Gastrointestinal infections

2020 ◽  
pp. 3008-3024
Author(s):  
Sarah O’Brien
Keyword(s):  
Gastrointestinal Disease ◽  
Systemic Disease ◽  
Acute Diarrhoea ◽  
Laboratory Diagnosis ◽  
Bloody Diarrhoea ◽  
Bacterial Toxin ◽  
Gastrointestinal Infections ◽  
Oral Rehydration ◽  
Gastrointestinal Pathogens ◽  
Traveller’S Diarrhoea

Gastrointestinal infections, especially diarrhoea and vomiting, are responsible for substantial morbidity, mortality, and socioeconomic penalties worldwide. Poor sanitation, inadequate water supplies, and globalization of food production, processing, and retailing increase the risk of large epidemics of food- and waterborne outbreaks of gastrointestinal disease. Acute diarrhoea can be caused by a range of pathogens. Gastrointestinal pathogens usually cause three principal syndromes: acute watery diarrhoea, acute bloody diarrhoea (inflammatory diarrhoea or dysentery), and persistent diarrhoea. They can also cause systemic disease. Patients who do not have high fever (>38.5°C), systemic illness, tenesmus, bloody diarrhoea, a prolonged course (>2 weeks), or dehydration require neither investigation nor treatment. Investigation is required in patients with any of these features, with faecal specimens examined by culture (bacterial pathogens and some protozoa), microscopy (ova, cysts, and parasites), immunoassays (some protozoa and viruses), and molecular methods, usually polymerase chain reaction (PCR) or reverse transcriptase PCR (bacterial toxin genes and viruses). A specific laboratory diagnosis is useful epidemiologically and therapeutically. Oral rehydration therapy is the priority for patients with mild to moderate diarrhoea as long as vomiting is not a major feature. Antimicrobial therapy is not recommended or usually required for uncomplicated diarrhoea, but antibiotic treatment is beneficial for cholera, giardiasis, cyclosporiasis, shigellosis, symptomatic traveller’s diarrhoea, Clostridium difficile diarrhoea, and typhoid. Antimotility drugs are useful in controlling moderate to severe diarrhoea in adults but they are not generally recommended for infants and young children under the age of 4 years. Strict attention to food and water precautions and hand washing helps reduce the risk of gastrointestinal infections. Immunization has not yet proved successful for combating many gastrointestinal pathogens, with the notable exception of rotavirus.

scholarly journals Predictors of aetiology and outcomes of acute gastrointestinal illness in returning travellers: a retrospective cohort analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Robert A. Lever ◽  
Louis Tapper ◽  
Sophie Skarbek ◽  
Peter L. Chiodini ◽  
Margaret Armstrong ◽  
...  
Keyword(s):  
Gastrointestinal Disease ◽  
Cohort Analysis ◽  
Laboratory Data ◽  
Gastrointestinal Symptoms ◽  
Healthcare Services ◽  
Bloody Diarrhoea ◽  
Gastrointestinal Illness ◽  
Gastrointestinal Infections ◽  
Factors Associated ◽  
Bacteriological Diagnosis

Abstract Background Gastrointestinal illness is a major cause of morbidity in travellers and is a common reason for presentation to healthcare services on return. Whilst the aetiology of imported gastrointestinal disease is predominantly infectious, outcomes are variable due to a range of phenomena such as post-infectious irritable bowel syndrome, drug resistance and occult pathology (both infectious and non-infectious). Previous studies have focussed on predictors of aetiology of gastrointestinal disease in travellers; we present a retrospective study combining both aetiological and early outcome data in a large cohort of returned travellers. Method We identified 1450 patients who attended our post-travel walk-in clinic with gastrointestinal symptoms between 2010 and 2016. Demographic, travel, clinical and laboratory data was collected through case note review. Logistic regression analysis to examine correlates of aetiology and outcome were performed in R (CRAN Project 2017). Results Of 1450 patients in our cohort 153 reported bloody diarrhoea and 1081 (74.6%) reported non-bloody diarrhoea. A definitive microbiological diagnosis was made in 310 (20.8%) of which 137 (9.4%) had a parasite identified and 111 (7.7%) had a bacterial cause identified. Factors associated with a parasitological diagnosis included history of travel to South Asia (aOR = 2.55; 95%CI 1.75–3.70, p < 0.0001) and absence of bloody diarrhoea (aOR = 0.22; 95%CI 0.066–0.53, p < 0.005). Factors associated with a bacteriological diagnosis included male gender (aOR = 1.69; 95%CI 1.10–2.62, p < 0.05), an age < 37 years on presentation (aOR = 2.04; 95%CI 1.25–3.43, p < 0.01), white cells on stool microscopy (aOR = 3.52; 95%CI 2.09–5.86, p < 0.0001) and a C-reactive protein level of >5iu/dL (aOR = 4.68; 95%CI 2.91–7.72, p < 0.0001). The majority (1235/1450, 82.6%) reported full symptomatic resolution by the first follow up visit; factors associated with lack of symptomatic resolution included female gender (aOR = 1.45 95%CI 1.06–1.99, p < 0.05), dysenteric diarrhoea (aOR = 2.14 (95%CI 1.38–3.25, p < 0.0005) and elevated peripheral leukocyte count (aOR = 1.58 95%CI 1.02–2.40, p < 0.05). Conclusions In a cohort of returned travellers, we were able to identify multiple factors that are correlated with both aetiology and outcome of imported gastrointestinal syndromes. We predict these data will be valuable in the development of diagnostic and therapeutic pathways for patients with imported gastrointestinal infections.

scholarly journals Predictors of Aetiology and Outcomes of Acute Gastrointestinal Illness in Returning Travellers: a Retrospective Cohort Analysis

2021 ◽  
Author(s):  
Robert A Lever ◽  
Louis Tapper ◽  
Sophie Skarbek ◽  
Peter L Chiodini ◽  
Margaret Armstrong ◽  
...  
Keyword(s):  
Gastrointestinal Disease ◽  
Cohort Analysis ◽  
Laboratory Data ◽  
Gastrointestinal Symptoms ◽  
Healthcare Services ◽  
Bloody Diarrhoea ◽  
Gastrointestinal Illness ◽  
Gastrointestinal Infections ◽  
Factors Associated ◽  
Bacteriological Diagnosis

Abstract Background: Gastrointestinal illness is a major cause of morbidity in travellers and is a common reason for presentation to healthcare services on return. Whilst the aetiology of imported gastrointestinal disease is predominantly infectious, outcomes are variable due to a range of phenomena such as post-infectious irritable bowel syndrome, drug resistance and occult pathology (both infectious and non-infectious). Previous studies have focussed on predictors of aetiology of gastrointestinal disease in travellers; we present a retrospective study combining both aetiological and early outcome data in a large cohort of returned travellers. Method: We identified 1450 patients who attended our post-travel walk-in clinic with gastrointestinal symptoms between 2010 and 2016. Demographic, travel, clinical and laboratory data was collected through case note review. Logistic regression analysis to examine correlates of aetiology and outcome were performed in R (CRAN Project 2017). Results: Of 1450 patients in our cohort 153 reported bloody diarrhoea and 1081 (74.6%) reported non-bloody diarrhoea. A definitive microbiological diagnosis was made in 310 (20.8%) of which 137 (9.4%) had a parasite identified and 111 (7.7%) had a bacterial cause identified. Factors associated with a parasitological diagnosis included history of travel to South Asia (aOR=2.55; 95%CI 1.75-3.70, p<0.0001) and absence of bloody diarrhoea (aOR=0.22; 95%CI 0.066-0.53, p<0.005). Factors associated with a bacteriological diagnosis included male gender (aOR=1.69; 95%CI 1.10-2.62, p<0.05), an age <37 years on presentation (aOR=2.04; 95%CI 1.25-3.43, p<0.01), white cells on stool microscopy (aOR=3.52; 95%CI 2.09-5.86, p<0.0001) and a C-reactive protein level of >5iu/dL (aOR=4.68; 95%CI 2.91-7.72, p<0.0001). The majority (1235/1450, 82.6%) reported full symptomatic resolution by the first follow up visit; factors associated with lack of symptomatic resolution included female gender (aOR=1.45 95%CI 1.06-1.99, p<0.05), dysenteric diarrhoea (aOR=2.14 (95%CI 1.38-3.25, p<0.0005) and elevated peripheral leukocyte count (aOR=1.58 95%CI 1.02-2.40, p<0.05).Conclusions: In a cohort of returned travellers, we were able to identify multiple factors that are correlated with both aetiology and outcome of imported gastrointestinal syndromes. We predict these data will be valuable in the development of diagnostic and therapeutic pathways for patients with imported gastrointestinal infections.

scholarly journals Efficacy of Probiotic Saccharomyces boulardii as an Adjuvant Therapy in Acute Childhood Diarrhoea

2017 ◽  
Vol 36 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Dillip Kumar Dash ◽  
Mrutunjaya Dash ◽  
M.D. Mohanty ◽  
Naresh Acharya
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Acute Diarrhoea ◽  
Oral Rehydration Therapy ◽  
Saccharomyces Boulardii ◽  
Care Hospital ◽  
Oral Rehydration ◽  
Group 2 ◽  
A Prospective Study ◽  
Group 1

Introduction: Administration of S. boulardii in addition to rehydration therapy in diarrhea found to be beneficial in many aspects owing to a variety of causes and importantly it is was not associated with any adverse effects.Material and Methods: We conducted a prospective study of children suffering from acute diarrhoea, at a private tertiary care hospital. Children were divided into 2 groups randomly as per odd(Group 1 ) and even (Group 2) bed allotted in indoor at the time of admission: Group 1 included children on oral rehydration therapy (ORT) + Zinc + Saccharomyces boulardii (Probiotic 5 billion CFU twice daily) and Group 2 comprised of children on ORT+ Zinc. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhoea.Results: Out of a total of 126 children less than 2 years, 2-6 years and 6-14 years were 72 (57.14%), 42(33.33%) and 12(09.52%) respectively. The duration of diarrhoea in Group 1 was 26.31 hours and Group 2 was 47.81 hours (p<0.01). The frequency of diarrhoea showed improvement within 24 and 72 hours in Group 1 and Group 2 respectively (p<0.01).Similarly, the mean duration of hospital stay was 2.68 days in Group 1 and 4.8 days in Group 2.The treatment cost was INR 850 and INR 1650 while social cost was INR 1250 and 2600 in Group 1 and 2 respectively.Conclusion:This study shows that S. boulardii reduced the duration, frequency and hospital stay of diarrhoea thereby reducing the treatment and social costs.J Nepal Paediatr Soc 2016;36(3):250-255

scholarly journals Technological prospection of Diminazene Aceturate, an Angiotensin II Converting Enzyme activator, in front of diarrheic disorders

2020 ◽  
Vol 9 (12) ◽  
pp. e1691210755
Author(s):  
Luan Kelves Miranda de Souza ◽  
Kerolayne de Melo Nogueira ◽  
Jand Venes Rolim Medeiros
Keyword(s):  
Gastrointestinal Disease ◽  
Biological Activities ◽  
Fluid Replacement ◽  
Special Focus ◽  
Diminazene Aceturate ◽  
Oral Rehydration ◽  
International Patent ◽  
Rehydration Solution ◽  
Antidiarrheal Agent ◽  
Patent Filing

Diarrhea, which is a gastrointestinal disease, has as its main characteristic the rapid passage of gastric contents through the intestine, which leads to the loss of water and electrolytes and consequent dehydration. The most common fluid replacement is the use of oral rehydration solution (ORS) together with the use of the drug loperamide. However, the use of this medication can cause severe bacteremia followed by sepsis and even death. Currently, there is no effective pharmacological treatment for diarrhea, therefore, it is noted the importance of seeking new therapeutic targets for the treatment of this disease. Thus, the aim of the present study was to conduct a research on the biological activities already described for Diminazene Aceturate with a special focus on antidiarrheal agents. For this, a survey was carried out, through patent filing searches, in the USPTO, EPO, WIPO and INPI databases, using keywords and Boolean operators. Thus, it was found in the international patent databases the number of documents referring to the use of Diminazene Aceturate in several areas, mainly in the pharmaceutical industry, but with a relatively low number of documents regarding the description of possible antidiarrheal action of the compound under study , which reinforces the innovative character of research involving the use of Diminazene Aceturate as an antidiarrheal agent.

scholarly journals Oral Rehydration Therapy in Young Infants less than 3 Months with Acute Diarrhoea and Modeate Dehydration

2019 ◽  
Vol 28 (3-4) ◽  
pp. 67-78 ◽  
Author(s):  
Sunoto Sunoto ◽  
Suharyono Suharyono ◽  
Aswitha D. Budiarso ◽  
Adnan S. Wiharta
Keyword(s):  
Acute Diarrhoea ◽  
Oral Rehydration Therapy ◽  
Sodium Concentration ◽  
Appropriate Technology ◽  
Plain Water ◽  
Oral Rehydration ◽  
Young Infants ◽  
Group I ◽  
Significant Difference ◽  
Intravenous Solution

Oral rehydration therapy (ORT) as an appropriate technology in the treatment of acute diarrhoeal diseases (ADD) has been accepted throughout the world. It has been proved that besides lifesaving, ORT has reduced about 70-80% of the use of intravenous solution and average cost of the treatment of ADD. If there is still problem, question or doubtfulness, is the use of WHO ORS in full concentration for the neonates and young infants less than 3 months of age. During one-year period it has been treated 72 cases of ADD in young infants less than 3 months of age with moderate dehydration. They were divided into 3 groups. The first group was treated with 100 mil kg bw of fluid consisting oftwothirds as WHO ORS in full concentration for 4 hours period and the rest, one-third, was given as plain water for 2 hours period. The second group was treated with kristalyte with the Na concentration of 51 mEq/L and the third group was treated with intravenous Ringer's lactate for 6 hours period. After the end of the study only 18 patients in each group could be matched and evaluated. From clinical observation and laboratory examinations, the result of the treatment in general, statistically shows no significant difference. Diarrhoea and vomiting stopped in all groups on the second day of treatment. Hyponatremia which occurred in 3 patients in Group I and 2 patients each in Group II and III improved  after 6 hours of treatment. Acidosis was corrected in all of the treatment groups in 6 hours period. Weight gain up to 6-9% of body weight on admission was achieved after 6 hours of treatment in all groups. No complication of hypernatremia, convulsion nor hypoglycaemia in all the treatment group. From this study it could be concluded that WHO ORS is quite safe and effective as ORS with low sodium concentration and intravenous treatment, as far as it is given slowly, little by little with a strict supervision.

Diagnosing systemic diseases.

2021 ◽  
pp. 224-243
Author(s):  
Shou-Hua Wang
Keyword(s):  
Abiotic Stresses ◽  
Systemic Disease ◽  
Laboratory Diagnosis ◽  
Pathogenicity Test ◽  
Systemic Diseases ◽  
Beet Curly Top Virus ◽  
Management Measures ◽  
Leaf Chlorosis ◽  
Resistant Varieties ◽  
Contact Transmission

Abstract A systemic disease is defined as one where a pathogen infects a plant systemically or affects the plant as a whole. There are certain types of diseases in hemp and cannabis crops that are viewed more as systemic rather than localized, based on both infection behaviour and symptom development. This chapter deals with diagnosing systemic diseases of cannabis crops, including vascular wilt caused by Fusarium Species, witches' broom caused by phytoplasmas, leaf curl caused by Beet curly top virus, plant stunting caused by Hop latent viroid, leaf chlorosis caused by Lettuce chlorosis virus and other viral diseases. Field diagnosis through symptom observation, problem classification, sampling, laboratory diagnosis by visual and microscopic examinations, isolation and colony observation, identification (PCR/DNA-based, morphological, ELISA), pathogenicity test, and key diagnostic evidence are described. Systemic disease management measures are discussed, focusing on inoculum prevention and vector control, monitoring mother plant health, managing insect vectors, controlling weeds, use of resistant varieties, avoiding contact transmission and reducing abiotic stresses.

Glucose Polymer in the Fluid Therapy of Acute Diarrhoea: Studies in a Model of Rotavirus Infection in Neonatal Rats

1994 ◽  
Vol 86 (4) ◽  
pp. 469-477 ◽  
Author(s):  
A. V. Thillainayagam ◽  
J. A. Dias ◽  
A. F. M. Salim ◽  
F. H. Mourad ◽  
M. L. Clark ◽  
...  
Keyword(s):  
Water Absorption ◽  
Polymer Solutions ◽  
Acute Diarrhoea ◽  
Optimal Size ◽  
Neonatal Rats ◽  
Rotavirus Infection ◽  
Oral Rehydration ◽  
Rehydration Solutions ◽  
All Solutions ◽  
Glucose Polymer

1. Unlike standard glucose-electrolyte oral rehydration solutions, solutions containing polymeric glucose as substrate can significantly reduce stool output, duration of diarrhoea and total oral rehydration solution requirements. However, neither the underlying mechanisms nor the optimal size and concentration of glucose polymer has been defined. 2. We have used a model of rotavirus diarrhoea in neonatal rats to compare the effects on water and solute absorption of varying the concentration of a glucose polymer (mean chain length five glucose residues) in experimental oral rehydration solutions. Three polymer (P) solutions were compared with solutions of identical electrolyte content (mmol/l: sodium, 60; potassium, 20; chloride, 60; citrate, 10) containing equivalent amounts of free glucose (G) as substrate by perfusion of the entire small intestine in situ. The polymer (9, 18, 36 mmol/l; 159, 168, 186 mosmol/kg, respectively) and the monomer (45, 90, 180 mmol/l; 195, 240 320 mosmol/kg) solutions were perfused in normal and rotavirus-infected neonatal rats. 3. In normal intestine polymer solutions promoted greater water absorption [P9, mean 291.4 (SEM 16.4); P18, 331.9(13.1); P36, 284.3 (11.8) μl mi−1 g−1] than their equivalent monomer solutions [G45, 220.8 (8.4); G90, 240 (21); G180,79.4 (145) μl min− g−1; P < 0.02]. In rotavirus-infected intestine, water absorption from all solutions declined, but the fall was much less pronounced from the polymer solutions [P9, 232.8 (6); P18, 277.2 (20.5); P36, 166 (18.2) μl min−1 g−1] than from their monomeric counterparts [G45, 116.7 (25.5); G90, 68.7 (12.4); G180, 21 (11.6) μl min−1 g−1; P < 0.005]. 4. In both the normal net absorptive state and the net secretory state induced by rotavirus infection, there was a striking inverse correlation between net water absorption and perfusate osmolality (r = −0.94 and r = −0.88, respectively; P < 0.05). In rotavirus-infected intestine, increasing the polymer concentration from 18 to 36 mmol/l resulted in a relative fall in water absorption (P < 0.01). The hypertonic solution G180 was associated with the lowest water absorption (P < 0.01). None of the solutions was able to reverse rotavirus-induced net secretion of sodium, which was similar from all solutions, whether polymer- or monomer-based. 5. These results (i) emphasize the pre-eminence of hypotonicity among the factors promoting water absorption from polymer-based oral rehydration solutions in acute diarrhoea, (ii) confirm the adverse consequence of raising substrate concentration (whether polymer or monomer) beyond certain limits and (iii) indicate that the concentration of this glucose polymer yielding the optimum compromise between substrate availability and low osmolality may be approximately 9–18 mmol/l.

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