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

The reported incidence of "pathogenic" bacteria, as judged by serotype, in the stools of children with acute diarrhoea has varied from 4 to 33% over the last twenty years. Techniques such as tissue culture provide a means for detecting enterotoxin-producing strains of bacteria, strains which often do not possess "pathogenic" serotypes. "Pathogenicity" requires redefinition, and the aetiological importance of bacteria in diarrhoea is probably considerably greater than previous reports have indicated. Colonization of the bowel by a pathogen will result in structural and/or mucosal abnormalities, and will depend on a series of complex interactions between the external environment, the pathogen, and the host and its resident bacterial flora. Enteropathogenic bacteria may be broadly classified as (i) invasive (e.g. Shigella, Salmonella and some Escherichia coli) which predominantly affect the distal bowel, or (ii) non-invasive (e.g. Vibrio cholerae and E. coli) which affect the proximal bowel. V. cholerae and E. coli elaborate heat-labile enterotoxins which activate adenylate cyclase and induce small intestinal secretion; the secretory effects of heat-stable E. coli and heat-labile Shigella dysenteriae enterotoxins are not accompanied by cyclase activation. The two major complications of acute diarrhoea are (i) hypernatraemic dehydration with its attendant neurological, renal and vascular lesions, and (ii) protracted diarrhoea which may lead to severe malnutrition. Deconjugation of bile salts and colonization of the small bowel with toxigenic strains of E. coli may be important in the pathophysiology of the protracted diarrhoea syndrome. The control of bacterial diarrhoea requires a corrdinated political, educational, social, public health and scientific attack. Bacterial diarrhoea is a major health problem throughout the world, and carries an appreciable morbidity and mortality. This is particularly the case during infancy, and in those developing parts of the world where malnutrition is common. This paper is concerned mainly with acute bacterial diarrhoea, and reviews the problem as a whole.
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PMID:The problem of bacterial diarrhoea. 79 97

Several clinical symptoms and laboratory findings from 352 pediatric patients, seen in the Emergency Room for acute diarrhea, were evaluated in order to develop a method to predict the bacterial etiology of the diarrhea. According to the microbiology findings, the patients were classified into two groups: proven bacterial diarrhea and diarrhea of another etiology. Among all clinical symptoms recorded, only the following were found to be useful for the prediction score: fever greater than 38 degrees C (8 points), fecal mucus (8 points), over fecal blood (6 points) and the presence of fecal leukocytes in a wet mount (7 points). An alternative score useful for outpatients was developed that does not include a score for the wet mount. When the fecal leukocyte score was included and a cutoff value of 20 points was assigned, a sensitivity of 74% and a specificity of 83% were obtained. When the score for the fecal leukocytes was excluded and a cutoff value of 13 points assigned a sensitivity of 84% and specificity of 59% were obtained. These rapid and simple scores may be useful methods for predicting acute bacterial diarrhea in children.
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PMID:[Clinical and laboratory indicators of etiology of diarrhea]. 149 21

The value of faecal leucocyte examination was assessed in 400 infants with acute diarrhoea and 40 normal healthy infants. Enteropathogens were isolated from 28.75%. Escherichia coli was the commonest (16.5%) followed by Salmonella typhimurium (7%), Vibrio cholerae (3.25%) and Shigella flexneri (1.5%). Exudative response was observed in 57.1% of stools with Salmonella and 66.6% each with Shigella and E.I.E.C. infections. 81.3%, 89.5% and 87.7% of stools from which EPEC and ETEC and no enteropathogens respectively were isolated showed minimal or no Leucocytic response. The test is useful to recognise probable invasive bacterial diarrhoea and to decide the cases in which stool culture could be advantageous.
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PMID:Role of faecal leucocytes in the diagnostic evaluation of acute diarrhoea. 179 52

Acute gastroenteritis is the commonest gastrointestinal disorder in children. It accounted for about 10% of the admissions to a general paediatric unit in Singapore. About 5% of total paediatric admissions to all the government hospitals in Singapore were due to acute gastroenteritis. Some 50% of the cases had no identifiable organism in the stools. Most of the remaining cases were due to bacterial or viral infections. The commonest bacteria responsible for acute gastroenteritis nowadays is Salmonella species. Other bacteria such as E. coli, Shigella and Campylobacter were responsible for a smaller proportion of bacterial diarrhoea in children. Rotavirus was the commonest viral agent responsible for acute diarrhoea among Singapore children. Most patients had mild diarrhoea and severe dehydration following acute gastroenteritis was not common. About 60% of the patients admitted to hospital were younger than two years of age. Bacterial infections were more common in infancy. Viral diarrhoea were more likely to be watery and bacterial diarrhoea were more likely to be bloody and mucoid. With regard to chronicity, it was the groups with mixed infection or bacteria infection which had a prolonged course. Treatment was directed at maintaining hydration and prevention of complications. Except for secondary lactase deficiency, other long term complications were rare.
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PMID:Gastrointestinal infections in Singapore children. 188 88

We report a prospective study of the cases of acute diarrhea admitted to our pediatric service during one year (n = 172) to elaborate a screening method to identify patients with bacterial diarrhea. A bacterial causative organism was identified in 31.4%. The most common species was Salmonella, followed by Campylobacter. We evaluated the clinical presentation parameters, looking for differences between the group were a bacterial organism was isolated and in the group where it was not. We designated a score valid as a first level screening for bacterial diarrhea. With a score greater than or equal to 7 the sensitivity was 81.5% and the specificity 60.2%. The latter increased to 95% when occult blood in feces was associated with the greater than or equal to 7 score (second screening level). We propose this clinical score as a criterion for the indication of fecal cultures in children with acute gastroenteritis.
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PMID:[Validity of a score of clinical parameters as a screening method in acute bacterial diarrhea in childhood]. 212 97

Campylobacter enteritis appears to be a frequent cause of bacterial diarrhoea, especially among children. The species isolated in our study are C. jejuni and C. coli. The clinical characteristics are acute diarrhoea (sometimes with blood) and abdominal pain. The evolution is usually favorable without treatment. In serious and prolonged cases, the treatment is based on Erythromycin which was active against all the strains.
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PMID:[Enteritis caused by enteropathogenic Campylobacter. Preliminary study (January 1988 to June 1989)]. 248 3

Acute diarrhoea is an important health problem in developed countries, particularly in young children. The attack rates for viral diarrhoea are similar in developed and developing countries. Rotavirus is the most common pathogen, followed by adenovirus. Bacterial diarrhoea is less common in developed than developing countries. The 2 most common bacterial pathogens are Campylobacter jejuni and Salmonella. The most serious consequence of diarrhoea is dehydration, and the treatment for this is the same whatever the pathogen. Recently, there have been major changes in the management of diarrhoea with emphasis on oral rehydration and early feeding. Two controversial areas are the sodium content of solutions designed for developed countries and the best route of administration of fluids to children with moderately severe dehydration. There have been 4 randomised controlled trials in developed countries comparing oral and intravenous rehydration. The findings have confirmed the experience in developing countries that most children without shock can be rehydrated orally, thus substantially reducing the need for intravenous fluids. It is important to give physiologically balanced solutions which contain 2% glucose and 50 to 90 mmol/L of sodium. Many of the commercially available oral solutions are appropriate for rehydration and maintenance of hydration in infants with diarrhoea of all types. They are recommended particularly for the prevention of dehydration in children of all ages with severe diarrhoea and for the treatment of dehydration. Children with mild diarrhoea and no dehydration can be given commercial clear fluids diluted with water, or homemade solutions made with table sugar and water. Salt must not be used. Babies should continue on breast milk or formula with extra water. Education is the key to successful oral rehydration, and the ultimate aim should be the prevention of dehydration.
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PMID:Oral rehydration in infantile diarrhoea in the developed world. 306 44

The bacteriological and clinical efficacy of norfloxacin 400 mg b.i.d. was compared to those of co-trimoxazole (160 mg of trimethoprim plus 800 mg of sulphamethoxazole) b.i.d. and placebo b.i.d. for the treatment of acute bacterial diarrhoea in a randomized double-blind trial. Of a total of 450 patients with acute diarrhoea, 303 had positive bacterial cultures and were evaluable for efficacy. The time to elimination of pathogens was significantly (p less than 0.001) shorter in the norfloxacin group than in the co-trimoxazole and placebo groups. At completion of treatment, bacteriological cure was found in 97.9%, 72.4% and 38.2% of patients treated with norfloxacin, co-trimoxazole and placebo, respectively. All pathogens were susceptible to norfloxacin and none of them developed resistance to norfloxacin during treatment. In the co-trimoxazole group, resistance to that antibiotic increased from 2% at inclusion to 65.6% at the end of treatment (p less than 0.001). In patients with shigellosis or cholera, the mean time to normalization of bowel movements was significantly shorter in the norfloxacin and co-trimoxazole groups than in the placebo group (p less than 0.05 and p less than 0.01, respectively). There were no significant differences between groups with respect to adverse events reported. In conclusion, norfloxacin was well tolerated and highly effective in the treatment of acute bacterial diarrhoea.
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PMID:Norfloxacin versus co-trimoxazole in the treatment of acute bacterial diarrhoea: a placebo controlled study. 307 64

In studies conducted in seven countries, 392 persons with acute diarrhea were enrolled and randomly assigned to one of three regimens. In order to compare the effectiveness of various therapies for acute gastroenteritis, patients were treated for five days with either norfloxacin, 400 mg twice daily, norfloxacin, 400 mg three times a day, or trimethoprim/sulfamethoxazole, (160 mg/800 mg) twice daily. Clinical cure occurred in 89 percent (lower dose) and 91 percent (higher dose) of those treated with norfloxacin, compared with 78 percent of those receiving trimethoprim/sulfamethoxazole; cure rates in each treatment group were greater when the patient's stool contained fecal leukocytes. In 105 of 106 (99 percent) patients treated with either dose of norfloxacin and in 49 of 52 (94 percent) trimethoprim/sulfamethoxazole-treated subjects, the bacterial enteropathogen identified in the pretreatment stool was eradicated on the posttreatment specimen. Two percent (two patients) of those receiving the lower dose of norfloxacin, 3 percent (two patients) of those receiving trimethoprim/sulfamethoxazole, and 4 percent (three patients) of those receiving the higher dose of norfloxacin experienced minor and transient adverse hematologic or blood chemistry reactions. In addition, mild cutaneous reactions that were attributed to the study medications developed in two patients receiving the higher dose of norfloxacin and in three patients who received trimethoprim/sulfamethoxazole. These studies indicate that norfloxacin is safe and effective therapy for bacterial diarrhea.
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PMID:Use of norfloxacin in the treatment of acute diarrheal disease. 330 Mar 16

Stools from acute diarrhoea were investigated for bacterial and viral pathogens. In one study involving 63 young children in a paediatric ward, 70% of the stools were positive for the pathogens looked for of which 37% contained bacteria, 22% viruses and 11% mixed cultures of bacteria and viruses. In another study in which 130 watery stools from routine specimens of patients of all ages were investigated, 36% were positive for pathogens with 11% bacteria, 18% viruses and 7% mixed pathogens. The high incidence of bacterial diarrhoea in young children was attributed to gastroenteritis caused by Salmonella species. Salmonella and rotavirus were found the most common pathogens in bacterial and viral diarrhoeas, and the most susceptible age group was under 5 years-old.
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PMID:Aetiology of diarrhoea in Singapore. 332 52


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