Bovine viral diarrhea infections in new world camelids—A review

Bovine virus diarrhea virus (BVDV) has recently been identified as an important infectious disease of new world camelids (NWC) particularly alpacas. Both sub-genotypes 1a, 1b and genotype 2 have been isolated. However, non-cytopathic BVDV 1b is reported to be primarily implicated in cases of BVDV in NWC's. Although suspected a BVDV strain unique to camelids have not been isolated. The most important source of BVDV is the immuno-tolerant persistently infected cria. Natural transient infection of BVDV in NWCs is reported to go almost undetected except for vague signs of illness, including lethargy and anorexia. Diarrhea does not appear to be a constant finding. Embryonal/fetal disease in NWC's includes early pregnancy loss, abortion and premature birth or the birth of persistently infected crias. Persistently infected disease can occur in both acute and chronic forms. In NWCs the chronic form of the condition is most commonly reported. Signs include chronic ill-thrift, poor weight gain or being underweight, intermittent illness, chronic diarrhea, joint swelling and episodes of nasal discharge and pneumonia despite antibiotic treatment. The mortality rate in NWCs appears to be close to 100%. Seroprevalence of BVDV in NWCs ranged from 2.05% to 11.11% however the possibility that the correct (homologous) BVDV strain is not being used in serological assays need to be considered. The importance of cattle as a source of BVDV for camelids is unclear although there is consensus of a spill-over from cattle to NWC's. Assays available for BVDV in cattle appear to work for camelids. An antigen ELISA which is the usual method for detecting BVD in cattle has not been validated in NWC's.     

Selection and Characterization of a Candidate Therapeutic Bacteriophage That Lyses the Escherichia coli O104:H4 Strain from the 2011 Outbreak in Germany

In 2011, a novel strain of O104:H4 Escherichia coli caused a serious outbreak of foodborne hemolytic uremic syndrome and bloody diarrhea in Germany. Antibiotics were of questionable use and 54 deaths occurred. Candidate therapeutic bacteriophages that efficiently lyse the E. coli O104:H4 outbreak strain could be selected rather easily from a phage bank or isolated from the environment. It is argued that phage therapy should be more considered as a potential armament against the growing threat of (resistant) bacterial infections.     

International regulatory requirements for Leptospira vaccine potency testing. Roundtable: Current requirements and opportunity for harmonization

Progress continues to be made in the ongoing efforts to replace, reduce, or refine the use of laboratory animals for Leptospira vaccine potency testing in certain markets/regions. Leptospira-containing vaccines, as with many veterinary vaccines, are manufactured and distributed both on a regional basis by local manufacturers and internationally by large multinational firms. Three general scenarios exist for the international testing and distribution of veterinary vaccines including: 1) the importing country recognizes the country of origin's testing and batch release data with no additional testing; 2) the importing country requires the manufacturer to conduct a specific potency assay based on the current importing market's regulations for the importing country or 3) the importing country requires retesting of the product in country prior to distribution. Scenarios 2 and 3 both have the potential to significantly increase the usage of laboratory animals for what may be considered redundant testing. Specific requirements for the importation of Leptospira vaccines in the United States, Europe, and Mexico were presented as well as efforts to reduce the use of laboratory animal testing through the availability of internationally recognized tests.     

Using Informatics and the Electronic Medical Record to Describe Antimicrobial Use in the Clinical Management of Diarrhea Cases at 12 Companion Animal Practices

Antimicrobial drugs may be used to treat diarrheal illness in companion animals. It is important to monitor antimicrobial use to better understand trends and patterns in antimicrobial resistance. There is no monitoring of antimicrobial use in companion animals in Canada. To explore how the use of electronic medical records could contribute to the ongoing, systematic collection of antimicrobial use data in companion animals, anonymized electronic medical records were extracted from 12 participating companion animal practices and warehoused at the University of Calgary. We used the pre-diagnostic, clinical features of diarrhea as the case definition in this study. Using text-mining technologies, cases of diarrhea were described by each of the following variables: diagnostic laboratory tests performed, the etiological diagnosis and antimicrobial therapies. The ability of the text miner to accurately describe the cases for each of the variables was evaluated. It could not reliably classify cases in terms of diagnostic tests or etiological diagnosis; a manual review of a random sample of 500 diarrhea cases determined that 88/500 (17.6%) of the target cases underwent diagnostic testing of which 36/88 (40.9%) had an etiological diagnosis. Text mining, compared to a human reviewer, could accurately identify cases that had been treated with antimicrobials with high sensitivity (92%, 95% confidence interval, 88.1%–95.4%) and specificity (85%, 95% confidence interval, 80.2%–89.1%). Overall, 7400/15,928 (46.5%) of pets presenting with diarrhea were treated with antimicrobials. Some temporal trends and patterns of the antimicrobial use are described. The results from this study suggest that informatics and the electronic medical records could be useful for monitoring trends in antimicrobial use.     

Illness in childhood predicts face preferences in adulthood

The value of different mate choices may depend on the local pathogen ecology and on personal infection susceptibility: when there is a high risk of infection, choosing a healthy or immunocompetent mate may be particularly important. Frequency of childhood illness may act as a cue of the ecological and immunological factors relevant to mate preferences. Consistent with this proposal, we found that childhood illness – and frequency of diarrhea in particular – was positively correlated with preferences for exaggerated sex-typical characteristics in opposite-sex, but not same-sex, faces. Moreover, this relationship was stronger among individuals with poorer current health. These data suggest that childhood illness may play a role in calibrating adult mate preferences and have implications for theories of disease-avoidance psychology, life-history strategy and cross-cultural differences in mate preferences.     

Caregiver recognition of childhood diarrhea, care seeking behaviors and home treatment practices in rural Burkina Faso: a cross-sectional survey

Introduction

To design effective national diarrhea control programs, including oral rehydration solution (ORS) and therapeutic zinc supplementation, information is needed on local perceptions of illness, external care seeking behaviors, and home treatment practices.

Methods

A cross-sectional, community-based household survey was conducted in the Orodara Health District, Burkina Faso. Caregivers of 10,490 children <27 months were interviewed to assess child diarrhea prevalence and related care practices. Characteristics of households, caregivers, children, and reported illnesses were compared for those caregivers who did or did not recognize the presence of diarrhea, as defined according to clinical criteria (≥3 liquid or semi-liquid stools/day). Multiple logistic regression models were used to examine factors associated with illness recognition and treatment.

Results

Clinically defined diarrhea was present in 7.6% (95% CI: 7.1–8.1%) of children during the 24 hours preceding the survey but recognized by only 55% of caregivers. Over half (55%) of the caregivers of 1,067 children with a clinically defined diarrhea episode in the past 14 days sought care outside the home; 78% of those seeking care attended a public sector clinic. Care was sought and treatment provided more frequently for children with fever, vomiting, anorexia, longer illness duration, and those living closer to the health center; and care was sought more frequently for male children. 80% of children with recent diarrhea received some form of treatment; only 24% received ORS, whereas 14% received antibiotics. Zinc was not yet available in the study area.

Conclusions

Caregivers frequently fail to recognize children''s diarrhea, especially among younger infants and when illness signs are less severe. Treatment practices do not correspond with international recommendations in most cases, even when caregivers consult with formal health services. Child caregivers need additional assistance to recognize diarrhea correctly, and both caregivers and health care providers need updated training on current diarrhea treatment recommendations.     

Cryptosporidiosis: a cause of summer diarrhea in children

Recent studies have suggested that some outbreaks of diarrhea in children may be caused by Cryptosporidium, a parasite associated with gastrointestinal and respiratory tract infection in animals. In a study of 7300 British Columbia patients with diarrhea, cryptosporidial oocysts were found in the stool samples of 46 (0.63%). It appears that the occurrence of cryptosporidiosis is related to three factors: the patient''s age, the time of year and the geographic location.     

HYPERNATREMIA—Its Significance in Pediatric Practice

Hypernatremic dehydration is a fairly common and potentially very dangerous illness in infants and children. It occurs during the course of a wide variety of illnesses.Predisposing factors include central nervous system diseases, decreased fluid intake, increased fluid losses from hyperventilation, perspiring, diarrhea and emesis, increased aldosterone output (contributing to sodium retention), the infant''s high obligatory renal water loss and the practice of feeding infants fluids with a comparatively high solute content.If the attending physician is aware of the predisposing factors and makes an early diagnosis and then rehydrates the patient slowly using solutions which contain some salt, the outcome will most likely be favorable. Even though the brain appears to be damaged during rehydration, the patient may make a complete recovery if proper supportive measures are instituted.     

Drinking Water Turbidity and Emergency Department Visits for Gastrointestinal Illness in New York City, 2002-2009

Background

Studies have examined whether there is a relationship between drinking water turbidity and gastrointestinal (GI) illness indicators, and results have varied possibly due to differences in methods and study settings.

Objectives

As part of a water security improvement project we conducted a retrospective analysis of the relationship between drinking water turbidity and GI illness in New York City (NYC) based on emergency department chief complaint syndromic data that are available in near-real-time.

Methods

We used a Poisson time-series model to estimate the relationship of turbidity measured at distribution system and source water sites to diarrhea emergency department (ED) visits in NYC during 2002-2009. The analysis assessed age groups and was stratified by season and adjusted for sub-seasonal temporal trends, year-to-year variation, ambient temperature, day-of-week, and holidays.

Results

Seasonal variation unrelated to turbidity dominated (~90% deviance) the variation of daily diarrhea ED visits, with an additional 0.4% deviance explained with turbidity. Small yet significant multi-day lagged associations were found between NYC turbidity and diarrhea ED visits in the spring only, with approximately 5% excess risk per inter-quartile-range of NYC turbidity peaking at a 6 day lag. This association was strongest among those aged 0-4 years and was explained by the variation in source water turbidity.

Conclusions

Integrated analysis of turbidity and syndromic surveillance data, as part of overall drinking water surveillance, may be useful for enhanced situational awareness of possible risk factors that can contribute to GI illness. Elucidating the causes of turbidity-GI illness associations including seasonal and regional variations would be necessary to further inform surveillance needs.     

Molecular mechanisms of enterotoxigenic Escherichia coli infection

Enterotoxigenic Escherichia coli (ETEC) are a major cause of diarrheal illness in developing countries, and perennially the most common cause of traveller's diarrhea. ETEC constitute a diverse pathotype that elaborate heat-labile and/or heat-stable enterotoxins. Recent molecular pathogenesis studies reveal sophisticated pathogen–host interactions that might be exploited in efforts to prevent these important infections. While vaccine development for these important pathogens remains a formidable challenge, extensive efforts that attempt to exploit new genomic and proteomic technology platforms in discovery of novel targets are presently ongoing.     

Effect of Women’s Perceptions and Household Practices on Children’s Waterborne Illness in a Low Income Community

An ecosystem approach to human health was adopted in a community-based study carried out in Bebnine, an underserved town in Lebanon. The objective of the study is to examine the association between women’s household practices and diarrhea among children in a setting where contaminated drinking water and intestinal diseases are common. A total of 280 women were randomly selected and interviewed using a structured questionnaire. Data were collected on 712 children between the ages of 6 and 14. The study instrument included determinants of diarrhea such as sociodemographic characteristics, water, sanitation, hygiene practices, gender variables, and behavioral risk factors. Multivariate regression analysis was employed to examine the association between water handling practices and diarrhea. The prevalence of diarrhea is 5%. Female children are more likely to suffer from diarrhea than male children (OR = 2.58; 95% CI: 1.19–5.62). Treatment of drinking water at the household level and the use of drinking water for cooking and the preparation of hot beverages are protective against diarrhea (OR = 0.15; 95% CI: 0.03–0.65). Female caretakers’ behaviors such as daily bathing and seeking medical care at times of illness are protective against diarrhea in children. The findings suggest that diarrhea is a gendered health problem. Female children, who are generally more involved in household activities than male children, are at higher risk of suffering from diarrhea. Female caretakers’ personal hygiene, household practices, and perceptions of diarrhea are additional risk factors. Intervention activities would be more effective if based on a better understanding of gender roles and household power relations.     

Bacteremia caused by viridans streptococci in 71 children.

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient''s illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient''s illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient''s illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.     

Advances in Multiphasic Screening and Testing

The multiphasic testing center of the future will probably be used both for periodic screening tests and for referrals by practicing physicians. Recent widespread interest of several branches of the Federal Government in multiphasic screening stems from the possibility that, through its use, the enormous cost of chronic illness to the country may be reduced.Recent advances in automation and the storage, retrieval, and analysis of data by computers make it economically feasible to obtain much more information about the patient''s health than ever before. New instrument developments include both screening and diagnostic analysis of electrocardiograms by computers, analysis of heart sounds by computer, and a wide variety of other physiological and biochemical instruments.To allow for the inclusion and evaluation of these new procedures, a number of multiphasic testing centers will be needed which can do both research and routine testing. Close cooperation between the medical profession, the public health services and industry will be needed to best serve both the public and the medical profession.     

Treatment engagement of individuals experiencing mental illness: review and update

Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization. Numerous variables may affect level of treatment engagement, including therapeutic alliance, accessibility of care, and a client's trust that the treatment will address his/her own unique goals. As such, we have found that the concept of recovery‐oriented care, which prioritizes autonomy, empowerment and respect for the person receiving services, is a helpful framework in which to view tools and techniques to enhance treatment engagement. Specifically, person‐centered care, including shared decision making, is a treatment approach that focuses on an individual's unique goals and life circumstances. Use of person‐centered care in mental health treatment models has promising outcomes for engagement. Particular populations of people have historically been difficult to engage, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. We review these populations and outline how various evidence‐based, recovery‐oriented treatment techniques have been shown to enhance engagement. Our review then turns to emerging treatment strategies that may improve engagement. We focus on use of electronics and Internet, involvement of peer providers in mental health treatment, and incorporation of the Cultural Formulation Interview to provide culturally competent, person‐centered care. Treatment engagement is complex and multifaceted, but optimizing recovery‐oriented skills and attitudes is essential in delivery of services to those with serious mental illness.     

Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study.

OBJECTIVE--To examine whether patients'' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction. DESIGN--Patients'' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later. SETTING--Two large teaching hospitals in Auckland, New Zealand. SUBJECTS--143 consecutive patients aged under 65 with their first myocardial infarction. MAIN OUTCOME MEASURES--Attendance at rehabilitation course; time before returning to work; measures of disability with sickness impact profile questionnaire for sleep and rest, social interaction, recreational activity, and home management; and sexual dysfunction. RESULTS--Attendance at the rehabilitation course was significantly related to a stronger belief during admission that the illness could be cured or controlled (t = 2.08, P = 0.04). Return to work within six weeks was significantly predicted by the perception that the illness would last a short time (t = 2.52, P = 0.01) and have less grave consequences for the patient (t = 2.87, P = 0.005). Patients'' belief that their heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities, and social interaction. A strong illness identity was significantly related to greater sexual dysfunction at both three and six months. CONCLUSIONS--Patients'' initial perceptions of illness are important determinants of different aspects of recovery after myocardial infarction. Specific illness perceptions need to be identified at an early stage as a basis for optimising outcomes from rehabilitation programmes.     

De novo acute infection and reactivation of hepatitis B virus in established cirrhosis.

Five patients with cirrhosis proved by biopsy had clinical, biochemical, and serological evidence of an acute hepatitis B infection. In two the illness was fulminant and led to death. Only one patient completely recovered. Serological markers for the hepatitis B virus were absent before the onset of the acute illness in four patients, which suggested that a de novo infection had been acquired as a result of recent transfusions of blood or blood products. The fifth patient, who had Goodpasture''s syndrome, had antibody to the core of hepatitis B virus, indicating previous exposure to the virus; his acute hepatitis may have been related to immunosuppressive drug treatment, which may have reactivated a dormant virus infection. Thus an acute type B viral hepatitis due to either a de novo or a reactivated infection may be superimposed on cirrhosis.     

Factors associated with diarrheal disease among children aged 1–5 years in a cholera epidemic in rural Haiti

Diarrheal illness is a major cause of morbidity and mortality among children in Haiti, and the impact of diarrheal illness was compounded by a cholera outbreak between 2010 and 2019. Our understanding of risk factors for diarrhea among children during this outbreak is limited. We conducted a secondary analysis of data collected as part of a cholera vaccine effectiveness study to identify factors associated with medically attended diarrhea among children in central Haiti from October of 2012 through November of 2016. We identified 47 children aged one to five years old who presented to medical clinics with acute, watery diarrhea, and 166 matched controls who did not have diarrhea, and we performed conditional logistic regression to identify factors associated with diarrhea. Discontinuing exclusive breastfeeding within one month of birth was associated with increased risk of diarrhea (RR 6.9, 95% CI 1.46–32.64), and diarrhea was inversely associated with reported history of supplementation with vitamin A (RR 0.05, 95% CI 0.004–0.56) and zinc (reported among 0% of cases vs. 17% of controls). Because of the concordance in supplementation patterns, it was not possible to attribute the association to vitamin A or zinc independently. While having a respondent who correctly identified ≥3 means of avoiding cholera was associated with reduced risk of diarrhea (RR 0.43, 95% CI 0.19–1.01), reported household sanitation practices and knowledge of cholera were not consistently associated with risk of diarrhea. These findings support ongoing efforts to reduce barriers to breastfeeding and promote pediatric supplementation with vitamin A and zinc in Haiti. Given the reduced efficacy of current oral cholera vaccines (OCV) among children, the results reinforce the importance of breastfeeding and micronutrient supplementation in preventing all-cause pediatric diarrheal illness generally and during cholera outbreaks.