Cases reported "Diarrhea, Infantile"

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1/14. flavobacterium meningosepticum sepsis in an infant with a diarrheal prodrome.

    A full term, previously normal 2 1/2-month-old black boy was transferred to our hospital from an outlying facility on hospital day 5 for failure to thrive. Three weeks before transfer, the infant was hospitalized for a diarrheal illness with fever. The baby received 3 days of ceftriaxone empirically and was discharged home after the sepsis evaluation was negative. Mild diarrhea and steady weight loss continued and the baby was readmitted. blood culture done on admission grew flavobacterium meningosepticum, an organism previously described as an uncommon cause of sepsis in neonates and immunocompromised individuals. As it is water-borne, it has been associated with infection via contaminated water. This organism is usually resistant to antibiotics commonly used for empiric treatment. To our knowledge, this is the first reported case of flavobacterium bacteremia associated with a prodromal and concurrent diarrheal illness.
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2/14. Congenital intractable diarrhea with possible defective crypt regeneration: report of a case.

    A male infant, born uneventfully from a consanguinous marriage, presented with intractable watery diarrhea from his third day of life, with subsequent malnutrition and failure to thrive. He received central parenteral nutrition beginning at three months of age after a poor response to a semielemental diet and peripheral parenteral nutrition. He was totally dependent on central parenteral nutrition thereafter. Although diarrhea disappeared with strict bowel rest, intolerance to minimal enteral feedings persisted throughout his 2 years 4 months of life. Investigations including stool examinations and repeated cultures, immune function studies, radiologic studies of the small bowel and screening for galactosemia and cystic fibrosis could not demonstrate a specific cause for the diarrhea. Repeated small intestinal biopsies at 1 month, 4 months and 1 year 5 months of age showed persistent villous atrophy with crypt hypoplasia and a low crypt mitotic index. Electron microscopic examination revealed normal-appearing microvilli. This child may have had a congenital enteropathy due to an inborn crypt regeneration defect causing lifelong intolerance to enteral feedings.
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3/14. Rare serotype non-typhoidal salmonella sepsis.

    An 11-month female with a poor socio-economic status presented to a tertiary care paediatric hospital with complaints of fever of 4-5 days and diarrhoea of 20 days duration. The patient didn't respond to the prescribed antimicrobials namely--norfloxacin and metronidazole. On admission she was diagnosed as persistent diarrhea with PEM grade III with sepsis. Stool examination and culture were negative for any pathogens, however blood culture yielded growth of salmonella Virchow which was susceptible to most common antimicrobial agents excepting trimethoprim sulfamethoxazole. salmonella Virchow is a common non-typhoidal Salmonellae causing bacteremia in the west, however this is the first report of bacteremia by S. virchow from india.
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4/14. transcultural nursing: providing culturally congruent care to the Hausa of Northwest africa.

    research around the world is now beginning to validate the theory of Cultural Care as an important means to provide culturally congruent care to clients, families, and groups of diverse cultures. knowledge of Leininger's Theory of Cultural Care Diversity and Universality can provide meaningful care to clients who have different traditional and current beliefs and values. The Leininger Sunrise Model can serve as a valuable guide to discover care meanings and practices related to the theory, and to provide practical and meaningful culture specific care decisions and actions by nurses. The three major modes of action, namely, cultural care maintenance or preservation, accommodation or negotiation, and repatterning or restructuring, are important differential means to provide culturally congruent care to clients within their own cultural setting. This article considers the application of such care for the Hausa of Northwest africa.(ABSTRACT TRUNCATED AT 250 WORDS)
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5/14. Travellers' diarrhoea among children returning to the United Kingdom from visits abroad.

    Between January 1984 and March 1986, 10 children aged between 7 and 56 months were admitted to Queen Elizabeth Hospital for Children in london with chronic travellers' diarrhoea, after visiting the Indian subcontinent, france or morocco. All the children were born in the United Kingdom and had been in good health before their journey abroad. On return to england most of these children were malnourished and two of them (twins) had a post-infective, tropical malabsorption-like syndrome. There was a high incidence of positive stool cultures and, on small intestinal biopsy, histological abnormalities were present in six. Children from the United Kingdom travelling abroad are at risk of developing severe travellers' diarrhoea, with serious consequences to their health and nutrition. There is a need for intensive parental education before travelling and this could be achieved through community health workers.
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6/14. Chronic diarrhea and failure to thrive in an infant with campylobacter jejuni.

    We report the case of an infant with chronic diarrhea and failure to thrive. campylobacter jejuni was isolated from stools and treatment with erythromycin resulted in eradication of infection and prompt resolution of symptoms. A 22-month-old girl was referred to our University Hospital because of weight loss and chronic diarrhea, which did not respond to repeated dietetic trials that excluded milk, gluten, and other foodstuffs. Microscopic examination of the jejunal biopsy specimen revealed a mild degree of partial mucosal atrophy with inflammatory infiltrates in the lamina propria without any hallmarks of celiac disease. Repeated stool cultures on Butzler medium were positive for C. jejuni. This finding was associated with a high titer of specific serum antibodies. erythromycin therapy without any other form of therapy led to prompt improvement, and the patient reached her "own" 50th centile as weight/height ratio. The aim of this report is to alert pediatric gastroenterologists of the possibility that Campylobacter may be associated with chronic diarrhea and failure to thrive.
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7/14. salmonella gastroenteritis in the first three months of life. A review of management and complications.

    Salmonellosis in older children and adults is usually a self-limited disease, but the risk of complications in infants is not well-defined. We performed a retrospective review of 52 patients. 90 days of age or less, seen at the St. Louis Children's Hospital between 1975 and 1981 with stool cultures positive for salmonella. Sixteen were 30 days old or less (neonates), 21 were 31- 60 days of age, and 15 were 61-90 days old. Among patients in whom blood cultures were done initially, bacteremia was most frequent in neonates: 5/11 (45%), compared to 2/18 (11%) in older infants. All seven infants presenting with bacteremia received 10 or more days of antibiotic therapy: yet complications (osteomyelitis, fatal meningitis or chronic diarrhea) developed in three of five neonates and one of two older infants. Complications also developed in seven of 22 patients who initially had negative blood cultures, including two infants in whom sepsis later developed and two infants who required intravenous hyperalimentation because of chronic diarrhea and malnutrition. The group of 23 patients who did not have blood cultures all did well. Salmonellosis is not necessarily a self-limited infection in young infants. Even in the absence of bacteremia, clinicans would appear to be justified in using antimicrobial therapy in infants 3 months of age or les with salmonella gastroenteritis, particularly neonates of older infants with symptoms of dysentery or failure to thrive.
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8/14. diarrhea due to campylobacter fetus subspecies jejuni. A clinical review of 63 cases.

    campylobacter fetus subspecies jejuni was isolated fom the feces of 63 (3.2%) of the 1,953 patients who had stools cultured at the Mayo Clinic in 1979. In contrast, salmonella and shigella combined were isolated from 31 (1.6%) patients. Two patients had double infections with salmonella species and C. fetus subsp jejuni. Three patients had no diarrhea at the time of stool culture. One patient, who had chronic lymphocytic leukemia, had both blood and stool cultures positive for C. fetus subsp jejuni. There was a seasonal incidence that peaked in July when 7.8% of all patients who had stools cultured had C. fetus subsp jejuni isolated. Thirteen cases occurred in children 5 years of age and younger and 29 cases occurred between the ages of 15 and 30 years. Clinical features often included a prodrome of malaise, which preceded the onset of abdominal cramps, diarrhea, anorexia, fever, nausea, and vomiting. Grossly bloody diarrhea occurred in 33 patients, and massive intestinal bleeding occurred in 1 patient as a late complication after diarrhea had resolved. Transient splenomegaly was attributed to C. fetus subsp jejuni on one occasion. Proctoscopic findings may be similar to those seen in inflammatory bowel disease or pseudomembranous colitis. Three patients were referred to this institution with newly diagnosed chronic ulcerative colitis, and one patient was referred with newly diagnosed Crohn's disease. C. fetus subsp jejuni was isolated from their stools, and the diagnosis of inflammatory bowel disease was subsequently dropped. A selected review of cases illustrates the variety of gastrointestinal manifestations seen with this organism.
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9/14. Isolation of toxin producing clostridium difficile from two children with oxacillin- and dicloxacillin-associated diarrhea.

    clostridium difficile was isolated from the feces of two infants who had developed watery diarrhea with blood-tinged stain. One child suffered from diarrhea after five days of parenteral oxacillin therapy; the diarrhea subsided within three days of cessation of therapy. The other infant developed diarrhea following four days of oral dicloxacillin; the diarrhea subsided within two days of cessation of therapy. C difficile was no longer detectable in the stools of the infants at that time. Tissue culture assay showed the presence of preformed fecal toxin and demonstrated the toxigenicity of the fecal isolates of C. difficile and reference strains. These findings show that C difficile may play a role in diarrhea associated with oxacillin and dicloxacillin in children.
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10/14. zinc deficiency in two infants during total parenteral alimentation for diarrhea.

    zinc deficiency was observed in two infants receiving total parenteral alimentation for chronic diarrhea. An acrodermatitis enteropathica-like rash occurred in both of the infants. staphylococcus aureus was cultured from the rash. Treatment with zinc resulted in rapid cure of the rash and a subsidence of other signs consistent with zinc deficiency.
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