益生菌与口服免疫球蛋白辅助治疗儿童轮状病毒肠炎的疗效比较

目的：比较益生菌及口服免疫球蛋白对儿童轮状病毒肠炎的疗效。方法：150例轮状病毒肠炎患儿随机分为3组,每组50例。3组患儿在给予基础治疗的同时给予不同的干预治疗方案。对照组予安慰剂治疗,益生菌组予双歧杆菌乳杆菌三联活菌治疗,免疫球蛋白组予抗轮状病毒鸡卵黄IgY口服治疗。每日记录大便次数、大便性状等临床症状,并于治疗后1、3、5、7、9、11?d收集新鲜大便标本,镜检行大便菌群紊乱分度,放射免疫法检测大便SIgA水平,双抗体夹心酶联免疫法检测大便轮状病毒排泄量。结果：与对照组比较,益生菌治疗组干预用药3 d后菌群失调改善,大便频次减少,继发肠道细菌感染发生率降低（P0.05）。免疫球蛋白组用药1 d后大便SIgA水平显著高于对照组（P<0.05）,治疗3 d后腹泻频次及大便病毒排泄量均低于对照组（P<0.05）。免疫球蛋白组病程较对照组显著缩短（4.5±1.0?d vs 5.8±1.7?d,P<0.05）。结论：对儿童轮状病毒肠炎,益生菌能缓解菌群紊乱及预防继发感染,但缓解临床症状较慢,且不能缩短病程。口服免疫球蛋白显效快,能快速清除病毒及促进机体SIgA生成,且能缩短病程。     

Antibodies to rotaviruses in chickens' eggs: a potential source of antiviral immunoglobulins suitable for human consumption

The prevalence of antibodies to human rotaviruses in commercially available eggs and egg products that are suitable for human consumption was investigated. The yolks of virtually all of the individual eggs and pasteurized pooled egg preparations contain antirotavirus antibodies detectable by means of enzyme immunoassay systems. Also, the eggs and egg preparations are capable of inhibiting the growth of two strains of rotaviruses in tissue culture. Chromatographic studies indicated that the antigen-binding activity is limited largely to the immunoglobulin fractions of the egg yolks. The antibody levels in eggs can be increased by the immunization of hens with purified rotavirus preparations, and the immunoglobulins isolated from the eggs of immunized hens can prevent the development of rotavirus gastroenteritis in experimentally infected animals. Egg preparations might serve as a practical source of antiviral antibodies suitable for consumption by infants and young children.     

Persistent diarrhoea: associated infection and response to a low lactose diet

Children aged 4-23 months with persistent diarrhoea received a low lactose diet, multivitamins, minerals and antibiotics for infection. Sixty-one (57 per cent) children improved with low lactose diet while 46 (43 per cent) failed. Children who failed were younger (8.9 +/- 3.5 vs. 11.3 +/- 4.4 months), had higher initial purging rate (146 +/- 102 vs. 109 +/- 102 g/kg/day) and consumed more ORS (138 +/- 77 vs. 95 +/- 79 g/kg/day). A higher proportion of children in the failure group needed unscheduled intravenous fluid (48 vs. 20 per cent) and lost body weight (24 vs. 0 per cent). Single and multiple stool pathogen were isolated from 44 and 45 per cent cases, respectively. Diarrhoeagenic Escherichia coli (66 per cent) was the most common pathogen isolated. Half of all pathogens including Campylobacter, rotavirus, cholera and non-typhoidal Salmonella were nosocomially acquired. Sixty four per cent of children had extraintestinal infections including acute lower respiratory infection (50 per cent), urinary tract infection (29 per cent) and septicaemia (11 per cent). The presence of extraintestinal infections were significantly associated with failure. Overall, 91 per cent of children had either intestinal and/or extraintestinal infections.     

Impact of zinc supplementation in malnourished children with acute watery diarrhoea

A double-blind, randomized, controlled clinical trial was conducted on 80 malnourished children with acute dehydrating diarrhoea to evaluate the efficacy of oral supplementation of zinc as an adjunct therapy to oral rehydration solution (ORS). After decoding it was observed that 44 children received zinc sulphate (177 mg/kg/day in three divided doses equivalent to 40 mg elemental zinc) in a syrup form and 36 children received only syrup placebo. Clinical parameters and microbiological findings of stool samples were comparable in the two groups at the time of enrollment. All the children (100 per cent) in the zinc supplemented group and 32 (89 per cent) children in the placebo group recovered within 5 days of hospitalization (p = 0.04). The zinc supplemented group had a significantly shorter duration of diarrhoea (70.4 +/- 10.0 vs. 103.4 +/- 17.1 h; p = 0.0001), passed less liquid stool (1.5 +/- 0.7 vs. 2.4 +/- 0.7kg; p=0.0001), consumed less oral rehydration solution (2.5 +/- 1.0 vs. 3.6 +/- 0.8 litre; p = 0.0001) and other liquids (867.0 +/- 466.1 vs. 1354.7 +/- 675.6 ml; p = 0.0001) as compared to the placebo group. Our findings suggest that zinc supplementation as an adjunct therapy to ORS has beneficial effects on the clinical course of dehydrating acute diarrhoea.     

Asymptomatic excretion of rotavirus before and after rotavirus diarrhea in children in day care centers

A 12-month prospective study of diarrhea in children in day care centers (DCCs) provided an opportunity to evaluate the duration of excretion of rotavirus from children before and after episodes of diarrhea caused by rotavirus. Ninety-nine episodes of rotavirus diarrhea occurred in 94 children. Asymptomatic rotavirus excretion occurred in 50% of children tested on the day before diarrhea occurred, 31% two days before diarrhea, and 9% in days 3 through 5 before diarrhea. Two children had positive specimens 11 and 13 days, respectively, before illness. During the week after cessation of diarrhea, 32% had positive specimens; 12% had positive stool specimens during the second week after diarrhea episodes. Electrophoretic testing of rotavirus RNA from stool specimens showed different electrophoretic migration patterns of the genomic RNA among the pairs tested, but the genomic RNA was the same within each pair of symptomatic and asymptomatic specimens. Excretion of rotavirus before and after diarrhea is common in children in DCCs; the role that asymptomatic excretion plays in the spread of this disease within DCCs is unknown.     

Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers

BACKGROUND: Certain strains of lactobacilli have been shown to promote recovery from rotavirus enteritis in hospitalized children. Few studies have examined the effect of probiotics in nonhospitalized children with mild diarrhea. METHODS: We studied in a randomized placebo-controlled trial the effect of lyophilized Lactobacillus rhamnosus 19070-2 and Lactobacillus reuteri DSM 12246, 10(10) colony-forming units of each strain twice daily for 5 days, on acute diarrhea in children in a cohort of children recruited from local day-care centers. The duration of diarrhea and assessment of stool consistency were recorded by the parents. RESULTS: In patients treated with the selected Lactobacillus strains, the mean duration of diarrhea after intervention was reduced (76 h in patients treated with probiotics vs. 116 h in the placebo group; P = 0.05). In patients with diarrhea for <60 h before start of treatment (early intervention), a more pronounced effect of probiotics was found. The time to recovery after early treatment was 79 h vs. 139 h in the placebo group (P = 0.02); 1 of 17 patients treated early vs. 6 of 13 in the control group still had loose stools 120 h after start of treatment (P = 0.03). CONCLUSIONS: In children from day-care centers with mild gastroenteritis, the combination of L. rhamnosus 19070-2 and L. reuteri DSM 12246 was effective in reducing the duration of diarrhea.     

Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children.

OBJECTIVE: The objective of this study was to determine the efficacy of Lactobacillus casei sps. rhamnosus (Lactobacillus GG) (LGG) in reducing the incidence of antibiotic-associated diarrhea when coadministered with an oral antibiotic in children with acute infectious disorders. STUDY DESIGN: Two hundred two children between 6 months and 10 years of age were enrolled; 188 completed all phases of the protocol. LGG, 1 x 10(10) - 2 x 10(10) colony forming units per day, or comparable placebo was administered in a double-blind randomized trial to children receiving oral antibiotic therapy in an outpatient setting. The primary caregiver was questioned every 3 days regarding the incidence of gastrointestinal symptoms, predominantly stool frequency and consistency, through telephone contact by blinded investigators. RESULTS: Twenty-five placebo-treated but only 7 LGG-treated patients had diarrhea as defined by liquid stools numbering 2 or greater per day. Lactobacillus GG overall significantly reduced stool frequency and increased stool consistency during antibiotic therapy by the tenth day compared with the placebo group. CONCLUSION: Lactobacillus GG reduces the incidence of antibiotic-associated diarrhea in children treated with oral antibiotics for common childhood infections.     

Longitudinal study of Giardia lamblia infection in a day care center population

An enzyme-linked immunosorbent assay was used to detect Giardia lamblia in stool specimens collected during a 15-month longitudinal study of diarrhea in 82 children 1 to 24 months old attending a day care center (DCC) in Houston. A total of 2727 stool specimens were collected on a weekly basis from the DCC children and were evaluated for rotavirus and Giardia. For DCC children who developed diarrhea stool specimens were also cultured for bacterial enteropathogens. During the 15-month study period, 48 episodes of Giardia infection were detected in 27 of 82 (33%) DCC children, compared with 57 episodes of rotavirus detected in 37 (45%) of these same DCC children. The duration of Giardia excretion was 2.0 +/- 1.5 weeks (mean +/- SD). Only 6 (7%) of the 82 DCC children, or 6 of the 27 (22%) with infection, developed symptoms attributable to Giardia. Ten of the 27 (37%) DCC children infected with Giardia had 2 or more episodes of infection. Giardia was identified in the DCC in all months except June. Two Giardia outbreaks occurred in 1 of the 6 DCC rooms under study. One outbreak was associated with overcrowding. Neither outbreak was associated with the introduction of a new Giardia-positive child into the involved room. In this study Giardia infection occurred commonly in the DCC throughout the year, was rarely associated with illness and was not associated with introduction of asymptomatic carriers into the DCC rooms.     

Dietary management of persistent diarrhea: comparison of a traditional rice-lentil based diet with soy formula

Recent studies have indicated that enteral diets can play an important role in the treatment of persistent diarrhea. Khitchri, a local weaning food in Pakistan, is composed of rice and lentils, which have previously been shown to be well tolerated in many children with acute diarrhea. The effectiveness of a khitchri and yogurt (KY) diet, which is inexpensive and widely available in Pakistan, was studied. One hundred two weaned boys (6 to 36 months old) with persistent diarrhea were randomly assigned to receive either soy formula (group A) or the KY diet (group B) for 14 days. Group A also received the KY diet in addition to formula for days 8 through 14. Twenty-nine children did not complete the study because of severe infection (13) or their family's decision to leave the study early (9 in group A and 7 in group B). Sixty-six children successfully completed the study protocol; there were five clinical failures in group A and two in group B. On a comparable caloric intake, there was a significantly lower stool volume (group B: 38 +/- 16 [mean +/- SD] vs group A: 64 +/- 75 g/kg per day, P less than .05) and frequency (B: 4.4 +/- 2.0 vs. A: 6.6 +/- 4.2 stools per day, P less than .005) in children fed KY during the first week of therapy. Group B children also had a significantly greater weight gain than children in group A during the first week (B: 468 +/- 373 g/wk vs A: 68 +/- 286 g/wk, P less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)     

Hospital surveillance of rotavirus infection and nosocomial transmission of rotavirus disease among children in Guinea-Bissau

BACKGROUND: Vaccination against rotavirus is protective against severe disease. Surveillance of rotavirus infection in developing countries might direct vaccination policy more efficiently. METHODS: We implemented WHO's generic protocols for hospital-and community-based surveillance of rotavirus gastroenteritis. From April 2001 to May 2002, and from January 2003 to June 2003, we conducted hospital surveillance for rotavirus infection at the only pediatric ward in the capital of Guinea-Bissau. Children less than 5 years of age admitted with diarrhea or developing diarrhea during hospitalization were enrolled in the study. Rotavirus infection was detected in the feces samples using an ELISA assay. Rectal swabs were also obtained and its use was validated against stool specimen. RESULTS: During the surveillance period, 161 cases of rotavirus infection were registered. During the season, rotavirus accounted for 35% of all hospitalized diarrhea cases. The rate of nosocomial disease was 1.6 per 1000 child-days (95% confidence interval [CI] = 1.02-2.51) with high rates for children aged 12 to 23 months of age (rate: 3.09; 95% CI = 1.47-6.48). Most of the rotavirus cases (93%) were in children less than 2 years of age and only 10 children aged less than 3 months were infected. Fever (risk ratio (RR) 1.56; 95% CI = 1.16-2.10) and vomiting (RR 1.38; 95% CI = 1.11-1.73) were more common in patients with rotavirus than in patients with nonrotavirus diarrhea. The case-fatality was 8%. Results from stool samples and rectal swabs were concordant in 96% of the pairs. Rectal swabs increased the detection of rotavirus cases by 6% and deaths by 33% over stool sample results. CONCLUSION: Rotavirus infections were confined to a 4-month period each year. It is an important cause of childhood diarrhea with high case-fatality ratio in Guinea-Bissau. The use of rectal swab appeared to increase the detection rate of rotavirus infection and the case-fatality rate. The high rate of nosocomial infections in hospitalized children emphasizes the need for prevention of disease.     

Prediction of total daily fecal excretion during acute childhood diarrhea

Clinical data from 133 male patients between 3 and 36 months of age were reviewed to identify factors that could predict high rates of fecal excretion during acute diarrhea. Diarrheal severity after hospitalization was measured by separate 4-h quantitative collections of feces during 6 days: the number of these 4-h collection periods with any stool output was used as an estimate of the number of bowel movements each day. The number of 4-h periods with any stool output was highly correlated with total fecal excretion expressed as grams per kilogram of body weight per day (p less than 0.001). The age of the patient, type of diarrhea, and type of diet had little effect on the relationship between stool "number" and amount. The number of bowel movements, as estimated during this study, was a highly sensitive (greater than 90%) and reasonably specific (greater than 70%) predictor of children at risk of high fecal excretion rates (greater than 50 g/kg/day or greater than 100 g/kg/day) during acute diarrhea.     

Partially hydrolyzed guar gum-supplemented oral rehydration solution in the treatment of acute diarrhea in children

BACKGROUND: Partially hydrolyzed guar gum (Benefiber; Novartis Nutrition, Minneapolis, MN, U.S.A.) is fermented by colonic bacteria liberating short-chain fatty acids (SCFAs), which accelerate colonic absorption of salt and water. The purpose of this study was to evaluate the effect of Benefiber (BF)-supplemented World Health Organization Oral Rehydration Solution (WHO ORS) in the treatment of acute noncholera diarrhea in children. METHODS: A double-blind, randomized, controlled clinical trial was performed at ICDDR,B in 150 male children aged 4 to 18 months who had watery diarrhea of less than 48 hours' duration. After admission, children were assigned to receive either WHO ORS or BF-supplemented WHO ORS until recovery. Major outcome measures, such as duration of diarrhea and amount of stool output, were compared between the treatment groups. RESULTS: Patients receiving BF-supplemented WHO ORS had significantly reduced duration of diarrhea compared with the control group (mean +/- SD, 74 +/- 37 vs. 90 +/- 50 hours, P = 0.03). Survival analysis for duration of diarrhea also showed a reduction the BF-supplemented WHO ORS-treated group (P = 0.025, log rank test). There was also less stool output daily from days 2 through 7 in the patients treated with BF-supplemented WHO ORS compared with that in the children treated with WHO ORS; the reduction was significant on day 7 only. CONCLUSION: Benefiber added to standard WHO ORS substantially reduces the duration of diarrhea and modestly reduced stool output in acute noncholera diarrhea in young children, indicating its potential as a new antidiarrheal therapy for acute diarrhea in children.     

Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants

OBJECTIVE: Nosocomial diarrhea is a major problem in pediatric hospitals worldwide. We evaluated the efficacy of orally administered Lactobacillus GG (LGG) in the prevention of this disease in young children. STUDY DESIGN: Eighty-one children aged 1 to 36 months who were hospitalized for reasons other than diarrhea were enrolled in a double-blind trial and randomly assigned at admission to receive LGG (n = 45) at a dose of 6 x 10(9) colony-forming units or a comparable placebo (n = 36) twice daily orally for the duration of their hospital stay. RESULTS: LGG reduced the risk of nosocomial diarrhea (> or =3 loose or watery stools/24 h) in comparison with placebo (6.7% vs 33.3%; relative risk: 0.2; [95% CI: 0.06-0.6]; number needed to treat: 4 [95% CI: 2-10]). The prevalence of rotavirus infection was similar in LGG and placebo groups (20% vs 27.8%, respectively; relative risk: 0.72; 95% CI: 0.33-1.56). However, the use of LGG compared with placebo significantly reduced the risk of rotavirus gastroenteritis (1/45 [2.2%] vs 6/36 [16.7%], respectively; relative risk: 0.13; 95% CI: 0.02-0.79; number needed to treat: 7; 95% CI: 3-40). CONCLUSIONS: Prophylactic use of LGG significantly reduced the risk of nosocomial diarrhea in infants, particularly nosocomial rotavirus gastroenteritis.     

Stool electrolyte content and purging rates in diarrhea caused by rotavirus, enterotoxigenic E. coli, and V. cholerae in children

One hundred twenty children below 5 years of age with diarrhea caused by Vibrio cholerae, enterotoxigenic Escherichia coli, or rotavirus were studied for stool electrolyte composition and purging rates. The mean purging rate in cholera was 60.1 ml, in ETEC 39.2 ml, and in rotavirus infection 31.4 ml/kg/8 hour. The mean stool sodium concentration in cholera was 88.9 mMol/L, in ETEC 53.7 mMol/L, and in rotavirus infection 37.2 mMol/L. Stool potassium concentration did not show much variation, Mean CO2 concentration in rotavirus infection was 6 mMol/L, significantly lower than in cholera and in ETEC diarrhea. In cholera, stool sodium concentration increased significantly with increase in purging rates; the same was not true in rotavirus and ETEC diarrhea. These differences are considered important factors in formulating replacement therapy in diarrhea.     

Effect of oral administration of tormentil root extract (Potentilla tormentilla) on rotavirus diarrhea in children: a randomized,double blind,controlled trial

OBJECTIVES: To determine the effectiveness of tormentil root extract (TRE) for treatment of rotavirus diarrhea in children. BACKGROUND: Rotavirus, one of the most widely spread pathogens of acute, dehydrating diarrhea in children, is estimated to cause >800 000 annual deaths of young children in developing countries. Currently no rotavirus vaccine is available. Management involves rehydration therapy. Available antiperistaltic or antisecretory drugs to reduce the severity of diarrhea can cause serious side effects in children. METHODS: A randomized, double blinded, placebo-controlled trial was conducted at Children's Hospital for Infectious Diseases #3, St. Petersburg, Russia in 40 children ranging in age from 3 months to 7 years with rotavirus diarrhea. We constructed 2 groups for comparison: a treatment group that consisted of 20 children treated with tormentil root extract; and a control group of 20 children who received a placebo. All patients received 3 drops of tormentil root extract or placebo per year of life, three times daily until discontinuation of diarrhea, or a maximum of 5 days. An objective method was used to evaluate diarrhea, and physical examination was used to assess degree of dehydration in children. RESULTS: The duration of diarrhea in the tormentil root extract treatment group was 3 days, compared with 5 days in the control group (P < 0.0001). In the treatment group 8 of 20 (40%) children were diarrhea-free 48 h after admission to the hospital, compared with 1 of 20 (5%) in the control group (P < 0.0001). Subjects in the treatment group received smaller volumes of parenteral fluids than subjects in the control group. CONCLUSIONS: The administration of tormentil root extract in controlled doses shortened the duration of rotavirus diarrhea and decreased the requirement for rehydration solutions. Tormentil root extract appears to be an effective measure to treat rotavirus diarrhea in children.     

Rotaviruses in infants with diarrhea studied by viral RNA electrophoresis in Ankara, Turkey

Incidence of rotavirus in children under 2 years of age, admitted to 2 children's hospitals i n Ankara, Turkey, from July 1984-June 1985 was measured using viral RNA electrophoresis in agarose gels. 375 children were selected at random from over 14,000 diarrhea admissions, and their stool specimens taken on admission were compared to those of 333 children without diarrhea. 61 (16.3%) of the diarrhea cases had detectable rotavirus, compared to 0% in controls. Bacteriologic tests for salmonella, Shigella and Campylobacter jejuni were positive for 51 (13.6%) of the diarrhea patients and 1.8% of controls. 1 child had both rotavirus and Salmonella. Rotavirus infection was highest in November- March, peaking in December. Bacterial diarrhea was prevalent in the summer. This pattern is typical of a temperate climate, although in developed countries bacterial gastroenteritis is not as prevalent. Since there are about 2340 diarrhea admissions annually for rotavirus in Ankara, from a population of 2,700,000, rotavirus vaccination seems appropriate.     

Hyperimmune cow colostrum reduces diarrhoea due to rotavirus: a double-blind, controlled clinical trial

The therapeutic efficacy of hyperimmune bovine colostrum (HBC) from cows immunized with four serotypes of human rotavirus was evaluated in a double-blind, randomized trial in 75 boys, aged 6-24 months, infected with rotavirus diarrhoea. The treatment group received 100 ml of HBC three times a day for 3 consecutive days, while the controls received the same amount of bovine colostrum from unimmunized cows. The two groups were comparable at entry. Patients who received HBC had a significantly shorter duration of diarrhoea than the controls (median 56 versus 72 h ( p < 0.001); confidence interval of median difference (CI) 8-32 h). Total stool output (g/kg) between admission and cessation of diarrhoea was reduced by 29% in the HBC-treated group compared with controls (median 205 versus 290g ( p = 0.04); CI= 1-154g). In 50% of the children in the study group, diarrhoea stopped by 48 h, whereas nearly 100% of the controls were still suffering from diarrhoea. No untoward effects were noted in either group. Colostrum from cows immunized with rotavirus antigen is clinically effective in reducing the duration and severity of childhood diarrhoea due to rotavirus.
Children, hyperimmune cow colostrum, rotavirus diarrhoea     

Stool electrolyte concentration in acute infantile diarrhea in France

Sodium, potassium and chloride stool content was studied in 107 children aged 1 to 32 months (11 +/- 8 months) presenting with acute diarrhea related to a rotavirus infection (34 cases), to an invasive pathogen (Salmonella or Shigella 14 cases, E. coli 4 cases), or of non-identified etiology (65 cases). The therapeutic protocol was the same in all cases: rehydration for the first 24 hours, progressive realimentation from the second or third day, no drugs being given. An average of 4 stools were analysed for each child (range 2-14), the fecal samples being collected over 2 to 4 consecutive days. Na+ and K+ (n = 366) were assayed by flame photometry and chloride (n = 88) by continuous colorimetry. In the stool samples taken as a whole, without taking into account etiology or day of sampling, the electrolyte concentration (mean +/- SD) was 42 +/- 20 mmol/l for Na+ (range 4-166), 51 +/- 24 mmol/l for K+ (range 5-195), and 24 +/- 11 mmol/l for Cl- (range 4-93). No significant variation of these values was observed according to etiology, duration, severity of the diarrheal syndrome, oral rehydration or nutrition.     

2009年北京地区儿童感染性腹泻病原学及耐药性分析

目的 研究北京地区儿童急性感染性腹泻的病原学变化、流行病学特征及耐药性变迁情况.方法 对2009年1月～10月肠道门诊疑诊为细菌性腹泻病者便标本做细菌培养和血清分型鉴定,药敏试验采用纸片扩散法,以免疫层析双抗体夹心法定性检测A群轮状病毒抗原.结果 256份标本检出病原菌4种87株(有1份便标本同时检出2种菌),检出率为34.0%.男女检出比为1.69∶1,2岁以下患儿55例(64.0%).沙门菌40株(46.0%),志贺菌23株(26.4%),致泻性大肠杆菌2株(2.3%),金黄色葡萄球菌22株(25.3%).志贺菌中D群13株(56.5%),22株金黄色葡萄球菌有20株发生于＜1岁婴儿.沙门菌和志贺菌的耐药率分别为:氨苄西林(65.0%;95.7%)、复方新诺明(20.0%;78.3%)、环丙沙星(7.5%;8.7%)、头孢曲松(15.0%;73.9%).256份标本中A群轮状病毒检测阳性47份,其中同时便培养阳性者13份.结论 2009年北京地区儿童细菌性腹泻的病原菌以非伤寒沙门菌为主,志贺菌以D群为主要流行株,二者的易感人群以2岁以下婴幼儿为主,金黄色葡萄球菌感染以1岁以下婴儿为主,阳性检出男孩居多.多重耐药仍以志贺菌明显,细菌与轮状病毒混合感染的比例上升.

Abstract：

Objective To investigate the etiology, epidemiologic features and drug resistance tendency of acute infectious diarrhea among children in Beijing area. Methods Enteric pathogenic bacteria were isolated, cultured and identified for serotype from the stool specimens of children with the initial clinical diagnosis of acute bacterial diarrhea in the intestinal clinic from January to October in 2009 ,and the antibiotic susceptibility of bacteria was tested by disk diffusion method. The cluster A rotavirus antigen was also detected by the qualitative technique of immunochromatographic double-antibody sandwich assay. Results Of the 256 stool specimens, 87 strains of 4 species of pathogenic bacteria were detected with the detectable rate of 34. 0% ,of which 2 strains were detected in one stool sample ,including 40 strains of salmonella (46. 0%) ,23 strains of shigella (26. 4%) ,2 strains of diarrheogenic escherichia coli (2. 3%) and 22 strains of staphylococcus aureus (25.3%). The positively detected patients consisted of 54 males and 32 females with the ratio of 1.69∶1 ,of whom 55 cases (64. 0%) were under 2 years of age. Of the 13 strains of shigella, 13 were sonnei shigella (56. 5%). And of the 22 strains of staphylococcus aureus,20 were detected among the infants under 1 year of age. The rates of crug resistance to certain antibiotics were lower in salmonella than in shigella (ampicillin :65. 0% vs. 95.7% ;compound sulfamethoxazole:20. 0% vs. 78. 3% ;ciprofloxacin:7.5% vs.8. 7% ;ceftriaxone: 15.0% vs. 73.9%). Of the 256 stool specimens ,47 were found positive for cluster A rotavirus,of whom 13 were also positive in stool bacteria culture. Conclusion Salmonella is the major pathogen among children with bacterial diarrhea in Beijing in 2009, and sonnei shigella is the main epidemic strains of shigella diarrhea. lnfants under 2 years of age are the susceptible population of the above two species of bacteria, while staphylococcus aureus mainly infect the infants under 1 years of age. Multi-resistance in shigella is still serious. The incidence of mixed infections of bacteria and rotavirus increases in children with infectious diarrhea.     

Rotavirus diarrhea in Jewish and Bedouin children in the Negev region of Israel: epidemiology, clinical aspects and possible role of malnutrition in severity of illness

We conducted a 1-year prospective study in the Negev region of southern Israel to determine the epidemiologic and clinical patterns of rotavirus diarrhea. A total of 605 patients were studied, 392 Bedouins and 213 Jews, 441 of whom had diarrhea (449 episodes) and 164 did not. Rotavirus was the most common organism detected in children with diarrhea (63 of 444; 14%) but was rarely found in controls (3 of 163; 2%) (P less than 0.001). In 22% (12 of 54) of the rotavirus-positive patients, at least one other organism was also detected. The rate of rotavirus detection decreased as age increased, from 18% in the first year to 8% in the third year of life. Hospitalization with rotavirus diarrhea occurred more frequently in the summer. However, during winter, when diarrhea was less prevalent in the community, the proportion of cases associated with rotavirus was higher. Compared with controls, malnourished children were more likely to be hospitalized. However, rotavirus was detected in similar proportions among well-nourished and malnourished cases with diarrhea. The most prevalent rotavirus serotype was type 1 (in 69%), followed by types 4 and 2 (18 and 13%, respectively). We estimated that during the study period, approximately 2% of all Bedouin infants vs. only 0.2% of Jewish infants were hospitalized with rotavirus disease in their first year of life. Clinical signs and symptoms and stool appearance were not useful in predicting rotavirus detection. Malnutrition seems to be an important indicator of disease severity, which may explain why the toll of rotavirus-associated morbidity and mortality is particularly high among children in developing countries.