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Query: UMLS:C0740441 (acute diarrhea)
 2,275 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute infectious diarrhoea is the major killer of children in the Third World. It is also the principal cause of malnutrition in children under 5 years of age. More than 4 million children die each year of diarrhoea and its complications. Acute diarrhoea kills by causing dehydration, which leads to hypovolaemia and metabolic acidosis. Recurrent episodes of diarrhoea lead to malnutrition as the result of anorexia, catabolism from infection, and lack of adequate caloric and protein intake because of the widespread custom of 'starving' diarrhoea. Oral rehydration therapy (ORT) is effective in the prevention and treatment of dehydration caused by diarrhoea. Because it is cheap, easy to administer and very effective, ORT has the potential to allow substantial reductions in the morbidity and mortality of acute diarrhoea in children living in less developed countries. The major obstacles to achieving its potential are the social ones of production and distribution of oral rehydration solutions and of educating parents in how to use ORT.
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PMID:Overview of the worldwide problem of diarrhoea. 306 40

It is obvious from this conference that although there are many more unresolved problems and questions than answers, the definition of the problems associated with pediatric diarrhea which face the medical/scientific community has been painstakingly, persistently, and frequently brilliantly illuminated by the efforts of many investigators. The presentations in this session will address and define areas for future productive investigation, particularly as they relate to the specific challenges of early feeding, nutrition, immunobiology, and the application of present knowledge to underdeveloped areas of the world. The lack of effectiveness of the many vaccines available for prophylaxis against gastrointestinal infection illustrates the need for fundamental research into the immunobiology of the intestine. It is apparent that humoral immunoglobulin cannot adequately forecast resistance to enteric challenge. Yet, while the newly appreciated role of surface IgA as a protector of intestinal surfaces against enteric invasion significantly updates understanding of intestinal immunology, it fails to adequately explain observations on the behavior and function of either the cellular elements of the intestinal immune mechanism or the function of other immunoglobulins present in the intestine. Dr. Harry R. Hill will discuss immunologic factors associated with the gastrointestinal tract. Dr. Jose Santos will present an update on one of the more complex issues associated with pediatric diarrhea to arise during the last decade, i.e., the influence of nutrition and the various states of malnutrition on the severity and outcome of diarrheal disease. Dr. Richard Guerrant will review the most serious problems in diarrheal control and research to be faced in the next decade. Areas of concern include the impact of polymicrobial diarrheal disease on morbidity, chronic vs. acute diarrhea, new etiologies of diarrheal disease, and the intraepidemic epidemiology of etiologic agents. Dr. John M. Masten will conclude the conference with a synopsis of the presentations.
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PMID:Research in pediatric diarrhea. 308 Jul 40

With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks.
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PMID:Risk factors for persistent diarrhoea. 314 3

Infantile diarrhea in France is usually benign and self limiting, but in rare cases dehydration or malnutrition with continuing diarrhea can occur. Dehydration may almost always be prevented and treated with an oral solution containing glucose and electrolytes. Rapid feeding adapted to the age of the child can help prevent nutritional problems. The need for antibiotics and other medications is very limited. Intestinal infection is the cause of most cases of infantile diarrhea. 10-15% of cases are caused by bacteria of various types and the vast majority of the remainder by viruses, with the rotavirus alone accounting for around 1/2 of cases. Oral rehydration can compensate for the exaggerated loss of water and electrolytes. No matter how serious the diarrhea or its cause, some potential for absorption of water and sodium is always retained. Sodium absorption is facilitated by the concomitant presence of glucose in the intestines. Oral rehydration solutions commercially available in France have an electrolyte content adapted to the average fecal loss locally observed in acute diarrhea. Oral rehydration solution is offered to infants at short intervals in a bottle, allowing the child to drink as the need arises. Significant quantities may be absorbed in the 1st 24 hours. Any vomiting usually ceases after administration of a small amount of glucose. Traditional dietary preparations for diarrhea such as carrot soup and products based on rice have essentially an absorbent power and do not diminish intestinal loss of water and electrolytes. In cases of severe dehydration with weight loss of over 10% and unconsciousness, intravenous rehydration is indicated. Whether oral or parietal, rehydration should always be rapid so that feeding can begin. Feeding should start after 24 or at most 48 hours of rehydration to maintain the nutritional state. Rapid feeding is usually well tolerated, but there may be a transitory intolerance to lactose or a secondary sensitivity to proteins in cow's milk. Breast feeding should not be interrupted, but bottle feedings should be stopped for 24-48 hours and reintroduced for infants under 3 months with protein formula not based on cow's milk and for those over 3 months with diluted formula.
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PMID:[Current treatment of acute diarrhea in infants]. 314 1

Furazolidone, a synthietic nitrofuran, is active against a broad spectrum of bacteria and Giardia lamblia. Since 1954, furazolidone has been used almost exclusively for the specific and symptomatic treatment of infectious diarrheal diseases. Diarrheal disease is the leading cause of death of children and a major contributing factor of malnutrition in the developing world. It can be avoided with proper water and waste treatment, personal hygiene, and food preparation. The most critical aspect of treating acute diarrhea is maintaining optimal hydration and electrolyte balance. Fluid and electrolyte replenishment must constitute the 1st line of therapy. Antimicrobial therapy, however, improves the outlook further. Effective antimicrobials reduce the average duration of illness and the likelihood of relapses, complications and death. The ideal antimicrobial for treating acute diarrhea is a single broad-spectrum antimicrobial agent of low toxicity that would be effective for empirical treatment of acute diarrheal disease. During 30 years of clinical use worldwide, the effectiveness of furazolidone has shown to be comparable or superior to that of other drugs used to treat these diseases. Because furazolidone has fairly low toxicity, it is a relatively safe drug. The most common reaction appears to be gastrointestinal distress, though dizziness, drowsiness, headaches, and general malaise have also been reported. A drug that acts specifically on its target is generally preferable to one with less specific activity. Furazolidone inhibits a variety of bacterial enzymes, an activity that minimizes the development of resistant organisms. Furazolidone is a single, broad-spectrum antimicrobial that is effective, relatively safe, specific, and is orally administered in tablet or suspension form.
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PMID:Furazolidone for treatment of diarrhoeal disease. 357 95

A comprehensive program review of Indonesia's Control of Diarrheal Diseases (CDD) program conducted in 1983 indicated that considerable success has been achieved in this area. Oral rehydration solution (ORS) is widely available, there has been community involvement, a strong managerial structure has developed, baseline data on diarrhea morbidity and mortality are being collected, and staff have received adequate training. At the same time, there have been some problems: inadequate use of ORS, a lack of coordination among CDD programs, insufficient surveillance, budgetary problems, and a lack of laboratory support. During the last 10 years, diarrhea mortality in Indonesia has been reduced by 50-70%, to about 20,000 (20% of child mortality). The Government has established the goal of reducing mortality from diarrhea to less than 1% of child deaths by the year 2000. A major strategy for achieving this goal is integrating family planning, nutrition, maternal-child health, immunization, and CDD programs. Another strategy involves improving research in this area. Areas for further research include: epidemiologic studies, rehydration treatment, antidiarrheal agents, social aspects, immunity and vaccine development, and laboratory examination. The cause of diarrheal diseases is not only enteric infection, it is indirectly caused by acute respiratory infection, malnutrition, measles and other systemic infection as well as the health knowledge and education of the mother. Priority is to be given to 7 areas of research: 1) the use of home-prepared rehydration fluids, 2) feeding practices during acute diarrhea that can prevent chronic diarrhea and malnutrition, 3) the determinants of progression to chronic diarrhea, 4) the impact of simple health information on hygienic and feeding practices on mortality, 5) the potential of using traditional birth attendants in ORS campaigns, 6) traditional attitudes and practices, and 7) the effectiveness of traditional medicines in diarrhea treatment.
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PMID:Research priorities on diarrhoeal diseases to support the Control of Diarrhoeal Diseases (CDD) programme in Indonesia. 370 66

In vitro uptake of 14C-L-glycine was studied in jejunal mucosa biopsy specimens from 27 patients with cholera (proven by stool culture) presenting within 48 h of onset of watery diarrhea. In time series experiments, 14C-L-glycine uptake was found to follow saturation kinetics (being saturated at 5 1/2 min), to be blocked by uncouplers of oxidative phosphorylation (sodium fluoride and 2:4-dinitrophenol), and that 14C-L-glycine uptake by both amino acid transport system 1) and amino acid transport system 4) were active during the active purging stage of cholera. Concentration series experiments were carried out to determine the Vmax and Kt of these transport systems, which were not significantly different. This study demonstrates continued absorption of amino acids (glycine) by two amino acid transport systems, provides scientific basis for use of glycine in "improved" oral rehydration solutions in the treatment of acute diarrhea, and emphasizes the importance of maintaining feeding during acute diarrhea in order to prevent development of malnutrition.
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PMID:In vitro determination of intestinal amino acid (14C-L-glycine) absorption during cholera. 371 14

This paper addresses the growing magnitude of morbidity and mortality from diarrheal disease; the definition, causes, and impact of chronic diarrhea; and unanswered questions about microbial etiologies, determinants of host susceptibility and impact, and the relevance of sociocultural setting to control strategies. Over 7% (12,600 children/day) of children in Africa, Asia, and Latin America die from diarrhea in their first 5 years of life, and poverty and rapid population growth are contributing to a worsening of this situation. Although advances have been made in our understanding of the etiology and management of acute diarrhea, little is known about the problem of chronic diarrhea the illness associated with the greatest risk of malnutrition. Moreover, 30-50% of cases of diarrhea remain with undiagnosed etiologies. Further study is needed to determine the role of cellular and humoral immunity in the specific enteric infections in order to enhance this immunity in new vaccine development. Genetic and age determinants of host susceptibility are important problems requiring further study. The social setting in which enteric infections take place may contribute to the transmission of or susceptibility to enteric infections. Future approaches to the control of diarrheal diseases must integrate advances in the following areas: epidemiologic, physiologic, biochemical, pharmacologic, immunologic, and antimicrobial control. The modern tools of molecular biology and improved understanding of scientific and social issues are expected to usher in an exciting new era in research on diarrheal diseases.
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PMID:Unresolved problems and future considerations in diarrheal research. 394 86

The response of infants with diarrhea and lactose intolerance to feedings containing soy protein and sucrose (Sobee), and/or to a carbohydrate free formula (RCF), to which glucose polymers (GP) were added, was assessed in twenty patients. They all were less than ten months of age and had varying degrees of malnutrition. Eleven had acute diarrhea and nine had chronic diarrhea. None of them had classical enteropathogenic strains and parasites in the stools. All had lactose intolerance when feedings were begun with cow's milk formula and some also had sucrose intolerance when fed sucrose containing soy formulas. They had persistent loose stools and excreted feces with an acid pH and with carbohydrates, thus they were given dietary treatment with RCF with GP. There were 9 patients with acute diarrhea and lactose intolerance (1 of them also had sucrose intolerance), who improved on RCF with GP feedings; but 2 patients (lactose and sucrose intolerant) failed to respond to this diet. There were six patients with chronic diarrhea and lactose intolerance (four of them also had sucrose intolerance), who improved on RCF with GP formula, but there were three patients who failed on this treatment. These data show that some infants with diarrhea, malnutrition, and lactose-sucrose intolerance may also develop intolerance to GP and require further dietary management with glucose as the source of carbohydrate in the diet.
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PMID:Tolerance to glucose polymers in malnourished infants with diarrhea and disaccharide intolerance. 396 31

Hospitalized infants suffering from acute diarrhea were used to test simple bedside methods of determining reducing substances and pH in multiple fresh stool specimens. 332 infants were tested, and thetests were useful in detecting a reduced capacity to tolerate lactose in 77% of these patients. Lactose intolerance was considered to be present when the stools had a carbohydrate content greater than .25% and/or a pH of less than 6. 75 of 77 lactose-tolerant patients recovered within 3 weeks of administration of a milk formula, whereas 111 of 195 with mild intolerance and 13 of 60 with severe lactose intolerance recovered while receiving the milk formula. Diarrhea of greater than 3 weeks duration occurred in 27% of those cases with mild and in with untreated severe intolerance; however, with prompt dietary treatment, a 62% of those cases favorable response always occurred. Lactose intolerance was positively correlated with increased severity of malnutrition; there were no correlations with previous episodes of gastroenteritis, with presence of enteropathogens or with associated infections. When antibiotic therapy was instituted, the stool pH increased toward alkaline, but the excretion of carbohydrates was not modified.
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PMID:Carbohydrate intolerance in infants with diarrhea. 517 Nov 4


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