A new etiology of traveler's diarrhea in children: Cryptosporidium diarrhea

Cryptosporidiosis is a frequent cause of Traveler's diarrhea in children. In its acute or chronic form, this diarrhea is often accompanied by dehydration and accompanying deterioration in health. Diagnosis may be reached by inspection of the stools, for parasites, utilising specific but simple procedures. The latter tests should be carried out by the laboratory in addition to the routine parasitological examination. Prognosis is good in immunocompetent children since the clinical signs spontaneously regress within about a month. The only treatment consists in symptomatic treatment of diarrhea. Spiramycin, though not constantly effective, is reserved for immunosuppressed patients.     

急性腹泻住院婴幼儿轮状病毒和诺如病毒感染的临床研究

目的了解腹泻婴幼儿诺如病毒(NoV)和A组轮状病毒(HRV)的感染状况、临床表现以及NoV的基因型分布。方法收集2009年4月至2010年5月间,198例<5岁的住院腹泻患儿的粪便标本和临床资料,并同时收集53例非腹泻患儿作为对照;采用酶联免疫吸附法(ELISA)检测A组HRV,实时定量RT-PCR方法检测NoV,并对阳性标本进行病毒部分测序;对腹泻患儿的腹泻严重程度进行评分比较。结果急性腹泻患儿中共检测到A组HRV感染137例(69.2%),NoV感染40例(20.2%),A组HRV和NoV的混合感染12例(6.1%)。而53例对照组患儿中共检测到A组HRV感染7例(13.2%),NoV感染19例(35.8%),A组HRV和NoV的混合感染3例(5.7%)。单纯A组HRV感染和单纯NoV感染患儿间的腹泻严重程度评分差异无统计学意义。NoV测序分析发现NoV感染病毒的主要基因型是GⅡ.3及GⅡ.4。结论 A组HRV仍然是婴幼儿腹泻中最常见的病原体,而NoV则是第二大病原体。婴幼儿中存在NoV隐性感染。     

Incidence, clinical features and epidemiology of rotavirus gastro-enteritis in hospitalized children.

Two hundred and eighteen patients with acute gastro-enteritis (GE) and 67 controls (patients admitted during the period of study for illness other than (GE) were included in this study. Their stool samples were subjected to the following tests to detect the presence of rotavirus: enzyme-linked immunosorbent assay (ELISA), latex agglutination and electron microscopy. Samples positive by any one or more of the above methods were considered positive for rotavirus and were subjected to polyacrylamide gel electrophoresis of viral RNA. Rotavirus was detected in 59 (27.1%) of the 218 GE samples and four (6%) of the control samples. ELISA was the most sensitive test and could detect viral antigen long after the other methods failed to do so.     

Loperamide versus diphenoxylate in diarrhea of infants and children

The antidiarrheal activity of loperamide and diphenoxylate was studied in infants and children. Of 714 age and sex matched cases, 214 were treated conventionally (C group), 260 received loperamide (L group) and 240 diphenoxylate (D group) in addition to supportive antidiarrheal therapy. In C group 50 per cent, in L group 93.1 per cent and in D group 77.1 per cent of patients improved within 36 hours. Then active cases of diarrhea of L & D groups were crossed-over. In L group 61.2 per cent and in D group 22.2 per cent improved. With diphenoxylate side effects observed were vomiting, sedation, intoxication, and paralytic ileus and with loperamide vomiting and constipation. Loperamide was found to be more effective and safer than diphenoxylate.     

婴幼儿腹泻相关腺病毒的基因型研究

目的 探讨婴幼儿腹泻患者腺病毒 （AdV） 的分布情况及基因型特点。方法 选取3岁以下腹泻患儿380例,提取粪便基因组DNA进行腺病毒PCR检测,并对检测阳性的进行克隆测序和基因型分析。结果 在380例样本中,共检出24例腺病毒,检出率为6.3% （24/380）。阳性病例中以2~3岁患儿为主。阳性标本病毒序列分析显示,肠道腺病毒41型检出率为4.2% （16/380）,非肠道腺病毒检出率为2.1% （8/380）：其中AdV1型2例,AdV2型2例,AdV7型1例,AdV12型2例,AdV31型1例。结论 婴幼儿腺病毒腹泻常见于2~3岁的婴幼儿,AdV41是主要流行优势株。     

Incidence and clinical features of patent ductus arteriosus in low-birthweight infants: a prospective analysis of 150 consecutively born infants.

The incidence of persistent patency of the ductus arteriosus beyond the third day of life was prospectively determined in 100 preterm infants with birthweights of 2,000 gm or less and 50 infants with birthweights of 2,001 to 2,500 gm. The overall incidence was 21% and was inversely related to increasing gestational age and birthweight. The data suggest that immaturity is the major determinant of the persistent patency of the ductus arteriosus. Spontaneous delayed closure of the ductus occurred in 79% of patients that survived the immediate neonatal period. There was a high degree of association between the presence of a patent ductus arteriosus (PDA) and respiratory distress syndrome (RDS). Eight infants with severe RDS and PDA developed heart failure and four required surgical ligation of the ductus. None of the infants with birthweights greater than 2,000 gm who had PDA developed heart failure or required surgical ligation of the ductus arteriosus.     

Chronic diarrhoea in infants and young children: Causes, clinical features and outcome

OBJECTIVES: To review the causes, clinical features and outcomes of Malaysian children who had chronic diarrhoea. METHODOLOGY: A prospective study was performed on children with diarrhoea of more than 14 days' duration who were managed at the Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur from 1 January 1996 to 31 December 1997. RESULTS: Twenty-seven patients (14 boys and 13 girls) were studied. The median age of onset of diarrhoea was 6 months and the mean duration of symptoms before referral was 66.5 days. The underlying causes of diarrhoea were found to be: (i) prolonged diarrhoea due to well-defined entities (intestinal lymphangiectasia, two cases; congenital glucose-galactose malabsorption, one case; post-small bowel resection, one case; (ii) postenteritis diarrhoea (cow's milk protein intolerance, eight cases; secondary lactose intolerance, four cases; transient monosaccharide intolerance, one case; (iii) gastrointestinal infections (nontyphoid Salmonella gastroenteritis, three cases; trichuriasis, two cases; amoebiasis, one case; adenovirus, one case; (iv) cases in which a firm diagnosis could not be established (three cases). The mean duration of hospital admission was 63 days. Sixteen cases required a change in diet, while nine cases required total parenteral nutrition. One death occurred. CONCLUSIONS: Chronic childhood diarrhoea in Malaysia had a variety of aetiologies. A specific diagnosis could be established in 90% of cases. Making a diagnosis was important because this led to appropriate therapy and a good outcome in 96% of cases.     

Salmonella typhimurium-associated severe protracted diarrhea in infants and young children

Eleven (13.8%) children (4-14 months; mean of 7.8 +/- 3.6 months) presenting with protracted diarrhea (duration greater than 21 days) and weight loss had associated infection with Salmonella typhimurium. All had documented weight loss of 16-25% and progressive clinical deterioration. On admission, they had high purging rates (greater than 4 ml/kg/h), hyponatremia (5/11), mucosal injury, and malabsorption as measured by 1 h blood D-xylose, fecal alpha 1-antitrypsin, and oral fat tolerance test. Diarrhea was secretory in 8 of 11 and fecal sodium was high (54-142 mEq/L; mean of 102 +/- 27 mEq/L). The organism showed multiple drug resistance. All patients received antibiotics (amikacin and nalidixic acid/norfloxacin) for 10-14 days, which was followed by rapid improvement in clinical status and absorption studies. The two youngest patients died. Due to ethical reasons, an untreated control group was not included. Use of appropriate antibiotics may benefit children with S. typhimurium-associated severe protracted diarrhea and rapid progressive weight loss.     

Drug treatment of acute infectious diarrhea in infants and children]

In this paper written by the Groupe francophone d'hépatologie, gastroentérologie et nutrition pédiatriques, recommendations are given on the indications of drugs in infant and child infectious acute diarrhea, based upon the current scientific knowledge on their effectiveness and tolerance. This paper complements an article on nutritional treatment of acute diarrhea written by the Comité de nutrition de la Société fran?aise de pédiatrie, and published in the same issue of the Archives de Pédiatrie.