causes of the syndrome. In the case of pneumonia, it is very difficult to determine the aetiology in most cases, so the vaccine trial offers a means of determining the burden of vaccine-preventable diseases. This is particularly important for pneumococcal vaccines as serotype replacement may reduce the effectiveness of the vaccines in the field. This approach would underestimate disease burden if vaccines were found to have an impact on syndromes other than those against which they are directed, and might lead to errors in estimation if there were erroneous assumptions about the efficacy of the vaccine against the condition under investigation.

Etiología de diarrea con sangre en niños de una comunidad rural / Etiology of bloody diarrhea in children of a rural village

Se investigó la etiología de diarrea con sangre en una cohorte de 75 niños rurales seguidos longitudinalmente durante los primeros dos años de vida. De un total de 636 episodios de diarrea, 71 (11%) mostraron la presencia de sangre. Se aisló un patógeno en 59 (83%) de los 71 casos; 35%mostraron la presencia de Escherichia coli enteroagregativa (EAEC), 11%de E. coli productora de toxinas tipo Shiga (SLT) I y/o II; 13%de Shigella, 7%de Campylobacter jejuni, o de E. coli enterotoxigénica (ETEC); y en 4%de E. coli enteropatógena (EPEC), E. coli enteroinvasora, Salmonella, Giardia lamblia, o Hymenolepis nana. Se encontraron cultivos mixtos en 16%de casos durante el primer año y en 18%durante el segundo. Estas mezclas fueron principalmente combinaciones de C. jejuni o ETEC con EAEC. el 78%de los niños con diarrea con sangre cursaron con un solo evento diarreico durante los primeros dos años de vida con duración promedio de siete días. Epidemiológicamente, la incidencia de diarrea con sangre se incrementó progresivamente durante los primeros dos años de vida, con un descenso significativo después de los diez meses de edad. La prevalenia de patógenos estuvo afectada por la estacionalidad, excepto para EAEC cuya prevalencia fué endémica. En el caso de Shigella y E. coli productora de SLT, la agrupación de casos en tiempo y el aislamiento de especies serológicamente idénticas indicaron que las infecciones fueron resultado de brotes de una fuente común

Balantidíase intestinal: relato de um caso / Intestinal balantidíasis: report of a case

A Balantidíase é uma doença rara em nosso meio. Na oportunidade, relatamos um caso em paciente idoso que veio a óbito, com perfuraçäo intestinal e revisamos a literatura pertinente