Circulation of enterotoxigenic Escherichia coli (ETEC) isolates expressing CS23 from the environment to clinical settings.

IMPORTANCE: The importance of clean water cannot be overstated. It is a vital resource for maintaining health and well-being. Unfortunately, water sources contaminated with fecal discharges from animal and human origin due to a lack of wastewater management pose a significant risk to communities, as they can become a means of transmission of pathogenic bacteria like enterotoxigenic E. coli (ETEC). ETEC is frequently found in polluted water in countries with a high prevalence of diarrheal diseases, such as Bolivia. This study provides novel insights into the circulation of ETEC between diarrheal cases and polluted water sources in areas with high rates of diarrheal disease. These findings highlight the Choqueyapu River as a potential reservoir for emerging pathogens carrying antibiotic-resistance genes, making it a crucial area for monitoring and intervention. Furthermore, the results demonstrate the feasibility of a low-cost, high-throughput method for tracking bacterial pathogens in low- and middle-income countries, making it a valuable tool for One Health monitoring efforts.

Prenatal and Postnatal Manifestations of Congenital Chloride Diarrhea Due to a Heterozygote Variant of the SLC26A3 Gene: A Case Report.

Congenital chloride diarrhea (CCD) is caused by a recessive mutation in the SLC26A3 gene and characterized mainly by watery diarrhea, hypochloremia and metabolic alkalosis. Various different mutations in SLC26A3 are responsible for the disease. In the prenatal period, the symptoms of CCD may include polyhydramnios, preterm labor and abdominal distension. The main feature of CCD is chloride-rich diarrhea, which leads to excessive loss of fluid and salt immediately after birth and is followed by weight loss and dehydration. Hyponatremia and hypochloremia are soon accompanied by hypokalemia and metabolic alkalosis. Untreated CCD is fatal even in the first weeks of life. Diagnosis is made by high fecal chloride concentrations in patients with serum electrolytes corrected by salt substitution and confirmed using genetic testing of peripheral blood samples. Here, we detail prenatal and postnatal manifestations of a preterm infant, born via Caesarian section, who was suspected to suffer intrauterine bowel obstruction. Upper median laparotomy was performed and no intestinal abnormalities found. The course of the neonatal period was complicated by severe diarrhea with hypochloremia, hyponatremia and metabolic alkalosis. Based on the patient's clinical picture and stool examination, a diagnosis of CCD was established. Mutation of the SLC26A3 gene was confirmed using genetic testing.

Molecular Epidemiology of Enteroaggregative Escherichia coli (EAEC) Isolates of Hospitalized Children from Bolivia Reveal High Heterogeneity and Multidrug-Resistance.

Enteroaggregative Escherichia coli (EAEC) is an emerging pathogen frequently associated with acute diarrhea in children and travelers to endemic regions. EAEC was found the most prevalent bacterial diarrheal pathogen from hospitalized Bolivian children less than five years of age with acute diarrhea from 2007 to 2010. Here, we further characterized the epidemiology of EAEC infection, virulence genes, and antimicrobial susceptibility of EAEC isolated from 414 diarrheal and 74 non-diarrheal cases. EAEC isolates were collected and subjected to a PCR-based virulence gene screening of seven virulence genes and a phenotypic resistance test to nine different antimicrobials. Our results showed that atypical EAEC (a-EAEC, AggR-negative) was significantly associated with diarrhea (OR, 1.62, 95% CI, 1.25 to 2.09, p < 0.001) in contrast to typical EAEC (t-EAEC, AggR-positive). EAEC infection was most prevalent among children between 7-12 months of age. The number of cases exhibited a biannual cycle with a major peak during the transition from warm to cold (April-June). Both typical and a-EAEC infections were graded as equally severe; however, t-EAEC harbored more virulence genes. aap, irp2 and pic were the most prevalent genes. Surprisingly, we detected 60% and 52.6% of multidrug resistance (MDR) EAEC among diarrheal and non-diarrheal cases. Resistance to ampicillin, sulfonamides, and tetracyclines was most common, being the corresponding antibiotics, the ones that are frequently used in Bolivia. Our work is the first study that provides comprehensive information on the high heterogenicity of virulence genes in t-EAEC and a- EAEC and the large prevalence of MDR EAEC in Bolivia.

Using satellite data to study the relationship between rainfall and diarrheal diseases in a Southwestern Amazon basin / O uso de dados de satélite para estudar a relação entre chuva e doenças diarreicas em uma bacia na Amazônia Sul-Ocidental

Abstract The North region is the second region in Brazil with the highest incidence rate of diarrheal diseases in children under 5 years old. The aim of this study was to investigate the relationship between rainfall and water level during the rainy season principally with the incidence rate of this disease in a southwestern Amazon basin. Rainfall estimates and the water level were correlated and both of them were correlated with the diarrheal incidence rate. For the Alto Acre region, 2 to 3 days’ time-lag is the best interval to observe the impact of the rainfall in the water level (R = 0.35). In the Lower Acre region this time-lag increased (4 days) with a reduction in the correlation value was found. The correlation between rainfall and diarrheal disease was better in the Lower Acre region (Acrelândia, R = 0.7) and rainfall upstream of the city. Between water level and diarrheal disease, the best results were found for the Brasiléia gauging station (Brasiléia, R = 0.3; Epitaciolândia, R = 0.5). This study’s results may support planning and financial resources allocation to prioritize actions for local Civil Defense and health care services before, during and after the rainy season.

Resumo A região Norte é a segunda no Brasil com a maior taxa de incidência de doenças diarreicas em crianças menores de 5 anos. O objetivo deste estudo foi investigar a relação entre chuva e nível do rio, principalmente durante a estação chuvosa, com a taxa de incidência da referida doença em uma bacia no sudoeste da Amazônia. Estimativas de chuva e nível do rio foram correlacionadas e ambos correlacionados com a taxa de incidência da diarreia. Para a região do Alto Acre, 2 a 3 dias de defasagem é o melhor intervalo para observar o impacto da chuva no nível do rio (R = 0.35). Na região do Baixo Acre essa defasagem aumentou (4 dias) com redução na correlação. A correlação entre chuva e doenças diarreicas foi melhor na região do Baixo Acre (Acrelândia, R = 0.7) e a chuva rio acima da cidade. Entre o nível do rio e as doenças diarreicas, os melhores resultados foram encontrados para a estação de Brasiléia (casos em Brasiléia, R = 0.3 e Epitaciolândia, R = 0.5). Os resultados deste estudo podem dar apoio ao planejamento e alocação de recursos financeiros para priorizar ações para Defesa Civil e serviços de saúde antes, durante e depois da estação chuvosa.

The cause of infant diarrhea / 国际检验医学杂志

Objective to analysis the cause of infant diarrhea in our hospital .Methods 3 260 cases of inpatient and outpatient children with diarrhea were collected from January 2014 to February 2015 .The cases were divided into five groups according to the test result and clinical diagnosis :indigestion ,rotavirus infection group ,bacterial diarrhea group ,lactose intolerance groups and other reason groups .And ,there were divided into four groups according to the age ,too .Results (1)The incidence of diarrhea in boys (60 .73% ) was higher than that in girls(39 .26% ) .(2)The main causes for diarrhea in the fall is bacterial diarrhea (53 .36% );ro‐tavirus infection in the winter (45 .12% ) ,respectively .(3 ) The highest incidence of children with diarrhea is 1 -12 months (49 .85% ) ,the highest incidence with diarrhea in 1-12 months was lactose intolerance (79 .61% ) .Conclusion Infantile diarrhea is still a high incidence of disease in children and caused by rotavirus infection ,bacterial infection ,lactose intolerance .

Multiple norovirus infections in a birth cohort in a Peruvian Periurban community.

BACKGROUND: Human noroviruses are among the most common enteropathogens globally, and are a leading cause of infant diarrhea in developing countries. However, data measuring the impact of norovirus at the community level are sparse. METHODS: We followed a birth cohort of children to estimate norovirus infection and diarrhea incidence in a Peruvian community. Stool samples from diarrheal episodes and randomly selected nondiarrheal samples were tested by polymerase chain reaction for norovirus genogroup and genotype. Excretion duration and rotavirus coinfection were evaluated in a subset of episodes. RESULTS: Two hundred twenty and 189 children were followed to 1 and 2 years of age, respectively. By 1 year, 80% (95% confidence interval [CI], 75%-85%) experienced at least 1 norovirus infection and by 2 years, 71% (95% CI, 65%-77%) had at least 1 episode of norovirus-associated diarrhea. Genogroup II (GII) infections were 3 times more frequent than genogroup 1 (GI) infections. Eighteen genotypes were found; GII genotype 4 accounted for 41%. Median excretion duration was 34.5 days for GII vs 8.5 days for GI infection (P = .0006). Repeat infections by the same genogroup were common, but repeat infections by the same genotype were rare. Mean length-for-age z score at 12 months was lower among children with prior norovirus infection compared to uninfected children (coefficient: -0.33 [95% CI, -.65 to -.01]; P = .04); the effect persisted at 24 months. CONCLUSIONS: Norovirus infection occurs early in life and children experience serial infections with multiple genotypes, suggesting genotype-specific immunity. An effective vaccine would have a substantial impact on morbidity, but may need to target multiple genotypes.

Concentração de sódio e glicose em soro de reidratação oral preparado por Agentes Comunitários de Saúde / Sodium and glucose concentration in therapeutical solution for oral rehydration prepared by Community Health Agents

A diarreia infantil é importante causa de morbimortalidade, sendo indicativo para terapia de reidratação oral (TRO). Este estudo objetivou avaliar o teor de sódio e glicose em soro de reidratação oral preparado por Agentes Comunitários de Saúde (ACS) que atuam em Unidades Básicas de Saúde (UBS), caracterizando o perfil e o conhecimento destes sobre a TRO. Após responderem questionário com informações profissionais e sobre a TRO, os ACS a prepararam por três métodos. O teor de glicose e de sódio das TRO foi determinado e comparado ao proposto pela OMS. Na análise estatística foram utilizados ANOVA, Tukey e odds ratio. Participaram do estudo 52 ACS, majoritariamente mulheres e com ensino médio completo (90,4 por cento). A adequação da TRO foi de 3,9; 9,8 e 28,9 por cento para a colher caseira, colher medida e punhado pitada, respectivamente. O preparo da TRO com a colher caseira resultou em 88,0 por cento das amostras com teor de sódio perigoso à saúde (>101 mmol/L). Entre os ACS, 38,5 por cento tinham menos de 2 anos de trabalho, com risco 4,8 vezes maior de preparar TRO inadequada em sódio. Os ACS referiram indicar a TRO no tratamento da diarreia infantil, desconhecendo efeitos colaterais do preparo inadequado. A composição da TRO produzida pelos ACS foi inadequada em todos os métodos. É recomendável treinamento dos ACS no preparo da TRO.

Infant Diarrhea is a major cause of morbidity and mortality in children and oral rehydration therapy (ORT) is required. This study evaluates the composition of ORT prepared by Community Health Agents (CHAs) working in Basic Health Units, assessing their profile and knowledge about ORT. After the CHAs answer specific questions, they are invited to prepare ORT using three methods. Glucose and sodium levels were then quantified and compared with WHO recommendations. ANOVA, Tukey and odds ratio were used for statistical analysis. 52 CHAs participated, mainly females, and 90.4 percent with full high school education. The adequacy of the ORT was 3.9; 9.8 and 28.9 percent for table spoon, measuring spoon and pinch and scoop, respectively. The ORT preparation by table spoon resulted in 88 percent of samples with dangerous levels of sodium (>101mmol/L). 38.5 percent of the CHAs had less than 2 years experience, leading to a 4.8 times greater risk of preparing ORT with high sodium. The CHAs indicated ORT as a treatment for diarrhea, though they were unaware of the side effects of inadequate preparation. The composition of the ORT produced by the CHAs was inadequate in all methods tested. The CHAs revealed a lack of knowledge of the side effects iof ORT with inadequate salt levels. The recommendation is to train the CHAs in ORT preparation.

Observation on the Curative Efficacy of Wentong Babu Plaster for Infant Diarrhea / 中国药房

OBJECTIVE:To study the curative efficacy of Wentong babu plaster for infant diarrhea.METHODS:A total of 62 infants with diarrhea were randomly assigned to either treatment group(n=32)or control group(n=30).Both groups were given Dioctahedral smectite,Bifid triple viable,fluid replacement,diet structure adjustment,etc.And the treatment group received additional Wentong babu plaster once daily for 5 days.The curative efficacy and the side effects of the two groups were observed.RESULTS:There are significant difference between the two groups in marked efficacy showing rate and response rate,both higher in treatment group than in control group(P

Detecção de roteiros e adenovírus na Grande São Paulo no período 1984-1986: estudo eletroforético do genoma dos rotavírus / Rotavirus and adenovirus detection in the Greater Säo Paulo in 1984-1986: eletrophoretic study of the rotavirus genome

No período de 1984 a 1986, 285 amostras de fezes de crianças com sintomatologia diarreica foram submetidas às provas diagnósticas de ensaio imunoenzimático, eletroforese em gel de poliacrilamida e microscopia eletrônica. Destas amostras, 15,4% foram positivas para rotavírus e 3,2% para adenovírus. Das 44 (15,4%) amostras positivas para rotavírus pelo método imunoenzimático, 37 apresentaram perfil eletroforético do RNA característico dos rotavírus. Destas últimas, 27 foram analisadas segundo o esquema de Lourenço et alii, 1981, tendo sido verificada grande heterogeneidade de perfis e predominância dos rota vírus do subgrupo 1 foi detectada (AU).