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Diet has a major role in the treatment of acute diarrhea in children, along with a minimal drug therapy, but not necessarily using antimicrobials. Children can successfully pas a diarrheal episode with diet and symptomatic treatment. It is important to know how to properly choose foods to introduce in ill children diet. There is a lack of statistical data in our region regarding dietary treatment in child diarrhea. This study was realized by completing a questionnaire regrading nutritional management in children with diarrhea. 110 persons from Dobrogea region completed this questionnaire. We analyzes demographic and clinical issues, people preferences in choosing different foods appropriate to this pathology and minimal knowledge about medication. Our results evidenced that general population knowledges regarding nutritional management of acute diarrheal disease in children and infants are appreciable. Foods like rice, toast, applesauce/baked apple, mint/figs/bilberry leaves teas, vegetables soup, bananas were found among people preferences, proving appropriate information. Antimicrobial drugs misusage is not reported, 83 out of 110 people avoiding them. [ABSTRACT FROM AUTHOR]

Globally, diarrheal diseases are a leading cause of death in children under five and disproportionately affect children in developing countries. Children who contract diarrheal diseases are rarely screened to identify the etiologic agent due to time and cost considerations associated with pathogen-specific screening and hence pathogen-directed therapy is uncommon. The development of biomarkers to rapidly identify underlying pathogens could improve treatment options and clinical outcomes in childhood diarrheal diseases. Here, we perform RNA sequencing on blood samples collected from children evaluated in an emergency room setting with diarrheal disease where the pathogen(s) present are known. We determine host response gene signatures specific to Salmonella, Shigella and rotavirus, but not E. coli, infections that distinguish them from each other and from healthy controls. Specifically, we observed differential expression of genes related to chemokine receptors or inflammasome signaling in Shigella cases, such as CCR3, CXCR8, and NLRC4, and interferon response genes, such as IFI44 and OASL, in rotavirus cases. Our findings add insight into the host peripheral immune response to these pathogens, and suggest strategies and limitations for the use host response transcript signatures for diagnosing the etiologic agent of childhood diarrheal diseases. [ABSTRACT FROM AUTHOR]

In infants and young children in Sub-Saharan Africa, iron-deficiency anemia (IDA) is common, and many complementary foods are low in bioavailable iron. In-home fortification of complementary foods using iron-containing micronutrient powders (MNPs) and oral iron supplementation are both effective strategies to increase iron intakes and reduce IDA at this age. However, these interventions produce large increases in colonic iron because the absorption of their high iron dose (≥12.5 mg) is typically ≤20%. We reviewed studies in infants and young children on the effects of iron supplements and iron fortification with MNPs on the gut microbiome and diarrhea. Iron-containing MNPs and iron supplements can modestly increase diarrhea risk, and in vitro and in vivo studies have suggested that this occurs because increases in colonic iron adversely affect the gut microbiome in that they decrease abundances of beneficial barrier commensal gut bacteria (e.g., bifidobacteria and lactobacilli) and increase the abundance of enterobacteria including entropathogenic Escherichia coli. These changes are associated with increased gut inflammation. Therefore, safer formulations of iron-containing supplements and MNPs are needed. To improve MNP safety, the iron dose of these formulations should be reduced while maximizing absorption to retain efficacy. Also, the addition of prebiotics to MNPs is a promising approach to mitigate the adverse effects of iron on the infant gut. [ABSTRACT FROM AUTHOR]

Background objective: Acute diarrheal diseases leading to dehydration, are among the leading causes of mortality in infants and young children in many developing countries. The objective of our study was to to assess knowledge, attitude and practice of mothers about use of oral rehydration salt for management of dehydration due to diarrhea in children less than five years of age. Study Design: Hospital based cross-sectional descriptive study. Setting: Oral rehydration center of Government Infectious Disease Children Hospital Peshawar. Period: February 16th, 2009 to March, 17th 2009. Patients and Methods: We enrolled 115 mothers of infants and children less than five years old by systematic random sampling. We included willing mothers for this study, children less than five years old showing some or no signs of dehydration due to three or more than three episodes of diarrhea within 24 hours. Exclusion criteria included unwilling mothers, severe dehydration due to diarrhea, complaints of severe vomiting and those having dysentery. Results: We evaluated 115 mothers, with majority 88 (76%) were 15-25 years age group and 27 (24%) were 26-36 years who visited oral rehydration center respectively. Majority of mothers were uneducated 97 (84%), Housewives 103 (90%), 59 (51%) had 4-6 children, 72 (63%) were living in Kacha house and about 84 (73%) had monthly family income less than 5000 rupees. It was found that 72 (63%) mothers knew benefits of oral rehydration salt in diarrheal dehydration. About 67 (58%) mothers were able to tell correct method of ORS preparation. 47 (41%) mothers knew that ORS should be discarded after one day usage, while 42 (37%) did not know. Doctors, 83 (72%) were found to be the most common source of information regarding ORS usage, followed by mothers-in-law, 21 (18%) and lady health workers (LHWs), 10 (10%) Conclusion: We concluded young mothers and uneducated mothers of children below five years were of opinion that only medicine is the best management for diarrheal dehydration. [ABSTRACT FROM AUTHOR]

Need and purpose: Rotavirus is the most common cause of severe diarrhea in infants and young children worldwide. The burden of rotavirus diarrhea in Indian children is not well established. The present study reviewed the epidemiology of rotavirus diarrhea in hospitalized children and in the community, molecular serotyping and under-five mortality caused by rotavirus diarrhea. Methods: Publications, reporting rotavirus diarrhea in Indian children, were retrieved through a systematic search of databases including Medline, PubMed, IndMed, websites of WHO, UNICEF, National Family Health Survey, Ministry of Health and Family Welfare, and Government of India. 'Human' studies in 'English' language were included. Age group selected was 0 month to 5 years. No restrictions were applied in terms of study design and time frame. Conclusions: Stool sample positivity varied from 4.6% in Kolkata to 89.8% in Manipur, among hospitalized children, and from 4% in Delhi to 33.7% in Manipur in community. Most cases of rotavirus diarrhea in India are caused by G1, G2, and G untypeable strains with distinct regional variations. Rotavirus was identified as an etiological agent in 5.2 to 80.5% cases of nosocomial diarrhea. Data are lacking for rotavirus mortality. [ABSTRACT FROM AUTHOR]

Objective To verify the validity and practicality of the implementation of new standardized treatment of diarrhea in children in the people's hospital of Funing. Methods Three hundred and thirteen cases of infantile diarrhea were selected as the observation group from August 1, 2013 to July 31, 2014, and were treated by new standardized program. The other 313 cases of infantile diarrhea were randomly selected as the control group from July 1, 2010 to July 31, 2013, and were treated by the original therapeutic protocol. We compared the therapeutic effect, cure rate, satisfaction and knowledge awareness of parents of children patients between observation group and control group with t-student test and chi square test. Results There were significant differences between observation group and control groups, in the therapeutic effect, cure rate, satisfaction and knowledge awareness of parents of children. The therapeutic effect in the observation group was significantly better than the control group (P < 0.01). Conclusion The validity and practicability of new rural standardized treatment of diarrhea in children is significantly better than the original therapeutic protocol. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life. Human breast milk is the healthiest form of milk for babies. Breastfeeding promotes health and helps to prevent diseases including diarrheal diseases. It contains all nutrients including antibodies (IgA),and lactoferrin, that potentially prevent infection and diarrhea in infants and children. Studies conducted in both developed and under developed nations have found that breast feeding is associated with significantly ( upto 64%) less diarrheal disease and the protective effect of breast feeding does not persist beyond two months after breast feeding is stopped. On the other hand, formula fed infants are found an upto 80% increased in the risk of developing diarrhea compared to breast fed infants and there is significantly more diarrheal disease in formula fed infants. Infection may be attributable to contamination of bottles, teats, milk, and food in infants who are not exclusively breastfed. Exclusive breastfeeding for the first six months of life and there after complementary feedings while breastfeeding continues for up to two years of age or beyond, enthusiastic support and involvement from clinicians, obstetricians and pediatricians, are essential in "breastfeeding vs formula feeding" issue and to reduce incidence of diarrheal diseases in infants and children. [ABSTRACT FROM AUTHOR]

Enteropathogenic Escherichia coli (EPEC) is a leading cause of infantile diarrhea in developing countries. EPEC strain E2348/69 is used worldwide as a prototype to study EPEC genetics and disease. However, isolates of E2348/69 differ phenotypically, reflecting a history of in vitro selection. To identify the genomic and phenotypic changes in the prototype strain, we sequenced the genome of the nalidbdc acid-resistant (Nalr) E2348/69 clone. We also sequenced a recent nleF mutant derived by one-step PCR mu-tagenesis from the Nalr strain. The sequencing results revealed no unintended changes between the mutant and the parent strain. However, loss of the pE2348-2 plasmid and 3 nonsynonymous mutations were found in comparison to the published streptomycin-resistant (Strr) E2348/69 reference genome. One mutation is a conservative amino acid substitution in ftsK. Another, in gyrA, is a mutation known to result in resistance to nalidixic acid. The third mutation converts a stop codon to a tryptophan, predicted to result in the fusion of hflD, the lysogenization regulator, to purB. The purB gene encodes an adenylosuccinate lyase involved in purine biosynthesis. The Nalr clone has a lower growth rate than the Strr isolate when cultured in minimal media, a difference which is corrected upon addition of adenine or by genetic complementation with purB. Addition of adenine or genetic complementation also restored the invasion efficiency of the Nalr clone. This report reconciles longstanding inconsistencies in phenotypic properties of an archetypal strain and provides both reassurance and cautions regarding intentional and unintentional evolution in vitro. [ABSTRACT FROM AUTHOR]

Rotavirus (RV) is the most common cause of severe diarrhea among infants and young children. Currently, there is no specific drug available against rotavirus, largely due to the lack of an ideal target molecule which has hampered drug development. Our previous studies have revealed that cyclosporin A (CsA) might be potentially useful as an anti-RV drug. We therefore used both cellular and mouse models to study the immunological safety and effectiveness of CsA as an anti-RV drug. We found that CsA treatment of HT-29 cells before, during, and after viral infection efficiently inhibited Wa strain RV replication and restored IFN-β expression in a HT-29 cell line model. Exploring the underlying mechanisms showed that CsA promoted Interferon Regulatory Factor-5 (IRF-5) expression (a key positive regulator of the type I IFN signaling pathway), but not IRF-1, IRF-3, or IRF-7. Additionally, CsA inhibited SOCS-1 expression (the key negative regulator of IFN-α/β), but not SOCS-2 or SOCS-3. The antiviral effect of CsA was confirmed in an RV-infected neonatal mouse model by evaluation of antigen clearance and assessment of changes in intestinal tissue pathology. Also, no differences in T cell frequency or proliferation between the CsA- and vehicle-treated groups were observed. Thus, both our in vitro and in vivo findings suggest that CsA, through modulating the expression of key regulators in IFN signaling pathway, promote type I IFN-based intracellular innate immunity in RV host cells. These findings suggest that CsA may be a useful candidate to develop a new anti-RV strategy, although further evaluation and characterization of CsA on RV-induced diarrhea are warranted. [ABSTRACT FROM AUTHOR]

Rotavirus (RV) is the most common cause of severe diarrhea among infants and young children. Currently, there is no specific drug available against rotavirus, largely due to the lack of an ideal target molecule which has hampered drug development. Our previous studies have revealed that cyclosporin A (CsA) might be potentially useful as an anti-RV drug. We therefore used both cellular and mouse models to study the immunological safety and effectiveness of CsA as an anti-RV drug. We found that CsA treatment of HT-29 cells before, during, and after viral infection efficiently inhibited Wa strain RV replication and restored IFN-β expression in a HT-29 cell line model. Exploring the underlying mechanisms showed that CsA promoted Interferon Regulatory Factor-5 (IRF-5) expression (a key positive regulator of the type I IFN signaling pathway), but not IRF-1, IRF-3, or IRF-7. Additionally, CsA inhibited SOCS-1 expression (the key negative regulator of IFN-α/β), but not SOCS-2 or SOCS-3. The antiviral effect of CsA was confirmed in an RV-infected neonatal mouse model by evaluation of antigen clearance and assessment of changes in intestinal tissue pathology. Also, no differences in T cell frequency or proliferation between the CsA- and vehicle-treated groups were observed. Thus, both our in vitro and in vivo findings suggest that CsA, through modulating the expression of key regulators in IFN signaling pathway, promote type I IFN-based intracellular innate immunity in RV host cells. These findings suggest that CsA may be a useful candidate to develop a new anti-RV strategy, although further evaluation and characterization of CsA on RV-induced diarrhea are warranted. [ABSTRACT FROM AUTHOR]

Objective. To estimate the prevalence of acute diarrheal diseases (ADD) during the two weeks previous to the interview among children <5 years of age and to describe alarm signs and feeding practices of parents and caregivers (PCG) during children's ADD. Materials and methods. Analysis of data from the National Health and Nutrition Surveys 2012 and 2006 and the National Health Survey 2000. Results. ADD prevalence decreased significantly from 2006 (13.1%) to 2012 (11.0%), particularly in the lower socioeconomic status. "Frequent bowel movements" were the main warning sign identified by PCG (66.0%) in contrast to "crying without tears" (4.3%) and "blood in faeces" (0.5%); only 42% PCG reported administering oral rehydration therapy. Factors associated with ADD were child's age <1 year and mother's age <20 years. Conclusions. It is necessary to reinforce appropriate ADD preventive and treatment practices among PCG of children <5 years of age. [ABSTRACT FROM AUTHOR]

Zinc is a trace mineral that is involved in many functions at the metabolic, endocrine, and digestive systems of the human body at the level of the child. By supplementing zinc in children with diarrhea, stool output total (g/kg), the stool output per day (g/kg/day), the time of cessation of diarrhea (hours) and the duration of episodes of diarrhea, are lower. Also, more rapid recovery from diarrhea in infants receiving oral zinc at 15-30 mg/day divided into 3 times a day for 2 weeks. In addition, we recommend the use of oral rehydration therapy with zinc supplementation for 10- 14 days during episodes of acute diarrhea in children under 5 years. The daily oral zinc reduces the duration of both acute and persistent diarrhea, and increase the survival of children. [ABSTRACT FROM AUTHOR]

Abstract: During an ongoing surveillance for diarrheal pathogens, an unusual human group A rotavirus strain G3P[10] (RVA/Human-wt/IND/mcs60/2011/G3P[10]) was detected in a stool sample of a 14months old girl child with acute diarrhea in Kolkata, eastern India. The VP7 nucleotide sequence of this strain revealed a close phylogenetic relationship to the prototype G3 strain AU-1 and Australian feline strain Cat2, whereas, the VP4 gene segment was closely related to the G8P[10] rotavirus 69M from Indonesia. Analysis of 11 gene segments of this unusual G3P[10] strain demonstrates a complex evolutionary pattern, with genes possibly derived from the group A rotaviruses of human DS-1-like and AU-1-like strains of simian and caprine host species. To our knowledge, this is the first complete genotyping report of any G3P[10] rotavirus, worldwide. [Copyright &y& Elsevier]

Abstract: Background: Group A rotaviruses are the leading cause of non-bacterial severe diarrhea disease in infants and young children. In humans, the most common genotypes are G1–G4 and G9. Recently, G12 strains have been sporadically reported in several countries, including Argentina, Brazil and Paraguay. Objectives: To analyze rotavirus strain diversity in Argentina during 2008–2009 and to describe the whole genome-based classification of emerging G12P[8] strains detected in our country. Study design: Rotavirus positive-samples (n =544) were collected from Argentinean children during 2008–2009, as a part of the National Surveillance Network for Viral Diarrheas. Specimens were genotyped by reverse transcription-polymerase chain reaction (RT-PCR) followed by nested-multiplex PCR. Sequencing of 11 genome segments was performed in 3 randomly selected G12P[8] strains. Results: G9P[8] was the most frequent strain in 2008, but in 2009 G3P[8] and G12P[8] were the most frequent strains in different geographical regions of the country. The novel emerging G12P[8] strains presented the following combination of genes: G12-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1 (i.e. genotype1, Wa-like strains). The phylogenetic analysis of the VP7 gene of the G12P[8] strains grouped them within lineage III. Previously reported Argentinean G12P[9] strains presented genes from genotype 3 (AU-1-like strains) with a VP7 gene from lineage II. Conclusions: The emergence of G12P[8] rotaviruses was due to the introduction of a new strain, rather than to a reassortment of the G12P[9] strains previously circulating in our country. This study assesses the temporal and geographical changes in genotypes prevalence as well as the periodic emergence of unusual G genotypes. [Copyright &y& Elsevier]

Objective: Distribution of breast milk substitutes (BMS) after the 2006 Yogyakarta earthquake was uncontrolled and widespread. We assessed the magnitude of BMS distribution after the earthquake, its impact on feeding practices and the association between consumption of infant formula and diarrhoea among infants and young children. Design: One month after the earthquake, caregivers of 831 children aged 0-23 months were surveyed regarding receipt of unsolicited donations of BMS, and on recent child-feeding practices and diarrhoeal illness. Setting: Community-level survey in an earthquake-affected district. Subjects: Primary caregivers of surveyed children. Results: In all, 75% of households with an infant aged 0-5 months and 80% of all households surveyed received donated infant formula; 76% of all households received commercial porridge and 49% received powdered milk. Only 32% of 0-5-month-old infants had consumed formula before the earthquake, but 43% had in the 24 h preceding the survey (P<0·001). Consumption of all types of BMS was significantly higher among those who received donated commodities, regardless of age (P<0·01). One-week diarrhoea incidence among those who received donated infant formula (25·4%) was higher than among those who did not (11·5%; relative risk =2·12, 95% CI=1·34, 3·35). The rate of diarrhoea among those aged 12-23 months was around five times the pre-earthquake rate. Conclusions: There were strong associations between receipt of BMS and changes in feeding practices, and between receipt of infant formula and diarrhoea. Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies. [ABSTRACT FROM AUTHOR]

The article focuses on the study which presents the systematic literature review for the identification of cohort studies that sought to quantify diarrhea incidence among any age group of children from 0-59. It mentions that by using the expectation-maximization algorithm the diarrhea incidence rates were observed at several stages and finds that it may be declining slightly, and there is a necessity of improving both prevention and treatment practices in low- and middle-income countries.

A total of six hundred stool samples collected from children and infants (0-5 years) presenting diarrhea at the hospital located in the four north central states of Nigeria (Niger, Kwara, Nasarawa and Federal Capital Territory) were examined for possible detection of rotavirus antigens using enzymes linked immunosorbent assay. 27 cases (5%) were found to be positive. The result of the reverse transcription (RT) of the viral RNA to cDNA revealed that, the vp7 gene appeared large and bold while the vp4 gene had small and faint bands. Further identification of the rotavirus isolated using Reverse transcription polymerase chain reaction (RT-PCR) and Agarose Gel electrophoresis, indicated strains G1 (11%), G2 (15%), G8 (15%) and P4 (8%), P6 (11%), P8 (11%) as the strains identified. An indication that, the above mentioned strains may be the dorminant strains in circulation in the study areas. Further investigation on the remaining parts of north central states is conducted in order to arrive at better conclusion on the strains of the virus present in the entire north central region. [ABSTRACT FROM AUTHOR]

The rationale for the use of probiotics in the management of infectious diseases is supported by their potential to influence and stabilize the composition of gut microbiota, enhance colonization resistance, and modulate immune function parameters. A literature review was conducted to determine the efficacy of using probiotics in selected infections: 11 infectious diarrhea in infants and children, 2) traveler's diarrhea, 3) necrotizing enterocolitis in infants, 4) Helicobacterpylori infection, 5) respiratory tract infections in adults and children, 6) ear, nose, and throat infections, and 7) infectious complications in surgical and critically ill patients. The different types of infections that have been subject to clinical studies with different probiotics obviously prevent any generic conclusions. Furthermore, the lack of consistency among studies focusing on 1 specific infection, in study design, applied probiotic strains, outcome parameters, and study population, along with the still limited number of studies, preclude clear and definite conclusions on the efficacy of probiotics and illustrate the need for better-aligned study designs and methodology. Exceptions were the management of infectious diarrhea in infants and traveler's diarrhea, antibiotic-associated diarrhea, and necrotizing enterocolitis. Sufficient consistent data exist for these applications to conclude that certain probiotics, under certain conditions, and in certain target populations, are beneficial in reducing the risk of infection. In addition, some evidence exists, although conclusions are premature, for the management of Helicobacterpyloriinfection and possible reduction of treatment side effects. Certain probiotics may also reduce the risk of various symptoms of respiratory tract infections in adults and children, including ear, nose, and throat infections, although data are currently far too limited to distill any clinical recommendations in this area. Positive but also negative results have been obtained in prevention of infectious complications in surgical and critically ill patients. For future studies it is recommended that researchers provide adequate power, identify pathogens, and report both clinical outcomes and immune biomarkers relating to putative underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To assess risk factors for diarrheal illness among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIG) clinic in Miami, FL. Design: A cross-sectional survey with questions about demographics, food safety practices, and diarrheal illness. Setting: WIG clinic operated by the Miami-Dade County Health Department in Florida. WIG is a tional program for nutritionally at-risk, low-income young children and pregnant or postpartum women. Participants: WIG female clients at least 18 years of age who arc able to read and speak English (n = 299). Main Outcome Measure: Diarrhcal illness, defined as having at least 3 loose stools for 2 or more consecutive days during the previous 30 days. Analysis: Univariate and multiple logistic regression analyses. Results: Food safety behaviors significantly associated with diarrhea! illness included not washing hands before preparing meals (P = .048) and baby bottles (P = .045) or after changing diapers (P = .009) and not washing all items that touched raw meat before preparing the next food item (P = .023). In general, pregnant women reported less frequent hand washing and had a lower food safety score than nonpregnant women (P = .002). Conclusions and Implications: These findings suggest that interventions to improve food handling practices such as proper hand washing are needed for WIG clients, particularly pregnant women. [ABSTRACT FROM AUTHOR]

A cross-sectional study was conducted to investigate the potential factors of food-hygiene practices of mothers on the prevalence of diarrhoea among their children. Mothers who had children aged 6 months--5 years were recruited in a hamlet in Viet Nam. The food-hygiene practices included hand-washing, method of washing utensils, separation of utensils for raw and cooked food, and the location where foods were prepared for cooking. A face-to-face interview was conducted, and data on 206 mothers were analyzed. The risk of diarrhoea was significantly higher among children whose mothers prepared food for cooking somewhere other than the table (typically on the ground) compared to children whose mothers prepared food on the table (adjusted odds ratio=2.85, 95% confidence interval 1.11-7.28). The results indicate that food-hygiene practices of mothers, such as avoiding preparing food for cooking on the ground, has a potential impact in preventing diarrhoea among children in Viet Nam. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of acute diarrheal disease's agents in children under five years who consulted to emergency services in Bucaramanga, Colombia, between September and October, 2006. Materials and methods: Descriptive study with prospective data collection. Stool samples were randomly collected through the days of the week and the time of the day (morning, afternoon, night). Each sample was tested for Rotavirus, Salmonella spp, Shigella spp, parasites and coccidias. Results: One-hundred and eighty children under five years were studied. The median age was 12 months. Rotavitus was detected in 44,4% (95%CI 37,1-52,0) of stool simples; no pathogenic agent was detected in 19,4% of cases. The prevalence of other pathogenic agents was: 8,9% (95%CI 5,2-14,0) Blastocystis hominis, 7,8% (95%CI 4,3-12,8) Giardia duodenalis, 7,8% (95%CI 4,3-12,8) Salmonella spp, 5,0% (95%CI 2,3-9,3) Entamoeba histolytica dispar, 2,8% (95%CI 0,9-6,4) Shigella spp, 2,8% (95%CI 0,9-6,4) Entamoeba histolytica plus Blastocystis hominis, 0,6% (95%CO 0,0-3,1) Giardia duodenalis plus Entamoeba histolytica, 0,6% (IC 95% 0,0-3,1) rotavirus plus Blastocystis hominis. Conclusions: Rotavirus has an important place in the municipality of Bucaramanga as the principal pathogenic agent in children under fiver years with acute diarrheal disease. [ABSTRACT FROM AUTHOR]

Enteropathogenic Escherichia coli (EPEC) are frequently isolated as a cause of infantile diarrhea in developing countries. Its pathogenicity is distinguished by histopathological alterations at the site of infection, known as attaching and effacing (A/E) lesions, in which bacterial virulence factors and host proteins participate. Intimin, a bacterial adhesin expressed by all EPEC described to date, is responsible for the intimate adherence of the bacteria to host cells and is essential for the formation of A/E lesions. Mucosal vaccination may represent an efficacious intervention to prevent EPEC infection and lower morbidity and mortality rates. Strategies for mucosal vaccinations that use lactic acid bacteria for the delivery of heterologous antigens rely on their safety profile and ability to stimulate the immune system. In the present work, we have constructed Lactobacillus casei strains expressing different fragments of intimin β, a subtype that is frequently expressed by EPEC strains. Mucosal immunization of mice with L. casei expressing intimin fragments induced specific systemic and mucosal antibodies. These antibodies were able to recognize native intimin on the surface of EPEC and to inhibit in vitro EPEC binding to epithelial cells. [ABSTRACT FROM AUTHOR]

Objective The major objective of this study is to provide estimates of diarrhoea mortality at country, regional and global level by employing the Child Health Epidemiology Reference Group (CHERG) standard. Methods A systematic and comprehensive literature review was undertaken of all studies published since 1980 reporting under-5 diarrhoea mortality. Information was collected on characteristics of each study and its population. A regression model was used to relate these characteristics to proportional mortality from diarrhoea and to predict its distribution in national populations. Findings Global deaths from diarrhoea of children aged less than 5 years were estimated at 1.87 million (95% confidence interval, CI: 1.56-2.19), approximately 19% of total child deaths. WHO African and South-East Asia Regions combined contain 78% (1.46 million) of all diarrhoea deaths occurring among children in the developing world; 73% of these deaths are concentrated in just 15 developing countries. Conclusion Planning and evaluation of interventions to control diarrhoea deaths and to reduce under-5 mortality is obstructed by the lack of a system that regularly generates cause-of-death information. The methods used here provide country-level estimates that constitute alternative information for planning in settings without adequate data. [ABSTRACT FROM AUTHOR]

Summary: Rotavirus is the main cause of severe, dehydrating diarrhoea in infants and young children. In industrialized countries, pediatric rotavirus gastroenteritis (PRGE) is responsible for high morbidity, particularly among children under 3 years of age attending day care centers (DCCs). The objectives of this study were to estimate the incidence, management and cost of PRGE in DCCs. We also described the nature of group A rotavirus genotypes. This study also compared the performance of different diagnostic techniques. The study was conducted from November 2004 to May 2005. Children aged less than 36 months, attending a participating DCC at least 4 times a week were included in the study. For any episode of acute gastroenteritis (AGE), defined as the occurrence of 3 or more watery or looser than normal stools and/or forceful vomiting within a 24h period, a fecal specimen was tested by Elisa test IDEIA™ Rotavirus (Dako) and the immunochromatographic test VIKIA® Rota-Adeno (BioMérieux). Sequencing by RT–PCR was performed to identify the rotavirus genotype. Among the 41 DCCs contacted, 18 (43.9%) agreed to participate. Out of 966 children, 547 attended a participating DCC at least 4 times a week and met the inclusion criteria. A total of 302 were included in the study. The clinical diagnosis of AGE was confirmed and validated, by the Elisa test, in 63 fecal specimens, of which 29 (46%) were positive for rotavirus antigen, with a predominance of P[8]G9 (86%). Our results showed good sensitivity and specificity for the VIKIA and Elisa methods when compared to RT–PCR. Among the PRGE cases, 36% were male and the median age was 12.2 months. The first rotavirus case was observed in December 2004 with a peak in January 2005. The incidence of PRGE cases was 2.2 [1.4–3.0] per 100 child–months in children aged less than 36 months of age, increasing to 3.4 per 100 child–months among children aged less than 24 months. Vomiting (P <0.0005) and behavior modification (P <0.001) were significantly more frequent for PRGE cases. A total of 85.7% PRGE cases sought medical attention. In 58.3% of these cases, at least one parent had to miss work for a mean duration of 2.1 days. The total cost of rotavirus cases seeking medical attention (with or without prescribed medication, days off work for parents or additional diaper consumption) was estimated at 275.54euros/case. The PRGE incidence rate is similar to that estimated in European studies conducted in DDC. These findings confirm that rotavirus transmission occurs not only in DCCs but within the family. This is the first study to give an estimate of the incidence and the cost of rotavirus infection in DCCs in France. [Copyright &y& Elsevier]

An essay is presented on the diarrheal infection among the African children in Yaoundé, Cameroon. It shows that diarrheal infection is the third most deadly infectious disease in the world which affects all ages. It is revealed that the disease is widely distributed throughout the area as a result of interactions between organisms living together in a specific conditions. Potencial solutions should be inspired by social issues that have been determining the growth of the place.

In most cases, acute diarrhoea will become self-limiting during the first few days after onset. For young children, however, health risks may develop when the disease lasts longer than 3 days. The purpose of the present trial was to determine whether the stool frequency of infants and toddlers suffering from acute diarrhoea could be normalised more quickly by administering the probiotic Escherichia coli Nissle 1917 (EcN) solution than by administering a placebo. The safety of EcN were also assessed. A total of 113 children (aged 2–47 months) with acute diarrhoea (> three watery or loose stools in 24 h) were randomised to either a group receiving the probiotic EcN suspension ( n = 55) or a group receiving the placebo suspension ( n = 58) in a confirmative, double-blind clinical trial. Depending on the age of patients, 1–3 ml per day of verum suspension (108 viable EcN cells per millilitre) or placebo were administered orally. The causes of the diarrhoea were viral rather than bacterial, but they were mainly unspecific infections. The median onset of treatment response (reduction of daily stool frequency to ≤ three watery or loose stools over at least 2 consecutive days) occurred more rapidly in the children receiving the EcN solution (2.5 days) than in those receiving the placebo (4.8 days), a significant difference (2.3 days; p = 0.0007). The number of patients showing a response was clearly higher ( p < 0.0001) in the EcN group (52/55; 94.5%) than in the placebo group (39/58; 67.2%). EcN was found to be safe and well-tolerated, and it showed a significant superiority compared to the placebo in the treatment of acute diarrhoea in infants and toddlers. [ABSTRACT FROM AUTHOR]

Atypical enteropathogenic Escherichia coli (aEPEC) strains are frequently implicated in infant diarrhoea in developing countries. Not much is known about the adherence properties of aEPEC; however, it has been shown that these strains can adhere to tissue-cultured cells. A chromosomal region designated the locus for diffuse adherence (LDA) confers aEPEC strain 22 the ability to adhere to culture cells. LDA is an afimbrial adhesin that contains a major subunit, LdaG, whose expression is induced on MacConkey agar at 37°C. We hypothesized that the bile salts found in this culture media induce the expression of LdaG. Strain 22 and the LdaG mutant were grown in Luria–Bertani (LB) media in the presence or absence of bile salts and heat-extracted surface-expressed proteins were separated by SDS-PAGE to determine whether expression of the 25 kDa LdaG protein was induced. Western blot analysis with anti-LdaG confirmed that bile salts enhance LdaG expression at 37°C. Adhesion assays on HeLa cells revealed that adhesion in a diffuse pattern of strain 22 increased in the presence of bile salts. We also confirmed that expression of the localized adherence pattern observed in the ldaG mutant required the presence of a large cryptic plasmid found in strain 22 and that this phenotype was not induced by bile salts. At the transcriptional level, the ldaG-lacZ promoter fusion displayed maximum beta-galactosidase activity when the parent strain was grown in LB supplemented with bile salts. Fluorescence Activated Cell Sorting analysis, immunogold labelling electron microscopy and immunofluorescence using anti-LdaG sera confirmed that LDA is a bile salts-inducible surface-expressed afimbrial adhesin. Finally, LdaG expression was induced in presence of individual bile salts but not by other detergents. We concluded that bile salts increase expression of LDA, conferring a diffuse adherence pattern and having an impact on the adhesion properties of this aEPEC strain. [ABSTRACT FROM AUTHOR]

Enteropathogenic E. coli (EPEC) is a major cause of infantile diarrhea, but the pathophysiology underlying associated diarrhea is poorly understood. We examined the role of the luminal membrane Cl(-)/OH(-) exchange process in EPEC pathogenesis using in vitro and in vivo models. Cl(-)/OH(-) exchange activity was measured as OH(-) gradient-driven (36)Cl(-) uptake. EPEC infection (60 minutes-3 hours) inhibited apical Cl(-)/OH(-) exchange activity in human intestinal Caco-2 and T84 cells. This effect was dependent upon the bacterial type III secretory system (TTSS) and involved secreted effector molecules EspG and EspG2, known to disrupt the host microtubular network. The microtubule-disrupting agent colchicine (100 muM, 3 hours) also inhibited (36)Cl(-) uptake. The plasma membrane expression of major apical anion exchanger DRA (SLC26A3) was considerably reduced in EPEC-infected cells, corresponding with decreased Cl(-)/OH(-) exchange activity. Confocal microscopic studies showed that EPEC infection caused a marked redistribution of DRA from the apical membrane to intracellular compartments. Interestingly, infection of cells with an EPEC mutant deficient in espG significantly attenuated the decrease in surface expression of DRA protein as compared with treatment with wild-type EPEC. EPEC infection in vivo (1 day) also caused marked redistribution of surface DRA protein in the mouse colon. Our data demonstrate that EspG and EspG2 play an important role in contributing to EPEC infection-associated inhibition of luminal membrane chloride transport via modulation of surface DRA expression. [ABSTRACT FROM AUTHOR]

Enterotoxigenic Escherichia coli (ETEC) is a common cause of bacterial infection leading to acute watery diarrhea in infants and young children. Although the prevalence of ETEC is high in Bangladesh and infections can be spread through food and contaminated water, limited information is available about ETEC in the surface water. We carried out studies to isolate ETEC from surface water samples from ponds, rivers, and a lake from a site close to field areas known to have a high incidence of diarrhea in Dhaka, Bangladesh, and Matlab, Bangladesh. ETEC strains isolated from the water sources were compared with ETEC strains isolated from patients with diarrhea at two hospitals in these areas. ETEC were isolated from 30% (45 of 150) of the samples from the surface water sources and 19% (518 of 2700) of the clinical specimens. One hundred ETEC strains isolated from patients with similar phenotypes as the environmental strains were compared for phenotypic and genotypic properties. The most common O serogroups on ETEC were O6, O25, O78, O115, and O126 in both types of strains. Pulsed-field gel electrophoresis analyses of the ETEC strains showed that multiple clones of ETEC were present within each colonization factor type and that some clones detected in the environment were also isolated from the stools of patients. The strains showed multiple and similar antibiotic resistance patterns. This study shows that ETEC is prevalent in surface water sources in Bangladesh suggesting a possible reason for the endemicity of this pathogen in Bangladesh. [ABSTRACT FROM AUTHOR]

Background Multiple studies document that probiotics are effective in treating infectious diarrhoea in children. Lactobacillus rhamnosus GG is the most extensively studied but effectiveness of other strains has been poorly examined. Aim To determine whether L. rhamnosus strains (573L/1; 573L/2; 573L/3) (Lakcid L, Biomed, Lublin, Poland) would be effective in shortening infectious diarrhoea. Methods In a randomized, double-blind, placebo-controlled trial, 87 children (age range: 2 months to 6 years) with infectious diarrhoea were administered Lakcid L at a dose 1.2 × 1010 CFU or placebo, twice daily, for 5 days. Primary outcome measure was the duration of diarrhoea. Secondary measures were duration of parenteral rehydration, adverse events, and gastrointestinal tract colonization by administered strains. Results In an intention to treat analysis of 87 children, the mean duration of diarrhoea in the treated group: 84 ± 56 h; placebo: 96 ± 72 h ( P = 0.36). In rotavirus infection: 76 ± 35 h vs. 115 ± 67 h ( P = 0.03), respectively. Duration of parenteral rehydration: 15 ± 14 h vs. 38 ± 33 h ( P = 0.006). Gut colonization by administered strains was 80% and 41% at five and 14 days, respectively. No adverse events were noted. Conclusions Administration of L. rhamnosus strains shortens the duration of rotaviral diarrhoea in children but not of diarrhoea of any aetiology. Intervention shortens the time of intravenous rehydration. [ABSTRACT FROM AUTHOR]

Background Although not currently recommended, dioctahedral smectite (smectite) is commonly used to treat acute infectious diarrhoea in many countries. Aim To evaluate systematically the effectiveness of smectite in treating acute infectious diarrhoea in children. Methods Using medical subject headings and free-language terms, the following electronic databases were searched for studies relevant to acute infectious diarrhoea and smectite: MEDLINE, EMBASE, CINAHL and The Cochrane Library; additional references were obtained from reviewed articles. Only randomized-controlled trials were included. Results Nine randomized-controlled trials (1238 participants) met the inclusion criteria. Combined data from six randomized-controlled trials showed that smectite significantly reduced the duration of diarrhoea compared with placebo. The pooled weighted mean difference was (−22.7 h, 95% CI: −24.8 to −20.6) with a fixed model and remained significant in a random effect model (−24.4 h, 95% CI: −29.8 to −19.1). The chance of cure on intervention day 3 was significantly increased in the smectite vs. the control group (RR 1.64, 95% CI: 1.36–1.98; number needed to treat 4, 95% CI: 3–5). Adverse effects were similar in both groups. Conclusions Smectite may be a useful adjunct to rehydration therapy in treating acute paediatric gastroenteritis. However, the results of this meta-analysis should be interpreted with caution as most of the included studies had important limitations. Cost-effectiveness analyses should be undertaken before routine pharmacological therapy with smectite is recommended. [ABSTRACT FROM AUTHOR]

Summary Background Pneumonia and diarrhea cause much morbidity and mortality in children younger than 5 years. Most deaths occur during infancy and in developing countries. Daily regimens of zinc have been reported to prevent acute lower respiratory tract infection and diarrhea, and to reduce child mortality. We aimed to examine whether giving zinc weekly could prevent clinical pneumonia and diarrhea in children younger than 2 years. Methods 1665 poor, urban children aged 60 days to 12 months were randomly assigned zinc (70 mg) or placebo orally once weekly for 12 months. Children were assessed every week by field research assistants. Our primary outcomes were the rate of pneumonia and diarrhea. The rates of other respiratory tract infections were the secondary outcomes. Growth, final serum copper, and final haemoglobin were also measured. Analysis was by intention to treat. Findings 34 children were excluded before random assignment to treatment group because they had tuberculosis. 809 children were assigned zinc, and 812 placebo. After treatment assignment, 103 children in the treatment group and 44 in the control group withdrew. There were significantly fewer incidents of pneumonia in the zinc group than the control group (199 vs 286; relative risk 0·83, 95% CI 0·73-0·95), and a small but significant effect on incidence of diarrhea (1881 cases vs 2407; 0·94, 0·88-0·99). There were two deaths in the zinc group and 14 in the placebo group (p=0·013). There were no pneumonia-related deaths in the zinc group, but ten in the placebo group (p=0·013). The zinc group had a small gain in height, but not weight at 10 months compared with the placebo group. Serum copper and haemoglobin concentrations were not adversely affected after 10 months of zinc supplementation. Interpretation 70 mg of zinc weekly reduces pneumonia and mortality in young children. However, compliance with weekly intake might be problematic outside a research program. [ABSTRACT FROM AUTHOR]

Objective. Investigating the secretory immune response during the acute phase of diarrhoeal disease is hampered by difficulty in collecting suitable control specimens. This is particularly the case in infants, as they are the most severely affected by this disease. In this study we examined the mucosal immunoglobulin response during the acute phase of diarrhoeal disease in infants. Material and methods. The intestinal outputs of secretory immunoglobulins (IgA, IgM) and non-secretory proteins (IgG, albumin, Al AT, eosinophil cationic protein (ECP)) were measured in 14 African children with acute watery diarrhoea (less than 3 days). These data were compared with those of 38 controls from the same area who had undergone whole-gut lavage (WGL) (inducing non-pathogenic watery diarrhoea) in a previous study of intestinal immunity and inflammation. Intestinal secretion rates were measured by multiplying the concentration of the substances by the rate of administration of WGL fluid (equal to the output) or by the output of diarrhoea. Statistical comparison was made using the Mann-Whitney U-test. Results. IgA output in subjects with diarrhoea was 1.8-fold greater (80.7 versus 45.6 mg/kg/day, p = 0.03), whereas IgM output was 10-fold greater (21 versus 2.1 mg/kg/day, p =0.0001). Albumin, A1AT and IgG were all also greater to varying degrees (2.5-6.8-fold). ECP was unchanged. Increases in the non-secretory proteins would suggest increased permeability of the gastrointestinal tract but transudation of serum was insufficient to explain the rise in immunoglobulin output. Conclusions. The 10-fold increase in IgM secretion compared with a smaller relative increase in IgA suggests that this is the primary mucosal immune response in acute diarrhoeal disease. [ABSTRACT FROM AUTHOR]

Despite much progress in the understanding of pathogenesis and of management, diarrhoeal illnesses remain one of the most important causes of global childhood mortality and morbidity. Infections account for most illnesses, with pathogens employing ingenious mechanisms to establish disease. In the developed world, an upsurge in immunemediated gut disorders might have resulted from a disruption of normal bacterial-epithelial cross-talk and impaired maturation of the gut's immune system. Oral rehydration therapies are the mainstay of management of gastroenteritis, and their composition continues to improve. Malnutrition remains the major adverse prognostic indicator for diarrhoearelated mortality, emphasising the importance of nutrition in early management. Drugs are of little use, except for specific indications although new agents that target mechanisms of secretory diarrhoea show promise, as do probiotics. However, preventive strategies on a global scale might ultimately hold the greatest potential to reduce the burden of diarrhoeal disease. These strategies include vaccines and, most importantly, policies to address persisting inequalities between the developed and developing worlds with respect to nutrition, sanitation, and access to safe drinking water. [ABSTRACT FROM AUTHOR]

Background: Rotaviruses are the most common agents of diarrheal illness of infants and young children. Gastroenteritis caused by rotaviruses is also more likely to be associated with severe dehydration compared to other viral gastroenteritis. Objectives: We determined the G-serotype of rotaviruses circulating in the Metro Toronto-Peel County region, during the 1997–1998 winter. Study design: Stool samples were collected in Metro Toronto-Peel county region from November 1, 1997 to June 30, 1998. Rotavirus presence was demonstrated by electron microscopy and ELISA. A reverse transcription-polymerase chain reaction (RT-PCR) assay for the amplification of the near-complete RHA segment 9 of rotavirus was developed and used to determine the G-serotype by sequencing and phylogenetic analysis. Results: A total of 135 rotavirus isolates were used as templates for RT-PCR. Of these, four could not be amplified and one revealed a mixed infection. The G-serotypes could be unambiguously determined for the other isolates. Of these, 85 were of G-serotype 1, 41 of G2, 1 of G3, 1 of G4, and 2 of G9. Conclusion: Our RT-PCR assay enables unambiguous determination of the G-serotype. The overall relative incidence of G-serotypes in Toronto is similar to that of other developed countries. Serotype G9 was present at low levels in Toronto. [Copyright &y& Elsevier]

A 3-month-old girl with congenital secretory diarrhea underwent a duodenal biopsy. Histologic study showed villous atrophy and large amounts of PAS-positive material within enterocyte cytoplasm. Despite a clinical suspicion of microvillous inclusion disease, 2 sessions of electron microscopy were unsuccessful in detecting the diagnostic inclusions. Instead, large aggregates of electron-lucent, vermiform membranous vesicles were observed in enterocyte cytoplasm, corresponding to the PAS-positive material. A third attempt at electron microscopy was successful in detecting small numbers of microvillous inclusions. These and other recently reported cases document an expanding spectrum of ultrastructural findings in this disease, including examples where the classic microvillous inclusions are overshadowed by other features. [ABSTRACT FROM AUTHOR]

Background: The administration of hydrating solutions and early refeeding improve recovery for infants and children with diarrhea.Objective: The aim of this study was to assess the efficacy of a low-osmolarity (30 mEq/L Na+) solution administered after the standard, high-osmolarity (90 mEq/L Na+) solution via a nasogastric tube (NGT) and followed by early refeeding to achieve more rapid body weight recovery in infants and children with acute diarrhea.Methods: Infants and children aged <5 years with acute diarrhea and dehydration (body weight loss of ≥10%) observed from January to August 2001 at Saint Camille Medical Center, Ouagadougou, Burkina Faso, were enrolled. Patients were randomized to 1 of 3 treatment protocols. Patients in group A received, via NGT, rehydration with a high-osmolarity solution for 3 hours, followed by a low-osmolarity solution for at least 3 additional hours. Patients in group B were given only a low-osmolarity solution via NGT. In group C, rehydration was carried out using a high-osmolarity solution via NGT.Results: Four thousand consecutively treated infants and children (2010 boys, 1990 girls; mean [SD] age, 3.5 [2.7] years) were enrolled. After the first 6 hours of infusion, 90% of the patients who had received the combined rehydration (group A) showed significant body weight recovery, versus 80% and 79% of the patients in groups B and C, respectively. Stool output significantly decreased for group A compared with groups B and C (114 vs 125 and 120 g/kg, respectively). Only 7% of the patients in group A required prolonged rehydration (>6 hours) with the low-osmolarity solution, versus 10% and 12% in groups B and C, respectively. A total of 3% of patients treated with combined rehydration required hospitalization, compared with 10% and 9% in groups B and C, respectively. At the end of infusion, 25% of the patients rehydrated only with a low-osmolarity solution showed poor body weight recovery and appeared lethargic, versus 10% in group A and 15% in group C. Patients who were rehydrated with a high-osmolarity solution showed symptoms of hypernatremia (serum Na+ concentration >140 mEq/L). At the end of rehydration (≥6 hours), all patients recovered their previous body weight, partially or totally, and refeeding was begun. Rehydration and diet were continued at home, or in neighboring areas for those living far away.Conclusions: In this study population, the administration of a high-osmolarity solution followed by a low-osmolarity solution and early refeeding was effective in the treatment of acute diarrhea and was well tolerated. [Copyright &y& Elsevier]

In this paper written by the Groupe francophone d’he´patologie, gastroente´rologie et nutrition pe´diatriques, recommandations are given on the indications of drugs in infant and child infectious acute diarrhea, based upon the current scientific knowledge on their effectiveness and tolerance. This paper complements an article on nutritional treatment of acute diarrhea written by the Comite´ de nutrition de la Socie´te´ franc¸aise de pe´diatrie, and published in the same issue of the Archives de Pe´diatrie. [ABSTRACT FROM AUTHOR]

Methods A multicentre, parallel-group, double-blind, double-placebo study was carried out to compare the efficacy, tolerability, and safety of racecadotril and loperamide in children aged 2 to 10 years who were suffering from acute diarrhoea. Patients received racecadotril (1.5 mg/kg) or loperamide (0.03 mg/kg) three times daily plus matching placebo until recovery. Fifty-two children received racecadotril and 50 loperamide. Results Patients on racecadotril passed a mean (± S.E.M.) of 2.7 ± 0.4 stools before recovery compared with 2.1 ± 0.4 stools for loperamide. The duration of diarrhoea was similar with both treatments. The incidence of adverse events was lower with racecadotril than with loperamide (11.5% vs. 22%), and significantly more patients on loperamide suffered from constipation (58% vs. 36.5%; P = 0.03). Moreover, significantly more children receiving loperamide required concomitant medication during the study (38% v 19.2%; P = 0.047). Measurement of abdominal circumference at the final consultation, 6 days after entry to the study, revealed no significant differences between treatments. Conclusions Racecadotril and loperamide were equally effective in treating acute diarrhoea in these children, and racecadotril had a superior tolerability and safety profile. [ABSTRACT FROM AUTHOR]

Investigates the effects of weaning foods and products used in preparing weaning foods on colonization and proliferation of bacteria pathogens in young children. Study in Ile-Ife, Oyo-State, Nigeria; Higher recovery rate of enteric pathogens from the stools of children who were fed weaning foods than from their counterparts who were breastfed exclusively; Unhygienic preparation of the weaning foods; Lack of potable water.

Gastrointestinal (GI) manifestations of post-natally acquired cytomegalovirus (CMV) in preterm neonates can vary from mild diarrhoea to severe necrotising enterocolitis. However, the suspicion of CMV-related GI disease remains low. Mild CMV disease localised to the GI tract may go undiagnosed initially until a more obvious complication such as strictures manifest. A case of CMV-associated enteritis in an extremely preterm neonate is presented. The diagnosis was established after the histopathology of the surgical specimen showed the presence of CMV inclusion bodies. Testing the stool specimen for CMV to establish the diagnosis when the pathology is limited to the GI tract is also discussed. [ABSTRACT FROM AUTHOR]

Presents several articles about chronic diarrhea on children. "Diarrhea caused by deficiency of sugar splitting enzymes," by H.A. Weijers, J.H. van de Kamer, W.K. Duke and I. Ijsseling; "Diarrhoea caused by the deficiency of sugar splitting enzymes," by H.A. Weijers and J.H. van de Kamer; "Digestion and absorption of disaccharides in man," by A. Dahlquist and B. Borgstrom.

In this article, the author offers information related to a research done at the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh. He informs that the research found a range of enteropathogens in the intestines of infants and young children in resource limited settings and including in those who were with no evident diarrhea.

The article presents a study of four subtypes of non-IgE-mediated gastrointestinal food allergies in infants and neonates. It says that the normal level of blood eosinophils is 0% to 4% however it rises to a specific level in the neonatal period particularly in low-birth-weight infants. In addition, it mentions that main symptoms of patients in cluster 3 were diarrhea and poor weight gain which were similar in patients with enteropathy.

Enteroaggregative Escherichia coli (EAEC) is a pathogen implicated in several infant diarrhea or diarrheal outbreaks in areas of endemicity. Although multiple genes involved in EAEC pathogenesis have been identified, the overall mechanism of virulence is not well understood. Recently, a novel secretion system, called type VI secretion (T6S) system (T6SS), has been identified in EAEC and most animal or plant gram-negative pathogens. T6SSs are multicomponent cell envelope machines responsible for the secretion of at least two putative substrates, Hcp and VgrG. In EAEC, two copies of T6S gene clusters, called sci-1 and sci-2, are present on the pheU pathogenicity island. In this study, we focused our work on the sci-1 gene cluster. The Sci-1 apparatus is probably composed of all, or a subset of, the 21 gene products encoded on the cluster. Among these subunits, some are shared by all T6SSs identified to date, including a ClpV-type AAA+ ATPase (SciG) and an IcmF (SciS) and an IcmH (SciP) homologue, as well as a putative lipoprotein (SciN). In this study, we demonstrate that sciN is a critical gene necessary for T6S-dependent secretion of the Hcp-like SciD protein and for biofilm formation. We further show that SciN is a lipoprotein, as shown by the inhibition of its processing by globomycin and in vivo labeling with [3H]palmitic acid. SciN is tethered to the outer membrane and exposed in the periplasm. Sequestration of SciN at the inner membrane by targeting the +2 residue responsible for lipoprotein localization (Gly2Asp) fails to complement an sciN mutant for SciD secretion and biofilm formation. Together, these results support a model in which SciN is an outer membrane lipoprotein exposed in the periplasm and essential for the Sci-1 apparatus function. [ABSTRACT FROM AUTHOR]

The article reports that acute diarrhoea is still the leading cause of infantile diarrhoea in less-developed countries and the most important symptom associated with malnutrition. The first study of worldwide morbidity and mortality from diarrhoeal disease showed that, based on population estimates in 1980, there were 744-1000 million episodes of diarrhoea and 4.6 million deaths each year in that decade from diarrhoeal disease in children younger than 5 years in Africa, Asia, and Latin America. A decade later, improved management reduced worldwide mortality to 3.3 million deaths per year, but the incidence of diarrhoea remained virtually unchanged. In Brazil, infants younger than 1 year of age represent the age group with a higher than average risk of death due to diarrhoea. The main bacterial enteric pathogen in less-developed countries, and particularly among infants 2 months to 1 year of age in low-income families who live in large urban centres, is enteropathogenic Escherichia coli (EPEC). EPEC can induce a copious secretory diarrhoea that may require intravenous hydration.

Points out that a major effort by public health education at the community level may be the most important strategy for preventing infantile infectious diarrhea. Presence of bacteria in weaning foods used either as supplements to breast feeding or as the sole feeding diet; Close relationship between diarrhea and malnutrition; Sociological impact of living practices of more affluent societies on poorer countries.