RESUMEN

The aim of this study was to determine the prevalence, virulence factors (stx, eae, ehxA and astA) and phylogenetic relationships [PFGE and multilocus sequence typing (MLST)] of Shiga toxin-producing Escherichia coli (STEC) strains isolated from four previous cohort studies in 2212 Peruvian children aged <36 months. STEC prevalence was 0.4 % (14/3219) in diarrhoeal and 0.6 % (15/2695) in control samples. None of the infected children developed haemolytic uraemic syndrome (HUS) or other complications of STEC. stx1 was present in 83 % of strains, stx2 in 17 %, eae in 72 %, ehxA in 59 % and astA in 14 %. The most common serotype was O26 : H11 (14 %) and the most common seropathotype was B (45 %). The strains belonged mainly to phylogenetic group B1 (52 %). The distinct combinations of alleles across the seven MLST loci were used to define 13 sequence types among 19 STEC strains. PFGE typing of 20 STEC strains resulted in 19 pulsed-field patterns. Comparison of the patterns revealed 11 clusters (I-XI), each usually including strains belonging to different serotypes; one exception was cluster VI, which gathered exclusively seven strains of seropathotype B, clonal group enterohaemorrhagic E. coli (EHEC) 2 and phylogenetic group B1. In summary, STEC prevalence was low in Peruvian children with diarrhoea in the community setting. The strains were phylogenetically diverse and associated with mild infections. However, additional studies are needed in children with bloody diarrhoea and HUS.

Asunto(s)

RESUMEN

BACKGROUND: Racecadotril (acetorphan), an enkephalinase inhibitor with antisecretory and antidiarrheal actions, is an effective and safe treatment for acute diarrhea in adults and children. Whether treatment with racecadotril and oral rehydration therapy is more effective than treatment with oral rehydration alone in hospitalized children with acute watery diarrhea is not known. METHODS: We treated 135 boys 3 to 35 months of age who had watery diarrhea of five days' duration or less with racecadotril (1.5 mg per kilogram of body weight orally every eight hours) or placebo, in addition to oral rehydration solution. The primary end point was the 48-hour stool output (measured in grams); the total stool output, duration of diarrhea, and total intake of oral rehydration solution were also measured. RESULTS: The mean (+/-SE) 48-hour stool output was 92+/-12 g per kilogram in the racecadotril group and 170+/-15 g per kilogram in the placebo group (P<0.001), a 46 percent reduction with racecadotril. The results were similar among the 73 boys with rotavirus infections. The total stool output was 157+/-27 g per kilogram in the racecadotril group and 331+/-39 g per kilogram in the placebo group (P<0.001). The median duration of diarrhea was significantly less (P<0.001) in the racecadotril group (28 hours regardless of rotavirus status) than in the placebo group (72 and 52 hours, respectively, for rotavirus-positive and rotavirus-negative patients). The intake of oral rehydration solution was significantly lower in the racecadotril group than in the placebo group (P<0.001). Racecadotril was well tolerated; only seven patients taking racecadotril had adverse effects, which were all mild and transient. CONCLUSIONS: In young boys with acute watery diarrhea, racecadotril is an effective and safe treatment.

Asunto(s)

Asunto(s)

RESUMEN

The diagnosis of cholera in infants based on clinical grounds is often difficult because other enteropathogens such as rotavirus or enterotoxigenic Escherichia coli (ETEC) can produced a very similar clinical picture. We studied 147 infants admitted consecutively to the Rehydration Unit of Cayetano Heredia Hospital in Lima, Perú, trying to identified those characteristics significantly associated with the isolation of Vibrio cholerae 01 on the admission stool culture. After a univariate comparison of cases and controls were selected those characteristics that showed a significantly different distribution. These were entered in a logistic regression model to analyze their interactions. After this analysis four variables remain significantly associated to cases: no history of fever, dehydration greater than 7%, fecal pH greater than 7 and no glucose in feces. Were developed a diagnostic score with these variables, which had a sensitivity of 77.6% and a specificity of 73.6%. It is important to prospectively validate the utility of this score.

Asunto(s)

RESUMEN

The presence of many enteropathogens which are not easily detectable by routine stool culture has led to the development of alternative diagnostic methods. One of these techniques, nucleic acid probe hybridization, has been used to identify Shigella spp. and enteroinvasive Escherichia coli (EIEC) in stool specimens through the detection of genetic material encoded by a specific large approximately 200-kbp virulence-related plasmid. In the present study, an alkaline phosphatase-labelled oligonucleotide probe developed to detect the gene for ipaH, a repetitive genetic sequence thought to be present on both the virulence-related plasmid and the chromosomes of all strains of Shigella and EIEC, was tested in a developing-country setting through a prospective clinical trial. In a group of 219 Peruvian adults and children with acute gastroenteritis, the ipaH probe detected 85% of cases of shigellosis and demonstrated a specificity of 95% when compared with simultaneous detection by several stool culture techniques. Additionally, three cases of EIEC infection which could not be diagnosed by culture methods alone were detected with the ipaH probe and were confirmed by plasmid analysis and Sereny testing. These preliminary results suggest that, with further research, the ipaH probe should prove to be a useful and rapid adjunct in the diagnosis of acute gastroenteritis in developing countries.

Asunto(s)

RESUMEN

We report the evaluation of a training programme on clinical management of infantile diarrhoea. The training programme was delivered through a series of on-site clinical courses offered to a selected group of physicians and nurses from 16 health units in Peru and a series of local workshops conducted in their own health units. The outcome of this training programme was assessed by pre- and post-tests, knowledge, attitude, and practice (KAP) questionnaires, and observational surveys. A significant improvement in medical knowledge about diarrhoea, in particular about the use of ORT and drug therapy, was observed. Although the observational surveys showed significant improvement in the use of ORT at health facilities (2.9% to 23.6%, p = 0.007) the rate observed was still low compared to the high level of knowledge on ORT that was demonstrated by the KAP questionnaires. A reduction of antibiotic prescription for inpatients with diarrhoea (85.7% to 64.8%, p = 0.025) was observed. The training programme was also effective in promoting the establishment of Oral Rehydration Units in the participants' health facilities.

PIP: Physicians designed a training program on clinical management of diarrhea which consisted of 11 clinical training courses at the Cayetano Heredia University Hospital in Lima, Peru for 37 physicians and 37 nurses from 16 hospitals in 20 various cities in Peru; a number of local workshops on overall features of clinical management of diarrhea cases; and supervisory pre- and posttraining visits to the hospitals. Health workers treated only 2.9% of dehydration cases and 25.7% of inpatient diarrhea cases before dehydration set in and 7.7% of similar outpatients with oral rehydration therapy (ORT) during the pretraining observational survey. After the training, these corresponding figures increased to 23.6% (p=.007), 57.6% (p=.002), and 88.9% (p.0001). The 23.6% rate was still low compared with the high level of knowledge about diarrhea treatment, however. Before training, they prescribed antibiotics to 85.7% of inpatients and 50% of outpatients. After the training, health workers still prescribed antibiotics to 50% of outpatients even though 95% knew correct drug prescription practices. On the other hand, they prescribed antibiotics to a lower percentage of inpatients (64.8%; p=.025). Before the course, they recommended breast feeding and weaning foods in 25.7% and 28.6% of inpatients, respectively, and in 47.1% and 41.2% of outpatients, respectively. Following the course, health workers were more likely to advise breast feeding and weaning foods for outpatients (p=.015 and p=.001, respectively), but tended not do so for inpatients. They were less likely to recommend breast feeding (25.7% vs. 19.4%). This evaluation helped promote creation of rehydration units in 12 of the participating hospitals. The results showed a need for continuous medical education for the health workers in the new units.

Asunto(s)

RESUMEN

To evaluate the efficacy of early treatment with erythromycin on the duration of fecal excretion and of diarrhea associated with Campylobacter jejuni, 170 patients, age 3 to 60 months, were randomly assigned in a double-blind fashion to receive either erythromycin ethyl succinate or placebo immediately after being seen at Cayetano Heredia Hospital because of acute dysentery. The groups' pretreatment characteristics were comparable. Of the 30 patients with stools positive for C. jejuni, 12 were in the placebo group and 16 in the treatment group. After 2 days of treatment, none of the patients in the placebo group and 36% of those in the erythromycin group had normal stools (P less than 0.05). After 5 days of treatment, 50% of the patients in the placebo group and 93% of those in the erythromycin group had normal stools (P less than 0.02). Fecal excretion of the organism continued significantly longer in the placebo group (P less than 0.01). There were no treatment failures in the treatment group compared with five (42%) in the placebo group (P less than 0.01). Thus, early administration of erythromycin significantly reduced the duration of both diarrhea and fecal excretion of the organism in infants and children with acute dysentery associated with C. jejuni.

Asunto(s)

RESUMEN

In a double-blind, randomized trial, we compared the efficacy of bicarbonate-containing oral rehydration solution vs citrate-containing solution in the treatment of infantile diarrheal dehydration and acidosis. Ninety-seven infants 3 to 24 months of age were entered in the study; 49 received bicarbonate-containing solution and 48 citrate-containing solution. The two groups were similar in all respects at the beginning of the study. Oral rehydration was successful (i.e., no intravenously administered fluids were required) in 85% of study patients; the success rate was similar in both treatment groups. Serum total CO2 concentration increased in a similar fashion in both groups, reaching near normal values at 48 hours after admission. We conclude that sodium citrate can be substituted for sodium bicarbonate in the formulation of the orally administered rehydration solution recommended by the World Health Organization for treatment of diarrheal dehydration in infants.

Asunto(s)