• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.4
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• pp.346-356
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• 2021

Purpose: Campylobacter species are currently the most common cause of bacterial gastroenteritis. In Lebanon, Campylobacter infection occurrence is underdiagnosed owing to the lack of specific culture and rapid test kits, particularly among children. This study aimed to evaluate the prevalence, laboratory findings, and clinical characteristics of Campylobacter infection in hospitalized children with acute gastroenteritis in South Lebanon. Methods: We conducted a 6-month retrospective cohort study between January and June 2018, including 291 children aged between 1 month and 12 years, who were admitted to a tertiary healthcare center in South Lebanon. The medical files of the patients were reviewed to retrieve the required clinical information, including clinical and laboratory data. Results: The prevalence of campylobacteriosis agents in pediatric patients with acute gastroenteritis is 12.02%. Patients infected with Campylobacter had more severe acute gastroenteritis than Campylobacter-negative patients and often presented with high-grade fever, diarrhea episodes more than six times per day, diarrhea lasting for more than five days, and dehydration. Indeed, children with high-grade fever (≥38.5℃) were five times more likely to test positive for Campylobacter than those with low-grade fever. In addition, the results showed a higher Vesikari score for the majority of Campylobacter-positive patients with severe acute gastroenteritis compared to a moderate profile for Campylobacter-negative patients. Conclusion: The present study findings highlight that Campylobacter infection is frequent among children with acute gastroenteritis. Therefore, the detection of Campylobacter should be carried out for the diagnosis of human gastroenteritis in Lebanon, along with the detection of routine enteropathogens.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.453-457
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• 2009

Purpose : Our aim was to describe the clinical features of noroviral gastroenteritis in children. Methods : This study included 22 children with noroviral gastroenteritis, as confirmed by stool RT-PCR, who were admitted to Bundang CHA Hospital between July 2006 and June 2008. Their medical records were reviewed and compared with those of 45 children with rotaviral gastroenteritis. Results : In the norovirus group, 19 (86.4%) children showed vomiting and 21 (95.5%) children showed diarrhea, while all children in the rotaviral group showed both vomiting and diarrhea. The duration of vomiting was not different in the two groups, but mean episodes of vomiting/24 h were higher in the norovirus group than in the rotavirus group. The duration of diarrhea was longer and mean episodes of diarrhea/24 h were higher in the rotavirus group. The Vesikari Scale was not different in the two groups. Frequency and duration of fever did not show a significant difference. Most children in both groups were below 2 years of age. Conclusion : Clinical features of noroviral gastroenteritis were largely similar to those of rotaviral gastroenteritis, but vomiting was more severe in noroviral infection, and diarrhea was more severe and prolonged in rotaviral infection. With regard to noroviral infection, further epidemiologic investigations and preventive efforts are essential.

• Clinical and Experimental Pediatrics
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• v.55 no.3
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• pp.77-82
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• 2012

Human astrovirus (HAstV) is a major cause of acute diarrhea among children, resulting in outbreaks of diarrhea and occasionally hospitalization. Improved surveillance and application of sensitive molecular diagnostics have further defined the impact of HAstV infections in children. These studies have shown that HAstV infections are clinically milder (diarrhea, vomiting, fever) than infections with other enteric agents. Among the 8 serotypes of HAstV identified, serotype 1 is the predominant strain worldwide. In addition to serotype 1, the detection rate of HAstV types 2 to 8 has increased by using newly developed assays. HAstV is less common compared with other major gastroenteritis viruses, including norovirus and rotavirus; however, it is a potentially important viral etiological agent with a significant role in acute gastroenteritis. A better understanding of the molecular epidemiology and characteristics of HAstV strains may be valuable to develop specific prevention strategies.

• Microbiology and Biotechnology Letters
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• v.47 no.2
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• pp.317-322
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• 2019

Gastroenteritis with diarrhea is one of the most infectious diseases in the world following respiratory infections. Notably, diarrhea-causing viruses (DVs) cause more than 70% of such cases. In this study, 3,065 stool specimens from patients with diarrhea (median age, 1.1 years; range, 0.0-91.1 years), who were admitted to the DanKook University Hospital, were examined using multiplex reverse transcription PCR (mRT-PCR). The target viruses were astrovirus (AstV), enteric adenovirus (EAdV), group A rotavirus (RotV), norovirus GI (NoV-GI), and norovirus GII (NoV-GII). The mRT-PCR results were analyzed based on various factors such as seasonality, age, presence of co-infection, and analyzed trends. The detection rate of the DVs during the study period was found to be 30.8% (n = 943/3,065). When the detection rate was analyzed monthly, the DV detection rate was found to be highest between December to January. Of the detected DVs, NoV-GII was the most common, accounting for 45.5% of the detected viruses (n = 446/980). Notably, 86.5% (n = 848/980) of the pathogens were detected in individuals who were less than 5 years of age. During the study period, NoV-GII and RotV showed alternating trends. In addition, both the number and rate of co-infections increased.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.2
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• pp.130-133
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• 2017

Noroviruses have been recognized as the leading cause of epidemic and sporadic gastroenteritis since the advent of molecular diagnostic technique. They have been documented in 5-31% of pediatric patients hospitalized with gastroenteritis. Although norovirus gastroenteritis is typically mild and self-limited, it causes severe, but sometimes fatal, conditions in the vulnerable population such as immunocompromised patients, young children, and the elderly. Bowel perforation due to norovirus infection is rare. We report a case of small bowel perforation with norovirus gastroenteritis in the infant with Down syndrome during the hospitalization with pneumonia. Severe dehydration may cause bowel ischemia and could have triggered bowel perforation in this case. Physicians should be alert to the potential surgical complications followed by severe acute diarrhea, especially in high risk groups.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.5
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• pp.464-471
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• 2020

Purpose: Some probiotic strains reduce the duration of acute diarrhea. Because of strain and product specificity, each product needs to be supported by clinical data. This study aimed to test the efficacy of the synbiotic food supplement Probiotical (Streptococcus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis, Bifidobacterium infantis, fructo-oligosaccharides) in children with acute gastroenteritis of likely infectious origin. The primary endpoint was the number of children with normal stool consistency during the treatment duration. Methods: A total of 46 children (aged 3.6 months to 12 years) with acute gastroenteritis that started less than 48 hours prior to their visit at a hospital-based emergency department were included in this prospective, randomized, placebo-controlled trial. All children were treated with oral rehydration solution and placebo (n=20) or the test product (n=26). Results: Significantly more children had a normal stool consistency on days 1 and 2 in the probiotic group: 5 children (20%) on day 1 in the probiotic group compared with none in the placebo group (p=0.046). On day 2, 11 children in the probiotic group (46%) and 3 (16%) in the placebo group (p=0.024) had a normal stool consistency. The mean duration of diarrhea was shorter in the probiotic group compared with that in the placebo group (3.04±1.36 vs. 4.20±1.34 days) (p=0.018). Conclusion: The test product was shown to normalize stool consistency significantly more rapidly than the placebo. These data confirm the findings from a previous study in a larger group of children performed in a primary healthcare setting.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.2
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• pp.239-242
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• 2004

Eosinophilic gastroenteritis is a rare condition of unknown etiology characterized by peripheral eosinophilia, eosinophilic infiltration of the gastrointestinal tract, and gastrointestinal symptoms. Eosinophilic gastroenteritis is generally classified according to the Klain classification: predominant mucosal, muscular, and subserosal disease. Mucosal involvement may result in abdominal pain, nausea, vomiting, diarrhea, weight loss, anemia, protein-losing enteropathy, and intestinal perforation. Patients with muscular layer disease generally have obstructive symptoms. Subserosal eosinophilic infiltration may result in development of eosinophilic ascites. Most commonly, the stomach, duodenum, and small bowel are involved. A 13-year-old girl came to our hospital presenting with chronic, intermittent abdominal pain. She showed peripheral eosinophilia and biopsy specimen of the duodenum revealed eosinophilic infiltration of the mucosal layer. We here report a case of eosinophilic gastroenteritis.

• Pediatric Infection and Vaccine
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• v.16 no.1
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• pp.61-72
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• 2009

Purpose : We evaluated the clinical features of Norovirus gastroenteritis compared with Rotavirus gastroenteritis in hospitalized children. Methods : We detected causative agents in 3,261 samples of children hospitalized with gastroenteritis symptoms at a single center of pediatrics between 2005 and 2006. Among 266 and 303 samples which tested positive for Norovirus and Rotavirus, we selected 73 and 182 samples of children with relatively pure gastroenteritis symptoms and retrospectively analyzed the corresponding medical records. Results : The male-to-female ratio of the Norovirus (+) and Rotavirus (+) groupswas 1.43:1 and 1.56:1 both groups were predominantly in males. The mean age of the Norovirus (+) and Rotavirus (+) groups was 36.7 and 24.4 months, respectively the children in the former group were older than the children in the latter group. The incidence in the Norovirus (+) group was more concentrated in the winter. The symptoms in the Norovirus (+), in decreasing order, included vomiting, diarrhea, and fever. The duration of vomiting, diarrhea, and fever was 2.1, 1.2, and 1.2 days. The maximum number of episodes of vomiting and diarrhea per day was 3.5 and 4.5, respectively. The severity score was 10.16. The symptoms inthe Rotavirus (+) group, in decreasing order, included diarrhea, vomiting, and fever. The duration of diarrhea, vomiting, and fever was 2.2, 4.3, and 2.2 days, respectively. The maximum number of episodes of vomiting and diarrhea per day was 3.3 and 6.5, respectively. The severity score was 11.9. The severity in the Norovirus (+) group was somewhat lower than the Rotavirus (+) group. The younger the child, the more severe the symptoms in the Norovirus (+) group. There was no difference between mono-and co-infection in severity and between the two groups regarding the hematologic findings. Conclusion : Based on the findings reported herein, additional studies about prophylaxis, as well as the epidemiology and clinical features of pediatric Norovirus gastroenteritis, are required.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.sup1
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• pp.53-61
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• 2009

The mainstay in the management of mild to moderately dehydrated children is fast rehydration by using hypotonic ORS (oral rehydration solution) and complete resumption of normal diet, including lactose-containing formula after 4 hours rehydration. Since the majority of young children with uncomplicated acute diarrhea will tolerate large amounts of undiluted non-human milk, withholding food and milk from children during diarrhea is not recommended anymore, regarding time to resolution and diarrhea control. In addition, routine dilution of milk and routine use of lactose-free formula are not necessary after fast ORS therapy. Breastfed infants and children fed with solid foods may safely continue receiving their usual diets during diarrhea instead of gradual reintroduction of feeding. However, young infants or children with severe diarrhea or malnutrition should be carefully treated under supervision if fed with lactose containing, non-human milk exclusively.

• Kosin Medical Journal
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• v.33 no.2
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• pp.150-158
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• 2018

Objectives: Although Campylobacter is the main cause for bacterial acute gastroenteritis (AGE), there has been no notable clinical research into it, especially for Korean children. In this study, we share our experience of clinical, laboratory and image findings with Campylobacter AGE. Methods: Between May 2013 and June 2016, children diagnosed as having Campylobacter AGE were retrospectively enrolled in our study. Campylobacter AGE was considered diagnosed when a patient had symptoms of bacterial AGE and a positive Campylobacter result in stool using multiplex PCR. Results: Among 539 patients with suspected bacterial AGE, 31 (5.8%) patients had a positive result for Campylobacter. The average age of the 31 patients was $10.2{\pm}5.0$ years with a range between 1.1 and 16.9 years. Eighteen (58%) of the total patients were hospitalized between June and August. Diarrhea (93.5%), abdominal pain (83%) and fever (83%) were common symptoms. For 20 patients (65%), diarrhea lasted for less than three days, and fever lasted for 2.1 days on average. Among the 20 patients subjected to imaging studies, 12 patients (60%) showed bowel wall thickening on the right side of colon. In blood tests of 30 patients, 22 (73%) and 29 (97%) patients exhibited leukocytosis and elevated C-reactive protein, respectively. During treatment for Campylobacter AGE, prediagnostic empirical antibiotics were used for 6 (19%) patients. All patients recovered without complications. Conclusions: Among the children with suspected bacterial AGE, 5.8% had a positive result on Campylobacter in stool using multiplex PCR. Therefore, we observe that Campylobacter AGE should be considered in school-age children who have diarrhea, fever, and abdominal pain.