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Eixo Encéfalo-Intestino , Pediatria , Humanos , Criança , Encéfalo , Trato GastrointestinalRESUMO
Feeding difficulties due to functional gastrointestinal (GI) symptoms (i.e., nausea, pain, and bloating) are well described in patients with hypermobile-type Ehlers-Danlos Syndrome. These symptoms are particularly difficult to treat when there is comorbid dysautonomia, usually manifesting as postural orthostatic tachycardia syndrome. Here, we describe a successful trial of multidisciplinary rehabilitative interventions to avoid placement of a surgical feeding tube in such a patient. Main components of intervention were intensive pelvic floor physiotherapy and biofeedback, occupational therapy focused on coping with feeding-related symptoms, psychology support, and medications targeting histamine blockade and enhancing intestinal motility.
RESUMO
BACKGROUND: Neurogastroenterology and motility (NGM) disorders are common and have a high health care burden. Although pediatric gastroenterology fellows are expected to obtain comprehensive training in the diagnosis and management of NGM disorders, there is ongoing concern for unmet training needs and lack of exposure in treating patients who suffer from NGM problems. METHODS: We conducted a cross-section survey of trainees listed as pediatric gastroenterology fellows in North American training programs in 2018 via direct E-mail and the pediatric gastroenterology listserv. Eighty-one pediatric gastroenterology fellows responded to the anonymous survey. RESULTS: A total of 53.1% of the fellows reported interest in NGM; however, 75.1% of the fellows believed they had not been adequately trained in NGM during their fellowship. Eighty percent of fellows with 2 weeks or less of dedicated motility training reported that they received inadequate NGM training, compared to 46.2% fellows who received 1 or more months of dedicated motility training (Pâ=â0.0148). The majority of fellows reported not being comfortable in performing gastrointestinal (GI) motility studies. The majority of fellows also reported not being comfortable in interpreting GI motility studies. CONCLUSIONS: Although most pediatric gastroenterology fellows expressed interest in NGM, the lack of exposure and dedicated training in motility during fellowship were identified as barriers to pursuing motility-focused careers. Furthermore, most fellows reported limited comfort with performing and/or interpreting motility studies. Changes are needed to encourage fellows to develop their interest and expertise in NGM.
Assuntos
Competência Clínica , Bolsas de Estudo/métodos , Gastroenterologia/educação , Pediatria/educação , Estudantes de Medicina/psicologia , Adulto , Criança , Estudos Transversais , Currículo , Educação de Pós-Graduação em Medicina , Feminino , Gastroenterologia/métodos , Motilidade Gastrointestinal , Humanos , Masculino , Pediatria/métodos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Postinfectious irritable bowel syndrome (PI-IBS) has been reported as a complication of bacterial diarrhea including travelers' diarrhea (TD). This study assessed the role of TD among US students in Mexico in triggering the onset of persistent abdominal symptoms (PAS) and IBS. METHODS: We conducted a 6-month follow-up of a cohort of 817 US students in Mexico as short-term study to assess the frequency of PAS and IBS. Using Rome II criteria for IBS, groups of students with PAS were then categorized as PI-IBS if they met the symptom criteria for IBS or as suffering from functional abdominal disorder (FAD) if they did not meet the criteria. RESULTS: FAD and IBS were commonly found in US students 6 months after leaving Mexico. Important variables in their development were younger adult age, longer stays in Mexico and occurrence of acute diarrhea while in Mexico. Diarrhea while in Mexico occurred more commonly for those later diagnosed with FAD, 101/196 (52%), relative risk (RR) = 1.5 [confidence interval (CI) 1.2-1.8; p = 0.001]; IBS, 20/32 (63%), RR = 2.5 (CI 1.2-5.0; p = 0.007); and PAS (FAD + IBS), 121/228 (53%), RR = 1.5 (CI 1.2-1.8; p < 0.001) compared with subjects who had experienced diarrhea while in Mexico but were not diagnosed with PAS at 6 months, 227/589 (39%). Diarrhea caused by heat-labile enterotoxin-producing enterotoxigenic Escherichia coli or Providencia ssp. demonstrated a greater risk of developing PAS. CONCLUSIONS: PAS occurred commonly in a subset of younger adult travelers who stayed longer in Mexico and experienced acute diarrhea while there. Further studies with this cohort will focus on host genetic associations with the development of PAS.
Assuntos
Diarreia , Escherichia coli/isolamento & purificação , Síndrome do Intestino Irritável , Providencia/isolamento & purificação , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idade de Início , Diarreia/complicações , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/fisiopatologia , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Síndrome do Intestino Irritável/etiologia , Síndrome do Intestino Irritável/fisiopatologia , Masculino , México/epidemiologia , Medição de Risco , Avaliação de Sintomas , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
Toxoplasma gondii invades any nucleated cell, but different replication speed and effects on survival/apoptosis processes have been found depending on cell type. There are scarce and controversial results regarding the effect of this parasite on host cell apoptosis within the brain. The invasion and replication of T. gondii RH strain within newborn mouse astrocytes were evaluated in the present work. At 4 hpi>90% cells were infected and harbored one to three parasitophorous vacuoles with one tazchyzoite/vacuole. Cell culture massive destruction started after 24 h of exposure, when the parasite already replicated, with a duplication time of around 5 h. The effect of T. gondii infection on apoptosis was also evaluated by changes in some anti- and pro-apoptotic markers. At early infection times decreased Bcl-2, Survivin and PUMA and increased Noxa expression was found, although Survivin and Noxa mRNA levels reverted towards an anti-apoptotic phenotype after 6 h. Caspases 3/7 activity decreased three hours after infection, although it returned to normal levels thereafter. This enzymatic activity was strongly stimulated by Cisplatin (anti-neoplasic drug) but it was inhibited by previous T. gondii infection. Likewise, parasite invasion prevented PARP-1 fragmentation and cell apoptosis induced by the same drug. In conclusion, astrocytes seem to activate some apoptosis signals shortly after infection, but the parasite takes control of the cell and inhibits programmed death for up to 24 h, until it replicates, egresses and generates cellular destruction.
Assuntos
Proteínas Reguladoras de Apoptose/genética , Astrócitos/parasitologia , Proteínas de Protozoários/genética , Toxoplasma/fisiologia , Animais , Animais Recém-Nascidos , Antineoplásicos/farmacologia , Apoptose , Proteínas Reguladoras de Apoptose/metabolismo , Astrócitos/citologia , Astrócitos/efeitos dos fármacos , Encéfalo/citologia , Caspases/metabolismo , Cisplatino/farmacologia , Feminino , Regulação da Expressão Gênica , Genes bcl-2/genética , Proteína Glial Fibrilar Ácida , Proteínas Inibidoras de Apoptose/genética , Proteínas Inibidoras de Apoptose/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Poli(ADP-Ribose) Polimerase-1 , Poli(ADP-Ribose) Polimerases/genética , Poli(ADP-Ribose) Polimerases/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Proteínas de Protozoários/metabolismo , Proteínas Repressoras/genética , Proteínas Repressoras/metabolismo , Organismos Livres de Patógenos Específicos , Survivina , Toxoplasma/crescimento & desenvolvimento , Proteínas Supressoras de Tumor/genética , Proteínas Supressoras de Tumor/metabolismoRESUMO
OBJECTIVE: To compare scintigraphic gastric emptying and antroduodenal manometry (ADM) studies with the wireless motility capsule test in symptomatic pediatric patients. STUDY DESIGN: Patients aged 8-17 years with severe upper gastrointestinal symptoms (ie, nausea, vomiting, retching, abdominal pain) referred for ADM were recruited. A standardized protocol for ADM was used. On a different day, participants were given a standardized meal and then swallowed the wireless motility capsule. A wireless receiver unit worn during the study recorded transmitted data. If not performed previously, a 2-hour scintigraphic gastric emptying study was completed at the time of ADM testing. RESULTS: A total of 22 patients were recruited, of whom 21 had complete scintigraphic gastric emptying study data and 20 had complete ADM data. The wireless motility capsule test had 100% sensitivity and 50% specificity in detecting gastroparesis compared with the 2-hour scintigraphic gastric emptying study. The wireless motility capsule test detected motor abnormalities in 17 patients, compared with 10 detected by ADM. Dichotomous comparison yielded a diagnostic difference between ADM and the wireless motility capsule test (P<.01). Migrating motor complexes were recognized in all patients by both ADM and the wireless motility capsule test. The wireless motility capsule test was well tolerated in all patients, and there were no side effects. CONCLUSION: In symptomatic pediatric patients, the wireless motility capsule test is highly sensitive compared with scintigraphic gastric emptying studies in detecting gastroparesis, and seems to be more sensitive than ADM in detecting motor abnormalities.
Assuntos
Endoscopia por Cápsula , Esvaziamento Gástrico , Gastroenteropatias/diagnóstico , Gastroparesia/diagnóstico , Adolescente , Criança , Feminino , Gastroenteropatias/diagnóstico por imagem , Gastroparesia/diagnóstico por imagem , Humanos , Masculino , Manometria/métodos , Cintilografia , Sensibilidade e EspecificidadeRESUMO
Toxoplasma gondii is a cosmopolitan protozoan which infects all homoeothermic species, including humans. This parasite may cause severe neurological problems in congenitally infected newborns or immunocompromised individuals, but it also provokes psychiatric and neurological disorders as well as behavioural and sensory deficit. There is controversy regarding the effect of T. gondii upon astrocytes, which may serve as parasite proliferation recipients or protective immune response activators within the central nervous system. This apparent contradiction could partially be due to the infection degree obtained in the different experiments reported. Thus, we decided to systematically review the in vitro models used to study these phenomena. Fifteen articles from which direct invasion and replication data could be gathered were found. Very heterogeneous results emerged, mainly due to diversity of models in relation to parasite strain (virulence), host species, parasite dose and evaluation times after infection. Also, the results were measured in diverse ways, i.e. some reported percent infected cells, while others informed parasites pervacuole or cell, or parasitic vacuoles per cell. Very few conclusions could be drawn, among them that human astrocytoma cell lines and mouse astrocytes seem more susceptible to infection and less resistant to tachyzoite proliferation than human primary culture astrocytes. The present study supports the need to reanalyse T. gondii astrocyte invasion and replication processes, especially with the use of actual technology, which allows detailed mechanistic studies.
Assuntos
Astrócitos/parasitologia , Toxoplasma/crescimento & desenvolvimento , Toxoplasma/patogenicidade , Animais , Técnicas de Cultura de Células , Células Cultivadas , Humanos , Camundongos , Toxoplasma/imunologiaRESUMO
BACKGROUND: Under normal conditions, the expression of CD14, which is the principal receptor for bacterial lipopolysaccharide, is down-regulated in the intestinal mucosa but increases in response to inflammatory stimuli. The aim of the present study was to investigate whether fecal CD14 levels increased in response to infection with diarrheagenic Escherichia coli and whether single nucleotide polymorphisms (SNPs) in the CD14 gene were associated with an increased susceptibility to traveler's diarrhea (TD) in US visitors to Mexico. METHODS: Six SNPs located at the promoter, exon, and untranslated regions of CD14 were typed in a prospective cohort study of 1360 visitors to Mexico at risk for TD. Stools from visitors with TD were studied for enteric pathogens by culture, colony hybridization, and polymerase chain reaction. Fecal soluble CD14 (sCD14) was measured in a subgroup of 203 adults with diarrhea and 66 healthy controls by enzyme-linked immunosorbent assay. RESULTS: The minor allele frequencies for CD14 SNPs were significantly different among the various racial and ethnic groups studied. Two SNPs in the promoter region of CD14 (-159 C > T; rs2569190 and -4191 C > T; rs5744441) were found to be associated with TD in White visitors. The -159 TT genotype was associated with a higher risk for TD (Relative risk [RR], 1.21; 95% confidence interval [CI], 1.05-1.38; P = .008), whereas individuals with the -4191 TT genotype were protected from infection (RR, 0.82; 95% CI, 0.71-0.92; P = .006). Subjects with TD excreted higher levels of fecal CD14 than did healthy controls (33,480 pg/mL vs 6178 pg/mL; P < .02). Fecal sCD14 levels were higher in stool samples from visitors with TD and the -159 TT genotype than they were in visitors with the CC/CT genotypes (P = .02), and stool samples from subjects with the -4191 CC genotype had higher fecal sCD14 levels than did stool samples from visitors with the CT/TT (P = .005) genotype. In a multivariate analysis with haplotypes constructed with the 6 SNPs studied, subjects with the haplotype containing the -159 C and the -4191 T allele were less likely to acquire TD (P = .015). CONCLUSIONS: Our study suggests that CD14 levels increase in response to bacterial diarrhea and that polymorphisms in the CD14 gene influence susceptibility to TD. Intestinal CD14 plays an important role in the innate immune response to enteric pathogens.
Assuntos
Diarreia/genética , Infecções por Escherichia coli/genética , Receptores de Lipopolissacarídeos/genética , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Viagem , Adolescente , Adulto , Canadá , Estudos de Coortes , Diarreia/epidemiologia , Diarreia/imunologia , Suscetibilidade a Doenças , Ensaio de Imunoadsorção Enzimática , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/imunologia , Fezes/química , Fezes/microbiologia , Feminino , Humanos , Receptores de Lipopolissacarídeos/análise , Masculino , México , Hibridização de Ácido Nucleico , Reação em Cadeia da Polimerase , Estudos Prospectivos , Estados Unidos , Adulto JovemRESUMO
Campylobacter jejuni is an unusual cause of travelers' diarrhea acquired in Mexico, but previous studies have relied only on stool culture for diagnosis. We conducted a cohort study to determine if antibody seroconversion to C jejuni would better reflect the occurrence of infection acquired in Mexico. Serum IgG, IgA, and IgM antibodies to Campylobacter seroconverted in only 2 of 353 participants (0.6%). These data further support that C jejuni infection is an unusual cause of travelers' diarrhea in US visitors to Mexico.
Assuntos
Anticorpos Antibacterianos/análise , Infecções por Campylobacter/imunologia , Campylobacter jejuni/fisiologia , Diarreia/microbiologia , Imunoglobulinas/análise , Viagem , Adolescente , Adulto , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/epidemiologia , Campylobacter jejuni/isolamento & purificação , Criança , Estudos de Coortes , Diarreia/diagnóstico , Diarreia/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina A/análise , Imunoglobulina G/análise , Imunoglobulina M/análise , Masculino , México , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Osteoprotegerin (OPG), an immunoregulatory member of the TNF receptor superfamily, is expressed in inflamed intestinal mucosa. We investigated whether OPG is produced by intestinal epithelial cells and tested the hypothesis that single-nucleotide polymorphisms (SNPs) in the gene encoding OPG (TNFRSF11B) are associated with traveler's diarrhea (TD) among North American travelers to Mexico. METHODS: OPG concentration was measured in the supernatants of T84 cells infected with various diarrheagenic Escherichia coli pathotypes. Genotyping was performed for 4 SNPs in the OPG gene for 968 North American travelers with or without TD. Stool samples from travelers with TD were evaluated for the presence of enteric pathogens. RESULTS: T84 cells produced higher OPG levels in response to infection with various diarrheagenic E. coli pathotypes than with E. coli controls (P<.05). A SNP in the exon 1 region of the OPG gene (OPG+1181G>C) was associated with TD in white travelers who stayed in Mexico for >1 week during the summer (P=.009) and for TD due to nonsecretory pathogens (P=.001). CONCLUSIONS: Our study suggests that OPG is secreted by intestinal epithelial cells in response to enteropathogens and that a polymorphism in the OPG gene is associated with an increased susceptibility to TD.
Assuntos
Diarreia/genética , Infecções por Escherichia coli/genética , Osteoprotegerina/genética , Osteoprotegerina/metabolismo , Polimorfismo de Nucleotídeo Único , Adolescente , Adulto , Análise de Variância , Linhagem Celular , Distribuição de Qui-Quadrado , Diarreia/epidemiologia , Diarreia/imunologia , Diarreia/microbiologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/imunologia , Infecções por Escherichia coli/microbiologia , Fezes/química , Fezes/microbiologia , Feminino , Predisposição Genética para Doença , Humanos , Inflamação/microbiologia , Mucosa Intestinal/citologia , Mucosa Intestinal/metabolismo , Masculino , México , Pessoa de Meia-Idade , Fatores de Risco , ViagemRESUMO
Anogenital distance (AGD) at birth is regarded as a useful measurement that reflects the prenatal androgenic status in rodents. However, the impact of xenoantiandrogens on human development is largely unknown. The aim of this study was to evaluate the potential antiandrogenic impact of prenatal DDT metabolites (p,p'-DDE and p,p'-DDT) exposure on infant AGD, using a non-age-dependent anal position index (API). As part of an ongoing perinatal cohort study on the effects of organochlorine pesticides in children's neurodevelopment, we conducted a cross-sectional study in 71 infants (37 males and 34 females). Maternal serum levels of DDT metabolites (p,p'-DDE and p,p'-DDT) before and during each trimester of pregnancy were determined by electron capture gas-liquid chromatography. During postnatal home visits at 3, 6, and 12 or 18 months of age, the children's weight and API were evaluated. Multiple lineal regression models were used to estimate the potential endocrine disruptor activity of prenatal p,p'-DDE exposure. Boys had significantly higher API values than girls (0.6 versus 0.5; P < 0.001). Only among boys, a doubling increase of maternal p,p'-DDE serum levels during the first trimester of pregnancy, were associated with a significant reduction of API (beta=-0.02; P= 0.02). No effect of p,p'-DDT on AGD was observed. Evidence of the effect of prenatal p,p'-DDE on external genital differentiation is scarce and not consistent in the literature. Further studies are needed to confirm a hormonal disruptive effect on the development of external genitalia, due not only to p,p'-DDE but also due to other antiandrogenic persistent compounds.
Assuntos
Canal Anal/anormalidades , Diclorodifenil Dicloroetileno/toxicidade , Exposição Materna , Canal Anal/efeitos dos fármacos , Antagonistas de Androgênios/metabolismo , Estudos de Coortes , Sistema Endócrino/efeitos dos fármacos , Feminino , Humanos , Recém-Nascido , Masculino , México , Gravidez , Primeiro Trimestre da Gravidez , Análise de Regressão , Fatores SexuaisRESUMO
We studied 1,179 North American travelers who visited Mexico from 2005 to 2007. Travelers' diarrhea (TD) was reported by 521 (44%) participants. Among subjects with TD, 218 cases were examined for cryptosporidiosis by polymerase chain reaction (PCR) and enzyme-linked immunoassays (ELISA). There were 14 (6%) cases of cryptosporidiosis and 141 cases (64%) of bacterial diarrhea. Compared with bacterial diarrhea, a longer stay in Mexico was a risk factor for cryptosporidiosis. Additionally, Cryptosporidium cases passed greater number of watery stools (P < 0.05), suffered more episodes of diarrhea (P < or = 0.05), and were more likely to experience tenesmus (P < or = 0.05) compared with bacterial causes of TD. ELISA detected seven (3%) cases of Cryptosporidium, whereas PCR identified an additional seven cases (6%). Speciation by 18SrRNA sequencing showed that 13 cases were caused by C. parvum and only 1 case was caused by C. hominis. ELISA showed a sensitivity of 50% and specificity of 100% compared with PCR.
Assuntos
Criptosporidiose/epidemiologia , Diarreia/epidemiologia , Diarreia/parasitologia , Viagem , Adolescente , Adulto , Animais , Canadá/epidemiologia , Cryptosporidium/classificação , Ensaio de Imunoadsorção Enzimática , Humanos , México/epidemiologia , Razão de Chances , Reação em Cadeia da Polimerase , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Enterotoxigenic Escherichia coli (ETEC) is a major cause of travellers' diarrhoea. We investigated the rate of diarrhoea attacks, safety, and feasibility of a vaccine containing heat-labile enterotoxin (LT) from ETEC delivered to the skin by patch in travellers to Mexico and Guatemala. METHODS: In this phase II study, healthy adults (aged 18-64 years) who planned to travel to Mexico or Guatemala and had access to a US regional vaccination centre were eligible. A centralised randomisation code was used for allocation, which was masked to participants and site staff. Primary endpoints were to investigate the field rate of ETEC diarrhoea, and to assess the safety of heat-labile toxins from E coli (LT) delivered via patch. Secondary endpoints included vaccine efficacy against travellers' diarrhoea and ETEC. Participants were vaccinated before travel, with two patches given 2-3 weeks apart. Patches contained either 37.5 mug of LT or placebo. Participants tracked stool output on diary cards in country and provided samples for pathogen identification if diarrhoea occurred. Diarrhoea was graded by the number of loose stools in 24 h: mild (three), moderate (four or five), and severe (at least six). Analysis was per protocol. The trial is registered with ClinicalTrials.gov, number NCT00516659. FINDINGS: Recruitment closed after 201 participants were assigned patches. 178 individuals received two vaccinations and travelled and 170 were analysed. 24 (22%) of 111 placebo recipients had diarrhoea, of whom 11 (10%) had ETEC diarrhoea. The vaccine was safe and immunogenic. The 59 LT-patch recipients were protected against moderate-to-severe diarrhoea (protective efficacy [PE] 75%, p=0.0070) and severe diarrhoea (PE 84%, p=0.0332). LT-patch recipients who became ill had shorter episodes of diarrhoea (0.5 days vs 2.1 days, p=0.0006) with fewer loose stools (3.7 vs 10.5, p<0.0001) than placebo. INTERPRETATION: Travellers' diarrhoea is a common ailment, with ETEC diarrhoea illness occurring in 10% of cases. The vaccine patch is safe and feasible, with benefits to the rate and severity of travellers' diarrhoea.
Assuntos
Diarreia/prevenção & controle , Vacinas contra Escherichia coli/uso terapêutico , Viagem , Administração Cutânea , Adolescente , Adulto , Diarreia/classificação , Diarreia/etiologia , Método Duplo-Cego , Vacinas contra Escherichia coli/administração & dosagem , Vacinas contra Escherichia coli/efeitos adversos , Guatemala , Humanos , México , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
Up to 60% of U.S. visitors to Mexico develop traveler's diarrhea (TD), mostly due to enterotoxigenic Escherichia coli (ETEC) strains that produce heat-labile (LT) and/or heat-stable (ST) enterotoxins. Distinct single-nucleotide polymorphisms (SNPs) within the interleukin-10 (IL-10) promoter have been associated with high, intermediate, or low production of IL-10. We conducted a prospective study to investigate the association of SNPs in the IL-10 promoter and the occurrence of TD in ETEC LT-exposed travelers. Sera from U.S. travelers to Mexico collected on arrival and departure were studied for ETEC LT seroconversion by using cholera toxin as the antigen. Pyrosequencing was performed to genotype IL-10 SNPs. Stools from subjects who developed diarrhea were also studied for other enteropathogens. One hundred twenty-one of 569 (21.3%) travelers seroconverted to ETEC LT, and among them 75 (62%) developed diarrhea. Symptomatic seroconversion was more commonly seen in subjects who carried a genotype producing high levels of IL-10; it was seen in 83% of subjects with the GG genotype versus 54% of subjects with the AA genotype at IL-10 gene position -1082 (P, 0.02), in 71% of those with the CC genotype versus 33% of those with the TT genotype at position -819 (P, 0.005), and in 71% of those with the CC genotype versus 38% of those with the AA genotype at position -592 (P, 0.02). Travelers with the GCC haplotype were more likely to have symptomatic seroconversion than those with the ATA haplotype (71% versus 38%; P, 0.002). Travelers genetically predisposed to produce high levels of IL-10 were more likely to experience symptomatic ETEC TD.
Assuntos
Toxinas Bacterianas/metabolismo , Diarreia/genética , Escherichia coli Enterotoxigênica/patogenicidade , Enterotoxinas/metabolismo , Infecções por Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Interleucina-10/genética , Polimorfismo de Nucleotídeo Único , Viagem , Adulto , Diarreia/imunologia , Diarreia/microbiologia , Diarreia/fisiopatologia , Escherichia coli Enterotoxigênica/metabolismo , Infecções por Escherichia coli/imunologia , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/fisiopatologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estados UnidosRESUMO
BACKGROUND AND AIMS: Enterotoxigenic Escherichia coli (ETEC) is the most common bacterial pathogen isolated from travelers suffering of diarrhea. Exposure to heat-labile toxin (LT) produces a high rate of seroconversion. However, the role of LT-producing ETEC (LT-ETEC) as a cause of diarrhea is controversial. We conducted a cohort study in US students traveling to Mexico to assess the ETEC-LT seroconversion rate after natural exposure. METHODS: Participants provided a serum sample on arrival and departure and a stool sample when ill. ETEC-LT immunoglobulin G antibodies were measured by enzyme-linked immunosorbent assay, and LT-ETEC were detected by means of polymerase chain reaction done on fecal DNA. RESULTS: A total of 422 participants with a mean age of 34.5 years were followed a mean of 19.9 days; 304 were females (72.0%), and 319 (75.6%) traveled during the summer months. In total, 177 individuals (41.9%) developed travelers' diarrhea and 33.9% had LT-ETEC identified in their stools. Among individuals having an LT-ETEC strain, 74% seroconverted compared to 11% of those not having diarrhea (p < 0.0001). When analyzed with a logistic regression model, the odds of seroconversion were significantly reduced in participants not having LT-ETEC in their stool (odds ratio = 0.1, p < 0.0001) after adjusting for season, length of stay, age, gender, race, and ethnicity. CONCLUSION: In US young adults traveling to Mexico, ETEC-LT seroconversion reliably identifies individuals naturally exposed to ETEC and correlates with symptomatic illness, length and season of travel.
Assuntos
Toxinas Bacterianas/isolamento & purificação , Diarreia/microbiologia , Enterotoxinas/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Viagem/estatística & dados numéricos , Adulto , Fatores Etários , Diarreia/epidemiologia , Ensaio de Imunoadsorção Enzimática , Infecções por Escherichia coli/epidemiologia , Proteínas de Escherichia coli , Fezes/microbiologia , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , México , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Fatores de Risco , Estações do Ano , Testes Sorológicos , Fatores Sexuais , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
Large field studies of travelers' diarrhea for multiple destinations are limited by the need to perform stool cultures on site in a timely manner. A method for the collection, transport, and storage of fecal specimens that does not require immediate processing and refrigeration and that is stable for months would be advantageous. This study was designed to determine if enterotoxigenic Escherichia coli (ETEC) and enteroaggregative E. coli (EAEC) DNA could be identified from cards that were processed for the evaluation of fecal occult blood. U.S. students traveling to Mexico during 2005 to 2007 were monitored for the occurrence of diarrheal illness. When ill, students provided a stool specimen for culture and occult blood by the standard methods. Cards then were stored at room temperature prior to DNA extraction. Fecal PCR was performed to identify ETEC and EAEC in DNA extracted from stools and from occult blood cards. Significantly more EAEC cases were identified by PCR that was performed on DNA that was extracted from cards (49%) or from frozen feces (40%) than from culture methods that used HEp-2 adherence assays (13%) (P < 0.001). Similarly, more ETEC cases were detected from card DNA (38%) than from fecal DNA (30%) or by culture that was followed by hybridization (10%) (P < 0.001). The sensitivity and specificity of the card test were 75 and 62%, respectively, compared to those for EAEC by culture and were 50 and 63%, respectively, compared to those for ETEC. DNA extracted from fecal cards that was used for the detection of occult blood is of use in identifying diarrheagenic E. coli.
Assuntos
Diarreia/microbiologia , Infecções por Escherichia coli/diagnóstico , Escherichia coli/isolamento & purificação , Sangue Oculto , Reação em Cadeia da Polimerase/métodos , Adolescente , Adulto , Aderência Bacteriana , Técnicas Bacteriológicas/métodos , Linhagem Celular , DNA Bacteriano/genética , Escherichia coli/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Manejo de Espécimes , Temperatura , Viagem , Estados UnidosRESUMO
This pilot study examined the change in the seroprevalence of the enteroaggregative Escherichia coli (EAEC) virulence factor dispersin in USA students during a short stay in Cuernavaca, Mexico, between June and August 2004. One hundred and ninety-five students provided paired serum samples - one on arrival to Mexico (pre-serum) and a second on departure from Mexico (post-serum) after a mean stay of 19 days. Serum samples were tested for IgG antibody to a recombinant purified dispersin protein by ELISA. For all travellers, with and without diarrhoea, the mean+/-sd pre-serum absorbance value (read at 450 and 570 nm) was 0.340+/-0.212 and the mean post-serum value was 0.513+/-0.316 (P<0.00001). Both travellers who developed diarrhoea and those who did not develop diarrhoea had an increase in IgG antibody to dispersin from the time of arrival to the time of departure from Cuernavaca (diarrhoea group 0.323+/-0.197 to 0.501+/-0.311, P<0.00001, and the asymptomatic group 0.354+/-0.224 to 0.525+/-0.321, P<0.00001). The pre-serum absorbance value (read at 450 and 570 nm) for IgG antibody to dispersin was not associated with protection against the development of diarrhoeal illness. These results indicate that USA travellers to Mexico show seroconversion for the EAEC virulence factor dispersin. Further studies are needed to characterize in more detail the host clinical and immunological responses to the dispersin protein.
Assuntos
Anticorpos Antibacterianos/sangue , Diarreia/epidemiologia , Infecções por Escherichia coli/epidemiologia , Proteínas de Escherichia coli/imunologia , Escherichia coli/imunologia , Viagem , Fatores de Virulência/imunologia , Adolescente , Adulto , Animais , Diarreia/imunologia , Diarreia/microbiologia , Escherichia coli/patogenicidade , Infecções por Escherichia coli/imunologia , Infecções por Escherichia coli/microbiologia , Humanos , Imunoglobulina G/sangue , México/epidemiologia , Camundongos , Camundongos Endogâmicos BALB C , Projetos Piloto , Estados Unidos , VirulênciaRESUMO
La lesión medular (LM) es un problema que afecta sobre todo a la población en edad laboral y, por lo tanto, sus repercusiones rebasan el ámbito familiar. La LM es irreversible para la mitad de las víctimas y en la actualidad los tratamientos existentes consisten en la asistencia y la estabilización espinal. Con el reconocimiento de la existencia de células madre (CM), el tratamiento de la LM ha recibido otro enfoque. Las CM se encargan de la renovación de los tejidos durante la vida del individuo y su reparación en caso de lesión. Las CM más atractivas desde el punto de vista terapéutico son las capaces de generar diversos tejidos, obtenibles con facilidad, y cuya manipulación es aceptable en términos éticos. En este artículo se presentan algunos de los estudios realizados con CM de diversos orígenes y su aplicación al tratamiento de la LM.
Spinal cord injury (SCI) is a trauma problem striking mainly working age adults, therefore affecting society beyond the victims family circle. Most of the victims of SCI will never recover; therapy for this type of injury consists basically on spinal cord support and stabilization. With the discovery of stem cells (SC), SCI treatment has been given another chance. Stem cells are responsible for tissue renewal throughout the individuals life, as well as tissue repair when needed. From the therapeutic point of view, the most appealing SC are those capable of generating a variety of tissues, those easily harvested, and finally, those ethically unquestioned. This article summarizes some studies carried with SC of various origins and their application to SCI treatment.
Assuntos
Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ratos , Traumatismos da Medula Espinal/reabilitação , Células-Tronco Adultas/citologia , Células-Tronco Adultas/transplante , Encéfalo/citologia , Regeneração Nervosa , Quadriplegia/etiologia , Quadriplegia/reabilitação , Quadriplegia/cirurgia , Traumatismos da Medula Espinal/cirurgia , Medula Espinal/citologia , Transplante de Células-Tronco , Células-Tronco/classificaçãoRESUMO
BACKGROUND: Diarrhea affects 40%-60% of travelers from industrialized nations who visit developing countries and is due to bacterial, viral, and parasitic agents. Lactoferrin is bactericidal to enteric pathogens, modulates the intestinal immune response, and is excreted in stool in response to infection with intestinal organisms. We investigated the impact that selected single-nucleotide polymorphisms (SNPs) in the human lactoferrin gene have on susceptibility to traveler's diarrhea. METHODS: Adults who had recently arrived in Mexico were studied prospectively for the occurrence and causal agent(s) of traveler's diarrhea, and genotyping was performed for 9 distinct lactoferrin SNPs. RESULTS: Of the 9 SNPs studied, only 1 SNP (located in exon 15) was associated with traveler's diarrhea (P=.004). When compared with healthy travelers, and after adjustment for known risk factors for traveler's diarrhea (such as age and duration and season of travel), subjects with the T/T genotype in amino acid position 632 were more likely to develop traveler's diarrhea (67% vs. 33%; relative risk [RR], 1.4; 95% CI, 1.2-1.7; P<.001), to have diarrhea with a pathogen identified (RR, 1.3; 95% CI, 1.1-1.6; P=.03), and to have a marker of intestinal inflammation in stool specimens (blood, mucus, or white blood cells; 52% vs. 38%; P=.036). The association was also significant when norovirus was not identified in stool samples (RR, 1.34; 95% CI, 1.06-1.34; P=.01). CONCLUSIONS: The T/T genotype in position codon 632 of the lactoferrin gene is associated with susceptibility to diarrhea in North Americans traveling to Mexico.