Assessment of simple methods of measuring intestinal transit times in children with gastroenteritis.

Intestinal transit times in children less than 3 years old with gastroenteritis were measured using carmine suspension and radioopaque pellets. Carmine transit times were short as expected in the acute illness, and lengthened on recovery to the values found in children without diarrhoea. Pellet transit times of the sick children were the same as those of controls without bowel disease. Solid markers may thus be misleading in acute diarrhoeal illness of childhood. Possible mechanisms are discussed.     

Approaches to immunization of infants and young children against gastroenteritis due to rotaviruses

Recent studies have shown that in developed countries rotaviruses are the single most important etiologic agents of acute gastroenteritis that requires hospitalization of infants and young children. Although deaths from gastroenteritis are, in general, infrequent in the developed countries, an effective rotavirus vaccine would clearly be of benefit to reduce the heavy toll of morbidity from gastroenteritis due to rotavirus. In the developing countries the impact of diarrheal diseases is staggering. It was recently estimated that in Asia, Africa, and Latin-America during a one-year period there would be 3.5 billion cases of diarrhea and 5-10 million deaths associated with diarrhea; in addition, diarrhea was ranked first in freqency in the categories of disease and mortality. In the developing countries rotaviruses are known to cause diarrhea, but their relative role in this high mortality rate is not yet known. epidemiologic data indicate that development of an effective rotavirus vaccine would reduce morbidity, and they suggest that a vaccine would also reduce a portion of the mortality from diarrheal disease. The prospects and approaches for the development of an effective rotavirus vaccine are presented. The recent successful propagation of rotavirus type 2 in cell culture represents an important step in this regard. In addition, the antigenic relation between human and animal strains offers another possible approach. The need for a live attenuated vaccine is indicated by the prime role played by local intestinal immunity in resistance to rotavirus disease.     

Mortality due to gastroenteritis of unknown etiology in the United States

Gastroenteritis of unknown etiology (GUE) is a significant cause of mortality in the United States. In the present study, the demographic and medical characteristics of people who died of GUE were examined, using the 1995-1997 Multiple Cause of Death files to calculate GUE death rates and proportionate mortality ratios. There were 13,153 GUE deaths during the period, or approximately 4400 deaths per year. Death rates were highest among infants and elderly persons, especially nursing home residents, and increased during the winter months. Compared with all decedents, GUE decedents were more likely to have certain other medical conditions, including bacteremia, volume depletion, renal failure, and human immunodeficiency virus/acquired immunodeficiency syndrome. Fatal GUE often appeared to be infectious in origin, but death certificates provide insufficient information to determine whether the causative agents were unknown or foodborne. The accuracy of GUE reporting on death certificates and the etiology of fatal GUE merit further investigation.     

Rotavirus infection in children with acute gastroenteritis in Ecuador

Electron microscopic examination of stools of 702 infants and young children hospitalized in the Emergency Service of the Alejandro Mann Children's Hospital in Guayaquil, Ecuador, between August 1978 and October 1979 showed rotavirus to be present in 148 (21.1%). During the study period rotavirus was detected throughout the year, with no distinct seasonal variation. In addition to rotavirus, adenovirus was detected in stools of five (0.7%) of the patients and unidentified small round virus particles in seven (1.0%).     

The clinical features of infantile gastroenteritis due to rotavirus.

The symptoms of 100 hospitalised cases of rotavirus infantile gastroenteritis are described. Most patients presented with high fever between the 2nd and 5th day, having started with diarrhoea or vomiting or both. 42% of the infants had upper respiratory tract symptoms. Severe electrolyte disturbance did not occur, although there was a suggestion of a correlation between the higher blood ureas and the number of rotavirus particles in the stools. The mean duration of illness of uncomplicated cases was 13.4 days. Infants were more severely affected when enteropathic coliforms were also present, the total duration of illness being extended to 23 days. It is suggested that rotavirus or similar virus infection may be an essential precursor in the majority of coliform gastroenteritis.     

Milkborne gastroenteritis due to Staphylococcus aureus enterotoxin B from a goat with mastitis

Three children developed Staphylococcus aureus food poisoning due to enterotoxin type B following ingestion of milk from a goat with overt mastitis.     

Acute severe hypertension associated with acute gastroenteritis in children

Acute severe hypertension in otherwise healthy children with acute illness requiring hospitalization for BP management is uncommon and warrants immediate evaluation. We describe 10 cases of children presenting with acute gastroenteritis and found to have acute severe hypertension. They required admission to the hospital for antihypertensive treatment, including 2 to the intensive care unit, but all had normalization of BP and were able to stop treatment with resolution of the acute illness. All patients had thorough testing for secondary causes of hypertension and for signs of end‐target organ damage, which were unremarkable. To our knowledge, acute severe hypertension in the setting of acute gastroenteritis without underlying kidney pathology and with complete resolution after illness has not been previously described. The mechanism of this association is not clear, although activation of the sympathetic nervous system is suspected. These cases illustrate the importance of thoroughly assessing BP in the acute setting.     

Campylobacter jejuni gastroenteritis in Turkish children

Summary Four hundred children between the ages of 1 month and 14 years with the complaint of diarrhea were studied to assessCampylobacter jejuni isolation rates in childhood acute gastroenteritis in Turkey and to clarify clinical presentations ofC. jejuni enteritis.C. jejuni was found to be the second most common isolate with a rate of 8.3%, the first beingShigella strains. The highest isolation rate was in the 6 to 14-year age range at 12%. The most frequent symptoms in patients withC. jejuni enteritis were abdominal pain (51.5%), vomiting (36.4%) and fever (30.3%). Stool examination revealed bloody mucous stool in 51.5% of the patients, and erythrocytes and/or leucocytes were detected in 42.4%. Only 12.1% of the patients withC. jejuni enteritis were hospitalized in this study.     

Efficacy of hormonal suppression in a patient with chyluria due to lymphangioleiomyomatosis

ABSTRACT: Lymphangioleiomyomatosis (LAM) is a rare lung disease affecting almost exclusively young women, characterised by abnormal proliferation of atypical smooth muscle cells. We describe a young woman presenting with chyluria secondary to the presence of a large retroperitoneal lymphangioleiomyoma. Immunohistochemical analysis revealed HMB45-negative LAM cells (HMB45 staining is absent only in rare cases) expressing low levels of estrogen receptors. Estrogen suppressive treatment with triptoreline, a synthetic analogue of Gn-RH, resulted in dramatic reduction of the retroperitoneal mass size. The role of estrogens in the pathogenesis of LAM remains poorly understood, and hormonal therapy is still debated, but this case suggests that at least in some LAM patients, possibly those with HMB45-negative disease and estrogen receptor expression, hormonal therapy may be effective in controlling the disease process.     

Estimating hospital admissions due to rotavirus gastroenteritis from hospital episode statistics

OBJECTIVES: To determine the proportion of hospital admissions, in children < 5 years old, coded for intestinal infectious disease or non-infectious gastroenteritis, using ICD-10 codes, that were due to rotavirus infection. To assess how many children admitted with rotavirus gastroenteritis were given the specific ICD-10 code (A080) for this disease. METHODS: Sixteen-month prospective, observational study of children < 5 years old, admitted to district general hospital with: acute gastroenteritis (> or =3 loose stools/day), proven rotavirus infection and those coded as intestinal infectious disease or non-infectious gastroenteritis. RESULTS: Four hundred and twenty children < 5 years old were admitted with acute gastroenteritis. Rotavirus was detected in 170 children's stools. Acute rotavirus gastroenteritis accounted for 81/397 (20%) children coded as having non-infectious gastroenteritis and 32/81 (40%) coded for intestinal infectious disease. Only 18 children were coded for rotavirus gastroenteritis. Potentially preventable rotavirus gastroenteritis occurred in 122 children; 78 coded as non-infectious gastroenteritis (20%) and 26 coded for intestinal infectious disease (34%). CONCLUSIONS: The proportion of children coded with diarrhoeal diseases and found to have rotavirus is less than previously estimated. Using the specific code for rotavirus infection to estimate hospital admissions would be a gross underestimate. Hospital episode statistics cannot reliably estimate the burden of disease due to rotavirus.     

Association of Helicobacter pylori infection with Shigella gastroenteritis in young children

OBJECTIVE: Helicobacter pylori infection is acquired mainly in early childhood. Much is unknown about the mode of transmission. The organism can be cultivated from cathartic stools and vomitus and is potentially transmissible during episodes of gastrointestinal tract illness. Because Shigella and Salmonella are common pathogens in enteric infections in children, we examined the association of H. pylori with Shigella and Salmonella infections in pediatric patients. METHODS: The study population included consecutive children aged 2-72 months hospitalized with acute gastroenteritis who had culture-proven shigellosis (N = 78) or salmonellosis (N = 76). Sixty-five healthy similarly aged children with culture-negative stools served as controls. Parents of cases were queried for personal and family characteristics and socioeconomic indicators. The stool specimens from all participants were tested for H. pylori antigen. RESULTS: On univariate analysis, Shigella gastroenteritis was significantly associated with H. pylori positivity (odds ratio, OR: 3.5, 95% confidence interval (CI): 1.5-8.8, p= 0.004) compared to controls. This association remained significant even after adjusting for living conditions, father's occupation, and father's education (OR = 3.38, 95% CI: 1.39-8.22, p= 0.007). Salmonella gastroenteritis was not associated with H. pylori positivity (OR = 1.1; 95% CI: 0.4-3.0, p= 0.8). CONCLUSION: H. pylori infection in young children is associated with Shigella gastroenteritis. This association warrants further investigation.