Trend of morbidity and mortality indicators due to acute diarrheal disease in children under five years old in the State of Piauí (2000-2019) / Tendência de indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos no estado do Piauí (2000-2019)

Abstract Objectives: to analyze the trend of morbidity and mortality indicators due to acute diarrheal diseases in children under five years old in Piauí. Methods: ecological study with data from the Information Technology Department at the Public Health System. The indicators of hospitalization rate and coefficient of mortality from the disease between 2000 and 2019 were calculated. A descriptive analysis of the indicators was carried out in the studied period and by the macro-regions in the State. For trend analysis, the simple linear regression model with log-transformation was used. Trends were classified as increasing, decreasing and stable, with a significance level of 5%. Results: the average on hospitalization rate was higher in the semi-arid macro-region (36.6/1000 children under five years old) and lower in Teresina (14.9/1000 children under five years old). The mean mortality coefficients were higher in the coastal macro-region (0.98/1000 live births) and lower in Teresina (0.47/1000 live births). The indicators showed a downward trend in all analyzed locations (p<0.05). A turning point was noted from 2009, with a significant reduction in hospitalization rates in the savanna and semi-arid macro-regions. Conclusion: indicators of morbidity and mortality due to acute diarrheal diseases in children under five years old showed a downward trend in Piauí between 2000 and 2019, with differences in trends between the evaluated macro-regions.

Resumo Objetivos: analisar a tendência de indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos no Piauí. Métodos: estudo ecológico com dados do Departamento de Informática do Sistema Único de Saúde. Calculou-se os indicadores taxa de internação e coeficiente de mortalidade pela doença entre 2000 e 2019. Realizou-se análise descritiva dos indicadores no período estudado e pelas macrorregiões do estado. Para análise da tendência, foi utilizado o modelo de regressão linear simples com log-transformação. As tendências foram classificadas como crescentes, decrescentes e estáveis, com nível de significância de 5%. Resultados: a média das taxas de internação foi maior na macrorregião semiárido (36,6/1000 menores de cinco anos) e menor em Teresina (14,9/1000 menores de cinco anos). A média dos coeficientes de mortalidade foi maior na macrorregião litoral (0,98/1000 nascidos vivos) e menor em Teresina (0,47/1000 nascidos vivos). Os indicadores mostraram tendência de redução em todos os locais analisados (p<0,05). Notou-se um ponto de inflexão a partir de 2009, com redução significativa das taxas de internação nas macrorregiões cerrados e semiárido. Conclusão: os indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos mostraram tendência de redução no Piauí entre 2000 e 2019, com diferenças das tendências entre as macrorregiões avaliadas.

Variabilidade climática e internações por doenças diarreicas infecciosas em um município da Amazônia Ocidental brasileira / Climate variability and hospitalizations due to infectious diarrheal diseases in a municipality of the Western Brazilian Amazon Region

Resumo A morbimortalidade por doenças diarreicas infecciosas ainda representa um grave problema de saúde no Brasil e está altamente relacionada a fatores como condições climáticas, ambientais e de vida da população. O objetivo deste estudo foi analisar a associação das taxas de internações por doenças diarreicas infecciosas na população do município de Rio Branco/AC com a precipitação, o nível do rio, a umidade e a temperatura, entre os anos de 2000 e 2013. Os dados foram extraídos do Sistema de Informações Hospitalares do SUS, do Instituto Nacional de Meteorologia e da Agência Nacional das Águas. Foram ajustados modelos múltiplos de regressão de Poisson e binomial negativa. Os resultados mostram que existe uma associação positiva entre as internações por doenças diarreicas infecciosas e o nível do Rio Acre (RT:1,07; IC95%:1,04 a 1,1); houve um decréscimo de 14% nestas taxas de internações entre os anos de 2000 e 2013 (RT:0,86; IC95%:0,85 a 0,87); o grupo mais vulnerável pertence à faixa etária de menores de 1 ano de vida. Este estudo mostrou a vulnerabilidade de uma cidade na Amazônia quanto à variabilidade climática e a respectiva influência epidemiológica na incidência de internações por doenças diarreicas infecciosas.

Abstract Morbimortality due to infectious diarrheal diseases still is a serious health issue in Brazil and is highly related to factors such as weather, environment, and people's life conditions. This study aimed to analyze the relationship between hospitalization rates due to infectious diarrheal diseases among the population of the municipality of Rio Branco (AC), Brazil and precipitation, river level, humidity and temperature between 2000 and 2013. Data were retrieved from the Hospital Information System of the SUS (Unified Health System), the National Institute of Meteorology and the National Water Agency. Multiple Poisson and negative binomial regression models were adjusted. Results showed that there is a positive association between hospitalization due to infectious diarrheal diseases and the level of the Acre river (RR: 1.07; CI 95%: 1.04 to 1.1); these hospitalization rates fell 14% between 2000 and 2013 (RR: 0.86; CI 95%: 0.85 to 0.87). The most vulnerable group was the age group of less than 1 year of age. This study showed the vulnerability of an Amazonian city to climate variability and its respective epidemiological influence on the incidence of hospitalizations due to infectious diarrheal diseases.

Detección molecular de Escherichia coli diarreogénica en pacientes pediátricos con síndrome diarreico agudo en Paraguay / Molecular detection of diarrheogenic Escherichia coli in pediatric patients with acute diarrheal syndrome in Paraguay

La Escherichia coli diarreogénica (ECD) se ha clasificado con base en criterios clínicos, epidemiológicos y moleculares en cinco grupos, cada uno con factores de virulencia específicos. El objetivo fue determinar la prevalencia de ECD en pacientes pediátricos con enfermedad diarreica aguda del Laboratorio Central de Salud Publica en el periodo 2012- 2015. Se procesaron muestras de heces con síndrome diarreico agudo, provenientes de pacientes pediátricos, en los cuales se buscó algún gen de virulencia ECD utilizando métodos convencionales de siembra y screening molecular, mediante PCR múltiple con cebadores diseñados específicamente para amplificar los genes de virulencia elt, est, eae, stx, ipaH y aggR. Del total de muestras analizadas, 13% (180/1379) de las muestras presentó algún factor de virulencia compatible con algún patotipo ECD con mayor predominio en niños de 1 a 3 años. La frecuencia de los distintos patotipos fue la siguiente: 61 (34%) ETEC, 40 (22%) EAEC, 41 (23%) EPEC, 27 (15%) EIEC, 7 (4%) STEC y 3 (2%) ETEC/EAEC, 1 (0.5%) ETEC/EAEC/EIEC. El porcentaje de E. coli diarreogénicas detectado tiene similitud con lo reportado en otros países de la región, lo que nos indica que estos patógenos son parte importante de la etiología de la enfermedad diarreica aguda infecciosa en la población infantil en nuestro país. Se debe destacar que para el diagnóstico de las diferentes categorías ECD, es necesario disponer de un procedimiento diagnóstico específico dirigido a la detección de los factores de virulencia utilizando métodos moleculares o métodos inmunológicos.

Diarrheagenic Escherichia coli (DEC) has been classified based on clinical, epidemiological and molecular criteria in five groups, each with specific virulence factors. The objective was to determine the prevalence of DEC in pediatric patients with acute diarrheal disease of the Central Laboratory of Public Health in the 2012-2015 period. A total of 1447 fecal samples of acute diarrheal syndrome from pediatric patients were processed in which a DEC virulence gene was searched using conventional screening and molecular screening methods with multiple PCR primers specifically designed to amplify virulence genes, st, lt, eae, stx, ipaH and aggR. From the total of analyzed samples, 13% (180/1379) of the samples presented some virulence factor compatible with a DEC pathogen type with greater predominance in children from 1 to 3 years. The frequency of the different pathogen types was as follows: 61 (34%) ETEC, 40 (22%) EAEC, 41 (23%) EPEC, 27 (15%) EIEC, 7 (4%) STEC and 3 (2% ETEC/EAEC, 1 (0.5%) ETEC/EAEC/EIEC. The percentage of DEC detected is similar to that reported in other countries of the region, which indicates that these pathogens are an important part of the etiology of acute infectious diarrheal disease in children in our country. It should be noted that for the diagnosis of different DEC categories, it is necessary to have a specific diagnostic procedure aimed at the detection of virulence factors using molecular methods or immunodiagnostic methods.

Prevalencia de bacterias enteropatógenas en niños que asisten a un hospital pediátrico en Resistencia, Chaco, Argentina / Prevalence of enteropathogenic bacteria in children attending a pediatric hospital in Resistencia, Chaco, Argentina

La enfermedad diarreica aguda continúa siendo uno de los problemas de salud pública más serios en los países en desarrollo, en los que constituye una de las causas principales de enfermedad y muerte en los niños menores de 5 años. Su epidemiología es totalmente dependiente de la región geográfica, nivel socio económico, costumbres y hábitos de la población.El objetivo del presente trabajo fue determinar la prevalencia de agentes etiológicos bacterianos causantes de diarrea aguda, en niños atendidos en un Hospital Pediátrico de Resistencia, Chaco, en el año 2013.Se investigó la presencia de Shigella spp., Salmonella spp., Campylobacte rspp., Escherichia coli O157:H7 en muestras de materia fecal de niños con enfermedad diarreica aguda. Sobre 823 muestras de materia fecal analizadas en el período mencionado, 93 resultaron positivas para alguno de los enteropatógenos estudiados (Tasa de recuperación del 11,3%).Las frecuencias de aislamiento de los enteropatógenos fueron: Shigella spp (82,8%), Salmonella spp (9,7%), Campylobacter spp (6,5%), y E. coli O157:H7 (1%).Con respecto a las especies, dentro del género Shigella predominó S. flexneri (60/77) seguida de S. sonnei (13/77) y S. boydii (4/77). Con excepción de E. coli O157, en el presente trabajo no se estudiaron los diferentes tipos patogénicos.Como en el resto del país, S. flexneri continúa siendo el agente etiológico más frecuentemente aislado. Este es el primer informe sobre la presencia de Campylobacter en coprocultivos en la provincia del Chaco.

Acute diarrheal disease remains one of the most serious problems of public health in developing countries, which is one of the leading causes of illness and death in children under 5 years. Its epidemiology is totally dependent on the geographic region, socioeconomic status, customs and habits of the population.The aim of this study was to determine the prevalence of bacterial etiologic agents causing acute diarrhea in children attending a Pediatric Hospital in the city of Resistencia, Chaco, during 2013.In this work Shigella spp, Salmonella sp, Campylobacter spp, Escherichia coli O157:H7 were investigatedAmong 823 stool samples analyzed, 93 were positive for any of the enteropathogens studied (recovery rate 11.3%).The frequency of isolation of enteric pathogens were: Shigella spp (82.8%), Salmonella spp (9.7%), Campylobacter spp (6.5%), and E. coli O157: H7 (1%).Respect to genus Shigella, Shigella flexneri was the prevalent (60/77) followed by S. sonnei (13/77) and S. boydii (4/77). With the exception of E. coli O157 in the present work the other pathogenic types were not studied.As in the rest of the country, S. flexneri remains the most frequently isolated etiologic agent. This is the first report about the presence of Campylobacter in stool cultures in the province of Chaco

Canal endémico de enfermedad respiratoria aguda y enfermedad diarreica aguda en menores de 5 años en una localidad de Bogotá / Endemic channel of acute respiratory disease and acute diarrheal disease in children under 5 years of age in a district of Bogotá

Objetivo Desarrollo de una herramienta útil para la planeación de atención en salud en menores de 5 años en la localidad de Ciudad Bolívar, elaborando un Canal Endémico para la Enfermedad Respiratoria Aguda y Enfermedad Diarreica Aguda, en menores de 5 años para el periodo comprendido entre los años 2008 a 2012. Metodología Estudio descriptivo con enfoque en vigilancia en salud pública, para la confección de un Canal Endémico en menores de 5 años atendidos en los servicios de atención del Hospital Vista Hermosa de nivel I. Resultados Se identificó la incidencia de Enfermedad Respiratoria Aguda para un periodo de 5 años, obteniendo un promedio mensual de 1265 + 79 casos mostrando dos periodos de pico anual; para la Enfermedad Diarreica Aguda se obtuvo un promedio mensual de 243 casos con un periodo de mayor incidencia. Conclusión La correcta elaboración de los Canales Endémicos en la atención primaria de salud permite dar las alertas de manera oportuna desde el primer nivel de atención para así guiar la toma de decisiones en salud y lograr una mejor administración de las redes de servicios.(AU)

Objective Developing a useful tool for planning health care for children under 5 years of age in the Ciudad Bolivar locality of Bogotá, developing an endemic channel for acute respiratory disease and acute diarrheal disease in children under 5 years of age for the period of 2008 to 2012. Methodology Descriptive study with a focus on public health surveillance for the preparation of an endemic channel for children under 5 years receiving care services in the Vista Hermosa Hospital Level I. Results The incidence of acute respiratory disease for a period of five years was identified with a monthly average of 1265 + 79 cases, showing two annual peak periods. Acute diarrheal disease, a monthly average of 243 cases was obtained with a period of higher incidence. Conclusion The correct preparation of the endemic channels in primary health care can provide alerts in a timely manner from the first level of care and guide decision-making in health and help achieve better network management services.(AU)

Doenças diarreicas agudas relacionadas ao saneamento básico no Estado de Pernambuco no período de 2008 a 2014 / Acute diarrheal diseases related to basic sanitation in the state of Pernambuco from 2008 to 2014

A doença diarreica aguda (DDA) é a doença que mais aflige a humanidade, ocorrendo anualmente mais de quatro bilhões de casos em todo o mundo: cerca de 1,8 milhões de crianças morrem em decorrência desta doença ou outras provocadas por água inadequada para o consumo humano e por más condições de saneamento. Este estudo analisa a correlação entre número de casos, internações e óbitos por doenças diarreicas agudas com as condições de saneamento básico, além de outras variáveis socioeconômicas, para o Estado de Pernambuco. Foi aplicado o teste de correlação de Spearman ao nível de 5% e 1%. Os dados são provenientes de: i) saneamento - Sistema de Informação de Atenção Básica (SIAB), ii) número e o custo das internações hospitalares - Sistema de Informação Hospitalar (SIH), iii) DDA por município - Sistema de Vigilância Epidemiológica das Doenças Diarreicas Agudas (SIVEP/DDA), e iv) dados populacionais e renda per capita - Instituto de Bibliografia e Estatística (IBGE). Observa-se que houve declínio no número de internações, gastos e óbitos por DDA, e que há correlação significativa e negativa entre o número de internações e de óbitos por DDA e fatores como renda, taxa de analfabetismo, serviço de coleta e lixo, esgotamento sanitário e energia elétrica. Em relação ao percentual de cobertura de atenção básica e de abastecimento de água, notouse uma correlação pouco significativa e positiva. Conclui-se que algumas características socioeconômicas dos municípios, em especial, o saneamento básico tem grande relevância com a DDA e suas consequências.(AU)

Acute diarrheal disease (ADD) is a disease that afflicts more humanity, occurring annually over four billion cases worldwide: about 1.8 million children die from this disease or other caused by inadequate water for human consumption and poor sanitation. This study examines the correlation between number of cases, hospitalizations and deaths from acute diarrheal diseases with basic sanitation, and other socioeconomic variables, for the state of Pernambuco. Spearman correlation test was used at 5% and 1%. The data are derived from: i) sanitation - Primary Care Information System (SIAB), ii) number and cost of hospital admissions - Hospital Information System (SIH), iii) DDA by municipality - Epidemiological Surveillance System Disease diarrheal Agudas (SIVEP / DDA), and iv) population data and per capita income - Institute of Bibliography and Statistics (IBGE). It is observed that there was a decline in the number of admissions, expenses and deaths by DDA, and that there is a significant negative correlation between the number of hospitalizations and deaths by DDA and factors such as income, literacy rate, collection service and waste, sewage health and electricity. Regarding the primary care coverage percentage and water supply, it was noted only a slight positive correlation. We conclude that some socioeconomic characteristics of municipalities, in particular sanitation has great relevance to the DDA and its consequences.(AU)

Morbimortalidade por doenças diarreicas agudas em crianças menores de 10 anos no Distrito Federal, Brasil, 2003 a 2012 / Acute diarrhoeal disease morbidity and mortality in children under 10 years old in the Brazilian Federal District, 2003 to 2012 / Morbimortalidad de las enfermedades diarreicas agudas en niños menores de 10 años en el Distrito Federal, Brasil, 2003 a 2012

OBJETIVO: descrever a morbimortalidade e a sazonalidade das doenças diarreicas nos menores de 10 anos de idade residentes no Distrito Federal, Brasil, de 2003 a 2012. MÉTODOS: estudo descritivo, com dados dos Sistemas de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), sobre Mortalidade (SIM), de Vigilância Epidemiológica das Doenças Diarreicas Agudas (Sivep-DDA) e planilhas de monitoramento da diarreia. RESULTADOS: foram contabilizados 558.737 casos de diarreia, com maior incidência entre menores de 1 ano (32,3 casos/100 crianças em 2003); no período, reduziram-se as taxas de hospitalização (de 6,5 para 3,0 internações/1000 crianças), mortalidade (de 4,5 para 1,5 óbitos/100 mil crianças) e letalidade hospitalar (de 0,70 para 0,49/100 crianças), com queda mais acentuada após a implantação da vacina contra rotavírus em 2006; as maiores taxas de internações ocorreram entre julho e setembro. CONCLUSÃO: houve redução de morbimortalidade por diarreia, principalmente em menores de 1 ano, com predomínio de internações na estação seca.

OBJECTIVE: to describe diarrhoeal disease morbidity, mortality and seasonality in children aged under 10 resident in Brazil's Federal District, 2003-2012. METHODS: this was a descriptive study using National Hospital Information System (SIH/SUS), Mortality Information System (SIM), Acute Diarrhoeal Disease Epidemiological Surveillance System (Sivep-DDA) as well as diarrhoea monitoring spreadsheets. RESULTS: 558,737 diarrhoea cases were registered with the highest incidence among children with less than one year old (32.3 cases/100 children in 2003); during the period there was a reduction in the hospitalization rates (from 6.5 to 3.0 hospitalizations/1,000 children), mortality rates (from 4.5 to 1.5 deaths/100,000 children) and hospital lethality (from 0.70 to 0.49/100 children), with a sharper decline after the implementation of rotavirus vaccine in 2006; highest hospitalization rates occurred between July and September. CONCLUSION: morbidity and mortality from diarrhoea reduced, particularly in children under one year old. Hospitalizations were more frequent during in the dry season.

OBJETIVO: describir la morbimortalidad y temporalidad de las enfermedades diarreicas agudas en niños menores de 10 años, residentes del Distrito Federal, Brasil, de 2003 a 2012. MÉTODO: estudio descriptivo, con datos del Sistema de Informaciones Hospitalarios (SIH/SUS), sobre Mortalidad (SIM), Vigilancia Epidemiológica de Enfermedades Diarreicas Agudas (SIVEP-DDA) y planillas de monitoreo de diarrea. RESULTADOS: fueron contabilizados 558.737 casos de diarrea, con mayor incidencia en niños menores de 1 año (32,3 casos/100 niños en 2003); en el período hubo reducción de las tasas de hospitalización (6,5 a 3,0 hospitalizaciones/1.000 niños), mortalidad (de 4,5 a 1,5 muertes/100 mil niños) y letalidad (de 0,70 a 0,49/100 niños), con declive más agudo después de la implantación de la vacuna contra rotavirus en 2006; las tasas de hospitalización más altos han ocurrido entre julio y septiembre. CONCLUSIÓN: hubo reducción de la morbimortalidad por diarrea, especialmente en niños menores de 1 año, con predominio de hospitalizaciones en la estación seca.

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.

Primer aislamiento de Escherichia coli enteroagregativo 0104: H4 de un caso de diarrea en Argentina / First isolation of enteroaggregative Escherichia coli 0104:H4 from a diarrhea case in Argentina

Se describe el primer aislamiento de una cepa de Escherichia coli enteroagregativo (EAEC) O104:H4 de un caso de diarrea aguda en Argentina. Se realizaron dos PCR múltiples como tamizaje: mPCR1 para los genes eae, lt y st, y mPCR2 para los genes IpaH, aggR, stx1y stx2. Se incluyó una mPCR para detectar los genes rfbO104, fliCH4 y terD, además de PCR simples para los genes del plásmido pCVD432, aaiC y lpfO113. Se realizaron ensayos bioquímicos, de sensibilidad a los antimicrobianos y de serotipificación. La cepa de E. coli identificada fue sensible a todos los antimicrobianos ensayados y presentó los genes aggR, aaiC, plásmido pCVD432, lpfO113, rfbO104, fliCH4 y terD. Si bien EAEC O104:H4 es un serotipo poco común, se han comunicado casos esporádicos, pero la preocupación global aumentó después del brote masivo ocurrido en Europa en 2011. El hallazgo de EAEC O104:H4 refuerza la necesidad de mejorar las metodologías para la detección de todos los patotipos de E. coli en Argentina

We describe the first isolation of an enteroaggregative Escherichia coli (EAEC) O104:H4 strain associated with an acute diarrhea case in Argentina. Two multiplex PCRs (mPCR) were performed as screening of genes mPCR1 (eae, lt, and st) and mPCR2 (IpaH, aggR, stx1 and stx2). A mPCR to detect the rfbO104, fliCH4 and terD genes, and PCR assays for the detection of pCVD432 plasmid, aaiC and lpfO113 genes were included. Biochemical and antimicrobial susceptibility assays as well as serotyping were performed. The identified E. coli strain was susceptible to all antimicrobials tested and harbored the aggR, aaiC, pCVD432 plasmid, lpfO113, rfbO104, fliCH4 and terD genes. Although serotype EAEC O104:H4 rarely spreads and sporadic cases have been reported, global concern increased after the large-scale outbreak in Europe in 2011. The finding of EAEC O104:H4 reinforces the need for improved methodologies for the detection of all E. coli pathotypes

Internações por gastroenterite e diarreia de origem infecciosa presumível em crianças de zero a cinco anos de idade / Hospitalization of children between zero and five years of age for gastroenteritis and diarrhea of presumed infectious origin

Introdução: A doença diarreica aguda na população infantil é um indicador de saúde, e este dado pode nortear a política de saúde local. O objetivo foi estimar a prevalência de internações por diarreia aguda de origem infecciosa presumível em crianças no Hospital Nossa Senhora da Conceição, no município de Tubarão, Santa Catarina, verificar o perfil epidemiológico dos casos e a taxa de internação por esta causa no período de 2008-2012. Métodos: Estudo transversal com coleta de dados em prontuários eletrônicos de internação por diarreia e gastroenterite de origem infecciosa presumível em crianças entre zero e cinco anos de idade. Resultados: Entre 1° de janeiro de 2008 e 31 de dezembro de 2012, ocorreram 5.690 internações (171 pelos CID10 A00 a A09). No mesmo período aconteceram 993 atendimentos ambulatoriais pela mesma causa. Entre as internações, 50,9% ocorreram no primeiro ano de vida, 59,7% entre primavera e verão, e 73,7% dos atendimentos foram pelo Sistema Único de Saúde. O tempo de internação variou de um a 20 dias, e o maior tempo de permanência hospitalar apresentou associação com a presença de complicações clínicas. Infecções do trato respiratório e anemia foram as comorbidades mais frequentes. Conclusões: A prevalência de diarreia foi de 3% do total de internações e 2,5% dos atendimentos ambulatoriais (AU)

Introduction: Acute diarrhea disease in children is an indicator of health, and this information can guide the local health policy. The aim was to estimate the prevalence of hospitalizations for acute diarrhea of presumed infectious origin in children at Hospital Nossa Senhora da Conceição in the city of Tubarão, Santa Catarina, and check the epidemiological profile of cases and the rate of hospitalization for this reason in the 2008- 2012 period. Methods: Cross-sectional study with data collection in electronic medical records of hospitalization for diarrhea and gastroenteritis of presumed infectious origin in children between zero and five years of age. Results: Between January 1, 2008 to December 31, 2012, there were 5690 hospitalizations (171 by CID10 A00 to A09). In the same period there were 993 outpatient visits for the same reason. Of all hospital admissions, 50.9 % occurred in the first year of life, 59.7 % between spring and summer, and 73.7 % of visits were through the Unified Health System. The length of stay ranged from one to 20 days and longer hospital stay was associated with the presence of clinical complications. Respiratory tract infections and anemia were the most common co-morbidities. Conclusions: The prevalence of acute diarrhea was 3% of total hospital admissions and 2.5% of outpatient care (AU)

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.

Acute childhood morbidities in rural Wardha : Some epidemiological correlates and health care seeking.

Background: In India, common morbidities among children under 3 years of age are fever, acute respiratory infections, diarrhea. Effective early management at the home level and health care-seeking behavior in case of appearance of danger signs are key strategies to prevent the occurrence of severe and life-threatening complications. Objectives: To find out the prevalence of acute child morbidities, their determinants and health-seeking behavior of the mothers of these children. Setting and Design: The cross-sectional study was carried out in Wardha district of central India. 0 Material and Methods: We interviewed 990 mothers of children below 3 years of age using 30-cluster sampling method. Nutritional status was defined by National Center for Health Statistics (NCHS) reference. Composite index of anthropometric failure (CIAF) was constructed. Hemoglobin concentration in each child was estimated using the 'filter paper cyanm ethemoglobin method.' Using World Health Organization guidelines, anemia was defined as hemoglobin concentration less than 110 g/L. Post-survey focus group discussions (FGDs) were undertaken to bridge gaps in information obtained from the survey. Statistical Analysis: The data was analyzed by using SPSS 12.0.1 software package. Chi-square was used to test the association, while odds ratios were calculated to measure the strength of association. Multiple logistic regression analysis was applied to derive the final model. Results: Anemia was detected in 80.3% of children, and 59.6% of children were undernourished as indicated by CIAF. The overall prevalence of acute morbidity was 59.9%. Children with mild anemia, moderate anemia and severe anemia had 1.52, 1.61 and 9.21 times higher risk of being morbid, respectively. Similarly, children with single, 2 and 3 anthropometric failures had 1.16, 1.29 and 2.27 times higher risk of being morbid, respectively. Out of 594 (60%) children with at least one of the acute morbidities, 520 (87.5%) sought health care, where majority (66.1%) received treatment from private clinics. The final model suggested that anemia and mother's poor educational status are predictors of childhood morbidity. Conclusions: Nutritional anemia and mother's poor educational status are the most important risk factors of acute childhood morbidity. There is need to revitalize existing health care delivery and child health programs in rural India with emphasis on immediate correction of nutritional anemia.

Prevalence of bacteria and intestinal parasites among food-handlers in Gondar town, northwest Ethiopia.

Food-handlers with poor personal hygiene working in food-service establishments could be potential sources of infection due to pathogenic organisms. The study was undertaken to determine the prevalence of bacteria and intestinal parasites among 127 food-handlers working in the cafeterias of the University of Gondar and the Gondar Teachers Training College, Gondar, Ethiopia. Fingernail contents of both the hands and stool specimens were collected from all the 127 food-handlers. The samples were examined for bacteria and intestinal parasites following standard procedures. Coagulase-negative staphylococci were the predominant bacteria species (41.7%) isolated from fingernail contents, followed by Staphylococcus aureus (16.5%), Klebsiella species (5.5%), Escherichia coli (3.1%), Serratia species (1.58%), Citrobacter species (0.8%), and Enterobacter species (0.8%). Shigella species were isolated from stool samples of four food-handlers (3.1%). None of the food-handlers was positive for Salmonella species and Shigella species in respect of their fingernail contents. No intestinal parasites were detected from fingernail contents. Intestinal parasites detected in the stools of the food-handlers included Ascaris lumbricoides (18.11%), Strongyloides stercoralis (5.5%), Entamoeba histolytica/dispar (1.6%), Trichuris trichiura (1.6%), hookworm species (0.8%), Gardia lamblia (0.8%), and Schistosoma mansoni (0.8%); 1.6% of the study subjects were positive for each of A. lumbricoides, T. trichiura, hookworm, and G. lamblia. The findings emphasize the importance of food-handlers as potential sources of infections and suggest health institutions for appropriate hygienic and sanitary control measures.

Epidemiology, clinical presentations and burden of rotavirus diarrhea in children under five seen at Ramathibodi Hospital, Thailand.

BACKGROUND: To be able to monitor the impact of rotavirus vaccines in the future, the authors designed the present study along with the Rotavirus Surveillance Project-Thailand. OBJECTIVE: To examine the epidemiology, clinical presentation, and direct medical cost of rotavirus-caused diarrhea in Thailand MATERIAL AND METHOD: Clinical presentations of all diarrhea cases during the study period were analyzed Rotavirus diarrhea was confirmed with polyacrylamide gel electrophoresis. Serological typing was characterized by reverse transcription-polymerase chain reaction. RESULTS: Between April 2001 and March 2002, 239 under 5-year-old diarrhea cases admitted in Ramathibodi Hospital, Thailand were identified Clinical presentations and laboratory results were analyzed from 85 cases. Rotavirus was identified in 48.2% of the specimens. The most common serotypes were G9 (67%), G4 (23%), and GI (2%) respectively. The most common age of rotavirus diarrhea was 12-17 months. The seasonal peak was during November 2001 to January 2002 (the cool and dry season in Thailand). The predominant symptoms were watery diarrhea, fever, and vomiting. Rotavirus diarrhea tended to have more dehydration and metabolic acidosis than other causes. The G4 serotype was associated with the most severe presentations. CONCLUSION: The proportion of rotavirus diarrhea in the present study was 48%. The mean direct medical cost per episode of rotavirus diarrhea per child was 2,101 baht (approximately 52 US $).

On the etiology of an outbreak of winter dysentery in dairy cows in Brazil

Winter dysentery (WD) is a seasonal infectious disease described worldwide that causes a marked decrease in milk production in dairy cows. In the Northern hemisphere, where the disease is classically recognized, bovine coronavirus (BCoV) has been assigned as a major etiologic agent of the disease. Nonetheless, in the Southern hemisphere, an in-deep etiological survey on WD cases had not been carried out. This study aimed to survey for BCoV by nested-RT-PCR, rotavirus by polyacrylamide gel electrophoresis (PAGE) and ELISA, bacteria by classical bacteriological methods and PCR for virulence factors and parasites by sugar flotation test on fecal samples of 21 cows from a farm during an outbreak of WD in São Paulo state, Southeastern Brazil. BCoV was detected in all 21 samples, while rotavirus was detected in two symptomatic cows. Escherichia coli, Yersinia intermedia, Providencia rustigianii Proteus penneri, Klebsiella terrigena and Enterobacter aglomerans were detected in samples from both asymptomatic and healthy cows in different associations. The study of E. coli virulence factors revealed that the strains isolated were all apathogenic. Cysts of Eimeria sp. and eggs of Strongyloidea were detected at low numbers in four of the symptomatic cows, with one co-infestation. These results suggest BCoV as the main etiologic agent of the cases of WD in Brazil, a conclusion that, with the clinical and epidemiological patterns of the disease studied herein, match those already described elsewhere. These findings give basis to the development of preventive measures and contribute to the understanding of the etiology of WD.

Em vacas leiteiras, a disenteria de inverno (DI) é uma doença infecciosa sazonal mundialmente relatada que ocasiona uma marcada queda na produção de leite; no hemisfério Norte, onde a doença é classicamente reconhecida, o coronavirus bovino (BCoV) tem um importante papel como agente etiológico. Entretanto, no hemisfério Sul, pesquisas etiológicas aprofundadas em casos de DI nunca forma realizadas. Este estudo objetivou a pesquisa de BCoV utilizando nested-RT-PCR, rotavírus utilizando eletroforese em gel de poliacrilamida (PAGE) e ELISA, bactérias com métodos bacteriológicos clássicos e PCR para fatores de virulência e parasitas pela técnica de flutuação em açúcar em 21 amostras fecais de vacas de uma fazenda durante um surto de DI no estado de São Paulo, Sudeste do Brasil. BCoV foi encontrado em todas as 21 amostras, enquanto que rotavírus foi encontrado em duas vacas sintomáticas. Escherichia coli, Yersinia intermedia, Providencia rustigiani, Proteus penneri, Klebsiella terrigena e Enterobacter aglomerans foram encontradas tanto em amostras de vacas sintomáticas quanto assintomáticas. O estudo de fatores de virulência para E. coli revelou que as amostras isoladas eram todas apatogênicas. Cistos de Eimeria sp. e ovos de Strongyloidea foram encontrados em baixos números em quatro animais sintomáticos, com uma co-infestação. Tais resultados sugerem o BCoV como o principal agente etiológico em casos de DI no Brasil, uma conclusão que, somada aos padrões clínicos e epidemiológicos da doença aqui estudada, concordam com aqueles descritos em outras regiões. Estes achados fornecem base o desenvolvimento de medidas preventivas e também contribuem para o entendimento sobre a etiologia da DI.

Aetiology of diarrhoea in a birth cohort of children aged 0-2 year(s) in rural Mirzapur, Bangladesh.

The incidence of aetiology-specific diarrhoea and the pathogenicity of infectious agents in a birth cohort (n=252) in rural Bangladesh were determined. Stool specimens or rectal swabs were collected from diarrhoeal cases over two years and routinely on a monthly basis. Stool samples from children with diarrhoea were compared with stool samples from children without diarrhoea to calculate rates of isolation and pathogenicity of agents. In total, 1750 stool specimens from diarrhoea patients and 5679 stool specimens from children without diarrhoea were tested. An infectious agent was identified in 58% of the stool specimens from diarrhoea patients and 21.6% of the stool specimens from children without diarrhoea. The most commonly-isolated pathogens from all specimens were enterotoxigenic Escherichia coli (ETEC), enteroadherent E. coli, Shigella, Campylobacter jejuni, Giardia, and rotavirus. ETEC (ST and LT-ST toxin), enterotoxigenic Bacteroides fragilis, Shigella, and rotavirus were associated more with disease than with asymptomatic infections. Aetiology-specific infections were associated with acute episodes. The isolated enteropathogens were essentially the same as those found in other tropical rural settings. Enterotoxigenic B. fragilis was also identified as a pathogen. Ongoing vaccine efforts focusing on Shigella, rotavirus, and ETEC would be useful.

Water supplies in some rural communities around Calabar, Cross River State, Nigeria: impact on water-related diseases.

Two traditional surface water sources and one piped supply around Calabar, Nigeria were examined to reveal the community water use patterns and the impact on water-related diseases. Using questionnaires, it was shown that some communities trekked long distances (up to 5 km) to reach their supply source. The quantity of water collected per day in each of the five rural sources was inadequate (approximately 6 buckets or 90 liters). The traditional water sources were not available all year round, forcing users to trek longer distances for alternative supplies. Only 4.4% of rural water users subjected them to any further treatment, such as boiling or filtration. Fetching water was the occupation of children; they were the worst hit by water-related diseases, such as diarrhea/ dysentery, stomachache, worms and scabies/craw-craw. About 84% of the respondents were dissatisfied with their water supplies. Deaths due to apparent water-related diseases occurred among 6.3% of respondents during the twelve months preceding the study. The overall impact was a loss of school hours/days, loss of labor and general discouragement. The community served with piped treated water fared better in all respects.

Microorganisms and parasites in chronic infective diarrhea.

AIM: To reveal the pattern of microorganisms in chronic infective diarrhea cases. METHODS: We examined all patients suffering from chronic infective diarrhea over a six year period The patients were examined physically and at the same time laboratory tests,colon enema X-ray and colonoscopy, ileoscopy, upper GI endoscopy and small bowel X-ray were performed. RESULTS: We found 138 (66. 7%) chronic infective diarrhea from 207 chronic diarrhea patients. Parasitic causes were Candida albicans (48.55%), Blastocystis hominis (6.52%), Entamoeba histolytica (3.62%), and Giardia lamblia (3.62%) etc. Bacterial causes were Pathogenic E. coli(34.78%), Aerobacter aerogenes (3.62%), Mycobacterium tuberculosis (3.62%), Geotrichum (1.45%), Shigella sonnei(0. 72%), Salmonella paratyphi (2.89%)etc. CONCLUSION: The most frequent microorganisms and parasites found in chronic infective diarrhea were pathogenic E.coli and Candida albicans.