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Herve Agaisse - One of the best experts on this subject based on the ideXlab platform.
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mechanisms of bacillary dysentery lessons learnt from infant rabbits
Gut microbes, 2020Co-Authors: Herve AgaisseAbstract:The bacterial pathogen Shigella flexneri causes more than 250 million cases of bacillary dysentery (Blood in Stool) every year across the world. This human-specific disease is characterized by prof...
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critical role of bacterial dissemination in an infant rabbit model of bacillary dysentery
Nature Communications, 2019Co-Authors: Mariana X Byndloss, Sanford H Feldman, Herve AgaisseAbstract:The bacterial pathogen Shigella flexneri causes 270 million cases of bacillary dysentery (Blood in Stool) worldwide every year, resulting in more than 200,000 deaths. A major challenge in combating bacillary dysentery is the lack of a small-animal model that recapitulates the symptoms observed in infected individuals, including Bloody diarrhea. Here, we show that similar to humans, infant rabbits infected with S. flexneri experience severe inflammation, massive ulceration of the colonic mucosa, and Bloody diarrhea. T3SS-dependent invasion of epithelial cells is necessary and sufficient for mediating immune cell infiltration and vascular lesions. However, massive ulceration of the colonic mucosa, Bloody diarrhea, and dramatic weight loss are strictly contingent on the ability of the bacteria to spread from cell to cell. The infant rabbit model features bacterial dissemination as a critical determinant of S. flexneri pathogenesis and provides a unique small-animal model for research and development of therapeutic interventions. The bacterial pathogen Shigella flexneri causes bacillary dysentery (Bloody diarrhoea). Here, Yum et al. present an infant rabbit model of S. flexneri infection that recapitulates human disease symptoms and features bacterial dissemination as an essential determinant of pathogenesis.
Jef Van Den Ende - One of the best experts on this subject based on the ideXlab platform.
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Clinical and microscopic predictors of Entamoeba histolytica intestinal infection in travelers and migrants diagnosed with Entamoeba histolytica/dispar infection.
PLOS Neglected Tropical Diseases, 2018Co-Authors: Steven Van Den Broucke, Jacob Verschueren, Emmanuel Bottieau, Marjan Van Esbroeck, Jef Van Den EndeAbstract:Background Amebiasis is a protozoal infection caused by Entamoeba histolytica, while the morphologically indistinguishable E. dispar is considered as non-pathogenic. Polymerase chain reaction (PCR) assays are necessary to differentiate both species. The most common clinical presentations of E. histolytica disease are amebic colitis and amebic liver abscess, but asymptomatic infection is also possible. We assessed the frequency and pattern of clinical symptoms and microscopic features in travelers/migrants associated with E. histolytica intestinal infection and compared them to those found in individuals with E. dispar infection. Methods We conducted a retrospective study at the travel clinic of the institute of Tropical Medicine, Antwerp, Belgium on travelers/migrants found from 2006 to 2016 positive for Entamoeba histolytica/dispar through antigen detection and/or through microscopy confirmed by PCR. All files of individuals with a positive PCR for E. histolytica (= cases) and a random selection of an equal number of Entamoeba dispar carriers (= controls) were reviewed. We calculated the sensitivity, specificity and likelihood ratios (LRs) of clinical symptoms (Blood in Stool, mucus in Stool, watery diarrhea, abdominal cramps, fever or any of these 5 symptoms) and of microscopic features (presence of trophozoites in direct and in sodium acetate-acetic acid-formalin (SAF)-fixed Stool smears) to discriminate between E. histolytica and E. dispar infection. Results Of all Stool samples positive for Entamoeba histolytica/dispar for which PCR was performed (n = 810), 30 (3.7%) were true E. histolytica infections, of which 39% were asymptomatic. Sensitivity, specificity and positive LRs were 30%, 100% and 300 (p 0.007) for presence of Blood in Stool; 22%, 100% and 222 (p 0.03) for mucus in Stool; 44%, 90% and 4.7 (p 0.009) for cramps and 14%, 97% and 4.8 (p = 0.02) for trophozoites in direct smears. For watery diarrhea, fever and for trophozoites in SAF fixated smears results were non-significant. Conclusions E. histolytica infection was demonstrated in a small proportion of travelers/migrants with evidence of Entamoeba histolytica/dispar infection. in this group, history of Blood and mucus in Stool and cramps had good to strong confirming power (LR+) for actual E. histolytica infection. Trophozoites were also predictive for true E. histolytica infection but in direct smears only.
Alves, Flavia Araujo - One of the best experts on this subject based on the ideXlab platform.
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Teste cutâneo de leitura tardia no diagnóstico em pacientes com suspeita de proctocolite eosinofílica
Universidade Federal de Uberlândia, 2015Co-Authors: Alves, Flavia AraujoAbstract:A proctocolite eosinofílica é uma manifestação clínica da alergia alimentar do tipo não mediado por imunoglobulina E (IgE) e caracterizada pela presença de sangue vivo nas fezes em decorrência de lesões geralmente restritas ao cólon distal. A confirmação diagnóstica é realizada por meio do teste de provocação oral, considerado o teste padrão-ouro no diagnóstico de alergias alimentares. Estudos anteriores recomendam a inclusão do teste cutâneo de leitura tardia como exame complementar em pacientes com suspeita de alergia alimentar que apresentam outros sintomas gastrointestinais. Foi objetivo deste estudo avaliar o teste cutâneo de leitura tardia no diagnóstico de proctocolite eosinofílica. Este é um estudo transversal e prospectivo, realizado em lactentes clinicamente normais, com sangramento retal pequeno, vivo e com duração mínima de 4 dias. Após 4 semanas de exclusão dietética do leite de vaca, as crianças foram submetidas ao teste cutâneo de leitura tardia com leite de vaca in natura, leite de vaca a 3,5% diluído em solução salina e leite de vaca a 3,5% diluído em petrolato, e, posteriormente, ao teste de provocação oral com fórmula polimérica à base de leite de vaca para confirmação do diagnóstico e construção de tabela de contingência e cálculo de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo. Tipo de alimentação infantil, período de amamentação, a idade da criança na introdução fórmula, a idade de início dos sintomas, peso e altura foram também investigados. A média de idade das 31 crianças avaliadas foi de 97,0 dias, 58,1% eram do gênero masculino, 90,0% nasceram por cesariana, 60,0% com idade gestacional superior a 38 semanas. A duração média do aleitamento materno foi de 166,4 dias (13,3% foram amamentadas exclusivamente, 70,0% recebiam tanto fórmula artificial como leite materno e 16,7% eram alimentados somente com fórmula artificial). Onze crianças (36,7%) continuaram recebendo leite materno mesmo após o processo de diagnóstico ter sido concluído. Dos lactentes participantes, 70,0% receberam a fórmula infantil no berçário. Na admissão, o peso médio e altura média foram de 5699 g e 59,1 cm, respectivamente. A idade média de início dos sintomas, conforme relatado pelos pais, foi de 46,5 dias. Todas as crianças apresentaram teste cutâneo de leitura tardia negativos, porém alergia alimentar do leite de vaca foi confirmada em seis crianças (19,3%) pela provocação oral. Portanto, o teste cutâneo de leitura tardia não parece ser um instrumento adequado para ser utilizado no diagnóstico de proctocolite eosinofílica.Eosinophilic proctocolitis is a clinical manifestation of food allergy non-IgE mediated and characterized by the presence of Blood in Stool due to lesions generally restricted to the distal colon. The diagnosis is confirmed by oral food challenge test, considered the gold standard in the diagnosis of food allergies. Previous studies recommend the inclusion of atopy patch test as complementary test in patients with suspected food allergy that also present other gastrointestinal symptoms. The aim of this study was to evaluate the use of the atopy patch test in the diagnosis of eosinophilic proctocolitis. A prospective cross-sectional study was performed on clinically normal infants with small fresh rectal bleeding with duration longer than 4 days. After 4 weeks of cow\'s milk exclusion, the atopy patch test was performed on the children with cow\'s fresh milk, cow\'s milk at 3.5% diluted in saline water and cow\'s milk diluted to 3.5% petrolatum, and subsequently performed the oral food challenge test with polymeric formula based on cow\'s milk to confirm the diagnosis and to construct the contingency table and calculate sensitivity, specificity, positive predictive value and negative predictive value. infant feeding type, breastfeeding, child\'s age when the formula was introduced, age when symptoms started to appear, weight and height were also investigated. Out of the 31 children who were analyzed, the average age was 97.0 days and 58.1% were male. 90.0% of infants were delivered by caesarean section and 60.0% with gestational age over 38 weeks. The average duration of breastfeeding was 166.4 days (13.3% were exclusively breastfed, 70.0% were mixed-fed and 16.7% were formula-fed). Eleven children (36.7%) continued to receive breast milk even after the diagnostic process had been completed. Out of all infants, 70.0% received infant formula in the nursery. On admission, the average weight and average height was 5699 g and 59.1 cm, respectively. The average age of when the symptoms started to appear as reported by the parents was 46.5 days. All children had negative atopy patch tests, however cow\'s milk food allergy was confirmed in six children (19.3%) using oral food challenge test. Therefore, the atopy patch test does not seem to be an appropriate instrument to be used in the diagnosis of eosinophilic proctocolitis
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Teste cutâneo de leitura tardia no diagnóstico em pacientes com suspeita de proctocolite eosinofílica
'EDUFU - Editora da Universidade Federal de Uberlandia', 2015Co-Authors: Alves, Flavia AraujoAbstract:Eosinophilic proctocolitis is a clinical manifestation of food allergy non-IgE mediated and characterized by the presence of Blood in Stool due to lesions generally restricted to the distal colon. The diagnosis is confirmed by oral food challenge test, considered the gold standard in the diagnosis of food allergies. Previous studies recommend the inclusion of atopy patch test as complementary test in patients with suspected food allergy that also present other gastrointestinal symptoms. The aim of this study was to evaluate the use of the atopy patch test in the diagnosis of eosinophilic proctocolitis. A prospective cross-sectional study was performed on clinically normal infants with small fresh rectal bleeding with duration longer than 4 days. After 4 weeks of cow\'s milk exclusion, the atopy patch test was performed on the children with cow\'s fresh milk, cow\'s milk at 3.5% diluted in saline water and cow\'s milk diluted to 3.5% petrolatum, and subsequently performed the oral food challenge test with polymeric formula based on cow\'s milk to confirm the diagnosis and to construct the contingency table and calculate sensitivity, specificity, positive predictive value and negative predictive value. infant feeding type, breastfeeding, child\'s age when the formula was introduced, age when symptoms started to appear, weight and height were also investigated. Out of the 31 children who were analyzed, the average age was 97.0 days and 58.1% were male. 90.0% of infants were delivered by caesarean section and 60.0% with gestational age over 38 weeks. The average duration of breastfeeding was 166.4 days (13.3% were exclusively breastfed, 70.0% were mixed-fed and 16.7% were formula-fed). Eleven children (36.7%) continued to receive breast milk even after the diagnostic process had been completed. Out of all infants, 70.0% received infant formula in the nursery. On admission, the average weight and average height was 5699 g and 59.1 cm, respectively. The average age of when the symptoms started to appear as reported by the parents was 46.5 days. All children had negative atopy patch tests, however cow\'s milk food allergy was confirmed in six children (19.3%) using oral food challenge test. Therefore, the atopy patch test does not seem to be an appropriate instrument to be used in the diagnosis of eosinophilic proctocolitis.Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorMestre em Ciências da SaúdeA proctocolite eosinofílica é uma manifestação clínica da alergia alimentar do tipo não mediado por imunoglobulina E (IgE) e caracterizada pela presença de sangue vivo nas fezes em decorrência de lesões geralmente restritas ao cólon distal. A confirmação diagnóstica é realizada por meio do teste de provocação oral, considerado o teste padrão-ouro no diagnóstico de alergias alimentares. Estudos anteriores recomendam a inclusão do teste cutâneo de leitura tardia como exame complementar em pacientes com suspeita de alergia alimentar que apresentam outros sintomas gastrointestinais. Foi objetivo deste estudo avaliar o teste cutâneo de leitura tardia no diagnóstico de proctocolite eosinofílica. Este é um estudo transversal e prospectivo, realizado em lactentes clinicamente normais, com sangramento retal pequeno, vivo e com duração mínima de 4 dias. Após 4 semanas de exclusão dietética do leite de vaca, as crianças foram submetidas ao teste cutâneo de leitura tardia com leite de vaca in natura, leite de vaca a 3,5% diluído em solução salina e leite de vaca a 3,5% diluído em petrolato, e, posteriormente, ao teste de provocação oral com fórmula polimérica à base de leite de vaca para confirmação do diagnóstico e construção de tabela de contingência e cálculo de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo. Tipo de alimentação infantil, período de amamentação, a idade da criança na introdução fórmula, a idade de início dos sintomas, peso e altura foram também investigados. A média de idade das 31 crianças avaliadas foi de 97,0 dias, 58,1% eram do gênero masculino, 90,0% nasceram por cesariana, 60,0% com idade gestacional superior a 38 semanas. A duração média do aleitamento materno foi de 166,4 dias (13,3% foram amamentadas exclusivamente, 70,0% recebiam tanto fórmula artificial como leite materno e 16,7% eram alimentados somente com fórmula artificial). Onze crianças (36,7%) continuaram recebendo leite materno mesmo após o processo de diagnóstico ter sido concluído. Dos lactentes participantes, 70,0% receberam a fórmula infantil no berçário. Na admissão, o peso médio e altura média foram de 5699 g e 59,1 cm, respectivamente. A idade média de início dos sintomas, conforme relatado pelos pais, foi de 46,5 dias. Todas as crianças apresentaram teste cutâneo de leitura tardia negativos, porém alergia alimentar do leite de vaca foi confirmada em seis crianças (19,3%) pela provocação oral. Portanto, o teste cutâneo de leitura tardia não parece ser um instrumento adequado para ser utilizado no diagnóstico de proctocolite eosinofílica
Anna Gavin - One of the best experts on this subject based on the ideXlab platform.
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diagnostic routes and time intervals for patients with colorectal cancer in 10 international jurisdictions findings from a cross sectional study from the international cancer benchmarking partnership icbp
BMJ Open, 2018Co-Authors: David Weller, Usha Menon, Alina Zalounina Falborg, Henry Jensen, Andriana Barisic, Anne Kari Knudsen, Rebecca J Bergin, David H Brewster, Victoria Cairnduff, Anna GavinAbstract:Objective international differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The international Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia). Design Patients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients’ primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression. Participants A total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses. Primary and secondary outcome measures interval lengths in days (primary), reported patient symptoms (secondary). Results The main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was ‘bleeding/Blood in Stool’. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). including screen-detected cases did not significantly alter the overall results. Conclusion ICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.
Steven Van Den Broucke - One of the best experts on this subject based on the ideXlab platform.
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Clinical and microscopic predictors of Entamoeba histolytica intestinal infection in travelers and migrants diagnosed with Entamoeba histolytica/dispar infection.
PLOS Neglected Tropical Diseases, 2018Co-Authors: Steven Van Den Broucke, Jacob Verschueren, Emmanuel Bottieau, Marjan Van Esbroeck, Jef Van Den EndeAbstract:Background Amebiasis is a protozoal infection caused by Entamoeba histolytica, while the morphologically indistinguishable E. dispar is considered as non-pathogenic. Polymerase chain reaction (PCR) assays are necessary to differentiate both species. The most common clinical presentations of E. histolytica disease are amebic colitis and amebic liver abscess, but asymptomatic infection is also possible. We assessed the frequency and pattern of clinical symptoms and microscopic features in travelers/migrants associated with E. histolytica intestinal infection and compared them to those found in individuals with E. dispar infection. Methods We conducted a retrospective study at the travel clinic of the institute of Tropical Medicine, Antwerp, Belgium on travelers/migrants found from 2006 to 2016 positive for Entamoeba histolytica/dispar through antigen detection and/or through microscopy confirmed by PCR. All files of individuals with a positive PCR for E. histolytica (= cases) and a random selection of an equal number of Entamoeba dispar carriers (= controls) were reviewed. We calculated the sensitivity, specificity and likelihood ratios (LRs) of clinical symptoms (Blood in Stool, mucus in Stool, watery diarrhea, abdominal cramps, fever or any of these 5 symptoms) and of microscopic features (presence of trophozoites in direct and in sodium acetate-acetic acid-formalin (SAF)-fixed Stool smears) to discriminate between E. histolytica and E. dispar infection. Results Of all Stool samples positive for Entamoeba histolytica/dispar for which PCR was performed (n = 810), 30 (3.7%) were true E. histolytica infections, of which 39% were asymptomatic. Sensitivity, specificity and positive LRs were 30%, 100% and 300 (p 0.007) for presence of Blood in Stool; 22%, 100% and 222 (p 0.03) for mucus in Stool; 44%, 90% and 4.7 (p 0.009) for cramps and 14%, 97% and 4.8 (p = 0.02) for trophozoites in direct smears. For watery diarrhea, fever and for trophozoites in SAF fixated smears results were non-significant. Conclusions E. histolytica infection was demonstrated in a small proportion of travelers/migrants with evidence of Entamoeba histolytica/dispar infection. in this group, history of Blood and mucus in Stool and cramps had good to strong confirming power (LR+) for actual E. histolytica infection. Trophozoites were also predictive for true E. histolytica infection but in direct smears only.