ABSTRACT
Despite intense international attention and efforts to reduce its incidence, Clostridium difficile infection (CDI) remains a significant concern for patients, clinicians, and healthcare organizations. It is costly for payers and disabling for patients. Furthermore, recurrent CDI is particularly difficult to manage, resulting in excess mortality, hospital length of stay, and other healthcare resource use. A greater understanding of the role of the gut microbiome has emphasized the importance of this diverse community in providing colonization resistance against CDI. The introduction of fidaxomicin, which has limited effect on the microflora has improved clinical outcomes in relation to disease recurrence. There are a number of other new agents in development, which appear to have a narrow spectrum of activity whilst exerting minimal effect on the microflora. Whilst the role of these emerging agents in the treatment of CDI is presently unclear, they appear to be promising candidates.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Clostridium Infections/drug therapy , Drugs, Investigational/therapeutic use , Gastrointestinal Microbiome/drug effects , Therapies, Investigational , Anti-Bacterial Agents/pharmacology , Clinical Trials as Topic , Clostridioides difficile/genetics , Clostridioides difficile/isolation & purification , Clostridium Infections/microbiology , Clostridium Infections/prevention & control , Clostridium Infections/transmission , Drug Administration Schedule , Drugs, Investigational/pharmacology , Environmental Microbiology , Humans , Intention to Treat Analysis , Meta-Analysis as Topic , Multicenter Studies as Topic , Observational Studies as Topic , Pragmatic Clinical Trials as Topic , Randomized Controlled Trials as Topic , RecurrenceABSTRACT
The current trend is to allow coeliac disease (CD) patients to introduce oats to their gluten free diet. We sought further data from the clinical setting with regards to oats consumption by coeliac patients. Several oat products were tested for wheat contamination using a commercial enzyme linked immunoassay (ELISA) kit, and six samples were examined by an ELISA using a cocktail of monoclonal antibodies, mass spectrometry, and western blot analysis. Nineteen adult CD patients on a gluten free diet were challenged with 50 g of oats per day for 12 weeks. Serological testing and gastroduodenoscopy was performed before and after the challenge. Biopsies were scored histologically and levels of mRNA specific for interferon gamma were determined by reverse transcription-polymerase chain reaction analysis. Oats were well tolerated by most patients but several reported initial abdominal discomfort and bloating. One of the patients developed partial villous atrophy and a rash during the first oats challenge. She subsequently improved on an oats free diet but developed subtotal villous atrophy and dramatic dermatitis during a second challenge. Five of the patients showed positive levels of interferon gamma mRNA after challenge. Some concerns therefore remain with respect to the safety of oats for coeliacs.
Subject(s)
Avena/adverse effects , Celiac Disease/pathology , Adult , Atrophy , Blotting, Western/methods , Celiac Disease/metabolism , Diet, Protein-Restricted/methods , Enzyme-Linked Immunosorbent Assay/methods , Female , Glutens/administration & dosage , Glutens/analysis , Humans , Interferon-gamma/analysis , Intestinal Mucosa/pathology , Intestine, Small/pathology , Male , Microvilli/pathology , Middle Aged , RNA, Messenger/analysis , Reverse Transcriptase Polymerase Chain Reaction/methodsABSTRACT
The "facultative" sewage-stabilization pond was investigated with respect to transmission of S. mansoni. The results of field and laboratory experiments suggest that the ecologic factors i.e., physical and chemical play important roles in a combined interplay affecting the hatchability of S. mansoni eggs, infectivity of miracidia of S. mansioni and the potential existence of the planorbid snails host, B. glabrata. The results seem to indicate the successful reduction of S. mansoni transmission in the pond itself. If the pond is designed properly in terms of depth, detention time, etc., it will serve as an efficient barrier for transmission of S. mansoni. It is expected that the same would be true for other human schistosomes.
Subject(s)
Biomphalaria/parasitology , Schistosoma mansoni/growth & development , Sewage , Animals , Biomphalaria/growth & developmentABSTRACT
Laboratory experiments were conducted to evaluate the role of the guppy, Lebistes reticulatus (Peters, 1859), as an active predator on Schistosoma mansoni miracidia. When five guppies were introduced into 3.5 liters of water containing 500 and 1200 miracidia on two corresponding tests, a dramatic reduction in number of miracidia was observed. In one experiment, no miracidia could be found after 60 minutes of exposure. The infection rates of vector snails, Biomphalaria glabrata, exposed to approximately 3000 miracidia in the presence of guppies were also greatly reduced. The results obtained suggest that L. reticulatus is a probable predator of S. mansoni miracidia and may, under field conditions, play an important role as a limiting or interfering factor in the transmission of S. mansoni.
