Clinical impact of a gastrointestinal PCR panel in children with infectious diarrhoea

ObjectivesMultiplex gastrointestinal PCR (GI-PCR) allows fast and simultaneous detection of 22 enteric pathogens (including Campylobacter, Salmonella, Shigella/enteroinvasive Escherichia coli (EIEC), among other bacteria, parasites and viruses). However, its impact on the management of children with infectious diarrhoea remains unknown.Patients/DesignAll children eligible for stool culture from May to October 2018 were prospectively included in a monocentric study at Robert-Debré University-Hospital.InterventionA GI-PCR (BioFire FilmArray) was performed on each stool sample.Main measuresData on the children’s healthcare management before and after GI-PCR results were collected. Stool culture results were also reported.Results172 children were included. The main criteria for performing stool analysis were mucous/bloody diarrhoea and/or traveller’s diarrhoea (n=130). GI-PCR’s were positive for 120 patients (70%). The main pathogens were enteroaggregative E. coli (n=39; 23%), enteropathogenic E. coli (n=34; 20%), Shigella/EIEC (n=27; 16%) and Campylobacter (n=21; 12%). Compared with stool cultures, GI-PCR enabled the detection of 21 vs 19 Campylobacter, 12 vs 10 Salmonella, 27 Shigella/EIEC vs 13 Shigella, 2 vs 2 Yersinia enterocolitica, 1 vs 1 Plesiomonas shigelloides, respectively. Considering the GI-PCR results and before stool culture results, the medical management was revised for 40 patients (23%): 28 initiations, 2 changes and 1 discontinuation of antibiotics, 1 hospitalisation, 2 specific room isolations related to Clostridioides difficile infections, 4 additional test prescriptions and 2 test cancellations.ConclusionThe GI-PCR’s results impacted the medical management of gastroenteritis for almostone-fourth of the children, and especially the prescription of appropriate antibiotic treatment before stool culture results.

The Probiotic Containing Foods in Military Dining

Probiotics are known to impact positively on one’s health, but this statement may have many concerns and challenges especially when it comes to military dining. The purpose of this review is to determine whether there is scientific research based justification to the recommend promotion of probiotic containing food(s) for service personal consumption. Several research findings have shown its beneficial effect on various conditions such as respiratory tract infections, gastro-intestinal diseases such as infectious diarrhoea, as well as for treating nosocomial infections when admitted to ICU. Peer reviewed literature was searched to identify original research related to the efficacy of pro/pre-biotic containing food(s) in prophylaxis or treatment of several service related ailments viz., acute infectious diarrhoea, depression, service related GI and liver diseases, irritable bowel syndrome, respiratory tract infections, Allergic rhinitis, dental health issues and female urogenital conditions. Available scientific evidence can be wisely used by the practitioners for different conditions keeping in mind the probiotic strain, dose, and method of delivery as the effect is not always the same in every person.

RISE OF RIFAXIMIN IN PAEDIATRIC INFECTIOUS DIARRHOEA

The incidence and risk of morality is high under the age of five years is due to diarrhoea. In India twenty percentages of paediatric deaths is due to diarrhoeal disease. It is the second cause of leading mortality in children after acute respiratory infections. Following on from the GEMS study when we looked at the data in the management of bacterial diarrhoea the primary treatments included oral rehydration solution, oral zinc probiotics and antibiotics. Anecdotally we noted that a lot of children were treated with oral antibiotics and the majority of them were treated with fluoroquinolones like Ofloxacin and drugs like Metronidazole there are multiple side-effects associated with the usage of fluoroquinolones and a major side-effect of that is the risk to the growing cartilage. We also noticed that irrational combinations such as imidazole like metronidazole have shown more problems than solutions .usage of Ofloxacin in children should be discouraged for all the side-effects plus the infectivity in the management of bacterial diarrhoea. The duration of treatment have paved the way for usage of drugs such as new molecules in paediatric i.e. rifaximin comes under the group of oral non-absorbable GI antibiotics broad-spectrum agents with antibacterial activity against gram positive and gram negative aerobes and Anaerobes makes Rifaximin a bactericidal drug in nature. Rifaximin is particularly recommended in children above the age of two years in acute infectious diarrhoea the mechanism of action of rifaximin is by inhibition of bacterial protein synthesis by reversibly binding to bacterial DNA dependent RNA polymerase. In this review we discussed the “phrma” behind rifaximin, clinical experience of rifaximin in children and indications and dosage of rifaximin in paediatric.

Dr. Józef Brudziński - the true ‘Father of probiotics’

Until now it has been Professor Elie Metchnikoff, a Russian researcher and scientist, who has been considered the discoverer of probiotics. In the early 20th century he associated the longevity and good health of Caucasian peasants with their consumption of a type of yoghurt containing strains of Lactobacillus acidophilus which were supposed to destroy the harmful microbiota of the intestines. However, at least a dozen years prior to Metchnikoff, a Polish doctor and scientist Dr. Józef Brudziński planned, conducted and described a study in which he applied a Bacillus lactis aërogenes suspension in treatment of infants with acute infectious diarrhoea. Here, we briefly characterise this study. Undoubtedly, apart from his fame as the neurologist who described meningeal symptoms, he deserves to be regarded as the true ‘Father of probiotics’.