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1.
J Travel Med ; 9(5): 247-50, 2002.
Article in English | MEDLINE | ID: mdl-12962598

ABSTRACT

BACKGROUND: Simple methods for detecting secretory immunoglobulin A (sIgA) immune responses following natural enteric infection and oral immunization are needed. METHODS: Fourteen students from the United States acquiring enterotoxigenic Escherichia coli (ETEC) diarrhea in Mexico were studied for fecal immunoglobulin A (IgA) response to their homologous infecting ETEC and to heat-labile (LT) toxin of ETEC using Dot-Blot microfiltration and enzyme-linked immunosorbent assay (ELISA) methods. Paired stool samples were collected on the day of presentation and 5 days later. RESULTS: Twelve of 14 (86%) patients with ETEC diarrhea (5 heat-stable [ST]/LT positive, 4 LT-only, and 5 ST-only) developed sIgA antibodies directed against their homologous ETEC and 6 (66%) of the 9 patients harboring ST/LT or LT-only strains developed sIgA LT-antibody responses. Single fecal samples from 9 healthy controls were negative for ETEC specific antibodies. CONCLUSIONS: Patients with diarrhea due to noninvasive ST/LT ETEC and LT ETEC commonly produce a specific sIgA antibody response early in the illness. We feel that the methods employed will be useful to detect antibodies during natural infection by enteric pathogens and following oral enteric vaccine administration.


Subject(s)
Diarrhea/immunology , Escherichia coli Infections/immunology , Immunoglobulin A/immunology , Travel , Antibody Formation , Antigens, Bacterial/immunology , Diarrhea/microbiology , Enterotoxins/immunology , Enzyme-Linked Immunosorbent Assay , Humans , Mexico/epidemiology , United States
3.
Clin Infect Dis ; 33(11): 1807-15, 2001 Dec 01.
Article in English | MEDLINE | ID: mdl-11692292

ABSTRACT

Rifaximin is a poorly absorbed rifamycin derivative under investigation for treatment of infectious diarrhea. Adult students from the United States in Mexico and international tourists in Jamaica were randomized to receive either rifaximin (400 mg twice per day) or ciprofloxacin (500 mg twice per day) for 3 days, following a double-blinded model, from June 1997 to September 1998. A total of 187 subjects with diarrhea were studied. Time from initiation of therapy to passage of last unformed stool was comparable for those receiving rifaximin or ciprofloxacin (median, 25.7 hours versus 25.0 hours, respectively). There was no significant difference in the proportion of subjects in the 2 groups with respect to clinical improvement during the first 24 hours (P=.199), failure to respond to treatment (P=.411), or microbiological cure (P=.222). The incidence of adverse events was low and similar in each group. Rifaximin is a safe and effective alternative to ciprofloxacin in the treatment of traveler's diarrhea.


Subject(s)
Anti-Infective Agents/therapeutic use , Ciprofloxacin/therapeutic use , Diarrhea/drug therapy , Rifamycins/therapeutic use , Adolescent , Adult , Anti-Infective Agents/adverse effects , Ciprofloxacin/adverse effects , Diarrhea/diagnosis , Diarrhea/microbiology , Double-Blind Method , Feces/microbiology , Female , Humans , Kinetics , Male , Microbial Sensitivity Tests , Middle Aged , Rifamycins/adverse effects , Rifaximin
4.
Clin Infect Dis ; 32(12): 1706-9, 2001 Jun 15.
Article in English | MEDLINE | ID: mdl-11360211

ABSTRACT

Enteroaggregative Escherichia coli (EAEC) has been reported to cause traveler's diarrhea and persistent diarrhea in children in developing countries and in immunocompromised patients. To clarify the prevalence of EAEC in traveler's diarrhea, we studied 636 US, Canadian, or European travelers with diarrhea: 218 in Guadalajara, Mexico (June--August 1997 and 1998), 125 in Ocho Rios, Jamaica (September 1997--May 1998), and 293 in Goa, India (January 1997--April 1997 and October 1997--February 1998). Stool samples were tested for conventional enteropathogens. EAEC strains were identified by use of the HEp-2 assay. EAEC was isolated in 26% of cases of traveler's diarrhea (ranging from 19% in Goa to 33% in Guadalajara) and was second only to enterotoxigenic E. coli as the most common enteropathogen in all areas. Identification of EAEC reduced the number of cases for which the pathogen was unknown from 327 (51%) to 237 (37%) and explained 28% of cases with unknown etiology. EAEC was a major cause of traveler's diarrhea in 3 geographically distinct study areas.


Subject(s)
Diarrhea/microbiology , Escherichia coli Infections/microbiology , Global Health , Travel , Adult , Diarrhea/epidemiology , Escherichia coli/classification , Escherichia coli/genetics , Escherichia coli/growth & development , Escherichia coli/isolation & purification , Escherichia coli Infections/epidemiology , Female , Humans , India/epidemiology , Jamaica/epidemiology , Male , Mexico/epidemiology , Prevalence , Tumor Cells, Cultured
5.
J Am Coll Cardiol ; 37(1): 251-7, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11153747

ABSTRACT

OBJECTIVES: The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC). BACKGROUND: Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS: Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS: Following stent placement, the mean vessel diameter increased from 0.9 +/- 1.6 to 7.4 +/- 2.6 mm (p < 0.05). Twenty-one of 28 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 +/- 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87%) remained patent at follow-up thus far. CONCLUSIONS: Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.


Subject(s)
Angioplasty, Balloon , Cardiac Catheterization , Femoral Vein , Iliac Vein , Stents , Vena Cava, Inferior , Child, Preschool , Constriction, Pathologic/therapy , Female , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/therapy , Humans , Male , Treatment Outcome
6.
Lancet ; 356(9224): 133-4, 2000 Jul 08.
Article in English | MEDLINE | ID: mdl-10963251

ABSTRACT

Almost two of three tourists developed traveller's diarrhoea during 2-week stays at high-risk destinations. Large differences in infection rates between hotels were seen. Patients with milder forms of diarrhoea show a similar chronology to those more severely affected. Although enterotoxigenic Escherichia coil was the most frequent cause, viral pathogens were detected more often than in other studies.


Subject(s)
Diarrhea/epidemiology , Diarrhea/etiology , Travel , Brazil/epidemiology , Cooking , Cross-Sectional Studies , Diarrhea/classification , Diarrhea/prevention & control , Feces/microbiology , Food Microbiology , Humans , India/epidemiology , Jamaica/epidemiology , Kenya/epidemiology , Risk Factors , Severity of Illness Index , Surveys and Questionnaires
7.
J Am Soc Echocardiogr ; 13(6): 561-9, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10849510

ABSTRACT

Limited information is available that describes the practical conversion of a pediatric echocardiography laboratory from videotape to a primarily digital format. To help pediatric echocardiographers begin to make the analog-to-digital transition, we report our pediatric digital acquisition protocol and the acquisition and storage parameters of 1000 unselected, consecutive digitally acquired studies of pediatric patients with known or suspected congenital or acquired heart disease. With the use of our acquisition protocol, a complete normal study requires 46 moving clips and 12 still-frame images. Five hundred consecutive patient studies acquired with "high" JPEG (Joint Photographers Experts Group) compression (group 1) were compared with the next 500 examinations acquired using "medium" JPEG compression (group 2) for number of moving clips, still images, and megabytes of storage space. No intergroup difference was found in the number of moving clips or still images. When JPEG compression was decreased from high to medium, the average clip storage requirement per patient increased, and the number of patients stored per 230-MB magneto optical disk decreased significantly. Non-ECG-triggered timed single-plane clips and still images required significantly more storage space than ECG-triggered single-beat clips and still images. The frequency of multiplane sweeps was.03% and was independent of diagnosis. With the use of high JPEG compression, the digital storage cost per patient was $1.90, which was 6.0 times greater than that for simultaneously recorded 120-minute VHS videotape. Many features of the digital paradigm, including decreased MOD storage space, enhanced serial study comparisons, random image access, and improved image quality, mitigate this cost differential.


Subject(s)
Analog-Digital Conversion , Echocardiography , Heart Diseases/diagnostic imaging , Child , Humans , Image Processing, Computer-Assisted
8.
Clin Diagn Lab Immunol ; 7(3): 501-3, 2000 May.
Article in English | MEDLINE | ID: mdl-10799468

ABSTRACT

We examined stool samples from travelers for secretory immunoglobulin A (sIgA) to enteroaggregative Escherichia coli (EAEC) during episodes of acute diarrhea. Ten paired samples from 10 patients with diarrhea caused by EAEC were examined for the presence of specific sIgA by dot blot and Western blot immunoassays. Five samples were positive by dot blotting, and two samples were positive by Western blotting.


Subject(s)
Diarrhea/diagnosis , Escherichia coli Infections/diagnosis , Immunoglobulin A/analysis , Adult , Antigens, Bacterial/analysis , Antigens, Bacterial/immunology , Blotting, Western , Chronic Disease , Diarrhea/immunology , Escherichia coli Infections/immunology , Feces/microbiology , Humans , Immunoblotting , Intestines/immunology , Mexico , Travel
9.
J Infect Dis ; 181(2): 779-82, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10669376

ABSTRACT

The relationship between enterotoxigenic Escherichia coli (ETEC) and travelers' diarrhea was examined in a high-risk area in 1992-1997. Toxin patterns, colonization-factor antigens (CFAs), and in vitro antimicrobial susceptibility were determined. In total, 928 US students with diarrhea acquired in Guadalajara, Mexico, were screened for enteric pathogens. Diagnosis of ETEC infection was done with oligonucleotide probes. ETEC was isolated in 19.9% of the travelers with diarrhea. CFAs were identified in 51% of the ETEC strains. The highest CFA frequency was observed among heat-stable isolates. Ampicillin, furazolidone, and sulfisoxazole resistance of ETEC increased during the study period. ETEC isolation rates and CFA patterns varied little during the 6 years of the study, which has implications for immunoprophylactic strategies. The finding that differences in the results of ribotyping and plasmid analysis change over time suggests that multiple strains of ETEC were responsible for the illness in the region studied.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bacterial Proteins/biosynthesis , Diarrhea/microbiology , Enterotoxins/biosynthesis , Escherichia coli Infections/microbiology , Escherichia coli/physiology , Fimbriae Proteins , Adolescent , Adult , DNA, Ribosomal/analysis , Diarrhea/epidemiology , Enterobacteriaceae/isolation & purification , Escherichia coli/drug effects , Escherichia coli/genetics , Escherichia coli/isolation & purification , Feces/microbiology , Humans , Mexico , Microbial Sensitivity Tests , Plasmids/genetics , Polymerase Chain Reaction , RNA, Ribosomal, 16S/genetics , RNA, Ribosomal, 23S/genetics , Students , Travel
10.
J Travel Med ; 7(1): 15-8, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10689233

ABSTRACT

BACKGROUND: Between December 6, 1994 and March 10, 1996, a study of the etiology of diarrhea was carried out among 332 travelers to five all-inclusive hotels in Negril, Jamaica. METHODS: Stool specimens were collected and sent to Montego Bay for laboratory analysis. Escherichia coli strains isolated at the Jamaican laboratory were sent to Houston for toxin testing. RESULTS: A recognized enteropathogen was found in 118 of the 332 (35.5%) cases. Enterotoxigenic E. coli (ETEC) were the most commonly identified pathogen (87/332; 26.2%) followed by Salmonella (4.2%) and Shigella (4.2%). Clustering of etiologically defined cases was studied at each hotel. A cluster was defined as 2 or more cases with the same pathogen identified in the same hotel within 7 days. In the 3 hotels with the highest number of cases of diarrhea, enteropathogens were part of a cluster in 65 of 99 cases (65.7%) of diarrhea of which an etiologic agent was identified. In the other 2 hotels, only 4 of 20 cases (20%) occurred in clusters. CONCLUSIONS: A total of 25 clusters of travelers' diarrhea cases was detected at the five hotels during the study period. Seventeen of 25 (68%) ETEC isolations occurred as part of a clustering of diarrhea cases. The largest outbreak of pathogen-identified diarrhea consisted of 7 cases of ETEC producing both heat-stable and heat-labile enterotoxins. In the Jamaican hotels with all inclusive meal packages most diarrhea cases occurred as small clusters, presumably as the result of foodborne outbreaks.


Subject(s)
Diarrhea/epidemiology , Diarrhea/microbiology , Escherichia coli Infections/epidemiology , Escherichia coli/isolation & purification , Travel , Campylobacter Infections/epidemiology , Campylobacter jejuni/isolation & purification , Cluster Analysis , Diarrhea/parasitology , Disease Outbreaks , Dysentery, Bacillary/epidemiology , Feces/microbiology , Feces/parasitology , Foodborne Diseases/epidemiology , Foodborne Diseases/microbiology , Foodborne Diseases/parasitology , Giardiasis/epidemiology , Humans , Jamaica/epidemiology , Salmonella Infections/epidemiology , Surveys and Questionnaires
11.
J Travel Med ; 7(6): 304-8, 2000.
Article in English | MEDLINE | ID: mdl-11179951

ABSTRACT

BACKGROUND: Gastric digestion of these antigens plays an important role, decreasing the ability to deliver antigens to the gut-associated lymphoid tissue. To overcome this obstacle, microencapsulated antigens from enterotoxigenic Escherichia coli (ETEC) were evaluated for oral immunization of mice. METHODS: Four groups of 10 each received 3 series of 3 doses each of (1) B subunit of cholera toxin (CTB), similar to heat-labile toxin of ETEC, (2) formalin-killed whole cell ETEC H10407 (FK-ETEC), (3) crude preparation of colonization factor antigen I (CFA/I), or (4) placebo. Serum antibody was measured on day 0 and 60 by ELISA. RESULTS: In group 1 a CTB antibody response was induced in all mice, 3 with 1:105 titer and 7 with 1:106. These antibodies neutralized cholera toxin-induced steriodogenesis of Y-1 adrenal cells. In group 2, 8 mice developed a whole H10407 bacteria antibody titer of 1:100, one 1:200 and one showed no immune response. In the same group, an anti-CFA/I response was observed in 6 mice and anti-LPS in 4 mice as determined by Western blot. All mice in group 3 showed > 1:104 anti-CFA/I antibody titer. Group 4 mice did not develop an immune response to any ETEC antigens. CONCLUSIONS: Microencapsulation appears to be a suitable approach for oral vaccination against ETEC and Vibrio cholerae.


Subject(s)
Antigens, Bacterial , Cholera Toxin/pharmacology , Diarrhea/prevention & control , Drug Compounding , Escherichia coli/immunology , Immunization , Animals , Antibodies, Bacterial/immunology , Cholera Toxin/administration & dosage , Cholera Toxin/immunology , Diarrhea/microbiology , Drug Delivery Systems , Methacrylates , Mice , Mice, Inbred ICR
12.
Am J Trop Med Hyg ; 62(6): 711-3, 2000 Jun.
Article in English | MEDLINE | ID: mdl-11304060

ABSTRACT

As part of a traveler's diarrhea study carried out in Guadalajara, Mexico, and Goa, India, we conducted a case control study to evaluate fecal markers of enteric inflammation in three groups. Forty-five cases of enteroaggregative Escherichia coli (EAEC) diarrhea were compared to 56 controls with enterotoxigenic E. coli (ETEC) diarrhea, and 126 controls with diarrhea without identifiable pathogens. For EAEC cases we found fecal leukocytes, occult blood, and lactoferrin in 13 (28.9%), 14 (31.1%), and 27 (60.0%) patients, respectively; for ETEC controls they were 15 (26.8%), 16 (28.6%), and 15 (26.8%) respectively; and for patients without identifiable pathogens 19 (15.1%), 34 (27.0%) and 27 (21.4%) were seen for the presence of a positive fecal lactoferrin test in EAEC cases was statistically significant compared to both control groups. The study provides evidence that EAEC infection is associated with an intestinal inflammatory response.


Subject(s)
Diarrhea/microbiology , Enteritis/microbiology , Escherichia coli Infections/microbiology , Escherichia coli/physiology , Travel , Adolescent , Adult , Bacterial Adhesion , Biomarkers , Case-Control Studies , Cell Line , Enteritis/pathology , Escherichia coli Infections/pathology , Feces/chemistry , Feces/cytology , Humans , Lactoferrin/analysis , Leukocytes/immunology , Occult Blood
13.
J Infect Dis ; 180(6): 2053-5, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10558969

ABSTRACT

This study sought to determine whether a specific polymerase chain reaction (PCR) for enterotoxigenic Escherichia coli (ETEC) toxins after chaotropic extraction of DNA from stool would increase the detection of ETEC over that of conventional oligonucleotide probe hybridization of 5 E. coli colonies per stool sample (a standard method). By DNA hybridization, 29 (21%) of 140 patients were positive for ETEC, and 59 (42%) of 140 were positive for ETEC when PCR was used. Sensitivity of the PCR assay was confirmed through spiked stool experiments to be approximately 100-1000 ETEC colonies per sample. Specificity of the assay was determined by showing an absence of ETEC by the PCR technique in a subgroup of 48 subjects and by confirming the presence of ETEC DNA of positive samples by dot blot procedure. PCR technique detected significantly more ETEC infections in these subjects than did the hybridization method (P<.0001).


Subject(s)
Bacterial Toxins/analysis , Diarrhea/microbiology , Enterotoxins/analysis , Escherichia coli Infections/diagnosis , Escherichia coli Proteins , Escherichia coli/isolation & purification , Polymerase Chain Reaction/methods , Bacterial Toxins/biosynthesis , Bacterial Toxins/genetics , DNA, Bacterial/analysis , DNA, Bacterial/isolation & purification , Diarrhea/diagnosis , Enterotoxins/biosynthesis , Enterotoxins/genetics , Escherichia coli/metabolism , Escherichia coli Infections/microbiology , Feces/microbiology , Humans , Nucleic Acid Hybridization , Sensitivity and Specificity , Travel
14.
Clin Infect Dis ; 29(2): 335-8, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10476738

ABSTRACT

The purpose of this study was to determine the role of enteroaggregative Escherichia coli (EAEC) in the development of traveler's diarrhea and the clinical response of patients with EAEC diarrhea following treatment with ciprofloxacin. Sixty-four travelers with diarrhea and no other recognized enteropathogen were enrolled in treatment studies in Jamaica and Mexico from July 1997 to July 1998. EAEC was isolated from 29 travelers (45.3%). There was a significant reduction in the duration of posttreatment diarrhea in the 16 patients treated with ciprofloxacin, as compared with that in the 13 patients who received placebo (mean of 35.3 versus 55.5 hours; P = .049). There was a nonsignificant reduction in the mean number of unformed stools passed during the 72 hours after enrollment in the ciprofloxacin-treated group (5.6), as compared with that in the placebo group (7.5) (P = .128). This study provides additional evidence that EAEC should be considered as a cause of antibiotic-responsive traveler's diarrhea.


Subject(s)
Anti-Infective Agents/therapeutic use , Ciprofloxacin/therapeutic use , Diarrhea/drug therapy , Escherichia coli Infections/drug therapy , Travel , Adult , Antidiarrheals/therapeutic use , Diarrhea/microbiology , Diarrhea/physiopathology , Escherichia coli/pathogenicity , Escherichia coli Infections/microbiology , Escherichia coli Infections/physiopathology , Humans , Rifamycins/therapeutic use , Rifaximin , Treatment Outcome
15.
IEEE Trans Rehabil Eng ; 7(2): 135-9, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10391583

ABSTRACT

A self-contained electronically controlled dynamic knee-brace system (DKBS) has been designed and tested which allows knee flexion during swing phase, but restricts flexion during the stance phase of gait. Cardiovascular energy measurements indicate that DKBS use allowed a more energy efficient gait.


Subject(s)
Braces , Leg , Adult , Equipment Design , Gait , Humans , Male , Materials Testing , Oxygen Consumption
16.
JAMA ; 281(9): 811-7, 1999 Mar 03.
Article in English | MEDLINE | ID: mdl-10071002

ABSTRACT

CONTEXT: Traveler's diarrhea (TD) can incapacitate travelers. Characteristics of TD could be helpful in identifying individuals who might benefit from a vaccine against TD. OBJECTIVE: To determine epidemiology, etiology, and impact of TD in Jamaica. Design Two-armed, cross-sectional survey conducted between March 1996 and May 1997. SETTING: Sangster International Airport and 10 hotels in Montego Bay area, Jamaica. SUBJECTS: To investigate epidemiology and impact, 30369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts. To investigate etiology, 322 patients (hotel guests) with TD provided stool samples. MAIN OUTCOME MEASURES: Attack and incidence rates of reported diarrhea and of classically defined TD (> or =3 unformed stool samples in 24 hours and > or =1 accompanying symptom), incapacity, risk factors, and etiology. RESULTS: The attack rate for diarrhea was 23.6% overall, with 11.7% having classically defined TD. For a mean duration of stay of 4 to 7 days, the incidence rate was 20.9% (all TD) and 10.0% (classic TD). Among airport respondents, the incapacity lasted a mean of 11.6 hours. Less than 3% of all travelers avoided potentially high-risk food and beverages. The most frequently detected pathogens were enterotoxigenic Escherichia coli, Rotavirus, and Salmonella species. CONCLUSIONS: A realistic plan for reducing TD is needed. Preventive measures such as the improvement of hygienic conditions at the destination, and/or the development of vaccines against the most frequent pathogens associated with TD may contribute toward achieving this goal.


Subject(s)
Diarrhea/epidemiology , Travel , Adolescent , Adult , Cost of Illness , Cross-Sectional Studies , Diarrhea/economics , Diarrhea/etiology , Diarrhea/therapy , Female , Humans , Incidence , Jamaica/epidemiology , Male , Middle Aged , Quality of Life , Risk Factors , Surveys and Questionnaires
17.
Pediatr Infect Dis J ; 18(2): 94-7, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10048678

ABSTRACT

BACKGROUND: Few data have been published recently on the etiology of outpatient pediatric diarrhea in the US. METHODS: We determined the etiology of acute, nondysenteric diarrhea among 147 children between 2 and 11 years old presenting to 9 outpatient clinics in various regions of the US between August, 1991, and August, 1993. Enteropathogens were sought by conventional laboratory methods. The various diarrheagenic Escherichia coli were sought. RESULTS: A recognized etiologic agent was detected in the stools of 89 (60.5%) children and 15 (10) patients had multiple agents detected. Rotavirus was found in 43 (29.3%) of the children, with a spring and winter peak in occurrence. Giardia lamblia was identified in 22 (15%) cases with a spring peak. HEp-2 cell-adherent E. coli were found in 15 (10.2%). Other agents found included: enteric adenovirus in 7 (4.8%); Salmonella in 5 (3.4%); enterohemorrhagic E. coli in 5 (3.4%); enteropathogenic E. coli in 2 (1.4%); enterotoxigenic E. coli in 2 (1.4%); Entamoeba histolytica in 1 (0.70%); and Campylobacter jejuni in 1 (0.7%). CONCLUSIONS: In addition to the presence of conventional enteropathogens, diarrheagenic E. coli (HEp-2 cell-adherent E. coli, enterohemorrhagic E. coli, enteropathogenic E. coli and enterotoxigenic E. coli) were associated with endemic pediatric diarrhea in the US.


Subject(s)
Diarrhea/etiology , Acute Disease , Ambulatory Care Facilities , Animals , Bacteria/isolation & purification , Child , Child, Preschool , Feces/microbiology , Humans , Parasites/isolation & purification , United States , Viruses/isolation & purification
18.
Article in English | MEDLINE | ID: mdl-10048903

ABSTRACT

The seroprevalence of HIV-1 in sub-Saharan African patients with diarrhea in the community remains largely unknown. We present the findings of a 2-month study that we undertook to ascertain the seroprevalence of HIV-1 in Zambian patients presenting with acute diarrhea in a community-based health center. A total of 256 patients with diarrhea and 140 apparently healthy controls was seen. Of the patients with diarrhea, 161 were < 16 years old and 95 were adults. Most children with diarrhea were < 6 years old (147 of 161; 91%). Overall, 81 of 256 (32%) patients with diarrhea were HIV-1-seropositive. When results from children < 18 months old and possibly having maternal anti-HIV-1 antibodies were excluded, 64 of 172 (37%) patients with diarrhea were HIV-seropositive. Rates of HIV-1 seropositivity for patients with diarrhea were significantly higher than were rates for diarrhea-free controls (p < .001 for both the total population; odds ratio [OR], 95% confidence interval [CI], 1.42 < 2.48 < 4.35) and population > 18 months old (OR, 95% CI, 1.54 < 2.90 < 5.49). Among children between 18 months and 5 years old, 14 of 63 (22%) were HIV-1-seropositive compared with 8 of 62 (13%) without diarrhea (p > .05, not significant). Moreover, 49 of 95 (52%) adults with acute diarrhea were HIV-1-seropositive compared with 10 of 44 (23%) healthy adult controls (p < .003; OR, 95% CI, 1.51 < 3.62 < 8.87). No significant differences were found in HIV-1 seroprevalence rates between males and females in all age groups. These data show a close association between acute diarrhea and HIV seropositivity in Zambian adults in the community.


PIP: Chronic diarrhea is a common clinical presentation of HIV infection worldwide and a major cause of mortality in cohorts of HIV-infected African children. Findings are presented from a study of HIV-1 seroprevalence among Zambian patients presenting to George Health Center, a community-based health center northwest of center Lusaka, with acute diarrhea during March-April 1994. 256 patients with diarrhea and 140 apparently healthy controls participated in the study. Of the patients with diarrhea, 161 were under 16 years old and 95 were adults. 147 (91%) of the children with diarrhea were under age 6 years. Overall, 81 of the 256 (32%) patients with diarrhea were HIV-1-seropositive. Excluding results from infants under age 18 months who may have had maternal anti-HIV-1 antibodies, 64 of 172 (37%) patients with diarrhea were HIV-seropositive. Among children aged 18 months to 5 years, 14 of 63 (22%) were HIV-1-seropositive compared with 8 of 62 (13%) without diarrhea. 49 of 95 adults with acute diarrhea were HIV-1-seropositive compared with 10 of 44 healthy adult controls. No significant differences were found in HIV-1 seroprevalence rates between males and females in all age groups. These data point to a close association between acute diarrhea and HIV seropositivity in this research setting.


Subject(s)
Diarrhea/complications , HIV Seropositivity/complications , HIV Seropositivity/epidemiology , HIV Seroprevalence , HIV-1 , Acute Disease , Adolescent , Adult , Case-Control Studies , Child , Child, Preschool , Community Health Centers , Humans , Infant , Infant, Newborn , Middle Aged , Zambia/epidemiology
19.
Salud Publica Mex ; 41(4): 263-70, 1999.
Article in English | MEDLINE | ID: mdl-10624137

ABSTRACT

OBJECTIVE: Determine the impact of dietary risk factors on patterns of infection by heat labile toxin-producing Escherichia coli (LT-ETEC). MATERIALS AND METHODS: Ninety-eight infants were followed from birth for one year in Guadalajara, Mexico, beginning in august of 1986. Stool and breast milk samples were collected weekly from infants and their mothers, respectively. Mothers were also interviewed on a weekly basis regarding the health of the infants. Parametric hazard models were fit to durations of different LT-ETEC disease states determined through the analysis of stools. The child's consumption of supplemental foods and liquids as well as specific levels of LT-ETEC-specific breast milk antibodies were included in each model as time-varying covariates. RESULTS: The hazard of LT-ETEC asymptomatic infection increased 400 percent among children who received oats gruel (hazard rate = 4.01; 95% CI 2.77-5.24). The duration of infection was reduced if the child had had a previous LT-ETEC diarrheal episode (2.12; 95% CI 1.74-2.49) but was prolonged if the child consumed herbal teas (0.53; 95% CI 0.27-0.7). Herbal teas and high LT-ETEC-specific breast milk antibody levels each reduced the hazard of symptomatic infection by ninety percent. Symptomatic episodes became asymptomatic more rapidly if a child was given rice water. CONCLUSIONS: Specific weaning foods increase the risk of infection. Breastmilk antibodies and liquid infusions reduce diarrheal disease and infection duration.


Subject(s)
Breast Feeding , Diarrhea, Infantile/epidemiology , Escherichia coli Infections/epidemiology , Feeding Methods , Infant Food , Breast Feeding/statistics & numerical data , Diarrhea, Infantile/etiology , Diarrhea, Infantile/microbiology , Escherichia coli/isolation & purification , Escherichia coli Infections/etiology , Escherichia coli Infections/microbiology , Feces/microbiology , Feeding Methods/statistics & numerical data , Humans , Infant , Infant Food/statistics & numerical data , Infant, Newborn , Mexico/epidemiology , Milk, Human/microbiology , Proportional Hazards Models , Risk Factors , Time Factors
20.
Digestion ; 59(6): 708-14, 1998.
Article in English | MEDLINE | ID: mdl-9813398

ABSTRACT

BACKGROUND/AIMS: Bacterial enteropathogens, the major cause of travelers' diarrhea, are customarily treated with antibacterial drugs. Rifaximin, a nonabsorbed antimicrobial was examined as treatment for travelers' diarrhea. METHODS: A randomized, prospective, double-blind clinical trial was carried out in 72 US adults in Mexico. Patients with acute diarrhea received one of three doses of rifaximin (200, 400 and 600 mg t.i.d.) or trimethoprim/sulfamethoxazole (TMP/SMX, 160 mg/800 mg b.i.d.) for 5 days. Results were compared with data from 2 placebo-treated historical control populations. RESULTS: The shortest duration of treated diarrhea was seen in the group receiving 200 mg rifaximin t. i.d (NS). Clinical failure to respond to treatment occurred in 6 of 55 (11%) rifaximin-treated subjects versus 5 of 17 (29%) of TMP/SMX-treated subjects (NS). Sixteen of twenty (80%) of the enteropathogens isolated from the rifaximin-treated subjects and 7 of 7 (100%) from the TMP/SMX group were eradicated by treatment (NS). Sixteen of twenty-four (67%) enteropathogens identified were susceptible to TMP and all 24 were inhibited by

Subject(s)
Anti-Bacterial Agents/therapeutic use , Diarrhea/drug therapy , Intestinal Absorption/drug effects , Rifamycins/therapeutic use , Travel , Acute Disease , Adolescent , Adult , Bacterial Infections/complications , Bacterial Infections/drug therapy , Bacterial Infections/metabolism , Diarrhea/metabolism , Diarrhea/microbiology , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Rifamycins/pharmacokinetics , Rifaximin , Sulfamethoxazole/therapeutic use , Trimethoprim/therapeutic use
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