Diarrhea and Malnutrition
Fima Lifshitz in Childhood Nutrition, 2020
The major cause of diarrhea is infection.1 The morbidity of infectious diarrhea in less-developed countries includes infections with many organisms, the most frequent being rotavirus, Campylobacter, enterotoxigenic enteric bacteria, shigella, salmonella, giardia and other parasites (Table 1). These infections account for approximately 750 million episodes of diarrhea per year in children and for approximately 5 million deaths per year among the 3 billion people living in Africa, Asia, and Latin America. Each of the world’s 338 million children under the age of 5 years suffers at least two or three episodes of diarrheal illnesses per year. In the developing world, over 7% of them die.3–4 In other words, every day diarrhea kills 12,600 children less than 5 years of age. A child living in the poorest areas of the world may have 3 to 10 episodes of diarrhea per year in the first 5 years of life, for a total of 15 to 50 episodes averaging 4 to 6 days each.5
Gastrointestinal disorders
Anne Lee, Sally Inch, David Finnigan in Therapeutics in Pregnancy and Lactation, 2019
Most gastrointestinal infections result in some form of gastroenteritis, with alteration of bowel habit (usually towards diarrhoea), abdominal discomfort, cramps or pain, nausea and/or vomiting. They are usually self-limiting and best treated with supportive measures. If symptoms are prolonged for more than 24–48 hours, stools should be examined for ova, cysts and parasites and microbial culture. Many episodes are due to enterotoxins or viruses, neither of which respond to antibiotics, which are best avoided even for proven bacterial infections. There is no indication for the routine use of antibiotics for gastrointestinal infections in pregnancy. By the time culture results are available the illness is often over, but it is important to monitor such infections for public health reasons.
Functional abdominal disorders
Michael JG Farthing, Anne B Ballinger in Drug Therapy for Gastrointestinal and Liver Diseases, 2019
There is epidemiological evidence that infectious diarrhea sometimes precedes the onset of IBS symptoms.74,110 In some series, up to one-quarter of patients with chronic IBS symptoms report such a history.74 It is not clear whether persistent symptoms reflect a physiological response to a previous infectious episode, even in the absence of demonstrable inflammation of the gut. Some have hypothesized that microscopic inflammatory changes such as infiltration of the enteric nervous system contribute to the development of IBS. Gwee et al.74 have shown that about one-quarter of patients with infectious diarrhea IBS continue to experience symptoms after 3 months. Nevertheless, it appears that the ‘mind’ plays a greater role than ‘matter’ since life-event stress and hypochondriasis are predictive factors in the persistence of IBS; in contrast, physiological parameters such as whole-gut transit time and sensory thresholds are not different in patients with or without IBS symptoms at 3 months after the episode of ‘infectious’ diarrhea.74 A confounding factor with interpretation of the predominant effect of psychological factors is the well-known presentation of the psychological disorder at the time of health-care seeking in IBS. Regrettably, the antecedent psychological profile is not available in these patients, and hence it cannot be concluded definitively that psychological trait determines postinfectious IBS.
Decreased performance of live attenuated, oral rotavirus vaccines in low-income settings: causes and contributing factors
Published in Expert Review of Vaccines, 2018
Daniel E. Velasquez, Umesh Parashar, Baoming Jiang
Rotavirus is the most important cause of severe gastroenteritis in children worldwide [1]. The main symptoms of rotavirus gastroenteritis are low-grade fever, vomiting, and acute watery diarrhea. Vaccines represent the optimal practice for preventing the severe consequences of rotavirus infection, especially in impoverished regions where resources and access to medical care are usually limited. Two live attenuated oral rotavirus vaccines were licensed in 2006. Rotarix (RV1, GSK Biologics) is a two-dose monovalent (G1P[8]) human rotavirus vaccine. RotaTeq (RV5, Merck & Co.) is a three-dose pentavalent vaccine consisting of a mixture of bovine-human mono-reassortants carrying the genes encoding the human G1, G2, G3, G4, and P[8] in the genetic background of a bovine rotavirus WC3 (G6P[5]) [2]. In 2009, the WHO recommended implementation of rotavirus vaccines worldwide. Rotavirus vaccine is recommended to be administered in infancy concurrently with polio, diphtheria-tetanus-pertussis, and pneumococcal (PCV) vaccines as early as 6 weeks of age [3,4]. Currently, rotavirus vaccines are introduced into national immunization programs of 85 countries and in a phase introduction of 7, including 41 GAVI-eligible countries with financial support for vaccine procurement [5]. Implementation of rotavirus vaccines into national vaccination programs has led to substantial declines in the burden of severe gastroenteritis in several countries [5–7].
Sequential change in serum VEGF levels in a case of tocilizumab-resistant TAFRO syndrome treated effectively with rituximab
Published in Modern Rheumatology Case Reports, 2021
Risa Wakiya, Tomohiro Kameda, Yohei Takeuchi, Hiroki Ozaki, Shusaku Nakashima, Hiromi Shimada, Norimitsu Kadowaki, Hiroaki Dobashi
A 62-year-old Japanese man had undergone antibiotic treatment for infectious gastroenteritis in a local hospital because of fever, abdominal pain and diarrhoea. Although abdominal pain and diarrhoea were improved with antibiotics, his fever remained. He underwent a series of medical tests. Laboratory studies showed elevation of his white blood cell count (WBC), C-reactive protein (CRP), alkaline phosphatase (ALP), γ-glutamyltransferase (γ-GT), total bilirubin (T-Bil), aspirate transaminase (AST), alanine transaminase (ALT), and creatinine (Cre) and thrombocytopenia. A computed tomography (CT) scan revealed mild hepatosplenomegaly, lymphadenopathy and swelling of the adrenal glands. He was then referred to our hospital for further diagnostic assessment. Upon physical examination, anasarca and abdominal distension were observed. No skin lesions were observed, and his superficial lymph nodes were not palpable.
Rotavirus vaccines performance: dynamic interdependence of host, pathogen and environment
Published in Expert Review of Vaccines, 2021
Debasish Saha, Martin O.C. Ota, Priya Pereira, Philippe Buchy, Selim Badur
There is no specific treatment for rotaviral diarrhea, but as with other forms of gastroenteritis, treatment is based on addressing dehydration through fluid replacement, either orally, through oral rehydration solutions (ORS), or intravenously, depending on the severity of dehydration [17,18]. Like for all cases of gastroenteritis, zinc supplementation is recommended to reduce the duration and severity of diarrhea [19] and breastfeeding encompasses an important aspect of rehydration therapy as well as nutrition for children under 2 years of age [20]. Prevention of infection remains the cornerstone of effective management of rotaviral disease. The provision of clean water, maintaining hygienic practices like handwashing, and promoting exclusive breastfeeding for 6 months is beneficial to reduce the risk of rotavirus infections. Lastly, rotavirus vaccines are considered to have an acceptable safety profile and are effective in preventing rotavirus gastroenteritis in children [17,21,22]. The World Health Organization (WHO) emphasizes on the use of rotavirus vaccination but together with the scaling-up of both prevention (promotion of early and exclusive breastfeeding, handwashing with soap, improved water, and sanitation) and treatment packages (including low-osmolarity ORS and zinc) [17].