-Associated Diarrhea

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Isolation and characterization of Clostridium difficile and toxin detection from faecal specimens in patients with Antibiotic associated diarrhea in a tertiary care centre

Isolation and characterization of Clostridium difficile and toxin detection from faecal specimens in patients with Antibiotic associated diarrhea in a tertiary care centre

Clostridium difficile (C. difficile) is a Gram positive, spore forming bacillus which grows anaerobically. It is a part of the normal flora in the gastrointestinal tract and is seen in 1-3% of healthy adults with a higher rate of colonization in infants. However, there is an increase in the incidence following long term hospitalization, surgery and more importantly following antibiotic usage. (1) Disruption of the normal flora occurs following antibiotic usage thereby allowing endogenous and environmental C. difficile to proliferate in the colon and produce toxins leading to Clostridium difficile infection (CDI). (2) Infection can result in a wide spectrum of diseases ranging from uncomplicated diarrhea to pseudomembranous colitis and toxic megacolon and can even lead to death. (3) In India, the estimated incidence of Clostridium difficile associated diarrhea (CDAD) has been found to be between 15- 25% in paediatric and adult patients who are on antibiotics. (4) Pépin et al. reported that fluoroquinolones were the most common antibiotics associated with the emergence of C. difficile followed by cephalosporins, macrolides, clindamycin and intravenous β–lactams/β-lactamase inhibitors. (5)
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Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic Associated Diarrhea Due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus

Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic Associated Diarrhea Due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus

We prospectively studied the comparative epidemiology and risk factors for Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus antibiotic-associated diarrhea (AAD). Four thousand six hundred fifty- nine inpatient fecal specimens (11 months) were tested for C. difficile cytotoxin, C. perfringens enterotoxin, and S. aureus by Vero cell assay, enzyme-linked immunosorbent assay, and growth on fresh blood agar, respectively. Two distinct age-, sex-, and location-matched control patient groups were used for multivariate logistic regression risk factor analyses: symptomatic patients who were AAD pathogen negative and asymptomatic patients with histories of recent antimicrobial therapy. All AAD pathogen isolates were DNA fingerprinted. In AAD cases, the prevalences of C. difficile cytotoxin, C. perfringens enterotoxin, and S. aureus were 12.7%, 3.3%, and 0.2%, respectively (15.8% overall). Age of >70 years was a common risk factor. Other risk factors for infective AAD and C. difficile AAD included length of hospital stay and use of feeding tubes (length of stay odds ratios [OR], 1.017 and 1.012; feeding tube OR, 1.864 and 2.808). Female gender and use of antacids were significantly associated with increased risk of C. perfringens AAD (OR, 2.08 and 2.789, respectively), but unlike what was found for C. difficile AAD, specific antibiotic classes were not associated with increased risk. A limited number of genotypes caused the majority of C. difficile and C. perfringens AAD cases. Similar to what was found for C. difficile AAD, there was epidemiological evidence of C. perfringens AAD case clustering and reinfection due to different strains. C. difficile AAD was approximately 4 and 60 times more common than C. perfringens AAD and S. aureus AAD, respectively. Risk factors for these AAD pathogens differed, highlighting the need to define specific control measures. There is evidence of nosocomial transmission in cases of C. perfringens AAD.
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Characteristics, Treatment, and Outcomes Associated with Clostridium difficile Associated Diarrhea in a Veterans Affairs Medical Center

Characteristics, Treatment, and Outcomes Associated with Clostridium difficile Associated Diarrhea in a Veterans Affairs Medical Center

We conducted a study to assess the characteristics, treatment and outcomes associated with Clo- stridium difficile associated diarrhea in a Veterans Affairs Medical Center. Fifty-eight consecutive individual cases of C. difficile infection in 2013 were observed within the Veterans Affairs New Jersey Health Care System (VA NJHCS). We molecularly typed all 58 individual strains and identi- fied the associated characteristics, treatment and outcomes. Forty-four out of 58 specimens (76%) which were probed had characteristics of the epidemic strain BI/NAP1/027 making this virulent strain the predominate strain at the VA NJHCS. All C. difficile BI/NAP1/027 strains were resistant to fluoroquinolones and sensitive to fidaxomicin, metronidazole and vancomycin. Fidaxomicin had the most potent in vitro activity (MIC 90 = 0.5 µg/ml) against the BI/NAP1/027 strain. Twenty-
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Efficacy of a synbiotic chewable tablet in the prevention of antibiotic associated diarrhea

Efficacy of a synbiotic chewable tablet in the prevention of antibiotic associated diarrhea

Infection by Clostridium difficile, a complication of treatment with antibiotics, causes antibiotic- associated diarrhea (AAD) and can lead to coli- tis and pseudomembranous colitis. Incidence of C. difficile infection is increasing among the elderly undergoing antibiotics therapy confined to health care facilities, conditions that are ex- pensive to treat, decrease the quality of life and are life threatening. Use of probiotics has been proposed as a method to decrease the inci- dence of AAD in health care facilities. To exam- ine the efficacy of using probiotics, 120 nursing home residents undergoing antibiotic therapy were provided with a synbiotic tablet containing two probiotics, Saccharomyces boulardii and Bacillus coagulans, and a prebiotic, fructooli- gosaccharide. Residents were evaluated retro- spectively for AAD and C. difficile infection. It was found that 95% of residents treated with antibiotics and taking the synbiotic tablet were free of AAD. More than 97% of the residents did not become infected with C. difficile. No adverse effects were reported. Minor side effects, gas- trointestinal upset and nausea, were reported by less than 6% of the residents. The cause of the minor side effects was not known. Only 2.5% of the residents stopped taking the synbiotic tablet because of the gastrointestinal upset. These Results suggest that use of the synbiotic tablet prevents AAD and C. difficile infection in nurs- ing home residents undergoing antibiotic ther- apy. It is concluded that this synbiotic tablet provides an easy to administer and safe ap- proach to controlling AAD and C. difficile infec- tion in residents in nursing homes.
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Prevalence and management of antibiotic associated diarrhea in general hospitals

Prevalence and management of antibiotic associated diarrhea in general hospitals

Several health economic studies focused on the health care costs related to Clostridium difficile associated diarrhea showing that these patients had a significant increase in hospital costs mainly associated to a longer length of stay [4,13,14]. Dubberke and colleagues pointed to the additional increased health care costs observed 6 months after the initial hospitalization period [5]. In health economic studies, the costs associated to the much more prevalent but less severe AAD cases were not in- cluded. In our study, we took a first step to this calculation with the estimation of the extra nursing time spent for the treatment of AAD patients enabling to calculate associ- ated extra costs for nursing care and material in a later phase of our study. In the study we also observed differ- ences in the total hospital length of stay in AAD and non-AAD patients. Among AAD patients, those with a Clostridium difficile infection had a median hospitalization of 43.5 days (range 24–51). These differences in length of stay are not corrected for any confounding factors and needs further analysis.
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Antibiotic-associated diarrhea: a systematic review with two decades of experience

Antibiotic-associated diarrhea: a systematic review with two decades of experience

the WHO/UNICEF, there is hardly any known antibiotic that potentially is not diarrheagenic in pediatric practice 1 though some antibiotics are decidely high-risk. 2 Nevertheless, diarrheal manifestations are not always significant. Practically each and every antibiotic has the inherent property of provoking diarrhea- like manifestations, usually by interference with the normal ecosystem of the gastrointestinal tract. 2-6 The problem is more frequent in infancy and childhood.

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Clinical and microbiological features of Aeromonas hydrophila associated diarrhea

Clinical and microbiological features of Aeromonas hydrophila associated diarrhea

hydrophila has been isolated from diarrheal stool specimens in greater frequency than from control stools 4, 6, 15, 31, 36, and neutralizing antibodies have been demonstrated in the seru[r]

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Ampicillin-Associated Diarrhea: Effect of Dosage and Route of Administration

Ampicillin-Associated Diarrhea: Effect of Dosage and Route of Administration

in stools increased with total dosage and was equal after oral or intravenous administration.’ In children, ampicillin ranging from 50 to the unus-.. ually high dose of 200 mg/kg/day res[r]

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Astrovirus associated diarrhea among Guatemalan ambulatory rural children

Astrovirus associated diarrhea among Guatemalan ambulatory rural children

Our longitudinal approach, with sample collection from healthy individuals, allowed us to examine the excretion of astroviruses shortly before the onset of diarrhea in 460 instances; les[r]

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Adenovirus associated with acute diarrhea: a case control study

Adenovirus associated with acute diarrhea: a case control study

Adenovirus serotypes 40 and 41 were considered to be the most remarkable pathogens associated with acute gastroenteritis [13]. A few studies reported the existence of non-enteric adenovirus in patients with diarrhea, but the role of non-enteric adenovirus played in diarrhea is unclear due to the lack of healthy control [6, 8–10, 12], A recent report conducted in Bangladesh, described the di- versity of adenovirus pathogens and the age, gender, major clinical symptoms of adenovirus positive diarrhea children, but lack of matched controls to determine the relationship between adenovirus and diarrhea, this study may not pro- vide a better speculation of adenovirus associated diarrhea [10]. A previous study reported that the positive rate of adenovirus were significantly different between community- acquired diarrhea and hospital-acquired diarrhea among children in Beijing china [8], and the adenovirus serotypes
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Management of chronic diarrhea in HIV-infected patients: current treatment options, challenges and future directions

Management of chronic diarrhea in HIV-infected patients: current treatment options, challenges and future directions

Challenges for the future are partly socioeconomic and partly medical. Socioeconomically, the overall aim for HIV-associated diarrhea should be that all disease-stricken individuals should have access to HAART. Of course, a proper medical investigation and directed therapy should be undertaken for each individual. Once this is in place, the challenge is to ensure that antiretroviral agents can act optimally. In doing so, there should be a high emphasis on good and adequate nutritional therapy. Also, we believe that special nutritional regimes such as colostrum-based therapies could have a role in this situation, especially as an adjunct to treatment of HIV-associated diarrhea.
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Characterization of Chloramphenicol Resistance in Beta Hemolytic Escherichia coli Associated with Diarrhea in Neonatal Swine

Characterization of Chloramphenicol Resistance in Beta Hemolytic Escherichia coli Associated with Diarrhea in Neonatal Swine

Antimicrobial susceptibility patterns of swine E. coli iso- lates. Beta-hemolytic E. coli is the most common bacterial etiologic agent of diarrhea in neonatal and postweaning pigs. Treatment of enteric E. coli infection in swine commonly in- cludes the use of broad-spectrum antibiotics (13, 16, 23). We characterized the patterns of susceptibility of 90 E. coli isolates from diarrheic neonatal pigs to 17 antimicrobial agents of human and veterinary therapeutic significance. The rates of resistance, as determined by measuring the MICs and compar- ing them to the resistance breakpoints established by NCCLS, are listed in Table 1. The highest rates of resistance were to tetracycline (96%), sulfamethoxazole (89%), kanamycin (84%), streptomycin (82%), FFN (64%), and CHL (53%). All isolates were susceptible to nalidixic acid, ciprofloxacin, amikacin, and ceftriaxone. Resistance to multiple drugs was frequently ob- served, with 66 of 90 (73%) of the E. coli isolates resistant to five or more antibiotics (data not shown). The swine E. coli isolates were similar to other clinical veterinary E. coli strains in terms of their decreased susceptibilities to tetracycline, gen- tamicin, streptomycin, and sulfamethoxazole (1, 11, 17, 19, 22,
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Molecular epidemiology of rotaviruses associated with pediatric diarrhea in Bangkok, Thailand

Molecular epidemiology of rotaviruses associated with pediatric diarrhea in Bangkok, Thailand

Classification and yearly distribution of 26 different RNA electropherotypes of human rotaviruses detected in stools obtained from diarrheic patients in greater Bangkok during 1982 to 19[r]

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Metagenomic Approach for Identification of the Pathogens Associated with Diarrhea in Stool Specimens

Metagenomic Approach for Identification of the Pathogens Associated with Diarrhea in Stool Specimens

Viral pathogens were also detected in C. difficile-positive sam- ples by MSS. In addition to norovirus and sapovirus detected by qRT-PCR assays, we also detected anellovirus and parechovirus using MSS. These two viruses were not tested by our diagnostic and research laboratories before sequencing. We later confirmed the presence of the two viruses by PCR assay, as described in the Materials and Methods. The four viral genera were detected in 27.3% (6/22) of C. difficile-positive samples and 1 symptomatic control. Norovirus was the most prevalent virus in these samples, as it was detected in 18.2% (4/22) of the C. difficile-positive sam- ples. We also found a copresence of norovirus, C. difficile, and C. perfringens in 1 sample. Sapovirus was found in 1 C. difficile-pos- itive sample and 1 symptomatic control sample with an unknown cause of diarrhea from the clinical lab. As described above, we found that Candida was predominant in this symptomatic con- trol. Of the above viruses, only norovirus and sapovirus are asso- ciated with diarrhea (21). It is unclear whether they may be the primary or secondary cause of the symptoms observed in these patients. These viruses are also sometimes detected in asymptom-
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Controlled study of Escherichia coli diarrheal infections in Bangladeshi children

Controlled study of Escherichia coli diarrheal infections in Bangladeshi children

Diarrhea continues to be one of the most common causes of morbidity and mortality among infants and children in devel- oping countries (31). Determination of the etiological agents of diarrhea is important in developing rational therapy and in implementing control measures. Continuing research has iden- tified at least five categories of diarrheagenic Escherichia coli. They are enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enteroinvasive E. coli (EIEC), enterohemor- rhagic E. coli (EHEC), enteroaggregative E. coli (EAggEC), and diffuse adherent E. coli (DAEC) (27). It has become clear that there are important regional differences in the prevalence of different categories of diarrheagenic E. coli (4, 6, 8, 11). Moreover, studies in the past have been confined to defining the roles of limited categories of diarrheagenic E. coli by cum- bersome phenotypic traits, and many such determinations rely on subjective tests (for example, tissue culture adherence assay for identification of EPEC, EAggEC, and DAEC) with a small number of subjects (6, 17, 20). The development of highly sensitive and specific probes for detection of all categories of diarrheagenic E. coli has dramatically altered the situation, making it comparatively easier to undertake comprehensive studies. Therefore, to define the association of various catego- ries of E. coli with diarrhea, we carried out a controlled study using DNA probes on E. coli isolates from children up to 5 years of age.
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Assessing water, sanitation and hygiene practices associated with diarrhea prevalence among households’ members in flood prone areas  along kilombero valley

Assessing water, sanitation and hygiene practices associated with diarrhea prevalence among households’ members in flood prone areas along kilombero valley

This study documents WASH practices in flood prone areas and their association with diarrhea prevalence. The results particularly involved household drinking water treating and storage, sanitation status, liquid waste and solid waste disposal methods as well as handwashing practices. The most emerging communicable diseases in flood prone areas is mainly through contaminated water, mud and dust which contaminated due to poor sanitation and lack of hygiene practices as well as insufficient facilities to protect them from epidemic threats (Jan et al., 2015). Despite of the fact that there is an increased use of improved water sources as compared to National Rural Mainland settings, there is no association with improved water sources for domestic purposes in flood prone areas of Kilombero Valley. This indicates that the transport of water from the source increases the risk. Ensuring safe water for domestic purposes, through water treatment at the point of use may reduce incidences of diarrhea (Mlenga, 2016). Water quality interventions particularly at the point of use (POU) treatment has been found to be the most effective in the control of diarrhea disease at household level (Dis, 2005). Boiling of water for drinking purposes could also minimize the problem of diarrhea although water may be recontaminated during cooling and also the practice may be economically and environmentally unsustainable to the communities under study (The Texas Department of Insurance, 2007). Generally, the treatment of drinking water is not mainly practiced in flood prone areas and even practiced inappropriately which may results into increased diarrhea incidence during and after flood occurrence as revealed in the results that there is association drinking water treatment and diarrhea incidence. The findings of drinking water storage facilities are in line with other studies that unhygienic storage conditions may have possibly led to further decline of water quality in households and eventually increases the risk of diarrhea disease (Tubatsi, 2015). Regardless of the water sources the manner in which the water is managed/ stored in the household remains critical if the contamination is to remain minimal (Mlenga, 2016). Thus, the improved household water storage vessels coupled with point
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Prevalence of multi drug resistant enteropathogenic and enteroinvasive Escherichia coli isolated from children with and without diarrhea in Northeast Indian population

Prevalence of multi drug resistant enteropathogenic and enteroinvasive Escherichia coli isolated from children with and without diarrhea in Northeast Indian population

In India, very few reports are available the occur- rence of EIEC associated with children diarrhea. In the present study, a total of 2.33% E. coli isolates were con- firmed as EIEC, of which 0.59 and 1.80% were from non- diarrhoeic and diarrhoeic patients, respectively. Other studies in India also reported less percentage of EIEC (1–1.5%) only in diarrheal patients [8, 16, 22]. The pres- ence of EIEC strains in non-diarrheic group suggests that their prevalence is high in this study region among other age groups or sources including contaminated food and water [9]. Detection of EIEC in association with infants or children is a paramount important issue for effective treatment and control of the disease. Given the potential importance of this invasive pathogen, more work should be focused on why EIEC is prevalent in children of non- diarrheic group of this study region.
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Escherichia coli: a brief review of diarrheagenic pathotypes and their role in diarrheal diseases in Iran.

Escherichia coli: a brief review of diarrheagenic pathotypes and their role in diarrheal diseases in Iran.

share A/E phenotype with some other strains of E. coli, therefore, strains that are eae+ bfpA+ stx- are classified as typical EPEC (tEPEC). Production of BFP protein induces the localized adherence pattern (LA) and most of tEPEC strains belong to classic O:H serotypes (22). Atypical EPEC (aEPEC), on the other hand, are of eae+ bfpA- stx- genetic background and display localized-like (LLA), diffuse (DA), or aggregative adherence patterns which is associated with the E. coli common pilus and other known adhesins (23). Most of the over 200 O-serogroups that have been identified among aEPEC strains, do not belong to classical EPEC serogroups and many have been designated nontypeable (24). Recently in a study done in Iran, multiplex PCR was used to differentiate between tEPEC, and aEPEC and PCR- RFLP for H typing of conventionally serogrouped isolates (25) showing the ease and applicability of this method for rapid screening of large number of isolates.
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NEWS AND ANNOUNCEMENTS

NEWS AND ANNOUNCEMENTS

ECHO virus, type 18, associated with respira- tory infection in older children, is always as-.. sociated with diarrhea in premature infants.[r]

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Inflammatory diarrhea due to enteroaggregative Escherichia coli: evidence from clinical and mice model studies

Inflammatory diarrhea due to enteroaggregative Escherichia coli: evidence from clinical and mice model studies

From November 2007 to October 2009, a systematic ac- tive surveillance was conducted at the NICED to detect the prevalence of different enteric pathogens among acute diarrheal patients admitted at the IDH. Stool specimens were collected from all age groups from every 5 th hospi- talized patient with diarrhea or dysentery on two ran- domly selected days (48 hrs) in a week. Two thousand five hundred nineteen stool specimens were collected in ster- ile containers and sent to the laboratory within 2 hrs. For the detection of enteric pathogens, conventional culture methods, immunologic and molecular microbiologic tech- niques were employed in the study [26].
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