Infectious etiology and indicators of malabsorption or intestinal injury in childhood diarrhea
Abstract
Introduction. The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease.
Objective. To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity.
Materials and methods. The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests.
Results. We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method.
Conclusions. Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.
Downloads
References
Brandt KG, Antunes MMC, Silva GAP. Acute diarrhea: Evidence-based management. J Pediatr (Rio J). 2015;91(Supp.1):S36-43. https://doi.org/10.1016/j.jped.2015.06.002
Global Burden of Diseases, Injuries, and Risk Factors Study. Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: A systematic analysis for the global burden of disease study 2016. Lancet Infect Dis. 2018;18:1211-28. https://doi.org/10.1016/S14733099(18)30362-1
Flórez ID, Niño-Serna LF, Beltrán-Arroyave CP. Acute infectious diarrhea and gastroenteritis in children. Curr Infect Dis Rep. 2020;22:4. https://doi.org/10.1007/s11908-020-0713-6
Pereira IV, Cabral IE. Diarréia aguda em crianças menores de um ano: subsídios para o delineamento do cuidar. Esc Anna Nery Rev Enferm. 2008;12:224-9. https://doi.org/10.1590/S1414-81452008000200004
Behera DK, Mishra S. The burden of diarrhea, etiologies, and risk factors in India from 1990 to 2019: Evidence from the global burden of disease study. BMC Public Health. 2022;22:92. https://doi.org/10.1186/s12889-022-12515-3
World Health Organization. Diarrhoeal disease. Accessed: 18 January 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
Cohen AL, Platts-Mills JA, Nakamura T, Operario DJ, Antoni S, Mwenda JM, et al. Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: Findings from the Global Pediatric Diarrhea Surveillance network. BMJ Glob Health. 2022;7:e009548. https://doi.org/10.1136/bmjgh-2022-009548
Merino VR, Nakano V, Delannoy S, Fach P, Alberca GGF, Farfan MJ, et al. Prevalence of enteropathogens and virulence traits in Brazilian children with and without diarrhea. Front Cell Infect Microbiol. 2020;10:549919. https://doi.org/10.3389/fcimb.2020.549919
Keller J, Layer P. The pathophysiology of malabsorption. Viszeralmedizin. 2014;30:150-4. https://doi.org/10.1159/000364794
Khouri MR, Huang G, Shia YF. Sudan stain of fecal fat: New insight into an old test. Gastroenterol. 1989;96:421-7. https://doi.org/10.1016/0016-5085(89)91566-7
Maranhão HS, Wehba J. Steatocrit and Sudan III in the study of steatorrhea in children: Comparison with the van de Kamer method. Arq Gastroenterol. 1995;32:140-5.
Sugai E, Srur G, Vázquez H, Benito F, Mauriño E, Boerr LA, et al. Steatocrit: A reliable semiquantitative method for detection of steatorrhea. J Clin Gastroenterol. 1994;19:206-9. https://doi.org/10.1097/00004836-199410000-00007
Cueto Rua EA, Nanfito G, Guzmán L. La enfermedad celíaca. Ludovica Pediátr. 2006;8:85-99.
Castro-Rodriguez JA, Salazar-Lindo E, León-Barúa R. Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements. Arch Dis Child. 1997;77:201-5. https://doi.org/10.1136/adc.77.3.201
Phuapradit P, Narang A, Mendonça P, Harris DA, Baum JD. The steatocrit: A simple method for estimating stool fat content in newborn infants. Arch Dis Child. 1981;56:725-7. https://doi.org/10.1136/adc.56.9.725
Tran M, Forget P, van Den Neucker A, Strik J, van Kreel B, Kuijten R. The acid steatocrit: A much improved method. J Pediatr Gastroenterol Nutr. 1994;19:299-303. https://doi.org/10.1097/00005176-199410000-00007
Faust EC, D’antoni JS, Odom V, Miller MJ, Peres C, Sawitz W, et al. A critical study of clinical laboratory technics for the diagnosis of protozoan cysts and helminth eggs in feces I. Preliminary communication. Am J Trop Med. 1938;18:169-83.
Pacheco FT, Silva RK, Martins AS, Oliveira RR, AlcântaraNeves NM, Silva MP, et al. Differences in the detection of Cryptosporidium and Isospora (Cystoisospora) oocysts according to the fecal concentration or staining method used in a clinical laboratory. J Parasitol. 2013;99:1002-8. https://doi.org/10.1645/12-33.1
Henriksen SA, Pohlenz JF. Staining of cryptosporidia by a modified Ziehl-Neelsen technique. Acta Vet Scand. 1981;22:594-6. https://doi.org/10.1186/BF03548684
Semrad CE. Approach to the patient with diarrhea and malabsorption. Goldman’s Cecil Medicine. 2012;1:895-913. https://doi.org/10.1016/B978-1-4377-1604-7.00142-1
Andrade JAB, Fagundes-Neto U. Diarréia persistente: ainda um importante desafio para o pediatra. J Pediatr (Rio J), 2011;87:199-205. https://doi.org/10.2223/JPED.2087
Motta MEFA, Silva GAP. Diarréia por parasitas. Rev Bras Saúde Mater Infant. 2002;2:117-27. https://doi.org/10.1590/S1519-38292002000200004
Pedraza DF, Queiroz D, Sales MC. Doenças infecciosas em crianças pré-escolares brasileiras assistidas em creches. Ciên Saúde Colet. 2014;19:511-28. https://doi.org/10.1590/1413-81232014192.09592012
Reis LB, Santos RS, Mota LH, Jesus JS, Oliveira JM, Andrade RS, et al. Enteroparasites, demographic profile, socioeconomic status and education level in the rural population of the Recôncavo of Bahia, Brazil. J Trop Pathol. 2019;48:197-210.
Ferreira ALC, Carvalho FF, Nihei OK, Nascimento IA, Shimabuku Junior RS, Fernandes RD, et al. Prevalence of intestinal parasites in children from public preschool in the Triple Border Brazil, Argentina, and Paraguay. ABCS Health Sci. 2021;46:e021205.
Burnett E, Parashar UD, Tate JE. Global impact of rotavirus vaccination on diarrhea hospitalizations and deaths among children <5 years old: 2006-2019. J Infect Dis. 2020;222:1731-9. https://doi.org/10.1093/infdis/jiaa081
Cauás RC, Falbo AR, Correia JB, Oliveira KMM, Montenegro FMU. Diarréia por rotavírus em crianças desnutridas hospitalizadas no Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Rev Bras Saúde Mater Infant. 2006;6:77-83. https://doi.org/10.1590/S1519-38292006000500011
Silva ML, Souza JR, Melo MMM. Prevalência de rotavírus em crianças atendidas na rede pública de saúde do estado de Pernambuco. Rev Soc Bras Med Trop. 2010;43:548-51. https://doi.org/10.1590/S0037-86822010000500015
Muller ECA, Morais MAA, Gabbay Y, Linhares AC. Ocorrência de adenovírus em crianças com gastrenterite aguda grave na Cidade de Belém, Pará, Brasil. Rev Pan-Amaz Saúde. 2010;1:49-55. https://doi.org/10.5123/S2176-62232010000300007
Morillo SG, Timenetsky MCST. Norovírus: uma visão geral. Rev Assoc Med Bras. 2011;57:453-8. https://doi.org/10.1590/S0104-42302011000400023
Wale M, Gedefaw S. Prevalence of intestinal protozoa and soil transmitted helminths infections among schoolchildren in Jaragedo Town, South Gondar Zone of Ethiopia. J Trop Med. 2022;2022:ID 5747978. https://doi.org/10.1155/2022/5747978
Sebaa S, Behnke JM, Baroudi D, Hakem A, Abu-Madi MA. Prevalence and risk factors of intestinal protozoan infection among symptomatic and asymptomatic populations in rural and urban areas of southern Algeria. BMC Infect Dis. 2021;21:888. https://doi.org/10.1186/s12879-021-06615-5
Belloto MVT, Santos Junior JE, Macedo EA, Ponce A, Galisteu KJ, Castro E, et al. Enteroparasitoses numa população de escolares da rede pública de ensino do Município de Mirassol, São Paulo, Brasil. Rev Pan-Amaz Saúde. 2011;2:37-44. https://doi.org/10.5123/S2176-62232011000100004
Newman RD, Moore SR, Lima AAM, Nataro JP, Guerrant RL, Sears CL. A longitudinal study of Giardia lamblia infection in northeast Brazilian children. Trop Med Int Health. 2001;6:624-34. https://doi.org/10.1046/j.1365-3156.2001.00757.x
Wu Y, Yao L, Chen H, Zhang W, Jiang Y, Yang F, et al. Giardia duodenalis in patients with diarrhea and various animals in northeastern China: Prevalence and multilocus genetic characterization. Parasit Vectors. 2022;15:165. https://doi.org/10.1186/s13071-022-05269-9
Silva RKNR, Pacheco FTF, Martins AS, Menezes JF, Costa-Junior HR, Ribeiro TCR, et al. Performance of microscopy and ELISA for diagnosing Giardia duodenalis infection in different pediatric groups. Parasitol Int. 2016;65:635-40. https://doi.org/10.1016/j.parint.2016.08.012
Pacheco FTF, Silva RKNR, Carvalho SS, Rocha FC, Chagas GMT, Gomes DC, et al. Predominance of Giardia duodenalis. AII sub-assemblage in young children from Salvador, Bahia, Brazil. Biomédica. 2020;40:557-68. https://doi.org/10.7705/biomedica.5161
Ocaña-Losada C, Cuenca-Gómez JA, Cabezas-Fernández MT, Vázquez-Villegas J, Soriano-Pérez MJ, Cabeza-Barrera I, et al. Clinical and epidemiological characteristics of intestinal parasite infection by Blastocystis hominis, Rev Clin Española. 2018;218:115-20. https://doi.org/10.1016/j.rceng.2018.01.008
Dourado A, Maciel A, Aca IS. Ocorrência de Entamoeba histolytica/Entamoeba dispar em pacientes ambulatoriais de Recife, PE. Rev Soc Bras Med Trop. 2006;39:388-9. https://doi.org/10.1590/S0037-86822006000400015
Soares NM, Azevedo HC, Pacheco FTF, Souza JN, Del-Rey RP, Teixeira MCA, et al. A cross-sectional study of Entamoeba histolytica/dispar/moshkovskii complex in Salvador, Bahia, Brazil. Biomed Res Int. 2019;2019:7523670. https://doi.org/10.1155/2019/7523670
Santos FLN, Goncalves MS, Soares NM. Validation and utilization of PCR for differential diagnosis and prevalence determination of Entamoeba histolytica/ Entamoeba dispar in Salvador City, Brazil. Braz J Infect Dis. 2011;15:119-25. https://doi.org/10.1016/S1413-8670(11)70156-8
Franzolin MR, Alves RCB, Kellertânia R, Gomes TAT, Beutin L, Barreto ML, et al. Prevalência de Escherichia coli diarreica em crianças com diarréia em Salvador, Bahia, Brasil. Mem Inst Oswaldo Cruz. 2005;100:359-63. https://doi.org/10.1590/S0074-02762005000400004
Moura MR, Mello MJG, Calábria WB, Germano EM, Maggi RR, Correia JB. Frequência de Escherichia coli e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarréia aguda. Rev Bras Saúde Mater Infant. 2012;12:173-82. https://doi.org/10.1590/S1519-38292012000200008
Lopes AIG, Trindade E, Pereira F, Antunes H, Dias JÁ, Ferreira R, et al. Gastrenterologia Pediátrica: aspectos práticos. Editor: Pereira F, SPED. Serviço de Gastrenterologia Pediátrica. Hospital Maria Pia. Centro Hospitalar do Porto, 2010. Accessed: 15 January 2023. Available: https://www.sped.pt/images/Publicacoes_SPED/LivroGastroPediatrica_Jul10.pdf
Hendrawati LD, Firmansyah A, Darwis D. Macronutrient malabsorption in acute diarrhea: Prevalence and affecting factors. Paediatr Indones. 2005;45:207-10.
Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, Tilburg M. Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterol. 2006;130:1527-37. https://doi.org/10.1053/j.gastro.2005.08.063
van der Neucker A, Kerkvliet EM, Theunissen PMVM, Forget PPH. Acid steatocrit: A reliable screening tool for steatorrhea. Acta Paediatr. 2007;90:873-5. https://doi.org/10.1111/j.1651-2227.2001.tb02448.x
Mendes PS, Ribeiro Junior HC, Mendes CM. Tendência temporal da mortalidade geral e morbidade hospitalar por doença diarreica em crianças brasileiras menores de cinco anos no período de 2000 a 2010. J Pediatr (Rio J). 2013; 89:315-25. https://doi.org/10.1016/j.jped.2012.10.002
Some similar items:
- Dioselina Peláez, Johanna Alexandra Rodríguez, Elva Lucía Rocha, Gloria Janeth Rey, Standardization of a method for concentration and detection of enteric viruses from drinking water , Biomedica: Vol. 30 No. 2 (2010)
- María del Pilar Chaves, Julián Alfredo Fernández, Isabel Ospina, Myriam Consuelo López, Ligia Moncada, Patricia Reyes, Giardia duodenalis prevalence and associated risk factors in preschool and school-age children of rural Colombia , Biomedica: Vol. 27 No. 3 (2007)
- Ángela Liliana Londoño-Franco, Juliana Loaiza-Herrera, Fabiana María Lora-Suárez, Jorge Enrique Gómez-Marín, Blastocystis sp. frequency and sources among children from 0 to 5 years of age attending public day care centers in Calarcá, Colombia , Biomedica: Vol. 34 No. 2 (2014)
- Adriana Arévalo, Sofía Duque, Rubén Santiago Nicholls, Experimental infection of the gerbil (Meriones unguiculatus) by Colombian isolates of Giardia duodenalis. , Biomedica: Vol. 25 No. 3 (2005)
- Marlén Andrea Alarcón, Milena Beltrán, Martha Liliana Cárdenas, María Claudia Campos, Presence and viability of Giardia spp. and Cryptosporidium spp. in drinking water and wastewater in the high basin of Bogotá river. , Biomedica: Vol. 25 No. 3 (2005)
- Dabeiba Adriana García, Rubén Santiago Nicholls, Adriana Arévalo, Orlando Torres, Sofía Duque, Obtention, purification and characterization of IgY polyclonal antibodies, developed in hens, directed against Colombian isolates of Giardia duodenalis. , Biomedica: Vol. 25 No. 4 (2005)
- Dioselina Peláez, Blanca Lisseth Guzmán, Johanna Rodríguez, Felipe Acero, Gerardo Nava, Presence of enteric viruses in water samples for consumption in Colombia: Challenges for supply systems , Biomedica: Vol. 36 (2016): Suplemento 2, Enfermedades virales
- Mayra L. Lúa, Arturo Plascencia, Patricia Paredes, Yaxsier de Armas, Miguel Raygoza, Erika Martínez, Fernando Siller, Iván Isidro Hernández, Etiological identification of viral agents in acute encephalitis in Guadalajara, México, 2011-2015 , Biomedica: Vol. 38 No. 2 (2018)
- Zulbey Rivero, Lisbeth Villareal, Ángela Bracho, Carem Prieto, Rafael Villalobos, Molecular identification of Entamoeba histolytica, E. dispar, and E. moshkovskii in children with diarrhea from Maracaibo, Venezuela , Biomedica: Vol. 41 No. Supl. 1 (2021): Mayo, Parasitología médica
- Elizabeth Lara-Reyes, Israel A. Quijano-Hernández , Roger I. Rodríguez-Vivas, Javier Del Ángel-Caraza, José Simón Martínez-Castañeda, Factors associated with endoparasites and ectoparasites in domiciled dogs in the metropolitan area of Toluca, México , Biomedica: Vol. 41 No. 4 (2021)
Copyright (c) 2024 Biomedica
This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
