1.

Hetzel M, Bonfoh B, Farah Z, Traore M, Simbe CF, Alfaroukh IO, Schelling E, Tanner M, Zinsstag J. Diarrhoea, vomiting and the role of milk consumption: perceived and identified risk in Bamako (Mali). Trop Med Int Health. 2004 Oct; 9(10):1132-8.

Swiss Tropical Institute, Basel, Switzerland. manuel.hetzel@unibas.ch

OBJECTIVES: To evaluate the public health impact of milk contamination in Bamako, Mali. METHODS: A case-control study assessed the risk-factors for food-borne toxi-infections with diarrhoea and vomiting as main clinical picture. A total of 131 schoolchildren between 5 and 20 years of age were interviewed by trained interviewers in schools in Bamako. A structured questionnaire was used to record health problems, food and particularly milk consumption habits and socio-economic indicators. RESULTS: Final multivariate logistic regression analysis identified regular consumption of boiled milk [odds ratio(OR) = 4.38; 95% CI = 1.15-16.71], age between 5 and 10 years (OR vs. age group 11-15 years = 3.28; 95% CI = 1.09-9.85) and the existence of dry latrines in the household (OR = 7.65; 95% CI = 1.92-30.55) as risk factors for diarrhoea and vomiting. Other milk products and the socio-economic level of the household were not significantly associated with the outcome. Many people were unaware of the potential risks of milk consumption. CONCLUSIONS: Milk products may be a risk factor for food-borne toxi-infections. Attention has to be paid to products considered 'safe', such as boiled or pasteurized milk. The low awareness of potential risks of many people may increase the risk of milk consumption. To achieve a sustainable increase in local milk production in Africa, milk quantity and production and transformation quality should be improved simultaneously.

2.

Cleary TG. The role of Shiga-toxin-producing Escherichia coli in hemorrhagic colitis and hemolytic uremic syndrome. Semin Pediatr Infect Dis. 2004 Oct; 15(4):260-5. Review.

Center for Infectious Diseases, School of Public Health, University of Texas Medical School, Houston, TX 77030, USA. Thomas.G.Cleary@uth.tmc.edu

The Shiga-toxin-producing E. coli represent a major class of pathogens that have been defined over the last twenty years. They cause distinctive clinical manifestations such as afebrile bloody diarrhea with severe abdominal pain (hemorrhagic colitis) and microangiopathic hemolytic anemia with renal failure (hemolytic uremic syndrome). The most common Shiga-toxin-producing E. coli is serotype O157:H7, although at least one hundred different serotypes share the virulence traits and clinical manifestations with this organism. Understanding the pathophysicology, improving diagnostic tools, and developing a treatment strategy are important areas of ongoing investigations.

3.

Schwetz I, Bradesi S, Mayer EA. The pathophysiology of irritable bowel syndrome. Minerva Med. 2004 Oct;95(5):419-26. Review.

Center of Neurovisceral Sciences and Women's Health (CNS), Division of Digestive Diseases and Brain Research Institute, Department of Medicine, Los Angeles, CA, USA.

Recent studies have provided evidence to suggest a possible role for mucosal immune activation in the pathophysiology of irritable bowel syndrome (IBS). On the other hand, novel findings using functional brain-imaging techniques support the concept that altered perception of visceral stimuli plays a key role in IBS symptom generation. These seemingly contradictory findings have revived the discussion about the relative contribution of peripheral versus central mechanisms in the symptom generation of IBS. In this review, we will provide evidence for the hypothesis that, in the absence of changes in visceral perception and alterations in endogenous pain modulation systems, chronic inflammatory mucosal changes in the gut are not a plausible mechanism to explain the presence of chronic abdominal pain, a clinical hallmark of IB.

4.

Butzler JP. Campylobacter, from obscurity to celebrity. Clin Microbiol Infect. 2004 Oct; 10(10):868-76. Review.

Department of Human Ecology, Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium. jean-paul.butzler@pandora.be

After its successful isolation from stools in the 1970s, Campylobacter jejuni has rapidly become the most commonly recognised cause of bacterial gastroenteritis in man. Reported cases of human campylobacteriosis represent only a small fraction of the actual number. In industrialised countries, the incidence of C. jejuni/Campylobacter coli infections peaks during infancy, and again in young adults aged 15-44 years. Acute self-limited gastrointestinal illness, characterised by diarrhoea, fever and abdominal cramps, is the most common presentation of C. jejuni/C. coli infection. The introduction of selective media has made the diagnosis of Campylobacter enteritis a simple procedure. In general, Campylobacter enteritis is a self-limiting disease which seldom requires antimicrobial therapy, although one in 1000 infections may lead to the Guillain-Barre syndrome. In industrialised countries, most infections are acquired through the handling and consumption of poultry meat. In developing countries, where the disease is confined to young children, inadequately treated water and contact with farm animals are the most important risk factors. Many infections are acquired during travel. Fluoroquinolone resistance has been reported in C. jejuni since the late 1980s in Europe and Asia, and since 1995 in the USA. The use of fluoroquinolones to treat animals used for food has accelerated this trend of resistance. In Australia, where fluoroquinolones have not been licensed for use in food production animals, C. jejuni remains susceptible to fluoroquinolones. The public health burden of Campylobacter spp. other than C. jejuni/C. coli remains unmeasured. Better diagnostic methods may reveal the true health burden of these organisms.