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Background and aims: Incomplete microscopic colitis (MCi) is a subtype of microscopic colitis (MC). Budesonide is recommended as a first-line treatment for MC. However, randomised trials on efficacy of treatment in MCi are missing. We therefore performed a randomised, placebo-controlled trial to evaluate budesonide as induction therapy for MCi. Methods: Patients with active MCi were randomly assigned to either budesonide 9 mg once daily or placebo for 8 weeks in a double-blind, double-dummy design. The primary endpoint was clinical remission, defined as a mean of

Background: Acute watery diarrhoea (AWD) is a leading cause of illness and death amongst children in developing countries. Electrolyte and acid-base disturbances play an important role in the associated morbidity and mortality. Objectives: To observe the acid-base and electrolyte changes in moderate and severe dehydration in AWD in children. Methods: This cross sectional study was carried out in the Observation and Referral Unit of Dhaka Shishu (Children) Hospital from July 2018 to December 2018. Children below five years of age who came with acute diarrhoea with moderate to severe dehydration were included in the study. After admission 2ml of whole blood was collected with all aseptic measures at the time of insertion of intravenous cannula before giving intravenous fluids to measure serum levels of Na and K while arterial blood was also taken for analysis. The data was analyzed by using SPSS version 20. Results: Total 125 AWD cases were admitted among them 98(78.4%) had moderate dehydration whereas 27(21.6%) had severe dehydration. Hyponatremic dehydration was present in 41(32.8%) cases. Among them 30(30.6%) had moderate dedydration and 11(40.4%) had severe dehydration, hypernatremic dehydration was present in 11.11% cases, hypokalemia was present in 54(43.2%) cases. Among them 42(42.86%) had moderate dedydration and 12(44.44%) had severe dehydration. Metabolic acidosis was present in 38(30.4%) cases [28(28.57%) in moderate dedydration and 10(37.04%) in severe dehydration]. The comparison of mean serum sodium and potassium value of the children with moderate and severe degrees of dehydration did not attain statistical significance, but there was a significant difference in bicarbonate concentration among moderate and severe dehydration cases (p=0.02). Conclusion: Hyponatremia and hypokalamia was the commonest electrolyte abnormality among moderate to severe dehydration with AWD. Mean serum sodium and potassium of the children with moderate and severe degrees of dehydration did not attain statistical significance, but bicarbonate concentration was significantly low among severe dehydration cases. DS (Child) H J 2020; 36(2): 120-124

Cryptosporidium parvum is a major zoonotic pathogen responsible for outbreaks of severe diarrhoea in humans and calves. Almost all investigations of cryptosporidiosis outbreaks caused by C. parvum have focused on its IIa subtype family in industrialized nations. From December 2018 to April 2019, approximately 200 neonatal calves on a large cattle farm in Hebei Province, China, were diagnosed with watery diarrhoea and over 40 died. To investigate the cause of the outbreak, faecal samples were taken during and after the outbreak from neonatal calves of ≤4 weeks of age (n = 40 and n = 56) and older calves of 4-24 weeks of age (n = 79 and n = 38). A total of 18 faecal samples collected from ill calves at the peak of the outbreak were analysed for four common enteric pathogens using an enzymatic immunoassay (EIA). In addition, 75 samples from neonatal calves were tested for rotavirus by EIA. All samples were analysed for Cryptosporidium spp. using PCR and sequencing techniques. Of the initial 18 samples from sick calves, ten were positive for C. parvum, five for rotavirus, and one for coronavirus. The overall prevalence of rotavirus in neonatal calves was 20.0% (15/75), with no significant differences during and after the outbreak. In contrast, Cryptosporidium parvum infections were significantly higher during the outbreak (60.0%, 24/40) than after the outbreak (30.4%, 17/56; p = .004). Cryptosporidium parvum infection was associated with the presence of watery diarrhoea in neonatal calves (OR = 11.19), while no association was observed between C. bovis infection and diarrhoea. All C. parvum isolates were identified as subtype IIdA20G1. This is one of the few reports of outbreaks of severe diarrhoea caused by C. parvum IId subtypes in calves. More attention should be directed towards the dissemination of C. parvum in China.

Background: Diarrhoea is one of the commonest causes of death in children in developing countries. Proper home management can reduce morbidity and mortality. High rates of dietary restriction, poor knowledge of preparation of ORS solutions and low attention given to clinical indicators are causes for seeking hospital management. This study was done to observe the knowledge of caregivers regarding home management of acute watery diarrhoea and to assess the impact of home management on severity of dehydration. Methods: This study was a prospective study carried out on children with acute diarrhea who attended outpatient department (OPD) of Rangpur Medical College Hospital and duration of the study was 6 months. A total of 100 cases were included in this study who fulfilled the definition of acute diarrhea by WHO. The investigator questioned each mother with the help of a preformed questionnaire. Results: In 85% of cases, caregivers perception about diarrhea was an increase in the frequency and fluidity of stool. About 95% of cases were initially treated at home; treatment was given at home with ORS (95%). There was change in feeding pattern and modified food was given (24%). Perception about ORS preparation was appropriate in 64% and inappropriate in 31% of cases. Inadequate amount of ORS was given in 74% cases. There was no interruption of breast feeding; dietary restriction during diarrhoea was observed only in 2% cases. Most of the parents did not know when to return immediately to hospital. Dehydration status of diarrhoeal cases was no dehydration (81%), some dehydration (18%) and severe dehydration (1%). In majority of the cases different drugs were used. Conclusion: Most of the caregivers’ decided to treat diarrhoea at home. Many of them had wrong perception about preparation of ORS and some of them did not know how to make ORS solution. Inadequate amount of ORS was given in most of the cases. Thus to lessen hospital burden and to prevent dehydration increased emphasis should be given to health education of home management of diarrhea.

Cryptosporidium and Toxoplasma are parasites that have caused problems worldwide. Cryptosporidium causes severe watery diarrhoea and may be fatal in immunocompromised patients and in infants. Nitazoxanide is the only agent currently approved by the FDA, but its efficacy is limited. Toxoplasmosis is also a problem in the immunocompromised, as currently available treatment options have limited efficacy and patient tolerance can be poor. In the present investigation, we screened libraries of epigenetic compounds to identify those that inhibited C. parvum growth. Nullscript was identified as a compound with an inhibitory effect on C. parvum and T. gondii growth, and was less toxic to host cells. Nullscript was also able to significantly decrease oocyst excretion in C. parvum-infected SCID mice., Graphical abstract Image 1, Highlights • A library of epigenetic compounds was used to screen for compounds effective against Cryptosporiium parvum. • Nullscript has been shown to be effective in inhibiting the growth of C. parvum and T. gondii. • Nullscript significantly decreased oocyst excretion in C. parvum-infected SCID mice.

Introduction: Globally,acute watery diarrhoea is amajor cause of childhood morbidityand mortality. It is the fourthleading cause of death in childrencontributing as high as 11% of allchildhood deaths. In Nigeria,acute watery diarrhoea causes240,106 deaths per year. Out ofpocket expenditure is a majorsource of healthcare funding inNigeria, hence treatment of acutewatery diarrhoea places extra financialburden on the familiesespecially those in the low socioeconomicclass.Objective: To determine the costof treatment of acute watery diarrhoeain children aged 6 to 36months.Methodology: This was a crosssectional study conducted on children aged 6-36 months who presented with acute watery diarrhoea from January through October 2017. Data obtained using interviewer-administered questionnaire, included sociodemography, duration of illness, treatment cost of the index diarrhoeal episode before presenting to our facility, transportation cost, food and other incidental cost, duration of hospitalization. Diagnostic tests requested and medications prescribed were obtained from the patient’s medical file. Information on drug cost, diagnostic test cost and hospital bed day cost were obtained from Nnamdi Azikiwe University Teaching Hospital (NAUTH) central pharmacy, NAUTH main laboratoryand account section respectively. Statistical Package for Social Sciences (SPSS) version 20 was used for data analysis. Result: Seventy two patients were recruited for the study, of whom 47(65.0%) were males giving a male female ratio of 1.9:1. Forty eight (66.6%) of the study participants belonged to the lower socioeconomic class while 22(30.6%) and 2(2.8%) belonged to the middle and upper socioeconomic class respectively. A mean total treatment post per diarrhoea episode derived from this study was # 37,572.2 ± #12,479.0 which at the time of the study was equivalent to US$ 104.7 ± US$ 34.8. This is well above the then Nigerian minimum monthly wage of 18,000.0 (US$ 50.1). Conclusion: The result of this study showed that the economic burden of acute watery diarrhoea is quite enormous especially to the low socio-economic group. Prevention and improvement of home treatment of diarrhoea may reduce the treatment cost. Key words: Acute watery diarrhoea, Cost, Children, Hospital

Introduction Microscopic colitis (MC) is an important cause of chronic, watery diarrhoea. Currently, there is no specific biomarker available to guide diagnosis. The use of faecal calprotectin (FCP) as a potential marker has been addressed in only a few studies. Further, bile acid malabsorption (BAM) often accompanies MC. Current practice recommends the selenium-labelled homocholic acid-taurine (SeHCAT) test, but at our centre, 7 alpha-hydroxy-4-cholesten-3-one (7αC) is used as a simpler and less expensive alternative to SeHCAT, with values over 22ng/mL indicating BAM. This study aims to evaluate the use of FCP as a biomarker in the diagnosis of MC and the role of 7αC in detecting concomitant BAM with MC. Methods Pathology records were retrospectively reviewed for patients diagnosed with collagenous colitis (CC) between 2000 and 2018 and lymphocytic colitis (LC) between 1995 and 2011. FCP and 7αc results, if measured within 6 months of pathological diagnosis, were extracted for analysis. Results Between 2000 and 2018, 646 CC cases were confirmed on histology. Of 646 patients, 147 had FCP measured; in 111 (75.5%) FCP was elevated with mean levels 238.1μg/g (SD±273.0); 140/646 had 7αC measured; 16 (11.4%) indicated BAM. Mean levels were 10.2ng/mL (SD±9.4). During a 21-year period (1995-2011), 204 LC diagnoses were made: 14/204 had FCP measured ; 8 (57.1%) were elevated. Mean levels were 128.4μg/g (SD±107.7). Of 204 LC patients, 20 had 7αC measured, 5 (25%) indicating BAM. Mean levels were 13.95ng/mL (SD±9.4). Discussion Both CC and LC were associated with raised FCP during the diagnostic phase, supporting the potential role of its use in clinical practice. Furthermore, we present results of using 7αC in identifying BAM amongst patients with MC. In our cohort, low levels of 7αC suggest relatively low concordance of BAM with MC.

Duodenal villous atrophy with olmesartan was described in 2012, 10 years following registration of olmesartan. Clinical features are severe watery diarrhoea, usually occurring in association with weight loss. Onset is delayed, with a mean duration of prior exposure to olmesartan of 3 years. Diagnosis may be delayed. Symptoms resolve over weeks following cessation of olmesartan. Epidemiological studies suggest increased risk with olmesartan, rather than a class effect of all angiotensin receptor blockers. Post-marketing surveillance for drug safety remains important.

Background: Acute gastroenteritis is considered as one of the most common causes of under-five morbidity and mortality worldwide. Standard treatment is the use of oral rehydration solution (ORS), intravenous fluid if indicated, and zinc supplement. Recently, the use of probiotics has been introduced as an adjunct to the treatment of acute gastroenteritis. The aim of this study is to determine the clinical efficacy of multi-strain probiotics as adjunct treatment of acute gastroenteritis. Methodology: A randomized controlled trial was done in 250 bed district Sadar Hospital, Brahmanbaria, Bangladesh from January 2016 to June 2017. After fulfilling the inclusion criteria, 507 children aged 2 months to 5 years were enrolled in this study. Those with dysentery, chronic diarrhea, diarrhea due to known genetic disorder, chronic illness, malnutrition, systemic infection, CNS disorder and congenital malformation were excluded. Children were divided into two groups randomly. One group was With Probiotic, zinc and standard WHO (ORS) as case and other group was Without Probiotic, zinc and standard WHO ORS as control. Results: Among 507 children, 257 were without probiotic while 250 were with probiotic. The mean difference in stool frequency between the two groups were 3.3 after 24 hours, 3.5 after 48 hours and 1.6 after 72 hours after hospitalization which was statistically significant (p=0.000). Reduction of stool frequency was highest after 48 hours of admission. Mean duration of hospital stay was 4.40±1.22 days in control and 4.03±.89 days in case group. Probiotic group children with exclusive breastfeeding had mean recovery time of 3.95±0.85 days and those who were not exclusively breastfeed had recovery time of 4.2±0.95 days (p=0.025). Conclusion: Probiotic is efficacious in reducing purging duration and frequency of acute watery diarrhea in children. Bangladesh J Child Health 2019; VOL 43 (2) :97-101

Retrovirus is the major cause of acute severe diarrhea in under five children and contributing 10,000 to 27000 deaths each year in Bangladesh. This cross-sectional study was designed to determine the risk factors associated with Rotaviral among under five children admitted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology during the period from 1st January to 31st December, 2018. Total 184 under five children with acute watery diarrhoea were enrolled in this study by convenient sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay (ELISA). Rotaviral antigen was found positive in 86 cases.The Rotavirus infection was found highest in age group of 7 to 12 months (50.56%) and in male (59.30%) children. It was found significantly higher in patients from lower socio-economic condition (64.00%), those who were from rural area (48.75%) and children who were not exclusively breastfed (83.87%). Bottle feeding, lower educational level of mother and overweight of children may serve as predisposing factors of rotavirus disease in these children. Bangladesh Med J. 2019 May; 48 (2): 32-37

Objective: Chronic watery diarrhoea is a classical symptom of collagenous colitis (CC). However, in some cases, the typical histologic findings of CC can be found in patients without this symptom. In this study we have performed a follow up on patients with a confirmed histological diagnosis of CC without the typical symptom watery diarrhoea Patients and methods: A structured medical record follow-up was performed on the subgroup of patients without watery diarrhoea but diagnosed with the typical CC histologic appearance in a previous study of microscopic colitis. Results: At follow up after a median time of 8 years (range: 0.33-12 years), five of these fifteen patients developed bowel symptoms but only two developed characteristic CC symptoms with watery diarrhoea. Conclusion: The majority of patients without chronic watery diarrhoea at diagnosis remained free from this symptom during follow up and only in a few cases symptoms attributed to CC developed.

Cholera is a severe diarrhoeal disease that spreads rapidly and affects millions of people each year, resulting in tens of thousands of deaths. The disease is caused byVibrio choleraeO1 and is characterized by watery diarrhoea that can be lethal if not properly treated. Cholera had not been reported in South America from the late 1800s until 1991, when it was introduced in Peru, wreaking havoc in one of the biggest epidemics reported to date. Within a year, the disease had spread to most of the Latin American region, resulting in millions of cases and thousands of deaths in all affected countries. Despite its aggressive entry, cholera virtually disappeared from the continent after 1999. The progression of the entire epidemic was well documented, making it an ideal model to understand cholera dynamics. In this review, we highlight how the synergy of socioeconomic, political and ecological factors led to the emergence, rapid spread and eventual disappearance of cholera in Latin America. We discuss how measures implemented during the cholera epidemic drastically changed its course and continental dynamics. Finally, we synthesize our findings and highlight potential lessons that can be learned for efficient and standardized cholera management programmes during future outbreaks in non-endemic areas.

Fecal pollution of water is a major concern in river based countries as it is associated with transmition of the pathogens. Rotavirus is one of them which is the major cause of acute severe dehydrating diarrhoea in children below five years. This cross-sectional observational study was designed to determine the association of contaminated water source with Rotaviral infection among under five children admitted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology during the period from 1st January to 31st December, 2018. Total 184 under five children with acute watery diarrhoea were enrolled in this study by convenient sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay (ELISA). Rotaviral antigen was found positive in 86 cases. The Rotavirus infection was found highest in age group of 7 to 12 months (50.56%) and in male (59.30%) children. It was found significantly higher in patients from lower socio-economic condition (64.00%), in rural area (48.75%) and those who consumed unboiled pond water (94.44%). It was found higher among those children who were not exclusively breastfed (83.87%). Bottle feeding, lower educational level of mother and improper hand washing may serve as predisposing factors of rotavirus disease in these children. Using of contaminated drinking and household water has an important relation with Rotaviral infection. Ignorance of using boiled water can play a significant role for increased prevalence of Rotaviral diarrhoea.

Food poisoning due to Clostridium perfringens normally results in a watery diarrhoea often accompanied by stomach cramps. The disease is generally mild and self-limiting and usually resolves within 24 hours. Complications aren’t very common, but in the very young or old, or those with a weakened immune system or underlying health conditions, the symptoms may be more severe and can result in dehydration which may require oral or intravenous fluid replacement. Rare complications include peritonitis and septicaemia. The main sources of infection are cooked meat and meat products that have been kept at an inappropriate temperature for a long time prior to being eaten. Diagnosis is usually made by finding large numbers of Cl. perfringens in a faecal sample or by the detection of one of its toxins. The illness can be prevented by good food hygiene practices such as ensuring that food is cooked at a sufficiently high temperature and is subsequently kept at an appropriate temperature prior to being eaten.

Cyclosporiasis is an illness characterised by watery diarrhoea caused by the food-borne parasite Cyclospora cayetanensis. The increase in annual US cyclosporiasis cases led public health agencies to develop genotyping tools that aid outbreak investigations. A team at the Centers for Disease Control and Prevention (CDC) developed a system based on deep amplicon sequencing and machine learning, for detecting genetically-related clusters of cyclosporiasis to aid epidemiologic investigations. An evaluation of this system during 2018 supported its robustness, indicating that it possessed sufficient utility to warrant further evaluation. However, the earliest version of CDC's system had some limitations from a bioinformatics standpoint. Namely, reliance on proprietary software, the inability to detect novel haplotypes and absence of a strategy to select an appropriate number of discrete genetic clusters would limit the system's future deployment potential. We recently introduced several improvements that address these limitations and the aim of this study was to reassess the system's performance to ensure that the changes introduced had no observable negative impacts. Comparison of epidemiologically-defined cyclosporiasis clusters from 2019 to analogous genetic clusters detected using CDC's improved system reaffirmed its excellent sensitivity (90%) and specificity (99%), and confirmed its high discriminatory power. This C. cayetanensis genotyping system is robust and with ongoing improvement will form the basis of a US-wide C. cayetanensis genotyping network for clinical specimens.

Background. To assess the diagnostic accuracy of loop-mediated isothermal amplification (LAMP) for the detection of Shigella from stool samples from children. Methods. Consecutive stool samples from children aged Results. Amongst the 374 stool samples tested, 291 samples were positive by LAMP and 213 were positive by the composite reference standard. The sensitivity of LAMP was 100 % (98.3–100 %) and its specificity was 51.6 % (43.6–59.5 %) with a disease prevalence of 57 %. The sensitivity and specificity of LAMP improved to 99.3 % (94.2–100) and 98.2 % (94.5–99.9), respectively, using latent class analysis, while assuming that genomic sequencing has perfect specificity. Discussion. The authors have standardized the LAMP procedure for direct application to clinical stool samples. LAMP is a sensitive and specific method for the diagnosis of Shigella from stool samples of children as compared to both culture and conventional PCR.

Porcine Epidemic Diarrhoea Virus (PEDV) causes watery diarrhoea, dehydration, and a high mortality rate among suckling pigs. Recently, PEDV had a large negative economic impact on the swine industries in Asia and North America. In 2014, PEDV re‐emerged in many European countries, but most countries only reported a few sporadic cases. Here, we report the epidemic wave that occurred in Italy from 2015 to 2017. During this time, PEDV was detected by real‐time PCR in 438 farms located mainly in the high‐density pig production area in Northern Italy. Most of the outbreaks were in farrow‐to‐finish, farrow‐to‐wean and finisher farms. Clinical signs were observed mainly in suckling and fattening animals, while mortality rates were higher in piglets, reaching 50%. A sequence analysis showed that a PEDV strain, similar to the OH851 S‐INDEL strain isolated in the USA in January 2014, was responsible for the outbreaks in Italy in 2015 and 2016. However, from January 2017, a recombinant variant strain, containing a portion of the Swine Enteric Coronavirus in the S1 gene, spread and almost completely outcompeted the previous nonrecombinant strain. In total, 14.1% of the environmental swabs collected from trucks at slaughterhouses after animals were unloaded tested positive for PEDV before the trucks were cleaned and disinfected, and 46% remained positive after cleaning and disinfection processes were performed. Moreover, environmental swabs indicated that 17.3% of the empty trucks arriving at the farms to load animals were PEDV‐positive. This study indicates that trucks can have an important role in the spread of PEDV in Italy.

Porcine deltacoronavirus (PDCoV) have recently emerged in several swine producing countries. Our survey found that in addition to porcine epidemic diarrhoea virus (PEDV), PDCoV has also been a causative enteric pathogen of diarrhoeic outbreaks occurring at swine farms around Japan since late 2013. Phylogenetic analysis using the complete genomes of PDCoVs detected in Japan in 2014 demonstrated that the PDCoVs from Japan may be closely related to the PDCoVs from the U.S. and Korea during 2013 to 2014 but not the PDCoVs from China and Hong Kong during 2004 to 2016 and from Thailand, Vietnam and Laos during 2015 to 2016. To investigate the pathogenicity of a representative Japanese PDCoV, we performed an experimental infection using hysterectomy-produced colostrum-deprived piglets. The PDCoV-inoculated piglets showed acute, watery diarrhoea, but all recovered and survived. In addition, all piglets inoculated with the Japanese PDCoV exhibited virus shedding at high level in faeces and viremia corresponding to their clinical symptoms. In the PDCoV-inoculated group, viruses were mainly detected from jejunums to colons by a quantitative PDCoV-specific PCR and microscopic observation. These findings would provide useful information for establishing a diagnostic methodology for distinguishing diarrhoea caused by PDCoV from that caused by other enteric pathogens, such as PEDV., Highlights • Our survey finds that PDCoV is a causative agent of outbreaks of diarrhoea in pigs in Japan since late 2013. • Our phylogenetic analysis reveals that PDCoVs from Japan are closely related to the recent PDCoVs from the U.S. and Korea. • Our study indicates that PDCoV-inoculated piglets showed acute, watery diarrhoea, but all recovered and survived. • Our study demonstrates that virus shedding in faeces and sera, and viral distribution in the PDCoV-inoculated piglets.

Acute gastroenteritis with persistent vomiting, high degree fever and blood streaking stools often suggests bacterial aetiology in children. Authors report a 13-year-old boy presenting with acute watery diarrhoea with persistent vomiting, fever of 103°F, abdominal cramps and blood streaking stools who failed to show any response to parenteral third-generation cephalosporin for 72 hours. The stool examination revealed numerous cystic and amoeboid forms of Blastocystis hominis. Metronidazole was started and the boy promptly responded within 24 hours. There was no recurrence of symptoms then onwards. The case highlights the crucial stool examination in case of acute diarrhoeal disease for rare aetiology.

Diarrhoeal disease is the second leading cause of death in children under age 5 worldwide, with rotavirus being the main etiology. In the Lao People's Democratic Republic, acute watery diarrhoea (AWD) was introduced as one of the national notifiable diseases in 2004. We retrospectively reviewed the aggregate (n = 117 277) and case-based (n = 67 755) AWD surveillance data from 2009 to 2013 reported weekly from 1115 health facilities nationwide. Rotavirus rapid test data from all eight sentinel sites in Vientiane Capital in 2013 were also collected for analysis. The incidence of AWD ranged between 215 and 476 cases per 100 000 population and increased from 2009 to 2012 when it levelled off. The most affected age group was children under 5 who were about seven to nine times more likely to have AWD than the rest of the population (P

SUMMARYToxigenic strains ofVibrio choleraeserogroups O1 and O139 have caused cholera epidemics, but other serogroups – such as O75 or O141 – can also produce cholera toxin and cause severe watery diarrhoea similar to cholera. We describe 31 years of surveillance for toxigenic non-O1, non-O139 infections in the United States and map these infections to the state where the exposure probably originated. While serogroups O75 and O141 are closely related pathogens, they differ in how and where they infect people. Oysters were the main vehicle for O75 infection. The vehicles for O141 infection include oysters, clams, and freshwater in lakes and rivers. The patients infected with serogroup O75 who had food traceback information available ate raw oysters from Florida. Patients infected with O141 ate oysters from Florida and clams from New Jersey, and those who only reported being exposed to freshwater were exposed in Arizona, Michigan, Missouri, and Texas. Improving the safety of oysters, specifically, should help prevent future illnesses from these toxigenic strains and similar pathogenicVibriospecies. Post-harvest processing of raw oysters, such as individual quick freezing, heat-cool pasteurization, and high hydrostatic pressurization, should be considered.

The study was schemed to investigate the prevalence, pathological conditions, mortality and clinical features of Newcastle disease in the small scale commercial broiler farms at Bochaganj upazila of Dinajpur district during January to June, 2014. A total 1950 birds (from 5 farms), among which 160 diseased and dead birds were selected out of which 99 (5.35%) birds were found to be positive for Newcastle disease. The clinical signs of the affected birds were sneezing, coughing, nasal discharge, laboured breathing, and torticolis. Broiler were inactive, weak and rough in appearance, greenish watery diarrhoea occur severely. Nervous sign include clonic, spasm and paralysis of the legs and wings. In this observation, the gross pathological lesions were slight to severe haemorrhages in caecal tonsils, typical lesions were proventricular haemorrhage, most commonly seen in the surface near the junction with the proventriculus. The prevalence of Newcastle disease in Bochaganj upazila was 5.35%. Mortality of Newcastle disease in non-vaccinated and vaccinated broiler flock was 20.76% and 4.6%, respectively.Asian J. Med. Biol. Res. June 2016, 2(2): 352-356

SummaryDespite Clostridium difficile infection (CDI) being a common cause of diarrhoea in hospitals worldwide, diagnostic testing or management guidelines are not available in most hospitals in China. In this prospective two-year study, the incidence of CDI among 276 patients with watery diarrhoea was 23.1%. Lack of diagnostic testing for CDI was associated with improper management in 26.4% of patients, risk of nosocomial transmission from lack of isolation precautions, and risk of community transmission from discharging symptomatic toxigenic C. difficile carriers. Updating practice guidelines in line with the current evidence and implementing diagnostic testing for CDI are recommended in hospitals in China.

Clostridioides(formerlyClostridium)difficileis a major cause of nocosomial infection in the USA and worldwide. It has a wide spectrum of presentation, ranging from an asymptomatic carrier state to fulminant colitis. Pseudomembranous colitis is a manifestation of severeC. difficileinfection (CDI), typically with progressive symptoms including watery diarrhoea, abdominal cramping and fevers and elevated white cell count and/or creatinine. It is diagnosed on three levels, including clinical assessment, stool assays and visualisation of the colonic mucosa. Laboratories will reject stools that do not meet criteria for testing. In the era of molecular testing for the presence of toxigenicC. difficileDNA, which only indicates the potential for infection, it is vital to use clinical evaluation in the diagnosis of CDI. We present an atypical case of pseudomembranous colitis affecting the right colon in a patient whose stools were rejected multiple times forC. difficiletesting.

Background A limited number of small-sized studies suggest that bile acid diarrhoea is frequent in patients with chronic watery diarrhoea and previous cholecystectomy. Aim To perform a systematic review and meta-analysis to assess the prevalence of bile acid diarrhoea in patients with chronic watery diarrhoea and previous cholecystectomy, and their response to colestyramine, including a new consecutive series of patients. Methods MEDLINE and EMBASE were searched up to January 2018. Selected studies included patients with previous cholecystectomy and chronic watery diarrhoea assessed by the 23-seleno-25-homotaurocholic acid (SeHCAT) test. We calculated the pooled rate of bile acid diarrhoea using the inverse double arcsine square root method. Additionally, the medical records of 291 consecutive patients with chronic watery diarrhoea in whom a SeHCAT test was performed were retrospectively reviewed and 74 with previous cholecystectomy were included in the meta-analysis. Results The search strategy identified eight relevant studies, which, together with the data of the present series, comprise 361 individuals. The pooled bile acid diarrhoea rate was 70% (95% CI 56%-82%), and was similar when using cut-offs of 10% or 15%. There was substantial heterogeneity (I2 = 84%). Five studies comprising 166 patients evaluated the effect of colestyramine in patients with bile acid diarrhoea. The pooled colestyramine response rate was 79% (95% CI 63%-91%) with substantial heterogeneity (I2 = 73%). Conclusions Two-thirds of patients with chronic watery diarrhoea and previous cholecystectomy have bile acid diarrhoea. Response to colestyramine in these patients is good.

Background Oral rehydration salt (ORS) is an affordable and effective intervention for the management of acute watery diarrhoea (AWD), especially in children under 5 years. A knowledge/practice gap exists among community pharmacists (CPs) in Lagos, Nigeria, and in many low to middle income countries. This gap results in underutilization of ORS for diarrhoea management. Objective The objective was to explore CPs’ views of the barriers and facilitators to the use of ORS in practice. Setting Community pharmacy practices, Lagos, Nigeria. Methods Qualitative methods were used to explore pharmacists’ views. Recruitment of participants were mainly at zonal meetings. A total of ten CPs participated based on maximum variation and snowballing sampling. Semi-structured interviews conducted covered knowledge, experiences and contextual issues. Interviews were audiorecorded, transcribed and analysed using framework approach to thematic analysis. Main outcome measure Pharmacists’ views of barriers and facilitators to the use of ORS. Results Barriers to the use of ORS include caregivers’ expectation for an antimicrobial, which was often explicitly and specifically for metronidazole. Also, CPs seemed to doubt applicability of ORS alone, therefore, responded to caregivers’ complaints about ORS, by dispensing metronidazole. These barriers appeared to have normalised metronidazole for AWD treatment in this setting. Current facilitators include the caregivers’ improved awareness of ORS and access to primary health centers that often resulted in increased demand for ORS in pharmacies. Conclusion CPs’ views showed that caregivers’ expectations for an antimicrobial may be the main barrier to the use of ORS in their practices.

Background: Although there is global decline in the death rates of children younger than 5 years old, the risk of a child dying before becoming 5 years of age remains highest in the WHO African Region (90 per 1000 live births). The highest rates of child mortality are seen in sub-Saharan Africa, where 1 in 8 children dies before age 5, more than 17 times the average for developed regions. The problem of child death in Ethiopia is worse, with an Ethiopian child being 30 times more likely to die by his/her fifth birthday than a child in Western Europe. Therefore, the aim of this study was to assess the prevalence and factors associated with diarrhoea among children younger than five years old. Objective: The objective of this study was to measure the prevalence of diarrhoea and its associated factors among children under-five years of age in Serbo town in Jimma zone, Ethiopia. Methods: A community-based, cross-sectional study was conducted on children younger than five years old from June to July 2017. A total of 250 under-five children were included in this study, and subjects were recruited by the multistage cluster sampling technique. Data were collected by a pre-tested questionnaire. The data were coded, entered, cleaned and analyzed the SPSS software package version 24. Result: The prevalence of childhood diarrhoea was 14.9% (n=26) high rate in under 2 years and no sex variation. The proportion of acute watery diarrhoea was 92.3% (n=24) of those children 76.9% (n=20) were treated in health institution. The age care takers was assessed and those 20-39 years of age had the highest rate 65.4% (n=17) of the two weeks diarrhoea prevalence. Mothers of children who had completed 1-6 grade had the highest rate 11 (42.3%) of two weeks diarrhoea prevalence. Conclusion: In this study, prevalence of diarrhoea among under-five children was quite high. The highest rate of the prevalence was significantly concentrated among children aged 20-29 (40.1%) months. The age of child, educational level of mothers, and the economic status of households were the most important variables that affected the occurrence of diarrhoea in children.

Although the impact of diarrhoeal disease on paediatric health in Nigeria has decreased in recent years, it remains an important cause of morbidity and mortality in children under 5 years.Rotavirusis recognised as an important aetiological agent, but information on the contribution of intestinal protozoa to watery diarrhoea in this age group in Nigeria is scarce. In this cross-sectional study, faecal samples from children admitted to healthcare centres in Abakaliki, Nigeria with acute watery diarrhoea (N= 199) and faecal samples from age-matched controls (N= 37) were examined forCryptosporidiumandGiardiausing immunofluorescent antibody testing and molecular methods.Cryptosporidiumwas identified in 13 case samples (6.5%) and no control samples. For three samples, molecular characterisation indicatedC. hominis, GP60 subtypes IaA30R3, IaA14R3 and IdA11.Giardiawas not detected in any samples. This contrast in prevalence between the two intestinal protozoa may reflect their variable epidemiologies and probably differing routes of infection. Given that these two parasitic infections are often bracketed together, it is key to realise that they not only have differing clinical spectra but also that the importance of each parasite is not the same in different age groups and/or settings.

Introduction : diarrhoea is the frequent and excessive discharge of bowels caused by a wide range of agents. Rotavirus is the most common agent that causes acute watery diarrhoea in children Under Five Years (U5). Globally, Diarrheal Diseases (DD) account for 1 in 9 deaths in children U5. In Ghana, rotavirus vaccine is administered in two doses at six and ten weeks. DD in children U5 from Brong Ahafo Region (BAR) were analyzed to establish trends and long-term changes, describe reasons for changes, determine where cases were occurring, detect aberrations in the patterns and determine the data quality.

International audience; AbstractGastrointestinal disease caused by the apicomplexan parasite Cryptosporidium parvum is one of the most important diseases of young ruminant livestock, particularly neonatal calves. Infected animals may suffer from profuse watery diarrhoea, dehydration and in severe cases death can occur. At present, effective therapeutic and preventative measures are not available and a better understanding of the host–pathogen interactions is required. Cryptosporidium parvum is also an important zoonotic pathogen causing severe disease in people, with young children being particularly vulnerable. Our knowledge of the immune responses induced by Cryptosporidium parasites in clinically relevant hosts is very limited. This review discusses the impact of bovine cryptosporidiosis and describes how a thorough understanding of the host–pathogen interactions may help to identify novel prevention and control strategies.