scholarly journals Respiratory cryptosporidiosis in Malawian children with diarrheal disease

2021 ◽  
Vol 15 (7) ◽  
pp. e0009643
Author(s):  
Pui-Ying Iroh Tam ◽  
Mphatso Chisala ◽  
Wongani Nyangulu ◽  
Herbert Thole ◽  
James Nyirenda
Keyword(s):  
Longitudinal Study ◽  
Diarrheal Disease ◽  
Induced Sputum ◽  
Gi Tract ◽  
Respiratory Involvement ◽  
Gi Symptoms ◽  
Stool Specimens ◽  
Moderate Malnutrition ◽  
Mean Cycle

Background Respiratory cryptosporidiosis has been documented in children with diarrhea. We sought to describe the dynamics of respiratory involvement in children hospitalized with gastrointestinal (GI) diarrheal disease. Methods We conducted a prospective, observational longitudinal study of Malawian children 2–24 months hospitalized with diarrhea. Nasopharyngeal (NP) swabs, induced sputum and stool specimens were collected. Participants that were positive by Cryptosporidium PCR in any of the three compartments were followed up with fortnightly visits up to 8 weeks post-enrollment. Results Of the 162 children recruited, participants had mild-moderate malnutrition (mean HAZ -1.6 (SD 2.1)), 37 (21%) were PCR-positive for Cryptosporidium at enrollment (37 stool, 11 sputum, and 4 NP) and 27 completed the majority of follow-up visits (73%). Cryptosporidium was detected in all compartments over the 4 post-enrollment visits, most commonly in stool (100% at enrollment with mean cycle thresholds (Ct) of 28.8±4.3 to 44% at 8 weeks with Ct 29.9±4.1), followed by sputum (31% at enrollment with mean Ct 31.1±4.4 to 20% at 8 weeks with Ct 35.7±2.6), then NP (11% with mean Ct 33.5±1.0 to 8% with Ct 36.6±0.7). Participants with Cryptosporidium detection in both the respiratory and GI tract over the study period reported respiratory and GI symptoms in 81% and 62% of study visits, respectively, compared to 68% and 27%, respectively, for those with only GI detection, and had longer GI shedding (17.5±6.6 v. 15.9±2.9 days). Conclusion Cryptosporidium was detected in both respiratory and GI tracts throughout the 8 weeks post-enrollment. The development of therapeutics for Cryptosporidium in children should target the respiratory as well as GI tract.

scholarly journals Respiratory cryptosporidiosis in Malawian children with diarrheal disease

2021 ◽  
Author(s):  
Pui-Ying Iroh Tam ◽  
Mphatso Chisala ◽  
Wongani Nyangulu ◽  
Herbert Thole ◽  
James Nyirenda
Keyword(s):  
Longitudinal Study ◽  
Diarrheal Disease ◽  
Induced Sputum ◽  
Gi Tract ◽  
Respiratory Involvement ◽  
Gi Symptoms ◽  
Stool Specimens ◽  
Moderate Malnutrition ◽  
Mean Cycle

Background: Respiratory cryptosporidiosis has been documented in children with diarrhea. We sought to describe the dynamics of respiratory involvement in children hospitalized with gastrointestinal (GI) diarrheal disease. Methods: We conducted a prospective, observational longitudinal study of Malawian children 2-24 months hospitalized with diarrhea. Nasopharyngeal (NP) swabs, induced sputum and stool specimens were collected. Participants that were positive by cryptosporidium PCR in any of the three compartments were followed up with fortnightly visits up to 8 weeks post-enrollment. Results: Of the 162 children recruited, participants had mild-moderate malnutrition, 36 (22%) were PCR-positive for cryptosporidium at enrollment (34 stool, 11 sputum, and 4 NP) and 27 completed the majority of follow-up visits (75%). Cryptosporidium was detected in all compartments over the 4 post-enrollment visits, most commonly in stool (94% at enrollment with mean cycle thresholds (Ct) of 28.8+/-4.3 to 44% at 8 weeks with Ct 29.9+/-4.1), followed by sputum (31% at enrollment with mean Ct 31.1+/-4.4 to 20% at 8 weeks with Ct 35.7+/-2.6), then NP (11% with mean Ct 33.5+/-1.0 to 8% with Ct 36.6+/-0.7). Participants with cryptosporidium detection in both the respiratory and GI tract over the study period reported respiratory and GI symptoms in 81% and 62% of study visits, respectively, compared to 68% and 27%, respectively, for those with only GI detection, and had longer GI shedding (17.5+/-6.6 v. 15.9+/-2.9 days). Conclusion: Cryptosporidium was detected in both respiratory and GI tracts throughout the 8 weeks post-enrollment. The development of therapeutics for cryptosporidium in children should target the respiratory as well as GI tract.

scholarly journals Performance and safety of induced sputum procedure in young children in Malawi: a prospective study

2021 ◽  
Author(s):  
Wongani John Nyangulu ◽  
Herbet Thole ◽  
Angella Chikhoza ◽  
Mike Msakwiza ◽  
James Nyirenda ◽  
...  
Keyword(s):  
Young Children ◽  
Prospective Study ◽  
Diarrheal Disease ◽  
Induced Sputum ◽  
Post Procedure ◽  
Minute Post ◽  
Stool Specimens ◽  
A Prospective Study ◽  
Respiratory Specimens ◽  
Infants And Young Children

AbstractBackground Collecting sputum specimens are a challenge in infants and young children. We assessed performance and safety of induced sputum (IS) collection in this population, embedded in a prospective study evaluating respiratory cryptosporidiosis in Malawian children with diarrheal disease. Methods We assessed sputum quality and correlation with detection of cryptosporidium, and evaluated safety and adverse events in 162 children. Results Among 159 stool specimens tested, 34 (21%, 95% CI 15.0 – 28%) were positive for Cryptosporidium spp. There were 160 IS and 161 nasopharyngeal (NP) specimens collected. The majority of IS specimens 122/147 (83%) were clear in appearance, and 132/147 (90%) were of good quality. Among the respiratory specimens tested, 10 (6.3%, 95% CI 2.5 – 10) IS and 4 (3% (95% CI 0 – 5)) NP were positive for Cryptosporidium spp. When stool cryptosporidium PCR was the gold standard, IS PCR sensitivity was higher (29 %, 95% CI 22 – 37) compared to NP PCR (12%, 95% CI 7 – 17) for detection of Cryptosporidium spp. One (0.4%) adverse event occurred, a drop in oxygen saturations at 30-minute post procedure evaluation. Consciousness – level, median respiratory rate and oxygen saturations were unchanged, before or after IS. Conclusions IS provides good quality specimens, is more sensitive than NP specimens for diagnosis of respiratory cryptosporidiosis, and collection can be done safely in children hospitalized with diarrheal disease.

scholarly journals Pneumatosis intestinalis in COVID-19

2020 ◽  
Vol 7 (1) ◽  
pp. e000434 ◽  
Author(s):  
Simone Meini ◽  
Chiara Zini ◽  
Maria Teresa Passaleva ◽  
Anna Frullini ◽  
Francesca Fusco ◽  
...  
Keyword(s):  
Pneumatosis Intestinalis ◽  
Respiratory Illness ◽  
Gi Tract ◽  
Right Colon ◽  
Case Presentation ◽  
Gi Symptoms ◽  
The Right ◽  
Cytomegalovirus Infections

IntroductionCOVID-19 is a respiratory illness due to novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), described in December 2019 in Wuhan (China) and rapidly evolved into a pandemic. Gastrointestinal (GI) tract can also be involved.Case presentationA 44-year-old man was hospitalised for COVID-19-associated pneumonia. A rapid recovery of respiratory and general symptoms was observed after 1 week of treatment with lopinavir/ritonavir plus hydroxychloroquine and broad-spectrum antibiotics (piperacillin–tazobactam plus teicoplanin). No GI symptoms were reported during hospitalisation, but a lung contrast-enhancement CT (CE-CT) excluding thromboembolism showed, as collateral finding, intraperitoneal free bubbles not present on a previous CT examination; the subsequent abdominal CE-CT described pneumatosis intestinalis (PI) involving the caecum and the right colon. Ciprofloxacin plus metronidazole was started, and the 2-week follow-up CT showed the complete resolution of PI.DiscussionThe pathogenesis of PI is poorly understood. PI involving the caecum and right colon has been described for HIV and Cytomegalovirus infections, but, to our best knowledge, never before in COVID-19. We hypothesise a multifactorial aetiopathogenesis for PI, with a possible role of the bowel wall damage and microbiota impairment due to SARS-CoV-2 infection, and we suggest a conservative management in the absence of symptoms.

scholarly journals Involvement of digestive system in COVID-19: manifestations, pathology, management and challenges

2020 ◽  
Vol 13 ◽  
pp. 175628482093462 ◽  
Author(s):  
Song Su ◽  
Jun Shen ◽  
Liangru Zhu ◽  
Yun Qiu ◽  
Jin-Shen He ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Gi Tract ◽  
Angiotensin Converting Enzyme 2 ◽  
Oral Transmission ◽  
Faecal Samples ◽  
Gi Symptoms ◽  
Tract Involvement ◽  
Stool Specimens ◽  
Novel Coronavirus ◽  
Loss Of Appetite

The pandemic of novel coronavirus disease (COVID-19) has developed as a tremendous threat to global health. Although most COVID-19 patients present with respiratory symptoms, some present with gastrointestinal (GI) symptoms like diarrhoea, loss of appetite, nausea/vomiting and abdominal pain as the major complaints. These features may be attributable to the following facts: (a) COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its receptor angiotensin converting enzyme 2 (ACE2) was found to be highly expressed in GI epithelial cells, providing a prerequisite for SARS-CoV-2 infection; (b) SARS-CoV-2 viral RNA has been found in stool specimens of infected patients, and 20% of patients showed prolonged presence of SARS-CoV-2 RNA in faecal samples after the virus converting to negative in the respiratory system. These findings suggest that SARS-CoV-2 may be able to actively infect and replicate in the GI tract. Moreover, GI infection could be the first manifestation antedating respiratory symptoms; patients suffering only digestive symptoms but no respiratory symptoms as clinical manifestation have also been reported. Thus, the implications of digestive symptoms in patients with COVID-19 is of great importance. In this review, we summarise recent findings on the epidemiology of GI tract involvement, potential mechanisms of faecal–oral transmission, GI and liver manifestation, pathological/histological features in patients with COVID-19 and the diagnosis, management of patients with pre-existing GI and liver diseases as well as precautions for preventing SARS-CoV-2 infection during GI endoscopy procedures.

The bidirectional association between Internet addiction and depression: a large-sample longitudinal study among Chinese university students (Preprint)

2020 ◽  
Author(s):  
Wan-Jun Guo ◽  
Xia Yang ◽  
Yu-Jie Tao ◽  
Ya-Jing Meng ◽  
Hui-Yao Wang ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Internet Addiction ◽  
Causal Effects ◽  
Causal Relationships ◽  
Depression Severity ◽  
Large Sample ◽  
Panel Model ◽  
Bidirectional Association ◽  
Predictive Effect

BACKGROUND Evidence indicates that Internet addiction (IA) is associated with depression, but longitudinal studies have rarely been reported, and no studies have yet investigated potential common vulnerability or a possible specific causal relationship between these disorders. OBJECTIVE To overcome these gaps, the present 12-month longitudinal study based on a large-sample employed a cross-lagged panel model (CLPM) approach to investigate the potential common vulnerability and specific cross-causal relationships between IA and CSD (or depression). METHODS IA and clinically-significant depression (CSD) among 12 043 undergraduates were surveyed at baseline (as freshmen) and in follow-up after 12 months (as sophomores). Application of CLPM revealed two well-fitted design between IA and CSD, and between severities of IA and depression, adjusting for demographics. RESULTS Rates of baseline IA and CSD were 5.47% and 3.85%, respectively; increasing to 9.47% and 5.58%, respectively at follow-up. Among those with baseline IA and CSD, 44.61% and 34.48% remained stable at the time of the follow-up survey, respectively. Rates of new-incidences of IA and CSD over 12 months were 7.43% and 4.47%, respectively. Application of a cross-lagged panel model approach (CLPM, a discrete time structural equation model used primarily to assess causal relationships in real-world settings) revealed two well-fitted design between IA and CSD, and between severities of IA and depression, adjusting for demographics. Models revealed that baseline CSD (or depression severity) had a significant net-predictive effect on follow-up IA (or IA severity), and baseline IA (or IA severity) had a significant net-predictive effect on follow-up CSD (or depression severity). CONCLUSIONS These correlational patterns using a CLPM indicate that both common vulnerability and bidirectional specific cross-causal effects between them may contribute to the association between IA and depression. As the path coefficients of the net-cross-predictive effects were significantly smaller than those of baseline to follow-up cross-section associations, vulnerability may play a more significant role than bidirectional-causal effects. CLINICALTRIAL Ethics Committee of West China Hospital, Sichuan University (NO. 2016-171)

scholarly journals Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

2021 ◽  
pp. 1-8
Author(s):  
Bin Yu ◽  
Andrew Steptoe ◽  
Yongjie Chen ◽  
Xiaohua Jia
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Episodic Memory ◽  
Cognitive Decline ◽  
Social Isolation ◽  
Mental Status ◽  
Chinese Older Adults ◽  
Confounding Variables

Abstract Background Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults. Methods This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up. Results Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = −0.03, p < 0.01; mental status: β = −0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = −0.05, p < 0.001; mental status: β = −0.03, p < 0.01) even after controlling for loneliness and all confounding variables. Conclusions Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

scholarly journals Factors associated with typical enteropathogenic Escherichia coli infection among children <5 years old with moderate-to-severe diarrhoea in rural western Kenya, 2008–2012

2020 ◽  
Vol 148 ◽  
Author(s):  
K. Fagerli ◽  
R. Omore ◽  
S. Kim ◽  
J. B. Ochieng ◽  
T. L. Ayers ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Severe Diarrhoea ◽  
Western Kenya ◽  
Factors Associated ◽  
Case Comparison ◽  
Escherichia Coli Infection ◽  
Logistic Regressions ◽  
Stool Specimens ◽  
Polymerase Chain

Abstract Typical enteropathogenic Escherichia coli (tEPEC) infection is a major cause of diarrhoea and contributor to mortality in children <5 years old in developing countries. Data were analysed from the Global Enteric Multicenter Study examining children <5 years old seeking care for moderate-to-severe diarrhoea (MSD) in Kenya. Stool specimens were tested for enteric pathogens, including by multiplex polymerase chain reaction for gene targets of tEPEC. Demographic, clinical and anthropometric data were collected at enrolment and ~60-days later; multivariable logistic regressions were constructed. Of 1778 MSD cases enrolled from 2008 to 2012, 135 (7.6%) children tested positive for tEPEC. In a case-to-case comparison among MSD cases, tEPEC was independently associated with presentation at enrolment with a loss of skin turgor (adjusted odds ratio (aOR) 2.08, 95% confidence interval (CI) 1.37–3.17), and convulsions (aOR 2.83, 95% CI 1.12–7.14). At follow-up, infants with tEPEC compared to those without were associated with being underweight (OR 2.2, 95% CI 1.3–3.6) and wasted (OR 2.5, 95% CI 1.3–4.6). Among MSD cases, tEPEC was associated with mortality (aOR 2.85, 95% CI 1.47–5.55). This study suggests that tEPEC contributes to morbidity and mortality in children. Interventions aimed at defining and reducing the burden of tEPEC and its sequelae should be urgently investigated, prioritised and implemented.

scholarly journals A longitudinal study over 40 years to study the metabolic syndrome as a risk factor for cardiovascular diseases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lars Lind ◽  
Johan Sundström ◽  
Johan Ärnlöv ◽  
Ulf Risérus ◽  
Erik Lampa
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
Longitudinal Study ◽  
Clinical Intervention ◽  
The Elderly ◽  
Adult Men ◽  
The Metabolic Syndrome ◽  
The Impact ◽  
Over 40 Years

AbstractThe impact of most, but not all, cardiovascular risk factors decline by age. We investigated how the metabolic syndrome (MetS) was related to cardiovascular disease (CVD) during 40 years follow-up in the Uppsala Longitudinal Study of Adult Men (ULSAM, 2,123 men all aged 50 at baseline with reinvestigations at age 60, 70, 77 and 82). The strength of MetS as a risk factor of incident combined end-point of three outcomes (CVD) declined with ageing, as well as for myocardial infarction, ischemic stroke and heart failure when analysed separately. For CVD, the risk ratio declined from 2.77 (95% CI 1.90–4.05) at age 50 to 1.30 (95% CI 1.05–1.60) at age 82. In conclusion, the strength of MetS as a risk factor of incident CVD declined with age. Since MetS was significantly related to incident CVD also at old age, our findings suggest that the occurrence of MetS in the elderly should not be regarded as innocent. However, since our data were derived in an observational study, any impact of MetS in the elderly needs to be verified in a randomized clinical intervention trial.

scholarly journals Multimorbidity patterns and memory trajectories in older adults: Evidence from the English Longitudinal Study of Ageing

2021 ◽  
Author(s):  
Rebecca Bendayan ◽  
Yajing Zhu ◽  
A D Federman ◽  
R J B Dobson
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Latent Class ◽  
Health Behaviours ◽  
Health Conditions ◽  
Delayed Recall ◽  
Class 1 ◽  
English Longitudinal Study ◽  
Psychiatric Problems

Abstract Background We aimed to examine the multimorbidity patterns within a representative sample of UK older adults and their association with concurrent and subsequent memory. Methods Our sample consisted of 11,449 respondents (mean age at baseline was 65.02) from the English Longitudinal Study of Ageing (ELSA). We used fourteen health conditions and immediate and delayed recall scores (IMRC and DLRC) over 7 waves (14 years of follow up). Latent class analyses were performed to identify the multimorbidity patterns and linear mixed models were estimated to explore their association with their memory trajectories. Models were adjusted by socio-demographics, BMI and health behaviors. Results Results showed 8 classes: Class 1:Heart Disease/Stroke (26%), Class 2:Asthma/Lung Disease (16%), Class 3:Arthritis/Hypertension (13%), Class 4:Depression/Arthritis (12%), Class 5:Hypertension/Cataracts/Diabetes (10%), Class 6:Psychiatric Problems/Depression (10%), Class 7:Cancer (7%) and Class 8:Arthritis/Cataracts (6%). At baseline, Class 4 was found to have lower IMRC and DLRC scores and Class 5 in DLRC, compared to the no multimorbidity group (n=6380, 55.72% of total cohort). For both tasks, in unadjusted models, we found an accelerated decline in Classes 1, 3 and 8; and, for DLRC, also in Classes 2 and 5. However, it was fully attenuated after adjustments. Conclusions These findings suggest that individuals with certain combinations of health conditions are more likely to have lower levels of memory compared those with no multimorbidity and their memory scores tend to differ between combinations. Socio-demographics and health behaviours have a key role to understand who is more likely to be at risk of an accelerated decline.

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