Browsing by Subject "ETEC"

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  • Lähteinen, Paula (Helsingfors universitet, 2012)
    Vasikkaripuli on nautojen yleisin sairaus neonataalikaudella. Perinteisesti vasikkaripulia on hoidettu mm. nesteyttämällä vasikkaa joko suun kautta tai huonompikuntoista potilasta eläinlääkärin toimesta, ja varmuuden vuoksi eläinlääkäri on laittanut vasikan antibioottikuurille. Sen hyödystä ei kuitenkaan ole selkeää konsensusta, ja tämän työn tarkoituksena on kerätä yhteen tieto, joka maailmalla alle kolmen viikon ikäisten vasikoiden ripulin antibioottihoidosta on olemassa. Vasikkaripuli on vanha sairaus, jota koskeva perustutkimus on pääasiassa vuosikymmeniä vanhaa. Suomen erityinen tautitilanne, jossa esimerkiksi salmonella on erittäin harvinainen tuotantoeläimillä, vaikeuttaa kansainvälisen kirjallisuuden soveltamista suomalaiseen ympäristöön. Myös erilaiset perinteet antibioottien käytössä ja osin sen seurauksena muokkautuneet patogeenien antibioottiresistenssitilanteet hankaloittavat kirjallisuudessa mainittujen antibioottisuositusten käyttämistä sellaisenaan. Suomessa tavallisimmin vasikkaripulin hoitoon käytetty trimetopriimi-sulfonamidi mainitaan myös kansainvälisessä kirjallisuudessa ensisijaisten hoitojen joukossa. Meillä ei sen sijaan ole totuttu käyttämään amoksisilliinia tai amoksisilliini-klavulaanihappoa nautojen hoidossa lainkaan, mutta ne nousevat esiin hoitosuosituksissa. Erilaisten lääkityssäännösten vuoksi suomalaisissa ohjeissa toissijainen valinta, fluorokinolonit, on maailmalla se viimeinen vaihtoehto. Suomessa ei taas juurikaan käytetä kolmannen tai neljännen polven kefalosporiineja, jotka ovat toisissa maissa kovassa käytössä. Tässä työssä pyrittiin myös etsimään kirjallisuudesta tietoa pohjoismaisesta erikoisuudesta, dihydrostreptomysiinistä, mutta suun kautta annettuna siitä ei löytynyt yhtään tieteellistä artikkelia. Myöskään tämän vanhan lääkkeen käyttöönottotutkimuksia ei löytynyt. Vasikkaripuli ei vaadi läheskään aina antibioottihoitoa, vaan nesteterapia on ensimmäinen ja tärkein hoitomuoto olosuhdekorjauksen ohella. Antibiootteja käytetään vain huonokuntoisille potilaille, joilla on ripulin lisäksi yleisoireita, esimerkiksi alentunut imurefleksi, yli 6 % dehydraatio, kuume, apaattisuus tai heikkous, tai sen ulosteissa on limaa. Huolehtimalla, että vasikka saa riittävästi vasta-aineita ternimaidosta, vältetään suuri osa ripuleista kokonaan. Antibioottien käyttö vasikkaripulin hoidossa on yleistä, mutta kasvava huoli lääkejäämistä lihassa ja antibioottiresistenssin kehittymisestä on ohjannut ajatuksia probioottien suuntaan. Niistä tehtyjä tutkimuksia ei eläinlääketieteellisestä kirjallisuudesta vielä juuri löydy, mutta ne ovat mielenkiintoinen lisätutkimuksen kohde tuleville vuosille.
  • Turunen, Katri; Antikainen, Jenni; Lääveri, Tinja; Kirveskari, Juha; Svennerholm, Ann-Mari; Kantele, Anu (2020)
    Background: Enterotoxigenic Escherichia coli (ETEC) is a major pathogen causing travellers' diarrhoea (TD) among visitors to low- and middle-income countries (LMIC). Scant data are available on rates of travel-acquired ETEC producing heat-labile (LT) and/or heat-stable (ST) toxin or its subtypes, STh (human) and STp (porcine) in various geographic regions, and on clinical pictures associated with each toxin. Methods: Using qPCR, we analysed LT, STh, and STp in stools positive for ETEC in a prospective study among 103 Finnish travellers visiting LMIC. They filled in questionnaires and provided stool samples before and after travel. We scrutinized geographic distribution of LT, STh, and STp ETEC findings, and association between these different ETEC subtypes and moderate/severe TD. Results: Among the 103 stool samples positive for ETEC toxins, the rate for LT was 76%, for STh 26%, and STp 41%. The rate for LT-only was 44%, for 5Th-only 6%, STp-only 16%, LT + STh 10%, LT + STp 15%, STh + STp 3%, and LT + STh + STp 8%. Findings varied by destination; the rates of LT, STh, and STp were 79%, 21%, and 57%, respectively, in Southern Asia (n = 14); 85%, 10%, and 20% in South-eastern Asia (n = 20); 84%, 13%, and 29% in Eastern Africa (n = 31); and 56%, 50%, and 63% in Western Africa (n = 32), respectively. Of travellers positive for LT, STh, and STp, 83%, 100%, and 88%, encountered TD; 35%, 55%, and 41% reported moderate/severe TD. STh was associated with moderate/severe TD. Conclusions: Toxin findings varied by destination; multiple toxins were commonly detected. Moderate/severe TD was reported most frequently by subjects with STh-ETEC.
  • Lääveri, Tinja; Vilkman, Katri; Pakkanen, Sari; Kirveskari, Juha; Kantele, Anu (2018)
    Background: Among visitors to the (sub)tropics, 20-50% contract travellers' diarrhoea (TD) and 5-30% take antibiotics. While shortening the duration of illness, antimicrobials predispose to acquisition of multi-drug resistant bacteria. Therefore, liberal use is no longer advocated. Although antibiotics kill pathogens, no data support the view that they could prevent post-infectious sequelae. We investigated how antibiotic use for TD abroad impacts the pathogen findings at return. Materials and methods: We revisited 456 travellers' clinical data and stool pathogens examined by qPCR for Salmonella, Yersinia, Campylobacter, Shigella, Vibrio cholerae and enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC) and enteroinvasive (EIEC) Escherichia coli. Results: Among travellers with TD, antibiotic users had pathogen-positive samples less frequently than non-users (50% versus 83%). The difference was significant for EPEC (23% versus 47%) and EAEC (27% versus 54%), but not ETEC (17% versus 26%) or the other pathogens. Shigella/EIEC was found more often among antibiotic users than non-users (4% versus 1%). Conclusion: Despite antibiotic treatment of TD, half of the users still had stool pathogens at return, reflecting either antibiotic resistance of pathogens or recolonisation/reinfection while abroad. Treatment of TD with antibiotics during travel should not be interpreted to indicate eradication of pathogens.
  • Lääveri, Tinja; Pakkanen, Sari H.; Antikainen, Jenni; Riutta, Jukka; Mero, Sointu; Kirveskari, Juha; Kantele, Anu (2014)
  • Martikainen, Outi (Helsingfors universitet, 2011)
    Diarrheagenic Escherichia coli (DEC) can cause diarrheal disease in humans. Like commensal E. coli, DEC are present in the human and mammalian, especially ruminant, and avian gut. They can also be present in soil and water environments. The food of animal origin can act as a transmission vehicle to infect humans. Infection may also be gained by drinking water contaminated by animal or human feces. DEC can be devided into five pathogroups based on their virulence traits: enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enterohaemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC) and enteroaggregative E. coli (EAEC). EPEC typically causes children’s diarrhea in developing countries. ETEC is a typical cause for tourist’s diarrhea and infantil diarrhoea in developing countries. EHEC causes bloody or non-bloody diarrhea that might lead to kidney dysfunction called hemolytic uremic syndrome (HUS) especially in young children. EIEC causes Shigella-like diarrhea which can be bloody. EAEC is mainly associated with prolonged diarrhea. This study was conducted to find out the prevalence of diarrheagenic E. coli in humans and food in Burkina Faso, on which there was no previous knowledge. Fecal samples were collected from children under five years of age suffering from diarrhea in two villages, Boromo and Gourcy, and in the capital Ouagadougou (110 samples). Raw meat samples (chicken, beef, mutton and bovine intestines used for human consumption) were collected from open markets in Ouagadougou (120 samples). Primary mixed bacterial cultures obtained from the samples were studied using multiplex PCR-method, which detects the virulence genes of the five pathogroups. In addition, 20 EHEC strains were isolated from meat samples using colony hybridization based on the detection of Shiga toxin gene stx and PCR-screening, and were characterized to reveal the possible virulence properties. The study demonstrated that DEC-infections in small children are common in Burkina Faso. Of the studied fecal samples, 59 % were positive for DEC. The most prevalent pathogroups were EAEC (32 %), ETEC (31 %) and EPEC (20 %). EIEC (2 %) and EHEC (1 %) were found only in a few samples. Mixed infections with more than one pathogroup were common (24 %). The difference in DEC prevalence between the different sampling locations was statistically significant. There were more DEC-infections in Gourcy than in Ouagadougou and Boromo. The study also showed that DEC occur commonly in raw meats sold at open markets in Ouagadougou. Of the studied meat samples, 43 % were positive for DEC. The most prevalent were EHEC (28 %), EPEC (20 %), ETEC (8 %) and EAEC (5 %). EIEC was not detected. Mixed contaminations with more than one pathogroup were relatively common (17 %) in meat. There was no statistical significance in DEC-prevalence between the different meats. When prevalence was considered by each pathogroup, EHEC was absent in chicken and the difference was statistically significant when compared to the other meats. The 20 EHEC strains isolated from the meat samples were grouped into 14 serotypes, some of which have previously been isolated from humans suffering from diarrheal disease and HUS. All the strains were positive for stx1 and half of them also for stx2, which is considered to be the more virulent form of Shiga toxin. Two EHEC strains were also positive for an ETEC-related gene of heat-stable enterotoxin Ia. Hence, the two strains were a mixture of two pathogroups and an evidence of gene transfer between different pathogroups. The youngest children do not consume meat but meat can be thought to represent a sample from their living environment, because food for children might be prepared in the same environment where raw meat products are handled. Thus contaminated meat can be a source of DEC-infections in little children.
  • Lääveri, Tinja; Pakkanen, Sari H.; Kirveskari, Juha; Kantele, Anu (2018)
    AbstractBackground Travellers' diarrhoea (TD) is a common health problem among visitors to the (sub)tropics. Much research deals with aetiology, prevention, and post-infection sequalae, yet the data may not allow comparisons due to incompatible definitions of TD and No TD control groups. Method The impact of defining TD and No TD control groups was explored by revisiting our recent data. We set up two TD groups: classical TD i.e. ≥3 loose or liquid stools/day and WHO TD (diarrhoea as defined by the WHO) i.e. any diarrhoea, and four No TD groups by TD definition and timing (no classical/WHO TD during travel, no ongoing classical/WHO TD). Results TD was recorded for 37% versus 65% of subjects when using classical versus WHO definitions, respectively; the proportions of the various pathogens proved similar. The strictest criterion for the No TD control group (no WHO TD during travel) yielded pathogens among 61% and the least strict (no ongoing classical TD) among 73% of the travellers; the differences were greatest for enteroaggregative Escherichia coli and Campylobacter. Conclusions Definition of TD and control group design substantially impact on TD study results. The WHO definition yields more cases, but the pathogen selection is similar by both definitions. Design of the No TD control group was found critical: only those remaining asymptomatic throughout the journey should be included.