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Oral rehydration therapy (ORT) is the best treatment for rehydrating patients with acute infectious diarrhoea and its use has reduced childhood mortality worldwide.1 Despite this, and despite better resources, success with oral rehydration is lower in developed countries, which have a higher frequency of intravenous fluid administration.2 This may be either due to different aetiology or because we are worse at using oral rehydration effectively. The aim of our study was to assess current professional conventions and attitudes surrounding oral rehydration in England and identify any incorrect but easily remedied practices. We conducted a telephone questionnaire study. A total of 109 units in England with acute admitting paediatric inpatient facilities were contacted and the most senior paediatric nurse available completed the …

OBJECTIVE: Clostridium difficile is a major cause of nosocomial infectious diarrhoea. Treatment of C. difficile infection (CDI) depends on disease severity. A combination of vancomycin and metronidazole is often recommended in severe cases. The aim of this study was to examine, in a murine model of CDI, if mice treated with a combination of vancomycin and metronidazole had a better clinical outcome than mice treated with vancomycin or metronidazole alone.DESIGN: C57BL/6J mice pretreated with an antimicrobial mixture were challenged with C. difficile VPI 10463 or phosphate-buffered saline by oral gavage. After the challenge, the mice were treated with placebo, vancomycin, metronidazole or a combination of vancomycin and metronidazole for 10 days. The mice were monitored for 20 days with weight and a clinical score. Stool samples were examined for C. difficile spore load and presence of C. difficile toxins.RESULTS: None of the mice in the vancomycin-treated group died during the treatment phase compared to a mortality of 17%, 33% and 55% in the combination, metronidazole and infected control group, respectively. Mice treated with vancomycin alone or in combination with metronidazole recovered from CDI faster than mice treated with metronidazole alone. However, after discontinuation of treatment, vancomycin-treated and combination-treated mice succumbed to clinical and bacteriological relapse.CONCLUSIONS: Mice treated with vancomycin alone had a better clinical outcome in the treatment phase of CDI than mice treated with metronidazole alone. A combination of vancomycin and metronidazole did not improve the clinical outcome when compared to treatment with vancomycin alone.TRIAL REGISTRATION NUMBER: The trial registration number from the Danish Experimental Animal Inspectorate is J number 2012-15-2934-00422.

Clostridium difficile represents the major infective causes of hospital-acquired infectious diarrhoea and one of the most common microorganisms responsible for health-care associated infection.

Clostridium difficile is an anaerobic Gram positive spore-forming bacterium, the leading cause of infectious diarrhoea (C. difficile infection; CDI) in hospitalised humans. The assumption that CDI is primarily a hospital-acquired infection is being questioned. Community-acquired CDI (CA-CDI) is increasing1 particularly in groups previously considered at low risk2,3. In Australia, CA-CDI rates doubled during 2011 and increased by 24% between 2011 and 20124. Two potentially high-risk practices in Australian food animal husbandry may present a risk for CA-CDI: slaughtering of neonatal animals for food, and effluent recycling to agriculture.

Invited commentary on ‘Community acquired infectious diarrhoea in children under 5 years of age in Dakar, Senegal’, Sire et al.The development of sensitive molecular methods for detecting and chara...

The modern view of probiotic therapy derives from the concept of a well functioning gut barrier and a normal balanced microbiota. The scientific conception of these host defences has changed; the gut barrier was seen primarily as a physical blockade to foreign antigen entry until its active role in shaping the immune response to luminal antigens was deciphered. Concomitantly, recent experimental and clinical studies demonstrate a dependency on healthy host-microbe interaction to cope with antigen challenges, and consequently attribute the gut microbiota an active role in barrier function.1–3 The most fully documented probiotic intervention is the treatment of acute infectious diarrhoea. Well controlled clinical studies have shown that probiotics such as Lactobacillus rhamnosus GG, L reuteri , L casei Shirota, and Bifidobacterium lactis Bb12 can shorten the duration of acute rotavirus diarrhoea.4,5 Numerous publications on different populations have since substantiated the success of specific probiotic strains in the adjunct management of viral …

Gastrointestinal diseases continue to have a major morbidity worldwide. Intestinal infections are the most common disorders of the gastrointestinal tract and infectious diarrhoeal disease continues to be a major cause of morbidity and mortality. Almost 5 million preschool children still die each year from infectious diarrhoea, either from dehydration and acidosis due to fluid losses or because of the direct effects of invasive micro-organisms on gut …

This is a commentary of a Cochrane review, published in this issue of EBCH, first published as: Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database of Systematic Reviews Commentary2010, Issue 11. Art. No.: CD003048. DOI: 10.1002/14651858.CD003048.pub3. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Acute Enteric Infections (AEI) occupy one of the leading places in structure of infectious pathology at children's age. A variety of etiological agents (bacteria, viruses and protozoa) causing infectious diarrhoea, the high frequency of mixed infections, frequent failures and uneven course prove the necessity of search of ways for optimization of diagnostic and therapeutic approaches according to modern scientific data. The principles of clinical and laboratory diagnostics of AEI are considered in the article. Criteria of the assessment of a disease severity, predictive criteria of development of the life-threatening states connected with the exicosis are presented. The principles of AEI treatment are presented from the modern positions, the necessity of an integrated approach and staging in therapy with the personified choice of preparations considering weight, phase and clinical form of a disease, age of a child and a macroorganism condition by the time of the disease beginning are introduced. The necessity of a strictly differentiated approach to prescription of antibiotics is emphasized. The data on expediency of inclusion of probiotics to starting AEI therapy of virus aetiology are separately presented taking into account strain-specific efficiency that provides the reliable reduction of degree of intensity and duration of the main symptoms of a disease, and also has beneficial impact on a condition of microflora of a gastrointestinal path.

Objective Infectious and non-infectious causes are associated with increased frequency of bowel movements (IFoBM). But, a viral aetiology to non-diarrhoeal IFoBM (IFoBM-ND) has not been described. Owing to an accidental infection by an echovirus 19 strain, persistent diarrhoea-associated virus, isolated from a child with persistent diarrhoea, DCR experienced persistent IFoBM-ND with an urgency to pass apparently normal stools more than once each day for about 3 months. A follow-up study was undertaken to determine the prevalence of IFoBM-ND, and association of non-polio enteroviruses (NPEVs) with the symptom in infants from birth to 2 years. Design A cohort of 140 newborns was followed for 6 months to 2 years from birth for IFoBM-ND. Stool samples collected every 14 days were examined for NPEVs, rotavirus and other viral/bacterial agents for their possible association with IFoBM-ND and diarrhoea. Results Of 403 NPEV infection episodes among 4545 oral polio vaccine strains-negative stool samples, approximately 29% were associated with IFoBM-ND (15% acute and 14% persistent), including resolution of 74% of constipation episodes, and 18% with diarrhoea, suggesting that about 47% of NPEV infection episodes in children below 2 years of age are associated with gastrointestinal symptoms. About 83% of IFoBM-ND episodes are associated with the NPEV infection and 17% of the episodes are of unknown aetiology. Conclusions NPEV is the single most frequently detected viral agent in children with IFoBM-ND and its association with the symptom is highly significant, warranting detailed investigations on the role of NPEVs in gastrointestinal diseases.

The enteric pathogens Campylobacter jejuni and Campylobacter coli are a major cause of infectious diarrhoea. Their ability to adhere to human epithelial cells is ubiquitous and their propensity to invade cells is also well documented and requires motility and de novo protein synthesis, as well as several host factors. The molecular basis of the interaction between campylobacters and host cells is only beginning to be elucidated. The characteristics of this interaction promise to be interesting and may provide new insights into host-pathogen interactions in other enteric diseases.

Achtergrond Probiotica zijn voedingssupplementen die levende micro-organismen of componenten daarvan bevatten. Ze zouden een gunstige invloed hebben op gezondheid en welzijn. Probiotica zouden bij acute diarree van infectieuze oorsprong de ziekteduur en ernst gunstig beinvloeden. Hun veronderstelde werking berust op een combinatie van activiteiten: ze gaan een strijd aan met pathogene micro-organismen om de beschikbare nutrienten en bindingsplaatsen in de darm; ze maken de darminhoud zuurder en bevorderen zowel specifieke als non-specifieke immuunreacties.

SUMMARY In this review we will briefly consider the important aetiological agents implicated in acute diarrhoea, the settings where illness most often occurs, the diagnostic approach needed to address proper management, followed by a discussion of therapy.

Infectious diarrhoea has been recognised as a serious public health problem for Aboriginal Australians, particularly infants and young children, for more than two decades. These diseases are caused by bacterial, viral and parasitic infections which are spread mainly by the faecal-oral route and which must be interrupted if prevention is to be effective. This paper reviews published reports on this subject and interventions which have been used elsewhere to reduce the incidence of infectious diarrhoea. These reports have important implications for Aboriginal health but interventions and strategies to overcome this problem must recognise the unique circumstances of Aboriginal people in Australia.

Gastro-intestinal disorders constitute the most important findings among an estimated 200.000 neonatal dairy calf mortalities in Denmark (5). Besides infectious diarrhoea, forestomach disturbances play an important role on its own or in combination with general weakness caused by, e.g., diarrhoea. Such disturbances may result from ruminal drinking, from abomaso-ruminal reflux or by forced feeding of weak calves with milk by stomach tube. In any case this leads to disturbed forestomach function, to poor milk utilisation and retarded growth. Reflux may occur in single calves with intestinal obstruction. Management factors which may precipitate reflux are however unknown. In the present experiment the possible role of feeding irregular amounts of milk on the occurrence of reflux is examined in young bucket fed Jersey calves. The investigation was made possible by the recent development of a simple milk coagulation test (4), to be performed on rumen samples, as an indicator of the occurrence of reflux., American Association of Bovine Practitioners Proceedings of the Annual Conference, 1992: Volume 3

UNLABELLED: Norovirus, the most commonly identified cause of both sporadic cases and outbreaks of infectious diarrhoea in developed countries, exhibits a complex epidemiology and has a strong wintertime seasonality. Viral populations are dynamic and evolve under positive selection pressure. METHODS: Time series-adapted Poisson regression models were fitted to daily counts of laboratory reports of norovirus in England and Wales from 1993 to 2006. FINDINGS: Inverse linear associations with daily temperature over the previous seven weeks (rate ratio (RR) = 0.85; 95% CI: 0.83 to 0.86 for every 1 degrees C increase) and relative humidity over the previous five weeks (RR = 0.980; 95% CI: 0.973 to 0.987 for every 1% increase) were found, with temperature having a greater overall effect. The emergence of new norovirus variants (RR = 1.16; 95% CI: 1.10 to 1.22) and low population immunity were also associated with heightened norovirus activity. Temperature and humidity, which may be localised, had highly consistent effects in each region of England and Wales. CONCLUSIONS: These results point to a complex interplay between host, viral and climatic factors driving norovirus epidemic patterns. Increases in norovirus are associated with cold, dry temperature, low population immunity and the emergence of novel genogroup 2 type 4 antigenic variants.

Infectious gastroenteritis continues to be a leading cause of mortality and morbidity worldwide. The cornerstone of treatment remains replacement of water and electrolyte losses with oral rehydration solution. Until a few years ago, probiotics were discussed primarily in the context of alternative medicine, but they are now entering mainstream medical practice since a decrease of the severity and duration of infectious gastroenteritis in approximately 24 hours has been shown for some strains. Therefore, probiotics are a potential add-on therapy in acute gastro-enteritis. The shortening of the duration of diarrhoea and the reduction in hospital stay result in a social and economic benefit. Evidence found in viral gastroenteritis is more convincing than in bacterial or parasitic infection. Mechanisms of action are strain specific and only those commercial products for which there is evidence of clinical efficacy should be recommended. Timing of administration is also of importance. In acute gastroenteritis, there is evidence for efficacy of some strains of lactobacilli (e.g. Lactobacillus caseii GG and Lactobacillus reuteri) and for Saccharomyces boulardii. Probiotics are "generally regarded as safe", but side effects such as septicaemia and fungaemia have very rarely been reported in high-risk situations. Although most studies conclude in a statistically significant shortening of the duration of diarrhea, the clinical relevance of this finding is limited. In conclusion, selected strains of probiotics result in a statistically significant but clinically moderate benefit in shortening the duration of diarrhoea caused by acute infectious gastroenteritis.

a ABSTRACT a The Foundation for Medical Research, 84A, RG Thadani Objective: Several medicinal plants have been evaluated for their antidiarrhoeal activity. Marg, Worli, Mumbai - Most studies evaluated their effect on intestinal motility and antimicrobial activity and, 400018, Maharashtra, India. therefore, did not take into account the pathogenesis of infectious diarrhoea. Features of b Naoroji Godrej Centre for infectious diarrhoea like abdominal pain, cramps, inflammation, and passage of blood/ Plant Research, Lawkin Ltd. mucus in the stools are the combined effect of one or more virulence factors of the infect- Campus, Shindewadi, Shirwal, ing organism. The effect of medicinal plants on the microbial virulent features can serve Satara - 412801, Maharashtra, as marker(s) for testing their efficacy. In this study, we evaluated the effect of a decoction India.

Acute diarrhoeal disease is the commonest single cause of morbidity and mortality worldwide. Infectious diarrhoea has been estimated to cause at least 5 million deaths each year in the developing world. Very young children are particularly susceptible to

Two recent studies published in this Journal draw attention to deficiencies in treatment of children with acute infectious diarrhoea in Australia.1,2 There is now no doubt that use of correctly constituted oral rehydration solutions provides optimal therapy for affected children unless circulation is compromised, vomiting is more than average, or complicating disorders are present. In the vast majority of cases, these complications do not occur. A high proportion of the childhood population experiences gastroenteritis at some time. It is known that 50% of Melbourne children require medical attention for rotavirus infection alone during their first 3 years of life, although less than 5% require admission.

Reviewing the possible value of probiotics in inflammatory bowel disease, Dr Jonkers and Dr Stockbrugger conclude that clearcut evidence is lacking (April 2003 JRSM1). The most impressive effects with probiotics so far are in children with acute infectious diarrhoea, particularly of viral causation. A meta-analysis revealed that probiotics lessened both duration of diarrhoea and stool frequency.2 The value of probiotics in inflammatory bowel disease is more difficult to assess because patients need to continue with existing mainstay medications. A multicentre trial in children with Crohn's disease, now underway in the USA, may provide further insight.3

Clostridium difficile is now recognised as the major cause of hospital acquired infectious diarrhoea. Data from Sir Charles Gairdner Hospital (SCGH) in Perth, Western Australia, is typical of many similar hospitals in developed countries. SCGH is a 600 bed adult university teaching hospital. During the period 1983 to 1992, C. difficile was detected in 917 patients who were being investigated for diarrhoeal illness. Up to 120 patients a year were infected, most of these being elderly females. Incidence rates increased from 23/100,000 occupied bed days in 1983 to 56/100,000 occupied bed days in 1990.

(2002) Pediatrics 109, 678; Van Niel CW, Feudtner C, Garrison MM, et al. . Lactobacillus therapy for acute infectious diarrhoea in children: a meta-analysis. . Apr; . : . –84. . [OpenUrl][1][Abstract/FREE Full Text][2] QUESTION: In children with acute infectious diarrhoea (ID), is treatment with Lactobacillus safe and effective for improving clinical outcomes? Studies were identified by searching Medline, EMBASE/Excerpta Medica, the Cochrane Controlled Trials Register, DARE, and CINAHL from 1966 to 2000, and AMED, MANTIS, the Complementary and Alternative Medicine Citation Index, and AltHealthWatch from 1985–2000. Search terms used were diarrhoea, gastroenteritis, or rotavirus combined with competitive inhibition, Lactobacillus , probiotic, yogurt, or yoghurt. Bibliographies of relevant papers were scanned, and key investigators were contacted. Randomised controlled trials (RCTs) were selected if they involved Lactobacillus treatment of ID in children, clinical outcomes were reported, the treatment group received Lactobacillus and the control group received a suitable placebo, the Lactobacillus and control groups were indistinguishable, and data assessors were blinded to participant treatment group. Studies in which patients … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DVan%2BNiel%26rft.auinit1%253DC.%2BW.%26rft.volume%253D109%26rft.issue%253D4%26rft.spage%253D678%26rft.epage%253D684%26rft.atitle%253DLactobacillus%2BTherapy%2Bfor%2BAcute%2BInfectious%2BDiarrhea%2Bin%2BChildren%253A%2BA%2BMeta-analysis%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.109.4.678%26rft_id%253Dinfo%253Apmid%252F11927715%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=109/4/678&atom=%2Febmed%2F7%2F6%2F185.atom

An oral vaccine that has the potential to prevent most life threatening rotavirus infections has been shown to be safe and effective in both developing and developed countries. Concern has been raised, however, that it might be prohibitively expensive for the nations that need it most. Infectious diarrhoea is a leading cause of paediatric morbidity and mortality worldwide. There are an estimated 130 million cases of diarrhoea caused by rotavirus each year-18 million of which are classed as severe-resulting in 873000 deaths annually. Several studies have shown that a live attenuated vaccine incorporating the four rotavirus serotypes that cause most of the illness in humans is …

200 children of different age groups presenting with infectious diarrhoea were treated with Septran (trimethoprim-sulphamethoxazole).

Diarrhoeal diseases are among the most important health problems in the world today. While they are generally mild, nuisance illnesses in the developed world, where clean water and sanitation are adequate, these diseases are the most common cause of death in young children in the developing world, where clean water is not available and sanitation is inadequate. In these areas, up to 25% of children may never reach their fifth birthday. In addition, although the impact on growth and nutritional status is difficult to quantify, the cumulative toll on overall child health is enormous. A wide variety of infectious agents are implicated in the aetiology of acute diarrhoeal illness, many of which were unknown 20 years ago. The epidemiology, pathogenic mechanisms and clinical presentation of the common bacterial and viral pathogens, as they are currently understood, will be discussed in this chapter.

60 male infants with acute watery diarrhea and moderate dehydration--but without the complications of fever or vomiting--were treated with either the standard WHO oral rehydration salt solution or with a modified solution in which the glucose was removed and powdered rice and dried edible seeds (Dal moong) were added. The rice-Dal moong combination is a traditional weaning food in India and has been noted to decrease the stool output in children with diarrheal disease. Infants who received rice and Dal moong had a significantly lower stool output already evident at 0-6 hours than infants who received the traditional oral rehydration solution. The weight gain was also significantly greater in the group of infants who received the rice-Dal moong mixture. As a result of the lower purging rate infants who received rice and Dal moong required significantly less fluid replacement than infants who received only the oral rehydration solution. Although the mechanisms by which rice and Dal moong decrease the purging rate in diarrhea are not understood it is clear that their addition to the WHO oral rehydration solution results in a more rapid and efficient rehydration and should become a standard practice. Both ingredients are inexpensive and readily available throughout India.

Although Clostridium difficile (C. difficile) is the leading cause of infectious diarrhoea in hospitalized patients, the economic burden of this major nosocomial pathogen for hospitals, third-party payers and society remains unclear. We developed an economic computer simulation model to determine the costs attributable to healthcare-acquired C. difficile infection (CDI) from the hospital, third-party payer and societal perspectives. Sensitivity analyses explored the effects of varying the cost of hospitalization, C. difficile-attributable length of stay, and the probability of initial and secondary recurrences. The median cost of a case ranged from $9179 to $11 456 from the hospital perspective, $8932 to $11 679 from the third-party payor perspective, and $13 310 to $16 464 from the societal perspective. Most of the costs incurred were accrued during a patient's primary CDI episode. Hospitals with an incidence of 4.1 CDI cases per 100 000 discharges would incur costs ≥$3.2 million (hospital perspective); an incidence of 10.5 would lead to costs ≥$30.6 million. Our model suggests that the annual US economic burden of CDI would be ≥$496 million (hospital perspective), ≥$547 million (third-party payer perspective) and ≥$796 million (societal perspective). Our results show that C. difficile infection is indeed costly, not only to third-party payers and the hospital, but to society as well. These results are consistent with current literature citing C. difficile as a costly disease.