Etiology of childhood diarrhea in Korea.

To assess the role of recently recognized enteropathogens in childhood diarrhea in Korea, 231 children with diarrhea admitted to and 104 children without diarrhea seen at the well-baby clinic or the outpatient department of Hanyang University Hospital in Seoul, Korea, were evaluated during a 14-month period. Stools were cultured for bacterial pathogens, including enterotoxigenic (heat-labile and heat-stable enterotoxin-producing) and enteroadherent organisms. Only those stools obtained from patients with diarrhea were examined for rotavirus. All Escherichia coli isolates were screened for Shiga-like toxin (SLT) I, SLT-II, enterohemorrhagic E. coli fimbriae, and enteroinvasiveness by colony hybridization. One or more pathogens were identified in 75.8% of the children with diarrhea. Rotavirus was the most frequently identified pathogen, accounting for 47% of the cases. Other major enteropathogens were enterotoxigenic E. coli (22%), Clostridium difficile (16%), enteroadherent E. coli (15%), and enteropathogenic E. coli (6%). Shigella spp., Campylobacter jejuni, Salmonella spp., SLT-I-and enterohemorrhagic-E. coli-fimbria-probe-positive E. coli serotype O26:H11 and enteroinvasive E. coli were isolated from only a few patients. Aeromonas hydrophila and E. coli O157 were not isolated. Compared with those of the controls, the isolation rates of heat-stable-enterotoxin-producing E. coli (P less than 0.05), C. difficile (P less than 0.025), and enteroadherent E. coli (P less than 0.05) were significantly higher in the patients with diarrhea. The greatest number of rotavirus, enterotoxigenic E. coli, and C. difficile cases were identified during the cool, dry months of October and November.     

Viral diarrhea in children in Beijing, China

A study was undertaken from November 1994 to August 1996 to determine the role of viruses in children (< or =5 years of age) hospitalized at Beijing Children Hospital, Beijing China, for acute diarrhea. Stool samples from diarrheal patients were investigated by ELISA, electron microscopy, and RT-PCR for the presence of rotavirus, calicivirus, astrovirus, and adenovirus. Group A rotavirus was detected in 55.9% of all diarrheal patients and comprised 82.5% of all viruses detected. Group A rotavirus samples were further characterized for their G-type specificity by RT-PCR. Four major G types (1-4) were identified. G1 to G4 accounted for 58.9%, 15.7%, 16.8%, and 6.3%, respectively, of the serotyped samples. Almost all rotavirus infections occurred in children less than 1 year of age, with a significant clustering during the winter months. Group C rotavirus was detected in one 18-month-old child. Astroviruses, caliciviruses, and adenoviruses were detected in 8.5%, 7.6%, and 2.5% of the hospitalized children, respectively. This, the first viral etiological study of childhood diarrhea in China, concludes that rotavirus G1-4 strains play an important role in severe diarrhea in Beijing children.     

Hypoglycemia during diarrhea in childhood. Prevalence, pathophysiology, and outcome

To determine the frequency and outcome of hypoglycemia during diarrhea in childhood, we screened 2003 consecutive patients less than 15 years of age who were admitted to a diarrhea treatment center in Dhaka, Bangladesh. Hypoglycemia, defined as a blood glucose concentration less than 2.2 mmol per liter, was found in 91 patients (4.5 percent), 39 (42.9 percent) of whom died. We also measured the plasma concentrations of glucoregulatory hormones and gluconeogenetic substrates in 46 of the patients with hypoglycemia who were 2 to 15 years old and in 25 normoglycemic patients matched with them for age and weight. The patients with hypoglycemia had had diarrhea for less time than the normoglycemic patients (median, 12 vs. 72 hours; P less than 0.05), and their last feeding had been 18 hours before admission, as compared with 9 hours for the normoglycemic patients (P less than 0.05). The groups were similar in terms of nutritional status, the proportion of patients who had fever, and the types of pathogens recovered from stool samples. The plasma C-peptide concentrations were low (less than 0.30 nmol per liter) in all the hypoglycemic patients. As compared with the normoglycemic patients, the patients with hypoglycemia had elevated median plasma concentrations of glucagon (44 vs. 11 pmol per liter; P = 0.001), epinephrine (3400 vs. 1500 pmol per liter; P = 0.012), norepinephrine (7500 vs. 2900 pmol per liter; P = 0.002), and lactate (3.5 vs. 2.1 mmol per liter; P = 0.020) and similar alanine and beta-hydroxybutyrate concentrations. Eighteen hypoglycemic patients with severe malnutrition had been ill longer than 26 better-nourished patients with hypoglycemia (median duration of illness, 18 vs. 10 hours; P = 0.023) and had lower median plasma concentrations of lactate (1.9 vs. 3.9 mmol per liter; P = 0.021) and alanine (173 vs. 293 micromol per liter; P = 0.040). We conclude that hypoglycemia is a major cause of death in association with diarrhea. Because the glucose counterregulatory hormones were appropriately elevated in the children with diarrhea and hypoglycemia, whereas the gluconeogenetic substrates were inappropriately low, we further conclude that the hypoglycemia observed in such patients is most often due to the failure of gluconeogenesis.     

北京市2010-2013年急性出血性结膜炎的病原学分析

目的 确定北京市急性出血性结膜炎的病原学及流行病学特征.方法 2010-2013年7月至10月在北京地区所有区县监测点收集急性结膜炎患者眼拭子标本,通过RT-PCR分别鉴定柯萨奇病毒A24变种(CVA24v)和肠道病毒70(EV70).分析急性出血性结膜炎的时间分布、患者性别、年龄及临床症状特征,利用系统发育树分析CA24v的VP1区、3Cpro区基因特征.结果 随机抽取的1144件急性结膜炎样本中,4.5％(52/1144)为CVA24v阳性,未检测到EV70.CVA24v相关急性出血性结膜炎在9月达到高峰.各年龄组发病差异有统计学意义,10-19岁年龄组发病率最高.CA24v和非CA24v急性结膜炎的症状构成比无统计学差异.北京市2007-2012年分离的CA24v株VP1、3Cpro的核苷酸序列同源性分别为95.2％-100％和92.8％-100％.结论 2010-2013年CVA24v是引起北京市急性出血性结膜炎的最主要病原体.     

Etiology and epidemiology of viral diarrhea in children under the age of five hospitalized in Tianjin, China

Viral diarrhea is a great threat to children's health in developing countries. We conducted a prospective surveillance study of acute diarrhea of young children at Tianjin Children's Hospital from April 2008 to April 2009. Viral infections were detected in 356 of the total 766 collected stool specimens (46.48%). Rotavirus infections were the most common (27.94%; predominant type G1), followed by adenovirus infections (17.62%; predominant type Ad41), norovirus infections (5.87%; predominant type GII-4/2006 b), and astrovirus infections (3.15%; only HAstV-1). Children younger than 1 year old were the most susceptible population to viral infections (87.9%). Diarrhea, vomiting, and fever were the most frequent clinical symptoms among the infected patients. The viral infections had no age, sex, or regional differences. Most infection rates were higher in the autumn, winter, and spring. This study supported that the rotavirus vaccine should be included in the Expanded Programme on Immunization in China.     

Identification of viral agents associated with diarrhea in young children during a winter season in Beijing, China.

BACKGROUND: Viral diarrhea remains a major cause of childhood morbidity and mortality worldwide. Although rotavirus was extensively studied in China, few comprehensive studies of all viral agents related to diarrhea in children have been conducted. OBJECTIVES: Our study was performed to investigate the role of enteric viruses in acute diarrhea in our country and to evaluate methods that could be used in routine diagnostics. STUDY DESIGN: One hundred stool samples were collected from children under 5 years of age seeking medical care for acute diarrhea during the winter season 2000/2001 in Beijing Children's Hospital. All specimens were initially screened microscopically for leucocytes/red blood cells. Samples with negative results were analyzed for virus presence using commercial EIAs and/or in-house RT-PCRs. RESULTS: At least one viral agent was found in 67% of the specimens. The frequency of rotavirus, astrovirus, norovirus and enteric adenovirus was 59%, 8%, 6% and 2%, respectively. Dual infections were found in 9.0% (6/67) of the positive samples. The results from rotavirus and astrovirus EIAs were concordant with those of rotavirus and astrovirus RT-PCRs. CONCLUSIONS: Enteric viruses play an important role in pediatric diarrhea during the winter season in China. A combination of microscopic examination of stool samples with specific EIA assays to detect virus antigen in stool specimens may be suitable for routine diagnostics.     

Clinical and molecular epidemiology of norovirus infection in childhood diarrhea in China

A prospective investigation was carried out among pediatric outpatients and inpatients with acute non‐dysenteric diarrhea between August, 2008 and July, 2009 in Shanghai, Hangzhou, Chongqing, and Tianjin, China. One step real‐time RT‐PCR was used for detection of norovirus (NoV) genogroups I and II (GI, GII). The NoV genotypes were classified based on partial capsid sequences. Rotavirus (RV) was detected in parallel. Among 4,123 fecal samples from outpatients, 1,067 (25.9%) were NoV‐positive, of which 1,051 (98.5%) belonged to GII and 1,309 (31.7%) were RV‐positive. In the inpatient group (n = 317), 25.6% were NoV‐positive and 41.6% were RV‐positive. Four hundred and fifty‐one out of 1,067 NoV‐positive strains were sequenced and genotyped and 6 typed strains were GI (3 GI.3, 2 GI.5, 1 GI.4) and 445 typed strains were GII. GII strains clustered into nine genotypes including GII.4 2006b (69.2%), the only GII.4 variant identified in this study, followed by GII.3 (23.8%), GII.6 (3.6%), GII.12 (1.3%), GII.2 (0.9%), GII.13 (0.4%), GII.14 (0.2%), GII.7 (0.2%), and GII.16 (0.2%). A peak of NoV infections was observed during the cold season in Tianjin, while NoV activity was higher between late summer and autumn and lower during winter in Shanghai, Hangzhou, and Chongqing. NoV is a common causative agent of childhood diarrhea in China and the seasons of NoV‐associated diarrhea varies between regions. The results show that NoV GII.4 2006b was the predominant strain circulating in China between 2008 and 2009. J. Med. Virol. 84:145–151, 2011. © 2011 Wiley Periodicals, Inc.     

Etiology of acute diarrhea in adults in southwestern Nigeria

Stool specimens from 113 adult outpatients with diarrhea in southwestern Nigeria and 63 controls were examined for bacterial and parasitic enteric pathogens. Enterohemorrhagic Escherichia coli (EHEC) (P < 0.02), enteroaggregative E. coli (EAEC) (P < 0.02), and Entamoeba histolytica (P < 0.0002) were significantly associated with diarrhea. Salmonella, Shigella, nontoxigenic Vibrio cholerae, other categories of diarrheagenic E. coli, as well as a variety of helminths were recovered more frequently from the stools of patients than from the stools of controls but did not show a significant association with disease. Multiple pathogens were recovered from 36.3% of specimens, and bloody diarrhea was commonly associated with E. histolytica and diarrheagenic E. coli infections. The majority of EHEC isolates were non-O157 strains that carried the stx(2) gene. Of the 23 EHEC-infected patients, 12 (52.2%) presented during the 10th week of the study. EHEC strains isolated within this cluster were more likely to hybridize with the enterohemolysin gene probe, to be nonmotile and sorbitol positive, and to fail to agglutinate O157 antisera. Pulsed-field gel electrophoresis demonstrated that the only strains with XbaI profiles that occurred more than once were isolated during the 10th and 11th weeks of the study, suggesting an outbreak. The study has demonstrated that E. histolytica, EHEC, and EAEC are important diarrheal pathogens within the study area and that sporadic and epidemic EHEC infections occur in developing as well as developed countries. Routine surveillance for diarrheagenic E. coli, even only at the tertiary-care level, would be useful in identifying outbreaks and assist in identifying environmental reservoirs and transmission routes.     

Etiology of children's diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates

We studied microorganisms associated with infant diarrhea in a group of 256 children admitted to a public pediatric hospital in Montevideo, Uruguay. Diagnostic procedures were updated to optimize detection of potential pathogens, which were found in 63.8% of cases, and to be able to define their characteristics down to molecular or antigenic type. Coinfection with two or more agents was detected in more than one-third of positive studies. Escherichia coli enteric virotypes, especially enteropathogenic E. coli (EPEC), were shown to be prevalent. Rotavirus, Cryptosporidium, Campylobacter (mainly Campylobacter jejuni), and Shigella flexneri were also often identified. Enterotoxigenic E. coli, Salmonella, and Giardia lamblia were sporadically recognized. Unusual findings included two enteroinvasive E. coli strains, one Shigella dysenteriae 2 isolate, and a non-O:1 Vibrio cholerae culture. EPEC bacteria and S. flexneri (but not Salmonella) showed unusually frequent antimicrobial resistance, especially towards beta-lactam antibiotics, which is the subject of ongoing work.     

Seroepidemiology of adult diarrhea rotavirus in China, 1977 to 1987.

In 1982, large outbreaks of diarrhea that were caused by group B adult diarrhea rotavirus (ADRV) occurred throughout the People's Republic of China. Until 1982, group B rotavirus had never been associated with disease in humans. To determine whether ADRV was a new virus introduced in 1982 or had been present before that time, we examined antibody titers of ADRV in gamma globulin (pooled immunoglobulin) pools that were prepared during 1977 to 1987 in four cities in the People's Republic of China (Shanghai, Lanzhou, Wuhan, and Chandu). ADRV antibodies were assayed by using a blocking enzyme-linked immunosorbent assay. Antibodies were present in most Chinese gamma globulins tested, including those collected in Shanghai before the 1982 epidemic, and absent from American reference pools. The highest titers of antibody to ADRV (3,200) were found in gamma globulins collected in 1983 in Shanghai just after the epidemic, and these were fourfold higher than titers present in the preceding years. The quality of the gamma globulins stored for up to 12 years was tested by measuring levels of immunoglobulin G to group A rotavirus; these were equally high in gamma globulin pools prepared in the United States and in all samples from the People's Republic of China. Serum samples from patients from an outbreak of ADRV had elevated titers to ADRV 3 and 16 months after the onset of symptoms. These findings, as well as other epidemiologic findings on ADRV, suggest that the organism is an important and continuing cause of diarrhea in the People's Republic of China, was present before the first epidemic in 1982, and represents a risk to surrounding populations in Asia.     

Prevalence of intestinal parasites in companion dogs with diarrhea in Beijing,China, and genetic characteristics of Giardia and Cryptosporidium species

Parasitology Research - Companion animals including dogs are one of the important components in One Health. Parasites may cause not only diseases in pet animals but also many zoonotic diseases...     

Etiology of diarrhea in young children in Denmark: a case-control study

Infectious gastroenteritis is one of the most common diseases in young children. To clarify the infectious etiology of diarrhea in Danish children less than 5 years of age, we conducted a 2-year prospective case-control study. Stools from 424 children with diarrhea and 870 asymptomatic age-matched controls were examined, and their parents were interviewed concerning symptoms. Rotavirus, adenovirus, and astrovirus were detected by enzyme-linked immunosorbent assay, and norovirus and sapovirus were detected by PCR. Salmonella, thermotolerant Campylobacter, Yersinia, Shigella, and Vibrio spp. were detected by standard methods. Shiga toxin-producing (STEC), attaching-and-effacing (A/EEC), enteropathogenic (EPEC), enterotoxigenic, enteroinvasive, and enteroaggregative Escherichia coli were detected by using colony hybridization with virulence gene probes and serotyping. Parasites were detected by microscopy. Overall, a potential pathogen was found in 54% of cases. More cases than controls were infected with rotavirus, Salmonella, norovirus, adenovirus, Campylobacter, sapovirus, STEC, classical EPEC, Yersinia, and Cryptosporidium strains, whereas A/EEC, although common, was not associated with illness. The single most important cause of diarrhea was rotavirus, which points toward the need for a childhood vaccine for this pathogen, but norovirus, adenovirus, and sapovirus were also major etiologies. Salmonella sp. was the most common bacterial pathogen, followed by Campylobacter, STEC, Yersinia, and classical EPEC strains. A/EEC not belonging to the classical EPEC serotypes was not associated with diarrhea, underscoring the importance of serotyping for the definition of EPEC.     

Pneumonia in childhood: Etiology and response to antimicrobial therapy

A prospective eight-month study was carried out in 50 children admitted to hospital for radiologically confirmed community-acquired pneumonia. A potential causative agent of infection was identified in 44 (88 %) cases. Using virus isolation, virus antigen detection and enzyme immunoassay serology, respiratory virus infection was diagnosed in 30 (60 %) patients. Antibody assays for seven bacteria and antigen detection from serum and urine forStreptococcus pneumoniae produced evidence of bacterial infection in 31 (62 %) cases.Streptococcus pneumoniae (38 %), respiratory syncytial virus (30 %) andMycoplasma pneumoniae (20 %) were the most common causative agents. A mixed infection was diagnosed in 25 (50 %) episodes. Nine patients failed to respond to antibiotics within 24 h after onset of treatment. Three of them had a pure viral infection, three a mixed viral-bacterial infection, two aMycoplasma pneumoniae infection mixed with other bacteria and one a pureMycoplasma pneumoniae infection. All threeMycoplasma pneumoniae infections were initially treated with penicillin.     

2011年北京市5岁以下婴幼儿A组轮状病毒腹泻监测

目的了解北京市5岁以下婴幼儿轮状病毒腹泻患者的流行特点。方法2011年1月至12月在北京市3家医院肠道门诊收集输液两次以上5岁以下腹泻患者病例604例,采集粪便标本,应用酶联免疫吸附试验检测轮状病毒抗原,阳性标本用半巢式反转录PCR进行基因分型。结果604例标本中96例轮状病毒抗原阳性,阳性率为15．89％。秋冬季为A组轮状病毒腹泻的发病高峰,其中11月份A组轮状病毒阳性率最高（55．56％,30／54）。轮状病毒腹泻主要发生于3—23月龄患者（93．76％,90／96）。对轮状病毒抗原阳性标本进行G／P分型,G分型以G3＋G9型混合感染占第一位（37．50％,36／96）,其它型别主要有G3型（28．12％,27／96）,G1型（11．46％,11／96）,G9型（9．38％,9／96）,G2型（8．33％,8／96）。P分型以P8型为主要优势株（86．46％,83／604）,其次为P4型（10．42％,10／96）。最常见的G／P基因型组合为G3＋G9／[P8]（36．46％,35／96）,其次为G3／[P8]（26．04％,25／96）,GI／[P8]（11．46％,11／96）,G9／[P8]（9．38％,9／96）,C2／[P4]（8．33％,8／96）。结论A组轮状病毒是北京市婴幼儿腹泻的主要病原之一,2011年主要流行株基因型组合为G3＋G9／P[8]。     

乌鲁木齐地区腹泻患儿中人博卡病毒感染分子流行病学调查

目的 了解新疆乌鲁木齐地区腹泻患儿中人博卡病毒1～4型(HBoV1 ～4)感染的分子流行情况.方法 收集新疆维吾尔自治区人民医院2011年1月至12月住院及门诊腹泻患儿粪便标本315例,用巢氏PCR扩增入博卡病毒(HBoV) NS1片段(518 bp),检测HBoV1～4型.结果 315份标本中,HBoV总阳性检出率为8.57％ (27/315),其中HBoV1、2、3、4型分别为2例、22例、3例、0例.除XJ1378外,其他26例HBoV均与参考株的核苷酸同源性达到98％ ～ 100％,但其中3例HBoV3型与大猩猩GBoV1型(HM145750.1)核苷酸同源性为92％,且系统进化显示HBoV3型NS1片段更接近于HBoV1型.HBoV感染呈全年散发,并无明显季节性.在性别、年龄及民族间均无差异.结论 本地区腹泻患儿中HBoV1 ～3型均有流行,且以HBoV2型为主要流行株.     

Cryptosporidium infection and diarrhea in rural and urban areas of Jiangsu, People''s Republic of China.

Screening of infants and children under age 15 years for Cryptosporidium oocysts in their stools was carried out in the suburb of Xuzhou City and six rural areas of Jiangsu Province. The infection rate varied from 0.7 to 5.06%. Of the total of 5,089 children examined, 89 (1.75%) were oocyst positive. The incidence was evidently higher in the group of children under age 4 years than it was in children from 4 to 15 years (P less than 0.01). Routine blood examination and immunoassay performed on blood samples from some of the infected children indicated that more than half of them had anemia and lower cellular immunity. Diarrhea was the main symptom of cryptosporidiosis. It was intermittent or persistent and was present in 57 of the 89 children positive for Cryptosporidium oocysts, while the other 32 children were asymptomatic carriers. Examination of stool specimens of adult members and domestic animals of about half of the infected families showed that two mothers, one pig, and one dog were positive for Cryptosporidium oocysts.