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.

Surveillance of antibiotic susceptibility pattern among shigella flexneri strain isolated in Nagpur district during three years period, January 2009-January 2012.

Objective : In the few cases of childhood dirrhea that require the antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains and pattern of antimicrobial resistance. Shigellosis is one of the most improtant examples of this group of intestinal infections. In order to establish such parameters in Nagpur city, this study was carried out to determine the antimcrobial resistance profile of Shigella flexneri isolated from patients suffering from diahhrea admitted to Various hoapitals in Nagpur district, India. Materials and Methods: The study included 110 stool samples collected from patients during the 3 year period. All the isolates were characterized and confirmed by VITEK® 2 GN ID cards and antimicrobial susceptibility was tested by VITEK® 2 AST test cards. Results: We received 73 positive cultures of S. flexneri out of 110 stool samples during three year periods of January 2009 to January 2012. S. flexneri strains presented a high resistance rate to Ampicillin (100%), Chloramphenicol (76.71%), Trimethoprime-sulfamethaxazole (TMP-SMZ) (68.49%) and low resistance to third- and fourth-generation Cephalosporin. None of the isolates was found to be resistant to Ciprofloxacin (MIC ≥ 4), Norfloxacin (MIC ≥12), and Nalidixic acid (MIC ≥30). Conclusion: Our results provide data on antimicrobial resistance to choose a proper antibiotic for the treatment of Shigellosis in our country. According to current findings, Quinolones and Cephalosporins are the drug of choice for the diarrheic patients. In conclusion, systematic monitoring is needed to identify changes in the antimicrobial resistance.

Isolation of Vibrio mimicus from a case of acute diarrhoea--a case report.

Over a four months period (June to September, 2003) 111 stool samples from cases of acute diarrhoea were screened for Vibronaceae in department of microbiology, Smt. N. H. L. Municipal medical college, Ahmedabad. All the isolates were identified by standard laboratory technique. A total of 36 species belonging to Vibrionaceae were isolated. Phage typing of all these Vibronaceae were done at National Institute Of Cholera and Enteric Disease, Kolkata. Out of 36 isolates, 35 were Vibrio cholereae and only one was Vibrio mimicus. We report this case because of rare strain.

Complementary foods associated diarrhea.

The World Health Organization regards illness due to contaminated food as one of the most widespread health problems in the contemporary world. Food safety especially in the weaning groups is one of the major concerns that have posed a threat to health of the children. Millions of children in the world die each year from diarrheal diseases; hundreds of millions suffer from frequent episodes of diarrhea and consequent impairment of nutritional status. Contaminated foods play a major role in the occurrence of diarrheal diseases. Apart from food contamination, transmission of infection occurs by direct contact, highly favored by the habits and customs of the people. Improper storage and handling of cooked food is equally responsible for food-borne illnesses, as during storage especially at ambient temperature (28-38 degrees C) there is the risks of multiplication of pathogenic organisms increase. Food safety education is a critical prerequisite and is an essential element in control and prevention of diarrheal diseases. However, no preventive measures can ever be successful without the acute involvement of the caretakers, other family members and the community. To sensitize the community in a catalytic manner, health workers, community leaders and community volunteers can act as effective change agent, to bring about a behavior that can lead to improvement in their real life practices, thereby reducing the prevalence of diarrheal episodes in young children. Food Safety Education Programs that involve volunteers are cost effective as they can be reached to a maximum number of people through limited health personnels, and by this, the community can be made responsible for its own health problems.

Antibiotic resistance in campylobacter jejuni in Rawalpindi and Islamabad. A preliminary study

To determine the antimicrobial resistance in Campylobacter jejuni isolated from stools of children suffering from diarrhoea/dysentery in our setup against the antimicrobials commonly used as empirical therapy. Study: A prospective cross sectional descriptive study. Place and duration of study: Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi from 29 August to 29 November 2002. Patients and methods: The study was carried out on eighteen isolates recovered from one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston [Oxoid] and Karmali media [Oxoid] beside other routine stool culture media. The cultures were incubated at 42oC under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production, resistance to cephalothin and sensitivity to nalidixic acid. Sensitivity testing was carried by Modified Kirby Bauer disc diffusion technique on lysed horse Blood Agar against ampicillin [10 ug], erythromycin [15ug], tetracycline [10ug], chloramphenicol [30ug], trimethoprim/ sulphamethoxazole [1.25ug/23.75ug], nalidixic acid [30ug] and ciprofloxacin [5ug]. One isolate [7.14%] was resistant to ciprofloxacin, three [16.66%] to chloramphenicol and four [22.22%] to nalidixic acid, five [27.77%] to erythromycin, seven [38.88%] to tetracycline, sixteen [88.88%] to trimethoprim/sulphamethoxazole and ampicillin respectively. The susceptibility pattern reflects variable susceptibility with maximum resistance to ampicillin and trimethoprim/sulphamethoxazole. Four isolates were resistant to nalidixic acid

Frequency of campylobacter jejuni in diarrhoea/dysentery in chidren in Rawalpindi and Islamabad

To determine the frequencyof Campylobacter jejuni infection in children suffering from diarrhoea/dysentery in the Department of Microbiology, Army Medical College and Military Hospital, Rawalpindi, from 29 August 2002 to 29 November 2002.The study was carried out on one hundred stool samples of children up to the age of twelve years admitted with diarrhoea/dysentery in Military hospital, Rawalpindi. The samples were collected in clean polypropylene containers containing Cary Blair medium. These were transported to the Microbiology Department, Army Medical College, Rawalpindi within 1-2 hours. The samples were inoculated on Modified Preston [Oxoid] and Karmali media [Oxoid] beside other routine stool culture media. The cultures were incubated at 42oC under microaerophilic conditions. The growth after 48 hours was provisionally identified by colonial morphology, oxidase test, Gram staining and motility. The organisms were identified to species level by hippurate hydrolysis, urease test, nitrate reduction, catalase test, H2S production and resistance to cephalothin.Eighteen% of samples yielded the growth of Campylobacter jejuni. Mean age of children with Campylobacter jejuni infection was 18 months with peak incidence from 12 to 21 months. Male female ratio was 1.7:1. All the children had loose motions. Seven out 18 [39%] had a combination of symptoms of loose motions, vomiting and pain abdomen. Those having fever with or without other complaints constituted 11 out of 18 [61.11%] i.e. more than 50% of all the children yielding C. jejuni had fever. About 90% of diarrhoeal stools had blood and fifty% also had mucous. There was either history of chicken meat consumption or contact with cattle and pets in most of the cases and both in some of them.Campylobacter jejuni is a frequent cause of diarrhoea/ dysentery in children in our set up. In children it is often related to pets keeping and chicken meat consumption. In the remaining, untreated drinking water may be the source. Campylobacter jejuni frequently presents with blood and mucous in stools with sporadic cases presenting with watery diarrhoea

Spirochetal dysentery: a case report and review of literature.

Spiral shaped bacteria have frequently been demonstrated from human faeces. Their role in causation of disease is, however, controversial; as they have been found to colonise the lower gastrointestinal tracts of both symptomatic and asymptomatic individuals. Here we report a case in which spiral shaped motile, gram negative and nonflagellated bacteria, probably belonging to the genus Borrelia, were demonstrated and associated with acute bloody diarrhea in a cardiac patient. The condition could successfully be treated with short course of Metronidazole. The relevant and up to date literature on this problem is also reviewed.