Search

To evaluate the diagnostic efficacy of stool-based Xpert MTB/RIF Ultra assay versus other assays for the detection of paediatric pulmonary tuberculosis (PTB).A prospective head-to-head comparative study was conducted from Dec 2017 to May 2019 in Shanghai Public Health Clinical Centre. Samples were collected from children (15 years) with abnormal chest imaging (X-ray or CT scan) results for the following tests: Ultra on stool sample (Ultra-Stool), Ultra on respiratory tract sample (Ultra-RTS), Xpert MTB/RIF assay (Xpert) on RTS (Xpert-RTS), acid-fast bacilli smear on RTS (AFB-RTS), and Mycobacterium tuberculosis (Mtb) culture on RTS (Culture-RTS). The results were compared with a composite reference standard.A total of 126 cases with paired results were analysed. Against a composite reference standard, Ultra-RTS demonstrated the highest sensitivity (52%) and specificity (100%). Ultra-Stool showed 84.1% concordance with Ultra-RTS, demonstrating 45.5% sensitivity and 94.7% specificity (kappa = 0.65, 95% CI= 0.51-0.79). The sensitivity of Ultra-Stool was similar to Mtb culture (45.5%, p = 1.000) and higher than AFB-RTS (27.3%, p0.05). Assay positivity was associated with age and infiltration range in chest imaging.When RTS is difficult to obtain, stool sample-based Ultra is a comparable alternative.

The fecal immunochemical test (FIT) is a tool used for colorectal cancer screening and its use is growing rapidly. FIT, applied as a qualitative or quantitative test, has far better sensitivity for hemoglobin than older, guaiac fecal occult blood tests. This translates into several advantages of FIT, including ability to screen using only 1 stool sample per cycle. This article reviews current understanding of FIT performance as a 1-time test and when applied programmatically. It outlines how to apply the test at the patient level and track performance at the program level. Future prospects for FIT application are highlighted.

Background Live oral pentavalent bovine-human reassortant rotavirus (RV) vaccine, RotaTeq®, contains bovine rotaviruses reassorted with human G-types G1, G2, G3 and G4, and P-type P[8]. Shedding of RotaTeq® vaccine, as studied by RT-PCR, has been shown to be more common than initially reported, and may include formation of vaccine-derived double-reassortant G1P[8] RVs. We studied the extent and duration of RotaTeq® vaccine virus shedding, genotypes shed, and clinical symptoms associated with shedding. Material and methods We enrolled a total of 301 infants who received RotaTeq® vaccine according to Finnish schedule at 2, 3 and 5 months of age. Stool samples were collected 5–10 days after the first and 0–7 days before the third dose of the vaccine. Additional stool samples 6 and 12 weeks later were collected if the second stool sample was positive. All stools were studied with RT-PCR for RV VP7, VP4 and VP6. Parents filled a symptom diary for a week after each vaccine dose. Results We found that 93% of the vaccinees shed vaccine related viral particles in one sample taken 5–10 days after the first dose, indicating that stool shedding is very common and may be regarded as a marker of successful vaccination. Genotype G1 was the predominant genotype in shedding, often in association with P[8], and the only genotype found in long-term shedding. Also G4 was commonly detected whereas other vaccine G-types and bovine-type P[5] were not. Conclusions Shedding of RotaTeq® vaccine-derived viruses is a sign for successful vaccination. Intense shedding of G1 with or without P[8]reflects effective multiplication and may be an important factor in the induction of protective immunity. Shedding of G1 containing vaccine viruses may be prolonged up to 8 months of age. These results suggest that the pentavalent vaccine functions largely like a monovalent G1 vaccine. Eudra-CT: 2014-004252-60.

The FRUVEDomics study investigates the effect of a diet intervention focused on increasing fruit and vegetable intake on the gut microbiome and cardiovascular health of young adults with/at risk for metabolic syndrome (MetS). It was hypothesized that the recommended diet would result in metabolic and gut microbiome changes. The 9-week dietary intervention adhered to the US Department of Agriculture Dietary Guidelines for Americans and focused on increasing fruit and vegetable intake to equal half of the diet. Seventeen eligible young adults with/or at high risk of MetS consented and completed preintervention and postintervention measurements, including anthropometric, body composition, cardiovascular, complete blood lipid panel, and collection of stool sample for microbial analysis. Participants attended weekly consultations to assess food logs, food receipts, and adherence to the diet. Following intention-to-treat guidelines, all 17 individuals were included in the dietary, clinical, and anthropometric analysis. Fruit and vegetable intake increased from 1.6 to 3.4 cups of fruits and vegetables (P .001) daily. Total fiber (P = .02) and insoluble fiber (P .0001) also increased. Clinical laboratory changes included an increase in sodium (P = .0006) and low-density lipoprotein cholesterol (P = .04). In the fecal microbiome, Erysipelotrichaceae (phylum Firmicutes) decreased (log2 fold change: -1.78, P = .01) and Caulobacteraceae (phylum Proteobacteria) increased (log2 fold change = 1.07, P = .01). Implementing a free-living 9-week diet, with intensive education and accountability, gave young adults at high risk for/or diagnosed with MetS the knowledge, skills, and feedback to improve diet. To yield greater impact, a longer diet intervention may be needed in this population.

Background The high burden of rotavirus acute gastroenteritis (AGE) is well documented among children under 5 years of age, with the majority of mortality occurring in developing countries. Nigeria ranked second worldwide in the number of rotavirus deaths in 2013. As Nigeria plans to introduce rotavirus vaccine soon, a pre-vaccine documentation of rotavirus disease burden is necessary to determine vaccine impact. Methods Routine rotavirus surveillance was conducted during 2011–2016 in 3 sentinel sites in Nigeria using the standard WHO protocol. Children under 5 years of age hospitalized for acute gastroenteritis were enrolled and demographic, clinical and outcome data were collected. A stool sample was subsequently obtained and tested for human rotavirus antigen using the Enzyme-linked immunosorbent assay (ELISA). Results 2694 children with acute gastroenteritis were enrolled during January 2011 to December 2016; of these, 1242 (46%) tested positive for rotavirus. Among the rotavirus positive cases, 66% and 94% were younger than 12 months and 24 months respectively. Marked peaks in rotavirus positivity were seen in January of each year. Vomiting, and use of oral and intravenous fluids occurred more often in rotavirus positive cases as compared to rotavirus negative cases. Conclusion The high prevalence of rotavirus disease highlights the need for urgent introduction of rotavirus vaccine in Nigeria. Additionally, this study provides pre-vaccine introduction disease-burden data that will serve as a baseline for rotavirus vaccine impact-assessment once vaccine has been introduced in the national immunization program.

Strain Marseille-P3237 was isolated from a stool sample of a healthy 35-year-old Congolese pygmy female. This anaerobic, Gram-negative, non-spore-forming and non-motile coccus-shaped bacterium is a member of the order Coriobacteriales. It exhibits a 2 009 306-bp genome with a 65.46 mol% G+C content and is closely related to, but distinct from, members of the Olsenella genus. We propose the creation of the new genus Libanicoccus gen. nov. and of the new species Libanicoccus massiliensis sp. nov. Keywords: Culturomics, Genome, Libanicoccus massiliensis, Pygmy, Taxonogenomics

Intestinal parasitic infections (IPIs) among schoolchildren in Republic of Marshall Islands (RMI) largely remains unknown, thus investigation on IPIs status to establish the baseline data is urgently needed. This cross-sectional study intended to investigate the current IPIs status and associated risk factors among schoolchildren at capital of RMI. Single stool sample from 400 schoolchildren (207 boys and 193 girls) aged 9.73 ± 2.50 yrs old was examined by employing merthiolate-iodine-formaldehyde concentration method. Demographic characteristics, uncomfortable symptoms and risk factors were obtained by questionnaires investigation. The overall prevalence of IPIs in schoolchildren was 22.8% (91/400), of them 24.2% harbored at least 2 different parasites. Notably, the majority was infected by waterborne protozoan parasites (82.4%, 75/91). Nine different intestinal parasites have been identified, of which six were pathogenic including Hook worm, Trichuris trichiura , Enterobius vermicularis , Entamoeba histolytica/dispar , Giardia intestinalis and Blastocystis hominis . Schoolchildren who ever complained dizziness or headache showed a significant higher prevalence of pathogenic IPIs than those who did not ( p 0.05). Schoolchildren who lived in urban area than rural area had higher chance to acquire pathogenic IPIs ( p = 0.03). However, none of risk factors were identified to be associated with pathogenic IPIs.

Rotavirus is the most important cause of severe childhood gastroenteritis worldwide. Rotavirus vaccines are available and rotavirus surveillance is carried out to assess vaccination impact. In surveillance studies, stool samples are stored typically at 4 °C or frozen to maintain sample quality. Uninterrupted cold storage is a problem in developing countries because of power interruptions. Cold-chain transportation of samples from collection sites to testing laboratories is costly. In this study, we evaluated the use of BBL™ Sensi-Discs™ and FTA ® cards for storage and transportation of samples for virus isolation, EIA, and RT-PCR testing. Infectious rotavirus was recovered after 30 days of storage on Sensi-Discs™ at room temperature. We were able to genotype 98–99% of samples stored on Sensi-Discs™ and FTA ® cards at temperatures ranging from −80 °C to 37 °C up to 180 days. A field sampling test using samples prepared and shipped from Cameroon, showed that both matrices yielded 100% genotyping success compared with whole stool and Sensi-Discs™ demonstrated 95% concordance with whole stool in EIA testing. The utilization of BBL™ Sensi-Discs™ and FTA ® cards for stool sample storage and shipment has the potential to have great impact on global public health by facilitating surveillance and epidemiological investigations of rotavirus strains worldwide at a reduced cost.

Human parechoviruses (HPeV) cause symptoms ranging from severe neonatal infections to mild gastrointestinal and respiratory disease. Use of PCR and genotyping has markedly improved the detection rate of HPeV but has simultaneously raised questions about the clinical relevance of positive tests. This retrospective study correlates positive HPeV1 or HPeV3 PCR tests in stools from children with their symptoms to determine clinical relevance. Children with HPeV1- or HPeV3-positive stool samples, as detected by real time RT-PCR and direct genotyping, between 2004 and 2008 were selected. Clinical data were retrospectively collected from the patient’s files and results were compared. One hundred and thirty-eight children with positive HPeV1 (n = 112) or HPeV3 (n = 26) stool samples were identified. Significantly more HPeV3-infected children were neonates or infants younger than 6 months of age. Meningitis or sepsis-like illnesses were diagnosed most frequently and were found in significantly younger children. Almost half of HPeV1-infected children had an underlying disease. Mild gastrointestinal disease was seen most frequently in these children. There was no clear correlation between viral load (Ct value) and severity of symptoms. In conclusion, HPeV3 detected by PCR in stool samples is associated with clinically relevant disease. For HPeV1, a positive stool sample is mainly associated with symptoms in children with underlying disease.

International audience; We report the main characteristics of "Eggerthella timonensis" strain Marseille-P3135 which was isolated from a stool sample of a healthy 8-year-old pygmy (Baka) girl.

International audience; We report the main characteristics of "Collinsella bouchesdurhonensis" strain Marseille-P3296, which was isolated from a stool sample of a healthy 50-year-old pygmy (Baka) woman.

International audience; This study presents the main characteristics of 'Mobilibacterium massiliense' strain P2510 (CSUR P2510) and 'Mobilibacterium timonense' strain P3194 (CSUR P3194), isolated from a stool sample of a patient at the Timone hospital and from a stool sample of a healthy 50-year-old pygmy (Baka) woman, respectively.

At the end of 2004, an outbreak of glycopeptide-resistant enterococci (GRE) spread from the Nancy Teaching Hospital to more than 40 facilities in the Lorraine region. Because this outbreak appeared to be uninhibited, a regional task force was set up to organize and co-ordinate the management of the outbreak, visiting the affected facilities to publicize the existing recommendations and take stock of the problems encountered in the field. The task force then proposed control measures specific to the region. The proposed measures included promoting the use of alcohol-based hand-rub solutions, isolation measures, enhanced screening policies, cohorting GRE-colonized patients and contacts in special wards with dedicated staff where possible, or failing that, isolating them in single rooms with additional "contact" precautions, maintaining these precautions for GRE-colonized patients until a negative stool sample was obtained after antibiotic treatment (which is a more restrictive definition of "cleared" than usually employed), regional co-ordination of the follow-up of GRE-colonized patients with the weekly publication of a list of institutions that were or had been affected to allow isolation measures to be adopted as soon as known-GRE-colonized patient were readmitted. It was not possible to determine the efficacy of each individual measure on the course of the outbreak. Nevertheless, we observed that the number of new GRE-colonized patients started to decrease following their implementation. Ultimately, 1077 GRE colonizations were recorded in Lorraine, and the outbreak is now under control.

In this study, 5 different commercial DNA extraction systems were tested on a stool sample collection containing 81 clinical stool specimens that were culture-positive for diarrheagenic Escherichia coli, Campylobacter jejuni, Salmonella enterica, or Clostridium difficile. The purified DNAs were analyzed by polymerase chain reaction (PCR) directed toward the relevant organisms. The results showed that conventional PCR combined with the extraction systems BioRobot EZ1 (Qiagen, Hilden, Germany), Bugs'n Beads (Genpoint, Oslo, Norway), ChargeSwitch (Invitrogen, Paisley, UK), QIAamp Stool Mini Kit (Qiagen), and 2 protocols (generic and Specific A) for EasyMag (BioMérieux, Marcy I'Etoile, France) were able to identify 89%, 62%, 85%, 88%, 85%, and 91%, respectively, of the pathogens originally identified by conventional culture-based methods. When TaqMan PCR was combined with the EasyMag Specific A protocol, 99% of the samples were correctly identified. The results demonstrate that the extraction efficiencies can vary significantly among different extraction systems, careful optimization may have a significant positive effect, and the use of sensitive and specific detection methods like TaqMan PCR is an ideal choice for this type of analysis.

Objective. The secretin–cholecystokinin test is the “gold standard” to evaluate exocrine pancreatic function. But this direct duodenal intubation test is invasive, particularly in children, time-consuming, and expensive. For several years, indirect noninvasive tests of pancreatic insufficiency have been developed, such as fecal chymotrypsin (FChT) and fecal elastase-1 (FEL-1) measurements. Generally, elastase-1 is truly admitted to be the most relevant test of exocrine pancreatic status. However, so far, no consensus for stool collection protocol exists. The aim of our study was to investigate the diagnostic advantage from measuring fecal proteases in stool samples collected for two or three consecutive days in comparison to one single stool sample collected at random. Design. A total of 69 children were divided into group A (stool samples collected for three consecutive days) and group B (stool samples collected for two consecutive days). These two groups included pancreatic-sufficient patients (PS) and severe pancreatic-insufficient patients (PI). One single determination of fecal chymotrypsin activity and of fecal elastase-1 concentration was realized on each stool. Results. The same relatively important intraindividual variability of fecal proteases was observed in group A and B (mean coefficients of variation (CVs) 36% vs. 40.2% for chymotrypsin, 22.2% vs. 26.8% for elastase-1). No significant PS or severe PI diagnostic discordance was observed between 1, 2, or 3 days of stool collections. Conclusion. Our study clearly shows that the determination of fecal proteases on one single stool collected at random is sufficient to evaluate pancreatic exocrine status for PS and severe PI.

International audience; We report here the main characteristics of 'Halomonas massiliensis' strain Marseille-P2426(T) (CSUR P2426), a new species of the Halomonas genus that was isolated from the stool sample of a healthy 24-year-old Senegalese man.

Members of the Bacteroides fragilis group are indigenous to the human and animal intestinal microbiota and they are responsible for several endogenous infections. Enterotoxigenic B. fragilis (ETBF) has been associated with acute diarrhea in children and farm animals. Immunodeficient patients are more predisposed to different opportunistic infections, including anaerobic infections. In this study, 130 stool samples were analysed from 56 immunodeficient and 74 healthy children. Enterotoxin production was detected by cytotoxicity assay on HT-29 cells and by PCR. B. fragilis sensu strictu was prevalent in both groups and ETBF species was detected from a single stool sample belonged to an immunodeficient child with AIDS. # 2001 Academic Press

Lin VW, Hsiao I, Goodwin D, Perkash I. Functional magnetic stimulation facilitates colonic transit in rats. Arch Phys Med Rehabil 2001;82:969-72. Objective: To investigate the effect of functional magnetic stimulation (FMS) on colonic transit in rats. Design: Experimental. Setting: Functional magnetic stimulation laboratory in a Veterans Administration health care system. Animals: Twenty-four female Wistar rats, divided into an experimental group and a control group. Interventions: All rats had technetium 99m (Tc 99m) infused through a cecal catheter to assess colonic transit times. FMS was performed over the cervical region; a figure of 8 magnetic coil was used in the experimental group. The colon was removed and sectioned into 10 segments, and a stool sample was taken in both groups. Main Outcome Measures: Distribution of radioactivity within the large intestine and stool were measured. Results: Geometric center calculations showed significant differences ( p Conclusion: FMS facilitates colonic transit in a rat model. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

The use of Gene-based simultaneous target amplification and recognition (GeneSTAR) technologies allows for the rapid detection of five different bacterial gastrointestinal pathogens from stool sample. The process involves DNA isolation, multianalyte polymerase chain reaction (PCR) amplification and single base mismatch detection in a microtiter plate format. The analysis is instrument compatible and can be completed in less than five hours.

This study evaluated ProSpecT/Giardia, an enzyme-immunoassay (EIA) test kit that detects Giardia-specific antigen 65 in aqueous extracts of human fecal specimens. During a four-month-period, 304 selected patients were examined, including 123 children from day care centres involved in an outbreak of giardiasis, 145 children as part of routine screening procedure and 36 adults suspected of having giardiasis, including six with Crohn's Disease. All specimens were submitted in SAF fixative and tested by ProSpecT/Giardia EIA test and examined microscopically (iron-haematoxylin stained sample as well as formalin-ether concentrated stool sample). Of the 304 samples examined, 21 were found positive by microscopic examination; these were all positive by EIA. An additional 20 samples were positive by EIA alone. Additional investigation showed that 18 of the 20 patients had clinical evidence of giardiasis, or had repeat stool specimens that were positive for G. lamblia microscopically. Two patients had no history of giardiasis with no microscopic evidence and were assumed falsely positive. We conclude that ProSpecT/Giardia EIA is a sensitive and specific test that is able to diagnose giardial infection significantly more frequently than microscopic examination alone.

Background & Aims Clostridium difficile infection (CDI) is a hospital-acquired infection with increasing incidence and severity. The most frequently used test to diagnose CDI is an enzyme immunoassay (EIA) for toxins A and B in stool samples. It is common to test 2 or more stool samples, based on the assumption that this detects CDI with greater sensitivity than analysis of 1 sample. We investigated whether repeat stool testing significantly improves the diagnostic yield for CDI. Methods We performed a retrospective analysis of hospitalized patients who were tested for CDI using EIA. From year 2005 to 2008, 39,402 stool samples from 17,971 patients with 29,373 diarrhea episodes were tested. Transition probabilities were calculated based on results from repeated tests. Results A total of 2692 diarrheal episodes (9.17%) were diagnosed with CDI. Based on results of 3 consecutive tests, 2675 (99.36%) were diagnosed with CDI. The first stool sample tested produced positive results for 90.7% of cases. When samples were tested consecutively, for the second and third time, an additional 6.6% and 2% patients had positive test results, respectively. If the first test result was negative, the probability of the second test result being positive was 2.7%. If the first 2 test results were negative, the probability of the third test result being positive was 2.3%. Conclusions In patients who had multiple stool samples tested for CDI by EIA, almost 91% were accurately diagnosed based on the results of a single stool sample alone. Subsequent testing yielded a positive result in only 8.6% of patients. We therefore recommend that repeat testing not be done on a routine basis because it does not significantly improve diagnostic yield.

Salmonella infections cause severe diarrhoea. Detection of positive specimen employing standard procedures takes at least 2 days. Faster approaches are necessary to start respective therapies earlier. Aim The aim of our work was the development of a rapid approach for the detection of Salmonella. Methods A small piece of the stool sample was incubated in selective media, e.g., selenit bouillon, for 20 h at 37°C. Subsequently, 150 μL from the top of the culture supernatant was taken and directly applied to 1 mL pure water. Bacteria were collected by centrifugation. Pellets were re-suspended in 1 mL water and centrifuged again. This washing step was repeated once. After air drying, bacteria were transferred onto a MALDI target, overlaid with HCCA matrix and subjected to MALDI-TOF MS analysis. Spectra were evaluated by MALDI Biotyper software. Experiments employing spiked stool samples were performed to establish the method. Subsequently, this approach was applied to routine samples and compared to the standard procedure. Results Over a time frame of 3 months, 1220 samples were analysed in parallel to the standard routine procedure. In total, 33 positive samples were identified. Fifteen of these were already positive after the direct streak of the stool sample and could be identified from the plate by MALDI Biotyper. Eighteen specimens were positive the same day by MALDI Biotyper analysis after the selective enrichment. No positive sample was missed by the novel approach which allowed detection of Salmonella after just one day of incubation.

A stool sample sent by a general practitioner on 3 August 1986 was found to contain Salmonella enteritidis. Enquiries revealed that the patient was a nurse on a psychogeriatric ward on the third floor of a building that was originally opened in 1931 as a maternity home. It was refurbished in 1982 and has been used as a psychogeriatric assessment centre with a daily average of 14 inpatients and 7 daypatients. Most of the patients suffered from dementia and many displayed disturbed behaviour. The ward was divided into two wings and the sanitary facilities were unsatisfactory. Deliberate attempts had been made to make the ward similar to a domestic environment. The kitchen resembled a large domestic kitchen with cooker, sink, washing machine and storage units. However, there was no wash-hand basin and the clothes washing machine was next to the dishwashing sink. There were poor facilities for staff handwashing near the patients’ bedrooms and toilets, the only sink in common use for this purpose being in the clinical room which was also used to wash up medicine cups. The ward was difficult to clean and often appeared dirty. Our enquiries on the ward revealed that four other members of staff were suffering from a diarrhoeal illness. The affected staff had not all been on duty at the same time. A common food source was sought but none was found. Main meals were sent to the ward from a central hospital kitchen. Breakfast was prepared on the ward for the patients but consisted only of low-risk items such as cereals and toast. Some staff ate in a central canteen but most brought their own food to work. There were no other reports of salmonellosis in the hospital staff or patients at that time. None of the