GASTROENTERITIS
Diagnosis, Diagnostics, Immunodiagnosis &
Immunodiagnostics:
ABSTRACTS
3252. Armon
K. Stephenson T. MacFaul R.
Eccleston P. Werneke U. An
evidence and consensus based guideline for acute diarrhoea management. [Review]
[69 refs] Archives of Disease in Childhood.
85(2):132-42, 2001 Aug.
Abstract
OBJECTIVE: To develop an evidence and consensus based guideline
for the management of the child who presents to hospital with diarrhoea (with
or without vomiting), a common problem representing 16% of all paediatric
medical attenders at an accident and emergency department. Clinical assessment,
investigations (biochemistry and stool culture in particular), admission, and
treatment are addressed. The guideline aims to aid junior doctors in
recognising children who need admission for observation and treatment and those
who may safely go home. EVIDENCE: A systematic review of the literature was
performed. Selected articles were appraised, graded, and synthesised
qualitatively. Statements on recommendation were generated. CONSENSUS: An
anonymous, postal Delphi consensus process was used. A panel of 39 selected
medical and nursing staff were asked to grade their agreement with the
generated statements. They were sent the papers, appraisals, and literature
review. On the second and third rounds they were asked to re-grade their
agreement in the light of other panelists' responses. Consensus was predefined
as 83% of panelists agreeing with the statement. RECOMMENDATIONS: Clinical signs
useful in assessment of level of dehydration were agreed. Admission to a
paediatric facility is advised for children who show signs of dehydration. For
those with mild to moderate dehydration, estimated deficit is replaced over
four hours with oral rehydration solution (glucose based, 200-250 mOsm/l) given
"little and often". A nasogastric tube should be used if fluid is
refused and normal feeds started following rehydration. Children at high risk
of dehydration should be observed to ensure at least maintenance fluid is
tolerated. Management of more severe dehydration is detailed. Antidiarrhoeal
medication is not indicated. VALIDATION: The guideline has been successfully
implemented and evaluated in a paediatric accident and emergency department.
[References: 69]
3253.Brown CM. Cann JW. Simons G.
Fankhauser RL. Thomas W. Parashar UD. Lewis MJ. Outbreak of Norwalk virus in a Caribbean island resort:
application of molecular diagnostics to ascertain the vehicle of infection.
Epidemiology & Infection. 126(3):425-32,
2001 Jun.
Abstract
In 1998, an outbreak of gastroenteritis affected at least 448
persons including 122 staff at a resort hotel in Bermuda. A survey among staff
indicated that gastroenteritis was associated with eating or drinking at the hotel
(OR = 60, 95% CI = 2.4-15.1). Multiple specimens of drinking water had elevated
faecal coliform levels and Escherichia coli present, suggestive of faecal
contamination. Stools from 18 of the 19 persons with gastroenteritis that were
tested were positive for genogroup-II Norwalk-like viruses (NLVs). RT-PCR
analysis of a 31 specimen of water produced a genogroup-II NLV genome with a
sequence identical to that of NLVs in the stools of three ill persons. This
outbreak shows the value of new molecular diagnostics to link illness with a
contaminated source through the use of sequence analysis. The risk of outbreaks
such as these could be reduced in tourism dependent regions like Bermuda and
the Caribbean by regular evaluation of data from the inspection and monitoring
of drinking water supplies and waste water systems, by ensuring the
chlorination of supplemental drinking water supplies and by establishing
food-safety initiatives.
3254.Chen CF. Wu KG. Hsu MC.
Tang RB. Prevalence and relationship between allergic diseases and
infectious diseases. Journal of Microbiology, Immunology & Infection. 34(1):57-62, 2001 Mar.
Abstract
In order to determine the prevalence of childhood allergic
diseases, infectious diseases, and the relationship between them, 8723 children
from three junior high schools in Tou-Cheng City, Taipei County, were studied
using questionnaires developed according to the International Study of Asthma
and Allergies in Childhood (ISAAC) criteria combined with supplementary
questions about infectious diseases. Students and their parents completed the
questionnaires at home. The age of the children ranged from 10 to 18 years old
(14.12 +/- 0.89 years), the majority (96.03%) was aged from 13 to 15 years old.
The 12-month prevalences of self-reported allergic disease symptoms were:
asthma symptom 8.2%, allergic rhinitis symptom 39.6%, and atopic dermatitis
symptom 5.9%. The prevalences of diagnosis of the allergic diseases were:
asthma 8.7%, allergic rhinitis 24.1%, and atopic dermatitis 3.9%. The 12-month
prevalences of diagnosis of infectious diseases were: pneumonia 0.6%,
bronchitis 7.2%, sinusitis 7.2%, purulent conjunctivitis 2.5%, otitis media
4.3%, encephalitis or meningitis 0.4%, gastroenteritis 14.5%, acne 23.9%,
purulent dermatitis 1.3%, and other infectious diseases 1.2%. Lifetime
admission rates of children due to infectious diseases were: pneumonia 1%,
bronchitis 1.8%, sinusitis 0.3%, purulent conjunctivitis 0.2%, otitis media
0.3%, encephalitis or meningitis 0.3%, gastroenteritis 2.1%, and other
infectious diseases 0.6%. The prevalence of infectious diseases was
significantly higher in children with allergic disease symptoms (defined as
asthma, allergic rhinitis, or atopic dermatitis). These results demonstrated
the presence of a link between allergic diseases and infectious diseases, which
may have some important clinical implications.
3255. Mittal N. Thompson JF. Kato T.
Tzakis AG. Tacrolimus and diarrhea: pathogenesis of altered metabolism.
[letter; comment]. Pediatric Transplantation.
5(2):75-9, 2001 Apr. No Abstract
3256. Pujari B D: Gastro-intestinal anastomosis : basics
and controversies. Indian J Surg 2000, 62(4), 251-60. (1 Apr.).
Abstract
Gastro-intestial
anastomosis is the commenest procedure performed on digestive tract. In
addition to other factors, the outcome depends upon the techniques, expertise
and experience of the surgeon. Since the healing of G.I. anatomosis can not be
observed and and manipulated on day to day basis, the diagnosis of anastomotic
break down is late leading to high mortality prolonging hospital stay and
resumption to work Over the years certain general and specific principles are
evolved for successful outcome based mainly on better understanding of
pathophysiology of anastomotic healing and prospective and retrospective
experimental and clinical studies. Still there are controversial areas
regarding the need and type of bowel preparation, role of routine nasogastric
use and abues of peritoneal drains, hand sewn versus stapled anastomosis, role
of other devices, choice of suture materials, inversion versus eversion,
continous versus interrupted sutures, double versus single layer anastomosis,
choise of staples etc. 98 ref.
3256.Tan AC. Kruimel JW. Naber TH. Eosinophilic gastroenteritis
treated with non-enteric-coated budesonide tablets. European Journal of
Gastroenterology & Hepatology.
13(4):425-7, 2001 Apr.
Abstract
A patient who presented with upper abdominal pain, nausea and
ascites together with peripheral eosinophilia is described. Based on a surgical
full-thickness biopsy of the antrum, the diagnosis of eosinophilic
gastroenteritis was made. Treatment with prednisone resulted in a clinical
response, but the prednisone dose could not be lowered below 5 mg. We preferred
to treat the patient with corticosteroids with minimal systemic side effects.
As there was gastric involvement, we could not give enteric-coated budesonide
capsules. Therefore, we treated the patient with budesonide tablets, which were
designed originally for use as a clysma but now are given orally. With this
treatment regimen, the patient has been in remission for more than 2 years.
3257.Todd WT. Dundas S. The
management of VTEC O157 infection. [Review] [48 refs] International Journal of
Food Microbiology. 66(1-2):103-10, 2001
May 21.
Abstract
VTEC O157 infections, although showing a relentless rise in
incidence over the last decade, only account for less than 10% of total food
poisoning notifications in the UK. Despite this, the propensity for this
infection to cause the serious and life-threatening clinical complications of
haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopaenic purpura
(TTP), in a significant proportion (2-15%) of sufferers, highlights the need to
focus on it both epidemiologically and clinically. The mortality rate of these
complications (3-17% and up to 30% in outbreaks) adds urgency to this
consideration. The pathogenesis and epidemiology of the illness caused by VTEC
O157 is now well described, allowing the potential for appropriate intervention
in outbreak and individual clinical management. The presence or absence of
symptoms, e.g. bloody diarrhoea, fever, vomiting, in VTEC O157 infections
compared with other causes of gastroenteritis may allow some selection of cases
for more intensive management. Age (< 15, > 65 years), clinical
hypochlorhydria. and a short incubation period have been associated with
complication (HUS/TTP) development. Antibiotic therapy in the pre-infection
period may predispose to complication development and there is evidence that it
may increase complications if used in the management of acute illness.
Laboratory markers such as early neutrophil leukocytosis have been shown both
to correlate with VTEC O157 infection and to predict complications in central
Scotland and Japan. The serum albumin and the C-reactive protein may act as
additional markers for HUS development. Laboratory markers may be
differentiated into those predicting HUS/TTP and those useful in monitoring its
development. A scheme for clinical management of affected cases is presented to
allow the attending clinician to select cases that may benefit from further
intervention to prevent or treat complications. [References: 48]
Apr 02
4048.
Bresee JS, El Arifeen S, Azim T, Chakraborty J,
Mounts AW, Podder G, Gentsch JR, Ward RL, Black R, Glass RI, Yunus M. Safety
and immunogenicity of tetravalent rhesus-based rotavirus vaccine in Bangladesh.
Pediatr Infect Dis J 2001
Dec;20(12):1136-43
BACKGROUND: Rotavirus is the most common cause of severe gastroenteritis among children worldwide. OBJECTIVES: To compare the safety, immunogenicity and shedding patterns of rhesus rotavirus (RRV)-tetravalent vaccine vs. placebo among infants in rural Bangladesh. METHODS: A double blinded, placebo-controlled trial was conducted in which infants (n = 120) were randomly assigned to receive three doses of either vaccine or placebo administered at approximately 6, 10 and 14 weeks of age together with routine immunizations. Data on possible adverse effects of vaccinations were collected daily for 7 days after each dose. Stool samples were collected after each dose, and serum samples were obtained before the first and after the third vaccination. RESULTS: Fever (> or = 38 degrees C), as measured by study assistants, was noted more frequently among vaccinees (15%) than among placebo recipients (2%) during the 7 days after vaccination but was not reported more frequently by parents of vaccinees vs. placebo recipients. Overall 87% of vaccinees had an antibody response (measured by IgA or anti-RRV-neutralizing antibodies) after vaccination compared with 32% of placebo recipients. Rates of seroconversion were higher among subjects with lower levels of prevaccination antibodies and those who shed rotavirus after vaccination. Vaccine strain viruses were detected in stools from placebo vaccine recipients who had evidence of IgA seroconversion. CONCLUSIONS: In this population RRV-tetravalent vaccine was comparably immunogenic and safe as in trials conducted in developed countries, where this vaccine has been proved effective in preventing severe rotavirus diarrhea. These data support continued evaluation of rotavirus vaccines in developing countries.
4049.
Collins SM, Piche T, Rampal P. The putative role
of inflammation in the irritable bowel syndrome. Gut 2001 Dec;49(6):743-5 No
abstract.
4050.
Nickerson CA, Goodwin TJ, Terlonge J, Ott CM,
Buchanan KL, Uicker WC, Emami K, LeBlanc CL, Ramamurthy R, Clarke MS,
Vanderburg CR, Hammond T, Pierson DL. Three-dimensional tissue assemblies:
novel models for the study of Salmonella enterica serovar Typhimurium
pathogenesis. Infect Immun 2001
Nov;69(11):7106-20
The lack of readily available experimental systems has limited knowledge pertaining to the development of Salmonella-induced gastroenteritis and diarrheal disease in humans. We used a novel low-shear stress cell culture system developed at the National Aeronautics and Space Administration in conjunction with cultivation of three-dimensional (3-D) aggregates of human intestinal tissue to study the infectivity of Salmonella enterica serovar Typhimurium for human intestinal epithelium. Immunohistochemical characterization and microscopic analysis of 3-D aggregates of the human intestinal epithelial cell line Int-407 revealed that the 3-D cells more accurately modeled human in vivo differentiated tissues than did conventional monolayer cultures of the same cells. Results from infectivity studies showed that Salmonella established infection of the 3-D cells in a much different manner than that observed for monolayers. Following the same time course of infection with Salmonella, 3-D Int-407 cells displayed minimal loss of structural integrity compared to that of Int-407 monolayers. Furthermore, Salmonella exhibited significantly lower abilities to adhere to, invade, and induce apoptosis of 3-D Int-407 cells than it did for infected Int-407 monolayers. Analysis of cytokine expression profiles of 3-D Int-407 cells and monolayers following infection with Salmonella revealed significant differences in expression of interleukin 1alpha (IL-1alpha), IL-1beta, IL-6, IL-1Ra, and tumor necrosis factor alpha mRNAs between the two cultures. In addition, uninfected 3-D Int-407 cells constitutively expressed higher levels of transforming growth factor beta1 mRNA and prostaglandin E2 than did uninfected Int-407 monolayers. By more accurately modeling many aspects of human in vivo tissues, the 3-D intestinal cell model generated in this study offers a novel approach for studying microbial infectivity from the perspective of the
host-pathogen interaction.
4051.
Szajewska H, Mrukowicz JZ. Probiotics in the
treatment and prevention of acute infectious diarrhea in infants and children:
a systematic review of published randomized, double-blind, placebo-controlled
trials. J Pediatr Gastroenterol Nutr
2001 Oct;33 Suppl 2:S17-25
BACKGROUND: This review was designed to assess the evidence from randomized controlled trials on effects of probiotics in the treatment and prevention of acute infectious diarrhea in infants and children. METHODS: A systematic review of published, randomized, double-blind, placebo-controlled trials on probiotics in the treatment or prevention of acute diarrhea defined as >3 loose or watery stools per 24 hours in infants and children. RESULTS: The use of probiotics as compared with placebo was associated with a significantly reduced risk of diarrhea lasting >3 days. The pooled estimate risk was 0.43 (95% CI, 0.34-0.53) with a fixed-effect model, and remained significant in a random-effect model (0.40; 95% CI, 0.28-0.57). Only Lactobacillus GG showed a consistent effect. Probiotics significantly reduced the duration of diarrhea when compared with placebo, particularly in rotaviral gastroenteritis-the pooled, weighted, mean difference (WMD) assuming the random-effect model was -20.1 hours (95% CI, -26.1 to -14.2) and -24.8 (95% CI, -31.8 to -17.9) respectively. A meta-analysis of the prevention studies was not feasible because of significant clinical and statistical heterogeneity. CONCLUSIONS: There is evidence of a clinically significant benefit of probiotics in the treatment of acute infectious diarrhea in infants and children, particularly in rotaviral gastroenteritis. Lactobacillus GG showed the most consistent effect, although other probiotic strains may also be effective. Further research is needed. Clinical and statistical heterogeneity of the prophylactic interventions preclude drawing firm conclusions about the efficacy of probiotics in preventing acute gastroenteritis.
July 02
4602.
Doe W. Oral
vaccines for gastrointestinal infections. Gastroenterol Today 2000, 4(4),
149-50. No abstract.
4603. Green
KY, Belliot G, Taylor JL, Valdesuso J, Lew JF, Kapikian AZ, Lin FY. A predominant role for Norwalk-like viruses
as agents of epidemic gastroenteritis in Maryland nursing homes for the
elderly. J Infect Dis. 2002 Jan 15;185(2):133 46.
Stool specimens from 156 Maryland nursing home residents, who became ill during 20 outbreaks of gastroenteritis from November 1987 through February 1988, were analyzed. All tested negative for astroviruses, enteroviruses, Group A rotaviruses, Sapporo-like caliciviruses, and enteric bacteria (i.e., Salmonella, Clostridium, and Shigella species). Eighty-two (52%) were positive for Norwalk-like viruses (NLVs), members of the family Caliciviridae. Six distinct genetic clusters within genogroups I and II of the NLVs were detected; a genogroup II (GII) virus closely related to the Camberwell virus in the NLV GII/4 genetic cluster was the predominant strain. Serologic evidence of infection with > or = 1 NLV was detected in 61 (56%) of 109 patients tested against 3 NLV antigens (i.e., Norwalk, Hawaii, and Toronto viruses). Sixteen (80%) outbreaks met the definition for an NLV outbreak. Taken together with a retrospective analysis of bacterial gastroenteritis in this same setting, these data support a major role for NLVs as etiologic agents of gastroenteritis in elderly persons.
4604. Iritani
N, Seto Y, Kubo H, Haruki K, Ayata M, Ogura H. Prevalence of "Norwalk-like
virus" infections in outbreaks of acute nonbacterial gastroenteritis
observed during the 1999-2000 season in Osaka City, Japan. J Med Virol. 2002
Jan;66(1):131-8.
We have investigated the incidence of Norwalk-like viruses (NLVs) associated with outbreaks of acute nonbacterial gastroenteritis in Osaka City, Japan, since April 1996 using reverse transcription (RT)-PCR and electron microscopy methods. From the results of the first 3 years, between April 1996 and March 1999, we previously reported that multiple genetic types of NLVs were detected in 71.9% of outbreaks using RT-PCR with Ando's primers except for one outbreak [Iritani et al., 2000]. However, during the 1999-2000 season, NLV outbreak strains, which could not be detected by RT-PCR with Ando's primers, were increased. From probe typing and sequence analysis, 76.9% of these undetectable outbreak strains were classified into the P1-B type and the others were untypable. These untypable strains were closely related with Alphatron type strains detected in the Netherlands. The P2-B probe type of the NLV outbreak strains was predominant (88.2%) in the 1999-2000 season. The phylogram based on the 81 nucleotide sequences from these P2-B outbreak strains formed 2 clusters closely related with Lordsdale virus. The dominant genetic type of the P2-B outbreak strains, during the 1996-1997 season in Osaka City, belonged in one of these 2 clusters. These findings of the emergence of NLVs escaping the RT-PCR method strongly indicated the importance of probe typing and sequence analysis to survey NLV infections. Our surveillance of NLV infection in the outbreaks, for these 4 years, showed that the predominant probe type and dominant genetic type of NLV outbreak strains changed each season. Copyright 2002 Wiley-Liss, Inc.
4605. Ishikawa
N, Fuchigami T, Matsumoto T, Kobayashi H, Sakai Y, Tabata H, Takubo N, Yamamoto
S, Nakanishi M, Tomioka K, Fujishima M.
Helicobacter pylori infection in rheumatoid arthritis: effect of drugs
on prevalence and correlation with gastroduodenal lesions. Rheumatology
(Oxford). 2002 Jan;41(1):72-7.
OBJECTIVE: The aim of this study was to investigate the impact of Helicobacter pylori infection on clinical features in patients with rheumatoid arthritis (RA) under medication with non-steroidal anti-inflammatory drugs. METHODS: One hundred and eighty-four patients with RA were tested for the presence of H. pylori infection. Clinical features and gastroduodenal lesions were compared between H. pylori-positive and -negative patients. RESULTS: One hundred and thirteen patients were positive and 71 patients were negative for H. pylori. The
age, severity of RA, prevalence of gastrointestinal symptoms and gastroduodenal lesions and the class of gastroprotective drugs were not different between the two groups. Reflux oesophagitis was less frequent and sulphasalazine was less frequently administered in the H. pylori-positive group. CONCLUSIONS: The severity of RA, prevalence of gastroduodenal lesions other than reflux oesophagitis and application of gastroprotective drugs do not seem to depend upon H. pylori infection in RA patients. Sulphasalazine may be protective
against H. pylori infection.
4606. Koumanidou
C, Vakaki M, Pitsoulakis G, Kakavakis K, Mirilas P. Sonographic detection of lymph nodes in the intussusception of
infants and young children: clinical evaluation and hydrostatic reduction. AJR
Am J Roentgenol. 2002 Feb;178(2):445-50.
OBJECTIVE: Our aim was to assess the sonographic appearance of enlarged lymph nodes in the intussusception in infants and young children and to investigate whether the enlarged lymph nodes affect the hydrostatic reduction rate of intussusception. MATERIALS AND METHODS: This retrospective case control study included a total of 65 children with intussusception, consisting of two groups: a study group of 28 patients with lymph nodes detected in intussusception and a reference group of 37 patients of similar age without lymph nodes in intussusception. The selection criterion for the study group was the presence of a minimum of two lymph nodes, of which at least one had a long axis of 11 mm or greater. The intussusception patterns, target or doughnut-like, and the presence of trapped fluid in the intussusception were also evaluated. Clinical records were reviewed for associated disease. The reducibility of both study and reference groups was assessed and correlated with all the sonographic features mentioned. RESULTS: Twenty-two of the 28 patients in the study group and none in the reference group had a recent or a current history of gastroenteritis. The overall hydrostatic reduction rate was 46.4% in patients with enlarged lymph nodes in the intussusception and 81.1% (p < 0.005) in patients without enlarged lymph nodes in the intussusception. Larger rather than numerous lymph nodes significantly affected the reducibility rate. Most of the reference group patients had a hydrostatic reduction at first attempt, whereas a second attempt at hydrostatic reduction was required in most of the study group patients. CONCLUSION: Enlarged lymph nodes in the intussusception are mainly found inpatients with a current or recent history of gastroenteritis and decrease the overall hydrostatic reduction rate.
Tositti
G, Fabri P, Romano L, de LF. Liver injury during gastroenteritis in adults: a
retrospective study in 727 cases. Am J Gastroenterol. 2002 Feb;97(2):487-8. No abstract.
Oct 2002
5329.
Almagro M,
del Pozo J, Garcia-Silva J, Castro A, Lopez-Calvo S, Yebra-Pimentel MT, Fonseca
E. Telogen effluvium as a clinical
presentation of human immunodeficiency virus infection.Am J Med. 2002 Apr
15;112(6):508-9. No abstract.
5330.
Ananthan S,
Alavandi SV. Biochemical characteristic and secretory activity of Aeromonas
species isolated from children with gastroenteritis in Chennai. Indian J. med
Res 1999 April; 109: 136-40. Attempt was made to delineate the phenotypic
markers for the detection of enterotixigenic strains of Aeromonas. Eighteen
Aeromonas species comprising one isolate of A.hydrophila, six isolates o A.
sobria and 11 isolates of A.caviae were obtained from 379 children suffering
from acute diarrhoea in Chennai. Nine of these isolates inclusive of three
A.sobria and six A.caviae were found to produce secretory response in vitro in
the rabbit intestinal mucosa mounted in the Ussing chambers as revealed by
significant increases in the short circuit current. Eleven stranins hydrolysed
aesculin, 8 fermented arabinose, 6 produced acetyl methyl carbinol, 14
producedlysine decarboxylase, 3 fermented swalicin, 9 produced b-haemolysin, 9
produced CAMP-like factor and only two isolates took up congo red dye. None of
these phenotypic traits were found to correlate with the in vitro secretory
activity.
5331.
Fleenor JT,
Hoffman TM, Bush DM, Paridon SM, Clark BJ 3rd, Spray TL, Bridges ND. Pneumatosis intestinalis after pediatric
thoracic organ transplantation. Pediatrics. 2002 May;109(5):E78-8.
OBJECTIVE: To review and
describe pneumatosis intestinalis (PI) in children who have undergone thoracic
organ transplantation and evaluate potential risk factors. METHODS: We
retrospectively reviewed abdominal radiographs obtained from June 1992 through
September 2000 in all pediatric (age <21 years) thoracic organ recipients
who survived at least 1 week after transplantation. In this group, a case was
defined as an episode of radiographically confirmed PI; those without PI were
assigned as controls. Variables analyzed included demographic data,
gastroenteritis history (stool cultures or symptoms of gastroenteritis), and
transplant-related factors (ie, graft type, rejection history, immunosuppression
regimen). Significance was defined as P <.05. RESULTS: Over this 8-year
period, PI occurred in 8 (7%) of 116 patients (0.86% annual risk). No child had
>1 diagnosed episode of PI. Of these 8 cases, 7 presented with 1 or more
abdominal symptoms. Three of these children had rotavirus antigen isolated in
their stool, 2 others were noted to have stool positive for Clostridium
difficile toxin, and in the other 3, no pathogen was identified. All cases were
treated with a regimen of intravenous antibiotics and total parenteral
nutrition. There were no deaths; however, 1 patient developed an Aspergillus
pulmonary infection during his course of antibiotic therapy, and another
underwent an exploratory laparotomy without bowel resection. Significant risk
factors included black race (unadjusted odds ratio: 16), younger age at
presentation (age <5 years; unadjusted odds ratio: 9), higher steroid dose
(steroid dose >0.5 mg/kg/d; unadjusted odds ratio: 7), and a higher
tacrolimus level at presentation (tacrolimus level >1; unadjusted odds
ratio: 6). PI did not occur with a steroid dose <0.4 mg/kg/d. Variables not
associated with increased risk for developing PI included gender, graft type,
total white blood cell count, recent antibiotic use, concurrent use of an antimetabolite,
cytomegaloviral infection, past use of extracorporeal membrane oxygenation, and
graft rejection history. CONCLUSIONS: Significant risk factors for the
development of PI in our pediatric thoracic organ transplantation population
included black race, younger age, higher daily steroid dosing, and a high
tacrolimus level at presentation. In the children diagnosed with PI, there were
no related deaths, significant gastrointestinal sequelae, or complications.
These findings suggest that in this population, PI will often have a benign
course when treated aggressively, and that steroid dosing should be reduced to
<0.5 mg/kg/d whenever possible.
5332.
Gewirtz AT,
Collier-Hyams LS, Young AN, Kucharzik T, Guilford WJ, Parkinson JF, Williams
IR, Neish AS, Madara JL. Lipoxin a4 analogs attenuate induction of intestinal
epithelial proinflammatory gene expression and reduce the severity of dextran
sodium sulfate-induced colitis. J Immunol. 2002 May 15;168(10):5260-7.
The anti-inflammatory
eicosanoid lipoxin A(4) (LXA(4)), aspirin-triggered 15-epi-LXA(4), and their
stable analogs down-regulate IL-8 secretion and subsequent recruitment of
neutrophils by intestinal epithelia. In an effort to elucidate the mechanism by
which these lipid mediators modulate cellular proinflammatory programs, we
surveyed global epithelial gene expression using cDNA microarrays. LXA(4)
analog alone did not significantly affect expression of any of the >7000
genes analyzed. However, LXA(4) analog pretreatment attenuated induction of
approximately 50% of the 125 genes up-regulated in response to the
gastroenteritis-causing pathogen Salmonella typhimurium. A major subset of
genes whose induction was reduced by LXA(4) analog pretreatment is regulated by
NF-kappaB, suggesting that LXA(4) analog was influencing the activity of this
transcription factor. Nanomolar concentrations of LXA(4) analog reduced
NF-kappaB-mediated transcriptional activation in a LXA(4) receptor-dependent
manner and inhibited induced degradation of IkappaBalpha. LXA(4) analog did not
affect earlier stimulus-induced signaling events that lead to IkappaBalpha
degradation, such as S. typhimurium-induced epithelial Ca(2+) mobilization or
TNF-alpha-induced phosphorylation of IkappaBalpha. To establish the in vivo
relevance of these findings, we examined whether LXA(4) analogs could affect
intestinal inflammation in vivo using the mouse model of DSS-induced
inflammatory colitis. Oral administration of LXA(4) analog
(15-epi-16-para-fluoro-phenoxy-LXA(4), 10 microg/day) significantly reduced the
weight loss, hematochezia, and mortality that characterize DSS colitis. Thus,
LXA(4) analog-mediated down-regulation of proinflammatory gene expression via
inhibition of the NF-kappaB pathway can be therapeutic for diseases
characterized by mucosal inflammation.
5333. Hatakka K, Savilagti E, Ponka A, Meurman JH, Poussa T, Nase L, Saxelin M, Korpela R. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. Selection BMJ – South Asia Edn. 2001; 17(6), 514-16. Examines weather long term consumption of a probiotic milk could reduce gastrointestinal and respiratory infections in children in day care cantres. Children in the Lactobacillus group had fewer days of absence from day care because of illness 4.9 (95% confidence interval 4.4 to 5.5)vs 5.8 (5.3 to 6.4) days, 16% differences, P=0.03; age adjusted 5.1 (4.6 to 5.6) vs 5.7 (5.2 to 6.3) days, 11% difference, P=0.09). There was also a relative reduction of 17% in the number of children suffering from respiratory infections with complications and lower respiratory tract infections (unadjusted absolute % reduction –8.6 (-17.2 to –0.1), P=0.05; age adjusted odds ratio 0.75 (0.52 to 1.09), P=0.13) and a 19% relative in antibiotic treatments for respiratory infection (unadjusted absolute % reduction 0.96 (-18.2 to –1.0), P=0.03; (adjusted odds ratio 0.72 (0.50 to 1.03) P=0.08) in the Lactobacillus group. Lactobacillus GG may reduce respiratory infections and their severity in children in day care. The effects of the probiotic Lactobacillus GG were modest but consistently in the same direction. 16 ref.
5334. Kate V, Ananthakrishna N, Ratnakar C, Badrinath S. Anti-H. pylori IgG seroprevalance rates in asymptomatic children and adults from south India. Indian J med Microbiol 2001; 19(2): 73-8. Abstract: Study was undertaken to determine the seroprevalenc of H.pylori in symptomatic children and compare it with that seen in the asymptomatic children and compare it with that seen in the asymptomatic adult population from south India. One hundred and five children and one hundred adults admitted to the wards for conditions other than gastrointestinal disorders were included for this study. H.pylori status was determined by ELISA for IgG. The prevalence of H.pylori in children of various ages varied from 44% to 46% with an overall prevalence of Hpylori which was significantly higher than in children (P=0.002). the prevalence of H.pylori increased markedly with age with the maximum colonization (74%0 occurring in yound adults (16-30 years). The antibody levels too followed a similar pattern. In conclusion, it was seen that almost half the hcildren in south India acquire H.pylori infection early in life which increases slowly and steadily with a peak prevalence in the yound adult. Gender does not affect the prevalence in children and adults. Gender does not affect the prevalence in children and adults. As age advances further thee is a slight decline in the prevalence of H.pylori infection. The immune response reflected by the levels of the antibody levels also follows the same pattern.
5335.
Lakhkar B,
Abubacker S. Duodeno-jejunal
hemangiomatosis. Indian J Pediat 2000; 67912):931-3.
Abstracta: Diffuse duodeno-jejunal
hemangiomatiosis in children is a rare cause of bilious vomitting. In the
clinical approach to bilious vomiting, tumours of the duodenum come at the end
of the differential list-not to mention
the rarity of hemangiomatosis. Isolated duodeno-jejunal hemangiomatosia as a
cause of bilious vomiting in children is being reported for the first time.
Analyses the various imaging modalities available to reach a clinical
diagnosis.
5336.
Lopman BA,
Brown DW, Koopmans M. Human caliciviruses in Europe. J Clin Virol. 2002
Apr;24(3):137-60. Review.
Caliciviruses are single-stranded RNA viruses, which are divided into four
genera based on their morphology and genomic structure. Viruses from two
genera, the Norwalk like viruses and Sapporo like viruses, are a common cause
of acute, nonbacterial gastroenteritis in humans. Although the first human
calicivirus discovered nearly 30 years ago, much of the epidemiological and
biological character of these viruses is only now beginning to unfold.
Investigation has been difficult due to a number of factors, the viruses cannot
be amplified by in vitro cell culture or animal models and electron microscopy
(EM) is often not sensitive enough to detect the viruses in stool samples.
Recent advances in molecular diagnostic techniques and the advent of a
baculovirus expression system have highlighted the clinical and public health
importance of calicivirus in all age groups, their ability to cause infection
via a number of transmission routes as well as their considerable genetic
diversity. These characteristics, in conjunction with the inability of humans
to develop long-term immunity make HuCV an important public health issue in
Europe and worldwide.
5337.
Nanda S.
Morbidity pattern and nutritional status of infants in some areas of Varanasi.
Indian J prev soc Med. 2000;31(3-4), 61-7. No abstract
5338.
Pennap G,
Pager CT, Peenze I, de Beer MC, Kwaga JK, Ogalla WN, Umoh JU, Steele AD.
Epidemiology of astrovirus infection in Zaria, Nigeria. J Trop Pediatr 2002 Apr;48(2):98-101
Astrovirus has been shown to be an important aetiological agent associated with
gastroenteritis in children, although few studies have been conducted in
Africa. In this study, stool specimens were obtained from 375 young children
less than 5 years of age with acute gastroenteritis presenting at Ahmadu Bello
University Hospital, and from a control group of 122 children without
diarrhoeal illness. The specimens were examined for the presence of human
astroviruses using a monoclonal antibody-based ELISA (Astrovirus IDEIATM, Dako,
UK). Negative staining electron microscopy was performed on specimens to
confirm the presence of astrovirus particles. Astrovirus was detected in 6.7
per cent (25/375) of the diarrhoeal stools compared to 5.7 per cent (7/122) of
the control specimens. Astrovirus seemed to infect older children and more than
half the children were between 1 and 4 years of age (15/25). Only four children
were less than 6 months old. A winter peak of shedding was observed.
5339.
Polyak S,
Smith TA, Mertz H. Eosinophilic gastroenteritis causing pancreatitis and
pancreaticobiliary ductal dilation. Dig Dis Sci. 2002 May;47(5):1091-5. No abstract.
5340.
Qamruddin AO,
Keaney MG, McCann R, Chadwick PR. Increased stool sampling during a waterborne
outbreak of cryptosporidiosis does not increase the detection of other faecal
pathogens. J Clin Pathol. 2002 Apr;55(4):271-4.
AIMS: To ascertain the effect of enhanced surveillance following an outbreak of
waterborne cryptosporidiosis on the number of faecal specimens submitted to the
local microbiology laboratory and the number positive for common enteric
pathogens. The outbreak provided an opportunity to estimate the extent of
routine under ascertainment of common enteric pathogens. METHOD: Retrospective
search of the computerised microbiology system database for details of faecal
examination requests for the period 26 April to 6 June in 1998 and 1999 (period
of outbreak). RESULTS: Specimens were received from 378 community patients
during the six week period 26 April to 6 June 1999. This was double that for
the same period in 1998 (a non-outbreak year). Oocysts of Cryptosporidium
parvum were detected in 59 patients, an eightfold increase compared with the
same period in 1998. Despite the greater number of patients tested, the
detection of other pathogens in patients with gastroenteritis was not altered
when compared with the same period in the previous year. CONCLUSION: This study
found no evidence of under ascertainment of gastrointestinal infection (common
bacterial pathogens and rotavirus) by local general practitioners.
5341.
Ramsook C,
Sahagun-Carreon I, Kozinetz CA, Moro-Sutherland D. A randomized clinical trial
comparing oral ondansetron with placebo in children with vomiting from acute
gastroenteritis. Ann Emerg Med. 2002 Apr;39(4):397-403.
STUDY OBJECTIVE: Vomiting
in children suffering from acute gastroenteritis interferes with the oral
rehydration process and equally frustrates parents and health care providers.
Adjuncts such as promethazine and metoclopramide are less than optimally effective
and are associated with side effects. Ondansetron, a 5-HT3 receptor antagonist
marketed as Zofran, is a safe and effective antiemetic used extensively in
oncology and postoperative patients. We evaluate the effect of the antiemetic
ondansetron versus placebo on the clinical outcome of patients with vomiting
from gastroenteritis in a pediatric emergency department. METHODS: This was a
randomized, prospective, double-blind clinical trial in a university-affiliated
children's hospital ED. Children between the ages of 6 months and 12 years who
had vomited at least 5 times during the preceding 24 hours were randomized to
receive either oral ondansetron or a taste- and color-matched placebo. Oral
rehydration was commenced 15 minutes later at 5 mL/min per standard oral
rehydration protocols. Patients were discharged after they voided and continued
standard oral rehydration at home with the introduction of a bananas, rice,
applesauce, and toast (BRAT) diet after the first 24 hours. Any patient
requiring admission was considered a treatment failure, and no further doses
were given. Discharged patients were given 5 additional doses to be used every
8 hours, and they were contacted by telephone 24 and 48 hours after discharge
to record the number of episodes of vomiting and diarrhea. The parents were
also required to complete a diary of the same information, which was mailed to
the investigators for confirmation of the telephone data. RESULTS: One hundred
forty-five patients were enrolled, of whom 51% (n=74) were randomized to
ondansetron. At baseline, age distribution, sex, and severity of illness did
not differ between the ondansetron and placebo groups. During the observation
period in the ED, the median number of episodes of vomiting was 0 in both
groups, but the rank sum of vomiting episodes was significantly lower in the
ondansetron group (P =.001). The number of episodes of emesis in the ED after
enrollment ranged from 0 to 7 in the placebo group and 0 to 2 in the
ondansetron group. During the 48 hours of follow-up, the median number of
episodes of vomiting remained 0, with no statistically significant difference
between the groups. There was no statistically significant difference in the
rank sum of episodes of diarrhea in the ED between the groups (P =.622); however,
during the next 48 hours, the patients in the ondansetron group had
significantly more diarrhea than the placebo group. A lower proportion of
patients receiving ondansetron compared with placebo required intravenous fluid
therapy (P =.015). The admission rate was also lower in patients receiving
ondansetron (P =.007). The revisit rate was higher in the ondansetron group
compared with the placebo group (P =.047). CONCLUSION: Ondansetron was
effective in reducing the emesis from gastroenteritis during the ED phase of
oral rehydration and in lowering the rates of intravenous fluid administration
and hospital admission.
5342.
Roy-Burman A,
Glader BE. Resolution of severe Donath-Landsteiner autoimmune hemolytic anemia
temporally associated with institution of plasmapheresis. Crit Care Med. 2002
Apr;30(4):931-4.
OBJECTIVES: To report a case of severe postinfectious autoimmune hemolytic
anemia (AIHA) owing to the Donath-Landsteiner (DL) antibody resolving with
plasmapheresis, and to review the pathophysiology of this underrecognized cause
of pediatric AIHA and its potential susceptibility to plasmapheresis therapy.
DESIGN: Descriptive case report. SETTING: A pediatric intensive care unit in a
university children's hospital. PATIENT: A 5-yr-old Hispanic female had gastroenteritis
followed by progressive intravascular hemolysis, initially attributed to acute
postinfectious cold hemagglutinin (immunoglobulin M) disease. INTERVENTION:
With no slowing in the rate of hemolysis, a continued need for frequent
transfusions, and a lack of response to corticosteroid and intravenous
immunoglobulin therapy, a 3-day course of plasmapheresis was administered.
MEASUREMENTS AND MAIN RESULTS: The patient presented to an emergency department
with an initial hematocrit of 22%, which fell to 12% by hospital admission. She
received nine transfusions over 7 days, with her hematocrit reaching a nadir of
11% on the 5th day of hospitalization. Once plasmapheresis was initiated, she
required no further transfusion. Analysis of serum from initial presentation
demonstrated biphasic hemolysis, confirming the presence of the DL antibody.
CONCLUSIONS: In AIHA, in which the direct antiglobulin test detects primarily
C3 rather than immunoglobulin G, especially in children, the DL antibody must
be considered. Confirming the diagnosis rapidly may be critical, especially in
cases of severe hemolysis, because this may help direct therapy. A low titer of
DL antibody can mediate severe intravascular hemolysis given its propensity to
sensitize, detach, and rebind erythrocytes with changes in temperature in the
microcirculation. However, given the transient and relatively brief production
of the DL antibody in postviral illness, early clearance of the offending
antibody may be possible with plasmapheresis, without the expectation for
significant rebound antibody production, potentially decreasing the length of
hospital stay and the need for transfusions.
5343.
Ruuska TH,
Karikoski R, Smith VV, Milla PJ. Acquired myopathic intestinal
pseudo-obstruction may be due to autoimmune enteric leiomyositis.
Gastroenterology. 2002 Apr;122(4):1133-9.
We describe a previously healthy boy who developed intestinal
pseudo-obstruction following an episode of gastroenteritis at age 2 years. At
presentation, the patient had mildly raised erythrocyte sedimentation rate and
C-reactive protein level, and elevated antineutrophil cytoplasmic antibodies,
antinuclear anti-DNA, and anti-smooth muscle antibodies. His
electrogastrography was myopathic with no dominant frequency. First full-thickness
intestinal biopsies showed a T lymphocytic myositis, particularly in the
circular muscle. Steroid therapy resulted in clinical remission; cessation of
steroids, in relapse. Further full-thickness biopsies showed an initial
reduction in alpha-smooth muscle actin immunostaining in circular muscle
myocytes and later atrophy and disappearance of many myocytes. Vascular and the
remaining enteric smooth muscle cells showed HLA-DR and intercellular adhesion
molecule 1 expression. These observations demonstrate the ability of enteric
myocytes to take part in an inflammatory response and to change their
phenotype, allowing them to act as antigen-presenting cells and to activate T
cells. This and possible cytokine production by the myocytes play a role in
their own destruction. This process responded to immunosuppressive therapy.
Pathogenesis:
5344.
Beyer K,
Castro R, Birnbaum A, Benkov K, Pittman N, Sampson HA. Human milk-specific
mucosal lymphocytes of the gastrointestinal tract display a TH2 cytokine
profile. J Allergy Clin Immunol. 2002 Apr;109(4):707-13.
BACKGROUND: A number of gastrointestinal disorders, including allergic
eosinophilic gastroenteritis and food protein-induced enteropathy, have been
associated with milk hypersensitivity. The immunologic reactions appear to
involve T cells that are activated by specific food proteins. OBJECTIVE: The
present study was performed to examine the cytokine profiles of milk-specific
lymphocytes from the duodenal lamina propria from children with milk-induced
gastrointestinal diseases. METHODS: Duodenal biopsy specimens obtained from 10
patients with allergic eosinophilic gastroenteritis, food protein-induced
enteropathy, or both and 12 control subjects were mechanically minced and
cultured with either mitogens (i.e., polyclonal T-cell expansion) or milk
proteins (i.e., milkspecific T-cell expansion). By using flow cytometry,
expanded T cells were phenotyped with anti-CD4, anti-CD8, anti-IL-4, anti-IL-5,
and anti-IFN-gamma mAbs. The milk specificity of the lines was evaluated by means
of the lymphocyte proliferation assay. In addition, the release of T(H)1,
T(H)2, and T(H)3 cytokines was determined after restimulation. RESULTS: In
patients and control subjects polyclonal expansion of mucosal lymphocytes
resulted in predominantly T(H)1 cells. Milk-specific mucosal T-cell lines could
be established in 60% of the patients but in none of the control subjects. In
contrast to the polyclonal expansion of T cells, the milk-specific expansion of
mucosal T cells showed a clear T(H)2 cytokine profile. On restimulation with
milk protein, these cells showed a high proliferative response. They released
T(H)2 cytokines, predominately IL-13, but failed to release T(H)3 cytokines
important in the development of oral tolerance. CONCLUSION: The release of
T(H)2 cytokines after stimulation of milk-specific mucosal T cells may play a
pathogenic role in the inflammatory changes seen in milk-induced
gastrointestinal disorders.
5345.
Butterfield
JH, Murray JA. Eosinophilic gastroenteritis and gluten-sensitive enteropathy in
the same patient. J Clin Gastroenterol. 2002 May-Jun;34(5):552-3. Review.
We report the clinical
and laboratory features of a 19-year-old man with findings of both eosinophilic
gastroenteritis and gluten-sensitive enteropathy. Before the onset of clinical
symptoms, the patient had received a series of hepatitis B vaccinations but had
not developed a measurable antibody response or any allergic reaction.
Radioallergosorbent test results were positive to several foods, and the total
serum immunoglobulin E (IgE) level was elevated. Adherence to a gluten-free
diet caused a normalization in the endomysial antibody titer; however, the
total serum IgE level continued to increase, and the total eosinophil count
remained elevated. Symptoms of recurrent vomiting and abdominal pain
necessitated prednisone burst therapy. The simultaneous occurrence of
eosinophilic gastroenteritis and gluten-sensitive enteropathy is rare; therapy
should be directed to each disorder individually.
5346.
Marie-Cardine
A, Gourlain K, Mouterde O, Castignolles N, Hellot MF, Mallet E,
Buffet-Janvresse C. Epidemiology of acute viral gastroenteritis in children
hospitalized in Rouen, France. Clin Infect Dis. 2002 May 1;34(9):1170-8.
This study assessed the
epidemiologic characteristics of acute viral gastroenteritis in hospitalized
children. A stool sample obtained from each child was analyzed for the presence
of astrovirus, calicivirus, rotavirus, adenovirus, enterovirus, and digestive
bacteria. Of the 438 stool samples obtained, 138 tested positive for > or =1
pathogen during the winters of 1997-1998 and 1998-1999 (P<.001). Virologic
tests revealed rotavirus in 17.3% of samples, calicivirus in 7.3%, astrovirus
in 6.8%, adenovirus in 0.7%, and > or =1 virus in 5.4%. Median age was
higher for patients with rotavirus gastroenteritis than it was for those with
astrovirus or calicivirus gastroenteritis (P=.014). Mean duration of
hospitalization was statistically significantly lower for children with
rotavirus gastroenteritis (P=.022), despite the more-frequent dehydration
observed among children with rotavirus versus those with astrovirus or
calicivirus gastroenteritis (P=.007). In contrast, enteral rehydration was more
rapidly achieved in patients with gastroenteritis due to rotavirus.
5347.
Marionneau S,
Ruvoen N, Le Moullac-Vaidye B, Clement M, Cailleau-Thomas A, Ruiz-Palacois G,
Huang P, Jiang X, Le Pendu J. Norwalk virus binds to histo-blood group antigens
present on gastroduodenal epithelial cells of secretor individuals.
Gastroenterology. 2002 Jun;122(7):1967-77.
BACKGROUND & AIMS:
Norwalk Virus (NV) is a member of the Caliciviridae family, which causes acute
epidemic gastroenteritis in humans of all ages and its cellular receptors have
not yet been characterized. Another calicivirus, Rabbit Hemorrhagic Disease
Virus, attaches to H type 2 histo-blood group oligosaccharide present on rabbit
epithelial cells. Our aim was to test if, by analogy, recombinant NV-like
particles (rNV VLPs) use carbohydrates present on human gastroduodenal
epithelial cells as ligands. METHODS: Attachment of rNV VLPs was tested on
tissue sections of the gastroduodenal junction and on saliva from individuals
of known ABO, Lewis, and secretor phenotypes. It was also tested on human
Caco-2 cells and on animal cell lines transfected with glycosyltransferases
complementary DNA (cDNA). Competition experiments were performed with synthetic
oligosaccharides and anticarbohydrate antibodies. Internalization was monitored
by confocal microscopy. RESULTS: Attachment of rNV VLPs to surface epithelial
cells of the gastroduodenal junction as well as to saliva was detected, yet
only from secretor donors. It was abolished by alpha1,2fucosidase treatment,
and by competition with the H types 1 and 3 trisaccharides or with anti-H type
1 and anti-H types (3/4) antibodies. Transfection of CHO and TS/A cells with an
alpha1,2fucosyltransferase cDNA allowed attachment of VLPs. These transfectants
as well as differentiated Caco-2 cells expressing H type 1 structures
internalized the bound particles. CONCLUSIONS: rNV VLPs use H type 1 and/or H
types (3/4) as ligands on gastroduodenal epithelial cells of secretor
individuals.
5348.
Nachamkin I.
Chronic effects of Campylobacter infection. Microbes Infect. 2002
Apr;4(4):399-403. Review.
Campylobacter jejuni is
one of the most common causes of bacterial gastroenteritis and chronic
sequelae, such as reactive arthritis and Guillain-Barre syndrome (GBS), are
known to follow uncomplicated infections. While little is known about reactive
arthritis following Campylobacter infection, our knowledge on the pathogenesis
of Campylobacter-induced GBS is expanding rapidly and is summarized in this
review.
5349.
Nager AL,
Wang VJ. Comparison of nasogastric and intravenous methods of rehydration in
pediatric patients with acute dehydration. Pediatrics. 2002 Apr;109(4):566-72.
OBJECTIVE: To assess the
safety, efficacy, and cost-effectiveness of rapid nasogastric hydration (RNG)
and rapid intravenous hydration (RIV) administered in the emergency department
(ED) to young children suffering with uncomplicated, acute moderate
dehydration. METHODS: Ninety-six children aged 3 to 36 months, who presented
with signs and symptoms of uncomplicated, acute moderate dehydration caused by
vomiting and/or diarrhea, presumed to be caused by viral gastroenteritis, were
randomly assigned to receive either RNG with a standard oral rehydration
solution or RIV with normal saline. Each solution was administered at a rate of
50 mL/kg of body weight, delivered over a 3-hour period in our urban pediatric
ED. All participants were weighed pretreatment and posttreatment and underwent
initial and final measurements of their serum electrolytes, blood urea
nitrogen, creatinine, and glucose levels, along with urine chemistry and urine
specific gravity. Telephone follow-up by completion of a standardized
questionnaire was obtained approximately 24 hours after discharge from the ED.
RESULTS: Ninety-two of 96 enrolled patients completed the study. Three patients
failed treatment (2 RIV and 1 RNG) and were excluded and hospitalized because
of severe, intractable vomiting, and 1 patient was withdrawn secondary to an
intussusception. Among 92 evaluable patients, 2 were found to be severely
dehydrated (>10% change in body weight) and were excluded from analysis,
leaving 90 patients (RNG: N = 46 and RIV: N = 44), who completed the study.
Both RNG and RIV were found to be a safe and efficacious means of treating
uncomplicated, acute moderate dehydration in the ED. Determinations of
electrolytes, blood urea nitrogen, creatinine, or glucose were not found to be
of value on an intent-to-treat basis in the care of these patients. The urine
specific gravity and incidence of ketonuria declined from levels commensurate
with moderate dehydration in the RNG group, but not as consistently so in the
RIV group. Both RNG and RIV were substantially less expensive to administer
than standard care with intravenous fluid deficit therapy in-hospital, and RNG
was more cost-effective to administer over RIV in the outpatient setting.
CONCLUSION: RNG and RIV administered in the ED are safe, efficacious, and
cost-effective alternatives to the standard treatment for uncomplicated, acute
moderate dehydration in young children. RNG is as efficacious as RIV, is no
more labor intensive than RIV, and is associated with fewer complications. In
addition, we found that most routine laboratory testing is of little value in
these patients and should be avoided, except when clearly clinically indicated.
5350.
Reeves JJ,
Shannon MW, Fleisher GR. Ondansetron decreases vomiting associated with acute
gastroenteritis: a randomized, controlled trial. Pediatrics. 2002
Apr;109(4):e62.
OBJECTIVE: Relatively
little research has examined the role of antiemetic agents in the treatment of
acute gastroenteritis. The use of the selective 5-HT3 receptor antagonists (eg,
ondansetron) offers a potentially valuable treatment option. The objective of
this study was to evaluate the efficacy of ondansetron for the treatment of vomiting
associated with acute gastroenteritis in children. METHODS: A randomized,
double blind, placebo-controlled trial was conducted in the emergency
department of a tertiary-care children's hospital. Eligible patients were 1
month to 22 years old and required intravenous fluids for gastroenteritis. Of
172 patients approached, 107 were enrolled (54 to intravenous ondansetron, 53
to placebo). The mean age was 5.3 years, and 53% of the patients were male. The
frequency of vomiting, admission rate, and occurrence of complications were
measured. RESULTS: After drug administration, 38 (70%) of the 54 patients in
the ondansetron group had complete cessation of vomiting compared with 27 (51%)
of the 53 patients in the placebo group. Sixteen (30%) of the 53 patients in
the placebo group required admission compared with 14 (26%) of the 54 in the
ondansetron group. An analysis of previously untreated patients with a measured
serum carbon dioxide > or =15 mEq/L showed that 11 (23%) of the 47 who
received placebo were admitted compared with 3 (7%) of the 43 who received
ondansetron. No significant complications were detected. CONCLUSIONS:
Intravenous ondansetron decreases vomiting in children with gastroenteritis. In
addition, ondansetron reduces the need for admission in those who are treated
at an initial visit to the emergency department and have a measured serum
carbon dioxide > or =15 mEq/L. The safety and low cost of this therapy
suggests that ondansetron can be valuable in treating gastroenteritis in
children.
5351.
Smith JL.
Campylobacter jejuni infection during pregnancy: long-term consequences of
associated bacteremia, Guillain-Barre syndrome, and reactive arthritist. J Food
Prot. 2002 Apr;65(4):696-708. Review.
Campylobacter jejuni
infections are the main cause of foodborne gastroenteritis in the United States
and other developed countries. Generally, C. jejuni infections are
self-limiting and treatment is not necessary; however, infections caused by
this organism can lead to potentially dangerous long-term consequences for some
individuals. Bacteremia, Guillain-Barre syndrome (GBS; an acute flaccid
paralytic disease), and reactive arthritis (ReA) are the most serious of the
long-term consequences of C. jejuni infections. During pregnancy, foodborne
infections may be hazardous to both the woman and the fetus. C. jejuni-induced
bacteremia during pregnancy may lead to intrauterine infection of the fetus,
abortion, stillbirth, or early neonatal death. Infection of a newborn by the
mother during the birth process or shortly after birth may lead to neonatal
enteritis, bacteremia, and/or meningitis. C. jejuni enteritis is the inducing
antecedent infection in approximately 30% of cases of GBS. Thus, pregnant women
infected with C. jejuni may contract GBS. GBS during pregnancy does not affect
fetal or infant development and does not increase spontaneous abortion or fetal
death; however, it may induce spontaneous delivery during the third trimester
in severe cases. Reactive arthritis occurs in approximately 2% of C. jejuni
enteritis cases and leads to the impaired movement of various joints. Pregnant
women with C. jejuni-induced reactive arthritis can be expected to deliver a
normal infant. A pregnant patient with GBS or ReA may be unable to care for a
newborn infant because of the physical impairment induced by these diseases.
Since C. jejuni infections put both fetuses and pregnant women at risk,
pregnant women must take special care in food handling and preparation to
prevent such infections.
5352.
Van Niel CW,
Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute
infectious diarrhea in children: a meta-analysis. Pediatrics. 2002
Apr;109(4):678-84.
OBJECTIVE: Childhood
diarrhea accounts for substantial morbidity and mortality worldwide. Multiple
studies in children have shown that Lactobacillus, administered orally, may
have antidiarrheal properties. We conducted a meta-analysis of randomized,
controlled studies to assess whether treatment with Lactobacillus improves
clinical outcomes in children with acute infectious diarrhea. METHODS: Studies
were sought in bibliographic databases of traditional biomedical as well as
complementary and alternative medicine literature published from 1966 to 2000.
Search terms were "competitive inhibition," "diarrhea,"
"gastroenteritis," "Lactobacillus," "probiotic,"
"rotavirus," and "yog(h)urt." We included studies that were
adequately randomized, blinded, controlled trials in which the treatment group
received Lactobacillus and the control group received an adequate placebo and
that reported clinical outcome measures of diarrhea intensity. These inclusion
criteria were applied by blind review and consensus. The original search
yielded 26 studies, 9 of which met the criteria. Multiple observers
independently extracted study characteristics and clinical outcomes. Data
sufficient to perform meta-analysis of the effect of Lactobacillus on diarrhea
duration and diarrhea frequency on day 2 were contained in 7 and 3 of the
included studies, respectively. RESULTS: Summary point estimates indicate a
reduction in diarrhea duration of 0.7 days (95% confidence interval: 0.3-1.2
days) and a reduction in diarrhea frequency of 1.6 stools on day 2 of treatment
(95% confidence interval: 0.7-2.6 fewer stools) in the participants who
received Lactobacillus compared with those who received placebo. Details of
treatment protocols varied among the studies. A preplanned subanalysis suggests
a dose-effect relationship. CONCLUSION: The results of this meta-analysis
suggest that Lactobacillus is safe and effective as a treatment for children
with acute infectious diarrhea.
Vaccines:
5353.
Griffin DD,
Fletcher M, Levy ME, Ching-Lee M, Nogami R, Edwards L, Peters H, Montague L,
Gentsch JR, Glass RI. Outbreaks of adult gastroenteritis traced to a single
genotype of rotavirus. J Infect Dis
2002 May 15;185(10):1502-5
Between November 1998 and
December 2000, the Centers for Disease Control and Prevention screened samples
from 263 outbreaks of gastroenteritis in the United States and identified 3
that were associated with rotavirus among adults. Rotaviruses from each
outbreak were further characterized by reverse-transcription polymerase chain
reaction. Surprisingly, all specimens were of serotype G2, a strain that is, as
determined by high-stringency hybridization analysis, genetically distinct in
all 11 gene segments from the other common rotavirus strains in circulation.
The unusual coincidence of identification of only G2 strains in these 3
outbreaks of rotavirus gastroenteritis among adults is similar to results from
other studies, in which G2 strains were found in association with more-severe
disease in children than other rotavirus serotypes and in association with
outbreaks of diarrhea among adults in Japan. Although rotavirus infections in
adults are relatively uncommon, which indicates that good overall protective
immunity exists, the predominance of G2 strains in outbreaks that have occurred
in adults suggests that natural immunity to more common strains does not always
provide adequate heterotypic immunity to G2 strains. For the rotavirus vaccines
under development, special attention may need to be paid to protection against
G2 strains.