Seroprevelance of Helicobacter pylori Infection among Students of Bingham University, Karu in North-Central Nigeria

Helicobacter pylori infection occurs worldwide, though the burden differs greatly between countries and within populations. Studies have shown that Helicobacter pylori infection is higher in developing countries, including Nigeria and among populations of low socio-economic status. The aim of this study was to ascertain the prevalence of Helicobacter pylori infection amongst students of Bingham University, Karu, Nassarawa State, Nigeria. A total of 565 blood samples were collected from students with their consents after completing a self-administered questionnaire. Each blood sample was spun for 5 minutes at 1000 rpm to get the serum, which was used to determine the presence of H. pylori antibody using a Helicobacter pylori test cassette. Of the 565 students screened, 31 were found to be positive, giving a prevalence of 5.5% (95%CI=3.6-7.4). Prevalence among the female students was higher at 6.3% in contrast to the male 4.5%, though this difference was not statistically significant (chi-square=0.904, P-value=0.34). Students aged 26-30 years showed the highest prevalence of 8.8% above 4.2%, 5.6% of the age ranges 15-20 and 21-25 years, respectively. Seropositivity of H. pylori increased with students’ year of study, with 100 Level having 9.3%, followed by 6.3% in 200 level. The 300 and 400 Levels had 5.8% and 2.5, respectively. Also, the students who were knowledgeable about the infection and those who were not had 15.7% and 3.2% seroprevalence, respectively. The low prevalence of the infection obtained in this study did not show sex or age differencesand could be as a result of the good sanitary living conditions or good feeding habits of the students. It is recommended that infected students should eat at regular intervals, obtain adequate treatment after stool analysis to confirm the infection, and also practice good sanitary habits. The school authority should keep on improving the living conditions of the students as this will enhance lower prevalence or total elimination of the infection.

Antibiotic-associated diarrhea in hospital: frequency and prophylaxis

The aim. To analyze the prevalence of antibiotic-associated diarrhea (AAD) caused by Clostridium difficile in a hospital setting.Materials and methods. 93 patients with 3 or more episodes of unformed stool (diarrhea) for two consecutive days or more, developed after the use of antibiotics, were monitored. All patients underwent rapid stool analysis for the presence of Clostridium difficile A and B toxins using the X/pert C. diff toxin A/B test.Results. Toxins A and/or B of Clostridium difficile were detected in 32 patients (34.4 %). The remaining patients (n = 61; 65.6 %) had idiopathic AAD. The most of the patients who were found to have Clostridium difficile toxins in the feces were in the infarction department, cardiology intensive care and trauma departments, i. e. they had severe diseases associated with reduced immunity and inactivity.Conclusions. The prevalence of AAD caused by Clostridium difficile in hospital settings is high. It is recommended to prescribe drugs for the correction of disorders of the gastrointestinal microflora from the first day of antibiotic therapy, since this will significantly reduce the prevalence of clinical manifestation of diarrhea associated with Clostridium difficile.

P151 Validation of the MaRIA Score in pediatric patients

Background To validate the Magnetic Resonance Index of Activity (MaRIA Score) in the pediatric population and determine if it would be possible to monitor inflammatory bowel disease (IBD) without invasive tests in some cases. Methods A cross-sectional and descriptive study of paediatric patients with previously diagnosed or suspected IBD who underwent upper endoscopy (EGD) and colonoscopy, blood tests, stool analysis and MR Enterography (MRE) in a 15 days range, from October 2018 to February 2020. The clinical and endoscopic situation were assessed with the activity indices PUCAI/PCDAI/shPCDAI and the activity scores UCEIS/Mayo/SES-CD respectively, according to the underlying pathologies. We considered analytical remission as FC< 250 mcg/g, ERS< 20 mm and CRP< 1 mg/dl. The MRE results were assessed with the MaRIA Score, that is validated for adults. Results Amongst 21 patients, 12 (57%) were males. 12 patients had Crohn ́s disease (CD) (57%), 3 had ulcerative colitis (UC) (14%), 6 had IBD unclassified (IBDu) (28%). The mean age at diagnosis was 14.2 ± 0.7 and the progression time of the disease was 3.9 ± 0.6 years. A total of 16 patients showed clinical remission (76%), 6 of them (28%) also had endoscopic and histological remission. Eight patients were receiving biological treatment (38%). The measured acute phase reactants (APR) were: CRP 0.9 ± 0.5 mg/dl, ESR 13.7 ± 2.6 mm, α1 acid glycoprotein 95.5 ± 1.1 mg/dl and fecal calprotectin (FC) of 1154.3 ± 254.8 mcg/g. Rotavirus, adenovirus, Clostridium difficile toxin analysis and stool culture were performed in 14 patients, all of them negative. The MaRIA Score values were 54.3 ± 53.3, being 0 in 11 cases. We found no differences between the MaRIA Score and the analytical remission. We found a significant correlation between the MaRIA Score and the PUCAI value (p < 0.05), but not with other clinical scores. Patients in clinical remission showed a tendency to have a lower MaRIA Scores, but these differences were not statistically significant (p = 0.09). The MaRIA Score showed lower values for those with endoscopic and histological remission (p < 0.05), All the patients with MaRIA Score> 0 were CD except one, diagnosed with UC. Out of the 15 patients with endoscopic/histological involvement, 10 presented a MaRIA Score> 0. Five of the 11 patients (45%) in whom the MaRIA Score was 0 did not have endoscopic and histological remission, only one of them had a diagnosis of CD. Conclusion The MaRIA Score was significantly correlated with endoscopic scores in pediatric IBD patients, especially in CD. However, based on the results of this study, the MRE should not replace the EGD and colonoscopy in order to thoroughly evaluate the disease activity.

PERSISTENT COLONIC SCHISTOSOMIASIS AMONG SYMPTOMATIC RURAL INHABITANTS IN THE EGYPTIAN NILE DELTA

Background and Aims: Human schistosomiasisis one of the most important and unfortunately neglected tropical diseases. The aim of the current study was to investigate the prevalence and characterize colonic schistosomiasis, among symptomatizing rural inhabitants of the Middle Northern region of the Egyptian Nile delta. Patients and Methods: This study recruited 193 inhabitants of the rural community in the Egyptian Nile Delta referred for colonoscopy because of variable symptoms. After giving a written informed consent, they were exposed to thorough history; clinical examination; stool analysis; abdominal ultrasonography, and pan-colonoscopy with biopsies. Results:Twenty-four cases out of the 193 patients had confirmed active schistosomiasis with prevalence rate of 12.4%. Bleeding with stool was the predominant manifestation of active schistosomainfection among the cases either alone or in combination with abdominal pain. On clinical examination, the majority of the patients (n=17; 70.8%)did not have organomegaly and 25% of them had clinically palpable splenomegaly. As far as, 75% of them had sonographically detected hepatic peri-portal fibrosis. Also 66.6% of patients havesignificant endoscopic lesions (polyps, ulcers, mass-like lesions), and 16.6% of them had colonic affection beyond the recto-sigmoid region. Conclusion:Colonic schistosomiasis still running among symptomatizing rural inhabitants of the Egyptian Nile Delta at a rate of 12.4%. Of them66.6% had significant endoscopic colorectal lesions. This persistent transmission of schistosomiasis in the rural community of the Egyptian Nile Delta sounds the alarm for continuing governmental efforts and plans to screen the high-risk groups.

A198 LEFLUNOMIDE-INDUCED COLITIS IN IMMUNOSUPPRESSED PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND RHEUMATOID ARTHRITIS

Background Leflunomide is an oral disease-modifying antirheumatic drug (DMARD), with anti-inflammatory and immunomodulatory properties that has been in use since 1998. Common leflunomide side-effects include gastrointestinal symptoms (nausea, abdominal pain and diarrhea), occurring in 10–20% of patients treated with leflunomide. Scarce evidence exists that leflunomide can cause colitis. Aims We present the case of a 61-year-old female, with Lupus Erythematosus who presented with colitis induced by long-term leflunomide treatment. Methods Case report and review of literature Results A 61-year-old female was seen by the gastroenterology team with complaints of diarrhea ongoing for 6 weeks associated with 10 lb weight loss. The patient had a complex medical history, including lupus, hypothyroidism, asthma, atrial fibrillation, recurrent C. difficile infection, Bell’s palsy and avascular necrosis secondary to long-term corticosteroid therapy. Previous immunosuppressive therapies included prednisone, mycophenolic acid (Myfortic), hydroxychloroquine, azathioprine, mycophenolate (CellCept) but due to multiple intolerances, she was initiated on leflunomide in 2014 and has been maintained on it since. Stool analysis ruled out infectious causes. COVID-19 testing was also negative. A CT of the abdomen revealed pancolitis. This was confirmed on colonoscopy, which revealed mild, Mayo 1 pancolitis and normal terminal ileum. She was initiated on Mezavant as a treatment for possible ulcerative colitis. However, during the hospitalization her symptoms, worsened and bloody diarrhea was noted. She underwent a subsequent endoscopic evaluation which revealed more severe disease, Mayo 2–3 colitis, with mucosal hyperemia and ulcerations, as well as effacement of the vasculature. Initial pathology results revealed mild colitis, but repeat pathology results revealed moderate active colitis, with cryptitis, crypt abscesses and significant apoptosis consistent with drug-induced colitis. Given these findings, the diagnosis of leflunomide-induced colitis was made. Leflunomide was therefore discontinued, the patient was initiated on a higher dose of corticosteroids and cholestyramine was initiated. Following these measures, her diarrhea resolved. Conclusions Leflunomide may cause diarrhea in up to 33% of patients. Challenges related to the diagnosis of leflunomide-induced colitis exist, including the rarity of the diagnosis, a not completely understood mechanism for acute leflunomide-induced diarrhea, as well as variable endoscopic and histologic findings associated with the diagnosis. This report illustrates a case of leflunomide-induced colitis which should be considered in patients on leflunomide, who present with symptoms of abdominal pain and diarrhea, even years after medication initiation. Funding Agencies None

Hookworm infection in infants: a case report and review of literature

Background Hookworm infections (Necator americanus, Ancylostoma duodenale) are common in rural areas of tropical and subtropical countries. Human acquisition results from direct percutaneous invasion of infective larvae from contaminated soil. Overall, almost 472 million people in developing rural countries are infected. According to simulation models, hookworm disease has a global financial impact of over US$100 billion a year. Hookworm infection in newborn or infancy is rare, and most of the cases reported in literature are from endemic countries. Here, we describe the case of an infant with an Ancylostoma duodenale infection and review the literature currently available on this topic. Case presentation An Italian 2-month-old infant presented with vomit and weight loss. Her blood exams showed anemia and eosinophilia and stool analysis resulted positive for hookworms’ eggs, identified as Ancylostoma duodenale with real time-PCR. Parasite research on parents’ stools resulted negative, and since the mother travelled to Vietnam and Thailand during pregnancy, we assumed a transplacental transmission of the infection. The patient was treated successfully with oral Mebendazole and discharged in good conditions. Discussion Hookworm helminthiasis is a major cause of morbidity in children in the tropics and subtropics, but rare in developed countries. Despite most of the patients is usually asymptomatic, children are highly exposed to negative sequelae such as malnutrition, retarded growth and impaired cognitive development. In infants and newborns, the mechanism of infection remains unclear. Although infrequent, vertical transmission of larvae can occur through breastfeeding and transplacentally. Hookworm infection should be taken into account in children with abdominal symptoms and unexplained persistent eosinophilia. The treatment of infants infected by hookworm has potential benefit, but further studies are needed to define the best clinical management of these cases.

Case Report: Primary Peritonitis as the Onset of Pediatric Ménétrier's Disease

Introduction: Primary peritonitis (PP) and Ménétrier's Disease (MD) are both rare conditions among pediatric population. Although about 150 MD cases have been described in the scientific literature to date, its onset with a PP is an unusual condition.Case Presentation: We present a case of an 11-year-old boy who was admitted to our unit because of abdominal pain and distension. Complementary tests showed ascites, bilateral pleural effusion, leukocytosis, increased acute phase reactants and hypoproteinemia with hypoalbuminemia. Laparoscopy ruled out appendicitis or visceral perforations and exposed purulent peritoneal fluid, compatible with PP. Biochemical stool analysis showed increased clearance of alpha-1-antitrypsin, which was consistent with a protein-losing enteropathy. Gastroscopy findings were compatible with MD. The clinical course was favorable and he had no recurrence after 12 months of follow-up.Conclusion: PP can be the first clinical manifestation of pediatric MD. Knowledge of MD and its generally benign nature in children is important in order to avoid excessive testing and unnecessary treatment.

Gastrointestinal Parasitosis in the Population of the City of N’Djamena [Chad]: Causes of Their Persistence

In tropical areas gastrointestinal parasitosis are constantly changing in frequency and the large number of asymptomatic carriers continue to be a public health problem. This study was carried out during the last trimester of 2019 in the city of N’Djamena (Chad). This work was designed to take a stock of the overall level of carriage of parasitic infections of the population of the city. Our study sample was made up of 366 individuals whose age varied from 1 to 77 years. Each subject included in this study benefited from parasitological stool analysis using three methods. The method of direct observation in physiological water, the method of concentration in formalin-ether and that of Kato Katz. The results obtained showed that 222 subjects were carriers of at least one species of parasite, or either a global infection rate of 60.66%. Ten species of gastrointestinal parasites were identified of which three species of protozoa: Entamoeba histolytica/dispar (34.70 %), Giardia intestinalis (3.55%), Entamoeba coli (0.55%) and seven species of helminths: Hymenolepis nana (18.85%), Ascaris lumbricoides (9.29%), Taenia saginata (8.20%), Hymenolepis diminuta (2.19%), Schiotosoma mansoni (0.27%), Heterophyes hetrophyses (0.55%) and Enterobius vermicularis (0.27%). In N’Djamena the parasitism of those investigated was mainly (45.63%) monospecific and poly-specific (bi-and tri-specific) in 15.03% of the causes while 39.34% of persons examined were free from all forms of protozoa and helminths. The epidemiology of pathogenic forms was linked to a lack of hygiene especially ignorance of the risk of faecal peril. It is therefore important to strengthen the health education of the population in this city in particular and throughout the country in general.

Poor diagnostic values of stool analysis and steatocrit test in detecting exocrine pancreatic insufficiency

BACKGROUND Exocrine pancreatic insufficiency (EPI) is one of the most challenging cases to be diagnosed accurately in Indonesia because of the unavailability of the fecal elastase-1 (FE-1) test, which is the primary indirect diagnostic tool till date. Stool analysis and steatocrit test are feasible alternatives as they can detect nutrient malabsorption, a consistent feature in EPI. Despite the common practice of using both tests, no study has ever been conducted in Indonesia to evaluate their accuracy. METHODS This cross-sectional diagnostic study was conducted in 182 children aged 6–60 months. Study subjects were divided into children with persistent diarrhea (PD), those with malnutrition, and healthy children. Children with PD and malnutrition were selected on the basis of clinical criteria and the WHO z-score. FE-1 test was used as the gold standard to detect EPI. Primary endpoints of this study were sensitivity and specificity of the stool analysis and the steatocrit test. The accuracy of both tests, represented by area under the curve (AUC) values, was also evaluated individually and in combination. RESULTS Each component of stool analysis and steatocrit test in each subgroup of patients generally had higher specificity than sensitivity. The specificity of both tests among healthy and malnourished children was good (≥70%), but among children with PD, the specificity of some components was <70%. The individual and combined AUC values of both tests in each subgroup of subjects were poor (<0.7). CONCLUSIONS Stool analysis and steatocrit test cannot be used as alternative methods for FE-1 to detect EPI.