The Short-term Effects of Temperature on Infectious Diarrhea among Children under 5 Years Old in Jiangsu,China:A Time-series Study(2015-2019)

The association between meteorological factors and infectious diarrhea has been widely studied in many countries.However,investigation among children under 5 years old in Jiangsu,China remains quite limited.Data including infectious diarrhea cases among children under five years old and daily meteorological indexes in Jiangsu,China from 2015 to 2019 were collected.The lag-effects up to 21 days of daily maximum temperature(Tmax)on infectious diarrhea were explored using a quasi-Poisson regression with a distributed lag non-linear model(DLNM)approach.The cases number of infectious diarrhea was significantly associated with seasonal variation of meteorological factors,and the burden of disease mainly occurred among children aged 0-2 years old.Moreover,when the reference value was set at 16.7°C,Tmax had a significant lag-effect on cases of infectious diarrhea among children under 5 years old in Jiangsu Province,which was increased remarkably in cold weather with the highest risk at 8℃.The results of DLNM analysis implicated that the lag-effect of Tmax varied among the 13 cities in Jiangsu and had significant differences in 8 cities.The highest risk of Tmax was presented at 5 lag days in Huaian with a maximum RR of 1.18(95% CI:1.09,1.29).Suzhou which had the highest number of diarrhea cases(15830 cases),had a maximum RR of 1.04(95%CI:1.03,1.05)on lag 15 days.Tmax is a considerable indicator to predict the epidemic of infectious diarrhea among 13 cities in Jiangsu,which reminds us that in cold seasons,more preventive strategies and measures should be done to prevent infectious diarrhea.

Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea

BACKGROUND Recently,stool multiplex polymerase chain reaction(PCR)tests have been developed for identifying diarrhea-causing bacterial pathogens.Furthermore,fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.METHODS Overall,400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital(January 2016 to December 2018).Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella,Campylobacter,Shigella,Escherichia coli O157:H7,Aeromonas,Vibrio,and Clostridium difficile.We reviewed clinical and laboratory findings using stool multiplex PCR.RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture(49.2%vs 5.2%),with Campylobacter as the most common pathogen(54%).Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR(1124.5±816.9 mg/kg vs 609±713.2 mg/kg,P=0.001).C-reactive protein(OR=1.01,95%CI:1.001-1.027,P=0.034)and sigmoidoscopy-detected colitis(OR=4.76,95%CI:1.101-20.551,P=0.037)were independent factors in stool PCR-based detection of bacterial pathogens.Sensitivity and specificity of calprotectin were evaluated to be 70.5%and 60.9%,respectively(adjusted cut-off value=388 mg/kg).CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture,and it is correlated with calprotectin expression.Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.

Antibacterial and anti-parasitic activities of Terfezia claveryi methanolic extract against some common pathogenic agents of infectious diarrhea

Objective:To assess the antidiarrheal effects of Terfezia claveryi methanolic extract against Escherichia coli,Salmonella typhimurium,Shigella flexneri,and Giardia lamblia.Methods:Antibacterial effects of the Terfezia claveryi methanolic extract were carried out by determining the minimum inhibitory concentration(MIC)and minimum bactericidal concentration through micro broth dilution technique.Furthermore,reactive oxygen species production and protein leakage were evaluated.To evaluate the in vitro anti-giardial effects of Terfezia claveryi methanolic extract,Giardia lamblia WB(ATCC®30957)trophozoites were treated with various concentrations of Terfezia claveryi methanolic extract for 10-360 min.In addition,the plasma membrane permeability of trophozoites treated with Terfezia claveryi methanolic extract was determined.The cytotoxicity effects of Terfezia claveryi methanolic extract against normal(HEK293T)and cancer(MCF-7)cells were also assessed using the MTT assay.Results:The MIC and minimum bactericidal concentration of Terfezia claveryi methanolic extract against bacterial strains were in the range of 0.52-1.04 and 1.04-2.08 mg/mL,respectively.The results revealed that reactive oxygen species production and protein leakage were significantly increased after the bacteria were treated with the Terfezia claveryi methanolic extract,especially at 1/3 and 1/2 MICs(P<0.001).Furthermore,Terfezia claveryi methanolic extract decreased the viability of Giardia lamblia trophozoites in a dose-dependent manner.Terfezia claveryi methanolic extract at 1,2,and 4 mg/mL resulted in 100%mortality in Giardia lamblia trophozoites after 360,240,and 120 min,respectively.Moreover,Terfezia claveryi methanolic extract altered the permeability of plasma membrane of Giardia lamblia trophozoites by increasing the concentration.MTT assay revealed that the 50%cytotoxic concentrations values for HEK293T and MCF-7 cells were 4.32 mg/mL and 6.40 mg/mL,respectively,indicating that Terfezia claveryi methanolic extract had greater cytotoxicity against cancer cells than normal cells.Conclusions:Terfezia claveryi methanolic extract had potent in vitro antibacterial and anti-parasitic effects on Escherichia coli,Salmonella typhimurium,Shigella flexneri,and Giardia lamblia by affecting cell membrane permeability and reactive oxygen species generation with no significant cytotoxicity on normal cells.

The mediatory role of water quality on the association between extreme precipitation events and infectious diarrhea in the Yangtze River Basin,China

Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change,it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies.Water quality may be the most important mediator,while relevant empirical evidence is limited.This study aimed to examine the role of water quality in the process of infectious diarrhea caused by extreme precipitation.Weekly infectious diarrhea cases,meteorological factors and water quality data in Yangtze River Basin in China between October 29,2007 to February 19,2017 were obtained.Two-stage statistical models were used to estimate city-specific extreme precipitation,water quality and infectious diarrhea relationships that were pooled to derive regional estimates.A causal mediation analysis was used to assess the mediation effect of water quality.In Yangtze River Basin,extreme precipitation events had a significant impact on infectious diarrhea(Incidence Rate Ratios[IRR]:1.027,95%Confidence Interval[CI]:1.013~1.041).After extreme precipitation events,the dissolved oxygen(DO)in surface water decreased(-0.123 mg/L,95%CI:-0.159 mg/L~-0.086 mg/L),while the un-ionized ammonia(NH(3)-N)increased(0.004 mg/L,95%CI:0.001 mg/L~0.006 mg/L).The combined overall effect of DO and NH(3)-N on infectious diarrhea showed that both low and high concentrations were associated with an increased risk of infectious diarrhea.The causal mediation analysis showed that the mediation proportion of the two water quality indexes(DO and NH(3)-N)is 70.54%(P<0.001).To reduce the health effects of extreme precipitation,in contrast to current population-oriented health strategies,those that take into account more direct and easy-to-intervene water quality indicators should be encouraged by future policies.

Inappropriate use of empirical antibiotics in adults with acute infectious diarrhea in a large teaching hospital

Overuse of antibiotics for the treatment of acute diarrhea is very common. The aim of the current study was to investigate the inappropriate use of antibiotics in adults with acute infectious diarrhea and to evaluate the association between the use of antibiotics and clinical features. To achieve this aim, we reviewed 4891 patients＇ medical records from Apr. 2008 to Oct. 2009. Of the total 4891 cases, 30.5% had clinical features of invasive bacterial diarrhea, 48.1% were prescribed with antibiotics, and 20.3% received inappropriate antibiotic treatment. Of note, 19% involved unnecessary antibiotic prescriptions in non-indicated cases, which accounted for 39.4% of all antibiotics prescribed in the total 4891 patients. There was no significant differences between physicians and medical trainees in the inappropriate use of antibiotics （P = 1.0）. Logistic regression analysis demonstrated that except for body temperature, other clinical symptoms including abdominal pain, tenesmus, and faecal WBC count （〉10 cells/HPF） were associated with the use of antibiotics. In addition, other clinical indicators including vomiting, stool frequency of 5-10 times/d, mucous stool, and fecal WBC count of 1-10 cells/HPF, which are not normally indicators for prescribing antibiotics, were also associated with the use of antibiotics. This might suggest that these symptoms were mistaken as features of invasive bacterial diarrhea, thus leading to the overuse of antibiotics.

Post-infectious irritable bowel syndrome:Mechanistic insights into chronic disturbances following enteric infection

Irritable bowel syndrome(IBS)is a commonly encountered chronic functional gastrointestinal(GI)disorder.Approximately 10%of IBS patients can trace the onset of their symptoms to a previous a bout of infectious dysentery.The appearance of new IBS symptoms following an infectious event is defined as post-infectiousIBS.Indeed,with the World Health Organization estimating between 2 and 4 billion cases annually,infectious diarrheal disease represents an incredible international healthcare burden.Additionally,compounding evidence suggests many commonly encountered enteropathogens as unique triggers behind IBS symptom generation and underlying pathophysiological features.A growing body of work provides evidence supporting a role for pathogen-mediated modifications in the resident intestinal microbiota,epithelial barrier integrity,effector cell functions,and innate and adaptive immune features,all proposed physiological manifestations that can underlie GI abnormalities in IBS.Enteric pathogens must employ a vast array of machinery to evade host protective immune mechanisms,and illicit successful infections.Consequently,the impact of infectious events on host physiology can be multidimensional in terms of anatomical location,functional scope,and duration.This review offers a unique discussion of the mechanisms employed by many commonly encountered enteric pathogens that cause acute disease,but may also lead to the establishment of chronic GI dysfunction compatible with IBS.

Recent advances in small bowel diseases:Part Ⅰ

As is the case in all parts of gastroenterology and hepatology,there have been many advances in our knowledge and understanding of small intestinal diseases.Over 1000 publications were reviewed for 2008 and 2009,and the important advances in basic science as well as clinical applications were considered.In Part Ⅰ of this Editorial Review,seven topics are considered:intestinal development;proliferation and repair;intestinal permeability;microbiotica,infectious diarrhea and probiotics;diarrhea;salt and water absorption;necrotizing enterocolitis;and immunology/allergy.These topics were chosen because of their importance to the practicing physician.

Optimal hang time of enteral formula at standard room temperature and high temperature

BACKGROUND Despite high risk of bacterial contamination,yet there are no studies that have evaluated the optimal hang time of blenderized and reconstituted powdered formulas at standard room temperature and high temperature.AIM To investigate the optimal hang time of both types of formulas at standard room temperature and high temperature.METHODS Ten specimens of blenderized formula and 10 specimens of reconstituted powdered formula were prepared using aseptic techniques.Five specimens of each formula were administered at 25℃and 32℃.Simulated administration was done in an incubator.The samples were collected at 0,2,4,6 h and aerobic culture was performed.Food and drug administration criteria were used to determine the unacceptable levels of bacterial contamination.RESULTS Unacceptable contamination for blenderized formula began at 4 h at 25℃and at 2 h at 32℃.As for the reconstituted powdered formula,there was no bacterial growth in all specimens up to 6 h at both temperatures.CONCLUSION The optimal hang time to avoid significant bacterial contamination of the blenderized formula should be limited to 2 h at standard room temperature and be administered by bolus method at high temperature,while a reconstituted powdered formula may hang up to 6 h at both temperatures.

A Literature Review—<i>Khaya senegalensis, Anacardium ouest</i>L., <i>Cassia sieberiana</i>DC., <i>Pterocarpus erinaceus</i>, <i>Diospyros mespiliformis</i>, <i>Ocimum gratissimum</i>, <i>Manihot esculenta</i>, <i>Vernonia amygdalina</i>Delile, <i>Pseudocedrela kotschyi</i>and <i>Daniellia oliveri</i>Possess Properties for Managing Infectious Diarrhea

The rise in antimicrobial resistance increases researchers’ interest in medicinal plants used for traditional treatment of infectious diseases. The study is based on ten (10) medicinal plants mostly cited in the treatment of diarrhea in West Africa: Khaya senegalensis, Anacardium ouest L., Cassia sieberiana DC., Pterocarpus erinaceus, Diospyros mespiliformis, Ocimum gratissimum, Manihot esculenta, Vernonia amygdalina Delile, Pseudocedrela kotschyi, Daniellia oliveri. The objective is to make a review on ethnopharmacological, pharmacological, toxicological and chemical data that enhance these medicinal plants in the fight against diarrheal infections. Specific keywords were used for bibliographic research in Google Scholar, Science Direct, PubMed Directory of Open Access Journals (DOAJ) and other databases. Generalities relating to diarrheal infections and scientific data on the ten selected plants in the fight against diarrheal infections were sought. From the results, it emerges that each of the ten plants has been listed as useful in the traditional treatment of diarrheal infections. Antibacterial tests showed their effectiveness on several bacterial strains responsible for bacterial infections. The chemical components identified as responsible for the activity of medicinal plants belong to the groups of saponins, flavonoids, alkaloids, tannins and others. An optimal use of these medicinal plants in the fight against diarrheal infections requires deep pharmacological, chemical and toxicological studies.

Pathogens and possible opinion for antibiotic treatment in adult patients with 1–14 fecal WBC/HPF of acute non-bloody diarrhea

The pathogens and opinion for antibiotic treatment in adult patients with 1-14 fecal white blood cells per high power field （WBC/HPF） of acute non-bloody diarrhea remain obscure. The study attempts to clarify it. Stool specimens of adult patients with acute non-bloody diarrhea and stool examination showing 1-14 fecal WBC/HPF were collected for bacterial culture and viral detection. Patients included in this study were 196 cases with mean age of （37.9±17.4） years and 42.3% was women. The bacterial and viral detection rates were 63 （32.1%） and 21 （10.7%）, respectively. Of the isolated pathogens, campylobacteria was present in 14 （22.0%） samples and was the most common bacteria and calicivirus was found in 10 （47.6%） samples and was the most common virus. Based on single pathogens, 46 cases were caused by invasive pathogens, 26 cases were caused by non-invasive pathogens. The body temperature was significantly higher in feverish patients caused by invasive pathogens than those caused by non-invasive pathogens （（38.44-0.7） ℃ vs （37.74-0.4） ℃, P = 0.002）. The probability of diarrhea caused by invasive pathogens was higher in patients with T〉38.4℃ than those with T_〈38.4℃ （RR = 1.5）. When T〉38.4℃ is used as the threshold for antibiotic treatment, the misuse rate of antibiotics would decrease from 26.9% to 3.8% （P = 0.021）. So T〉38.4 ℃ may be used as a possible reference value for antibiotic treatment in adult patients with 1-14 fecal WBC/HPF of acute non-bloody diarrhea.