Effect of dietary nucleotide supplementation on diarrhoeal disease in infants

The effects of a nucleotide-supplemented formula on diarrhoeal disease was studied in 141 infants (group 1) who belonged to the low socioeconomic stratum; 148 controls (group 2) received the same formula but unsupplemented. Group 1 experienced less episodes of diarrhoea (109 versus 140), including less first episodes (74 versus 102; chi-square = 8.19, p < 0.004; odds ratio 2.01) and for a lesser number of days (807 versus 996 days); 45.0% and 31.1% of infants in groups 1 and 2, respectively, never developed episodes of diarrhoea. There were no differences in the clinical characteristics of the episodes or in the enteropathogens isolated from symptomatic or asymptomatic infants. The mechanisms through which nucleotides decrease the incidence of diarrhoeal disease in infants remain unclear.     

Enterotoxin-producing bacteria and parasites in stools of Ethiopian children with diarrhoeal disease

Enterotoxinogenic bacteria were isolated from 131 (37%) of 354 Ethiopian infants and children with acute gastrointestinal symptoms. Only one of these isolates belonged to the classical enteropathogenic serotypes of Esch. coli. Two colonies from each patient were isolated and tested for production of enterotoxin by the rabbit ileal loop test, the rabbit skin test, and an adrenal cell assay. However, only 38% of the isolated enterotoxinogenic strains were Esch. coli; the others belonged to Klebsiella, Enterobacter, Proteus, Citrobacter, Serratia, and Aeromonas. In 18 patients both isolates were toxinogenic and belonged to different species. The incidence of intestinal parasites was 35% with no apparent correlation to the occurrence of toxinogenic bacteria in the stools.     

Solar disinfection of water reduces diarrhoeal disease: an update

349 Maasai children younger than 6 years old were randomised by alternate household to drink water either left in plastic bottles exposed to sunlight on the roof of the house or kept indoors (control). The trial was run in Maasai by Maasai community elders. Children drinking solar disinfected water had a significantly lower risk of severe diarrhoeal disease over 8705 two weekly follow up visits; two week period prevalence was 48.8% compared with 58.1% in controls, corresponding to an attributable fraction of 16.0%. While this reduction is modest, it was sustained over a year in free living children. It confirms solar disinfection as effective in vivo as a free, low technology, point of consumption method of improving water quality. The continuing use of solar disinfection by the community underlines the value of community participation in research.     

Enterotoxin-producing bacteria and parasites in stools of Ethiopian children with diarrhoeal disease.

Enterotoxinogenic bacteria were isolated from 131 (37%) of 354 Ethiopian infants and children with acute gastrointestinal symptoms. Only one of these isolates belonged to the classical enteropathogenic serotypes of Esch. coli. Two colonies from each patient were isolated and tested for production of enterotoxin by the rabbit ileal loop test, the rabbit skin test, and an adrenal cell assay. However, only 38% of the isolated enterotoxinogenic strains were Esch. coli; the others belonged to Klebsiella, Enterobacter, Proteus, Citrobacter, Serratia, and Aeromonas. In 18 patients both isolates were toxinogenic and belonged to different species. The incidence of intestinal parasites was 35% with no apparent correlation to the occurrence of toxinogenic bacteria in the stools.     

Solar disinfection of water reduces diarrhoeal disease: an update.

349 Maasai children younger than 6 years old were randomised by alternate household to drink water either left in plastic bottles exposed to sunlight on the roof of the house or kept indoors (control). The trial was run in Maasai by Maasai community elders. Children drinking solar disinfected water had a significantly lower risk of severe diarrhoeal disease over 8705 two weekly follow up visits; two week period prevalence was 48.8% compared with 58.1% in controls, corresponding to an attributable fraction of 16.0%. While this reduction is modest, it was sustained over a year in free living children. It confirms solar disinfection as effective in vivo as a free, low technology, point of consumption method of improving water quality. The continuing use of solar disinfection by the community underlines the value of community participation in research.     

Intestinal sugar permeability: relationship to diarrhoeal disease and small bowel morphology

The permeability of the intestine was studied in 39 children (1 month to 3 years of age) with diarrhoea and in 28 children (6 months to 15 years of age) undergoing duodenal biopsy. Permeability was measured by differential absorption from an isotonic oral load containing 3.5 g lactulose, 0.5 g L-rhamnose, 0.5 g D-xylose, and 5 g lactose. Urinary sugar excretion was determined by quantitative thin-layer chromatography. Children with acute gastroenteritis had a greatly increased permeability, with a mean lactulose/L-rhamnose excretion ratio of 0.43 +/- 0.31 (normal less than 0.07). Children retested 3-16 weeks after complete recovery of their gastroenteritis had normal permeability (0.045 +/- 0.018). Children with chronic diarrhoea also had an increased permeability (0.12 +/- 0.074), but significantly less than the acute gastroenteritis group (p less than 0.01). Abnormal proximal small bowel morphology was associated with increased permeability, and a strong correlation between crypt depth and permeability was observed (r = 0.66, p less than 0.001). Abnormal intestinal permeability was associated with diarrhoeal disease and with mucosal damage. It appears to be a reliable and useful index of mucosal integrity.     

Factors associated with sclerema in infants with diarrhoeal disease: a matched case-control study

Aim: To identify clinical and biochemical factors associated with sclerema in infants with diarrhoeal illness, and their outcome.
Methods: In this case-control study, we enrolled 30 infants with clinical sepsis with sclerema (cases) and another 60, age- and sex-matched infants with clinical sepsis but without sclerema (controls) from among those admitted to the special care unit (SCU) and longer stay unit (LSU) of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) for their diarrhoeal illness from May 2005 through April 2006. Sclerema as the dependant variable while hypoxia, hypothermia, C-reactive protein (CRP) level, serum total protein and prealbumin level were the major independent variables compared in the analysis. Differences in proportions were compared by the chi-square test and differences of mean were compared by Student's t -test or Mann–Whitney test, as appropriate.
Results: The case-fatality was significantly higher among the cases than the controls (30% vs. 2%, CI 2.9–565.5). After adjusting for confounders, infants with sclerema were more likely to be hypothermic (OR 11.6, 95% CI 1.1–126.5), and have lower serum total protein (OR 1.12, 95% CI 1.04–1.21) and prealbumin (OR 1.5, 95% CI 1.1–2.3).
Conclusion: Diarrhoeal infants having clinical sepsis presenting with hypothermia, lower serum protein and prealbumin are prone to be associated with sclerema.     

A worldwide survey on the treatment of diarrhoeal disease by oral rehydration in 1979

How do you treat diarrhoea?, questionnaires were sent to 586 health workers in 81 countries and 58% replied. Treatments for acute diarrhoea were scored for popularity, including retrospective questions about therapy three years earlier. Oral rehydration was apparently widely used in 1976, and this had increased by 1979. Intravenous therapy was also important. Kaolin and sulphonamides are becoming less popular, but antibiotics are still widely prescribed. The most commonly used oral rehydration mixtures in 1979 were home made, simple salt-sugar solutions. A complete formula, as recommended by WHO, was used by a smaller number. 30% of the responders reported no difficulty with oral rehydration, but many did not favour the method. The main technical complaint in 28% of replies was that patients could not take enough fluid, and vomiting was reported in 22%. Local beliefs about the cause of diarrhoea related to some food or fluid ingested according to 45% of responders. Such diet-related beliefs may adversely affect the use of oral therapy.     

Adhesion of bacteria to mucosal surfaces—an area of increasing importance in diarrhoeal disease

Conclusion The study of the adhesive interactions between host and microorganisms is likely to have major repercussions in many aspects of the study of infectious diseases. In the field of bacterial diarrhoea, it has already been shown that the ability to adhere to the brush border of the intestinal mucosa is an essential pre-requisite to colonisation of the intestine, thus initiating the chain of events leading to proliferation, enterotoxin production, small-intestinal secretion, and overt diarrhoea. The interruption of this chain of events by a new generation of therapeutic agents which act by inhibiting the adhesion of pathogenic bacteria, or by rendering them non-adhesive with specific IgA, will usher in a new era in the treatment of diarrhoeal disease.Curriculum vitae. David Candy was born in 1947 in the UK. He graduated in 1971 from the Medical School of the University of Adelaide, South Australia. After working with Dr. John Harries in Paediatric Gastroenterology at the Hospital for Sick Children, Great Ormond St., he began full-time research as the Rayne Foundation Research Fellow, in 1977. His topics of research include studies of the pathophysiology of bacterial enterotoxins and adhesion.     

Survey on immunization, diarrhoeal disease and mortality in Quang Ninh Province, Vietnam.

A survey on EPI, CDD, child morbidity, and mortality was conducted in 1988 in one province of northeastern Vietnam. Thirty out of 114 communes were randomly selected for the survey and the interviews were made by 60 students from the provincial nursing school, supervised by 10 teachers. It was found that 23 per cent of the children (n = 211) were fully vaccinated, while 54 per cent had partial coverage. Lack of information or ignorance were the main causes of vaccination failure. The adjusted yearly diarrhoeal rate was 1.6 per child under 5 years of age (n = 9.691). Infant mortality and under-five mortality rates were found to be 28 per thousand live births (95 per cent confidence interval: 21-35; n = 2.321) and 44 (36-52), respectively. High literacy among mothers, good breast-feeding practices, low mortality due to diarrhoea, malaria, and measles, and a well-functioning rural health care system were considered to be the main contributing factors to the low infant mortality. The results also point out the weaknesses in the existing reporting system and indicates the need for follow-up studies.