Hospitalizaciones por diarrea con sangre en un centro pediátrico de referencia en Uruguay / Hospitalizations due to bloody diarrhea in a pediatric reference center in Uruguay / Internações por diarreia sanguinolenta em um centro de referência pediátrica no Uruguai

Introducción: La diarrea con sangre es un motivo frecuente de admisión hospitalaria en niños, con gastroenteritis aguda; en la mayoría de los casos se tratan de infecciones leves y autolimitadas, pero pueden producirse complicaciones graves. Objetivos: Describir la etiología y características clínico- evolutivas de los niños menores de 15 años hospitalizados por diarrea con sangre en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell entre los años 2012- 2023. Materiales y métodos: Estudio retrospectivo mediante revisión de historias y registros de laboratorio. Variables: demográficas, estado nutricional, hidratación, motivos de hospitalización, ingreso unidades de cuidados intensivos (UCI), enteropatógenos, tratamientos, evolución. Resultados: Se incluyeron 229 niños, mediana de edad de 8 meses; sexo masculino 61%; eutróficos 88%, bien hidratados 55%, con comorbilidades 11%, prematurez 6,5%. El motivo de hospitalización fue diarrea con sangre/disentería sin otro síntoma 45%. Se solicitó coprovirológico/coprocultivo en 98% y detección por técnicas de ácidos nucleicos en materia fecal 5,2%. Se identificó al menos un agente patógeno en 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecciones en 12%. Se indicaron antibióticos a 86%; ceftriaxona 62%, azitromicina 35%. Ingresaron a UCI 6,5% (15), presentaron complicaciones 10/14, fallo renal agudo 5 y alteraciones del medio interno 3. La mayoría presentó buena evolución. Conclusiones: La diarrea con sangre/disentería continúa siendo una causa importante de hospitalización afectando en su mayoría a niños sanos menores de 5 años. Los patógenos detectados con mayor frecuencia fueron bacterias principalmente Shigella sp., Salmonella sp. y E coli diarreogénicas. Se reportó alta prescripción de antibióticos, cumpliendo en la mayoría de los casos con las recomendaciones.

Introduction: Bloody diarrhea is a common reason for hospital admission in children with acute gastroenteritis; In most cases these are mild and self-limiting infections, but serious complications can occur. Goals: To describe the etiology and clinical-evolutionary characteristics of children under 15 years of age hospitalized for bloody diarrhea at the Pediatric Hospital, Centro Hospitalario Pereira Rossell between the years 2012-2023. Materials and methods: Retrospective study through review of histories and laboratory records. Variables: demographics, nutritional status, hydration, reason for hospitalization, intensive care unit (ICU) admission, enteropathogens, treatments, evolution. Results: 229 children were included, median age 8 months; male sex 61%; eutrophic 88%, well hydrated 55%, with comorbidities 11%, prematurity 6.5%. The reason for hospitalization was bloody diarrhea/dysentery without other symptoms 45%. Coprovirological/coproculture was requested in 98% and detection by nucleic acid techniques in fecal matter was requested in 5,2%. At least one pathogenic agent was identified in 34,3%: Shigella sp. 38%; Salmonella sp 19,5%; coinfections in 12%. Antibiotics were indicated for 86%; ceftriaxone 62%, azithromycin 35%. Were admitted to the ICU 6,5% (15), 10/14 had complications, 5 had acute kidney failure and 3 had alterations in the internal environment. The majority had a good evolution. Conclusions: Bloody diarrhea/dysentery continues to be an important cause of hospitalization, affecting mostly healthy children under 5 years of age. The most frequently detected pathogens were bacteria, mainly Shigella sp., Salmonella sp. and diarrheagenic E coli. High prescription of antibiotics was reported, complying in most cases with the recommendations.

Introdução: A diarreia com sangue é um motivo comum de internação hospitalar em crianças com gastroenterite aguda; Na maioria dos casos, estas são infecções leves e autolimitadas, mas podem ocorrer complicações graves. Metas: Descrever a etiologia e as características clínico-evolutivas de crianças menores de 15 anos internadas por diarreia sanguinolenta no Hospital Pediátrico Centro Hospitalario Pereira Rossell entre os anos de 2012-2023. Materiais e métodos: Estudo retrospectivo por meio de revisão de histórias e registros laboratoriais. Variáveis: dados demográficos, estado nutricional, hidratação, motivo da internação, internação em unidade de terapia intensiva (UTI), enteropatógenos, tratamentos, evolução. Resultados: foram incluídas 229 crianças, mediana de idade 8 meses; sexo masculino 61%; eutrófico 88%, bem hidratado 55%, com comorbidades 11%, prematuridade 6,5%. O motivo da internação foi diarreia sanguinolenta/disenteria sem outros sintomas 45%. O estudo coprovirologico/coprocultivo foi solicitado em 98% e a detecção por técnicas de ácidos nucleicos em matéria fecal foi solicitada em 5,2%. Pelo menos um agente patogênico foi identificado em 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecções em 12%. Os antibióticos foram indicados para 86%; ceftriaxona 62%, azitromicina 35%. Foram internados em UTI 6,5% (15), 10/14 apresentaram complicações, 5 tiveram insuficiência renal aguda e 3 apresentaram alterações no meio interno, a maioria teve boa evolução. Conclusões: A diarreia/disenteria com sangue continua a ser uma causa importante de hospitalização, afetando sobretudo crianças saudáveis ​​com menos de 5 anos de idade. Os patógenos mais frequentemente detectados foram bactérias, principalmente Shigella sp., Salmonella sp. e E. coli diarreiogênica. Foi relatada elevada prescrição de antibióticos, cumprindo na maioria dos casos as recomendações.

Manual de Monitoramento das Doenças Diarreicas Agudas - MDDA / Manual for Monitoring Acute Diarrheal Diseases - MADD

Neste manual serão abordados: orientações para a notificação dos casos individuais e surtos de doenças diarreicas, bem como implantação da MDDA e utilização do Sistema Informatizado de Vigilância Epidemiológica de Doenças Diarreicas Agudas (Sivep-DDA); conceitos acerca das DDA, recomendações, medidas de prevenção e manejo adequado dos casos; materiais e ferramentas utilizados na investigação das DDA no Estado do Rio Grande do Sul (RS). (AU)

Presencia de Escherichia coli en la playa Pucusana, Lima, y su potencial efecto en la salud pública / Presence of by Escherichia coli in Pucusana Beach, Lima and its potential effect on public health

RESUMEN Objetivo: Determinar los valores de la bacteria e indicador fecal Escherichia coli (EC) para aguas de mar de uso seguro y recreacional de la playa Pucusana, Lima. Materiales y Métodos: Las campañas de muestreos se realizaron una vez por semana en el estío del 2019 y fueron procesados en el Laboratorio de Microbiología de la FCB de la Universidad Ricardo Palma mediante colimetría y el método del número más probable (NMP). Resultados: Se comprobó la presencia de EC en todas las muestras analizadas, con valores promedio superiores a 1000 NMP/100 ml. en todas las muestras recogidas. Diez cepas fueron enviadas al INS que determinó que no existe ningún serotipo patogénico, y de acuerdo con regulación peruana la calificación es inaceptable. Conclusiones: Se demuestra la carencia de salubridad ambiental y su relevancia en salud pública. Los factores de riesgo son producidos principalmente por la producción y vertido de las aguas residuales llevados por los colectores al mar y aunque una importante proporción de estas aguas son procesadas en la Planta de Tratamiento de Aguas Residuales PTAR Pucusana se identificaron vertimientos domésticos y municipales que descargan al Pacífico, problemática que debe tener un buen manejo y fiscalización ambiental porque deteriora el medio ambiente sobre todo los mares.

ABSTRACT Objective: To determine the values o f the bacteria and fecal indicator Escherichia coli (EC) for seawater of safe and recreational use of the Pucusana beach, Lima. Materials and Methods: The campaigns of samplings were carried out once a week in the summer of 2019 and were processed in the microbiology laboratory of the Faculty of Biological Sciences (FCB) of the Ricardo Palma University using colimetry and the method of the most probable number (NMP). Results: The presence of EC was verified in all the analyzed samples, with average values higher than 1000 MPN/100 ml. in all collected samples. Conclusions: The lack of environmental health and its relevance in public health is demonstrated. The risk factors are produced mainly by the production and discharge of wastewater. residuals carried by the collectors to the sea and although an important proportion of these waters are processed at the PTAR Pucusana Wastewater Treatment Plant. Domestic and municipal discharges that discharge into the Pacific were identified, a problem that must have good management and environmental control because it deteriorates the environment and the seas.

Laboratory-based surveillance of Shigella spp. from human clinical cases in Colombia, 1997-2018 / Vigilancia por el laboratorio de Shigella spp. aislada de casos clínicos humanos en Colombia, 1997-2018

Abstract | Introduction: Shigellosis is endemic in low-and middle-income countries, causing approximately 125 million episodes of diarrhea and leading to approximately 160.000 deaths annually one-third of which is associated with children. Objective: To describe the characteristics and antimicrobial resistance profiles of Shigella species recovered in Colombia from 1997 to 2018. Materials and methods: We received isolates from laboratories in 29 Colombian departments. We serotyped with specific antiserum and determined antimicrobial resistance and minimal inhibitory concentrations for ten antibiotics with Kirby-Bauer tests following the Clinical and Laboratory Standards Institute recommendations. Results: We analyzed 5,251 isolates of Shigella spp., most of them obtained from stools (96.4%); 2,511 (47.8%) were from children under five years of age. The two most common species were S. sonnei (55.1%) and S. fbxneri (41.7%). The highest resistance rate was that of tetracycline (88.1%) followed by trimethoprim-sulfamethoxazole (79.3%) and ampicillin (65.5%); 50.8% of isolates were resistant to chloramphenicol, 43.6% to amoxicillin/clavulanic acid, and less than 1% to cefotaxime, ceftazidime, gentamicin, and ciprofloxacin. In S. sonnei, the most common resistance profile corresponded to trimethoprim-sulfamethoxazole (92%) whereas in S. fbxneri the most common antibiotic profiles were multidrug resistance. Conclusions. In Colombia, children under five years are affected by all Shigella species. These findings should guide funders and public health officials to make evidence-based decisions for protection and prevention measures. The antimicrobial resistance characteristics found in this study underline the importance of combating the dissemination of the most frequently isolated species, S. sonnei and S. ftexneri.

Resumen | Introducción. La shigelosis es endémica en los países de ingresos bajos y medios y ocasiona aproximadamente 125 millones de episodios de diarrea y 160.000 muertes al año, un tercio de los cuales se presenta en niños. Objetivo. Describir las características y los perfiles de resistencia antimicrobiana en aislamientos de Shigella spp. recuperados en Colombia entre 1997 y 2018. Materiales y métodos. Los aislamientos provenían de laboratorios en 29 departamentos de Colombia. La serotipificación se hizo con antisueros específicos de Shigella spp. y, la determinación de los perfiles de resistencia y la concentración inhibitoria mínima de diez antibióticos, por Kirby-Bauer. Resultados. Se estudiaron 5.251 aislamientos de Shigella spp. obtenidos de materia fecal (96,4 %); el 47,8 % de ellos correspondía a niños menores de cinco años. Las especies más frecuentes fueron S. sonnei (55,1 %) y S. ftexneri (41,7 %). Se presentó resistencia a tetraciclina (88,1 %), trimetoprim-sulfametoxasol (79,3 %), ampicilina (65,5 %), cloranfenicol (50,8 %) y amoxicilina-acido clavulánico (43,6 %). La resistencia no superó el 1 % contra cefotaxime, ceftazidima, gentamicina y ciprofloxacina. Para S. sonnei, el perfil de resistencia más frecuente correspondió a trimetoprim-sulfametoxasol, en contraste con S. ftexneri, cuyos perfiles fueron todos multirresistentes. Conclusiones. Los niños menores de cinco años se vieron afectados por todas las especies de Shigella spp., aspecto que los legisladores en salud pública deben considerar a la hora de tomar decisiones en torno a las medidas de prevención y protección frente a esta enfermedad. Las características de resistencia antimicrobiana de los aislamientos de Shigella spp. en Colombia ponen de manifiesto la importancia de combatir la diseminación de las dos especies más frecuentes en casos clínicos, S. sonnei y S. ftexneri.

Colitis amebiana necrosante, presentación de un caso / Necrotizing amebian colitis, case report

Resumen Introducción: La Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS) han definido la amebiasis como la infección por Entamoeba histolytica, independientemente de los síntomas. La colitis amebiana necrosante es una forma rara de amebiasis que se asocia con una alta morbilidad y mortalidad. Caso clínico: Presentamos a un paciente femenino de 68 años, con antecedentes de diabetes mellitus tipo 2, con colitis amebiana necrosante con múltiples perforaciones, que fue sometida a una hemicolectomía derecha con íleo-transverso anastomosis. Conclusiones: Se necesitan intervenciones efectivas para prevenir la colitis amebiana y terapias adicionales para tratar la colitis amebiana fulminante y mejorar los resultados.

Abstract Background: Amebiasis has been defined by World Health Organization (WHO) and Pan American Health Organization (PAHO) as the infection with Entamoeba histolytica regardless of symptoms. Necrotizing amoebic colitis is a rare clinical form of amebosis that is associated with high morbidity and mortality. Case Report: We present a 68-years-old-female patient with necrotizing amoebic colitis with multiple perforations who survived after right hemicolectomy with ileus-transverse anastomosis. Conclusions: Effective interventions to prevent amebic colitis, and additional therapies to treat fulminant amebic colitis are needed to improve outcomes.

Acute diarrhea with blood: diagnosis and drug treatment / Diarreia aguda com sangue: diagnóstico e tratamento medicamentoso

Abstract Objective To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy. Sources of Data A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review. Synthesis of Data Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines. Conclusions Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost-effective preventative measure in future.

Resumo Objetivo Reiterar a importância epidemiológica da Shigella na diarreia aguda com sangue, fornecer uma visão geral do tratamento e ressaltar a necessidade da correta indicação da antibioticoterapia. Fontes dos dados Realizada pesquisa nos bancos de dados Medline e Scopus, além de documentos científicos e diretrizes da Organização Mundial da Saúde, com a identificação de artigos de revisão e artigos originais considerados relevantes para fundamentar a revisão do tipo narrativa. Síntese dos dados Diferentes patógenos têm sido associados à diarreia aguda com sangue, a Shigella é o mais frequente. As manifestações da shigelose em indivíduos saudáveis são geralmente de intensidade moderada e desaparecem em poucos dias. Pode haver progressão para disenteria franca com sangue e muco, dor em abdome inferior e tenesmo. A coprocultura bacteriana convencional é o padrão-ouro para o diagnóstico etiológico, porém novos testes moleculares foram desenvolvidos, os quais permitem ao médico iniciar tratamento antibacteriano direcionado, sanar uma grande preocupação atual, devido à crescente resistência da Shigella. Estratégias de prevenção incluem aleitamento, medidas de higiene, educação em saúde, tratamento da água e o potencial uso de vacinas. Conclusões A diarreia aguda é uma importante causa de mortalidade em crianças com menos de cinco anos e a shigelose é a principal causa de diarreia aguda com sangue em todo o mundo. A preocupação atual é o aumento da resistência microbiana aos antibióticos preconizados, o que traz uma dificuldade adicional ao manejo terapêutico. Embora ainda não exista vacina disponível para Shigella, várias candidatas estão em fase de testes clínicos, podem futuramente ser a medida preventiva mais custo-efetiva.

Uso de probióticos en el tratamiento y la prevención de diarrea aguda en niños / Probiotics to prevent and treat acute diarrhea in children / Probióticos para o tratamento e prevenção da diarréia aguda em criancas

Resumen: El principio del uso de probióticos proviene de la utilización de productos fermentados, desde tiempos muy antiguos. Se definen como microorganismos vivos, que administrados en cantidades adecuadas, confieren beneficios para la salud. Entre las utilidades atribuidas a los probióticos, las más extensamente estudiadas han sido los efectos en niños con diarrea aguda. Existe abundante bibliografía sobre la utilización de estos productos en el tratamiento y la prevención de diarrea aguda infecciosa, y prevención de diarrea nosocomial y de diarrea asociada al uso de antibióticos. Los estudios son heterogéneos en su metodología y muestran resultados dispares, incluso contradictorios. En la interpretación de éstos es imprescindible tener en cuenta las cepas de probióticos utilizadas, las dosis administradas y las características de los pacientes en quienes fueron probadas. Existe evidencia del beneficio de algunas cepas de probióticos en el tratamiento y la prevención de diarrea aguda en niños. Varias guías de práctica clínica los recomiendan. En Uruguay existe poca oferta de estos productos, y la información disponible es escasa, lo cual dificulta su prescripción segura. Se revisa en este documento la evidencia científica publicada sobre el uso de probióticos en niños con diarrea aguda.

Summary: Probiotics from fermented products have been used since ancient times. They are living microorganisms, which, at appropriate levels, can provide health benefits. Among the benefits of probiotics, the most broadly studied has been the effect on children with acute diarrhea. There is extensive literature regarding the use of probiotics for the treatment and prevention of acute infectious diarrhea, for the prevention of nosocomial diarrhea and for antibiotic-caused diarrhea. The studies show heterogeneous methodologies and mixed results, even contradictory. For their interpretation, it is essential to take into account the probiotic strains used, the doses administered and the characteristics of the patients tested. There is evidence of the benefit of some probiotics strains in the treatment and prevention of acute diarrhea in children. Several Clinical Practice Guidelines recommend them. In Uruguay, there is little supply of these products, and the information available is scarce, which makes them difficult to prescribe. In the present document, we review the existing published scientific evidence regarding the use of probiotics in children with acute diarrhea.

Resumo: Os probióticos de produtos fermentados têm sido utilizados desde os tempos antigos. São microrganismos vivos que, em níveis adequados, podem proporcionar benefícios à saúde. Entre os benefícios dos probióticos, o mais amplamente estudado tem sido o efeito em crianças com diarréia aguda. Existe extensa literatura sobre o uso de probióticos para o tratamento e prevenção de diarreia infecciosa aguda, para prevenção de diarreia intra-hospitalar e diarreia causada por antibióticos. Os estudos mostram metodologias heterogêneas e resultados mistos, até contraditórios. Para sua interpretação, é essencial levar em consideração as cepas probióticas utilizadas, as doses administradas e as características dos pacientes testados. Há evidências do benefício de algumas cepas de probióticos no tratamento e prevenção de diarreia aguda em crianças. Várias diretrizes de prática clínica as recomendam. No Uruguai, há pouca oferta desses produtos e a informação disponível é escassa, o que dificulta sua prescrição. No presente documento, revisamos as evidências científicas publicadas sobre o uso de probióticos em crianças com diarreia aguda.

Epidemiological characteristics and strategies for the prevention of diarrheal disease in indigenous children: A scoping review.

AIM: The aim of the present scoping review was to map the scientific evidence about diarrheal disease in indigenous children and the strategies that can be used to prevent it. METHODS: The subject headings were indigenous population; child; diarrhea; dysentery; epidemiology; and prevention, primary; also the following keywords characteristic, epidemiologic study; and children. The databases consulted were Latin American and Caribbean Health Sciences Literature, MEDLINE via the US National Library of Medicine/National Institutes of Health, and Web of Science. Initially, 268 studies were identified, and after being screened using the eligibility criteria, six were selected. Finally, via reference tracking, five more were identified. The final sample was made up of eleven articles. RESULTS: The results confirmed higher mortality rates due to diarrheal disease among indigenous children who are socially disadvantaged and living in poor hygienic and basic sanitation conditions. Among the primary prevention strategies are basic sanitation, health education better hygiene habits, animal control, breastfeeding, supplementing the diet with zinc, vitamins, and the rotavirus vaccine. The preventive strategies included the use of oral rehydration solutions, adequate nutrition, prescribed antimicrobials, and intravenous fluid replacement with glycaemic and electrolyte correction in severe cases. CONCLUSION: In conclusion, public policies regarding the indigenous population and cross-cultural care should be strengthened. The present study confirmed that, at a global level, there is a lack of publications studying this issue.

Acute diarrhea with blood: diagnosis and drug treatment.

OBJECTIVE: To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy. SOURCES OF DATA: A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review. SYNTHESIS OF DATA: Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines. CONCLUSIONS: Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost-effective preventative measure in future.

Balantidiasis colónica: reporte de un caso fatal y revisión de la literatura

La balantidiasis es una zoonosis producida por el Balantidium coli, que habita el intestino grueso del cerdo y del hombre. La infección es infrecuente en humanos y afecta principalmente al colon. Se produce con mayor frecuencia en países en desarrollo, regiones tropicales y subtropicales. La balantidiasis colónica puede presentarse en la mayoría de los casos de forma asintomática y llegar en los casos más graves como diarrea disentérica que puede complicarse con hemorragia digestiva baja e incluso perforación. Presentamos el caso de un varón de 72 años, proveniente de la sierra peruana de ocupación agricultor y criador de ganado porcino y ovino, quién acude por 3 meses de enfermedad caracterizado inicialmente por deposiciones líquidas con moco sin sangre, dolor abdominal cólico, náuseas, vómitos y en el último mes de enfermedad presenta diarrea disentérica. Se ingresa a colonoscopía por sospecha de colitis infecciosa, encontrándose en la muestra en fresco y biopsia de tejido colónico trofozoitos de Balantidium coli. Paciente recibe tratamiento con amebicida y antibacteriano sin mejoría clínica, presentando como complicación múltiples perforaciones en colon sigmoides, tratado con resección y colostomía terminal. Finalmente, paciente fallece a pesar de recibir manejo médico y quirúrgico.

Balantidiasis is a zoonosis produced by Balantidium coli, which inhabits the large intestine of the pig and man. Infection is uncommon in humans and mainly affects the colon. It occurs more frequently in developing countries, tropical and subtropical regions. Colonic balantidiasis can occur in most cases asymptomatically and reach in the most severe cases such as dysenteric diarrhea that can be complicated by low digestive bleeding and even perforation. We present the case of a 72-year-old man, from the Peruvian highlands, who was a farmer and breeder of swine and sheep, who came for 3 months of illness, initially characterized by liquid stools with bloodless mucus, abdominal pain, nausea, vomiting and in the last month of illness he presents dysenteric diarrhea. Colonoscopy was performed due to suspicion of infectious colitis, Balantidium coli trophozoites were found in the fresh sample and colonic tissue biopsy. Patient receives treatment with amebicide and antibacterial without clinical improvement, presenting as a complication multiple perforation in the sigmoid colon, treated with resection and terminal colostomy. Finally, the patient died despite receiving medical and surgical treatment.

Dysentery by CTX-M Type ESBL Producing Shigella flexneri / Disentería por Shigella flexneri productora de BLEE tipo CTX-M

According to the World Health Organization, diarrheal infections cause 525 000 deaths of children under five years of age every year, and shigellosis. Shigellosis is a relevant cause of dysentery, which increases the morbidity and mortality in pediatric patients. Therefore, emergingthe emergence of antimicrobial resistant strains of Shigella is a concerningworrisome problem worldwide. We report the case of a 7-year-old patient with acute dysentery caused by CTX-M Type ESBL Producing Shigella flexneri, being. This was the first case treated in the Specialties Hospital of Specialties of the Armed Forces N°1, in Quito, Ecuador. The antibiogram demonstrated sensibilityshowed sensitivity to ampicillin-sulbactam. As a result, after five days of microbiologically directed treatment, the patient improved his condition without relapse. Proper clinical diagnoses and accurate laboratory studies like stool culture and antibiogram are crucial to givingindicate an appropriate therapy in infections caused by Shigella and other enteric bacilli(AU)

Según la Organización Mundial de la Salud, las infecciones diarreicas provocan 525 000 muertes de niños menores de cinco años de edad cada año. La shigelosis es una causa importante de disentería que aumenta la morbilidad y mortalidad de los pacientes pediátricos. Es por eso que el surgimiento de cepas de Shigella resistentes a los antibióticos es un preocupante problema a nivel mundial. Presentamos el caso de un paciente de 7 años de edad con disentería aguda provocada por Shigella flexneri productora de BLEE tipo CTX-M. Se trata del primer caso tratado en el Hospital de Especialidades de las Fuerzas Armadas Nº 1, en Quito, Ecuador. El antibiograma mostró sensibilidad a la combinación ampicilina/sulbactam. Al cabo de cinco días de tratamiento microbiológico, el paciente mejoró su estado y no se produjeron recaídas. Un diagnóstico clínico correcto, así como estudios precisos de laboratorio como los cultivos de heces y los antibiogramas, son vitales para indicar una terapia apropiada en las infecciones causadas por Shigella y otros bacilos entéricos(AU)

Entamoeba histolytica como causa de diarreia crônica / Entamoeba histolytica as a cause of chronic diarrhea / Entamoeba histolytica como causa de diarrea crónica

A diarreia crônica, caracterizada pela presença de mais de três dejeções de consistência pastosa durante pelo menos quatro semanas, é frequentemente encontrada na prática clínica. Na diarreia crônica, a probabilidade de uma etiologia infecciosa é baixa, sendo as causas funcionais, inflamatórias, osmóticas ou secretórias mais comuns. A amebíase intestinal é uma causa de diarreia crônica, causada pelo protozoário Entamoeba histolytica, sendo comum e prevalente em países em desenvolvimento. Pode ter várias formas de apresentação, sendo na maioria dos casos assintomática. Apresenta-se o caso clínico de um paciente de 27 anos, sexo masculino, raça caucasiana, homem que pratica sexo com homens (HSH), com diarreia crônica com início há cerca de seis anos. O exame objetivo não revelava alterações. Realizou exame parasitológico de fezes, com isolamento de quistos de Entamoeba histolytica. Foi medicado com metronidazol e paromomicina com resolução clínica do quadro. É importante para o Médico de Família equacionar esta etiologia na investigação de pacientes com diarreia, para um correto e atempado diagnóstico e tratamento, de modo a evitar exames desnecessários, possíveis complicações, a transmissão do agente e um grave problema de saúde pública.

Chronic diarrhea, characterized by the presence of more than three loose stools for at least four weeks, is often found in clinical practice. In chronic diarrhea, the probability of an infectious etiology is low, having usually a functional, inflammatory, osmotic or secretory origin. Intestinal amebiasis is a cause of chronic diarrhea, caused by the protozoan Entamoeba histolytica, common and prevalent in developing countries. It can have different presentations but most patients are asymptomatic. We present a 27-year-old Caucasian male, man who have sex with men (MSM), with chronic diarrhea starting six years ago. The physical exam was normal. A parasitological stool examination was performed with isolation of cysts of Entamoeba histolytica. He was treated with metronidazole and paromomycin with clinical resolution. It is important for General Practice to address this etiology in the investigation of patients with diarrhea for a correct and timely diagnosis and treatment, to avoid unnecessary testing, possible complications, transmission of the agent and a serious public health problem.

La diarrea crónica, caracterizada por la presencia de más de tres heces de consistencia blanda durante al menos cuatro semanas, es frecuentemente encontrada en la práctica clínica. En la diarrea crónica, la probabilidad de una etiología infecciosa es baja, siendo las causas funcionales, inflamatorias, osmóticas o secretoras más comunes. La amebiasis intestinal es una causa de diarrea crónica, causada por el protozoario Entamoeba histolytica, siendo común y prevalente en los países en desarrollo. Puede tener varias formas de presentación, siendo en la mayoría de los casos asintomática. Presentamos un paciente de 27 años, sexo masculino, caucásico, hombre que tiene sexo con hombres (HSH), con diarrea crónica con inicio hace cerca de seis años. El examen objetivo no reveló alteraciones. Realizó un examen parasitológico de heces, con aislamiento de quistes de Entamoeba histolytica. Fue medicado con metronidazol y paromomicina con resolución clínica del cuadro. Es importante para el médico de familia considerar esta etiología en la investigación de pacientes con diarrea, para un correcto y oportuno diagnóstico y tratamiento, de modo a evitar, exámenes innecesarios, posibles complicaciones, la transmisión del agente y un grave problema de salud pública.

Eficacia de racecadotrilo en el tratamien-to de la enfermedad diarreica aguda, en niños de 3 a 36 meses, en el servicio de emer-gencia del Hospital Vicente Corral Mos-coso. Ensayo clínico controlado ciego. 2014 / Racecadotril effectiveness in the treatment of acute diarrhea in chil-dren from 3 to 36 months. Emergency department, Hospital Vicente Corral Mosocoso. Blind clinical controlled trial. 2014

Objetivo:Determinar la eficacia del tratamiento combinado de sales de rehidratación oral (SRO) y racecadotrilo frente al uso de SRO y placebo en los niños de 3 a 36 meses con enfermedad diarreica aguda (EDA), en el Servicio de Emergencia del Hospital Vicente Corral Moscoso (HVCM). Método:Ensayo clínico controlado ciego, en niños de 3 a 36 meses del servicio de emergencia del HVCM, con cuadro de enfermedad diarreica aguda, sin deshidratación o con deshidratación leve o moderada, que no necesiten hos-pitalización, sin tratamiento antidiarreico o antibiótico previo, cuyos padres o representantes legales firmen el consentimiento informado. Se reclutaron 79 pacientes, 45 en el grupo SRO más racecadotrilo y 34 grupo SRO más placebo. Resultados:Los grupos fueron comparables clínicamente, los pacientes del grupo SRO más racecadotrilo mostraron una diferencia significativa en el número de diarreas por día a partir de las 48 horas [2.7 (DS: ±1.5), grupo SRO más pla-cebo 4.1 (DS: ±2,6)] con una p: 0.012; a las 72 horas, el grupo racecadotrilo [2.2 (DS: ±1.7), y grupo placebo 3.3 (DS: ±2,5)] con p: 0.027. No se encontró diferencia significativa en las primeras 24 horas (p: 0.27). Conclusiones:Racecadotrilo es un medicamento eficaz en disminuir el número de diar-reas a partir de las 48 horas, en el tratamiento inicial de niños con EDA, acompañando a la terapia con SRO en un grupo de pacientes atendidos en el Hospital Vicente Corral Moscoso.

Objective:To determine the efficacy of the combined treatment of oral rehydration salts (ORS) and racecadotril against the use of ORS and placebo in children aged between 3 and 36 months with acute diarrhea disease (ADD), in the Vicente Corral Moscoso Hospital (VCMH) emergency service. Method:It is a blind controlled clinical trial in children from 3 to 36 months of the VCMH emergency service, with acute diarrheic disease, without dehydration or mild or moderate dehydration; they do not need hospitalization, without previous antidiarrheal treatment or antibiotic, if their parents or legal representatives sign the informed consent. A total of 79 patients were recruited, 45 in the ORS plus racecadotril group and 34 ORS plus placebo group. Results:The groups were clinically comparable, the patients in the ORS plus racecadotril group showed a significant difference in the number of diarrheas per day from 48 hours [2.7 (DS: ± 1.5), the ORS plus placebo group 4.1 (DS: ± 2.6)] with a p: 0.012; at 72 hours, the racecadotril group [2.2 (DS: ± 1.7), and placebo group [3.3 (DS: ± 2.5)] with p: 0.027. No significant difference was found in the first 24 hours (p: 0.27). Conclusions:Racecadotril is an effective medication to reduce the number of diarrhea after 48 hours, in the initial treatment of children with ADD accompanying ORS therapy in a group of patients treated at the Vicente Corral Moscoso Hospital.

Aspectos clínicos y epidemiológicos de las enfermedades diarreicas agudas secretoras. Hospital General Docente "Juan B. Viñas González". 2014 / Clinical and epidemiological aspects of acute diarrheal secretory diseases. General Hos-pital "Juan B. Viñas González". 2014

Se realizó un estudio observacional, descriptivo, de corte transversal, con una población de estudio compuesta por 634 pacientes pediátricos con cuadro de diarrea aguda secretoria, que fueron ingresados en el Hospital General Docente "Juan B. Viñas González" de Palma Soria-no, Cuba, durante el período enero-diciembre, 2014. Los resultados arrojaron un predominio del rango de edades de 1 a 4 años, para un 30.4%; la mayoría de ellos, residentes en zonas rurales (64.5%), donde la calidad del agua de consumo no era la adecuada (46.8%) y la dispo-sición de las excretas tenían deficiencias en un 45.1% de los casos. Los síntomas predomi-nantes fueron fiebre y vómitos para un 47.4% y 45 % respectivamente y los signos fueron: los ojos hundidos en un 57.4% y sequedad de las mucosas (45.1%), como complicaciones se reportó: la deshidratación con 55.2%, la hipoglucemia (50.9%) y la acidosis metabólica (34.9%), presentando en ocasiones, un niño más de una complicación, lo que motivó un 35% de ingresos en los servicios de cuidados progresivos; sin embargo, no hubo fallecidos por esta causa en el tiempo estudiado.

An observational, descriptive, and cross-sectional study was carried out. 634 pediatric patients with acute diarrhea were the study population who were admitted to the General Hospital "Juan B. Viñas González" of Palma Soriano, Cuba, during the period January-De-cember 2014. The results showed a predominance of the age range between 1 and 4 years (30.4%); most of them, residents in rural areas (64.5%) where the quality of drinking water was not adequate (46.8%) and the disposal of excreta were deficient in 45.1% of cases. The predominant symptoms were fever and vomiting 47.4% and 45% respectively and the signs were: the sunken eyes (57.4%) and dryness of the mucous membranes (45.1%). There were some complications such as: dehydration (55.2%), hypoglycaemia (50.9%) and metabolic acidosis (34.9%); it was sometimes presented a child with more than one complication, which motivated a 35% of income in the progressive care services. However, there were no deaths due to this cause in the time studied.

Características clinicoepidemiológicas de la enfermedad diarreica aguda por Vibrio cholerae en pacientes de hasta 10 años / Clinical epidemiological characteristics of the acute diarrheal disease due to Vibrio cholerae in patients up to 10 years

Se realizó una investigación observacional, descriptiva y transversal de 95 niños en las edades de 0 a 10 años, con diagnóstico de enfermedad diarreica aguda a causa del Vibrio cholerae, atendidos en el Hospital Infantil Norte Dr Juan de la Cruz Martínez Maceira de Santiago de Cuba, durante el 2016, a fin de caracterizarles según algunas variables clínicas y epidemiológicas. Entre los principales resultados se obtuvo que el grupo etario más afectado fuera el de 0 a 11 meses y el municipio con mayor número de casos el de Santiago de Cuba, los que correspondieron fundamentalmente a las áreas de salud de los policlínicos Frank País García, José Martí Pérez y Josué País García. Asimismo se evidenció que la principal manifestación del proceso infeccioso fue la diarrea líquida y la complicación más frecuente, la deshidratación isotónica moderada. Todos los niños egresaron vivos, lo cual demuestra la eficacia de la atención médica en el territorio suroriental de Cuba

An observational, descriptive and cross-sectional investigation of 95 children aged 0 to 10, with diagnosis of acute diarrheal disease due to Vibrio cholerae, assisted in Dr Juan de la Cruz Martínez Maceira Northern Children Hospital in Santiago de Cuba, was carried out during 2016, in order to characterize them according to some clinical and epidemiological variables. Among the predominant results there were the 0 to 11 months age group as the most affected and the presence of a higher number of cases in Santiago de Cuba municipality, that corresponded mainly to the health areas of Frank País García, José Martí Pérez and Josué País García polyclinics. Also it was evidenced that the main manifestation of the infectious process was the liquid diarrhea and the most frequent complication, the moderate isotonic dehydration. None of the children died, which demonstrates the effectiveness of medical care in the southeastern territory of Cuba

Diarrea aguda infecciosa: ¿qué debe saber un gastroenterólogo?, ¿cómo mejoramos el diagnóstico etiológico? / Acute infectious diarrhea: what should a gastroenterologist know? how do we improve the etiological diagnosis?

Acute infectious diarrhea is still a major public health problem, both in developing and developed countries, causing morbidity, mortality and high costs. Acute diarrhea particularly affects people in extrema age ranges, travelers and immunosuppressed individuals. Traditional microbiological study, based on cultures, direct microscope analysis, and antigen tests show poor performance, due to low sensitivity and specificity, slowness and the diversity of bacteria, viruses and parasites that complicate getting the results. New molecular techniques based on multiple polymerase chain reaction (PCR) kits allow for the identification, in few hours and simultaneously, of many agents, such as bacteria, viruses and parasites, with high sensitivity and specificity; which will probably transform etiological diagnosis of acute diarrhea

La diarrea aguda infecciosa continúa siendo un problema de salud pública tanto en países en vías de desarrollo como en países desarrollados, causando morbi-mortalidad y grandes gastos económicos. Las diarreas agudas son especialmente importantes en personas con edades extremas, viajeros e inmunodeprimidos. El estudio microbiológico tradicional basado en cultivos, análisis microscópico directo y pruebas de antígenos tiene un rendimiento pobre, dado por su baja sensibilidad y especificidad, lentitud y la gran diversidad de bacterias, virus y parásitos que dificultan la obtención de resultados. Las nuevas técnicas de diagnóstico molecular basadas en kits de reacción de polimerasa en cadena (PCR) múltiple permiten identificar en pocas horas y en forma simultánea una gran cantidad de agentes, tanto bacterias, virus, como parásitos, con alta sensibilidad y especificidad, lo que probablemente transformará el diagnóstico etiológico de las diarreas agudas.

Bacteriemia por Shigella flexneri en dos lactantes / Shigella flexneri bacteremia in children: two case report and review of literature

Resumen Shigella spp. es el aislamiento microbiológico más frecuente en las diarreas bacterianas en Argentina. Clínicamente puede causar desde una diarrea acuosa hasta disentería. En forma infrecuente causa complicaciones extraintestinales, con una incidencia de bacteriemia desde 0,4 a 7,3%; asociado a factores de riesgo como niños menores de un año de edad e inmunodeficiencias, entre otros. Presentamos los casos clínicos de dos lactantes con bacteriemia por Shigella flexneri, que consultaron por fiebre y diarrea, uno de ellos con diagnóstico de inmunodeficiencia primaria.

Shigella spp. is the most frequent micro-biological isolation in bacterial diarrhea in Argentina. It causes a watery diarrhea or dysenteric disease. It rarely causes extraintestinal problems. It has an incidence of bacteremia of 0,4-7,3%, and its appearance compels us to look for associated risk factors, as children under one year of age and immunodeficiency, among others. We describe two children with Shigella flexneri bacteremia. They presented with fever and diarrhea. One of them had primary immune deficiency.

Enfermedades diarreicas agudas en menores de 5 años, Centro de Salud de Villa Adela / Acute diarrheal diseases in children under 5 years old, Villa Adela

La diarrea aguda es el aumento en el número de evacuaciones, con disminución en su consistencia, de instalación súbita, generalmente infecciosa, adquirida por contaminación fecal oral y con amenaza al equilibrio hidroelectrolítico. Objetivo: evaluar los casos de enfermedad diarreica aguda en niños menores de cinco años, en el centro de salud Dr. Odilón Renderos, ubicado en el Barrio Villa Adela de Comayagüela, durante el período de enero a abril del 2017. Material y Métodos: mediante investigación- acción participativa se realizó un estudio descriptivo retrospectivo transversal; la población de estudio la constituyó 45 expedientes clínicos con diagnóstico de diarrea aguda durante un periodo de 4 meses. La muestra fue de 23 expedientes con la información completa. Se hizo visita domiciliaria, con el propósito de observación directa del ambiente casero, condición de la vivienda y el sistema de obtención de agua. Se solicitó al jefe de familia autorización para la toma de muestras de agua y análisis bacteriológico, a su vez se realizaron charlas a las familias, con demostraciones de purificación y uso de agua en forma adecuada. Resultados: se observó un aumento de la frecuencia de casos de diarrea en el periodo de estudio, en enero de 8(17.7%) al mes de abril 13(28.9%); los más afectados fueron los menores de un año y la frecuencia fue de 12(52.2%); la complicación que presentaron fue la deshidratación 1(4.4%) y el tratamiento fue sales de rehidratación oral 22(95.6%). En relación al abastecimiento de agua para consumo de las familias 13(57%) usó agua embotellada; 6(29%) agua de la llave y 4(14%) hierve el agua. El análisis bacteriológico del agua, de 7 muestras, 6(85%) resultaron positivas con coliformes y 1(15%) resultó negativa. Conclusión: en la atención médica general se presentan casos de diarrea, las más frecuentes son las agudas, causadas por bacterias de origen hídrico, la tendencia de las diarreas en el periodo de estudio fue ascendente en los meses de enero y abril, estacionaria en los otros dos meses.

Hibridização in situ fluorescente para diagnóstico de Brachyspira hyodysenteriae e B. pilosicoli ­em suínos / Fluorescence in situ hybridization for diagnosis of Brachyspira hyodysenteriae e B. pilosicoli in swine

Disenteria Suína e Colite Espiroquetal são duas enfermidades importantes em suínos causados pela Brachyspira hyodysenteriae e Brachyspira pilosicoli, respectivamente. O diagnóstico eficaz dessas espécies é extremamente importante para a adoção de estratégias adequadas para o controle. Propõe-se avaliar a técnica de hibridização in situ de fluorescência (FISH) para detecção de B. hyodysenteriae e B. pilosicoli em fragmentos histopatológicos de intestino de suínos e compará-la ao PCR duplex. Foram analisadas amostras de fezes e intestinos de suínos de terminação com histórico de diarreia pelas técnicas de reação em cadeia da polimerase duplex (dPCR), hibridização in situ fluorescente (FISH) para diagnóstico dessas bactérias. Foram utilizadas 34 amostras de intestino de suínos de campo positivos para alguma das duas espécies de Brachyspira sp. nos testes de FISH ou PCR. Das 34 amostras analisadas, foram detectadas 28 (82,35%) positivas na PCR e no FISH. Dentre as 29 amostras positivas para B. hyodysenteriae, 23 (79,3%) foram positivas à PCR e 21 (72,4%) no FISH. Os resultados de FISH e PCR não diferiram estatisticamente entre si. Baseado no fato dessa técnica poder ser realizada em tecidos formolizados, ser prática, rápida e associar a marcação especifica do agente com lesões histológicas, o FISH demonstrou ser mais uma alternativa no diagnóstico de Brachyspira hyodysenteriae e B. pilosicoli.(AU)

Growing and finishing pigs are affected by pathogenic spirochetes of the genus Brachyspira sp., which cause a significant economic impact due to direct and indirect losses. Thus, efficient diagnosis of these species enables better technical intervention to prevent or treat diseases. This study aimed to evaluate the fluorescent in situ hybridization (FISH) for the diagnosis of B. hyodysenteriae and B. pilosicoli in histopathologic fragments of pig's intestine and compare it to the duplex PCR. Thirty-four samples collected from pigs positive for these species in at least one of the tests were used in the study. Out of the 34 analyzed intestine samples, 28 (82.35%) were positive by PCR and FISH. Among the 29 B. hyodysenteriae positive samples, 23 (79.3%) were positive by PCR and 21 (72.4%) by FISH. There was no statistical difference among the detection rate of the used tests. Based on the fact this technique can be performed in formalin fixed tissue samples, it is practical, fast and allows the association of labeling a specific agent with histological lesions, FISH has become an alternative diagnostic method for Brachyspira hyodysenteriae and B. pilosicoli.(AU)

Hibridização in situ fluorescente para diagnóstico de Brachyspira hyodysenteriae e B. pilosicoli ­em suínos / Fluorescence in situ hybridization for diagnosis of Brachyspira hyodysenteriae e B. pilosicoli in swine

Disenteria Suína e Colite Espiroquetal são duas enfermidades importantes em suínos causados pela Brachyspira hyodysenteriae e Brachyspira pilosicoli, respectivamente. O diagnóstico eficaz dessas espécies é extremamente importante para a adoção de estratégias adequadas para o controle. Propõe-se avaliar a técnica de hibridização in situ de fluorescência (FISH) para detecção de B. hyodysenteriae e B. pilosicoli em fragmentos histopatológicos de intestino de suínos e compará-la ao PCR duplex. Foram analisadas amostras de fezes e intestinos de suínos de terminação com histórico de diarreia pelas técnicas de reação em cadeia da polimerase duplex (dPCR), hibridização in situ fluorescente (FISH) para diagnóstico dessas bactérias. Foram utilizadas 34 amostras de intestino de suínos de campo positivos para alguma das duas espécies de Brachyspira sp. nos testes de FISH ou PCR. Das 34 amostras analisadas, foram detectadas 28 (82,35%) positivas na PCR e no FISH. Dentre as 29 amostras positivas para B. hyodysenteriae, 23 (79,3%) foram positivas à PCR e 21 (72,4%) no FISH. Os resultados de FISH e PCR não diferiram estatisticamente entre si. Baseado no fato dessa técnica poder ser realizada em tecidos formolizados, ser prática, rápida e associar a marcação especifica do agente com lesões histológicas, o FISH demonstrou ser mais uma alternativa no diagnóstico de Brachyspira hyodysenteriae e B. pilosicoli.(AU)

Growing and finishing pigs are affected by pathogenic spirochetes of the genus Brachyspira sp., which cause a significant economic impact due to direct and indirect losses. Thus, efficient diagnosis of these species enables better technical intervention to prevent or treat diseases. This study aimed to evaluate the fluorescent in situ hybridization (FISH) for the diagnosis of B. hyodysenteriae and B. pilosicoli in histopathologic fragments of pig's intestine and compare it to the duplex PCR. Thirty-four samples collected from pigs positive for these species in at least one of the tests were used in the study. Out of the 34 analyzed intestine samples, 28 (82.35%) were positive by PCR and FISH. Among the 29 B. hyodysenteriae positive samples, 23 (79.3%) were positive by PCR and 21 (72.4%) by FISH. There was no statistical difference among the detection rate of the used tests. Based on the fact this technique can be performed in formalin fixed tissue samples, it is practical, fast and allows the association of labeling a specific agent with histological lesions, FISH has become an alternative diagnostic method for Brachyspira hyodysenteriae and B. pilosicoli.(AU)