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Cytomegalovirus colitis should be considered in a patient presenting with bloody stool even among immunocompetent patients.

Chronic diarrhea in children is challenging both with regards to etiological diagnosis and for management. Etiology and pathophysiological mechanisms vary widely from neonates to adolescents. Congenital or genetic causes are more frequent in neonates, while infections, allergy and immune-mediated mechanisms are more frequent in childhood. A thorough history and proper physical examination are required to decide for further diagnostic evaluation. The approach to a child with chronic diarrhea should be age specific and based predominantly on the pathophysiological mechanism involved. The nature of the stool like watery, bloody or fatty (steatorrhea) can suggest the probable etiology and organ system involved. After routine tests, evaluation with specific serological tests, imaging, endoscopy (gastroscopy/colonoscopy), histopathology of intestinal mucosa, breath tests or radionuclide imaging may be required to make a definitive diagnosis. Genetic evaluation is important in congenital diarrheas, monogenic inflammatory bowel disease (IBD) and immunodeficiency disorders. Management is aimed at stabilization, nutritional support and etiology specific treatment. Specific therapy can be as simple as exclusion of specific nutrient or as complicated as small bowel transplant. Evaluation and management require expertise and thus patients need to be referred in a timely fashion. This will minimise morbidity including nutritional consequences and improve outcome. [ABSTRACT FROM AUTHOR]

Shiga-like toxin-producing Escherichia coli (STEC) is a well-known cause of foodborne acute diarrheic diseases, especially in children and the elderly. The potentially fatal complications associated with toxin production range from bloody diarrhea and ischemic colitis to kidney failure, hemolytic–uremic syndrome (HUS), and colon perforation. Here, we describe a case and literature review of STEC-induced colitis, highlighting the clinical features and the necessary tools for the best diagnostic approach and management. Facing challenging differential diagnosis, ranging from ischemic colitis and inflammatory bowel disease to infectious processes due to a pathogenic or opportunistic agent, we conducted a step-by-step exploration. Following bacteriological investigation, imagistic screening, and colonoscopy, we ruled out some of the initial suppositions and reached a final diagnosis, while also considering the pathological results. Although antibiotics are not indicated in this pathology, our patient did receive antibiotics, given the risk of translocation and colon perforation, without any associated complications such as HUS or peritonitis. Detailed and rigorous investigations conducted by a multi-specialty team are required for prompt medical support. Coping with the symptoms and refraining from further complications are the mainstem aims of treatment. [ABSTRACT FROM AUTHOR]

Shigella infection strains producing shiga toxin results in bloody diarrheais a dangerous symptom in children under five years of age that can even lead to death. Therefore, this study was conducted to isolate Shigella strains producing shiga toxin from 150 samples which were taken from bloody stool of children under the five years of age. They were suffering from the diarrhea during the period from March 2021 to March 2022 in Tikrit city, Iraq. The results showed the possibility to isolate six isolates of Shigella sonnei at ratio 4% of the total samples. The isolates producing shiga toxin were identified by using stx1 gene. The results showed two isolates of Shigella possessing stx1 gene, at ratio 33.33 of total S. sonnei strains. The two isolates producing shiga toxin have been submitted to NCBI, then accepted as Iraqi strains in NCBI under the registration numbers OK127759.1 and OK127760.1. The Iraqi strains registered in NCBI showed agreement with a global strain of 99-100% that were recorded by registration numbers in Malaysia (CP060117.1), China (CP000038.1), United Kingdom (CP066810.1), Hungary (CP019689.1), Somalia (CP023645.1), Spain (CP022672.1), Italy (CP035008.1), India (CP041322.1), Australia (CP045932.1), Nigeria (CP046286.1), Switzerland (CP049183.1), USA (CP053751.1) and South Korea (CP055292.1). As for the sensitivity test, the results showed that the strain OK127759.1 was resistant to antibiotics azithromycin, ceftazidime, cefotaxime, ceftriaxone, augmentin and tetracycline. And it was sensitive to gentamicin and intermediately sensitive to ampicillin, chloramphenicol and nalidixic acid. As for the strain OK127760.1, the results showed his strain was intermediately sensitive to gentamicin and resistant to the other antibiotics which were used in the test. ZnO-NPs with a concentration of 200 μg/ml showed the highest inhibitory effectiveness against S. sonnei strains OK127759.1 and OK127760.1 with inhibition diameter of 22 mm and 21 mm respectively. [ABSTRACT FROM AUTHOR]

Key Clinical Message Cytomegalovirus colitis should be considered in a patient presenting with bloody stool even among immunocompetent patients.

Objectives: This study aimed to investigate molecular confirmation of the causative agents of diarrhea and its antimicrobial susceptibility tests in the samples collected from patients who have symptoms of diarrhea. There is a relative lack of diagnostic studies on the causative agents of diarrhea in Mongolia, especially on the causative agents of bacterial diarrhea and their antibiotic susceptibility. Methods: A rectal swab and stool sample were taken from 187 patients admitted to the NCCD Mongolia with a diagnosis of diarrhea and infection between June 2018 and April 2020 using a hospital-based instantaneous survey model, and bacteriology, molecular biology, and antibiotic susceptibility testing were performed at the laboratory of Bacteriology and Immunology, Institute of Veterinary Medicine. Results: Of the 187 samples, N=127 (67.9%), p

Shiga-like toxin-producing Escherichia coli (STEC) is a well-known cause of foodborne acute diarrheic diseases, especially in children and the elderly. The potentially fatal complications associated with toxin production range from bloody diarrhea and ischemic colitis to kidney failure, hemolytic–uremic syndrome (HUS), and colon perforation. Here, we describe a case and literature review of STEC-induced colitis, highlighting the clinical features and the necessary tools for the best diagnostic approach and management. Facing challenging differential diagnosis, ranging from ischemic colitis and inflammatory bowel disease to infectious processes due to a pathogenic or opportunistic agent, we conducted a step-by-step exploration. Following bacteriological investigation, imagistic screening, and colonoscopy, we ruled out some of the initial suppositions and reached a final diagnosis, while also considering the pathological results. Although antibiotics are not indicated in this pathology, our patient did receive antibiotics, given the risk of translocation and colon perforation, without any associated complications such as HUS or peritonitis. Detailed and rigorous investigations conducted by a multi-specialty team are required for prompt medical support. Coping with the symptoms and refraining from further complications are the mainstem aims of treatment.

Background: Shiga toxin-producing E. coli (STEC) infections affect children and adults worldwide, and treatment remain solely supportive. Up to 15–20% of children infected by high-risk STEC (i.e., E. coli that produce Shiga toxin 2) develop hemolytic anemia, thrombocytopenia, and kidney failure (i.e., hemolytic uremic syndrome (HUS)), over half of whom require acute dialysis and 3% die. Although no therapy is widely accepted as being able to prevent the development of HUS and its complications, several observational studies suggest that intravascular volume expansion (hyperhydration) may prevent end organ damage. A randomized trial is needed to confirm or refute this hypothesis. Methods: We will conduct a pragmatic, embedded, cluster-randomized, crossover trial in 26 pediatric institutions to determine if hyperhydration, compared to conservative fluid management, improves outcomes in 1040 children with high-risk STEC infections. The primary outcome is major adverse kidney events within 30 days (MAKE30), a composite measure that includes death, initiation of new renal replacement therapy, or persistent kidney dysfunction. Secondary outcomes include life-threatening, extrarenal complications, and development of HUS. Pathway eligible children will be treated per institutional allocation to each pathway. In the hyperhydration pathway, all eligible children are hospitalized and administered 200% maintenance balanced crystalloid fluids up to targets of 10% weight gain and 20% reduction in hematocrit. Sites in the conservative fluid management pathway manage children as in- or outpatients, based on clinician preference, with the pathway focused on close laboratory monitoring, and maintenance of euvolemia. Based on historical data, we estimate that 10% of children in our conservative fluid management pathway will experience the primary outcome. With 26 clusters enrolling a mean of 40 patients each with an intraclass correlation coefficient of 0.11, we will have 90% power to detect a 5% absolute risk reduction. Discussion: HUS is a devastating illness with no treatment options. This pragmatic study will determine if hyperhydration can reduce morbidity associated with HUS in children with high-risk STEC infection. Trial registration: ClinicalTrials.gov NCT05219110. Registered on February 1, 2022. [ABSTRACT FROM AUTHOR]

Background: Dysentery is an inflammatory bowel disease (IBD) infected by micro-organisms invading the intestinal mucosa.Objectives: This study sought to determine the epidemiologic profile of this disease and its related factors in South Khorasan Province, Iran.Methods: This cross-sectional study was conducted on 1181 patients with dysentery during 2016-2020 in South Khorasan Province. The data collection tool was the individual examination form completed in the diseases surveillance system, approved by Diseases Control of Ministry Center of Health and Medical Education. Data were analyzed using SPSS 18 software.Results: The highest prevalence was observed in counties (i.e., Sarbisheh, Zirkooh, Darmiyan, and Nehbandan) sharing a border with Afghanistan. The highest prevalence of the disease was reported in men (n=639, 54.1%) and villagers (n=702, 59.4%). As well, the age group under 6 years old had the highest frequency of the affected cases (n=110, 30.6%). The most common causes of dysentery were connected with the genus Shigella (48.2%) and E. coli (30.9%).Conclusion: The genus Shigella and E. coli were found to be the most important causes of dysentery in South Khorasan Province, Iran. In addition, the highest prevalence of diarrheal diseases had been observed in counties located on the borderlines.

Aim: Ischemic colitis (IC) is one of the most common causes of lower gastrointestinal bleeding, especially in patients over 60 years of age. In this study, we investigated the clinical and demographic characteristics of patients with IC detected by colonoscopy. Material and Method: This study was conducted retrospectively by examining the patient records of patients who underwent colonoscopy for various reasons between January 2014 and December 2017. Patients with IC pre-diagnosis in the colonoscopy reports were included in the study. A total of 130 patients were found, 18 patients were excluded from the study due to lack of data and the study was conducted with 112 patients. Results: Definitive IC was diagnosed in 56 of 112 patients who had a preliminary diagnosis of colonoscopy (50%). The average age of patients diagnosed with definitive IC was 68, of which 30 were male and 26 were female. It was observed that IC patients applied to the hospital with complaints of abdominal pain, hematochezia, diarrhea and fever. It is observed that ischemic colitis is most frequently affects left colon. In the doppler findings of patients with IC, all mesenteric vessels and aorta were normal in the vast majority of patients (70%). When predisposing factors that may cause IC were examined, hypertension was observed in 59% of patients, coronary artery disease in 59%, diabetes mellitus in 21% and heart failure in 18%. The vast majority of patients improved with medical therapy (89%). Six patients were given surgery for colon resection (11%), 4 of these patients recovered, but two patients became exitus due to the common thromboembolic condition and associated extensive ischemia (4%). Conclusion: IC is a disease that presents symptoms such as bloody diarrhea and abdominal pain, especially in elderly male patients with predisposing risk factors, frequently seen in the left colon and responds well to medical treatment, and should be considered in every patient with acute diarrhea and abdominal pain.

This case report presents a 7-month-old male who was admitted to the emergency room with red-colored stools, initially raising concerns for serious gastrointestinal issues. The child, who had a history of milk protein allergy and eczema, had recently been prescribed cefdinir for an ear infection and was also consuming a hydrolyzed formula containing iron. Despite initial findings of elevated white blood cell count, mild anemia, and hyperkalemia, a stool heme-occult test was negative. The negative heme-occult lead to the consideration of cefdinir-induced stool discoloration as a possible diagnosis, a benign side effect that occurs in the presence of iron supplementation. Following the discontinuation of cefdinir, the patient's symptoms resolved completely on follow up with his pediatrician. A rare occurrence, cefdinir-induced red stool discoloration must be considered in cases of benign appearing infants with "bloody" stools., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shammout et al.)

Canine parvovirus (CPV) is an infectious disease with clinical signs of bloody diarrhea (hemorrhagic enteritis) which is cause of death in infected dogs. A five-month-old female local dog with a weight of 4.3 kg, black and white coat on the ventral side came to the Rumah Sakit Hewan Pendidikan, Faculty of Veterinary Medicine, Udayana University with complaints of weakness, loss of appetite since the day before and vomiting in the morning of the examination. The dog is rescued and never been vaccinated before. Clinical examination showed weakness such as holding pain, pink pale eye mucosae, delayed skin turgor, Capillary Refill Time (CRT) more than two seconds, and increased respiratory rate. Dogs do not respond to handfeeding. On observation the dog experienced clear and foamy vomiting and foul-smelling bloody diarrhea. The native stool faecal examination showed negative results, while the CPV antigen rapid test examination showed positive results. Complete blood count showed that on the first day of hospitalization the dog had leukopenia, granulocytopenia, hyperchromic normocytic anemia and thrombocytopenia. The dog was diagnosed with CPV with a dubious prognosis. Dogs were given fluid therapy using sodium chloride 0.9% infusion and vitamin B complex, anti-emetic ondansetron, antibiotic cefotaxime, and vitamin K. Dogs were also treated with traditional medicine Fu Fang 1 mL and trigona honey 1 mL. Dogs are given a special feed Hills Prescription Diet A/D Urgent Care. The dog's condition improved after offering therapy for seven days and the dog was declared cured and could be sent home on the ninth day. [ABSTRACT FROM AUTHOR]

Hemolytic uremic syndrome (HUS) represents one of the main causes of severe acute kidney injury in children. The most frequent form of HUS is caused by Shiga toxin-2 (Stx2)-producing Escherichia coli. Hemoglobinuria and hematuria are markers of glomerular damage, but their use has never been validated in HUS. We retrospectively analyzed the presence of hemoglobinuria/urinary red blood cells (RBCs) in children with Stx2-positive bloody diarrhea (BD) or with already ongoing STEC-HUS with the aim of validating its role in early identifying HUS. We reviewed all the pediatric patients with Stx2+ BD (group 1) and with ongoing HUS (group 2) referred to our center from 2010 to 2019. A total of 100 children were eligible for the study. In group 1, 22 patients showed hemoglobinuria/hematuria, while 41 remained negative. In 15/22 positive patients (68.2%), blood tests ruled in HUS, while in 7 (31.8%), HUS was excluded. Among the 41 patients persistently negative for hemoglobinuria/hematuria, no one developed HUS. The 37 STEC-HUS children (group 2) all had hemoglobinuria/RBCs at admission. Conclusion: Hemoglobinuria/hematuria for the diagnosis of HUS in children with Stx2+ BD showed a sensitivity of 100% and a specificity of 85%. We strongly recommend patients with BD carrying Stx2 in stools to be closely monitored with urine dipstick/urinalysis to early identify HUS. What is Known • Children with bloody diarrhea secondary to Shiga toxin 2 are at high risk of hemolytic uremic syndrome, thus have to be carefully monitored for the development of the disease, in order to early be hospitalized and treated. What is New • Urine dipstick for hemoglobinuria can be used as an easy, inexpensive, and repeatable tool to early diagnose children with bloody diarrhea secondary to Shiga toxin 2 to have developed hemolytic uremic syndrome, with no risk of false-negative results. [ABSTRACT FROM AUTHOR]

Intestinal myiasis caused by fly larvae parasitic in gastrointestinal tract was rare reported in children. We reported an infant with bloody diarrhea caused by intestinal myiasis. A 1 year and 7 months old boy presented with the only symptom of bloody diarrhea of unknown origin. In the second week of onset, numerous moving worms were observed in the bloody stool after bowel preparation with polyethylene glycol for colonoscopy. The bloody diarrhea disappeared after 1 week of combined therapy with albendazole and metronidazole. On follow-up after 6 months, the patient remained well without bloody diarrhea. In conclusion, intestinal myiasis being a rare disease that is very challenging to diagnose, physicians should remember it when they receive cases of bloody diarrhea with non-specific symptoms without any apparent cause. [ABSTRACT FROM AUTHOR]

Shiga toxin-producing Escherichia coli (STEC) are important foodborne pathogens that can cause human infections ranging from asymptomatic carriage to bloody diarrhea (BD) and fatal hemolytic uremic syndrome (HUS). However, the molecular mechanism of STEC pathogenesis is not entirely known. Here, we demonstrated a large scale of molecular epidemiology and in-depth genomic study of clinical STEC isolates utilizing clinical and epidemiological data collected in Region Jönköping County, Sweden, over a 15-year period. Out of 184 STEC isolates recovered from distinct patients, 55 were from patients with BD, and 129 were from individuals with non-bloody stools (NBS). Five individuals developed HUS. Adults were more associated with BD. Serotypes O157:H7, O26:H11, O103:H2, O121:H19, and O104:H4 were more often associated with BD. The presence of Shiga toxin-encoding gene subtypes stx2a, stx2a + stx2c, and stx1a + stx2c was associated with BD, while stx1a was associated with milder disease. Multiplex virulence and accessory genes were correlated with BD; these genes encode toxins, adhesion, autotransporters, invasion, and secretion system. A number of antimicrobial resistance (AMR) genes, such as aminoglycoside, aminocoumarin, macrolide, and fluoroquinolone resistance genes, were prevalent among clinical STEC isolates. Whole-genome phylogeny revealed that O157 and non-O157 STEC isolates evolved from distinct lineages with a few exceptions. Isolates from BD showed more tendency to cluster closely. In conclusion, this study unravels molecular trait of clinical STEC strains and identifies genetic factors associated with severe clinical outcomes, which could contribute to management of STEC infections and disease progression if confirmed by further functional validation.

This study was carried out for detection of some virulence factors for E coli O157:H7 isolated from patients with bloody hemorrhagic diarrhea or urinary tract infection (UTI). A total of 200 bloody diarrhea and 150 urine samples were collected from children of both sexes between the age of 3 and 10 years, who were suffering from bloody diarrhea and urinary tract infection (UTI) in the period from September to December 2016 in, Central Children Hospital and Children Safe Hospital in Baghdad/Iraq. All samples were screened to detect the presence of non-sorbitol fermenting colonies on sorbitol MacConkey agar supplemented with Cefixime -Tellurite (CT-SMAC) also cultured on other enrichment and selective media(Hicrome and Eosin methylen blue) at 37°C for 24hrs. The isolates were identified by Vitek 2 system and they were confirmed by latex agglutination test. A total of 11 isolate, 8 (4%) from bloody diarrhea and 3 (2%) isolates from urine samples were diagnosed as E. coli O157:H7 that appeared on CT-SMAC as small, circular and colorless colonies with smoky center whereas on Hicrome media as dark purple to magenta colored moiety colonies, positive for Vitek2 and latex agglutination. Polymerase chain reaction (PCR) was employed to detect some virulence genes of isolates ,as hlyA (responsible for hemolysine) flicH7 (encoding fimbria) and rfbO157 (encoding- lipopolysaccharide) using specific primers of 534, 625 and 259 bp for previous genes respectively . The result of PCR amplification revealed presence of hly A , flic H7 and rfb O157 genes in all isolate.

Ischemic colitis (IC) associates with older age, hypertension, and heart disease, among others. Young-onset IC is rare. We aimed to delineate clinical characteristics of young patients (<40 years) with IC. Cases from 1984 to 2017 were re-reviewed. Of the 60 cases available, 52% (n = 31) had histologic features of IC. Fifty-five percent were female with a mean age of 32 (range = 14-40) years. Fifty-eight percent (n = 18) were resections. The most common presentations were diarrhea and abdominal pain. Three teenagers had IC associated with prior surgery, volvulus, and constipation. In the 21- to 40-year group, 43% (n = 12) lacked clinical associations. A second subset (n = 6, 21%) had histories of immune dysregulation (lupus, dermatomyositis, vasculitis) and poorly controlled HIV/AIDS (n = 5, 18%). Smoking and cocaine were endorsed by 1 and 2 patients, respectively. One patient had premature atherosclerosis while another had HMG Co-A lyase deficiency. Vasculitis was identified in 22% of the resections and in none of the biopsies. Nineteen percent of patients died (n = 6) from complications of IC, all treated surgically, including 1 patient previously misdiagnosed as ulcerative colitis; 2 patients died of unrelated causes. While rare before 20 years of age, IC in teenagers relates to mechanical issues and is rare in children. Associations in young adults include immune dysregulation, cocaine and cigarette use, and premature atherosclerosis. Our retrospective cohort had a surgical mortality rate within the range reported by others, highlighting the importance of accurate diagnosis in young individuals. [ABSTRACT FROM AUTHOR]

To describe an operating protocol for bloody diarrhea (BD) in a pediatric population as a rapid response to a public health threat represented by an excess of pediatric HUS cases in the Apulia region (Southern Italy) starting from 2013. The protocol was set up with the goal of correct clinical management of Shiga toxin-producing Escherichia coli (STEC) infections, reductions in subsequent cases of hemolytic uremic syndrome (HUS), and improved short- and long-term disease outcomes. The protocol consisted of rapid hospitalization of children with bloody diarrhea (BD), hematochemical laboratory tests every 12–24 hours, and prompt laboratory diagnosis of STEC. No antibiotics were recommended until diagnosis. Children positive for STEC infections underwent early vigorous volume expansion. In June–December 2018, 438 children with BD were hospitalized, of which 53 (12.1%) had a STEC infection. The most common serogroups were O26 (36.1%), O111 (23.0%), and O157 (14.8%). Thirty-one samples carried the stx2 gene. Four cases evolved into HUS (7.5%), all with favorable outcome despite neurological involvement in two cases. Prompt and accurate laboratory diagnosis of STEC infections is of the utmost importance in patients with BD for correct clinical management. The strict adherence to the protocol could reduce the progression rate of STEC infections to HUS and prevents complications. Enhanced BD surveillance may help reduce cases of pediatric HUS in Southern Italy. [ABSTRACT FROM AUTHOR]

Bloody diarrhea in young children is usually a sign of invasive enteric infection that carry a substantial risk of serious morbidity and death. Objectives : to identify the proportion of infective bloody diarrhea out of total number of gastro-enteritis cases,also to identify the prevalence of different etiological agents and to find the relation between the main infective etiological types of bloody diarrhea and some sociodemographic factors of this study. Retrospective study was conducted in Children Welfare Teaching Hospital / Baghdad during period extending from 1 st of January to 30 th of June 2016. Information was collected by reviewing the records of patients with acute infective bloody diarrhea under 5 years of age admitted during 2015. The study revealed that the proportion of infective bloody diarrhea was 10. 9% out of the total gastroenteritis (788) cases admitted during 2015, and Entamoeba Histolytica was the most common isolated pathogen in the study42 (48%) patients. followed by E.coli 15 cases (17.4%), shigella, salmonella 7(8%) and 4(4.7%) respectively . The most vulnerable age was those below 2 years (58%) and males were affected more than females (1.3:1), (37%) were bottle fed. The majority had chlorinated tap water supply (82.6%). [ABSTRACT FROM AUTHOR]

Diarrhea is a symptom of a disease that often occurs in dogs, but the diagnosis and therapy usually only based on clinical symptoms. The purpose of this case report is to examine, diagnose and treat a dog with diarrhea. The material of this report is a 4 moths old of female mixbreed dog. The dog examinated including physical, faecal and profile blood examination. Examination of faecal samples includes gastrointestinal parasitic and bacteria identifications. The results of the anamnese and physical examination was found that the dog did not has appetite, vomited, weak, bloody diarrhea and body temperature 40.1℃. The results of faecal examinationcould be isolated Escherichia coli which was sensitive to ampicillin, and blood examination showed neutrophilia and lymphocytopenia. The dog was diagnosed suffered diahrrea caused by E. coli and was treated intra-muscularly for 5 days with 5 mg/kg body weight of ampicillin, twice a day, and 1 time 1 ml vitamin K and 0.37 ml vitamin B-complex. The results of the therapy showed a development of healing gradually and the dog was declared cured on the 7th day of treatment.

In July–August 2009, eight patients with bloody diarrhea complicated by hemolytic uremic syndrome (HUS) were admitted to hospitals in Tbilisi, Georgia. We started active surveillance in two regions for bloody diarrhea and post-diarrheal HUS. Of 25 case-patients who developed HUS, including the initial 8 cases, half were ⩾15 years old, 67% were female and seven (28%) died. No common exposures were identified. Among 20 HUS case-patients tested, Shiga toxin was detected in the stools of 2 patients (one with elevated serum IgG titers to several Escherichia coli serogroups, including O111 and O104). Among 56 persons with only bloody diarrhea, we isolated Shiga toxin-producing E. coli (STEC) O104:H4 from 2 and Shigella from 10; 2 had serologic evidence of E. coli O26 infection. These cases may indicate a previously unrecognized burden of HUS in Georgia. We recommend national reporting of HUS and improving STEC detection capacity.

In Queensland, Australia, 31 of 96 Shiga toxin‒producing Escherichia coli cases during 2020-2022 were reported by a specialty pathology laboratory servicing alternative health practitioners. Those new cases were more likely to be asymptomatic or paucisymptomatic, prompting a review of the standard public health response.

Background Haemolytic Uraemic Syndrome (HUS) is a serious complication of Shiga toxin-producing Escherichia coli (STEC) infection and the key reason why intensive health protection against STEC is required. However, although many potential risk factors have been identified, accurate estimation of risk of HUS from STEC remains challenging. Therefore, we aimed to develop a practical composite score to promptly estimate the risk of developing HUS from STEC. Methods This was a retrospective cohort study where data for all confirmed STEC infections in Ireland during 2013–15 were subjected to statistical analysis with respect to predicting HUS. Multivariable logistic regression was used to develop a composite risk score, segregating risk of HUS into 'very low risk' (0–0.4%), 'low risk' (0.5–0.9%), 'medium risk' (1.0–4.4%), 'high risk' (4.5–9.9%) and 'very high risk' (10.0% and over). Results There were 1397 STEC notifications with complete information regarding HUS, of whom 5.1% developed HUS. Young age, vomiting, bloody diarrhoea, Shiga toxin 2, infection during April to November, and infection in Eastern and North-Eastern regions of Ireland, were all statistically significant independent predictors of HUS. Demonstration of a risk gradient provided internal validity to the risk score: 0.2% in the cohort with 'very low risk' (1/430), 1.1% with 'low risk' (2/182), 2.3% with 'medium risk' (8/345), 3.1% with 'high risk' (3/98) and 22.2% with 'very high risk' (43/194) scores, respectively, developed HUS. Conclusion We have developed a composite risk score which may be of practical value, once externally validated, in prompt estimation of risk of HUS from STEC infection. [ABSTRACT FROM AUTHOR]

The article discusses the case study of the 17-year-old African American male presented to the emergency department complaining of 5 days of diarrhea, which was watery and intermittently bloody, and a fourth generation human immunodeficiency virus (HIV) antigen/antibody test positive and differentiation assay confirmed infection with HIV-1, patient was started on amoxicillin for untreated streptococcal pharyngitis and oral nystatin for thrush.

In Argentina, hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC-HUS) infection is endemic, and reliable data about prevalence and risk factors have been available since 2000. However, information about STEC-associated bloody diarrhea (BD) is limited. A prospective study was performed during the period October 2018-June 2019 in seven tertiary-hospitals and 18 referral units from different regions, aiming to determine (i) the frequency of STEC-positive BD cases in 714 children aged 1-9 years of age and (ii) the rate of progression of bloody diarrhea to HUS. The number and regional distribution of STEC-HUS cases in the same hospitals and during the same period were also assessed. Twenty-nine (4.1%) of the BD patients were STEC-positive, as determined by the Shiga Toxin Quik Chek (STQC) test and/or the multiplex polymerase chain reaction (mPCR) assay. The highest frequencies were found in the Southern region (Neuquén, 8.7%; Bahía Blanca, 7.9%), in children between 12 and 23 month of age (8.8%), during summertime. Four (13.8%) cases progressed to HUS, three to nine days after diarrhea onset. Twenty-seven STEC-HUS in children under 5 years of age (77.8%) were enrolled, 51.9% were female; 44% were Stx-positive by STQC and all by mPCR. The most common serotypes were O157:H7 and O145:H28 and the prevalent genotypes, both among BD and HUS cases, were stx 2a -only or -associated. Considering the endemic behavior of HUS and its high incidence, these data show that the rate of STEC-positive cases is low among BD patients. However, the early recognition of STEC-positive cases is important for patient monitoring and initiation of supportive treatment., (Copyright © 2023 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.)

The current study investigated the gene responsible of hepatic toxin in Campylobacter jejuniisolatesthat isolated from children suffering diarrhea using polymerase chain reaction technique (PCR). The results showed that only one C. jejuni isolate that obtained from watery diarrheal stool was carrying hepatic toxin gene. Hepatic toxin was extracted fromproducedC.jejuniisolateand tested its effectiveness by liver function test in Swiss mice female type Balb/c (Mus musculus). The intravenous injection of 100 μg / 0.5 ml of hepatic toxin extract led to a significant increase in the mean concentration of liver enzymes Glutamate oxaloacetate transaminase (GOT) and Glutamate pyruvate transaminase (GPT), while the increase was not significant in mean concentration of the enzyme Alkaline phosphatase (ALP) compared with the control mice. In addition, histopathological study showed that hepatic toxinextracthad severe effects represented by multiple foci of inflammatory cells, bloody congestion, and necrosis in liver, hemorrhage and penetration of inflammatory cells in the spleen, while no histological changes was induced by hepatic toxin extract in the intestine. [ABSTRACT FROM AUTHOR]

Nowadays, Klebsiella oxytoca is described as a causative organism for antibiotic-associated hemorrhagic colitis (AAHC). Here we report two cases of pediatric AAHC, from which K. oxytoca was cultured after starting amoxicillin-clavulanate or amoxicillin treatment. The patients developed severe abdominal pain and a large amount of bloody diarrhea. K. oxytoca was obtained in intestinal fluid culture of a boy through the colonoscopy. On the other hand, colonic tissue culture and intestinal fluid culture were negative of the other patient. K. oxytoca was detected in stool culture when he was admitted. These cases showed characteristic endoscopic findings of segmental hemorrhagic colitis, and both boys recovered spontaneously within 2-3 days after they stopped taking the antibiotics. Therefore, in children who develop relatively large amount of bloody diarrhea after antibiotic treatment, we should consider AAHC caused by K. oxytoca. [ABSTRACT FROM AUTHOR]