A blind, randomized comparison of racecadotril and loperamide for stopping acute diarrhea in adults

AIM: Racecadotril is a specific enkephalinase inhibitor that exhibits intestinal antisecretory activity without affecting intestinal transit. Loperamide is an effective anti-diarrheal agent, but it usually induces constipation. This study is to compare the efficacy, safety, and tolerability of racecadotril versus loperamide in the outpatient treatment of acute diarrhea in adults. METHODS: A two-center, randomized, parallel-group, single-blind study was carried out to compare the efficacy, tolerability, and safety of racecadotril (100 mg thrics daily) and loperamide (2.0 mg 2 twics daily) in 62 adult patients suffering from acute diarrhea. The main efficacy criterion used was the duration of diarrhea after beginning the treatment (in hours). Other signs and symptoms were also evaluated. RESULTS: The clinical success rates for these anti-diarrheal treatments were 95.7% and 92.0% for racecadotril and loperamide respectively. Patients on racecadotril had a median duration of diarrhea of 19.5 h compared with a median of 13 h for patients on loperamide. Rapid improvement in anal burn and nausea was found for each drug. However, more patients on loperamide suffered from reactive constipation (29.0% vs 12.9%). Itching, another adverse event was notably higher in the racecadotril group (28.6% vs 0%). With regard to other adverse events, the two medications showed similar occurrence rates and similar concomitant medication usage rates. CONCLUSION: Racecadotril and loperamide are rapid, equally effective treatments for acute diarrhea in adults, but loperamide treatment is associated with a higher incidence of treatment-related constipation.

A scoring system for assessing the severity of acute diarrhea of adult patients

BACKGROUND: Diarrhea is frequently seen in developed and developing countries, and severe diarrhea is characterized by the high risk of death. Thus, it is very important to assess the severity of diarrhea early. We conducted a multi-center study to identify risk factors for the severity of diarrhea in adult patients and formulate an adult diarrhea state score(ADSS) for out-patient clinicians.METHODS: A total of 219 adult patients with acute diarrhea were divided into two groups: 132 patients with mild diarrhea and 87 with severe diarrhea. Logistic regression was used to determine risk factors for the severity of diarrhea. The risk factors were assessed and an ADSS was formulated. Receiver operating characteristic(ROC) analysis was made to evaluate the diagnostic accuracy of ADSS, and the Kappa test was used to confi rm the diagnostic reliability.RESULTS: Five risk factors for evaluating the severity of diarrhea in adults included age(P<0.05), axillary temperature(P<0.01), mean arterial pressure(P<0.01), white blood cell count(WBC; P<0.01), and WBC in stool(P<0.01). The area under the ROC curve for ADSS was 0.958 when the cut off value was 4(a sensitivity of 0.909; a specif icity of 0.874), and the Kappa value was 0.781(P<0.05).CONCLUSION: The risk factors associated with the pathogenic condition of diarrhea were identifi ed, quantifi ed and formulated into an ADSS, which has high diagnostic accuracy and reliability for the early identifi cation of patients with severe acute diarrhea.

Frequency of E.coli pathotypes in acute diarrhea of children and its related factorsat Beassat hospital,Sanandaj

Objective:Diarrhea is a leading cause of morbidity and mortality among children in developing countries.The bacterial pathogen most commonly associated with childhood diarrhea is Escherichia coli.A one-year prospective study was carried out in Sanandaj to determine the prevalence and roles of the different E.coli pathotypes in children less than five years of age with acute diarrhea.Methods:Rectal swab were collected prospectively from children with acute diarrhea and transported to the Department of Microbiology,School of Medicine, KUMS,Sanandaj during 2008.The study was approved by the institutional ethics committee.Results:During this study period,rectal swabs were investigated from a total of 466 children 1 to 144 months of age(mean, 29.97 months±S.D) with diarrhea.Among the children,191(41%,191/466) were girls,and 275 (59%,275/466) were boys.The age-specific incidence rates of acute diarrhea among children 13-24 and 1 - 12 months of age were 37.37%(37/99) and 26.26%(26/99),respectively,during the study period.A total of 99 strains of E.coli were detected.EPEC 59(59.59%) and EIEC 22(22.22%),were the most commonly found Escherichia coli strains detected in stools from children.Disk diffusion testing showed E.coli strains resistance to tetracycline(89.89%),chloramphenicol(88.88%),Ampicillin(79.79%),Amoxicillin (75.75%) and Ceficime(75.75%).Among risk factors like age,sex,haemoglubin,fathers and mothers education,food and weight of children only mother's education was significant(P =0.018).Conclusion: In most of the clinical laboratories in Iran,E.coli does not considered as an etiologic agent responsible for diarrhea. Results in this study revealed that E.coli should be considered as an etiologic agent causing acute diarrhea among children.We therefore,recommend the routine isolation and identification of E.coli strains in all the clinical laboratories in Sanandaj.Guidelines for appropriate use of antibiotics in Sanandaj need updating.

Prolonged acute diarrhea in adults: Decades of observation from epidemiological perspective in urban Bangladesh

The study aimed to determine the epidemiological, clinical characteristics, and etiology of adults aged ≥20 years presented with prolonged acute diarrhea (≥7 days). A total of 18,210 adults aged ≥20 years were enrolled in the Diarrheal Disease Surveillance System of icddr,b between 1993-2012 and included into the analysis. Of these, 17,631 (97%) had duration of diarrhea ≤6 days, 418 (2%) diarrhea presented with a duration of 7 - 13 days and rest 161 (1%) had history of diarrhea ≥14 days. A higher proportion of adult individuals who had duration of diarrhea ≥14 days (70% vs. 56%;p male. At least 73% of all patients used oral rehydration solution;but proportion was lower among prolonged acute diarrhea groups. Use of antimicrobials was higher among those with duration 7 - 13 days (81%) and ≥14 days (81%). Diarrhea lasting ≥14 days, 47% were suffering from chronic energy deficiency and 30% had history of smoking. Individuals with diarrhea ≥7 days less frequently presented with vomiting, watery stool, frequency of stool >10 times/24 hours, drowsy or lethargy, fast breathing, some or severe dehydration, received intravenous saline for initial corrections of dehydration and stayed for longer duration in hospital (≥24 hours) but more often presented with abdominal pain. Stool microscopic examination showed less frequent presence of red blood cells (36% vs. 44%;p = 0.043) and fecal leucocytes (50% vs. 59%;p = 0.029) among individuals with diarrhea ≥14 days compared to those with ≤6 days. None was infected with Vibrio cholerae (≥14 days) (3% for 7 - 13 days);however, isolation rate of Aeromonas was higher among adults with duration for ≥14 days (11%). Only 15% with ≥14 days were positive for Shigella contrary to 19% (7 - 13 days) and 56% (≤6 days). Differences in sociodemographic, clinical presentation and etiology varied with duration of diarrhea among adults.

Management of acute diarrhea in adults in hospitals in Beijing did not adhere well to Manatsathit working party guidelines

How hospital physicians adhere to guidelines on management of diarrhea in adults has not been adequately assessed. The purposes of this study were to evaluate the management of acute diarrhea in adults and to assess the adherence of hospital physicians to the Manatsathit working party recommended guidelines. A cross sectional survey was carried out during May to July 2011 among physicians in 10 hospitals in Beijing, China. Data were collected for 400 patients （208 females and 192 males） with the mean age of （35.54-14.8） years. Overall, 357 （89.3%） patients presented with watery diarrhea and 43 （10.7%） patients presented with bloody diarrhea. Of 357 patients who needed fluid and electrolyte therapy, however, up to 114 （31.9%） patients were not ordered any fluid and electrolyte replacement; although only 28 （7.8%） actually supposed to use the antibiotics due to an age of higher than 65 years or being immunologically compromised, however, 186 （52.1%） were prescribed antibiotics which significantly deviated from the guidelines recommended by the Manatsathit working party. Antimotility drugs were only used in seven patients with watery diarrhea, which was in line with the guidelines. Hospital physicians in Beijing did not adhere well to the guidelines for the management of acute diarrhea. Physicians might need to be refreshed on the guidelines in this specific field.

Viral and Bacterial Etiology of Acute Diarrhea among Children under 5 Years of Age in Wuhan, China

Background： Acute diarrhea remains the serious problem in developing countries, especially among children under 5 years of age. Currently, only two or three common diarrhea pathogens were screened at most hospitals in China. The aim of this study was to provide a wide variety of diarrhea pathogens and their antimicrobial resistance patterns in children under 5 years of age. Methods： Totally 381 stool samples collected from Tongji Hospital between July 1, 2014 and June 30, 2015 were tested by culture and/or polymerase chain reaction for eight kinds of bacteria and five kinds of viruses. An antimicrobial sensitivity test was performed using dilution method recommended by the Clinical and Laboratory Standards Institute. Results： Viral infections were mainly identified in infants （0-11 months）, whereas bacterial infections were more prevalent in the age of 24-59 months. About 69.8% of samples were positive for at least one pathogen, 51.7% of samples were virus positive, followed by bacteria positive cases （19.4%）, and 12.6% of cases displayed co-infections with two viruses or a virus and a bacterium. Rotavirus was the most prevalent pathogen, followed closely by norovirus, while Salmonella was the most commonly isolated bacteria, followed by diarrheagenic Escherichia coli （DEC） and Campylobacter. More than 40% of Salmonella spp. and DEC isolates were resistant to first-line antibiotics （ampicillin, trimethoprim-sulfamethoxazole, and tetracycline）. Around 10% of Salmonella spp. isolates were resistant to ceftriaxone and ciprofloxacin simultaneously. Campylobacter spp. displayed high resistance to ciprofloxacin but kept low resistance to azithromycin and doxycycline. Conclusions： The etiology of acute diarrhea varies in children of different age groups. The high frequency of infection with viruses suggests the urgent demand for new viral vaccine development. Proper use of antibiotics in the treatment of acute diarrhea is crucial due to the high level of antibiotic resistance.

Effect of Warming Moxibustion on Shenque Acupoint for the Treatment of Acute Diarrhea in Children with Infantile Cerebral Palsy

Objective:To observe the effect of warming moxibustion on Shenque acupoint(RN8) for the treatment of acute diarrhea in children with infantile cerebral palsy(ICP).Methods:Clinical observation was performed on 60 ICP children suffering from acute diarrhea,who were randomly assigned to two groups equally.The Mox group was treated with warming moxibustion on Shenque acupoint(RN8) and the control group treated with Smecta.The efficacy was evaluated by markedly effective rate and total effective rate after a 6-d...

Comparative study on epidemiological and etiological characteristics of patients with acute diarrhea with febrile or non-febrile symptoms in China

Background Acute diarrhea with fever can potentially represent a more severe form of the disease compared to non-febrile diarrhea. This study was to investigate the epidemiological characteristics and enteric pathogen composition of febrile-diarrheal patients, and to explore factors including pathogens associated with fever by age group.Methods A nationwide surveillance study of acute diarrheal patients of all ages was conducted in 217 sentinel hospitals from 31 provinces (autonomous regions or municipalities) in China between 2011 and 2020. Seventeen diarrhea-related pathogens, including seven viruses and ten bacteria, were investigated and their association with occurrence of fever symptoms was assessed using multivariate logistic analysis.Results A total of 146,296 patients with acute diarrhea (18.6% with fever) were tested. Th diarrheal children below 5 years had the highest frequency of fever (24.2%), and related to significantly higher prevalence of viral enteropathogens (40.2%) as compared with other age groups (P < 0.001). Within each age group, the febrile-diarrheal patients were associated with a significantly higher prevalence of bacterial pathogens than afebrile-diarrheal patients (allP < 0.01). There was discrepancy when each pathogen was compared, i.e., nontyphoidalSalmonella (NTS) was over-represented in febrile vs non-febrile patients of all age groups, while the febrile vs non-febrile difference for diarrheagenicEscherichia coli (DEC) was only significant for adult groups. The multivariate analysis revealed significant association between fever and infection with rotavirus A among children [odds ratio (OR) = 1.60], for DEC in adult groups (OR = 1.64), for NTS in both children (OR = 2.95) and adults (OR = 3.59).Conclusions There are significant discrepancy of the infected enteric pathogens in patients with acute diarrhea with fever between age groups, and it is valuable for priority detection of NTS and rotavirus A in patients with children < 5 years old and NTS and DEC in adult patients. The results may be useful in identifying dominant pathogen candidates for the application of diagnostic assays and prevention control.

Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: A systematic review with meta-analysis

BACKGROUND Diarrhea is a major infectious cause of childhood morbidity and mortality worldwide.In clinical trials,Lactobacillus rhamnosus GG ATCC 53013(LGG)has been used to treat diarrhea.However,recent randomized controlled trials(RCTs)found no evidence of a beneficial effect of LGG treatment.AIM To evaluate the efficacy of LGG in treating acute diarrhea in children.METHODS The EMBASE,MEDLINE,PubMed,Web of Science databases,and the Cochrane Central Register of Controlled Trials were searched up to April 2019 for metaanalyses and RCTs.The Cochrane Review Manager was used to analyze the relevant data.RESULTS Nineteen RCTs met the inclusion criteria and showed that compared with the control group,LGG administration notably reduced the diarrhea duration[mean difference(MD)-24.02 h,95%confidence interval(CI)(-36.58,-11.45)].More effective results were detected at a high dose≥1010 CFU per day[MD-22.56 h,95%CI(-36.41,-8.72)]vs a lower dose.A similar reduction was found in Asian and European patients[MD-24.42 h,95%CI(-47.01,-1.82);MD-32.02 h,95%CI(-49.26,-14.79),respectively].A reduced duration of diarrhea was confirmed in LGG participants with diarrhea for less than 3 d at enrollment[MD-15.83 h,95%CI(-20.68,-10.98)].High-dose LGG effectively reduced the duration of rotavirus-induced diarrhea[MD-31.05 h,95%CI(-50.31,-11.80)]and the stool number per day[MD-1.08,95%CI(-1.87,-0.28)].CONCLUSION High-dose LGG therapy reduces the duration of diarrhea and the stool number per day.Intervention at the early stage is recommended.Future trials are expected to verify the effectiveness of LGG treatment.

Clinicopathogenic studies of acute diarrhea in children

AIM To demonstrate the etiologic pathogens of acute diarrhea in children and the diagnostic value of stool pH. METHODS From May 1988 to April 1992, 368 children with acute diarrhea were studied. Fresh stools were examined routinely, and stool pH were tested with pH paper, then the samples in the culture medium of the Cary Blair were sent to the lab for bacteria isolation and identification. The rotavirus was identified by the method of ELISA from the supernatant. RESULTS Thirty one pathogens and 385 bacteria strains were found in the 368 examples, with a detectable rate of 67 7%, including 37 8% of mixed infections. Among bacteria families, vibrionaceae is the most common (39 7%), and among bacteria genuses, aeromonas is the most common (26 8%). In bacterial diarrhea, the stool pH tends to be basic while in viral diarrhea to be acid. CONCLUSION There are 31 pathogens for the children′s acute diarrhea in this area. It is quite difficult to make an etiologic diagnosis only by clinial signs. However, stool pH is of some value for early diagnosis of the disease.

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.

Formulation of an Early Warning Infectivity Score System for Adult Patients with Acute Bacterial Diarrhea

The aim of our study was to develop a scoring system to predict whether diarrhea is of a bacterial origin and whether the diarrheal patients constitute a potential source of infection to others. Adults with acute diarrhea （n=424） were enrolled in the study. Logistic regression and standard regression coefficients were used to formulate the Early Warning Infectivity Score System for Adults with Acute Bacterial Diarrhea （EWIS-ABD）. Four risk factors were identified by logistic regression, including body temperature （P〈0.01）, abdominal pain （P〈0.01）, leukocyte count in stool （P〈0.01）, and unclean dietary history （P〈0.01）. EWIS-ABD was thus developed, in which the value 〉5 points was set as an indicator of bacterial diarrhea. The incidence of bacterial diarrhea increased along with the elevated score. EWIS-ABD was more specific for bacterial diarrhea than for viral diarrhea. The accuracy and reliability of EWIS-ABD was high by prospective validation in 478 patients with acute diarrhea.

Clostridium difficile causing acute renal failure: Case presentation and review

AIM: Clostridium difficile infection is primarily a nosocomial infection but asymptomatic carriers of Clostridium difficile can be found in up to 5% of the general population. Ampicillin, cephalosporins and clindamycin are the antibiotics that are most frequently associated with Clostridium difficile-associated diarrhea or colitis. Little is known about acute renal failure as a consequence of Clostridium difficile-associated diarrhea. METHODS: In this case report, we describe the course of Clostridium difficile-associated diarrhea in an 82-year-old patient developing acute renal failure. Stopping the offending agent and symptomatic therapy brought a rapid improvement of diarrhea and acute renal failure, full recovery was gained 18 d after admission. In a systematic review we looked for links between the two conditions. RESULTS: The link between Clostridium difficile-assoaated diarrhea and acute renal failure in our patient was most likely volume depletion. However, in experimental studies a direct influence of Clostridium difficile toxins on renal duct cells could be shown. CONCLUSION: Rapid diagnosis, nonspecific supportive treatment and specific antibiotic treatment, especially in the elderly, may lower excess mortality Clostridium difficile-associated diarrhea and renal failure being possible complications.

Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis

A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d.Beginning 3 wk before he arrived in our hospital,he took 3 rd-generation cephalosporin(cefixime) for 2 wk due to chronic left ear otitis media.Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon.After 7 d of oral metronidazole treatment,his symptoms completely disappeared.We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime.

Acute hepatitis associated with increased atypical lymphocyte

To the Editor:Hepatitis A and hepatitis E are acute infectious diseases caused by hepatitis A virus(HAV)and hepatitis E virus(HEV),which are mainly transmitted through the fecal-oral route[1].The early clinical symptoms of patients with hepatitis A or E are nonspecific,including fever,chills,abdominal pain,diarrhea,and rash[2].

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.

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.

急性腹泻患儿粪便病原微生物检验结果及耐药情况分析

目的探讨急性腹泻患儿粪便病原微生物检验结果及耐药情况。方法选取2021年1月-2023年1月我院收治的167例急性腹泻患儿,采集所有患儿粪便标本送检,开展病原微生物培养与药敏试验。统计病原微生物检检验结果、分析急性病原微生物分布特点、志贺氏菌属、沙门氏菌属的耐药情况。结果167急性腹泻患儿共检出109株病原微生物,其中细菌51株(46.79%)、病毒48株(44.04%)、真菌10株(9.17%);51株细菌(46.79%)以志贺氏菌属(13.76%)、沙门氏菌(22.02%)、大肠埃希菌(4.59%)为主;48株病毒(44.04%),以轮状病毒(22.94%)、诺如病毒(15.60%)为主,真菌10株(9.17%);志贺氏菌属、沙门氏菌属对氨苄西林、哌拉西林、四环素的耐药性偏高,均>50%;对氨苄西林/舒巴坦、阿莫西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、氯霉素、环丙沙星、左氧氟沙星、氨曲南的耐药性偏低,均﹤50%;对厄他培南、亚胺培南、美罗培南未产生耐药性。结论急性腹泻患儿粪便病原微生物以病毒、志贺氏菌属、沙门氏菌属、大肠埃希菌多见,临床需据此开展针对性治疗,以加快患者病情转归。

小儿肠胃康颗粒联合蒙脱石散剂辅助治疗儿童急性细菌性腹泻病的疗效

目的:探讨小儿肠胃康颗粒联合蒙脱石散剂辅助治疗儿童急性细菌性腹泻病的临床疗效。方法:选取2021年3月至2022年2月我院门诊收治的96例急性细菌性腹泻病患儿按简单随机化分组法分为对照组和联合组各48例。两组患儿均给予对症治疗(依据细菌培养及药敏试验结果选择敏感性抗菌药物、调整饮食结构、纠正电解质紊乱及菌群失调等),在此基础上,对照组给予蒙脱石散剂治疗,联合组在对照组治疗基础上给予小儿肠胃康颗粒,疗程为2周。比较两组患儿胃肠道不适症状改善时间,检测治疗前后两组患儿血清胃肠激素及免疫功能变化情况,统计不良反应发生情况。结果:治疗后,联合组治疗总有效率高于对照组(100.00%vs.91.67%),但差异无统计学意义(P>0.05),联合组疗效等级优于对照组(Z=2.691,P<0.05)。治疗后,两组患儿大便次数较同组治疗前减少(P均<0.01),联合组大便次数较对照组更少(t=5.771,P<0.05),且联合组腹泻、脱水、食欲减退、腹痛、腹胀缓解时间及大便性状改变时间均较对照组更短(P均<0.05)。治疗后,联合组胃动素(MOT)、胃泌素(GAS)水平低于对照组,生长抑素(SS)、P物质(SP)水平高于对照组,差异均有统计学意义(P均<0.05)。治疗后,联合组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)水平高于对照组(P均<0.05)。两组患儿不良反应发生率比较差异无统计学意义(χ^(2)=0.546,P=0.460)。结论:小儿肠胃康颗粒联合蒙脱石散剂治疗儿童急性细菌性腹泻病整体价值优于单用蒙脱石散剂治疗,可缩短患儿胃肠道不适症状缓解时间,改善胃肠道动力学及免疫功能,安全性较高。

猪急性腹泻综合征冠状病毒S蛋白多克隆抗体的制备及在检测该病毒感染中的应用

为制备猪急性腹泻综合征冠状病毒(SADS-CoV)纤突蛋白(S)的多克隆抗体(PAb),本研究经PCR扩增SADS-Co V S蛋白S1亚基C端结构域(S1-CTD)基因片段(384 bp),并将其克隆至原核表达载体p GEX-6p-1中,构建重组质粒p GEX-6p-1-S1-CTD,经双酶切和测序鉴定正确后,转化大肠杆菌BL21(DE3)感受态细胞,利用IPTG诱导表达,通过western blot鉴定重组S1-CTD蛋白(rS1-CTD)的表达及反应原性。结果显示,r S1-CTD以包涵体的形式表达,在40 ku处出现特异性条带。诱导表达后的r S1-CTD经不同浓度尿素重悬并超声离心,SDS-PAGE检测后切胶纯化,得到纯化的重组蛋白。利用BCA试剂盒测得蛋白的浓度为33μg/m L。将该重组蛋白乳化后经3次免疫新西兰大白兔,并在3免一周后采血,分离血清获得S1-CTD蛋白PAb。将SADS-Co V感染Vero E6细胞24 h后,以获得的兔PAb为一抗,分别采用western blot和间接免疫荧光试验(IFA)检测该PAb的反应原性。Western blot结果显示,在约250 ku处出现特异性条带,而阴性对照组无该条带;IFA结果显示,SADS-Co V感染的细胞中出现绿色荧光,而阴性对照细胞无绿色荧光。将SADS-Co V感染仔猪的回肠组织制备病理切片,以制备的PAb为一抗,通过免疫组织化学(IHC)检测SADS-Co V的抗原。结果显示,该组织切片中出现棕色阳性信号,而阴性对照仔猪回肠组织切片则无该棕色信号。表明该PAb可与感染SADS-Co V的仔猪回肠组织中的相应抗原发生特异性免疫反应。综上所述,本实验制备的S1-CTD蛋白PAb具有良好的反应原性和免疫原性,可以用于western blot、IFA、IHC检测体内外SADS-Co V的感染,为后续SADS-Co V检测方法的建立及S蛋白生物学功能的研究奠定基础。