NNIW02 - Acute Diarrhea : Its Nutritional Consequences in Children

Editor(s): J.A. Bellanti. vol. 02


Bovine Milk Immunoglobulins

Author(s): H. Hilpert, J.A. Bellanti, R.K. Chandra

Bovine Milk Immunoglobulins

Author(s): H. Hilpert, H. Link-Amster

Influence on the Growth Parameters of Children

Author(s): W.J. Klish

Influence on the Growth Parameters of Children

Author(s): L. Mata

Etiologic Agents of Acute Diarrhea: Bacterial and Parasitic

Author(s): G. Ruiz-Palacios

Epidemiology of Acute Diarrhea in Childhood

Author(s): R.E. Black, K.H. Brown, S. Becker

Epidemiology of Acute Diarrhea in Childhood

Author(s): R.E. Black, K.H. Brown, S. Becker

Epidemiology of Acute Diarrhea in Childhood

Author(s): L. Mata

Dr. Suskind: In the last community you referred to, what were the specific measuresyou took to achieve such a dramatic change?Dr. Mata: This is a long-term study of a large, typical rural population with a veryactive rural health program and a good water supply. In addition, we have initiated anintervention program in the hospital where most of the women deliver their babies.The custom in that hospital was to separate the infant from the mother. We did changethat. We put the mother and infant together. We tried to promote breast-feeding byplacing a psychologist in the hospital to work with the mothers and teach them howto breast-feed. We have been very successful with this program of inducing breastfeedingto the extent that more than 85% of the infants are breast-fed exclusively forat least 2 months. Further, a rural health program of immunization assures that everychild is vaccinated. After 4 years of field work, 1,700 infants have been vaccinatedagainst the usual diseases of childhood—measles, whooping cough, and so forth, andwe have not had any deaths due to diarrhea either in 3 years.

In Vitro Cultivation of Human Rotavirus in Ma 104 Cells

Author(s): T. Konno, T. Kutsuzawa, H. Suzuki

Recently, viruses or virus-like particles have been detected by electron microscopicexamination in stools from patients with acute diarrhea; they areconsidered the causative agents of acute diarrhea (3). Among them, the humanrotavirus has been recognized as a most important pathogen of acute diarrheain infants and young children in many parts of the world. However, theseviruses associated with acute diarrhea have been identified mainly on the basisof their morphological and immunological features. Although a great deal ofeffort has been directed to adaptation of these viruses to continued propagationin cell cultures, only several animal viruses, including rotavirus strains, havebeen adapted to grow efficiently to high titer in cell culture (13). The difficultiesin propagating human enteric viruses, particularly rotavirus in conventionalcell culture systems, have hampered rapid progress in virological, serological,and epidemiological studies on viral diarrheal diseases.

Adenoviruses as Etiologic Agents of Acute Gastroenteritis

Author(s): R.H. Yolken

The recent elucidation of etiologic agents of infantile diarrhea has markedlyimproved our understanding of the pathophysiology and epidemiology of acutenonbacterial gastroenteritis. In addition, the study of these agents has led tothe formulation of potential strategies for the prevention and treatment ofthese infections. The agent of nonbacterial gastroenteritis in children whichhas received the most attention is human rotavirus. This agent is responsiblefor a large percentage of the serious cases of diarrhea which occur in childrenliving in both developed and developing countries (3,8). However, in spite ofthe importance of this agent, it is clear that there are numerous episodes ofserious diarrheal disease which cannot be explained by infection with rotavirusor with known bacterial agents.

Selected Aspects of Pathogenesis of Human and Murine Rotavirus Infections

Author(s): M. Riepenhoff-Talty, H. Suzuki, P.L. Ogra

Following the important discovery by Bishop and her colleagues in 1973(1) that reovirus-like particles in duodenal biopsies of children with diarrheahad an etiologic relationship to their enteritis, the study of rotaviruses andthe disease they produce has been intense. While the inability to cultivatehuman rotavirus in vitro retarded some studies, the availability of animalmodels in which species-specific rotaviruses produced nearly an identical diseasewere an obvious advantage (2,3,4,9). One prominent similarity betweenrotavirus-induced enteritis in humans and other mammals was the age restrictionof serious disease to the young. In human infants the peak age appearsto be 8 to 16 months; in mice it is 5 to 10 days. This age restriction is not wellunderstood.

Etiologic Agents of Acute Diarrhea: Viral

Author(s): A. Kapikian, R. Yolken

Dr. Kapikian: Recently, Dr. Masutto has been able to grow twenty out of twentyfourfield isolates in cell cultures directly, and he has been able to show that thesepossibly fall into three sera types. This finding appears to show that there are perhapsa finite number of rotavirus sera types as in the rhinovirus field where there are overa hundred at present. Thus, the hopes of developing a vaccine are more plausible nowbecause there are not literally hundreds of sera types.

Bacterial and Parasitic Agents of Acute Diarrhea

Author(s): R.B. Sack

The number of enteric bacteria recognized as causing acute diarrheal diseasehas increased rapidly during the past 10 years. Not only have new organismsbeen described, but new mechanisms of pathogenesis, including enterotoxinmediatedsecretion, have been elucidated. Whereas previously very few(~20%) cases of acute diarrhea could be diagnosed etiologically, now thatfigure is closer to 80%, a large share being viral agents which have been discussedpreviously (33).

Etiologic Agents of Acute Diarrhea: Bacterial and Parasitic

Author(s): G. Ruiz-Palacios

Dr. Levine: Dr. Sack mentioned data in animals showing that strains that have losttheir toxins but still contain adhesion colonization factor can cause diarrheal diseasein neonatal animals. Also he raised the question as to whether that phenomenon isrelevant or occurs in man. I would like to mention some instances where we think wehave seen it occurring.

Influence on the Growth Parameters of Children

Author(s): R.E. Black, K.H. Brown, S. Becker

Dr. Klish: I was fascinated to find out, from Dr. Black's data, that E. coli wasresponsible for causing growth failure, in contrast with rotavirus. I would have expectedthe opposite, since rotavirus seems to produce a disease that causes relatively severemalabsorption of at least the carbohydrates, and E. coli tends to produce a diseasemore attuned to cholera, causing massive malabsorption of fluid and electrolytes butnot so much of other nutrients.

Metabolic Consequences

Author(s): W.J. Klish

Dr. Suskind: If we look at the changes that occur in the host as a result of infection,we see two factors that are playing a role in their nutritional depletion.One is the effect of the infectious process and the other is the effect of gastroenteritisin terms of malabsorption of nutrients. The combination of the two leads to the clinicaland metabolic changes that have been discussed previously.

Bovine Milk Immunoglobulins

Author(s): C. Mietens, H. Hilpert, H. Werchau

Dr. Bellanti: I would like to ask Dr. Hilpert whether in the preparation of his material,the bacterial extracts were injected intramuscularly or were they given locally into thecow's udder?Dr. Hilpert: It was a combined immunization, locally into the udder and intramuscularly.

Malnutrition and Immunological Response

Author(s): R.K. Chandra

The association between famine and pestilence has been recorded in ancienthistory. Puranic literature and biblical references cite observations that suggestan increase in the prevalence and severity of infection among starved individualsand populations. Besides these historic observations, several types ofevidence may be marshalled to support causal links between malnutrition,impaired immunity, and infectious illness.

Malnutrition and Immunological Response Immunological Deficiencies Related to Diarrheal Diseases

Author(s): F.T. Koster

This chapter examines how immune defects may participate in the nutritioninfectioninteraction in terms of enteric disease susceptibility. The relationshipbetween diarrhea, malnutrition, and immunological defenses is a complexscheme of interactions.

Malnutrition and Immunological Response Diarrhea and Immunity

Author(s): R.C. Hurtado

An excellent review has been presented describing how immune defensemechanisms may participate in nutrition-infection interaction, with specialemphasis on the diarrheic syndrome (F. Koster, this volume).

Malnutrition and Immunological Response Discussion

Author(s): R. Edelman, R.K. Chandra, J.A. Bellanti

Dr. Edelman: I should like to ask Dr. Chandra whether there is a relationship betweenantibody affinity and malnutrition. I do not remember him discussing whether thereare any changes in the type of antibody that is produced in malnourished individuals.

Role of Breast-Feeding in the Nutritional Status of Infants Role of Breast-Feeding for the Nutrition and Immunologic Development of the Infant

Author(s): R. Lodinova-Zadnikova, H. Tlaskalova-Hogenova

For about 200 million years, mammals have been feeding their babies withtheir own milk. Humans have been the only species to interrupt the practiceby making milk products for artificial feeding. Formulas based on cow's milkbecame available in many countries, without knowing enough about the consequencesof their use.

Role of Breast-Feeding in the Nutritional Status of Infants Comments

Author(s): B.J. Schmidt

This chapter reports chiefly on our epidemiological studies that have beenconducted over the last 14 years in the lowest socioeconomic classes of ourLatin American communities.

Role of Breast-Feeding in the Nutritional Status of Infants Discussion

Author(s): F.T. Koster, L.Hanson, L. Mata, M.M. Levine

Dr. Pierce: I think there is now a rather large body of evidence, from a variety ofanimal species and also from humans, to indicate that parental immunization, evenin the instance of prior enteric priming is clearly a two-edged sword.

Nutritional Benefits Related to Oral Therapy an Overview

Author(s): D.R. Nalin

The subject of oral therapy's nutritional effects is still somewhat controversialdue to apparent inconsistencies between findings of different investigatorsand even of the same investigators in different studies. Moreover, thecomplex and costly nature of longitudinal studies of nutritional impact haspermitted completion of relatively few such studies to date.

Nutritional Benefits Related to Oral Therapy Comments

Author(s): M. Santosham

As discussed by Dr. Nalin (this volume) many questions remain unansweredin the area of nutrition related to oral therapy. The magnitude of the problemrelated to diarrheal disease mortality and morbidity has been pointed out bya number of authors in this volume. An example of the diarrheal diseasemorbidity is shown in Table 1.

Nutritional Benefits Related to Oral Therapy Discussion

Author(s): L. Mata, M. Santosham, M.M. Black, W.J. Klish

Dr. Klish: It's always been my bias, as well as other people's, that the oral rehydrationsolutions that are on the market now need not be as nutritionally deficient as they are.The presence of glucose in these solutions is largely based on studies done in the late1960s that showed that glucose enhances the absorption of sodium through the couplingeffect in the gut mucosa. More recently, it has also been shown that the same couplingexists with amino acids.

Prevention of Acute Diarrhea in Children an Overview

Author(s): R. Edelman

The World Health Organization published data in 1977 (41) showing thatdiarrhea still ranks among the leading causes of death and illness in developingcountries; mortality rates in some regions continue to be as high as those ofthe industrial nations 80 years ago, when 4,000 per 100,000 infants died withdiarrhea.

Prevention of Acute Diarrhea in Children Comments

Author(s): J.O. Mora

The prevention of acute diarrhea, particularly in childhood, is a world challenge(14). As happens with most socially induced health problems resultingfrom inequity and poverty, its root causes are difficult to overcome, and itsprevention is not a straightforward and easy task.

Prevention of Acute Diarrhea in Children Discussion

Author(s): Dr. Robins

Dr. Robbins: I would like to make some unrelated comments about the problem ofvaccines designed to prevent diarrheal disease. The first comment comes from ourexperience with the use of pneumococcal vaccine to treat pneumonia. We are enteringan age where the diseases that we are going to prevent are caused by a variety of agents.We no longer have vaccines with high degrees of specificity, such as against diphtheriaor tetanus.