Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:


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 January 2003  

6004.      Alfa MJ, Swan B, VanDekerkhove B, Pang P, Harding GK. The diagnosis of Clostridium difficile-associated diarrhea: comparison of Triage C. difficile panel, EIA for Tox A/B and cytotoxin assays. Diagn Microbiol Infect Dis. 2002 Aug;43(4):257-63.


This study prospectively compared; Triage(R) C. difficile test (TCT), TechLab C. difficile toxin A-B enzyme immuno-assay (EIA), and cell-culture cytotoxin test (CT). Of the 400 stools tested, 99 were positive by any test with 92, 41 and 58 detected by TCT, EIA and CT, respectively. Culture of discordant samples indicated that 52 contained C. difficile (42 toxigenic, 10 non-toxigenic), 10 contained Clostridium species and 2 had no detectable clostridium isolates. There were 21/42 toxigenic C. difficile isolates from 17 patients whose stools were negative when originally tested by CT. Review of available patient charts indicated that 12/14 did not previously or currently have C. difficile associated diarrhea, whereas 2 patients developed disease within a few days. Compared to CT as the gold standard, the sensitivity and specificity were; 93%, 89% and 66%, 99% for TCT and EIA respectively. The 8 stool samples with Toxin A(-) Toxin B(+) isolates were detected in 8, 4, and 6 samples by TCT, EIA and CT, respectively. In summary, TCT as a screening test allowed reliable reporting for 85% of stools on the day of receipt. For the 15% of stools requiring further testing we recommend the use of CT.


6005.      Dunn JJ, Columbus ST, Aldeen WE, Davis M, Carroll KC. Trichuris vulpis recovered from a patient with chronic diarrhea and five dogs. J Clin Microbiol. 2002 Jul;40(7):2703-4.


We report a case of human infection with the whipworm of dogs, Trichuris vulpis, in a woman with duodenal ulcer disease, chronic diarrhea, and close contact with dogs. Morphologically, T. vulpis ova resemble those of the human whipworm (T. trichiura) but are nearly twice their size.

6006.      Groisman GM, Amar M, Livne E. CD10: a valuable tool for the light microscopic diagnosis of microvillous inclusion disease (familial microvillous atrophy). Am J Surg Pathol. 2002 Jul;26(7):902-7.


Microvillous inclusion disease (MID) is a specific disorder of the intestinal brush border that leads to intractable secretory diarrhea in infants. At present, electron microscopic analysis is required for its definitive diagnosis. However, this technique is not always available or feasible, and the diagnostic microvillous inclusions may not be evident in all specimens. Accordingly, the availability of a panel of histochemical and immunohistochemical stains displaying a specific staining pattern for MID will allow pathologists to reach a definitive diagnosis of this disorder without recourse to electron microscopy. CD10 is a membrane-associated neutral peptidase, shown to have a linear brush-border staining pattern in normal small intestine. We studied the staining pattern of CD10 in small intestinal biopsies from six patients with MID and in 24 control cases (10 normal small intestine, 10 celiac disease, two autoimmune enteropathy, and two allergic enteropathy). All MID cases revealed prominent cytoplasmic CD10 immunoreactivity in surface enterocytes. In contrast, all control cases showed linear brush-border staining. Similar results were obtained with periodic acid-Schiff, polyclonal carcinoembryonic antigen, and alkaline phosphatase, three stains known to show cytoplasmic staining of surface enterocytes in MID. In conclusion, CD10 is a valuable tool for the diagnosis of MID. It may be used as part of a panel that includes other stains with a distinctive staining pattern in MID such as periodic acid-Schiff, polyclonal carcinoembryonic antigen, and alkaline phosphatase. We suggest that the definitive diagnosis of MID can be reached when small bowel biopsies from infants with intractable diarrhea display cytoplasmic staining of surface enterocytes with the above-mentioned stains.

6007.      Kang YH, Park YK, Ahn JB, Yeun JD, Jee YM. Identification of human astrovirus infections from stool samples with diarrhea in Korea. Arch Virol. 2002 Sep;147(9):1821-7.


Human astrovirus (HAstV) infections were confirmed in 17 (1.5%) of 1153 children and adults with diarrhea, from different regions of Korea, by testing their stool samples by reverse transcription-polymerase chain reaction using primers targeted to partial ORF 1a. Genotypes of isolates were determined by sequencing the 289-bp PCR products. The predominant genotype was HAstV type 1, with intragenotypic variation of 0.7%. Unlike Norwalk-like viruses (NLVs), rotavirus and enteric adenovirus, no data on HAstV have been reported in association with diarrhea in Korea. The incidence of HAstV infection reported in this study indicates that HAstV is one of the viral agents causing gastroenteritis in Korea, and that a continuous molecular epidemiological study of HAstV infection is required.

6008.      Kannan S, Chattopadhyay UK, Pal D, Shimada T, Takeda Y, Bhattacharya SK, Ananthanarayanan PH. Isolation and identification of Aeromonas from patients with acute diarrhoea in Kolkata, India. Indian J med Microbiol. 2001; 19(4): 190-2.

Abstract: Isolation of diarrhoea causing Aeromonas was carried out in the division of Active Surveillace, National Institute of Cholera and Enteric Diseases (NICCED), Kolkata for a period of 12 months from January 1999 to December 1999. Out of 602 stool samples collected from patients with acute diarrhoea admitted in Infectious Disease (ID) Hospital Kolkatta, 64 (10.6%) samples were identified positive for Aeromonas as the pathogen. The different isolated and identified species from patients with acute diarrhoea were A. hydrophila (60%), A. caviae (20%), A veronii (10%), A. schubertii (4%), A. jandaei (3%). Most of the isolated Aeromonas strains showed resistance to commonly employed antibiotics. All the clinical isolated of Aeromonas possessed virulence genes encoding for aerolysin and cytotonic enterotoxin genes. Except A. schubertii and A. jandaei, all the other species possessed the gene for haemolysis.

6009.      Moyenuddin M, Williamson JC, Ohl CA. Clostridium difficile-associated diarrhea: current strategies for diagnosis and therapy. Curr Gastroenterol Rep. 2002 Aug;4(4):279-86. Review.


Clostridium difficile, a spore-forming toxigenic bacterium, is one of the most common causes of infectious diarrhea and colitis in the United States. Most patients with C. difficile infection have recently received antimicrobial therapy--usually clindamycin, cephalosporins, or the extended-spectrum penicillins. Clinical presentation varies from asymptomatic colonization to mild diarrhea to severe colitis. The mainstay of diagnosis is detection of C. difficile toxin A, toxin B, or both with a cytotoxin test or enzyme immunoassay of the stool of patients who have received antibiotic therapy and have features of C. difficile-associated diarrhea. Enzyme immunoassays that detect both toxins are preferred because of their higher diagnostic accuracy. If the first assay is negative and C. difficile-associated diarrhea is strongly suspected, a second assay may be performed. Ten days of oral metronidazole is the preferred therapy for most initial infections. Vancomycin is considered second-line therapy because of its cost and potential to select for vancomycin resistance. About 20% to 25% of patients experience reinfection or relapse after initial therapy and require retreatment. The disease can best be prevented by limiting the use of broad-spectrum antibiotics and adhering to control techniques.



6010.      Bernier C, Gounon P, Le Bouguenec C. Identification of an aggregative adhesion fimbria (AAF) type III-encoding operon in enteroaggregative Escherichia coli as a sensitive probe for detecting the AAF-encoding operon family. Infect Immun. 2002 Aug;70(8):4302-11.


Enteroaggregative Escherichia coli (EAEC) is recognized as an emerging cause of diarrhea in children and adults worldwide, and recent studies have implicated EAEC in persistent diarrhea in patients infected with human immunodeficiency virus (HIV). In this study, we identified aggregative adhesion fimbria type III (AAF-III) in isolate 55989, a typical EAEC strain. Analysis of the sequence of the plasmid-borne agg-3 gene cluster encoding AAF-III showed this cluster to be closely related to the agg and aaf operons and to the afa operons carried by diffusely adherent pathogenic E. coli. We investigated the adhesion properties of a collection of 25 EAEC strains isolated from HIV-infected patients presenting with persistent diarrhea. We found that a minority of strains (36%) carried sequences similar to those of the agg and aaf operons, which encode AAF-I and AAF-II, respectively. We developed PCR assays specific for the agg-3 operon. In our collection, the frequency of AAF-III strains was similar (12%) to that of AAF-I strains (16%) but higher than that of AAF-II isolates (0%). Differences between EAEC strains in terms of the virulence factors present render detection of these strains difficult with the available DNA probes. Based on comparison of the agg, aaf, and agg-3 operons, we defined an AAF probe internal to the adhesion gene clusters and demonstrated that it was efficient for the identification of EAEC strains. We investigated 32 EAEC isolates, of which only 34.4% were detected with the classical CVD432 probe (detecting pAA virulence plasmids) whereas 65.6% were detected with the AAF probe.


6011.      Caccio SM, De Giacomo M, Pozio E. Sequence analysis of the beta-giardin gene and development of a polymerase chain reaction-restriction fragment length polymorphism assay to genotype Giardia duodenalis cysts from human faecal samples. Int J Parasitol. 2002 Jul;32(8):1023-30.


The flagellate parasite Giardia duodenalis is a major cause of diarrhoea in humans and in animals worldwide. Molecular techniques are particularly useful for studying the taxonomy, the population structure, the zoonotic potential of animal isolates, and the correlation between the genetic variability of the parasite and the range of clinical symptoms observed in humans. In this work, a new PCR assay that targets the beta-giardin gene was tested on 21 Giardia duodenalis reference strains representing Assemblages A, B and E, which are associated with infections of humans and other mammals. The assay was then applied to 30 faecal samples collected from Italian persons. The sequence analysis of 31 PCR products from both reference strains and clinical samples showed that each Assemblage is clearly distinct from the others on the basis of specific substitutions; the sequence diversity was approximately 5%, and all substitutions occurred at the third codon positions of the gene. The analysis of the intra-Assemblage variability allowed for the identification of three genotypes within Assemblage A, and of four genotypes within Assemblage B. Interestingly, two genotypes were identified only in the clinical samples and not in reference strains. Finally, a simple PCR-restriction fragment length polymorphism method was developed for the rapid discrimination of Assemblages and applied for the direct genetic analysis of cysts present in human faecal samples.

6012.      Camilleri M, Atanasova E, Carlson PJ, Ahmad U, Kim HJ, Viramontes BE, McKinzie S, Urrutia R.  Serotonin-transporter polymorphism pharmacogenetics in diarrhea-predominant irritable bowel syndrome. Gastroenterology. 2002 Aug;123(2):425-32.


BACKGROUND & AIMS: A serotonin (5-HT)(3) receptor antagonist relieves symptoms in women with diarrhea-predominant irritable bowel syndrome (D-IBS). 5-HT undergoes reuptake by a transporter protein (SERT). Polymorphisms in the promoter for synthesis of SERT (SERT-P) influence response to serotonergic medications in depression. Our hypothesis is that polymorphisms of the promoter region for the SERT influence colonic transit in response to treatment with alosetron in D-IBS. METHODS: Thirty patients (15 men, 15 women) with D-IBS received 1 mg twice a day alosetron for 6 weeks; colonic transit was measured by scintigraphy at baseline and at the end of treatment. Twenty-three patients consented to provide blood DNA samples. Long, short, and heterozygous SERT polymorphisms were identified by polymerase chain reaction-based restriction fragment length polymorphisms and confirmed by direct sequencing. We sought pharmacogenomic association of long, short, and heterozygote polymorphisms with a change in colonic transit and with an a priori-defined, clinically meaningful change in transit at 24 hours (>1.1 colonic regions). RESULTS: SERT polymorphisms tended to be associated with colonic transit response (P = 0.075); there was a greater response in those with long homozygous than heterozygous polymorphisms (P = 0.039). Slowing of transit by >1.1 colonic region was observed in 9 women and 3 men and was more frequent in long homozygous than heterozygous patients (P = 0.024). Age, gender, and duration of IBS were not significantly different in the 3 groups. CONCLUSIONS: Genetic polymorphisms at the SERT promoter influence response to a 5-HT(3) antagonist in D-IBS and may influence benefit-risk ratio with this class of compounds.


6013.                  Elias WP, Uber AP, Tomita SK, Trabulsi LR, Gomes TA. Combinations of putative virulence markers in typical and variant enteroaggregative Escherichia coli strains from children with and without diarrhoea. Epidemiol Infect. 2002 Aug;129(1):49-55.


Enteroaggregative Escherichia coli (EAEC) is defined by the ability to produce aggregative adherence (AA) to cultured cells. We analysed 128 EAEC strains, isolated from children with and without diarrhoea, regarding the presence of 11 EAEC virulence genes. Seventy strains carried and 58 lacked the EAEC probe sequence; 17 probe positive and 31 probe negative strains showed variations in the AA pattern. All EAEC probe positive strains carried at least one EAEC marker; aspU (94.3%), irp2 (91.4%), and aggR (74.3%) were the most prevalent. Conversely, among the EAEC probe negative strains, 41.4% were devoid of any marker and astA predominated (44.8%). No significant statistical difference in the prevalence of any marker between cases and controls in both EAEC probe groups or AA variants was found. We suggest that the EAEC probe positive strains may have a higher pathogenic potential or alternatively, EAEC probe negative strains may harbour virulence factors as yet undescribed.

6014.                  Kukuruzovic R, Robins-Browne RM, Anstey NM, Brewster DR. Enteric pathogens, intestinal permeability and nitric oxide production in acute gastroenteritis. Pediatr Infect Dis J. 2002 Aug;21(8):730-9.


BACKGROUND: Aboriginal children hospitalized with diarrheal disease in northern Australia have high rates of acidosis, hypokalemia and osmotic diarrhea, as well as abnormal small bowel permeability and elevated nitric oxide (NO) production. METHODS: In a study of 291 diarrheal admissions and 84 controls, we examined the relationship of diarrheal severity outcomes with specific enteric pathogens. NO production was measured by urine nitrate plus nitrite excretion on a low nitrate diet, small bowel permeability by the lactulose:rhamnose ratio on a timed blood specimen and stool pathogens by standard microbiologic investigations and PCR. RESULTS: The addition of diagnostic tests for diarrheagenic to standard stool microbiologic testing increased the rate of specific diagnoses from 53% to 75%, but with multiple pathogens isolated from 34%. The most frequently isolated pathogens from diarrheal patients were enteroaggregative (28.9%), rotavirus (26.5%), enteropathogenic (17.2%), spp. (10.7%), (7.2%) and (7.2%). High geometric mean permeability ratios (95% confidence intervals) occurred with rotavirus (19.6; 15.3 to 25.1), enteroaggregative (21.2; 15.3 to 29.3) and (23.0; 15.1 to 35.1) compared with 9.4 (6.8 to 13.1) for no pathogens. NO production was highest for (3.7; 2.3 to 6.1) compared with 0.6 (0.4 to 1.1) for no pathogens. Multiple regression analysis revealed significant associations ( <0.001) for rotavirus with acidosis and osmotic diarrhea, for with wasting and hypokalemia and for with severe and prolonged diarrhea.CONCLUSIONS: Cryptosporidium, Strongyloides, rotavirus and enteroaggregative are important contributors to the severe manifestations of acute gastroenteritis in Australian Aboriginal children.


6015.      Lathem WW, Grys TE, Witowski SE, Torres AG, Kaper JB, Tarr PI, Welch RA. StcE, a metalloprotease secreted by Escherichia coli O157:H7, specifically cleaves C1 esterase inhibitor. Mol Microbiol. 2002 Jul;45(2):277-88.


Escherichia coli O157:H7 causes diarrhoea, haemorrhagic colitis, and the haemolytic uraemic syndrome. We have identified a protein of previously unknown function encoded on the pO157 virulence plasmid of E. coli O157:H7, which is the first described protease that specifically cleaves C1 esterase inhibitor (C1-INH), a member of the serine protease inhibitor family. The protein, named StcE for secreted protease of C1 esterase inhibitor from EHEC (formerly Tagn), cleaves C1-INH to produce (unique) approximately 60-65 kDa fragments. StcE does not digest other serine protease inhibitors, extracellular matrix proteins or universal protease targets. We also observed that StcE causes the aggregation of cultured human T cells but not macrophage-like cells or B cells. Substitution of aspartic acid for glutamic acid at StcE position 435 within the consensus metalloprotease active site ablates its abilities to digest C1-INH and to aggregate T cells. StcE is secreted by the etp type II secretion pathway encoded on pO157, and extracellular StcE levels are positively regulated by the LEE-encoded regulator, Ler. StcE antigen and activity were detected in the faeces of a child with an E. coli O157:H7 infection, demonstrating the expression of StcE during human disease. Cleavage of C1-INH by StcE could plausibly cause localized pro-inflammatory and coagulation responses resulting in tissue damage, intestinal oedema and thrombotic abnormalities.


6016.      Miyamoto K, Chakrabarti G, Morino Y, McClane BA. Organization of the plasmid cpe Locus in Clostridium perfringens type A isolates. Infect Immun. 2002 Aug;70(8):4261-72.


Clostridium perfringens type A isolates causing food poisoning have a chromosomal enterotoxin gene (cpe), while C. perfringens type A isolates responsible for non-food-borne human gastrointestinal diseases carry a plasmid cpe gene. In the present study, the plasmid cpe locus of the type A

non-food-borne-disease isolate F4969 was sequenced to design primers and probes for comparative PCR and Southern blot studies of the cpe locus in other type A isolates. Those analyses determined that the region upstream of the plasmid cpe gene is highly conserved among type A isolates carrying a cpe plasmid. The organization of the type A plasmid cpe locus was also found to be unique, as it contains IS1469 sequences located similarly to those in the chromosomal cpe locus but lacks the IS1470 sequences found upstream of IS1469 in the chromosomal cpe locus. Instead of those upstream IS1470 sequences, a partial open reading frame potentially encoding cytosine methylase (dcm) was identified upstream of IS1469 in the plasmid cpe locus of all type A isolates tested. Similar dcm sequences were also detected in several cpe-negative C. perfringens isolates carrying plasmids but not in type A isolates carrying a chromosomal cpe gene. Contrary to previous reports, sequences homologous to IS1470, rather than IS1151, were found downstream of the plasmid cpe gene in most type A isolates tested. Those IS1470-like sequences reside in about the same position but are oppositely oriented and defective relative to the IS1470 sequences found downstream of the chromosomal cpe gene. Collectively, these and previous results suggest that the cpe plasmid of many type A isolates originated from integration of a cpe-containing genetic element near the dcm sequences of a C. perfringens plasmid. The similarity of the plasmid cpe locus in many type A isolates is consistent with horizontal transfer of a common cpe plasmid among C. perfringens type A strains.


6017.      Tosetti C. Angiotensin-converting enzyme inhibitors and diarrhea. J Clin Gastroenterol. 2002 Jul;35(1):105-6.  No abstract.


6018.      Carlsson E, Bosaeus I, Nordgren S. Body composition in patients with an ileostomy and inflammatory bowel disease: validation of bio-electric impedance spectroscopy (BIS). Eur J Clin Nutr. 2002 Jul;56(7):680-6.


OBJECTIVE: To validate bio-electric impedance spectroscopy (BIS) by comparison with other methods for determination of body water compartments in stable subjects with an ileostomy and no or minor small bowel resection for inflammatory bowel disease (IBD). SUBJECTS: Twenty-one subjects were included, age range 36-65 y (female/male=12/9), Crohn's disease (CD), n=14, ulcerative colitis (UC), n=6 and indeterminate colitis (IDC), n=1. METHODS: Fluid compartments were assessed by the use of three independent methods: BIS, dual-energy X-ray absorptiometry (DXA) and dilution techniques (DIL); tritiated water (total body water, TBW); and bromide (extracellular water, ECW), respectively. Intra-cellular water (ICW) was calculated as TBW-ECW. For comparison TBW was also predicted according to an empirical formula. Differences were analysed using Bland-Altman plots. RESULTS: The mean TBW values obtained from the impedance measurement differed in the order of -2.21 (DIL) to 1.41 (DXA) in women and -2.01 (DIL) to 2.61 (DXA) in men, from the measured and derived values of total body water. Prediction of TBW gave values that were close to BIS, with a mean difference of -0.31 in male subjects and +0.51 in female subjects.Assessment of ECW revealed that the mean difference between dilution and impedance was less in women than in men (P<0.01). CONCLUSION: The differences between all methods to assess fluid compartments are pronounced. To further investigate the use of the method in clinical practice for dynamic monitoring of rehydration in ileostomates with acute diarrhoea, repeated measurements together with comparison with weight fluid-balance charts are suggested. SPONSORSHIP: The study was supported by grants from the Swedish Medical Research Council (17X-03117), Goteborgs Lakarsallskap and IB and A Lundbergs forskningsstiftelse.


6019.      Cohen MB. Shiga toxin-producing E coli: two tests are better than one. J Pediatr. 2002 Aug;141(2):155-6. No abstract.


April 2003 

6641.  Baqui AH, Black RE, El Arifeen S, Yunus M, Chakraborty J, Ahmed S, Vaughan JP. Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial. BMJ. 2002 Nov 9;325(7372):1059.

OBJECTIVE: To evaluate the effect on morbidity and mortality of providing daily zinc for 14 days to children with diarrhoea. DESIGN: Cluster randomised comparison. SETTING: Matlab field site of International Center for Diarrhoeal Disease Research, Bangladesh. PARTICIPANTS: 8070 children aged 3-59 months contributed 11 881 child years of observation during a two year period. INTERVENTION: Children with diarrhoea in the intervention clusters were treated with zinc (20 mg per day for 14 days); all children with diarrhoea were treated with oral rehydration therapy. MAIN OUTCOME MEASURES: Duration of episode of diarrhoea, incidence of diarrhoea and acute lower respiratory infections, admission to hospital for diarrhoea or acute lower respiratory infections, and child mortality. RESULTS: About 40% (399/1007) of diarrhoeal episodes were treated with zinc in the first four months of the trial; the rate rose to 67% (350/526) in month 5 and to >80% (364/434) in month 7 and was sustained at that level. Children from the intervention cluster received zinc for about seven days on average during each episode of diarrhoea. They had a shorter duration (hazard ratio 0.76, 95% confidence interval 0.65 to 0.90) and lower incidence of diarrhoea (rate ratio 0.85, 0.76 to 0.96) than children in the comparison group. Incidence of acute lower respiratory infection was reduced in the intervention group but not in the comparison group. Admission to hospital of children with diarrhoea was lower in the intervention group than in the comparison group (0.76, 0.59 to 0.98). Admission for acute lower respiratory infection was lower in the intervention group, but this was not statistically significant (0.81, 0.53 to 1.23). The rate of non-injury deaths in the intervention clusters was considerably lower (0.49, 0.25 to 0.94). CONCLUSIONS: The lower rates of child morbidity and mortality with zinc treatment represent substantial benefits from a simple and inexpensive intervention that can be incorporated in existing efforts to control diarrhoeal disease.

6642.  Eisenberg JN, Wade TJ, Hubbard A, Abrams DI, Leiser RJ, Charles S, Vu M, Saha S, Wright CC, Levy DA, Jensen P, Colford JM Jr.  Associations between water-treatment methods and diarrhoea in HIV-positive individuals. Epidemiol Infect. 2002 Oct;129(2):315-23.

This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we employed logistic regression and marginal structural modelling of the data. The relative risk of diarrhoea for 'always' vs. 'never' drinking boiled water was 0.68 (95% CI 0.45-1.04) and for 'always' vs. 'never' drinking bottled water was 1.22 (95 % CI 0.82-1.82). Drinking filtered water was unrelated to diarrhoea (1.03 (95% CI 0.78, 1.35) for 'always' vs. 'never' drinking filtered water]. Adjustment for confounding did not have any notable effect on the point estimates (0.61, 1.35 and 0.98 for boiled, bottled, and filtered water respectively, as defined above). The risk of diarrhoea was lower among those consuming boiled water but this finding was not statistically significant. Because of these findings, the importance of diarrhoea in immunocompromised individuals, and the limitations of cross-sectional data further prospective investigations of water consumption and diarrhoea among HIV-positive individuals are needed.

6643.  Osendarp SJ, Santosham M, Black RE, Wahed MA, van Raaij JM, Fuchs GJ.  Effect of zinc supplementation between 1 and 6 mo of life on growth and morbidity of Bangladeshi infants in urban slums. Am J Clin Nutr. 2002 Dec;76(6):1401-8.

BACKGROUND: Evidence for an effect of zinc supplementation on growth and morbidity in very young infants in developing countries is scarce and inconsistent. OBJECTIVE: We assessed the effect of zinc supplementation on growth and morbidity in poor Bangladeshi infants aged 4-24 wk. DESIGN: Infants from Dhaka slums were enrolled at 4 wk of age and randomly assigned to receive 5 mg elemental Zn/d (n = 152) or placebo (n = 149) until 24 wk of age. They were followed weekly for information on compliance and morbidity; anthropometric measurements were performed monthly. Serum zinc was assessed at baseline and at 24 wk of age. RESULTS: At 24 wk of age, serum zinc concentrations were higher in the zinc than in the placebo group (13.3 +/- 3.8 and 10.7 +/- 2.9 micro mol/L, respectively; P < 0.001). Significantly greater weight gains were observed in the zinc than in the placebo group for 43 infants who were zinc deficient (< 9.18 micro mol/L ) at baseline (3.15 +/- 0.77 and 2.66 +/- 0.80 kg, respectively; P < 0.04). In the other infants, no significant differences were observed in mean weight and length gains during the study period. Zinc-deficient infants showed a reduced risk of incidence of acute lower respiratory infection after zinc supplementation (relative risk: 0.30; 95% CI: 0.10, 0.92); among the non-zinc-deficient infants there were no significant differences between treatment groups. CONCLUSIONS: Zinc-deficient Bangladeshi infants showed improvements in growth rate and a reduced incidence of acute lower respiratory infection after zinc supplementation. In infants with serum zinc concentrations > 9.18 micro mol/L, supplementation improved only biochemical zinc status.

6644.  Vaishnavi C. Clinical Spectrum and pathogenesis of escherichia coli diarrhoeas. Gastroenterol Today 2002,6(6),7-10.(ISA 016214, Vol 38 No16 ,16Aug. 2002)

6645.  Viera AJ, Hoag S, Shaughnessy J. Management of irritable bowel syndrome. Am Fam Physician. 2002 Nov 15;66(10):1867-74.

Irritable bowel syndrome is the most common functional disorder of the gastrointestinal tract and is frequently treated by family physicians. Despite patients' worries about the symptoms of irritable bowel syndrome, it is a benign condition. The diagnosis should be made using standard criteria after red flags that may signify organic disease have been ruled out. An effective physician-patient relationship is vital to successful management. Episodes of diarrhea are best managed with loperamide, while constipation often will respond to fiber supplements. Antispasmodics or anticholinergic agents may help relieve the abdominal pain of irritable bowel syndrome. Refractory cases are often treated with tricyclic antidepressants. Newer agents such as tegaserod and ondansetron target neurotransmitter receptors in the gastrointestinal tract Some forms of psychologic treatment may be helpful, and gastroenterology consultation is occasionally needed to reassure the patient. Comorbid conditions such as depression or anxiety should be investigated and treated.



6646.  Berin MC, Darfeuille-Michaud A, Egan LJ, Miyamoto Y, Kagnoff MF. Role of EHEC O157:H7 virulence factors in the activation of intestinal epithelial cell NF-kappaB and MAP kinase pathways and the upregulated expression of interleukin 8. Cell Microbiol. 2002 Oct;4(10):635-48.

Enterohaemorrhagic Escherichia coli O157:H7 (EHEC) is a gastrointestinal pathogen that is generally non-invasive for intestinal epithelial cells, yet causes acute intestinal inflammation, diarrhoea, haemorrhagic colitis and haemolytic uraemic syndrome. To study signal transduction pathways activated in human intestinal epithelial cells by EHEC, we took advantage of EHEC O157:H7 and isogenic mutants deficient in the major EHEC virulence factors, intimin (eae-) and Shiga toxin (stx-). Infection with wild-type EHEC activated p38 and ERK MAP kinases and the nuclear translocation of the transcription factor NF-kappaB. Downstream, this was accompanied by increased expression of mRNA and protein for the neutrophil chemoattractant IL-8. Isogenic eae- and stx- mutants also activated p38 and ERK MAP kinases, and NF-kappaB and stimulated increases in IL-8 protein secretion similar to those of wild-type EHEC. Further, inhibition of either p38, ERK or NF-kappaB activation abrogated the IL-8 response induced by wild-type EHEC and the mutants. Epithelial cell MAP kinase and NF-kappaB pathways leading to IL-8 secretion were also activated by isolated EHEC H7

flagellin, which was active when added to either the apical or basolateral surface of polarized human intestinal epithelial cells. We conclude that EHEC interacting with intestinal epithelial cells activates intracellular signalling pathways and an epithelial cell proinflammatory response independent of either Shiga toxin or intimin, two of the major known virulence factors of EHEC. The activation of proinflammatory signals in human colon epithelial cells in response to this non-invasive pathogen appears to depend to a significant extent on H7 flagellin.

6647.  Ward B, Andrews R, Gregory J, Lightfoot D.  The use of sequential studies in a salmonellosis outbreak linked to continental custard cakes. Epidemiol Infect. 2002 Oct;129(2):287-93.\

We investigated an outbreak of 54 cases of Salmonella Typhimurium phage type 9 (STM9) with a specific antibiotic resistance pattern. We used sequential analytic studies: two retrospective cohort studies, a case-control study, and a modified case-control study. An outbreak of salmonellosis due to Salmonella Typhimurium PT9 SSu (resistant to streptomycin and sulphafurazole) was identified. Fifty-four cases had illness onset from November 1998 to March 1999. Notifications commenced following a restaurant birthday party in December 1998. An initial cohort and case control study found no association with consumption of custard cake. However, case follow-up identified another cohort of people who had attended a birthday party in February at which 8/27 people who consumed a continental custard cake were ill compared to 0/10 who did not (P = 0.07). A revised case control study found illness was strongly associated with consumption of a particular continental custard cake (Mantel-Haenszel matched OR infinity, P = 0.00004). This report highlights the epidemiological value of using sequential study types, and persisting with the investigation of apparently sporadic food-borne outbreaks.


6648.  Beckly J, Lewis S. Probiotics and antibiotic associated diarrhoea. The case for probiotics remains unproved. BMJ. 2002 Oct 19;325(7369):901 No abstract.

6649.  Gera T, Sachdev HP. Effect of iron supplementation on incidence of infectious illness in children: systematic review. BMJ. 2002 Nov 16;325(7373):1142.

OBJECTIVE: To evaluate the effect of iron supplementation on the incidence of infections in children. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: 28 randomised controlled trials (six unpublished and 22 published) on 7892 children. INTERVENTIONS: Oral or parenteral iron supplementation or fortified formula milk or cereals. OUTCOMES: Incidence of all recorded infectious illnesses, and individual illnesses, including respiratory tract infection, diarrhoea, malaria, other infections, and prevalence of positive smear results for malaria. RESULTS: The pooled estimate (random effects model) of the incidence rate ratio (iron v placebo) was 1.02 (95% confidence interval 0.96 to 1.08, P=0.54; P<0.0001 for heterogeneity). The incidence rate difference (iron minus placebo) for all recorded illnesses was 0.06 episodes/child year (-0.06 to 0.18, P=0.34; P<0.0001 for heterogeneity). However, there was an increase in the risk of developing diarrhoea (incidence rate ratio 1.11, 1.01 to 1.23, P=0.04), but this would not have an overall important on public health (incidence rate difference 0.05 episodes/child year, -0.03 to 0.13; P=0.21). The occurrence of other illnesses and positive results on malaria smears (adjusted for positive smears at baseline) were not significantly affected by iron administration. On meta-regression, the statistical heterogeneity could not be explained by the variables studied. CONCLUSION: Iron supplementation has no apparent harmful effect on the overall incidence of infectious illnesses in children, though it slightly increases the risk of developing diarrhoea.

6650.  Martin-Sosa S, Martin MJ, Hueso P. The sialylated fraction of milk oligosaccharides is partially responsible for binding to enterotoxigenic and uropathogenic Escherichia coli human strains. J Nutr. 2002 Oct;132(10):3067-72.

Milk oligosaccharides can act as soluble receptors that block bacterial adhesion to the different epithelia. Colonization factor antigens (CFA)/I- and CFA/II-expressing enterotoxigenic Escherichia coli (ETEC) strains constitute one of the main causes of diarrhea in infants. Here, the inhibition of hemagglutination mediated by these strains by milk oligosaccharides was tested. Human milk oligosaccharides showed a strong inhibitory capacity, which decreased when the oligosaccharides were desialylated. Because milk oligosaccharides also are present in the urine of neonates receiving mothers' milk, their ability to bind two uropathogenic Escherichia coli (UPEC) strains was also examined. UPEC strains expressing P (Pap) and P-like (Prs) fimbriae are responsible for infections of the urinary tract such as pyelonephritis and cystitis. The hemagglutination mediated by these strains was inhibited by human milk oligosaccharides. The sialylated fraction was partially responsible for this inhibition in the case of the UPEC expressing the P-like fimbria because differences were found after desialylation. Although bovine milk oligosaccharides were less efficient at inhibiting the hemagglutination of ETEC strains, they were still quite good inhibitors of UPEC strains.

 July 2003


7142.      Ahuja M C, Khambar B. Antibiotic associated diarrhoea:  a controlled  study comparing plain antibiotic with those containing protected lactobacilli. J Indian Med Ass 2002, 100(5), 334-5. (24818 Vol 38, No. 20, 16 Dec 2023)

7143.      De Boissieu D, Waguet JC, Dupont C.  The atopy patch tests for detection of cow's milk allergy with digestive symptoms. J Pediatr. 2003 Feb;142(2):203-5.

Infants (n = 35) with digestive symptom were investigated for diagnosis of cow's milk allergy (CMA). Milk atopy patch tests (APTs) were positive in 19 of 24 CMA versus 1 of 11 in non-CMA patients (P <.001). This sensitivity (79%) and specificity (91%) suggest that the APT could improve the detection of conditions related to CMA.

7144.      Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, Sternberg A, Kopelman Y, Scapa E.   Diagnosing small bowel Crohn's disease with wireless capsule endoscopy. Gut. 2003 Mar;52(3):390-2.

BACKGROUND: The small bowel is the most commonly affected site of Crohn's disease (CD) although it may involve any part of the gastrointestinal tract. The current methodologies for examining the small bowel are x ray and endoscopy. AIMS: To evaluate, for the first time, the effectiveness of wireless capsule endoscopy in patients with suspected CD of the small bowel undetected by conventional modalities, and to determine the diagnostic yield of the M2A Given Capsule. PATIENTS: Seventeen patients (eight males, mean age 40 (15) years) with suspected CD fulfilled study entry criteria: nine had iron deficiency anaemia (mean haemoglobin 10.5 (SD 1.8) g%), eight had abdominal pain, seven had diarrhoea, and three had weight loss. Small bowel x ray and upper and lower gastrointestinal endoscopic findings were normal. Mean duration of symptoms before diagnosis was 6.3 (SD 2.2) years. METHODS: Each subject swallowed an M2A Given Capsule containing a miniature video camera, batteries, a transmitter, and an antenna. Recording time was approximately eight hours. The capsule was excreted naturally in the patient's bowel movement, and the data it contained were retrieved and interpreted the next day. RESULTS: Of the 17 study participants, 12 (70.6%, six males, mean age 34.5 (12) years) were diagnosed as having CD of the small bowel according to the findings of the M2A Given Capsule. CONCLUSIONS: Wireless capsule endoscopy diagnosed CD of the small bowel(diagnostic yield of 71%). It was demonstrated as being an effective modality for diagnosing patients with suspected CD undetected by conventional diagnostic methodologies.

7145.      Heitkemper MM, Cain KC, Jarrett ME, Burr RL, Hertig V, Bond EF.   Symptoms across the menstrual cycle in women with irritable bowel syndrome. Am J Gastroenterol. 2003 Feb;98(2):420-30.

OBJECTIVE: The purpose of this study was to describe the patterns of GI, somatic, and psychological symptoms across the menstrual cycle in women with irritable bowel syndrome, and to determine whether symptoms differed by oral contraceptive use or predominant bowel pattern. METHODS: A daily diary was used to assess symptoms across one menstrual cycle. Repeated-measures analysis of covariance, controlling for age and body mass index, was used to compare patterns of symptoms across the menstrual cycle by oral contraceptive use and predominant bowel pattern (diarrhea, constipation, alternating). Data from control women are presented for comparison. RESULTS: For somatic and psychological as well as GI symptoms, women with irritable bowel syndrome had higher symptom severity than did controls. Women with irritable bowel syndrome using oral contraceptives had lower cognitive, anxiety, and depression symptoms (p < 0.05, but not significant after multiple comparison adjustment), but no differences were seen for most symptoms of irritable bowel syndrome. All symptoms except diarrhea were highest in the alternating group and lowest in the diarrhea group, with the constipation group either intermediate or close to the alternating group. This pattern was significant after multiple comparisons adjustment for GI symptoms, and trending toward significance (p < 0.05, but not significant after multiple comparison adjustment) for menstrual, sleep, and cognitive symptoms. The strongest menstrual cycle effect was seen in somatic and menstrual symptoms. The pattern of symptoms over the menstrual cycle did not differ by predominant bowel pattern or by oral contraceptive use. CONCLUSIONS: Many of the symptoms examined differed by predominant bowel pattern and menstrual cycle phase, not just the GI symptoms. The menstrual cycle variation was similar regardless of oral contraceptive use or predominant bowel pattern.

7146.      Iwashita A, Yao T, Schlemper RJ, Kuwano Y, Yao T, Iida M, Matsumoto T, Kikuchi M.  Mesenteric phlebosclerosis: a new disease entity causing ischemic colitis. Dis Colon Rectum. 2003 Feb;46(2):209-20.

PURPOSE: Nonthrombotic stenosis or occlusion of the mesenteric veins is a rare cause of intestinal ischemia. The aim of this study was to describe a new disease entity causing chronic ischemic colitis. METHODS: Seven patients were diagnosed as having mesenteric phlebosclerosis. All seven patients had calcifications in the small mesenteric veins and their intramural branches. No evidence of vasculitis or portal hypertension was recognized. None of the patients had a history of gastrointestinal disease or of prolonged drug use. We report clinical, laboratory, radiographic, endoscopic, and histopathologic  findings. RESULTS: Clinical findings included abdominal pain and diarrhea of a gradual onset and chronic course. A positive fecal occult blood test and mild anemia were often found. The patients had linear calcifications and stenosis in the right colon, which were discovered by plain abdominal radiography and barium enema, respectively. Endoscopic findings included edematous, dark colored mucosa and ulcerations. Four patients underwent a subtotal colectomy because of persistent abdominal pain or ileus. The histopathologic findings were macroscopically characterized by a dark purple or dark brown colored colonic surface, the swelling and disappearance of plicae semilunares coli, and marked thickening of the colonic wall, while they were microscopically characterized by marked fibrous thickening of the venous walls with calcifications, marked submucosal fibrosis, deposition of collagen in the mucosa, and foamy macrophages within the vessel walls. CONCLUSIONS: These peculiar lesions have not previously been fully described. The cause and pathogenesis still remain unknown. We conclude that such lesions represent a new clinicopathologic disease entity and propose the term "idiopathic mesenteric phlebosclerosis."

7147.      Klaus A, Hinder RA, DeVault KR, Achem SR.   Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course. Am J Med. 2003 Jan;114(1):6-9.

PURPOSE: To evaluate the incidence, severity, and clinical course of postoperative bowel dysfunction, primarily diarrhea, after laparoscopic antireflux surgery. METHODS: Patients who underwent laparoscopic antireflux surgery during January to December 1998 responded to a questionnaire about pre-existing and postoperative bowel symptoms, which included questions about the type of bowel dysfunction (diarrhea, abdominal pain, bloating, constipation), onset in relation to surgery, frequency, severity, duration, use of medical resources or diagnostic evaluations, and treatment outcome. RESULTS: Of the 109 patients who underwent laparoscopic antireflux surgery at our center during the study, 84 (77%) completed the survey. Thirty-six (43%) had no bowel dysfunction before or after surgery, whereas 29 (35%) had pre-existing bowel dysfunction. New bowel symptoms developed postoperatively in 30 patients (36%), including bloating in 16 (19%) and diarrhea in 15 (18%). Two thirds of the patients with new diarrhea developed it within 6 weeks after surgery. The severity of the diarrhea ranged from mild to debilitating; 4 had fecal incontinence. Most patients (13/15) with diarrhea had symptoms for > or =2 years following surgery. No patient was hospitalized, and only 2 patients reported temporary work loss. CONCLUSION: Postoperative bowel dysfunction, namely diarrhea, is an important adverse effect of antireflux surgery. Awareness of this complication should lead to prompt recognition, effective management, and reduction in anxiety.

7148.      Lo W, Sano K, Lebwohl B, Diamond B, Green PH.  Changing presentation of adult celiac disease. Dig Dis Sci. 2003 Feb;48(2):395-8.

The mode of presentation of celiac disease in the United States is not known. We investigated the demographic and clinical features of 227 patients with biopsy-proven celiac disease and determined if there had been changes over time. The patients had been entered into a database; those seen prior to 1990 were retrospectively entered while those seen subsequently were prospectively entered. A "symptomatic" presentation described the "classical" presentation of celiac disease with prominent gastrointestinal symptoms: diarrhea and weight loss. Females were younger and had a longer duration of symptoms compared to males. The modes of presentation were symptomatic (62%), anemia or reduced bone density (15%), screening first-degree relatives (13%), and incidental diagnosis at endoscopy (8%). We compared those diagnosed before and after 1993 (when serologic testing was first used), and noted a reduction in those presenting with diarrhea, 73% vs 43% (P = 0.0001) and a reduction in the duration of symptoms, from 9.0 +/- 1.1 years to 4.4 +/- 0.6 years (P < 0001). In conclusion, the percentage of celiac disease patients presenting with diarrhea has decreased, probably related to the more widespread use of serologic testing for celiac disease.

7149.      Marth T, Raoult D.   Whipple's disease. Lancet. 2003 Jan 18;361(9353):239-46.

Whipple's disease, or intestinal lipodystrophy, is a systemic infectious disorder affecting mostly middle-aged white men. Patients present with weight loss, arthralgia, diarrhoea, and abdominal pain. The disease is commonly diagnosed by small-bowel biopsy; the appearance of the sample is characterised by inclusions in the lamina propria staining with periodic-acid-Schiff, which represent the causative bacteria. Tropheryma whipplei has been classified as an actinomycete and has been propagated in vitro, which allows the possibility of improving diagnostic strategies, for example through antibody-based detection of the bacillus on duodenal tissue or in circulating monocytes. Cell-mediated immunity in active and inactive Whipple's disease has subtle defects that might predispose some individuals to symptomatic infection with this bacillus, which probably occurs ubiquitously. Although most patients respond well to empirical antibiotic treatment, some with relapsing disease have a poor outlook. The recent findings and concerted research might allow development of new strategies for diagnosis, treatment, and monitoring of patients with Whipple's disease.

7150.      Massey V, Gregson DB, Chagla AH, Storey M, John MA, Hussain Z.   Clinical usefulness of components of the Triage immunoassay, enzyme immunoassay for toxins A and B, and cytotoxin B tissue culture assay for the diagnosis of Clostridium difficile diarrhea. Am J Clin Pathol. 2003 Jan;119(1):45-9.

We studied 557 nonduplicate fresh stool specimens from adult patients clinically suspected of having Clostridium difficile-associated diarrhea. All samples were tested in parallel with an in-house cytotoxin B tissue culture assay (CTA), the C DIFFICILE TOX A/B II test (TA/B; TechLab, Blacksburg, VA), and the Triage Micro C DIFFICILE Panel (Biosite Diagnostics, San Diego, CA). The Triage device detects toxin A (TA) and glutamate dehydrogenase (GDH) simultaneously. Of the specimens, 350 were negative and 95 were positive for all markers. Another 112 specimens yielded discrepant results. The CTA found 143 positive specimens. Results of the components of the Triage and TA/B were compared separately with those of CTA. GDH was the most sensitive but least specific marker, whereas TA and TA/B were less sensitive but highly specific. Because of these attributes and a quick turnaround time, GDH would be the best screening test for C difficile-associated diarrhea. CTA detected the highest number of cases of C difficile-associated diarrhea and would be most useful as a confirmatory test for GDH-positive and TA-negative specimens. 

7151.      Parry SD, Stansfield R, Jelley D, Gregory W, Phillips E, Barton JR, Welfare MR.  Is irritable bowel syndrome more common in patients presenting with bacterial gastroenteritis? A community-based, case-control study. Am J Gastroenterol. 2003 Feb;98(2):327-31.

OBJECTIVE: Irritable bowel syndrome (IBS) has been reported to follow infectious diarrhea. Food-borne infections affect 76 million people in the United States and 9.4 million in England per year; of these, only a small percentage of patients see their doctor, and even fewer will have stool culture confirmation. We hypothesized that patients who present to their doctor with gastroenteritis and have positive stool samples may be different from the normal population with regard to their pre-existing bowel symptoms. Our aim was to determine if patients with bacterial gastroenteritis were more likely to have prior IBS, functional dyspepsia, or functional diarrhea, compared with a control population. METHODS: Between January, 2000 and January, 2001, subjects with stool positive bacterial gastroenteritis and control subjects from the same primary care practice were invited to participate. The main outcome measure was the presence of IBS, functional dyspepsia, or functional diarrhea diagnosed using self-report Rome II modular questionnaires. RESULTS: A total of 217 people with recent bacterial gastroenteritis and 265 community controls consented to participate in the study. Of these, 89/217 cases and 46/265 controls had one of the functional GI disorders (OR = 3.3; 95% CI = 2.17-5.00). IBS was present in 67 cases (31%) and 26 controls (10%) (OR = 4.1; 95% CI = 2.49-6.72). There was no statistically significant difference in the presence of prior functional dyspepsia or functional diarrhea. CONCLUSIONS: IBS is more frequent before diagnosis in people with bacterial gastroenteritis presenting to their primary care physician than in community controls. Studies that examine the rate of IBS after bacterial gastroenteritis need to carefully exclude people with prior IBS in a systematic way.

7152.      Pimentel M, Mayer AG, Park S, Chow EJ, Hasan A, Kong Y.  Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003 Jan;48(1):86-92.

It has recently been determined that there is an increased prevalence of bacterial overgrowth in IBS. Since there are two gases (hydrogen and methane) measured on lactulose breath testing, we evaluated whether the different gas patterns on lactulose breath testing coincide with diarrhea and constipation symptoms in IBS and IBD. Consecutive patients referred to the gastrointestinal motility program at Cedars-Sinai Medical Center for lactulose breath testing were given a questionnaire to evaluate their gastrointestinal symptoms. Symptomswere graded on a scale of 0-5. Upon completion of the breath test, the results were divided into normal, hydrogen only, hydrogen and methane, and methane only positive breath tests. A comparison of all subjects and IBS subjects was undertaken to evaluate diarrhea and constipation with regards to the presence or absence of methane. This was further contrasted to Crohn's and ulcerative colitis (UC) patients in the database. After exclusion criteria, 551 subjects from the database were available for comparison. Of the 551 subjects (P < 0.05, one-way ANOVA) and in a subgroup of 296 IBS subjects (P < 0.05, one-way ANOVA), there was a significant association between the severity of reported constipation and the presence of methane. The opposite was true for diarrhea (P< 0.001). If a breath test was methane positive, this was 100% associated with constipation predominant IBS. Furthermore, IBS had a greater prevalence of methane production than Crohn's or UC. In fact, methane was almost nonexistent in the predominantly diarrheal conditions of Crohn's and UC. In conclusion, a methane positive breath test is associated with constipation as a symptom.

7153.      Simren M, Stotzer PO, Sjovall H, Abrahamsson H, Bjornsson ES.   Abnormal levels of neuropeptide Y and peptide YY in the colon in irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2003 Jan;15(1):55-62.

OBJECTIVE: To assess the levels of gut peptides involved in gastrointestinal motor, secretory and sensory function in colonic biopsies in irritable bowel syndrome (IBS) patients and healthy controls. METHODS: We studied 34 patients with IBS and 15 subjects without gastrointestinal symptoms. The predominant bowel pattern in the IBS patients was constipation in 17 patients (IBS-C) and diarrhoea in 17 patients (IBS-D). With radioimmunoassay, the levels of vasoactive intestinal peptide (VIP), substance P, neuropeptide Y (NPY) and peptide YY (PYY) were analysed in biopsies from the descending colon and ascending colon obtained during colonoscopy. RESULTS: The IBS patients had lower levels of PYY in the descending colon than the controls, but the levels in the ascending colon did not differ. The NPY levels were lower in IBS-D than in IBS-C, both in the ascending colon and in the descending colon. Low levels of VIP were more common in IBS patients, but mean levels did not differ between groups. No group differences were observed for substance P. The levels of VIP, substance P and NPY were higher in the ascending colon than in the descending colon, whereas the opposite pattern was seen for PYY. CONCLUSION: IBS patients demonstrate lower levels of PYY in the descending colon than controls. Colonic NPY levels differ between IBS subgroups based on the predominant bowel pattern. These findings may reflect the pathophysiology of IBS and the symptom variation within the IBS population. Copyright 2003 Lippincott Williams & Wilkins

7154.      Singh U K, Rajnit Prasad, Ranjeet Kumar, Jaiswal B P. Management of diarrhoea in practice. Indian J Padiat 2002, 69(8), 687-95. (24049, Vol 38, No. 23, 1 dec 2023)

7155.      Song J, Swekla M, Colorado P, Reddy R, Hoffmann S, Fine S.   Liver abscess and diarrhea as initial manifestations of ulcerative colitis: case report and review of the literature. Dig Dis Sci. 2003 Feb;48(2):417-21. No abstract available.

7156.      Xuan BH, Thi TX, Nguyen ST, Goldfarb DS, Stokes MB, Rabenou RA.   Ichthyotoxic ARF after fish gallbladder ingestion: a large case series from Vietnam. Am J Kidney Dis. 2003 Jan;41(1):220-4.

Fish gallbladders are consumed in rural areas of Asia as a traditional medicine to improve symptoms of arthritis, decreased visual acuity, and impotence. Consumption of large amounts of this traditional medicine can result in systemic toxicities; in particular, acute renal failure. We reviewed records of all admissions to Cho Ray Hospital (Ho Chi Minh City, Vietnam) between January 1995 and December 2000 after this ingestion. Clinical courses and outcomes were similar in 16 of 17 patients. Within hours, patients experienced profuse vomiting (n = 16) and diarrhea (n = 15). All developed acute renal failure, with a mean serum creatinine concentration of 14.7 +/- 3.9 mg/dL (1,299.5 +/- 344.8 micromol/L). Four patients administered intravenous fluid (IVF) developed extracellular fluid volume overload, as did 1 patient not administered IVF. Time to peak creatinine concentration was 8.6 +/- 3.0 days, which was accompanied by decreased urine volume (174.7 +/- 161.6 mL/24 h). Blood pressure remained normal, with a mean arterial pressure of 91 +/- 12 mm Hg. Twelve patients required renal replacement therapy. A mean of 1.9 +/- 1.1 hemodialysis sessions was performed per patient. Sixteen patients recovered renal function; 1 patient died of fulminant hepatic failure. Kidney biopsies showed features of acute tubular injury. Acute renal failure after fish gallbladder ingestion is characterized by a failure to respond to IVF, an 8.6-day interval to peak creatinine level, frequent need for dialysis therapy, and findings on renal biopsy consistent with acute tubular necrosis. Acute renal failure after fish gallbladder ingestion has an excellent prognosis. However, death from fulminant hepatic failure can occur. Copyright 2003 by the National Kidney Foundation, Inc.



7157.      Amo K, Tanaka-Taya K, Inagi R, Miyagawa H, Miyoshi H, Okusu I, Sashihara J, Hara J, Nakayama M, Yamanishi K, Okada S.   Human herpesvirus 6B infection of the large intestine of patients with diarrhea. Clin Infect Dis. 2003 Jan 1;36(1):120-3.

Four patients had severe diarrhea after undergoing stem cell transplantation. Human herpesvirus 6B (HHV-6B) DNA was detected in large intestine tissue specimens and in peripheral blood mononuclear cells. In situ hybridization was positive for HHV-6B DNA in the nuclei of goblet cells and, sometimes, in the histiocytes in the submucous region of the large intestine, which suggests that HHV-6B may infect and reactivate in these cells.

7158.      Brown KH.  Diarrhea and malnutrition. J Nutr. 2003 Jan;133(1):328S-332S.

Publication of the WHO monograph, "Interactions of Nutrition and Infection," in 1968 by Scrimshaw, Taylor and Gordon stimulated many scientists to pursue further research on these issues. With regard to the relationships between diarrhea and malnutrition, the research conducted since 1968 can be categorized in one of three major areas: 1) the impact of diarrhea on nutritional status, particularly in young children; 2) nutritional risk factors for diarrhea; and 3) appropriate dietary therapy for patients during and after enteric infections. The results of these studies have prompted a number of changes in the clinical treatment of patients with diarrhea and in public health policies regarding its prevention.

7159.      Cordonnier C, Buzyn A, Leverger G, Herbrecht R, Hunault M, Leclercq R, Bastuji-Garin S.  Epidemiology and risk factors for gram-positive coccal infections in neutropenia: toward a more targeted antibiotic strategy. Clin Infect Dis. 2003 Jan 15;36(2):149-58.

The objective of this study was to evaluate the risk of acquiring gram-positive coccal infections in febrile neutropenic patients and to develop risk indexes for gram-positive and streptococcal infections. This prospective, multicenter study included 513 patients. The prevalence of gram-positive coccal infections was 21% (14% were staphylococcal infections and 7.8% were streptococcal infections). The mortality rate during the month after study enrollment was 5%. On multivariate analysis, the occurrence of gram-positive coccal infections was significantly associated with receipt of high-dose cytarabine therapy, proton pump inhibitors, and gut decontamination with colimycin without glycopeptides and presence of chills. Staphylococcal infection was significantly associated with use of nonabsorbable colimycin, and streptococcal infection was associated with diarrhea, use of nonabsorbable antifungals, receipt of high-dose cytarabine, and gut decontamination with colimycin. The relative risks for streptococcal infection were 2.9, 13.2, and 20.7 in the presence of 1, 2, and > or =3 parameters, respectively. Risk factors for staphylococcal and streptococcal infections differ among neutropenic patients. A simple scoring system for predicting streptococcal infection is proposed.

7160.      Ilnyckyj A, Balachandra B, Elliott L, Choudhri S, Duerksen DR.  Post-traveler's diarrhea irritable bowel syndrome: a prospective study. Am J Gastroenterol. 2003 Mar;98(3):596-9.

OBJECTIVE: Anecdotal evidence suggests that irritable bowel syndrome (IBS) can develop after an episode of traveler's diarrhea (TD). This observation supports a contemporary paradigm proposed for the etiology of IBS and may have important implications for public health strategies aimed at preventing TD. This study aimed to determine the incidence of IBS in people experiencing TD. METHODS: A total of 109 healthy adults traveling outside of Canada or the United States were identified and enrolled in a prospective, cohort field study. GI symptoms before and after travel were assessed using the Rome I criteria. Travel diaries and questionnaires were used to assess for TD. RESULTS: The incidence of TD in the study cohort was 44%. Among those experiencing TD, the incidence of IBS was 4.2%. In those not experiencing TD, the incidence of IBS post-travel was 1.6% (relative risk = 2.5, 95% CI = 0.2-27.2, p = 0.41, ns). There was no significant difference in the incidence of IBS between the exposed and nonexposed groups. CONCLUSIONS: This study does not support a large association between TD and an increased risk of developing IBS. A small increase in relative risk may have been undetected because of the size of the study.

7161.      Landauer N, Gartner R, Folwaczny C.   A rare but endocrine cause of chronic diarrhea. Am J Gastroenterol. 2003 Jan;98(1):227-8. No abstract available.

7162.      Makino K, Oshima K, Kurokawa K, Yokoyama K, Uda T, Tagomori K, Iijima Y, Najima M, Nakano M, Yamashita A, Kubota Y, Kimura S, Yasunaga T, Honda T, Shinagawa H, Hattori M, Iida T.   Genome sequence of Vibrio parahaemolyticus: a pathogenic mechanism distinct from that of V cholerae. Lancet. 2003 Mar 1;361(9359):743-9.

BACKGROUND: Vibrio parahaemolyticus, a gram-negative marine bacterium, is a worldwide cause of food-borne gastroenteritis. V parahaemolyticus strains of a few specific serotypes, probably derived from a common clonal ancestor, have lately caused a pandemic of gastroenteritis. The organism is phylogenetically close to V cholerae, the causative agent of cholera. METHODS: The whole genome sequence of a clinical V parahaemolyticus strain RIMD2210633 was established by shotgun sequencing. The coding sequences were identified by use of Gambler and Glimmer programs. Comparative analysis with the V cholerae genome was undertaken with MUMmer. FINDINGS: The genome consisted of two circular chromosomes of 3288558 bp and 1877212 bp; it contained 4832 genes. Comparison of the V parahaemolyticus genome with that of V cholerae showed many rearrangements within and between the two chromosomes. Genes for the type III secretion system (TTSS) were identified in the genome of V parahaemolyticus; V cholerae does not have these genes. INTERPRETATION: The TTSS is a central virulence factor of diarrhoea-causing bacteria such as shigella, salmonella, and enteropathogenic Escherichia coli, which cause gastroenteritis by invading or intimately interacting with intestinal epithelial cells. Our results suggest that V parahaemolyticus and V cholerae use distinct mechanisms to establish infection. This finding explains clinical features of V parahaemolyticus infections, which commonly include inflammatory diarrhoea and in some cases systemic manifestations such as septicaemia, distinct from those of V cholerae infections, which are generally associated with non-inflammatory diarrhoea.

7163.      Oncul O, Zarakolu P, Oncul O, Gur D.  Antimicrobial susceptibility testing of Campylobacter jejuni: a comparison between Etest and agar dilution method. Diagn Microbiol Infect Dis. 2003 Jan;45(1):69-71.

The susceptibility of Campylobacter jejuni strains (n = 50) against nine antimicrobials were determined in comparison with Etest (AB BIODISK, Solna, Sweden) and agar dilution method to further investigate the correlation between the two methods. All the strains were isolated from stool samples of patients with diarrhea in 1998 and found to be highly susceptible (>84%) to ampicillin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin and erythromycin. The essential agreement between two methods was 66.6% (+/-1 log(2) dilution) and 85.5% (+/-2 log(2) dilution). The agreement of susceptibility categories was higher at 94.4%.

7164.      Zhang S, Kingsley RA, Santos RL, Andrews-Polymenis H, Raffatellu M, Figueiredo J, Nunes J, Tsolis RM, Adams LG, Baumler AJ.   Molecular pathogenesis of Salmonella enterica serotype typhimurium-induced diarrhea. Infect Immun. 2003 Jan;71(1):1-12. No abstract available.


7165.      Floch MH.  Saccharomyces: is it a probiotic or a pathogen and what is the significance of an elevated anti-S. cerevisiae antibody? J Clin Gastroenterol. 2003 Jan;36(1):5-6. No abstract available.

7166.      Veyradier A, Obert B, Haddad E, Cloarec S, Nivet H, Foulard M, Lesure F, Delattre P, Lakhdari M, Meyer D, Girma JP, Loriat C.   Severe deficiency of the specific von Willebrand factor-cleaving protease (ADAMTS 13) activity in a subgroup of children with atypical hemolytic uremic syndrome. J Pediatr. 2003 Mar;142(3):310-7.

OBJECTIVE: The von Willebrand factor-cleaving protease (VWF-cp) activity has been reported to be deficient in adults with thrombotic thrombocytopenic purpura (TTP) and generally normal in adults with hemolytic uremic syndrome (HUS). The goal of this study was to determine VWF-cp activity in children with typical postdiarrheal (d+) HUS or atypical non-postdiarrheal (d-) HUS.Study design We measured VWF-cp activity in the plasma of 64 children with either (d+) HUS (n = 41) or (d-) HUS (n = 23). RESULTS: In the acute phase of HUS, VWF-cp activity was normal (>50%) in 54 children and undetectable (<5%) in one (d+) HUS and in 6 (d-) HUS children. After a 3-month remission, the (d+) HUS patient recovered a 100% VWF-cp activity, and the 6 (d-) HUS patients kept an undetectable level. In these 6 (d-) HUS patients, the disease was characterized by a neonatal onset and several relapses (hemolytic anemia, thrombocytopenia, transient acute renal failure, cerebral ischemia), and sometimes the development of arterial hypertension or end stage renal failure. CONCLUSION: A subgroup of pediatric patients with atypical (d-) HUS, with hematologic symptoms starting at birth and a recurrent course progressively involving kidney and brain, is related to VWF-cp deficiency and actually corresponds to Upshaw-Schulman syndrome revisited as congenital TTP.


October 2003

7873.  Adsul B, Gandewar K, Airan C, Abhyankar M, Pawar D. Comparative evaluation of efficacy and tolerability of fixed dose combination of ofloxacin-tinidazole against ciprofloxacin-tinidazole against ciprofloxacin-tinidazole in the management of acute infections diarrhoea. Indian med Gaz 2002, 136(8), 309-25. ISA 003630, Vol 39, No 4, 16 Feb 2024

7874.  Akiyoshi DE, Dilo J, Pearson C, Chapman S, Tumwine J, Tzipori S.  Characterization of Cryptosporidium meleagridis of human origin passaged through different host species. Infect Immun. 2003 Apr;71(4):1828-32.


Cryptosporidium meleagridis, a protozoon first observed in turkeys, has been linked by several investigators to cryptosporidiosis in humans. C. meleagridis is the only known Cryptosporidium species that infects both avian and mammalian species. We describe the successful propagation of C. meleagridis (isolate TU1867), originally purified from a patient with diarrhea, in laboratory animals including chickens, mice, piglets, and calves. TU1867 was readily transmitted from one animal host to another, maintaining genetic homogeneity and stability. The rate of infectivity and virulence of TU1867 for the mammalian species were similar to those of Cryptosporidium parvum. Laboratory propagation of genetically and phenotypically stable and well-characterized reference isolates, representing various Cryptosporidium species, particularly those infectious to humans, will improve considerably the spectrum and quality of laboratory and field investigations on this medically important protozoa.

7875.  Andrews CN, Raboud J, Kassen BO, Enns R.  Clostridium difficile-associated diarrhea: predictors of severity in patients presenting to the emergency department. Can J Gastroenterol. 2003 Jun;17(6):369-73.


OBJECTIVE: Experiences with Clostridium difficile-associated diarrhea (CDAD) were reviewed to determine predictors of severity in patients presenting from the community. METHODS: All patients admitted to two hospitals over 4.5 years with a primary diagnosis of CDAD were reviewed. Patients requiring a hospital stay of greater than 14 days, colectomy, intensive care unit admission or who died were classified as 'severe CDAD' and compared with the remainder of the patients (termed 'mild CDAD'). RESULTS: One hundred fifty-three patients (mean age 63.4+/-20.5 years, range 21 to 93, 64.7% female) were reviewed. Forty-four per cent of the patients had community-acquired CDAD, and the remainder had hospital-acquired disease. There were 44/153 (28.8%) patients with severe CDAD, of which 10/153 (6.5%) died. The severe group had more patients over 70 years old (75% versus 43% in the mild group, OR 3.09, CI 1.81-8.63, P<0.001) and had more comorbid disease (median two major organ systems affected [range zero to five] versus one [range zero to four] in the mild group, OR 1.52, CI 1.27-2.65, P<0.05). Patients with recurrent CDAD were more likely to have severe CDAD (12/44 versus 10/109 in the mild group, OR 4.10, CI 1.47-9.40, P<0.01). CONCLUSION: Age over 70 years, comorbid illness and CDAD recurrence are significant risk factors for severe disease and a poor outcome in patients admitted to hospital for CDAD.


7876.  Ayyagari A, Bhargava A, Agarwal R, Mishra SK, Mishra AK, Das SR, Shah R, Singh SK, Pandey A.   Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience. Telemed J E Health. 2003 Spring;9(1):89-94.


Telemedicine (TM) services a process in which expert medical advice from afar is provided using electronic signals to transfer the medical data from one site to another. As a pilot project to assess the efficacy of TM in developing countries like India, a telemedicine center was set up at the main hospital of Mahakumbh mela--a grand religious fair, at Prayag, a city in north India. The daily reporting of the in-patient and outpatient cases at the fair revealed a surge of diarrhea cases among the pilgrims at the fair. This information was communicated to the referral center at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), which, with the help of its microbiology department, conducted microbiological examinations of stool samples and rectal swabs of patients along with various water samples. Vibrio cholerae was isolated in 22.6% (7/31) of the samples. This information was immediately relayed to the Main Hospital at the fair online, and then to the health authorities, who took strict and prompt measures to improve hygiene. Subsequently, the number of diarrhea cases decreased considerably in a matter of a few days, and thus an epidemic disaster was averted, which could have created havoc in such a large gathering.

7877.  Bellanti JA, Zeligs BJ, Malka-Rais J, Sabra A.   Abnormalities of Th1 function in non-IgE food allergy, celiac disease, and ileal lymphonodular hyperplasia: a new relationship? Ann Allergy Asthma Immunol. 2003 Jun;90(6 Suppl 3):84-9.


BACKGROUND: Non-IgE mechanisms may also be involved food allergy (FA). Our group has been studying the immunopathogenesis clinical entities in children with gastro-intestinal symptoms and in whom biopsies of the terminal ileum show lymphoid tissue masses referred to as ileal lymphonodular hyperplasia. Our more recent studies have demonstrated Th1/Th2 cytokine profiles associated with non-IgE FA and other clinical entities. OBJECTIVE: We investigated 12 subjects with non-IgE FA (group 1) and 4 subjects with celiac disease (group 2). Cytokine profiles and immunologic studies of lymphocytes in peripheral blood and from gastro-intestinal biopsy tissues from patients in groups 1 and 2 were also evaluated. METHODS: Group 1 consisted of 12 children with clinical symptoms of anorexia, diarrhea, and abdominal pain. The diagnosis of non-IgE FA was established by positive double-blind, placebo-controlled food challenge and reduced or negative immediate-type skin testing and negative IgE radioallergosorbent tests. Group 2 consisted of four patients with celiac disease and three adult females with biopsy-proven clinical symptoms of  eliac disease. RESULTS: In group 1, peripheral blood CD4 and CD8 lymphocyte distributions were normal, with a predominance of CD4+ cells with a decreased intracellular Th1 cytokine pattern and a normal Th2 intracellular cytokine pattern. In contrast, all four patients in group 2 not only displayed abnormal CD4 and CD8 peripheral blood lymphocyte distributions (CD8 > CD4), but also an abnormal predominance of CD4+ cells with an increased Th1 and a normal Th2 cytokine pattern. A similar abnormal pattern of CD4 > CD8 ratio was observed in intestinal biopsies. All 12 patients in group 1 showed lymphonodular hyperplasia in each of the biopsies and by ileoscopy. CONCLUSIONS: These studies suggest that abnormalities in Th1 function may not only play a role in some patients with non--IgE-mediated FA in whom decreased Th1 function is seen, but also in patients with celiac disease in whom an increased Th1 function is seen. The studies also suggest that lymphonodular hyperplasia may be a hallmark histologic lesion in patients with non--IgE-mediated FA.

7878.  Bhudevi B, Weinstock D.  Detection of bovine viral diarrhea virus in formalin fixed paraffin embedded tissue sections by real time RT-PCR (Taqman). J Virol Methods. 2003 Apr;109(1):25-30.


Real time quantitative RT-PCR (Taqman) identified specifically BVD virus in freshly processed formalin-fixed paraffin-embedded tissue sections and archival samples up to 7 years old. Samples included tissue from both acutely and persistently infected animals. To assess RNA degradation due to tissue handling and processing, freshly collected tissues from a calf persistently infected with BVD virus were stored at 4 degrees C or room temperature for up to 1 week prior to 24 h formalin fixation and routine histologic processing. Samples stored at 4 degrees C for up to a week prior to fixation were positive while samples stored at room temperature were positive at 74 h but became negative after 96 h. Fixation of fresh tissue in formalin for 1 week prior to processing resulted in a mild decrease in signal strength compared with tissue fixed for 24-48 h. Real time RT-PCR improves diagnosis of BVD infection by allowing prospective and retrospective identification of BVD virus in tissues processed routinely and stored for histologic evaluation.

7879.  Carroccio A, Iacono G, Cottone M, Di Prima L, Cartabellotta F, Cavataio F, Scalici C, Montalto G, Di Fede G, Rini G, Notarbartolo A, Averna MR.   Diagnostic accuracy of fecal calprotectin assay in distinguishing organic causes of chronic diarrhea from irritable bowel syndrome: a prospective study in adults and children. Clin Chem. 2003 Jun;49(6 Pt 1):861-7.


BACKGROUND: Fecal calprotectin (FC) has been proposed as a marker of inflammatory bowel disease (IBD), but few studies have evaluated its usefulness in patients with chronic diarrhea of various causes. We evaluated the diagnostic accuracy of a FC assay in identifying "organic" causes of chronic diarrhea in consecutive adults and children. METHODS: We consecutively enrolled 70 adult patients (30 males, 40 females; median age, 35 years) and 50 children (20 males, 30 females; median age, 3.5 years) with chronic diarrhea of unknown origin. All patients underwent a complete work-up to identify the causes of chronic diarrhea. FC was measured by ELISA. RESULTS: In adult patients, FC showed 64% sensitivity and 80% specificity with 70% positive and 74% negative predictive values for organic causes. False-positive results (8 of 40 cases) were associated with the use of aspirin (3 cases) or nonsteroidal antiinflammatory drugs (1 case) and with the presence of concomitant liver cirrhosis (3 cases). False-negative results mainly included patients suffering from celiac disease (5 cases). Patients with IBD (9 cases) were identified with 100% sensitivity and 95% specificity. In pediatric patients, sensitivity was 70%, specificity was 93%, and positive and negative predictive values were 96% and 56%. False-negative results (11 of 35 cases) were associated mainly with celiac disease (6 cases) or intestinal giardiasis (2 cases). CONCLUSIONS: FC assay is an accurate marker of IBD in both children and adult patients. In adults, false negatives occur (e.g., in celiac disease) and false-positive results are seen in cirrhosis or users of nonsteroidal antiinflammatory drugs. Diagnostic accuracy is higher in children.

7880.  Das R, Nath P, Khan Z. correlates of diarrhoea in under five of a rural community and treatment given to them. Indian J prev soc Med 2001, 32(1-2), 62-9. ISA 004560, Vol 39, No 5, 1 Mar 2003.

7881.  de Almeida CM, Quintana-Flores VM, Medina-Acosta E, Schriefer A, Barral-Netto M, Dias da Silva W.  Egg yolk anti-BfpA antibodies as a tool for recognizing and identifying enteropathogenic Escherichia coli. Scand J Immunol. 2003 Jun;57(6):573-82.

7882.  Eliakim R, Fischer D, Suissa A, Yassin K, Katz D, Guttman N, Migdal M.  Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn's disease. Eur J Gastroenterol Hepatol. 2003 Apr;15(4):363-7.


Enteropathogenic Escherichia coli (EPEC) is a major aetiological agent of childhood diarrhoea in developing countries. The structural repeating protein A subunit, BfpA, found in the bundle-forming pilus, is one of the virulent factors for EPEC pathogenesis. Recombinant BfpA in laying hens elicited sustained and vigorous antibody production. Immunoglobulin Y (IgY) anti-BfpA antibodies were recovered from egg yolk, purified and characterized. Immunoadsorption with whole extracts of the isogenic E. coli EPEC adherence factor (EAF) strain that lacks BfpA rendered the resulting IgY preparations capable of: (a) recognizing purified or recombinant BfpA proteins in a dose-dependent fashion; (b) blocking the colonization of HeLa cells by EPEC EAF+, in vitro; (c) specifically identifying E. coli bearing EAF+; and (d) inhibiting the growth of E. coli EAF+ but not the EAF strain. IgY anti-BfpA is potentially useful as a specific, low-cost immunobiological reagent to screen human faecal specimens for the presence of EPEC.

7883.  Fawzi WW, Msamanga GI, Wei R, Spiegelman D, Antelman G, Villamor E, Manji K, Hunter D.  Effect of providing vitamin supplements to human immunodeficiency virus-infected, lactating mothers on the child's morbidity and CD4+ cell counts. Clin Infect Dis. 2003 Apr 15;36(8):1053-62. Epub 2003 Apr 02.


A total of 1078 human immunodeficiency virus (HIV) type 1-infected women from Tanzania were randomized in a placebo-controlled trial using a factorial design to examine the effects of supplementation with vitamin A (preformed vitamin A and beta carotene) and/or multivitamins (vitamins B, C, and E). Supplements were given during pregnancy and lactation. Children of women in the multivitamin arms had a significantly lower risk of diarrhea than did those in the no-multivitamin arm (P=.03). The mean CD4+ cell count was 151 cells/microL higher among children in the multivitamin arms than among those in the no-multivitamin arm (P=.0006). HIV-positive children experienced a benefit apparently similar to that in HIV-negative children (P=.34, by test for interaction). Maternal receipt of vitamin A significantly reduced the risk that the child would have cough with a rapid respiratory rate, a proxy for pneumonia (P=.03), but receipt of vitamin A had no effect on diarrhea or CD4+ cell count. Provision of multivitamin supplements (including those with vitamins B, C, and E) to HIV-infected, lactating women may be a low-cost intervention to improve their children's health.


7884.  Foster AP, Knowles TG, Moore AH, Cousins PD, Day MJ, Hall EJ.  Serum IgE and IgG responses to food antigens in normal and atopic dogs, and dogs with gastrointestinal disease. Vet Immunol Immunopathol. 2003 May 12;92(3-4):113-24.


In human food allergy, with or without concurrent atopy, there may be significant increases in serum allergen-specific IgE. Serological methods have been tried but are not currently recommended for diagnosis of suspected food allergy in dogs. The aim of this study was to investigate humoral immune responses to food antigens in dogs. Serum IgG and IgE antibodies specific for food antigens were measured by enzyme linked immunosorbent assay (ELISA) using polyclonal anti-dog IgG and IgE reagents. Antigens tested were beef, chicken, pork, lamb, chicken, turkey, white fish, whole egg, wheat, soybean, barley, rice, maize corn, potato, yeast and cow's milk. Three groups were examined: normal dogs, dogs with atopic dermatitis (AD); and dogs with one of four types of gastrointestinal (GI) disease: small intestinal bacterial overgrowth (SIBO), inflammatory bowel disease (IBD), food-responsive disease, and infectious diarrhoea. Statistically significant differences in food-specific antibodies were not detected between the GI subgroups. There were statistically significant differences in the IgE concentration between the normal dogs, and dogs with atopic or GI disease, for all of the antigens tested. There were statistically significant differences in the average IgG concentrations between the normal dogs, and dogs with atopic or GI disease, for all of the antigens tested, except egg and yeast. The relationship of antigen responses for pooled data was analysed using principle component analysis and cluster plots. Some clustering of variables was apparent for both IgE and IgG. For example, all dogs (normal and diseased) made a similar IgG antibody response to chicken and turkey. Compared with other groups, atopic dogs had more food allergen-specific IgE and this would be consistent with a Th(2) humoral response to food antigens. Dogs with GI disease had more food allergen-specific IgG compared with the other groups. This may reflect increased antigen exposure due to increased mucosal permeability which is a recognised feature of canine intestinal disease.

7885.                  Giles FJ, Cooper MA, Silverman L, Karp JE, Lancet JE, Zangari M, Shami PJ, Khan KD, Hannah AL, Cherrington JM, Thomas DA, Garcia-Manero G, Albitar M, Kantarjian HM, Stopeck AT.  Phase II study of SU5416--a small-molecule, vascular endothelial growth factor tyrosine-kinase receptor inhibitor--in patients with refractory myeloproliferative diseases. Cancer. 2003 Apr 15;97(8):1920-8.


BACKGROUND: Increased bone marrow angiogenesis and vascular endothelial growth factor (VEGF) levels are of adverse prognostic significance in patients with myeloproliferative disorders (MPD), including agnogenic myeloid metaplasia (AMM), chronic myeloid leukemia in blastic phase (CML-BP), and chronic myelomonocytic leukemia (CMML). VEGF is a soluble, circulating, angiogenic molecule that acts through receptor tyrosine kinases (RTK), including VEGF receptor 2 (VEGFR-2). SU5416 is a small-molecule RTK inhibitor (RTKI) that targets VEGFR-2, c-kit, and fms-related tyrosine kinase Flk2. METHODS: Adult patients with advanced CMML, AMM, CML-BP, or other BCR-ABL negative MPD were entered on a multicenter, Phase II study. RESULTS: Thirty-two patients (19 patients with BCR-ABL negative MPD, 6 patients with CMML, 4 patients with CML-BP, and 3 patients with AMM) with a median age of 66 years (range, 29-85 years) received SU5416 145 mg/m(2) twice weekly intravenously for a median of three 4-week cycles (maximum, 12 cycles). Drug-related Grade 3-4 toxicities included acute abdominal pain (13%), bone pain (9%), infusion-related dyspnea (9%) or headache (6%), fatigue (6%), diarrhea (3%), and catheter site reactions (3%). Eleven patients (34%) did not receive a second cycle of therapy (6 patients had progressive disease, 3 because of adverse events; 2 patients withdrew due to lack of response). One patient with AMM achieved a partial response. Eight patients received more than 6 months of therapy. CONCLUSIONS: SU5416 had minimal clinical activity in patients with MPD. Long-term administration of a twice-weekly, hyperosmolar, intravenous solution containing polyoxyl 35 castor oil was difficult. More tolerable RTKI may be worthy of further investigation in patients with MPD. Copyright 2003 American Cancer Society.

7886.  Hollerweger A, Macheiner P, Brunner W.  Suspicion of microscopic colitis raised by sonographic examination. J Clin Ultrasound. 2003 May;31(4):207-10.


This report describes the case of a 57-year-old woman who was incidentally identified as having lymphocytic colitis after she underwent routine transabdominal sonographic examination. She initially reported having no irregularities in her bowel movements. Sonography revealed the following nonspecific findings: watery stool in the entire colon, slight thickening of the hypoechoic mucosal layer and moderate thickening of the hyperechoic submucosal layer of the colon, and no pathologic findings in the small intestine. On additional questioning, the patient said that she had had watery diarrhea for the last 10 years, with as many as 10 bowel movements daily. Endoscopic examination and biopsy were performed. Histopathologic examination of biopsy specimens showed lymphocytic infiltration of the mucosa and some collagen deposits, consistent with a diagnosis of lymphocytic colitis. Treatment was begun with loperamide, sulfasalazine, and budesonide. Within 3 weeks of the start of treatment, the number of bowel movements decreased to 1-2 daily. Follow-up sonography at that time revealed normalization of the bowel contents and disappearance of the thickened submucosal layer of the colon. Nonspecific sonographic findings like those in this case lead to the need to rule out various diseases through further appropriate evaluations to identify the correct diagnosis. Copyright 2003 Wiley Periodicals, Inc. 31:207-210, 2003

7887.  Houghton LA, Atkinson W, Whitaker RP, Whorwell PJ, Rimmer MJ.  Increased platelet depleted plasma 5-hydroxytryptamine concentration following meal ingestion in symptomatic female subjects with diarrhoea predominant irritable bowel syndrome. Gut. 2003 May;52(5):663-70.


BACKGROUND: Meal ingestion is often associated with exacerbation of gastrointestinal symptoms in subjects with irritable bowel syndrome (IBS). Furthermore, recent preliminary data suggest that 5-hydroxytryptamine (5-HT) concentration in platelet poor plasma is elevated following meal ingestion in some subjects with diarrhoea predominant IBS (d-IBS) compared with healthy subjects, although it is not known whether this is related to postprandial symptomatology. Aim: To expand on previous data by evaluating a larger number of subjects but also to assess plasma 5-hydroxyindole acetic acid (5-HIAA) concentrations, 5-HT turnover, platelet 5-HT stores, and any relationship to symptomatology. METHODS: We assessed platelet depleted plasma 5-HT and 5-HIAA concentrations for two hours (60 minute intervals) under fasting conditions, and then for a further four hours (30 minute intervals) after a standard carbohydrate meal (457 kcal), together with fasting platelet 5-HT concentrations in 39 female subjects with d-IBS (aged 19-52 years; mean age 33) and 20 healthy female volunteers (aged 20-46 years, mean age 28). IBS symptomatology, in particular abdominal pain and bloating, and urgency to defecate were assessed throughout the study RESULTS: When related to fasting levels, there was no statistically significant difference in postprandial plasma 5-HT concentrations between d-IBS and healthy subjects. However, when fasting levels were not taken into consideration, d-IBS subjects exhibited higher postprandial plasma 5-HT concentrations compared with healthy subjects (p=0.040). Furthermore, d-IBS subjects who exhibited postprandial symptomatology had higher levels of postprandial plasma 5-HT, whether assessed with respect to fasting baseline levels (p=0.069) or not (p=0.047), compared with d-IBS subjects who did not report postprandial symptomatology. This appeared to be associated with a concomitant increase in plasma 5-HIAA (p=0.161) but reduction in turnover (p=0.058). Lastly, d-IBS subjects had higher platelet concentrations of 5-HT than healthy subjects (p=0.009). CONCLUSIONS: These data suggest that postprandial symptomatology may be associated with increased platelet depleted plasma 5-HT concentrations in female subjects with d-IBS. In addition, the presence of increased platelet stores of 5-HT may act as a useful marker for the diagnosis and management of d-IBS.

7888.  Jacobson M, Englund S, Ballagi-Pordany A.  The use of a mimic to detect polymerase chain reaction-inhibitory factors in feces examined for the presence of Lawsonia intracellularis. J Vet Diagn Invest. 2003 May;15(3):268-73.


Lawsonia intracellularis is an intracellular organism that causes proliferative enteritis in pigs. This bacterium is difficult to culture, and antemortem demonstration of the microbe is therefore often performed on fecal samples by polymerase chain reaction (PCR). Polymerase chain reaction is sensitive and specific, but inhibitory factors in feces might cause false-negative results. This article describes the construction and use of an internal standard, a mimic. The mimic is amplified by the same primers as those used for L. intracellularis DNA and thus could indicate false-negative results in clinical samples. The amplicon was clearly visible when as few as 10 mimic molecules were added per amplification reaction and when no inhibitors werepresent. When fecal samples were spiked with the mimic, the detection limit was 10(2) molecules per PCR. Sixty clinical samples, 20 from wild boars, 20 from growing pigs with diarrhea, and 20 from pigs without diarrhea, were prepared by a boiling procedure and subjected to PCR together with 10(3) mimic molecules. Nine samples were positive, of which 7 originated from pigs with diarrhea and 2 from pigs without diarrhea. In 14 samples from wild boars, in 8 samples from pigs without diarrhea, and in 3 samples from pigs with diarrhea, neither the mimic nor the target DNA was visible. This indicated the presence of inhibitors in these samples. It is concluded that the mimic can be used as an internal control in the diagnosis of L. intracellularis to indicate inhibition of PCR.

7889.  Keizman D, Brill S, Umansky M, Rattan Y, Hallak A, Halpern Z, Konikoff FM.   Diagnostic yield of routine push enteroscopy with a graded-stiffness enteroscope without overtube. Gastrointest Endosc. 2003 Jun;57(7):877-81.


BACKGROUND: Push enteroscopy has become a standard procedure for evaluation of small intestinal disorders. Its diagnostic yield and acceptability, however, has been hampered by the use of an overtube, which is both inconvenient and potentially hazardous. This study assessed the clinical value of enteroscopy with a graded-stiffness videoenteroscope without an overtube. METHODS: A total of 121 consecutive patients (mean age 59 years, range 12-89 years) underwent diagnostic enteroscopy. All procedures (n = 126) were performed with a push-type graded-stiffness videoenteroscope without an overtube. Indications were the following: unexplained iron deficiency anemia (45%), GI bleeding (29%), abdominal pain (6%), malabsorption (5.5%), imaging abnormality (5.5%), diarrhea (4%), intestinal obstruction (3%), and vomiting (2%). RESULTS: The mean depth of instrument insertion distal to the pylorus was 121 cm. A diagnosis was made in 40% of all procedures. The findings included ulcerations or erosions in 43%, angioectasia in 35%, inflammation in 14%, tumors in 6%, and varices in 2%. In all cases of a positive enteroscopic diagnosis, therapeutic maneuvers were performed, and no patient needed a further diagnostic procedure. Patient comfort was good. No complications were observed. CONCLUSIONS: Routine enteroscopy with a graded-stiffness enteroscope without an overtube is safe and comfortable for the patient and the endoscopist, and has a clinical efficacy comparable with that reported for enteroscopy with use of an overtube. A prospective, randomized study is warranted to assess the exact role of this form of enteroscopy in patient care.

7890.  Lee JB, Youn SJ, Nakagomi T, Park SY, Kim TJ, Song CS, Jang HK, Kim BS, Nakagomi O.  Isolation, serologic and molecular characterization of the first G3 caprine rotavirus. Arch Virol. 2003 Apr;148(4):643-57.


We isolated a rotavirus in cell culture, named the GRV strain, from a stool specimen of a Korean goat with diarrhea, and performed an in-depth characterization. At various passage levels in cell culture, the GRV strain retained its pathogenicity for goat kids, thereby for the first time establishing that a caprine rotavirus can cause diarrhea in goat kids. The GRV strain grew to a high titer and agglutinated group O human erythrocytes. The GRV VP7 protein was 96% identical with the RRV (simian rotavirus) and R2 (lapine rotavirus) VP7 proteins, and slightly less similar to the SA11 (simian rotavirus) and HCR3 (feline/canine-like human rotavirus) VP7 proteins. The GRV VP4 protein was 93% identical with the RRV VP4 (P[3]) and 90% identical with the SA11 VP4 (P[2]). However, phylogenetic analysis including more VP4 sequences from representative P[3] strains unambiguously placed the GRV VP4 in the cluster of P[3] VP4s. A high level of two-way cross neutralization with RRV substantiated that GRV was a G3P5[3] strain, thus identifying GRV as the first caprine rotavirus with such a phenotype. The GRV NSP4 sequence belonged to the AU-1 allele, as does the RRV NSP4 sequence. Genetic analysis by RNA-RNA hybridization revealed that the overall genomic RNA constellation of the GRV strain was unique among mammalian rotavirus genogroups and that it was almost equally related to, yet distant from, simian rotavirus RRV, feline/canine rotavirus FRV64 (or CU-1), feline/human rotavirus FRV-1 (or AU-1), and lapine rotavirus R2. The availability of the GRV strain will further expand our limited knowledge of caprine rotaviruses.

7891.  Lin S, Branch MS, Shetzline M.  The importance of indication in the diagnostic value of push enteroscopy. Endoscopy. 2003 Apr;35(4):315-21.


BACKGROUND AND STUDY AIMS: Small-bowel enteroscopy (SBE) is frequently used to examine patients suspected of small-bowel disease. Unfortunately, the diagnostic yield varies widely, from 13 % to 78 % of cases. This disparity may be in part attributable to the vast array of indications for the use of the procedure. The purpose of this study was to examine the diagnostic yield of small-bowel enteroscopy for various indications. PATIENTS AND METHODS: This is a retrospective cohort study of all patients who underwent SBE over a 5-year period, from 1995 to 1999. RESULTS: The indications were grouped into in-patient gastrointestinal blood loss (46% of the patient population), outpatient gastrointestinal blood loss (33 %), abnormal radiographic study (7%), iron-deficiency anemia (5%), and others (9%, defined as anemia not otherwise specified, abdominal pain, nausea and vomiting, diarrhea, and weight loss). The overall diagnostic yield was 42 %. Gastrointestinal bleeding had the highest yield, at 44% (in-patient gastrointestinal blood loss 51%, outpatient gastrointestinal blood loss 40%; P=0.1314). Patients with iron-deficiency anemia had a yield of 42%, and patients with a previous abnormal radiograph had a yield of 41%. The combined diagnostic yield for the indications in the "other" category was 21% --significantly lower than in patients with gastrointestinal bleeding, abnormal radiographs, and iron deficiency (P=0.049). CONCLUSIONS: SBE is safe and useful in the evaluation of small-bowel disease. Although the overall yield is highly dependent on the specific indication, it is effective for patients with in-patient or outpatient gastrointestinal blood loss, patients with abnormal radiographs that demonstrate small-bowel pathology considered to be within reach of the enteroscope, and iron-deficiency anemia. There are insufficient data to support the use of enteroscopy for other indications such as anemia not otherwise specified, abdominal pain, nausea and vomiting, and chronic diarrhea, and in these cases it is unlikely to be useful.

7892.  Ly Q, Runzi M, Menzel J, Rehbehn KU, Zimmermann A, Buchler MW, Friess H.  Pancreatic Intraductal Ultrasonography (IDUS) Allows Early Diagnosis of Pancreatic Carcinoma in Situ: A Case Report. Endoscopy. 2003 Jun;35(6):534-7.


A 66-year-old woman was admitted with diarrhea, weight loss, slight recurrent abdominal pain, and raised serum amylase and lipase. Lactose intolerance was diagnosed, and treatment was begun. The symptoms diminished. However, slight back pain and elevated serum amylase and lipase levels persisted. A pancreatic tumor was then suspected. Ultrasound, spiral computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) examinations were inconclusive. Endoscopic retrograde cholangiopancreatography (ERCP) showed a slight narrowing of the pancreatic duct within the pancreatic body, and endoscopic ultrasound (EUS) revealed a 10 mm intrapancreatic lesion. Finally, intraductal ultrasonography (IDUS) reliably identified a small  pancreatic tumor. The tumor was resected, and histology confirmed a well-differentiated adenocarcinoma in situ (UICC stage 0, TisN0M0). This case shows that using high-resolution imaging techniques such as EUS plus IDUS, small malignant pancreatic lesions can be detected at an early stage, when curative action is possible.

7893.  Mbonu CC, Davison DL, El-Jazzar KM, Simon GL.  Clostridium difficile colitis associated with Hemolytic-Uremic syndrome. Am J Kidney Dis. 2003 May;41(5):E14.


The authors report the case of a 46-year-old woman who presented with vomiting and profuse bloody diarrhea. Laboratory studies were significant for a hematocrit of 27% and lactate dehydrogenase of 5,394 U/L (5,394 U/L). Her renal function deteriorated rapidly with a peak creatinine of 12.4 mg/dL (1,096.4 &mgr;mol/L), and platelet count dropped simultaneously to a nadir of 123,000/&mgr;L (123 x 10(9)/L]. Schistocytes were observed in peripheral blood smear. Stool was positive for Clostridium difficile toxin A by enzyme immunoassay (EIA). Stool assay for Shiga-like toxin was negative by EIA, and stool cultures returned negative for Escherichia coli O157:H7 and other enteric pathogens. A diagnosis of C difficile colitis associated with hemolytic-uremic syndrome was made; the patient received plasmapheresis and recovered with no relapse after 10 months of follow-up. This is the second reported case of C difficile colitis associated with hemolytic-uremic syndrome in an adult.

7894.  McLauchlin J, Amar CF, Pedraza-Diaz S, Mieli-Vergani G, Hadzic N, Davies EG.   Polymerase chain reaction-based diagnosis of infection with Cryptosporidium in children with primary immunodeficiencies. Pediatr Infect Dis J. 2003 Apr;22(4):329-35.


BACKGROUND: Patients with deficient cell-mediated immunity are prone to chronic biliary tract infection with Cryptosporidium, which can lead to the development of sclerosing cholangitis and acute cryptosporidiosis after bone marrow transplantation (BMT). The organism is very difficult to detect during asymptomatic periods. METHODS: PCR techniques were compared with standard microscopy for detecting the organism in such patients. Amplification targets were two fragments of the 18S ribosomal RNA gene (unnested) and part of the Cryptosporidium oocyst wall protein gene (nested and unnested). Twenty eight-patients with primary immunodeficiencies were studied including: CD40 ligand deficiency (13); undefined combined immunodeficiency (10); major histocompatibility complex II deficiency (2); and other defects (3). Samples analyzed included stool, bile and liver tissue. RESULTS: Of 25 patients tested prospectively, Cryptosporidium could be detected by PCR but not by microscopy in 12, only 3 of whom had a known history of infection. Five of this group had sclerosing cholangitis. Nine of the PCR-positive patients subsequently underwent BMT and 5 developed acute posttransplant diarrhea and cholangiopathy associated with Cryptosporidium excretion. Of the 13 PCR-negative patients, 3 had cholangiopathy (sclerosing cholangitis in 1 and minor changes in 2). Four of these underwent BMT and none developed cryptosporidiosis. In 3 patients, studied only after developing post-BMT cholangiopathy and diarrhea, Cryptosporidium was detected by PCR but not by microscopy. Genotyping and sequencing showed multiple types of Cryptosporidium in approximately one-third of positive cases. CONCLUSIONS: These results indicate that PCR-based procedures are more sensitive than microscopy for detecting Cryptosporidium in patients with immunodeficiencies.

7895.  Ngeleka M, Pritchard J, Appleyard G, Middleton DM, Fairbrother JM.  Isolation and association of Escherichia coli AIDA-I/STb, rather than EAST1 pathotype, with diarrhea in piglets and antibiotic sensitivity of isolates. J Vet Diagn Invest. 2003 May;15(3):242-52.


To identify emerging Escherichia coli that have the potential to cause diarrhea in pigs, the prevalence of E. coli pathotypes was determined among 170 and 120 isolates from diarrheic and nondiarrheic piglets, respectively. The isolates were tested for F4, F5, F6, F18, and F41 fimbriae, for E. coli attaching and effacing (EAE), porcine attaching and effacing-associated (Paa), and adhesin involved in diffuse adherence (AIDA-I) factors, for LT, STa, STb, and enteroaggregative heat-stable (EAST1) enterotoxins, and for Shiga toxins (Stxl, Stx2, and Stx2e), using DNA hybridization and polymerase chain reaction. All isolates were O-serotyped and tested for antibiotic resistance against 10 drugs. Seventeen different pathotypes, accounting for 40.0% of the isolates, were recovered from diarrheic piglets. The main pathotypes included EAST1 (13.5%), F4/LT/STb/EAST1 (6.5%), AIDA-I/STb/EAST1 (4.1%), F5/STa (2.9%), EAE/EAST1 (2.9%), and AIDA-I/F18 (2.3%). Only 3 pathotypes, EAE (11.7%), EAST1 (10.8%), and EAE/EAST1 (3.3%), were recovered from nondiarrheic piglets. Paa factor was detected in 8.8% and 7.5% of isolates from diarrheic and nondiarrheic piglets, respectively, and always was associated with other virulence determinants. Overall, 22.9% of isolates from diarrheic piglets appeared to be enteropathogens: enterotoxigenic E. coli (11.7%), enteropathogenic E. coli (3.5%), and E. coli isolates (3.0%) for which none of the above adherence factors was detected. Pathotypes AIDA-I/STb/EAST1 and AIDA-I/STb were isolated only from diarrheic piglets and accounted for 4.7% of isolates. Strains of these pathotypes induced diarrhea when inoculated into newborn colostrum-deprived pigs, in contrast to an isolate positive only for EAST1, which did not induce diarrhea. Antibiotic sensitivity test showed that isolates of the AIDA-I/STb/EAST1 and AIDA-I/STb pathotypes were the only strains sensitive to enrofloxacin, gentamicin, neomycin, and trimethoprim-sulfamethoxazole. This study showed that at least 20.5% of isolates from diarrheic piglets appeared to be associated with AIDA-I/STb pathotype and that EAST1 pathotype is probably not an important marker for diarrhea in piglets.

7896.  Rusynyk RA, Ghosh MS, Babameto GP, Grundfast MB. Endoscopic diagnosis of Waldenstrom's macroglobulinemia masquerading as chronic diarrhea. Gastrointest Endosc. 2003 May;57(6):800-1. No abstract.

7897.  Somers SC, Lembo A.  Irritable bowel syndrome: evaluation and treatment. Gastroenterol Clin North Am. 2003 Jun;32(2):507-29.


Irritable bowel syndrome is a common gastrointestinal disorder characterized by abdominal pain, bloating, and disturbed defecation in the absence of other medical conditions with similar presentations. Because physical findings and currently available diagnostic tests lack sufficient specificity for clinical use, the diagnosis of IBS is based on characteristic symptoms as outlined in several symptom-based criteria for IBS. When used in combination with a detailed history, physical examination, and limited diagnostic testing, these criteria are a valid method of diagnosing IBS. Once a confident diagnosis of IBS has been made, treatment of IBS should be based on the predominant symptom while taking into account the severity of symptoms and the degree of functional impairment both physically and psychologically. Most patients with IBS have mild symptoms and education, reassurance, dietary and lifestyle changes, and a therapeutic physician-patient relationship form the backbone of treatment. A smaller number of patients have moderate symptoms, which are typically intermittent, but may at times interrupt their normal activities. In addition to dietary and lifestyle modifications, pharmacologic intervention based on the predominant symptom (diarrhea, constipation, or pain) may be used to relieve symptoms. Finally, a small subset of patients has severe or intractable symptoms. These patients, often seen in tertiary referral centers, often have constant pain symptoms and psychosocial impairments. A multidisciplinary approach including pharmacologic treatments, psychologic treatments, and possibly a mental health or pain center involvement may be beneficial.


7898.  Ali NS, Zuberi RW.  Association of iron deficiency anaemia in children of 1-2 years of age with low birth weight, recurrent diarrhoea or recurrent respiratory tract infection—a myth or fact? J Pak Med Assoc. 2003 Apr;53(4):133-6.

7899.  Givens MD, Heath AM, Brock KV, Brodersen BW, Carson RL, Stringfellow DA.   Detection of bovine viral diarrhea virus in semen obtained after inoculation of seronegative postpubertal bulls. Am J Vet Res. 2003 Apr;64(4):428-34.

7900.  Gunson RN, Mackie P, Leanord A, Carman WF.  First rotavirus, now astrovirus: the evolving benefits of RT-PCR. Commun Dis Public Health. 2003 Apr;6(1):66-7.

7901.  Hoet AE, Nielsen PR, Hasoksuz M, Thomas C, Wittum TE, Saif LJ.  Detection of bovine torovirus and other enteric pathogens in feces from diarrhea cases in cattle. J Vet Diagn Invest. 2003 May;15(3):205-12.

7902.  Ide T, Michgehl S, Knappstein S, Heusipp G, Schmidt MA.  Differential modulation by Ca2+ of type III secretion of diffusely adhering enteropathogenic Escherichia coli. Infect Immun. 2003 Apr;71(4):1725-32.

7903.  Jones RW, Ross J, Hoshino Y.  Identification of parental origin of cognate dsRNA genome segment(s) of rotavirus reassortants by constant denaturant gel electrophoresis. J Clin Virol. 2003 Apr;26(3):347-54.

7904.  Jores J, Zehmke K, Eichberg J, Rumer L, Wieler LH.  Description of a novel intimin variant (type zeta) in the bovine O84:NM verotoxin-producing Escherichia coli strain 537/89 and the diagnostic value of intimin typing. Exp Biol Med (Maywood). 2003 Apr;228(4):370-6.

7905.  McLauchlin J, Amar CF, Pedraza-Diaz S, Mieli-Vergani G, Hadzic N, Davies EG.  Polymerase chain reaction-based diagnosis of infection with Cryptosporidium in children with primary immunodeficiencies. Pediatr Infect Dis J. 2003 Apr;22(4):329-35.

7906.  Peters IR, Helps CR, Batt RM, Day MJ, Hall EJ.  Quantitative real-time RT-PCR measurement of mRNA encoding alpha-chain, pIgR and J-chain from canine duodenal mucosa. J Immunol Methods. 2003 Apr 1;275(1-2):213-22.

7907.  Smeds A, Pertovaara M, Timonen T, Pohjanvirta T, Pelkonen S, Palva A.   Mapping the binding domain of the F18 fimbrial adhesin. Infect Immun. 2003 Apr;71(4):2163-72.

7908.  Wei J, Goldberg MB, Burland V, Venkatesan MM, Deng W, Fournier G, Mayhew GF, Plunkett G 3rd, Rose DJ, Darling A, Mau B, Perna NT, Payne SM, Runyen-Janecky LJ, Zhou S, Schwartz DC, Blattner FR.   Complete genome sequence and comparative genomics of Shigella flexneri serotype 2a strain 2457T. Infect Immun. 2003 May;71(5):2775-86.


7909.  Jones RW, Ross J, Hoshino Y.  Identification of parental origin of cognate dsRNA genome segment(s) of rotavirus reassortants by constant denaturant gel electrophoresis. J Clin Virol. 2003 Apr;26(3):347-54.


Rotaviruses are the single most important etiologic agents of severe diarrhea in infants and young children worldwide. They possess a triple capsid morphology and a genome of 11 segments of double-stranded (ds) RNA. During the course of the development of various live, attenuated reassortant rotavirus vaccines, we often experienced difficulty in identifying the parental origin of certain genome segment(s) of a reassortant vaccine candidate. Various assays have been utilized for determination of the parental origin of reassortant virus genes, including polyacrylamide gel electrophoresis (PAGE), DNA and/or RNA hybridization assays and gene sequence analysis. The traditional PAGE is simple and easy to perform, however, it is common to find that certain cognate dsRNA segment(s) cannot be differentiated by this assay due to a high degree of sequence homology among different rotavirus strains. Constant denaturant gel electrophoresis (CDGE) is one of several methods that have been used to screen DNA fragments for small sequence changes or point mutations. By using the CDGE, we were successful in partially denaturing rotavirus dsRNA thereby changing the physical properties of the genome segment(s) in the gel and thus differentiating the cognate genome segment(s) of rotavirus reassortants. The CDGE provides a simple and reliable assay system for identification of parental gene origins of a rotavirus reassortant.


7910.  Kozelsky TF, Meyers GE, Sloan JA, Shanahan TG, Dick SJ, Moore RL, Engeler GP, Frank AR, McKone TK, Urias RE, Pilepich MV, Novotny PJ, Martenson JA; North Central Cancer Treatment Group.  Phase III double-blind study of glutamine versus placebo for the prevention of acute diarrhea in patients receiving pelvic radiation therapy. J Clin Oncol. 2003 May 1;21(9):1669-74.


PURPOSE: A phase III, randomized, double-blind study was conducted by the North Central Cancer Treatment Group to determine the efficacy and toxicity of oral glutamine for the prevention of acute diarrhea in patients receiving pelvic radiation therapy (RT). PATIENTS AND METHODS: All 129 patients enrolled from 14 institutions between February 1998 and October 1999 were eligible. Patients received 4 g of glutamine or placebo orally, twice a day, beginning with the first or second day of RT and continuing for 2 weeks after RT. During treatment, patients were assessed weekly for toxicity, and a bowel function questionnaire was administered. The primary measures of treatment efficacy were diarrhea levels measured by maximum grade of diarrhea, incidence of diarrhea, and average diarrhea score. After completion of RT, the bowel function questionnaire was administered weekly for 4 weeks and at 12 and 24 months. Toxicity was measured by National Cancer Institute common toxicity criteria. RESULTS: The median age of patients was 69 years (range, 34 to 86 years). The two treatment arms were balanced with respect to all baseline factors. There were no significant differences in toxicity by treatment. Quality-of-life scores and the mean number of problems reported on the bowel function questionnaire were virtually identical for both treatment groups. The incidence of grade 3 or higher diarrhea was 20% for the glutamine arm and 19% for the placebo arm (P =.99). The maximum number of stools per day was 5.1 for the glutamine arm and 5.2 for the placebo arm (P =.99). CONCLUSION: There is no evidence of a beneficial effect of glutamine during pelvic RT.

7911.  Licitra EJ, Vyas V, Nelson K, Musanti R, Beers S, Thomas C, Poplin E, Smith S, Lin Y, Schaaf LJ, Aisner J, Gounder M, Rajendra R, Saleem A, Toppmeyer D, Rubin EH.  Phase I evaluation of sequential topoisomerase targeting with irinotecan/cisplatin followed by Etoposide in patients with advanced malignancy. Clin Cancer Res. 2003 May;9(5):1673-9.


PURPOSE: To investigate pharmacologically guided addition of etoposide to a weekly irinotecan/cisplatin chemotherapy. PATIENTS AND METHODS: Patients with advanced nonhematologic malignancies were eligible. Treatment consisted of i.v. administration of 50 mg/m(2) irinotecan and 20 mg/m(2) cisplatin on days 1, 8, 15, and 22 of a 42-day cycle or on days 1 and 8 of a 21-day cycle. Etoposide was administered in a dose-escalating fashion 2 days after each dose of irinotecan/cisplatin, either i.v. as a single dose or p.o. as two doses administered 12 h apart. Pharmacologic analyses included measurement of plasma concentrations of irinotecan, SN-38, and SN-38 glucuronide, as well as quantitation of topoisomerase protein levels in peripheral blood mononuclear cells (PBMNCs). RESULTS: A total of 40 patients with a variety of malignancies received 122 cycles of therapy. Dose-limiting toxicities included neutropenia and diarrhea, with the 21-day cycle tolerated better than the 42-day cycle. For the 21-day cycle, the maximum tolerated dose was 75 mg/m(2) for i.v. etoposide and 85 mg/m(2) for oral etoposide. Objective responses were observed in four patients with previously treated mesothelioma, gastric, breast, and ovarian cancer, respectively. PBMNC levels of topoisomerase IIalpha were increased at the time of etoposide administration in two patients, with these patients having the highest SN-38 glucuronide peak-plasma-concentration and area-under-the-curve values among 15 patients with available pharmacokinetic data. One of these patients had a partial response to therapy. CONCLUSIONS: Pharmacologically guided administration of etoposide in combination with irinotecan/cisplatin using a 21-day cycle is associated with acceptable toxicity and significant antitumor activity. The finding that PBMNC topoisomerase IIalpha protein levels increased after irinotecan/cisplatin treatment in two of six patients supports the continued development of sequential topoisomerase targeting in the treatment of malignancy.

7912.  Luong TV.  De-worming school children and hygiene intervention. Int J Environ Health Res. 2003 Jun;13 Suppl 1:S153-9.


Helminths or worm infestations refer to worms that live as parasites in the human body and are a fundamental cause of disease associated with health and nutrition problems beyond gastrointestinal tract disturbances. Globally, over 3.5 billion people are infected with intestinal worms, of which 1.47 billion are with roundworm, 1.3 billion people with hookworm and 1.05 billion with whipworm. School children aged 5 - 15 years suffer the highest infection rate and worm burden that attributes to poor sanitation and hygiene. About 400 million school-age children are infected with roundworm, whipworm and hookworm worldwide, a large proportion of whom are found in the East Asia region (Cambodia, China, Lao PDR, Thailand and Vietnam). These parasites consume nutrients from children they infect, thus retarding their physical development. They destroy tissues and organs, cause abdominal pain, diarrhoea, intestinal obstruction, anaemia, ulcers and other health problems. All of these consequences of infection can slow cognitive development and thus impair learning. De-worming school children by anthelmintic drug treatment is a curative approach for expelling the heavy worm load. However, drug therapy alone is only a short-term measure of reducing worm infection and re-infection is frequent. Control measures through improved sanitation, hygiene and de-worming are needed to prevent infection and re-infection. UNICEF has supported many governments in this (and other) regions to assist in the provision of water supply and sanitary facilities and intensive hygiene education in many schools through the Water, Environment and Sanitation (WES) programme. The UNICEF supported school sanitation and hygiene education (SSHE) programme, and other programmes, could effectively enhance behaviour change in children to break the routes of worm transmission and other waterborne diseases.

7913.  Ooi BS, Seow-Choen F.  Endoscopic view of rectal amebiasis mimicking a carcinoma. Tech Coloproctol. 2003 Apr;7(1):51-3.


We report the case of a 45-year-old man with rectal amebiasis, presenting with rectal bleeding and chronic diarrhea, confirmed on rectal biopsy. The endoscopic view was highly suggestive of a carcinoma and caused confusion about its etiology. The striking difference in the endoscopic view before and after medical therapy of the tumor-like lesion was remarkable. This case illustrates the importance of an accurate histologic diagnosis before definitive treatment and highlights the mimicry of rectal carcinoma by rectal amebiasis on endoscopy.

7914.  Talley NJ.  Pharmacologic therapy for the irritable bowel syndrome. Am J Gastroenterol. 2003 Apr;98(4):750-8.

The management of the irritable bowel syndrome (IBS) remains unsatisfactory. For abdominal pain, antispasmodics are, at best, of only modest efficacy. Tricyclic antidepressants in low dose are useful (with the number needed to treat being three), but side effects and patient concerns regarding use of a centrally acting agent for depression remain limitations. Selective serotonin reuptake inhibitors are of uncertain efficacy in IBS. Opioid agonists, especially loperamide, are useful for diarrhea but not for pain in IBS; rebound constipation also remains a problem. Bile salt sequestering agents are not of established value in IBS but seem to be useful clinically in a small group of IBS patients with diarrhea. Aloestron, a 5HT(3) antagonist, should be reserved, if available, for women with severe diarrhea predominant IBS who have failed to respond to conventional therapy, and started at a low dose. Fiber and bulking agents may help constipation in some trials, but the evidence that they are efficacious in IBS is equivocal; they are frequently prescribed as first-line drugs for IBS regardless of the primary bowel disturbance but often increase bloating, gas, and pain. Laxatives are not of established value in IBS but are often taken by patients with constipation predominant IBS. Tegaserod, a partial 5HT(4) agonist, is now available in the United States and other countries for use in women with IBS whose primary bowel symptom is constipation; its efficacy in men and in those with alternating bowel habits is unknown. Probiotics are of uncertain efficacy. Chinese herbal medicine data are insufficient. Other new drugs in development include the cholecystokinin antagonists and novel visceral analgesics. Both current and potential therapies for IBS are reviewed in this article.


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