Síndrome urémico hemolítico: reporte de dos casos pediátricos con nexo epidemiológico / Hemolytic uremic syndrome: report of two pediatric clinical cases with epidemiologic link / Síndrome urémico hemolítico: reporte de casos pediátricos con nexo epidemiológico

Introducción: el síndrome hemolítico urémico (SHU) es en muchos países, de las causas más frecuentes de insuficiencia renal aguda. La mayoría de los casos ocurre luego de un episodio de gastroenteritis aguda (GEA) por Escherichia coli productora de toxina Shiga (STEC). En Uruguay a pesar de ser una enfermedad de notificación obligatoria, existe subregistro. Objetivo: describir dos casos clínicos de SHU asociados a GEA con nexo epidemiológico. Casos clínicos: se trata de dos varones de 4 y 5 años, sanos. En los días previos, ingesta de carne en el mismo local comercial. Consultaron por dolor abdominal, deposiciones líquidas y vómitos reiterados. El niño de 4 años presentaba fiebre y deposiciones líquidas con sangre. El niño de 5 años dolor abdominal. El estado de hidratación y las constantes vitales eran normales en ambos. Fueron admitidos a cuidados moderados. A las 48 horas y a los 5 días, respectivamente, agregan palidez cutáneo-mucosa intensa, edemas y oliguria. Estudios complementarios: anemia, plaquetopenia e insuficiencia renal. Ingresaron a cuidados intensivos y se realizó diálisis peritoneal. La investigación de STEC fue negativa y la evolución favorable. Conclusiones: en menores de 5 años el SHU asociado a GEA es la forma de enfermedad más frecuente. En Uruguay predominan las cepas STEC no-O157. En estos casos no se pudo identificar el agente. La existencia de un nexo epidemiológico alerta sobre la necesidad de extremar los cuidados en la preparación y cocción de la carne. Debido a la asociación con una enfermedad prevalente, es necesario tener presente esta complicación para poder sospecharla e iniciar el tratamiento en forma precoz y oportuna.

Introduction: hemolytic uremic syndrome (HUS) is one of the most frequent causes of acute renal failure in many countries. Most cases occur after an episode of acute gastroenteritis (GEA) due to the Shiga toxin producing Escherichia Soli (STEC). In Uruguay, despite being a disease that requires mandatory notification, it is under reported. Objective: to describe two clinical cases of HUS associated with GEA with an epidemiological link. Clinical cases: these are two healthy boys aged 4 and 5 years. In the previous days, they reported meat intake in the same commercial premises. They consulted for abdominal pain, liquid stools and repeated vomiting. The 4 year old boy had a fever and bloody stools. The 5 year old boy had abdominal pain. They both showed normal hydration levels and vital signs. They were admitted to moderate care. At 48 hours and 5 days, respectively, they showed intense skin and mucosal paleness, edema and oliguria. Complementary studies: anemia, thrombocytopenia and renal failure. They were admitted to intensive care and peritoneal dialysis was performed. The STEC's investigation was negative and the evolution favorable. Conclusions: in children under 5 years of age, HUS associated with GEA is the most frequent form of the disease. In Uruguay, non-O157 STEC strains predominate. In these cases, the agent could not be identified. The existence of an epidemiological link warns us about the need for extreme care in the preparation and cooking of meat. Due to the association with a prevalent disease, it is necessary to keep this complication in mind in order to suspect it and initiate early and timely treatment.

Introdução: a síndrome hemolítico urêmica (SHU) é uma das causas mais frequentes de insuficiência renal aguda em muitos países. A maioria dos casos ocorre após um episódio de gastroenterite aguda (GEA) devido à Escherichia Coli, a toxina produtora de Shiga (STEC). No Uruguai, apesar de ser uma doença de notificação compulsória, há subnotificação. Objetivo: descrever dois casos clínicos de SHU associada à AGE com vínculo epidemiológico. Casos clínicos: dois meninos saudáveis com idades entre 4 e 5 anos. Nos dias anteriores, eles reportaram consumo de carne nos mesmos estabe- lecimentos comerciais. Eles consultaram para dor abdominal, fezes líquidas e vômitos repetidos. O menino de 4 anos teve febre e fezes com sangue. O menino de 5 anos teve dores abdominais. O estado de hidratação e os sinais vitais foram normais em ambos meninos. Foram internados em cuidados moderados. Às 48 horas e 5 dias, respectivamente, apresentaram aliás palidez intensa da pele e mucosas, edema e oligúria. Realizaramse estudos complementares: anemia, trombocitopenia e insuficiência renal. Eles foram internados em terapia intensiva e realizouse diálise peritoneal. A investigação do STEC foi negativa e a evolução favorável. Conclusões: em crianças menores de 5 anos, a SHU associada à GEA é a forma mais frequente da doença. No Uruguai, predominam cepas STEC não-O157. Nesses casos, o agente não pôde ser identificado. A existência de um nexo epidemiológico alerta para a necessidade de extremo cuidado no preparo e cozimento da carne. Devido à associação com doença prevalente, é necessário considerar essa complicação para suspeitar e iniciar o tratamento precoce e oportunamente.

First report of human astrovirus MLB2 in Brazil detected in feces of children with acute gastroenteritis living in the state of Roraima, Northern Brazil

ABSTRACT Human astrovirus (HAstV) 1-8 and highly divergent HAstVMLB1−3 genotypes have been detected in children both with and without acute gastroenteritis (AGE). One hundred and seventy fecal samples from children (≤5 years old) living in the Amazon region were evaluated for the presence of HAstV1-8, HAstV MLB1−3 and HAstVVA1−3, using an usual RT-PCR protocol and a new protocol with specific primers designed to detect HAstVMLB1−3. HAstVMLB1 and HAstV MLB2, as well as the HAstV3 and 5 genotypes were detected. HAstVMLB1−2 genotype was detected for the first time in Brazil at a frequency of 3.5% (6/170).

La administración de ondansetrón no mejora la evolución de los niños con gastroenteritis aguda sin deshidratación / Administration of ondansetron does not improve the course of children with acute gastroenteritis without dehydration

Sobre la base de una viñeta clínica de un niño con gastroenteritis aguda sin deshidratación, el autor de este artículo realiza una búsqueda bibliográfica para revisar la evidencia que avala el uso de ondansetrón para tratar sus vómitos, práctica bastante común en instituciones con acceso a este fármaco en sus centrales de emergencia. Luego de dicha búsqueda, el autor concluye que en niños con gastroenteritis aguda sin deshidratación, la administración de ondansetrón no reduce la necesidad de hidratación intravenosa ni la frecuencia ni la severidad de los vómitos. (AU)

Based on a clinical vignette of a child with acute gastroenteritis without dehydration, the author of this article performs a literature search to review the evidence supporting the use of ondansetron to treat his vomiting, a fairly common practice in institutions with access to this drug in their emergency rooms. After this search, the author concludes that in children with acute gastroenteritis without dehydration, the administration of ondansetron does not reduce the need for intravenous hydration or the frequency or severity of vomiting. (AU)

Factores predictores de reconsulta por gastroenteritis aguda en urgencias pediátricas: estudio de casos y controles / Predictor factors for emergency department revisiting of children with acute gastroenteritis: case-control study

INTRODUCCIÓN: El objetivo de este trabajo es describir factores de riesgo de reconsulta en pacientes con diagnóstico de gastroenteritis aguda, identificables en su primera visita a Urgencias. PACIENTES Y MÉTODO: Estudio casos-control, incluye pacientes entre 0-16 años que consultan en Urgencias de un hospital terciario durante 4 años. Se define caso el episodio de Urgencias con diagnóstico de gastroenteritis que reconsulta durante las 72 h posteriores. Se seleccionó un control por cada caso, siendo este el primer paciente que consultó tras cada caso con el mismo diagnóstico y que no reconsultó posteriormente. Se estudiaron variables epidemiológicas, clínicas e intervenciones diagnóstico-terapéuticas llevadas a cabo durante la primera visita, realizándose análisis uni y multivariable del riesgo de reconsulta utilizando modelos de regresión logística. RESULTADOS: Los diagnósticos de gastroenteritis supusieron el 5,3% de todas las visitas a urgencias. 745 pacientes (6,2%) reconsultaron en las siguientes 72 h. En el análisis multivariado se encontró asociación entre la reconsulta con cada año de aumento de edad (OR 0,94; IC 95%: 0,91-0,97), ausencia de vacunación de rotavirus (OR 1,47; IC 95%: 1,11-1,95), no valoración previa en atención primaria (OR 1,55; IC 95%: 1,09-2,19), mayor número de deposiciones en las últimas 24 h (OR 1,06; IC 95% 1,02-1,10) y recogida de coprocultivo en Urgencias (OR 1,54; IC 95%: 1,05-2,24). CONCLUSIONES: Los pacientes de menor edad con elevada frecuencia de deposiciones son especialmente susceptibles de volver a consultar en los servicios de Urgencias. La vacunación frente a rotavirus podría disminuir las reconsultas. Ninguna de las actuaciones diagnóstico-terapéuticas realizadas parece disminuir el número de revisitas a Urgencias.

INTRODUCTION: The objective of this work is to describe risk factors for reconsultation in patients with an acute gastroenteritis diagnosis, identifiable in their first visit to the Emergency Department. PATIENTS AND METHOD: Case-control study, including patients aged between 0-16 years who consulted in the Emer gency Department (ED) of a tertiary hospital for 4 years. The case is defined as the episode with a gastroenteritis diagnosis that reconsulted within 72 hours. A control was selected for each case, which was the first patient to consult after each case with the same diagnosis and not reconsulted later. Epidemiological and clinical variables, and diagnostic-therapeutic interventions carried out during the first visit were studied. Univariate and multivariate analyses of the reconsultation risk were per formed using logistic regression models. RESULTS: Gastroenteritis diagnoses accounted for 5.3% of all ED visits. 745 patients (6.2%) reconsulted within 72 hours. Multivariate analysis found association between reconsultation with each year of increasing age (OR 0.94, 95% CI 0.91-0.97), absence of rotavirus vaccination (OR 1.47, 95% CI: 1.11-1.95), no prior assessment in primary care (OR 1.55, 95% CI 1.09-2.19), increased stool output in the last 24 hours (OR 1.06, 95% CI 1.02-1.10), and stool collection in the ED (OR 1.54, 95% CI 1.05-2.24). CONCLUSIONS: Younger patients with an increased stool output are especially susceptible to return to the ED for consultation. Rotavirus vaccination could reduce reconsultation. None of the diagnostic-therapeutic actions carried out seems to reduce the number of visits to the ED.

Gastroenteritis aguda por norovirus en pacientes con atención hospitalaria: estudio transversal / Acute gastroenteritis due to norovirus in patients with hospital care: a cross-sectional study

Resumen Introducción: Debido a la disponibilidad de técnicas moleculares en la atención clínica, las gastroenteritis agudas (GEA) por norovirus han retomado importancia como un agente causante de hospitalización. El objetivo de este estudio fue describir las características clínicas y evolutivas de pacientes menores de 16 años hospitalizados por GEA por norovirus. Métodos: Estudio retrospectivo. Se recabó información clínica de los pacientes atendidos en hospitalización del 1 de noviembre del 2016 al 28 de febrero del 2018 por GEA con detección de norovirus (genotipo I y II) en heces por medio de reacción en cadena de la polimerasa con transcriptasa inversa. Resultados: Estudiamos 103 pacientes; 96 (93.2%; intervalo de confianza del 95% [IC 95%]: 86.6-96.7%) con deteccion de genotipo II y 7 (6.8%; IC 95%: 5.3-8.7%) de genotipo I; 76 (73.8%) ≤5 anos. El 48.5% fueron atendidos durante el invierno. La evolucion fue a la autolimitacion en menos de 7 días en todos con manejo hidroelectrolitico. No hubo diferencias en la gravedad y sintomas segun el grupo viral: en ambos predominaron los vómitos (82%). Solo un paciente cursó con perforación intestinal por coinfección con Shigella sp.; tres pacientes (3.1%) manifestaron crisis convulsivas (dos febriles y una epiléptica). Conclusiones: La GEA por norovirus, a pesar de causar una enfermedad meritoria de hospitalización, tiene un pronóstico favorable con autolimitación rápida. Su detección por pruebas rápidas en heces podría evitar la prescripción injustificada de antibióticos.

Abstract Background: Because of the availability of molecular techniques in clinical care, acute gastroenteritis (AGE) due to norovirus has returned to importance as a causative agent of hospitalization. The aim of this study was to describe the clinical features and evolution of patients less than 16 years hospitalized for AGE associated with norovirus. Methods: Retrospective study. Clinical information of the patients attended from November 1, 2016 to February 28, 2018 by AGE with detection of norovirus (genotype I and II) in faeces by means of polymerase chain reaction with reverse transcriptase was collected. Results: We studied 103 patients; 96 (93.2%; 95% confidence interval [95% CI]: 86.6-96.7%) with genotype II detection and seven (6.8%; 95% CI: 5.3-8.7%) genotype I; 76 (73.8%) ≤5 years. 48.5% attended during the winter. The evolution was to self-limitation in less than 7 days in all with hydro electrolytic management. There were no differences in the severity and symptoms according to the viral group; in both cases the vomiting predominated (82%). Only one patient had intestinal perforation due to co-infection with Shigella sp.; three patients (3.1%) manifested seizures (two febrile and one epileptic convulsions). Conclusions: Despite causing a meritorious disease of hospitalization, GEA by norovirus has a favorable prognosis with rapid self-limitation. Its timely detection by rapid tests in feces could avoid the unjustified prescription of antibiotics.

Aspectos relevantes sobre Salmonella sp en humanos / Relevant aspects of Salmonella sp in humans

Introducción: En el ámbito mundial, las infecciones por Salmonella sp poseen gran importancia por lo incapacitante de estas y los costos que implican para el sistema de salud de una nación, principalmente aquellas en vías de desarrollo donde persiste con mayor frecuencia este patógeno. Objetivo: Realizar una descripción de los principales aspectos relacionados con epidemiología, etiología, transmisión, patogénesis, diagnóstico y tratamiento de las especies de Salmonella que causan enfermedad en el humano. Métodos: Búsqueda de bibliográfica actual sobre Salmonella sp a través del uso de repositorios como Google Academics, Scielo y PubMed, utilizando las palabras de búsqueda: Salmonella, epidemiología, transmisión, patogénesis, diagnóstico, tratamiento. De 147 artículos consultados, 52 presentaron utilidad para el cumplimiento del objetivo de la revisión. : Las infecciones por Salmonella sp son un problema de salud en países en vías de desarrollo, siendo la resistencia bacteriana uno de los principales retos a enfrentar en los próximos años, al igual que como ocurre con otras infecciones bacterianas(AU)

Introduction: In the world, Salmonella sp infections have great importance due to their incapacitating nature and the costs associate for the health system in some nations, mainly those in development process where this pathogen persists frequently. Objective: To make a description of the main aspects related with the epidemiology, etiology, transmission, pathogenesis, diagnosis and treatment of Salmonella species that cause disease in humans. Method: Search current bibliography about Salmonella sp through the use of repositories such as Google Academics, Scielo and PubMed, and using the search words: Salmonella, epidemiology, transmission, pathogenesis, diagnosis, treatment. From 147 articles consulted, 52 were useful for the review objective. Conclusion: Salmonella sp infections are a health problem in developing countries, being bacterial resistance one of the main challenges to face in the coming years, as occurred with other bacterial infections(AU)

Semiquantitative fecal calprotectin test in postinfectious and non-postinfectious irritable bowel syndrome: cross-sectional study / Teste calprotectina fecal semiquantitativa na síndrome do intestino irritável pós-infecciosa e não pós-infecciosa: estudo transversal

CONTEXT AND OBJECTIVE:The presence of a certain degree of inflammation in the gut wall is now accepted in irritable bowel syndrome (IBS). Fecal calprotectin is considered to be a reliable test for detecting intestinal inflammation. Our aim was to assess the presence of inflammation in postinfectious IBS (PI-IBS), compared with non-postinfectious IBS (NPI-IBS). A secondary objective was to determine the usefulness of a rapid fecal calprotectin test in inflammatory bowel diseases (IBD).DESIGN AND SETTING:This was a cross-sectional study. Patients with IBS and IBD at a single tertiary gastroenterology center were prospectively included in this study.METHODS:116 patients with Rome III IBS score (76 females; 48 ± 12 years) were investigated; 24 patients (15 females) had PI-IBS. Intestinal inflammation was assessed using the semiquantitative fecal calprotectin test. The results were expressed as T1, T2 or T3 according to the severity of inflammation (< 15 μg/g; 15-60 μg/g; > 60 μg/g). Using the same test, we evaluated 20 patients with IBD (12 males; 47 ± 13 years).RESULTS:None of the patients with IBS had a T2 or T3 positive test. Among PI-IBS patients, 33% had a T1 positive test. Among NPI-IBS patients, 9.8% had a T1 positive test, which was significantly different to PI-IBS. The calprotectin test was positive in all IBD patients: 80% with T3, 10% with T2 and 10% with T1.CONCLUSIONS:Using a semiquantitative test for fecal calprotectin, positive tests were more frequent in PI-IBS patients than in NPI-IBS patients.

CONTEXTO E OBJETIVO:A presença de certo grau de inflamação na parede do intestino é agora aceita na síndrome do intestino irritável (SII). A calprotectina fecal é considerada teste confiável para detectar inflamação intestinal. Nosso objetivo foi avaliar a presença de inflamação na SII pós-infecciosa (SII-PI), em comparação com a SII não pós-infecciosa (SII-NPI). Um objetivo secundário foi determinar a utilidade de um teste rápido fecal da calprotectina em doenças inflamatórias intestinais (DII).TIPO DE ESTUDO E LOCAL:Este foi um estudo transversal. Pacientes com SII e DII em um único centro terciário de gastroenterologia foram prospectivamente incluídos neste estudo.MÉTODOS:116 pacientes com escore Roma III de SII (76 mulheres, 48 ± 12 anos) foram investigados; 24 pacientes (15 mulheres) tinham SII-PI. Inflamação intestinal foi avaliada pelo teste semi-quantitativo de calprotectina fecal. Os resultados foram expressos como T1, T2 ou T3 de acordo com a gravidade da inflamação (< 15 μg/g; 15-60 mg/g; > 60 mg/g). Usando o mesmo teste, foram avaliados 20 pacientes com DII (12 homens, 47 ± 13 anos).RESULTADOS:Nenhum dos pacientes com SII teve um teste positivo T2 ou T3. Na PI-IBS, 33% tiveram um teste positivo T1. Entre os pacientes SII-NPI, teste T1 positivo estava presente em 9,8%, taxa significativamente diferente quando comparada com SII-PI. O teste de calprotectina foi positivo em todos os pacientes com DII: 80% com T3, 10% com T2 e 10% com T1.CONCLUSÕES:Usando teste semi-quantitativo para calprotectina fecal, relatamos positividade em pacientes SII-PI com mais frequência que em pacientes SII-NPI.

Gastroenteritis por Salmonella spp. en tres lactantes asociada a contacto con tortugas acuáticas / Salmonella spp. gastroenteritis associated to pet turtles in three infants

Non-typhoidal salmonellosis is an important cause of acute diarrhea in children. Generally they are acquired by consumption of contaminated food, but contact with reptiles is an increasing cause of this zoonoses. We describe three pediatric cases of gastroenteritis by Salmonella (Montevideo, Newport and Pomona), related to having turtles as pets. In two cases, the bacteria were isolated from the patient’s stools and the turtle’s droppings. The same genetic subtype by PFGE was obtained in both isolates. All the children recovered. Information and public health measures should be undertaken to control this zoonoses which affects young children.

Las infecciones por Salmonella no tíficas, son una importante causa de diarrea aguda en niños. Generalmente adquiridas por alimentos contaminados, el contacto con animales, especialmente reptiles, también es responsable de esta zoonosis. Describimos tres casos de lactantes con gastroenteritis por Salmonella (S. Montevideo, S. Newport y S. Pomona), relacionados a contacto con tortugas mascotas. En dos de los casos se aisló Salmonella en las deposiciones de los niños y de las tortugas. En todos hubo proximidad entre los niños y los acuarios y/o tortugas, siendo probable la contaminación en la preparación de alimentos. El estudio de clonalidad por electroforesis de campo pulsado demostró el mismo subtipo genético en el aislado correspondiente al paciente y en el procedente de la mascota, lo cual confirmó la fuente zoonótica de los casos. Esta zoonosis debe ser abordada por las autoridades de salud y las sociedades científicas, ya que representa un importante riesgo para la salud, especialmente de niños pequeños.

Molecular Characteristics of Noroviruses Genogroup I and Genogroup II Detected in Patients With Acute Gastroenteritis

Noroviruses are the leading cause of epidemic gastroenteritis, including foodborne outbreak, in Korea. The prevalence of human noroviruses was studied in diarrheal stool samples of patients with acute gastroenteritis by conventional duplex reverse transcription (RT)-PCR. Diarrheal stool samples were collected from 1,685 patients from the local hospitals in Seoul. The prevalence of the noroviruses was 22.8% (222/972 patients) in 2012 and 11.2% (80/713 patients) in 2013, with a total of 17.9% (302/1,685 patients). Genotyping was performed on 302 norovirus-positive stool samples to reveal 5.6% prevalence of genogroup I (GI) (17/302) and 94.4% prevalence of genogroup II (GII) (285/302). The patients with norovirus-associated acute gastroenteritis mostly showed prevalence of GII norovirus, especially GII.4 (64.6%; 195/302).

Campylobacter hyointestinalis Isolated From a Human Stool Specimen

No abstract available.

Estudo retrospectivo dos astrovirus humanos associados a casos de gastrenterite aguda em crianças residentes em tres regioes do Brasil: nordeste, sudeste e sul no período de 1994 a 2011 / Retrospective study of human astrovirus associated with cases of acute gastroenteritis in children living in three regions of Brazil: northeast, southeast and south in the period 1994-2011

Os astrovírus humanos (HAstVs) pertencem a família Astroviridae e são associados agastrenterite aguda (GA) em crianças menores de cinco anos, tanto nos paísesdesenvolvidos como naqueles em desenvolvimento, o que os tornam de interesse nocampo da Saúde Pública. A família Astroviridae é dividida em dois gêneros:Avastrovirus e Mamastrovirus. No gênero Mamastrovirus, encontram-se os astrovirusassociados à infecção em mamíferos, tanto humanos como animais. Até 2008, osastrovirus associados a doenças em humanos eram restritos a oito genótipos,conhecidos como HAstV 1-8. A partir de então novos HAstVs foram sendo descritos,associados a doenças em humanos, como os HAstVs MLB1-3 e os HAstVs VA1-4.Opresente estudo consiste no estudo epidemiológicos retrospectivos (1994 a 2011) paradetecção e caracterização molecular de HAstV em amostras de fezes provenientes decrianças com menos de cinco anos de idade com GA, em diferentes regiões do Brasil:Nordeste, Sudeste e Sul. Incluem-se neste trabalho três estudos: 1) Estudo dosHAstV em casos esporádicos de GA ocorridos em crianças menores de cinco anos deidade, em três regiões brasileiras (Nordeste, Sudeste e Sul), durante o período de2005 a 2011, incluindo a pesquisa dos novos HAstV; 2) Estudo dos HAstV em criançascom GA, atendidas na creche Bertha Lutz, FIOCRUZ-RJ, durante o período de janeirode 1994 a dezembro de 2008; 3)...

Human astrovirus (HAstVs), belong to Astroviridae family, and are associatedwith acute gastroenteritis (GA) in children under five years-old, both indeveloped and in developing countries, which makes them of interest in thePublic Health field. The Astroviridae family is divided into two genera:Avastrovirus and Mamastrovirus. Mamastrovirus are the astrovirusesassociated to infection in mammals, both humans and animals. By 2008, theastrovirus associated with human disease were restricted to eight genotypes,known as HAstV 1-8. Since then, new HAstVs have been described, associatedwith human disease, such as HAstVs MLB1-3 and HAstVs VA1-4. The presentstudy is the retrospective epidemiological study (1994 to 2011) for the detectionand molecular characterization of HAstV in stool samples from children underfive years old presenting GA, in different regions of Brazil: Northeast, Southeastand South. Three studies are presented: 1) Study of HAstV in sporadic cases ofGA occurred in children under five years old in three Brazilian regions(Northeast, Southeast and South) from 2005 to 2011, including the descriptionof a new HAstV; 2) Study of HAstV in children with GA, attending the day careBertha Lutz, FIOCRUZ-RJ from January 1994 to December 2008 and 3) Studyof HAstV in children under two years old presenting GA and hospitalized inNiteroi, Rio de Janeiro from April to September 2003. The detection of HAstVwas performed using different protocols for detection and molecularcharacterization such as: Reverse–transcriptase polymerase chain reaction,(RT- PCR), Single step RT -PCR (OneStep RT-PCR) and RealTime RT- PCR.The HAstV detected were characterized by partial sequencing of ORF2 regionof the viral genome. The study 1 demonstrated the HAstV detection frequencyin 7.1 % of samples, and described the first ASTV MLB1 in Brazil. Themolecular characterization identified the circulation genotypes HAstV -1, 2, 3, 4,5, 6 and 8...

Gastrenterite eosinofílica / Eosinophilic gastroenteritis

A gastrenterite eosinofílica é uma doença rara com apresentação heterogênea caracterizada pela presença de intenso infiltrado de eosinófilos em um ou em múltiplos segmentos do trato gastrin- testinal. Foi realizada revisão da literatura com ênfase em diag- nóstico, diagnóstico diferencial e tratamento, com o objetivo de divulgá-la entre a comunidade médica e viabilizar diagnóstico e tratamento precoces dessa entidade clínica, a fim de evitar complicações.(AU)

Eosinophilic gastroenteritis is a rare disease with heterogeneous presentation characterized by intense eosinophilic infiltration in one or multiple segments of the gastrointestinal tract. This review of the literature emphasized diagnosis, differential diagnosis and treatment in order to disseminate this clinical entity among the medical community and facilitate early diagnosis and treatment in order to avoid complications.(AU)

Detección de norovirus en niños con diarrea adquirida en la comunidad o nosocomial en el Hospital Guillermo Grant Benavente de Concepción, Chile / Norovirus detection in children with community-acquired or nosocomial diarrhea at Guillermo Grant Benavente Hospital in Concepción, Chile

Introduction: Norovirus (NoV) are RNA viruses highly contagious, stable in the environment, genetically variable, and the most common cause of viral sporadic acute gastroenteritis worldwide. This is the first study carried out in Concepcion, Chile, to investigate the presence of NoV as an etiologic agent of viral diarrheas in hospitalized children. Objective. To detect the presence and genogroup of NoV in children with diarrhea and to compare it with rotavirus (RV) and adenovirus (AdV). Material and Methods: A one year descriptive, prospective study in children 0-14 years old. A single diarrheic stool sample per patient was analyzed for the presence of NoV, RV and AdV. Clinical data were unknown at the moment of sampling. Real time RT-PCR with Taqman™ probes for NoV and the immunocromatography VIKIA™ kit for RoV /AV detection were used. Results: Infection for NoV (25.5%) was significantly higher than for RV (15.9%) and AdV (6.2%). It was even greater in infants younger than 2yr. old (n: 103): NoV 34%, RV 17.5%, AdV 7.8%. Children 2-4 yr. old had 11.8% infection of NoV and RV. Children older than 4, only had 12% RV and 4% AdV. Children hospitalized for diarrhea (n: 92) had: 21.7% of both NoV and RV, and 7.6% AdV; whereas children hospitalized for other causes (n: 53) had 32.1% NoV,5.7% RV and 3.8% AV. The proportion of infection due to NoV was significantly higher in males (31.5%) than in females (19.4%). The average frequency during the year was higher for NoV (30.3%) than for RV (14.7%) except in summer. Conclusion: The presence of NoV was higher than RV in children with diarrhea. NoV infection showed defined characteristics regarding age, gender, seasonal occurrence and nosocomial transmission that are important epidemiological features.

Introducción: Los norovirus (NoV) son virus ARN altamente contagiosos, resistentes, variables genéticamente y una de las etiologías más frecuente de gastroenteritis viral esporádica mundial. Este es el primer trabajo en Concepción, Chile, de búsqueda de NoV como etiología viral de diarreas en niños hospitalizados. Objetivo: Determinar la presencia y genogrupo de NoV en niños con diarrea y compararla con la frecuencia de rotavirus (RV) y adenovirus (AdV). Material y Método: Estudio descriptivo, prospectivo de un año, en niños de 0-14 años ingresados por diarrea aguda o que la adquirieron dentro del hospital. La muestra de deposiciones diarreica se tomó una sola vez por paciente. Las fichas clínicas se analizaron al finalizar el estudio etiológico. Para la detección de NoV se utilizó RPC-TR a en tiempo real con sondas Taqman® y para detección de RV/AdV, el kit VIKIA® de inmunocromatografia. Resultados: La infección por NoV (25,5%) fue significativamente más frecuente que por RV (15,9%) y AdV (6,2%). La mayor presencia de infección fue en pacientes bajo2 años de edad (n: 103): NoV 34,0%, RV 17,5%, AdV 7,8%. La detección en niños hospitalizados por diarrea fue: NoV y RV 21,7% cada uno; AdV 7,6%. En niños con diarrea nosocomial hospitalizados por otras causas se detectó NoV en 32,1%, RV en 5,7% y AdV en 3,8%. La presencia de NoV fue significativamente mayor en varones (31,5%) que en niñas (19,4%). El promedio de diarreas durante el año fue mayor para NoV (30,3%) que para RV(14,7%), excepto en verano. Discusión y Conclusión: La presencia de NoV fue mayor que la de RoV en niños con diarrea y con una tendencia nosocomial que podría deberse a las características del virus que favorece infecciones de ambiente confinado, como hospitales, asilos y cruceros. La infección por NoV presentó características definidas, en edad, género, ocurrencia estacional y relevancia nosocomial, que aportan datos epidemiológicos importantes.

Utilidad clínica de la procalcitonina en gastroenteritis aguda / Use of procalcitonin as diagnostic marker in acute gastroenteritis

Introducción: No hay ningún marcador hematológico que diferencie con seguridad entre gastroenteritis aguda (GEA) bacteriana y no bacteriana. Nuestro objetivo fue evaluar la procalcitonina (PCT) como marcador de GEA de origen bacteriano y analizar su correlación con el ingreso hospitalario. Pacientes y Método: Estudio prospectivo de niños diagnosticados de GEA en el departamento de Urgencias durante un período de 7 meses que requirieron de analítica sanguínea y muestras de heces. Se analizaron variables epidemiológicas, clínicas y analíticas. Se excluyeron pacientes con enfermedad digestiva crónica, diarrea prolongada, inmunodeficiencia o tratamiento antibiótico previo. El estudio fue aprobado por el Comité de Ética y se solicitó consentimiento informado. Resultados: Se analizaron 45 pacientes. Los niños con GEA bacteriana tenían mayor edad (p = 0,027), mayor mediana de PCT y proteína C reactiva (PCR) (p = 0,001). Los valores de PCT y PCR que mejor discriminaron la etiología bacteriana fueron PCT > 0,5 mg/L (sensibilidad: 64,3 por ciento, especificidad: 83,9 por ciento, cociente de probabilidad positivo (CPP): 4) y PCR > 3 mg/dL (sensibilidad: 78,6 por ciento, especificidad: 90,3 por ciento, CPP: 8). No se encontró asociación entre la elevación de dichos marcadores y una mayor probabilidad de hospitalización. Conclusión: La procalcitonina, al igual que la PCR, se eleva en gastroenteritis bacterianas (p = 0,001), no siendo estos marcadores predictores de hospitalización.

Introduction: There is no hematological marker that reliably differentiates between bacterial and nonbacterial acute gastroenteritis (AGE). The objective of this study is to evaluate procalcitonin (PCT) as a marker for bacterial AGE and analyze its relationship with hospital admission. Patients and Method: A prospective study of children diagnosed with AGE was conducted at the emergency room during a period of seven months, which required blood and stool samples. Epidemiological, clinical and analytical variables were analyzed. Patients with chronic digestive disease, prolonged diarrhea, immunodeficiency or prior antibiotic treatment were excluded. The study was approved by the Ethics Committee and an informed consent was requested. Results: 45 patients were analyzed. Children with bacterial GEA were older (p = 0.027) and presented higher median PCT and C-reactive protein concentrations (CRP) (p = 0.001). The PCT and CRP values that best discriminated bacterial infection were PCT > 0.05 mg/L (sensibility 64.3 percent specificity 83.9 percent, positive probability coefficient (PPC): 4), and CRP > 3mg/dL (sensibility 78.6 percent, specificity 90.3 percent, PPC: 8). No association between the elevation of these markers and higher hospitalization probability was found. Conclusion: Procalcitonin, like CRP, is elevated in bacterial gastroenteritis (p = 0.001), but these markers are not a predictor of hospitalization.

Evaluation of an Immunochromatographic Assay for the Rapid and Simultaneous Detection of Rotavirus and Adenovirus in Stool Samples

BACKGROUND: We evaluated the analytical and clinical performances of the SD BIOLINE Rota/Adeno Rapid kit (SD Rota/Adeno Rapid; Standard Diagnostics, Inc., Korea), an immunochromatographic assay (ICA), for the simultaneous detection of rotaviruses and adenoviruses in human stool samples. METHODS: We tested 400 clinical stool samples from patients with acute gastroenteritis and compared the ICA results with the results obtained by using ELISA, enzyme-linked fluorescent assays (ELFA), PCR, and multiplex reverse transcription-PCR (mRT-PCR). To assess the analytical performance of the SD BIOLINE Rota/Adeno Rapid kit, we determined its detection limit, reproducibility, cross-reactivity, and analytical reactivity for adenovirus subtypes, and performed interference studies. RESULTS: The overall agreement rates among the tested methods were 91.5% for rotavirus and 85.5% for adenovirus. On the basis of mRT-PCR, the overall agreement, positive agreement, and negative agreement rates of the ICA were 95.6%, 100%, and 94.9% for rotavirus, and 94.0%, 71.4%, and 94.8% for adenovirus, respectively. Using the ICA, we detected all the subtypes of adenovirus tested, but the analytical reactivities for adenovirus subtypes were different between the 4 adenovirus detection methods. The high reproducibility was confirmed, and no cross-reactivity or interference was detected. CONCLUSIONS: The SD BIOLINE Rota/Adeno Rapid kit showed acceptable analytical and clinical performances. However, interpretation of adenovirus positive/negative result should be cautious because of different detectability for adenovirus subtypes among adenovirus detection methods.

Características epidemiológicas y clínicas de las gastroenteritis agudas según su etiología por rotavirus u otra en niños menores de 5 años atendidos en una institución privada de la Ciudad Autónoma de Buenos Aires / Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old at a private institution in the city of Buenos Aires

Introducción. La gastroenteritis aguda es una enfermedad frecuente en pediatría. Rotavirus es el principal agente etiológico. Objetivos. Describir las características epidemiológicas y clínicas de las gastroenteritis agudas según su etiología por rotavirus u otra en niños menores de 5 años en una institución privada de Buenos Aires. Objetivo secundario: evaluar los costos. Material y métodos. Estudio transversal, descriptivo, observacional, de un año de duración, en niños menores de 5 años con gastroenteritis. El rotavirus fue diagnosticado mediante la prueba VIKIA® Rota-Adeno. Se recolectaron datos demográficos, clínicos y de vacunación. Se realizó el análisis univariado de los datos. Resultados. Se incluyeron 275 pacientes; 18,5% fueron R+. Rotavirus fue más frecuente en los menores de 2 años y entre marzo y junio. Las gastroenteritis por rotavirus fueron más graves, requirieron más internaciones (OR 2,07; IC 95% 1,17 a 7,13) y provocaron más costos. En la muestra estudiada la variable vacunación redujo el riesgo de infección por rotavirus. Conclusiones. Las gastroenteritis agudas por rotavirus se diferenciaron de otras etiologías por tener un pico estacional, y por la mediana de edad, la gravedad, la asociación con internación y el aumento de los costos.

Introduction. Acute gastroenteritis is a common disease in children. Rotavirus is the major etiologic agent. Objectives. To describe the epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old in a private institution in the City of Buenos Aires. Secondary objective: to analyze related costs. Material and Methods. Cross sectional, descriptive, observational study conducted during one year in children younger than 5 years old with gastroenteritis. The presence of rotavirus was diagnosed with the VIKIA® Rota-Adeno test. Demographic, clinical and immunization data were collected. A univariate data analysis was performed. Results. A total of 275 patients were included; 18.5% of them were R+. Rotavirus was more common in children younger than 2 years old and in the period between March and June. The cases of rotavirus gastroenteritis were more severe, required more hospitalizations (OR 2.07; 95% CI 1.17-7.13), and resulted in higher costs. In the sample studied, the immunization outcome measure reduced the risk of rotavirus infection. Conclusions. Acute gastroenteritis caused by rotavirus were different from other etiologies in that they had a seasonal peak and in relation to the median age of patients, the severity of the condition, the association with hospitalization and the increase in costs.

Prevalence and characters of Entamoeba histolytica infection in Saudi infants and children admitted with diarrhea at 2 main hospitals at south Jeddah: a re-emerging serious infection with unusual presentation

In this study, Entamoeba histolytica had high prevalence and unusual presentation by affecting high proportion of infants under 1 year; severe clinical manifestations, and laboratory findings that were known to be usually encountered in invasive amebiasis as significant leukocytosis for age, neutrophilic leukocytosis for age, and positive C-reactive protein were found among more than 50% of admitted Saudi infants and children with E. histolytica infection in our locality. E. histolytica can be a re-emerging serious infection when it finds favorable environmental conditions and host factors which are mainly attributed to inadequate breastfeeding in this study. This may occur in any other area of the world with the same risk factors, so we must be ready to tackle it with effective and more powerful preventive measures.

Molecular characterization of Salmonella strains in individuals with acute diarrhea syndrome in the State of Sucre, Venezuela / Caracterização molecular de cepas de Salmonella em indivíduos com síndrome da diarreia aguda no Estado de Sucre, Venezuela

INTRODUCTION:In Venezuela, acute diarrheic syndrome (ADS) is a primary cause of morbi-mortality, often involving the Salmonella genus. Salmonella infections are associated with acute gastroenteritis, one of the most common alimentary intoxications, and caused by the consumption of contaminated water and food, especially meat. METHODS: Conventional and molecular methods were used to detect Salmonella strains from 330 fecal samples from individuals of different ages and both sexes with ADS. Polymerase chain reaction (PCR) was used for the molecular characterization of Salmonella, using invA, sefA, and fliC genes for the identification of this genus and the serotypes Enteritidis and Typhimurium, respectively. RESULTS: The highest frequency of individuals with ADS was found in children 0-2 years old (39.4%), and the overall frequency of positive coprocultures was 76.9%. A total of 14 (4.2%) strains were biochemically and immunologically identified as Salmonella enterica subsp. enterica, of which 7 were classified as belonging to the Enteritidis serotype, 4 to the Typhimurium serotype, and 3 to other serotypes. The S. enterica strains were distributed more frequently in the age groups 3-4 and 9-10 years old. CONCLUSIONS: The molecular characterization method used proved to be highly specific for the typing of S. enterica strains using DNA extracted from both the isolated colonies and selective enrichment broths directly inoculated with fecal samples, thus representing a complementary tool for the detection and identification of ADS-causing bacteria.

INTRODUÇÃO: Na Venezuela, síndrome da diarreia aguda (SDA) é a principal causa de mórbi-mortalidade, muitas vezes envolvem o gênero Salmonella. Infecções por Salmonella são associadas com gastroenterite aguda, uma das mais comuns intoxicações alimentares causada pelo consumo de água e alimentos contaminados, principalmente carne. MÉTODOS: Métodos convencionais e moleculares foram usados para detectar cepas de Salmonella em 330 amostras de fezes de indivíduos com SDA de diferentes idades e ambos os sexos. A reação em cadeia da polimerase (PCR) foi utilizada para a caracterização molecular de genes Salmonella invA, sefA e fliC para identificar o gênero e os sorotipos Enteritidis e Typhimurium, respectivamente. RESULTADOS: A maior frequência de indivíduos com SDA foi encontrada em crianças de 0-2 (39,4%) anos, e a frequência total de culturas de fezes positiva foi de 76,9%. Um total de 14 (4,2%) cepas foram bioquímica e imunologicamente identificados como Salmonella enterica subsp. enterica, dos quais 7 foram classificados como pertencentes ao sorotipo Enteritidis, Typhimurium sorotipo 4 e 3 para outros sorotipos. Cepas S. enterica foram distribuídas mais frequentemente em grupos de 3-4 e 9-10 anos de idade. CONCLUSÕES: O método de caracterização molecular usada provou ser altamente específico para tipificar as estirpes dos S. enterica usando tanto DNA extraído de colônias isoladas e direta e caldos de enriquecimento seletivo inoculados com amostras fecais, o que representa uma ferramenta complementar para a detecção e identificação de bactérias que causam a SDA.