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Article
Etiology and Clinical Manifestations of Infectious Bloody Diarrhea in Children Welfare Teaching Hospital

Author: Mohammad Fadhil Ibraheem
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 1 Pages: 35-39
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Dysentery is an important cause of morbidity and mortality among children less than five years, it is caused by viral, bacterial, or protozoan infections or parasitic infestations. About 10% of all diarrheal episodes in children less than five years are dysenteric, but these causes about 15% of all deaths attributed to diarrhea are dysenteric.OBJECTIVE:To highlight the causes and clinical manifestations of bloody diarrhea in children younger than six years of age and to clarify the most important associated factors.METHODS: A prospective study was carried out on Children Welfare Teaching Hospital /Medical city/Baghdad, on 92 children who were admitted to the hospital with bloody diarrhea, their ages ranged between two months -6 years. The period of study is from (first of November 2013-30th of April 2014). A thorough history were carried out, general stool examination and stool culture were done by taking fresh stool samples collected from these children and underwent to serial investigations. Any patients who had received antibiotics during their illness were excluded from the study.RESULT: Ninety two patients their age ranged from second month of life till 6 years old that admitted to the children welfare teaching hospitals because of bloody diarrhea. The most common microorganism isolated was E .histolytica 59(64.13%) followed by Shigella spp.11 (11.96%).It was found that male 51(55.43%) and female 41(44.57%), most of them live in urban 39(42.40%) or suburban 31(33.69%) area, most of them consume tap water 47(51.08%),more than half of them with mixed feeding 42(56.75%), the most common age group affected was the first two years74(80.43%).Regarding the clinical presentation it was found that in amoebic dysentery the most common finding was tenesmus 52(88.13%),followed by fever 35(59.32%), vomiting 19(32.20%),then convulsion4(6.77%), while in Shigellosis the most common finding was fever 9(81.81%), followed by tenesmus 8(72.72%),vomiting7(63.63%), then convulsion 4(36.36%).CONCLUSION: E. histolytica was the most common microorganism isolated in patients with bloody diarrhea and the most common age group affected was the first two years of life.Mixed feeding in the first two years was associated with higher rate of infection Consuming of boiled water associated with least incidence of bloody diarrhea and the most common presentation were tenesmus, fever, vomiting, and convulsion.


Article
Infectious bloody diarrhea in children 2 month – 5years, Descriptive hospital Based Study

Authors: Mustafa Sh. Ahmed --- Afrah A. Al-Ma'eeni --- Dhia H. Al-Beldawi ضحى البلداوي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2011 Volume: 53 Issue: 2 Pages: 136-141
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Dysentery is an important cause of morbidity and mortality associated with diarrhea. About 10% of all diarrheal episodes in children less than 5 years are dysenteric, but these cause about 15% of all deaths attributed to diarrhea. Objective : To demonstrate the most common pathogens causing bloody diarrhea in children between 2 months and 5 years old, to describe some of the associated factors accompanying bloody diarrhea and to highlight the most important clinical features.Patients and methods: A descriptive study of 82 children, between the age of 2 months to 5 years with bloody diarrhea, who were admitted to the Children Welfare Teaching Hospital/ Medical City/ Baghdad during the period between 1st of March 2009 to 28th of February 2010. Information regarding demographic data was taken from their parents. All the patients were examined carefully mainly for the signs and degree of dehydration. General stool examination and stool culture done for patients with bloody diarrhea.Other 100 patients with acute watery diarrhea were also taken as a comparison group. Results: Entamoebahistolyticatrophozoite was the most common isolated pathogen in the study group specimens. It was identified in 38 (46.3%) of patients followed by Shigella species in 10 (12.2%) cases and the least was non typhoidal salmonella in 5 (6.1%) cases. The most vulnerable age was 2-24 months 51(62.2%) cases. Fifty eight and half percent of patients were from urban areas. Half of the patients (50%) were bottle fed. The majority had chlorinated tap water supply (82.9%). This study showed a higher frequency of the following symptoms: Fever (73.2%), Tenesmus (46.3%), Rectal prolapse (1.2%) and convulsion (4.9%) in patients with bloody diarrhea; while in patients with watery diarrhea, the frequencies of these symptoms were: (62%, 28%, 0% and 1% respectively), Severe dehydration was observed in only (15.9%) of cases and the majority of them were seen in patients with bacterial bloody diarrhea.Conclusions:Entamoebahistolyticawas the most frequent offending pathogen in patients with bloody diarrhea in this study. Infants 2-24 months old were the main affected group. Bottle feeding preference,and non-boiling of drinking water made children more prone to have bloody diarrhea. High fever and tenesmus were the most frequent clinical symptoms associated with bloody diarrhea. More frequent bowel motions, high fever, and convulsion were all more commonly seen with bacterial bloody diarrhea than in amebic bloody diarrhea.


Article
Histopathological Study of Escherichia coli O157:H7 Isolated from Children with Bloody Diarrhea in Mice

Authors: Laith M. Najeeb --- Amina N. Al-Thwaini --- Mohamed B. Al-Jobory
Journal: Al-Nahrain Journal of Science مجلة النهرين للعلوم ISSN: (print)26635453,(online)26635461 Year: 2018 Volume: 00 Issue: 1 Pages: 88-94
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Escherichia coli O157:H7 is well documented with Shiga toxin–producing serotypes of E. coli. Infection with this type of pathogenic bacteria may lead to hemorrhagic diarrhea and kidney failure. This study was carried out to detect the pathogenicity of E. coli O157:H7 isolated from patients with bloody diarrhea. A total of 200 bloody diarrhea samples were collected from children of both sexes, with age between 3 to10 years in the period from beginning of September to the end of December 2016 in Al-Eskan Pediatrics Hospital and Children Safe Hospital (Baghdad/Iraq). The samples were cultured aerobically on enrichment and selective media, then the isolates were identified by Vitek 2 and they were confirmed by latex agglutination test. Eight isolates were diagnosed and identified as Escherichia coli O157:H7. The pathogenicity of the stool recovered isolates were study to recognize the alterations in some organs of mice after experimentally infected with this pathogen. Twelve mice provided by animal house of AL-RAZI center in Baghdad, divided into two groups each group consist of 6 mice. The first group injected with 0.2 ml of de-ionized water and left as control group, whereas the second group infected orally with 0.2 ml of 1.8x106cfu/ml. The animals of two groups sacrificed 24-48 hours post infection. The histopathological examination of intestine for infected mice showed infilteration of inflammatory cells, focal lining epithelial stratification, with multiple layer basal lamina degeneration, then distention of villi appeared with increase inflammatory cells infiltration. The liver showed accumulation of lymphocyte, hemorrhage in central vein with sinuses expansion and, hepatocyte cells showed, degeneration, increase nuclear size and increase hyperchromasia with irregular chromatin distribution. The histopathological examinations of the control group were naïve.


Article
Molecular identification of some virulence related genes for E. coli O157:H7 isolated from bloody diarrhea and UTI in Baghdad city.
الكشف الجزيئي لبعض الجينات ذات الصلة بعوامل الضراوة للاشيريشيا القولونية O157:H7 المعزولة من الاسهال الدموي والتهاب المجاري البولية في مدينة بغداد

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Abstract

This study was carried out for detection of some virulence factors for E coli O157:H7 isolated from patients with bloody hemorrhagic diarrhea or urinary tract infection (UTI). A total of 200 bloody diarrhea and 150 urine samples were collected from children of both sexes between the age of 3 and 10 years, who were suffering from bloody diarrhea and urinary tract infection (UTI) in the period from September to December 2016 in, Central Children Hospital and Children Safe Hospital in Baghdad/Iraq. All samples were screened to detect the presence of non-sorbitol fermenting colonies on sorbitol MacConkey agar supplemented with Cefixime -Tellurite (CT-SMAC) also cultured on other enrichment and selective media(Hicrome and Eosin methylen blue) at 37°C for 24hrs. The isolates were identified by Vitek 2 system and they were confirmed by latex agglutination test. A total of 11 isolate, 8 (4%) from bloody diarrhea and 3 (2%) isolates from urine samples were diagnosed as E. coli O157:H7 that appeared on CT-SMAC as small, circular and colorless colonies with smoky center whereas on Hicrome media as dark purple to magenta colored moiety colonies, positive for Vitek2 and latex agglutination. Polymerase chain reaction (PCR) was employed to detect some virulence genes of isolates ,as hlyA (responsible for hemolysine) flicH7 (encoding fimbria) and rfbO157 (encoding- lipopolysaccharide) using specific primers of 534, 625 and 259 bp for previous genes respectively . The result of PCR amplification revealed presence of hly A , flic H7 and rfb O157 genes in all isolate.

هذه الدراسة نفذت للكشف عن بعض عوامل الضراوة لبكتريا E coli O157:H7 المعزولة من المرضى بالاسهال الدموي والتهاب المجاري البولية . جمعت 200 حالة اسهال دموي و150 عينة ادرار من الاطفال من كلا الجنسين بين عمر 3 الى10 سنوات والذين يعانون من الاسهال الدموي والتهاب المجاري البولية في الفترة من شهر ايلول الى شهر كانون الاول 2016 في مستشفى الطفل المركزي ومستشفى حماية الطفل في بغداد/ العراق. جميع العينات فحصت للكشف عن وجود المستعمرات الغير مخمره للسوربيتول على وسط سوربيتول ماكونكي الاكار المدعم بالسفكسيم وكذلك زرعت على اوساط اخرى غنيه وانتخابيه (هايكروم , وايوسين مثيلين الازرق) على درجة حرارة 37 درجه مئويه ولمدة 24 ساعه .العزلات تم الكشف عنها عن طريق جهاز الفايتك وتم تاكيدها باستخدام فحص التلازن . من مجموع 11 عزلة , 8 (4%) من المرضى المصابين بالاسهال الدموي و 3 (2%) عزلت من الادرار شخصت كبكتريا E coli O157:H7 والتي ظهرت على وسط سوربيتول ماكونكي اكار صغيره , دائرية , عديمة اللون مع مركز داخن وعلى وسط الهايكروم ظهرت المستعمرات بلون ارجواني مظلم الى محمر , موجبة لفحص الفايتك وفحص التلازن . تفاعل البلمرة المتسلسل استخدم لكشف بعض جينات الضراوة للعزلات مثل hly A (المسؤول عن تحلل كريات الدم الحمراء) , ) flicH7المسؤول عن الالتصاق ) و rfbo157 (المسؤول عن عامل الضراوه ( lipopolysaccharide من خلال استخدام بادئات خاصه 534, 625و259 لكل قاعده للجينات السابقه على التوالي . نتيجة تضاعف تفاعل البلمره المتسلسل اظهرت وجود الجينات hly A, flicH7, rfb O157 في جميع العزلات .

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