Persistent Diarrhea in Developing Countries

Abstract

Globally diarrheal diseases account for almost a fifth of all deaths of children under 5 years, with an estimated 2.2 million deaths annually. Of these deaths, a significant proportion are related to episodes of persistent diarrhea (PD; defined as diarrhea of >14 days with growth faltering). PD has been shown to identify children with a substantially increased diarrheal burden. These account for 36–54% of all diarrhea-related deaths. Although the exact pathogenesis of PD remains unclear, most episodes are related to prior acute infectious diarrhea with prolongation of the most recent episode. This may be related to several host factors such as preexisting undernutrition, micronutrient deficiency, immune deficiency and inappropriate therapy of the most recent acute diarrheal episode. The common final event appears to be prolonged intestinal mucosal injury and ineffective repair. In contrast to post-infectious PD, some infants may have severe intractable diarrhea due to a variety of disorders, many of which have a hereditary basis. These now form the dominant type of prolonged diarrhea in developed countries. The management of PD depends upon close attention to nutritional rehabilitation and early recognition of complications. Although a variety of pathogens have been associated with PD, there is little role for oral antimicrobial therapy in the routine treatment of PD. However, attention to rehydration, appropriate screening and treatment of systemic infections and enteral nutrition rehabilitation with easily digestible diets are critical in managing such children, frequently in ambulatory settings. Administration of zinc and vitamin A may shorten the duration of PD and also help reduce recurrences. However, the most important preventive strategies for PD are exclusive breastfeeding in the first 6 months of life, continued breast feeding for 2 years with appropriate complementary feeding and optimal management of acute diarrheal episodes.

Persistent diarrhea: still an important challenge for the pediatrician

“…Os principais microorganismos enteropatogênicos isolados nas culturas de fezes das crianças portadoras de DP nos mais diferentes centros ao redor do mundo estão relacionados nas listas a seguir 23 . As características epidemiológicas dos pacientes com DP não variam de forma significativa em relação ao agente causador.…”

“…Por outro lado, as intervenções indicadas para diminuição da incidência da DP incluem: aleitamento materno exclusivo e prolongado; e estratégias seguras de alimentação para garantir adequado desenvolvimento pondero-estatural, considerando-se que a desnutrição proteico-calórica é fator de risco para esta síndrome 23 . A desnutrição é um dos principais contribuintes para a morbimortalidade pediátrica.…”

Beneficial Role of Green Plantain [Musa paradisiaca] in the Management of Persistent Diarrhea: A Prospective Randomized Trial

“…The diets were supplied either in bottles The nutritional (underweight) status was established according to WHO tables, taking weight-for-age z score Յ 2D [2]. The percentage of z score is referred to the median of the National Centre for Health Statistics standard (NCHS) [19].…”

“…In addition, clinical failure of dietary therapy was defined as persistence of diarrhea with inability to maintain hydration by the oral route, and/or weight loss for Ն3 consecutive days after achieving a caloric intake target of 100 kcal/kg/d [2]. Finally, the cost and cost-benefit ratio were analyzed and compared.…”

“…Acute onset prolonged diarrhea or persistent childhood diarrhea (PD; defined as diarrhea lasting for Ͼ14 days [1], usually with weight loss) is a condition associated with undernutrition, malabsorption, growth failure, and high mortality rate [1][2][3][4], and it is widely prevalent among infants in the developing countries where poverty and poor sanitation conditions co-exist [4,5]. PD has thus been considered by some as a nutritional disorder [4] and therefore, nutritional rehabilitation with improved intestinal function must be considered in its management.…”