Differential Diagnosis of Acute Diarrhea

Acute diarrhea is a condition of increased water stool content, stool volume, and number of bowel movements that lasts less than 14 days. Mild diarrhea is usually self-limiting; however, undertreated moderate to severe diarrhea may cause severe dehydration and lead to hypovolemic shock. In order to prevent severe dehydration and treat patients appropriately, it is crucial for health care providers to determine the right diagnosis of patients with acute diarrhea. This article focuses on pathophysiology, general patient presentation, diagnostic tests and differential diagnosis lists of acute diarrhea to discuss which diagnosis should be made based on patient presentation and objective data.     

Enteric anendocrinosis attributable to a novel Neurogenin-3 variant

Congenital diarrhea and enteropathies (CODEs) are a group of monogenic disorders that often present with severe diarrhea in the first weeks of life. Enteric anendocrinosis (EA), an extremely rare cause of CODE, is characterized by a marked reduction of intestinal enteroendocrine cells (EC). EA is associated with recessively inherited variants in Neurogenin-3 (NEUROG3) gene. Here we investigate a case of a male infant who presented with mysterious severe malabsorptive diarrhea since birth. Thorough clinical assessments and laboratory tests were successful to exclude the majority of differential diagnosis categories. However, the patient's diagnosis was not established until the genetic test using whole-exome sequencing (WES) was performed. We identified a novel homozygous missense disease-causing variant (DCV) in NEUROG3 (c.413C>G, p.Thr138Arg). Moreover, molecular dynamic simulation analysis showed that (p.Thr138Arg) led to a global change of the NEUROG3 orientation affecting its DNA binding capacity. To the best of our knowledge, this is the first time to apply WES to reach a differential diagnosis of patients with CODEs. Our study not only expands our knowledge about NEUROG3 variants and their clinical consequences but also proves that WES is a very effective tool for the diagnosis of CODEs. This might be of value in early diagnosis of diseases and prenatal CODEs detection.     

小儿轮状病毒感染腹泻实验室检查结果分析

目的:探讨小儿腹泻轮状病毒感染的实验室检查特点,为临床提供实验数据.方法:对1764名0～7岁腹泻患儿进行大便轮状病毒检测、血常规、大便常规和生化检查.结果:1764份腹泻标本轮状病毒阳性率42.6%,轮状病毒感染患儿黄颜色大便占62.9%,水样便和稀汁便占68.1%,外周血中性粒细胞0.74±0.17,肝功能异常占22.8%,心酶异常占26.7%.结论:轮状病毒者感染具有大便颜色以黄色居多,性状以水样便和稀汁便为主,粘液少,红细胞少、白细胞少和外周血中性粒细胞增高等实验室检查特点,并可导致肝功能异常和心肌酶异常.     

Apparently increased trough levels of tacrolimus caused by acute infantile diarrhea in two infants with biliary atresia after liver transplantation

Two infants with biliary atresia who exhibited three-fold increased trough levels of tacrolimus and required reduced doses during episodes of acute infantile diarrhea within 5 months of liver transplantation are described. The cause of the increase was not explained simply by hemoconcentration as a result of significant loss of extracellular fluid during these episodes. It does highlight an important issue: that of the continuing need to carefully monitor the trough levels of tacrolimus in such infants.     

Epidemiology of acute diarrhea in children living in Sicily

A longitudinal survey (February 1984 - January 1985) on the incidence of acute diarrhea episodes in a sample of 8,164 children (aged 0–12 years) living in southeastern Sicily was carried out by means of weekly telephone interviews with doctors practising in the territory. The incidence rate was 0.479 (0.472–0.485 95% C.I.) per child per year and the frequency of episodes was significantly higher (p < 0.001) in children aged 0–4 years (0.86). Diarrhea was more frequent in industrial areas than in rural ones, and almost half (45.1%) of the total episodes had a mild course. No death from diarrhea occurred and admission to hospital was reported for 8.4% of all cases.Corresponding author.     

Comparison of yogurt, soybean, casein, and amino acid–based diets in children with persistent diarrhea

Although previous studies have shown successful treatment of persistent diarrhea (PD) with the use of yogurt-based diets, some recent ones speculate the need of special formulas for the nutritional management of PD complicated cases. In the present study, we tested the hypothesis that the consumption of 3 lactose-free diets, with different degrees of complexity, is associated with lower stool output and shorter duration of diarrhea when compared with the use of a yogurt-based one on the nutritional management of PD. A total of 154 male infants, aged between 1 and 30 months, with PD and with or without dehydration, were randomly assigned to 1 of 4 treatment groups. Throughout the study, the patients were placed in a metabolic unit; their body weights and intakes of oral rehydration solution, water, and formula diets, in addition to outputs of stool, urine, and vomit, were measured and recorded at 24-hour intervals. Four different diets were used in this study: diet 1, yogurt-based formula; diet 2, soy-based formula; diet 3, hydrolyzed protein-based formula; and diet 4, amino acid–based formula. Throughout the study, only these formula diets were fed to the children. The data showed that children fed the yogurt-based diet (diet 1) or the amino acid–based diet (diet 4) had a significant reduction in stool output and in the duration of diarrhea. The use of an inexpensive and worldwide-available yogurt-based diet is recommended as the first choice for the nutritional management of mild to moderate PD. For the few complicated PD cases, when available, a more complex amino acid–based diet should be reserved for the nutritional management of these unresponsive and severe presentations. Soy-based or casein-based diets do not offer any specific advantage or benefits and do not seem to have a place in the management of PD.     

肠易激综合征辨证分析

肠易激综合征（IBS）是一组持续存在或反复发作的临床症候群,主要症状有腹痛、腹胀、排便习惯改变和大便性状异常、黏液便等,经检查排除可引起这些症状的器质性疾病。临床分为肝木乘脾型腹泻、脾胃虚弱型腹泻、脾肾阳虚型腹泻、肝郁脾虚型便秘四型,根据临床辨证分别施以不同治法,不同方药治疗,有显著疗效。同时,教育患者平时养成良好的饮食卫生习惯,不饮生水,不食生冷瓜果,忌食辛辣、油腻、肥厚之品,保持心情舒畅,怡情悦志,注意保暖,可加强疗效,防止复发。     

用DIG标记的寡核苷酸基因探针杂交技术进行人轮状病毒VP7G血清型鉴定

目的：建立用地高辛（Ｄｉｇｏｘｉｇｅｎｉｎ，ＤＩＧ）标记的寡核苷酸基因探针鉴定Ａ群轮状病毒ＶＰ７Ｇ血清型的分子杂交技术，并应用该技术研究河南Ａ群轮状病毒的Ｇ血清型分布。方法：根据轮状病毒编码糖蛋白ＶＰ７的基因核苷酸序列，选择该基因高保守区序列中与ＶＰ７Ｇ血清型高度相关的核苷酸片段，人工合成，并用ＤＩＧ标记。在优选的杂交条件下进行杂交：结果：①Ｇ１、Ｇ２、Ｇ３和Ｇ４四种Ｇ血清型特异性寡核苷酸探针只与同血清型的轮状病毒参考毒株杂交，无交叉杂交现象。灵敏度和特异性达到放射性同位素３２Ｐ标记的水平。②１８８份经ＰＡＧＥ确定的轮状病毒阳性标本中，７９份（４２．０％）、３５份（１８．６％）、１５份（７．９％）分别与Ｇ１、Ｇ２或Ｇ３型探针杂交；未检出Ｇ４型；５６份（２９．８％）未能分型；３份分型特殊。结论：该Ｇ血清型分型技术具有高度特异性和灵敏度     

长泰乐口服液治疗成人急性感染性腹泻45例临床观察

长泰乐生物保健口服液是一种新型腹泻治疗药物，用该药治疗感染性腹泻４５例，与用氟哌酸治疗的对照组比较，结果表明疗效相近，且比后者使用安全。我们认为该药可代替抗生素用于治疗感染性腹泻轻、中型患者，尤其适用于老年、孕妇和儿童。对非感染性腹泻有良好的治疗前景。