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

Infants and young children are particularly susceptible to a recently identified viral enteritis which is highly contagious and seems both common and universal. In this disease, virus invades the upper intestinal epithelium, causing acute diarrhoea with early fever and vomiting. We studied a similar disease in pigs, infecting three-week-old animals with transmissible gastroenteritis virus (TGE), which also invades the upper intestinal epithelium. In this model, diarrhoea is massive 16-40 hours after infection, when stools contain increased electrolytes but no excess of sugar. In the jejunum of intact pigs at the 40-hour stage we found altered Na+ and water flux, decreased mucosal activities of disaccharidases and Na+, K+-ATPase, but normal adenylate cyclase activity. At the same stage the response of Na+ flux to glucose was blunted in jejunal epithelium studied in Ussing short-circuit chambers and in suspensions of villous cells; Cl- flux responded normally to theophylline, and thymidine kinase and sucrase activities of cells isolated from jejunal villi were similar to those found in crypt cells. Probably by 40 hours after infection most virus has been shed from the mucosa. Viral diarrhoea clearly differs from enterotoxigenic diarrhoea. Consideration of its pathogenesis must take into account the dynamic nature of the mucosal epithelium and the factors governing differentiation of enterocytes as they migrate from crypt to villus. Sufficient information is available now to characterize one specific and apparently prevalent viral enteritis in man and to identify additional viral enteritides. There is hope that preventative therapy can be developed. Our understanding of the mechanisms of viral diarrhoea is limited, but the availability of an animal model and the promise of others makes us optimistic that these deficiencies can be remedied. Greater understanding of the pathogenesis of viral diarrhoea should better the active therapy of affected infants and children.
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PMID:Viral gastroenteritis: recent progress, remaining problems. 104 55

Since over half of the children aged 5 years and under in the developing world suffer from mild-moderate malnutrition, means of correcting nutrition deficiencies are essential. In the case of the child with diarrhea, malnutrition is exacerbated by a number of disease-related factors including anorexia, cultural or medical withdrawal of food, and purgation. It was discovered, in a study among Apache children, that early and rapid replacemtnt of volume loss and correction of electrolyte imbalance using glucose-electrolyte solutions administered orally can restore physical well-being and appetite to children suffering from acute diarrhea, and hence enhance these children's nutritional status. The solution recommended contained, in millimolar concentrations per liter: sodium, 81; potassium, 18; choride, 71; HC03, 28; and glucose, 139. A field trial of oral therapy for acute diarrhea in children is called for tod etermine the extent of effects on nutrition and mortality, as well as to indicate some of the cultural and logistical problems which remain to be solved.
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PMID:Oral glucose-electrolyte therapy for diarrhea: a means to maintain or improve nutrition? 105 11

A double-blind study was conducted to test the prophylactic effect of a non-absorbable broad-spectrum antimicrobial (oral colistin sulfate) against acute diarrhea in Apache children. Children 1 to 6 months old had over twice the morbidity from diarrhea if assigned to the antimicrobial group as compared to placebo, while the toddler group (7-30 months) taking the antimicrobial had somewhat less diarrhea. Enteropathogenic E. coli were significantly more often isolated from the antimicrobial group (but only in well children). No special effect on the children's growth by the antimicrobial was discerned.
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PMID:Attempted prevention of diarrheal disease in Apache children with a non-absorbable broad-spectrum antimicrobial. 109 Nov 71

Results are presented of the laboratory examination of faeces specimens from 20,273 patients with acute diarrhoea. These were household index cases seen in general practice in a London borough during the years 1953-68. An annual average of about 2 per cent of households in the area were affected, but there was considerable fluctuation with year and season. Half the patients were children although only one-fifth of the population at risk was under 15 years of age. The greatest incidence of diarrhoea was among children under 5 years old. Male children, but female adults predominated. Specimens were sent for laboratory diagnosis at the discretion of the general practitioner. The laboratory found some abnormality in nearly a third and there were indications that transmissible infection was involved in about one-fifth of patients. The most common diagnosis was Sonne dysentery (9 per cent) which came in epidemic waves and made its greatest impact among young school children. Microscopy was useful, and giardiasis was diagnosed in 1-4 per cent of index patients. Other parasites were less commonly found. Fatty globules characteristic of an infectious condition we have called 'fatty diarrhoea' were frequently observed by microscopy in stools from young children and occasionally from older persons. Blood or pus cells were seen in less than half the shigella and salmonella infections and in a much smaller proportion of the remainder. A test for occult blood performed on specimens from all patients of 40 years or older was positive, in the absence of visible red cells, in a tenth of these cases. Other studies on the bacteriology of diarrhoea in general practice are referred to and some epidemiological comparisons made. The possible place of unidentified infective agents in the aetiology of undiagnosed diarrhoeas and of 'fatty diarrhoea' is discussed.
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PMID:Diarrhoea in general practice: a sixteen-year report of investigations in a microbiology laboratory, with epidemiological assessment. 109 96

A search for intestinal enterotoxigenic Escherichia coli was made in 59 Apache children hospitalized with 64 episodes of acute diarrhea. Esch. coli isolates from acute-phase and convalescent-phase specimens of small-bowel fluid and stool were tested in three currently recognized models: the adult-rabbit ileal loop; infant rabbit; and the adrenal-cell assay. Enterotoxigenic strains were isolated from 10 children during acute diarrheal episodes (16 per cent); none were isolated from convalescent-phase specimens. None of 64 "enteropathogenic" serotypes of Esch. coli from 43 children with diarrhea, however, caused fluid production in the ileal-loop model. These results suggest that enterotoxigenic Esch. coli may be the cause of considerable diarrhea in this population and that the term "enteropathogenic" as applied to serotypes of Esch. coli needs to be redefined.
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PMID:Enterotoxigenic Escherichia-coli-associated diarrheal disease in Apache children. 109 55

Growth of bacteria greater than 10-5 organisms/ml was found in 22 children, of whom 17 gave a histroy of chronic diarrhoea. The other 8 children had either no diarrhoea or where having an acute attack lasting for a few days. In those with chronic diarrhoea, Esch. coli, bacteroides, and enterococci tended to occur more frequently, whereas streptococci occurred more frequently in those with acute diarrhoea. Bacilli, staphylococci, micrococci, klebsiellas, pseudomonads, and candidas often occurred in both groups and in large numbers in those with chronic diarrhoea. This confirms previous reports in other parts of the world that some children with malnutrition have considerable bacterial contamination of the jejunum, and that this may be of aetiological significance as a cause of much of the diarrhoea seen in malnourished children. It is possible too that this may be important in the pathogenesis of malnutrition. The presence of intestinal parasites in these malnourished children is also noted. A double-blind trial in the use of antibiotics in this condition is advocated to determine whether it is possible to break the diarrhoea-malabsorption-malnutrition cycle. At the same time the effect of simply removing the child to a more sanitary environment, together with an estimate of the natural clearance of bacteria from the upper intestine, should be evaluated.
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PMID:Jejunal microflora in malnourished Gambian children. 109 72

Most ampicillin-resistant Shigella are susceptible to cephalexin. Randomized treatment with cephalexin or ampicillin was given to 154 infants and children with acute diarrhea. Rectal swab cultures revealed Shigella in 42%, Salmonella in 6%, enteropathogenic Escherichia coli in 2%, and no pathogen in 50%. Cephalexin failed to eradicate Shigella after 5 days of treatment in 76% of patients as contrasted with 28% of ampicillin-treated patients with susceptible organisms. Shigella persisted in 78% of ampicillin-treated patients with resistant organisms. Diarrhea lasted more than 5 days in 43% of cephalexin-treated patients, in 56% of the ampicillin group with resistant organisms, but in only 9% of ampicillin-treated patients with susceptible organisms. The failure of cephalexin was due to the relatively high minimal inhibitory concentrations and minimal bacterial concentrations of 5 or 10 mug/ml and, although serum concentrations were twice the minimal bacterial concentration, they were not sufficient to demonstrate killing by the serum dilution method. In vitro susceptibility or resistance of Shigella to ampicillin correlated with clinical success or failure. Cephalexin is not a suitable drug for treatment of shigellosis in patients with ampicillin-resistant organisms.
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PMID:Comparative efficacy of cephalexin and ampicillin for shigellosis and other types of acute diarrhea in infants and children. 109

The abilities of Escherichia coli to induce diarrhea by enterotoxin production and by intestinal cell penetration have not been explored simultaneously in children with diarrheal disease. In this study, we investigated 36 infants and children with acute diarrhea and 17 healthy controls. From each patient's rectal swab culture, E coli colonies were tested for enterotoxin production by intragastric inoculation in suckling mice and screened for cell penetration with HEp-2 cells. Colonies showing invasiveness in HEp-2 cells were further tested by inoculation into guinea pig conjunctivae. Salmonella or Shigella strains were isolated from 42% of the patients with diarrhea. Enterotoxin-producing strains of E coli were found in 86% of the diarrhea group and in 41% of controls. Strains with capability to invade epithelial cells were found in 30% of the diarrhea group and in 12% of controls. In seven patients, E coli strains demonstrated both enterotoxin production and invasiveness. In an overall view, considering Salmonella, Shigella, and enteroinvasive or enterotoxigenic E coli, a possible etiologic agent was demonstrated in 94% of infants with diarrheal disease. However, the high frequency of enterotoxigenic strains in healthy controls suggest that in some patients with diarrhea there may be a coincidental carrier state with diarrhea actually due to another cause.
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PMID:Enteroinvasive and enterotoxigenic Escherichia coli. Occurrence in acute diarrhea of infants and children. 109 46

Antitoxin titers to heat-labile Escherichia coli enterotoxin were measured in Apache children hospitalized with acute diarrhea and in Apaches of different age groups without diarrhea in Whiteriver, Ariz. The study suggests that in this locale, exposure to enterotocigenic E. coli is probably widespread and occurs early in life. Antitoxin titer rises after idarrheal disease associated with enterotocigenic E. coli infection, however, were not regulary found.
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PMID:Antibodies to heat-labile Escherichia coli enterotoxin in Apaches in Whiteriver, Arizona. 110 21

Two hundred and seventy-one infants with acute diarrhoea were studied for the presence of carbohydrate malabsorption and 110 infants (40.6%) were found to have carbohydrate intolerance. Malnutrition and severe diarrhoea were found to increase the predisposition to carbohydrate intolerance. The incidence of major complications, protracted diarrhoea and mortality were significantly higher in the carbohydrate intolerant infants as compared to those with carbohydrate tolerance.
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PMID:Carbohydrate intolerance in infants with acute diarrhoea and its complications. 115 66


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