Journal of diarrhoeal diseases research最新文献

This study, a cross-sectional survey, was conducted to assess how mothers take care of their children with diarrhoea and to develop a model of health-care seeking behaviour. Multistage sampling was used. Mothers whose children aged less than five years had suffered from diarrhoea in the last fortnight were included. Nurses interviewed the mothers to collect data. Variables included in the interview were: mothers' characteristics, children's characteristics, clinical data, treatment given by the mother, maternal health-seeking behaviour and mothers' information about diarrhoea and dehydration. Variables corresponding to the clinical data were grouped to identify dehydration signs and the need for medical care. Dehydration was defined as the presence of two or more of the following reported signs: thirst, sunken eyes, sunken fontanelle, or scanty urine. The need for medical care was defined as the presence of one or more of the following characteristics: illness lasting more than three days, vomiting, fever, bloody diarrhoea or dehydration. A sample of 747 mothers was obtained. Household treatments consisted of herbal teas to stop diarrhoea (52.3%), liquids to prevent dehydration (92.2%), symptomatic drugs (35.2%) and changes in feeding patterns (36.3%), which consisted in suppressing milk and dairy products and interrupting breast feeding (12.2%). Mothers sought medical assistance when they perceived a worsening of clinical conditions. Clinical signs statistically associated with their decision were: bloody diarrhoea, vomiting, illness longer than three days, weight loss, and fever. The signs of dehydration were not associated with health care-seeking because the mother did not recognise them. It is concluded that maternal educational programmes should emphasise, besides the proper use of oral rehydration therapy, teaching mothers to identify signs of dehydration as an indication to seek timely medical care.

Seven Candida albicans isolates (four from patients with diarrhoea and three from healthy persons) underwent two passages through rat ileal loop (RIL) to see the effect of consecutive passages on the adherence to rat intestinal epithelium. The isolates from patients with diarrhoea showed a significant enhancement in adherence after the first passage (1.95 x 10(4) cfu/cm2 versus 3.67 x 10(4) cfu/cm2). There was no further increase between the first passage (3.67 x 10(4) cfu/cm2) and the second one (3.61 x 10(4) cfu/cm2). A similar pattern was observed with the three nondiarrhoeal isolates. Animal passage of this fungus probably leads to better interactions between the cell surfaces causing the enhanced adherence.

Campylobacter jejuni is an important human enteropathogen worldwide. Chickens are the major reservoir and source of campylobacter infection. Ten clinical isolates from human and five chicken strains were tested for the adherence, invasion and cytotoxin assay in HeLa and HEp-2 cells. All human strains adhered to both the HeLa (10(3) to 3 x 10(4) bacteria/mL of cell lysate) and HEp-2 cells (2 x 10(3) to 4 x 10(4) bacteria/mL of lysate). All chicken strains also adhered to the HEp-2 cells (10(2) to 10(3) bacteria/mL), but only two strains adhered to the HeLa cells. Six clinical and none of the chicken strains invaded the mammalian cells. Both the adherence and invasion were better observed in HEp-2 than in HeLa cell lines. All three isolates from patients having invasive diarrhoea and only one strain from a patient having watery diarrhoea produced cytotoxin. All three invasive strains also adhered to polystyrene surface after the localised destruction of the HEp-2 cells, a phenomenon not reported earlier. Adherence was markedly inhibited by the whole cell lysate and the acid glycine extracts, and the results were comparable. This study indicates that the clinical isolates of C. jejuni are more virulent than the chicken strains, HEp-2 is better for the adherence/invasion assay and HeLa is better for cytotoxin assay. The acid glycine extracts probably contain the key adhesins for C. jejuni.

The Phene Plate (PhP) system is a commercially available typing system based on the measurements of kinetics of selected biochemical reactions of bacteria grown in liquid medium in 96-well microplates. The system uses numerical analysis to identify biochemical phenotypes among the tested strains. In the present study, a set of 16 discriminatory tests were used to differentiate 117 strains of Vibrio cholerae O1 from MExico and Bangladesh. The stability of PhP types of 16 isolates under different storage temperatures and after repeated subcultures were also evaluated. The PhP system had a reproducibility of 95%. Storage either at +4 degrees C or -70 degrees C, did not affect the reactions of the isolates, whereas 4 strains (25%) stored at room temperature and 5 strains (31%) subjected to 30 consecutive subcultures, exhibited minor changes in their biochemical reactions. Endemic isolates of V. cholerae O1 from Bangladesh were more diverse (diversity index = 0.84 to 0.93) than epidemic isolates from Mexico (diversity index = 0.73). Using a collection of 33 heterogeneous isolates of classical biotype of vibrios, PhP typing and ribotyping were compared. PhP typing discriminated more types (n = 23) than ribotyping (n = 5), whereas a combination of both yielded 27 types. The PhP system appears to be a simple, reliable and highly discriminating method for typing of V. cholerae, and may prove especially useful as a first screening method in epidemiological studies of V. cholerae.

To evaluate the efficacy of erythromycin and trimethoprim-sulphamethoxazole (TMP-SMX) in the treatment of cholera in children aged 1-8 years, a randomised clinical trial was conducted at a diarrhoea treatment centre in Bangladesh from December 1991 to June 1992. Fifteen children received erythromycin, 50 mg/kg per day, in four equally divided doses, 18 children received 10 mg/kg per day of trimethoprim and 50 mg/kg per day of sulphamethoxazole in two equally divided doses (12 hourly) for five days, and 15 children received no antibiotic; children in all three groups received intravenous cholera saline for severe dehydration and for mild to moderate dehydration, a rice-based oral rehydration solution. The mean stool volumes in mL/kg body weight in the two treatment groups were less than that of the control group, and there were no significant differences in stool volume among the two treatment groups. However, 67% of the children in the erythromycin group and 82% in the TMP-SMX group recovered within 72 hours compared to 33% in the control group (p < 0.01). Similarly, the bacteriological cures were 80% in the erythromycin group and 83% in the TMP-SMX group compared to only 27% in the control group (p < 0.001). These results confirm that both erythromycin and trimethoprim-sulphamethoxazole are effective antimicrobials in the treatment of cholera. These drugs are of value specially in younger children in whom tetracycline is contraindicated or when the infecting Vibrio cholerae are resistant to tetracycline.

The antidiarrhoeal activities of leaf extracts of Ocimum gratissimum were investigated by disc diffusion and tube dilution methods. The extracts were active against Aeromonas sobria, Escherichia coli, Plesiomonas shigelloides, Salmonella typhi, and Shigella dysenteriae. The leaf extracts were most active against S. dysenteriae and least active against S. typhi. The sensitivity of the organisms measured in terms of zone of inhibition ranged from 8.00 to 19.50 mm. The minimum inhibitory concentrations were from 4.00 to 50.00 mg ml-1, while the minimum bactericidal concentration ranged from 8.00 to 62 mg ml-1. The potentials of the leaf extract for the treatment of diarrhoeal diseases is discussed.

Although both malaria and diarrhoea are major public health problems in developing countries, and separately each has been the subject of intense research, few studies have investigated the interaction between these two conditions. The interaction between diarrhoea and malaria among children aged 4 months to 12 years in two tertiary health-care facilities, University College Hospital, Ibadan, and Lagos University Teaching Hospital, Lagos, Nigeria was studied. In Ibadan, the prevalence of diarrhoea among the cerebral malaria patients on admission as 11.7% (7/60) compared to 9.3% (215/2312) among other admissions in 1990 (chi square = 0.16; p = 0.6913). Similarly, no significant difference in the prevalence of diarrhoea was found between the cerebral malaria patients (14.3%) and other patients (16.1%) seen in Lagos in 1992 (chi square = 0.06, p = 0.81). Thus, cerebral malaria does not seem to be associated with an increased or decreased prevalence of diarrhoea when compared with other conditions. The prevalence of malarial parasitaemia among the 554 diarrhoea patients studied in Ibadan during 1993-1994 was 13.6% compared with 17.9% among the 347 controls (chi square = 3.75, p = 0.053). However, of the children with diarrhoea, malarial parasitaemia was more common among the dehydrated patients (25.4%) than among the well-hydrated patients (11.6%) (chi square = 8.11, p = 0.004). These data suggest that diarrhoea is merely coincidental in severe malaria and conversely, malarial parasitaemia is similarly coincidental in children with acute diarrhoea, although it may be more frequent among dehydrated diarrhoea patients than well-hydrated ones.

Five Aeromonas jandaei and 12 Aeromonas trota isolates were tested for the production of haemolysin and enterotoxin, and the correlation between these two properties. The majority (10 isolates) of the strains produced beta-haemolysis. The titres of haemolytic activity for both species were 8-64 HU/mL. In the initial ileal loop test, only two (A. trota) of the 17 isolates produced enterotoxin. One each of these 2 A. trota strains was beta-haemolytic and non-haemolytic. The remaining isolates of A. trota and A. jandaei included alpha-, beta- and non-haemolytic strains, and failed to cause any fluid accumulation in the initial tests, but did so after one-to-five sequential passages through the rabbit ileal loops. Three alpha- and 4 non-haemolytic strains switched over to the production of beta-haemolysis when they showed the positive ileal loop reaction. However, on repeated subcultures or on storage in the laboratory, all of them reverted back to their original alpha- or non-haemolytic character and no longer produced enterotoxin.

This study was designed to screen several treatments for their effects on mucosal repair in an established model of piglet rotavirus enteritis. Six ingredients selected to facilitate repair were added to the oral rehydration solution (ORS) and subsequently to the diet: L-glutamine (GLN); rice solids; a soluble fiber (carboxymethylcellulose); nucleotides; polyamines; and fructooligo-saccharides. Rotavirus infection consistently induced a watery diarrhoea lasting 5 to 10 days and produced a jejunal mucosal lesion which was maximal at 3 days, post-inoculation (manifested by a reduction of villus surface area to 30% to 50% of normal). By 7 to 10 day post-inoculation, the villus surface area returned to 50% to 80% of normal. None of the supplemental ingredients added to the ORS had a significant effect in either shortening the clinical illness or in stimulating recovery of the affected mucosa. It is concluded that several types of "Super ORS" are ineffective in enhancing repair in viral enteritis in neonatal colostrum-deprived piglets. These results do not rule out beneficial effects of the additives tested in subjects with more extensive intestinal damage, in those who receive breast milk, or in those with bacterial enteritis.