Associated factors of protracted diarrhea.

The associated factors in 80 children (less than 2 yrs) with protracted diarrhea (greater than 21 days duration) and weight loss were: secondary carbohydrate intolerance (36): enteric pathogens (non typhoidal salmonella (11), enteropathogenic E. coli 'EPEC' (6), giardia (4), and shigella (3); cow's milk protein intolerance (3), gluten intolerance (3); miscellaneous (5); and undiagnosed enteropathy (9). Three of the EPEC showed localised pattern of adherence in vitro with HEP-2 cells. Most patients with salmonella and EPEC had severe secretory diarrhea with large fecal sodium losses. All 6 patients who died had secretory diarrhea and very high fecal sodium. All but 4 patients could be effectively managed with a chicken puree-glucose-coconut oil based diet.

Intestinal glucoamylase & other disaccharidases in children with protracted diarrhoea.

Brush border lactase, sucrase and glucoamylase activities were assessed in jejunal mucosal biopsy specimens from 34 children (median age 11 months; range 1.5-38) having protracted diarrhoea with failure to thrive and 8 well nourished children with normal jejunal mucosal histology (median age 10.2 months; range 2-37). All enzymes showed progressive decrease in activity which was directly in relation to increasing degree of mucosal injury (P less than 0.002). Lactase was significantly reduced even in patients with protracted diarrhoea and normal mucosa (P less than 0.05). Glucoamylase and sucrase were significantly reduced only in the presence of mucosal injury (P less than 0.01). Our data suggest that most children with protracted diarrhoea may not tolerate lactose containing feeds and may need lactose-free diets preferably based on starch. A small number of children with protracted diarrhoea, who have severe mucosal injury may not be able to handle even starch and may require diets based on short chain glucose polymers. The findings of this study, need to be corroborated with well-controlled metabolic balance studies.

Efficacy of nalidixic acid in the treatment of acute bloody diarrhea.

Of sixty four children (mean age 20.1 +/- 1.2 mo) with acute bloody diarrhea and high fever, 47 had infection with non-typhoidal Salmonella (NTS) (20), Shigella (15) and enteropathogenic E. coli (EPEC) (12) and were treated with nalidixic acid (NA). The mean duration (h) of presence of macroscopic blood in the stool following institution of treatment was significantly shorter (p less than 0.05) in those with EPEC (11.5 +/- 4.9) as compared to NTS (30.4 +/- 15.4) or Shigella groups (22.9 +/- 15.6). The number of children having less than or equal to 50% reduction in stool frequency within 72 h was: NTS (17); Shigella (14); EPEC (10). Negative stool cultures on day 5 were obtained in all patients with Shigella and EPEC and 16 (80%) of those with NTS. Two patients with NTS and one with EPEC failed to respond to NA.