Porcine Deltacoronaviruses: Origin, Evolution, Cross-Species Transmission and Zoonotic Potential

Porcine deltacoronavirus (PDCoV) is an emerging enteropathogenic coronavirus of swine that causes acute diarrhoea, vomiting, dehydration and mortality in seronegative neonatal piglets. PDCoV was first reported in Hong Kong in 2012 and its etiological features were first characterized in the United States in 2014. Currently, PDCoV is a concern due to its broad host range, including humans. Chickens, turkey poults, and gnotobiotic calves can be experimentally infected by PDCoV. Therefore, as discussed in this review, a comprehensive understanding of the origin, evolution, cross-species transmission and zoonotic potential of epidemic PDCoV strains is urgently needed.

A study of rotavirus infection in acute diarrhoea in children less than 5 years of age

: Diarrhoeal diseases account for an estimated 1.5 million deaths globally every year making it the second leading cause of childhood mortality. In India 1 out of every 250 children die of rotavirus diarrhea each year.: To find out the incidence of rotavirus infection in acute diarrhoeal cases in children under 5 years of age.: A prospective study was conducted on 100 non repetetive stool samples of Children under 5 years of age, presenting with acute diarrhea and hospitalized in the pediatric ward, during December 2015 to November 2016. Stool samples were processed according to premier rotaclone enzyme immunoassay protocol for the detection of rotavirus antigen, adhering to standard laboratory precautions.: The incidence of acute diarrhoeal diseases was 5.86% in our setting. was detected in 29% cases by ELISA method.The antigen detection by EIA is a reliable test, as it is quantitative and also has high sensitivity and specificity. Hence, can be routinely employed to prevent major morbidity and mortality among children, especially less than 5 years of age.

Incidence of clinical malaria, acute respiratory illness, and diarrhoea in children in southern Malawi: a prospective cohort study

Background Malaria, acute respiratory infections (ARIs) and diarrhoea are the leading causes of morbidity and mortality among children under 5 years old. Estimates of the malaria incidence are available from a previous study conducted in southern Malawi in the absence of community-led malaria control strategies; however, the incidence of the other diseases is lacking, owing to understudying and competing disease priorities. Extensive malaria control measures through a community participation strategy were implemented in Chikwawa, southern Malawi from May 2016 to reduce parasite prevalence and incidence. This study assessed the incidence of clinical malaria, ARIs and acute diarrhoea among under-five children in a rural community involved in malaria control through community participation. Methods A prospective cohort study was conducted from September 2017 to May 2019 in Chikwawa district, southern Malawi. Children aged 6–48 months were recruited from a series of repeated cross-sectional household surveys. Recruited children were followed up two-monthly for 1 year to record details of any clinic visits to designated health facilities. Incidence of clinical malaria, ARIs and diarrhoea per child-years at risk was estimated, compared between age groups, area of residence and time. Results A total of 274 out of 281 children recruited children had complete results and contributed 235.7 child-years. Malaria incidence was 0.5 (95% CI (0.4, 0.5)) cases per child-years at risk, (0.04 in 6.0–11.9 month-olds, 0.5 in 12.0–23.9 month-olds, 0.6 in 24.0–59.9 month-olds). Incidences of ARIs and diarrhoea were 0.3 (95% CI (0.2, 0.3)), (0.1 in 6.0–11.9 month-olds, 0.4 in 12.0–23.9 month-olds, 0.3 in 24.0–59.9 month-olds), and 0.2 (95% CI (0.2, 0.3)), (0.1 in 6.0–11.9 month-olds, 0.3 in 12.0–23.9 month-olds, 0.2 in 24.0–59.9 month-olds) cases per child-years at risk, respectively. There were temporal variations of malaria and ARI incidence and an overall decrease over time. Conclusion In comparison to previous studies, there was a lower incidence of clinical malaria in Chikwawa. The incidence of ARIs and diarrhoea were also low and decreased over time. The results are promising because they highlight the importance of community participation and the integration of malaria prevention strategies in contributing to disease burden reduction.

Rotavirus Genotypes in Abuja, Nigeria

Introduction: Nigeria had planned to introduce the rotavirus vaccine in the National Immunisation Programme in 2014, but this has yet to be done. Nigeria has the continent's highest mortality due to diarrhoeal diseases with little information on specific, prevalent genotypes. Aim: The study's main objectives were to identify the predominant rotavirus genotypes and examine the effects of existing local vaccination programs on prevailing rotavirus genotypes and on preventing rotavirus diarrhoea. Methodology: A one-year prospective descriptive study of children under 5 with acute diarrhoea was conducted from June 2018 to May 2019. Children with acute diarrhoea attending Asokoro District Hospital, Abuja. Children without diarrhoea were also recruited as a control group. Rotavirus ELISA and RNA extraction were done with commercially available kits, and positive samples were subjected to RT-PCR and electrophoresis to determine VP7 (G) and VP4 (P) genotypes. Results: Rotavirus-ELISA was positive among 231 (17.8%) children with diarrhoea and 29 (2.2%) of controls, with November, December. The predominant VP7 genotypes was G1 (n=116, 50.2%) followed by G9 (n=66, 28.5%). Viral Protein, VP4 (P) was mostly P [8] (n=143, 74.8%) followed by P [4] (n=21, 10.9%). The predominant genotype combinations found were G1 P [8] (n=108, 46.7%), G9 P [8] (n=62, 26.8%), and G2 P [4] (n=18, 7.7%). Very few mixed infections were found in the study, 2 (0.8%). Among 94 unvaccinated children with rotavirus isolates that were genotyped, G1 P [8] (n=88, 49.4%) and G9 P [8] (n=43, 24.1%) were predominant. Among 32 vaccinated children, G1 P [8] (n=13, 40.2%) and G9 P [8] (n=9, 28.1%) were predominant. Conclusion: The emergence of new genotypes such as G 12 P [4] found in this study emphasize the need for continued prospective monitoring of rotavirus at the molecular level to detect new threats to vaccine programs in future.

SP7.1.16 Endoscopy and biopsy for chronic diarrhoea: an audit and cost analysis

Aims The aim of the study is to analyse the costs of performing diagnostic endoscopy with histopathological sampling for patients suffering with chronic or persistent diarrhoea. Methods 300 patients were identified who required an endoscopy in 2019 according to the British Society of Gastroenterology guidelines. Patient’s presenting complaint, endoscopic and histological diagnosis and follow up plans were noted. 147 patients were included into our study whose presenting complaint was solely chronic or persistent diarrhoea. Those who presented with acute diarrhoea, PR bleeding or other concomitant indication for lower gastrointestinal endoscopy were excluded. Data from the national schedule of NHS costs was used to calculate expenditure. Results The total expenditure calculated for the 147 patients was £55,973. There was a total of 126 colonoscopies and 21 flexible sigmoidoscopies performed by the department. The number of patients who received medical treatment following endoscopy was 13/147 (9%) 8 of whom had nonspecific colitis on histology. There were 29 patients (20%) who required symptomatic treatment and there were 98 patients (66%) who received no intervention or were discharged immediately and 7 patients (5%) that required surgical intervention. The total cost of procedures not leading to surgical or medical management with steroids or immunomodulators was £47733 which is 85.3% of the total expenditure. Conclusion A significantly large proportion of investigations lead to no intervention or symptomatic treatment of the patient. Given this lack of diagnostic yield and financial burden, there could be room for advancement in the current guidelines for managing persistent diarrhoea.

THE FREQUENCY OF HYPONATREMIA AND HYPOKALEMIA IN MALNOURISHED CHILDREN WITH ACUTE DIARRHEA

Background: Malnutrition is a major global health problem, with the major burden being in South Asia and Sub-Saharan Afric. The study was undertaken to determine the frequency of hyponatremia an hypokalemia in malnourished children with acute diarrhea. Methods: Hospital based prospective study was conducted on 100 children between the age group of 6months to 5years presenting with acute diarrhea was include in the study. Results: Hyponatremia was observed in total 15 (15.00%) cases of diarrhea. Regarding the grade of malnutrition, hyponatremia was observed in only 4.44% in grade 1, 8.69% in grade, 41.67% in grade 3 and 60.00% in grade 4 malnutrition respectively. Hypokalemia was noticed in 10.00% cases (10 out of 100) with acute diarrhea. The frequency of hypokalemia was 4.44% in grade 1, 8.69% in grade 2, 25.00% in grade 3 and 40.00% in grade 4 malnutrition respectively. Conclusion: Electrolyte disturbances are often subclinical in malnourished children, but become obvious during the episode of acute diarrhoeal disease. Hence serum electrolytes of every malnourished child with acute diarrhoea should be estimated in order to do immediate correction and avoid serious life-threatening outcome. Keywords: IAP, Malnutrition, Diarrhoea

Molecular detection of Strongyloides sp. in Australian Thoroughbred foals

Background Strongyloides westeri is found in the small intestine of young horses, mainly in foals up to about 16 weeks of age. The main source of infection for foals is through transmammary transmission, and foals can develop acute diarrhoea, weakness, dermatitis and respiratory signs. The epidemiology of S. westeri in Australia is largely unknown. Further, molecular techniques have never been employed for detection of S. westeri in horses. This pilot study aimed to assess the utility of a molecular phylogenetic method for the detection of S. westeri in the faeces of foals. Methods Faecal samples were collected from a foal of less than 2 months of age, and eggs of Strongyloides sp. were detected using the modified McMaster technique. DNA was extracted from purified eggs, and a partial fragment of the small subunit of the nuclear ribosomal DNA (18S) was characterised using polymerase chain reaction, DNA sequencing and phylogenetic methods. Results Microscopic examination of faeces revealed small ellipsoidal eggs typical of Strongyloides sp. The 18S sequence generated by PCR in this study revealed 98.4% identity with that of a reference sequence of S. westeri available from GenBank. Phylogenetic analyses revealed a polyphyletic clustering of S. westeri sequences. Conclusion This is the first study reporting the detection of DNA of Strongyloides sp. in faeces of a foal using a molecular phylogenetic approach targeting the variable region of 18S rDNA. It is anticipated that this study will allow future molecular epidemiological studies on S. westeri in horses. Graphical abstract

ACUTE DIARRHOEA AMONG UNDER FIVE YEARS OLD CHILDREN OF UNDERPRIVILEGED COMMUNITY IN KOTA KINABALU, SABAH

The severity of childhood diarrhoea is linked with poor socioeconomic status, unhygienic living environment, and caregiver’s behaviour. This study is to determine the risk factors and economic burden associated with diarrhoea in children under 5 years of age. A case-control study using convenience sampling method with 105 cases and 105 controls was performed in Menggatal health clinic, Kota Kinabalu, Sabah between March-June 2017. Younger caregivers, without formal education, poor knowledge, practice handwashing with water only and stopped breastfeeding were associated with diarrhoea. Household with poor economic status, a family of five and more, crowded, with a pet, unsafe drinking water, no sanitary toilet, unsanitary garbage disposal and consuming street vendor food also associated with diarrhoea. The mean of total direct costs, total indirect costs and total incurred costs were (Ringgit Malaysia) RM 9.70, RM 59.40, and RM 14.30, respectively. As a conclusion, the risk factors for diarrhoea under 5 years of age still presents in Sabah. Environmental factors and hygienic practice are needed to control under 5 diarrhoea.

Nutritional outcome of appropriate feeding during and after acute diarrhoea in children

A sample of 120 children with acute diarrhoea was divided into two equal study groups. There was no difference between groups in pre-intervention and post-intervention findings during the acute phase of diarrhoea. Upon discharge, Group A patients were supplied weekly with sufficient milk formula and cereal together with adequate nutritional advice while Group B patients were supplied with food or nutritional advice only if requested by the mothers. Forty nine patients from each group were followed each week for four weeks. Group B infants showed a higher incidence of recurrent diarrhoeal attacks and a significantly longer duration of recurrent diarrhoea than Group A infants. Moreover, Group A infants scored a significantly higher weight increment than Group B ones after four weeks of follow up