AbstractThe aim of the research was to determine the intestinal carriers of C. difficile in different human population groups in Serbia. The research enrolled 877 persons with formed stools: (newborn children in maternity hospitals for up to two weeks old) (23), group A; children aged from two weeks to two years (121), group B; children aged two to 10 years (54), group C, healthy individuals aged 10 and over (516), group D; patients hospitalized for at least 48 hours (100), group E; staff of the Clinical Center in Nis, Serbia, (63), group F. The toxins A and B of C. difficile were detected by ELISA-ridascreen Clostridium difficile Toxin A/B (R — Biopharm AG, Darmstadt, Germany). The toxin A of C. difficile was detected using ColorPAC Toxin A test (BectonDickinson, New Jersey, USA). Out of the total number of persons (877), the carriers of certain types of toxin-producing strains of C. difficile were distributed as: 6.04% (A−/B−), 1.83% (A+/B+) and 0.11% (A−/B+). In most groups (5/6), the dominance of non-toxigenic (A−/B−) isolates was established, with the rate of carriers 1.75 – 30.43% depending on the group. Toxigenic isolates were prevalent only in the group F in relation to non — toxigenic (7.94% versus 4.76% of persons). In other groups, the carriers of toxigenic strains ranged from 0.00 – 17.45%. The presence of asymptomatic intestinal carriers of C. difficile in the human population, indicate the possible reservoirs and sources of infection.
Carriage of Clostridium (C.) difficile in the intestinum of children, as well as its role in the disease (diarrhea) onset, is still controversial. The aim of this study is to investigate the community-acquired Clostridium difficile infection (CA-CDI) in Serbian pediatric population and to describe the basic clinical characteristics and risk factors for CA-CDI occurrence in Serbian pediatric population. The data obtained from 63 Serbian pediatric patients with CA-CDI and from control group of 126 children with community-acquired diarrhea, whose stool specimens were negative for C. difficile and toxins A/B, were mutually compared. In the current work, we found that children with CA-CDI display a significantly less severe disease clinical presentation than children with diarrheas of other origin. Lethal outcome was noted in two cases, but in children with severe underlying diseases (Crohn's disease and leukemia). By using the multivariate statistical regression model, the following statistically significant risk factors for community-acquired C. difficile-associated diarrhea development were determined: previous application of laxatives (OR = 0.199, CI 0.55-0.79, p = 0.015), general antibiotic use during the previous 2 months (OR = 0.05, CI 0.02-0.17, p < 0.001), and specifically the use of penicillins (OR = 0.112, CI 0.04-0.31, p < 0.0001) and cephalosporins (OR = 0.16, CI 40.06-0.44, p < 0.0001). Antibiotics from the groups of cephalosporins and penicillins were found to be the most important independent risk factors. Laxative application plays a significant role in the community-acquired Clostridium difficile infections in children, with mechanisms that are not completely understood.
The aim of this study was to determine the seroprevalence of Helicobacter pylori and the distribution of anti-H.pylori IgA and IgG antibodies in asymptomatic children aged between 7 and 18 y. We studied the serum samples of 283 children using the commercial ELISA test for the detection of anti-H. pylori IgA and IgG antibodies. The overall prevalence of anti-H. pylori antibodies was 36.4%. The seroprevalence was 35%, 28.3%, 37.5%, and 42.2% for the ages of 7, 10, 14 and 18 y, respectively. Serum IgG antibodies alone were detected in 88.3%, IgA alone in 4.9%, and both IgA and IgG antibodies were detected in 6.8% of samples. The mean levels of IgG antibodies to H. pylori increased with age. We concluded that the prevalence of H. pylori antibodies in Serbian children was high (36.4%), ranging from 35% to 42.2%. The detection of IgG antibodies is useful for the determination of seroprevalence in asymptomatic children.
Amoxicillin could be the therapy of choice in pediatric practice. The macrolides should not be recommended for the empirical therapy of pneumococcal respiratory tract infection in our local area.
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