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A 6-year safety surveillance of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in South Korea

Lee SM, Lee JH, Song ES, Kim SJ, Kim JH, Jakes RW, et al.

Hum Vaccin Immunother, 2018 Aug 07.
PMID: 30084702 DOI: 10.1080/21645515.2018.1502525

In 2010, Korea introduced 10-valent pneumococcal conjugate vaccine for children aged 6 weeks to 5 years against invasive disease caused by Streptococcus pneumoniae serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, 23F and cross-reactive 19A. The aim of this 6-year real-world study of 646 healthy Korean children from 16 centers vaccinated in routine practice is to monitor vaccine safety, as per Ministry of Food and Drug Safety regulations. Around 50% had a past or existing medical condition, 19.3% an existing condition and 7.6% received concomitant medication). Total of 489 recorded adverse events (AEs) were reported in 274 infants; 86% were mild and the rest moderate, only three were reported as serious. Most AEs (97.8%) were not related to vaccination; one case of injection-site swelling and of fever was related, two cases of fever were probably related, five cases of fever and one case each of diarrhea and coughing were possibly related. None of the serious AEs were related to vaccination. Of 11 adverse drug reactions (ADRs) in 10 subjects, none were serious. Overall, 263 subjects (40.7%) received medication (mainly antibiotics or antipyretics) for the treatment of an AE, of which 6 subjects were treated for an ADR. There was no difference in the incidence of AEs according to age, sex or concomitant vaccination. Subjects with an existing medical condition had significantly more AEs than those without any conditions (p = 0.03), but no differences regarding ADRs. Four-dose vaccination with PHiD-CV appears to have a clinically-acceptable safety profile for Korean children. ClinicalTrials.gov identifier: NCT01248988.

Matched MeSH terms: Diarrhea
A 9-year study of shigellosis in Northeast Malaysia: Antimicrobial susceptibility and shifting species dominance

Banga Singh KK, Ojha SC, Deris ZZ, Rahman RA

Z Gesundh Wiss, 2011 Jun;19(3):231-236.
PMID: 21654922

AIMS: In Malaysia, Shigella spp. is the third most common bacterial agent responsible for childhood diarrhoea. This study was conducted to determine the prevalence and antimicrobial susceptibility patterns of Shigella spp. isolated from patients admitted to the Hospital Universiti Sains Malaysia from January 2001 to December 2009. SUBJECTS AND METHODS: A hospital-based retrospective study was used. Stool samples from patients were cultured using a standard culture method. Shigella spp. isolates were identified by biochemical and serological methods, and the antimicrobial susceptibility pattern was evaluated using the Kirby-Bauer disc-diffusion method. RESULTS: A total of 138 Shigella spp. were isolated from a total of 14,830 routine stool specimens, yielding an isolation rate of 0.93% that corresponded to 9.99% of the 1,381 bacterial pathogens isolated. Of these isolates, S. sonnei was the predominant species, followed by S. flexneri and S. boydii. Seasonal variation was noticed, and no significant differences were detected in the demographic data for S. flexneri and S. sonnei. The susceptibility of all isolated Shigella strains was tested against seven antibiotics. Ceftriaxone (99.1%), ciprofloxacin (98.4%), and nalidixic acid (93.8%) were effective against the Shigella strains, whereas tetracycline and trimethoprim-sulfamethoxazole exhibited high frequencies of resistance (58.4% and 53.8%, respectively). CONCLUSION: This study is important for public health education aimed at reducing the morbidity and mortality associated with Shigella spp. infection. Our results also will be helpful for paediatricians and microbiologists in the selection of appropriate antibiotics for the management of diarrhoea.

Matched MeSH terms: Diarrhea
A brief review of fifty years of medical history in Selangor, Federation of Malaya

Milne JJC

Med J Malaya, 1948;2:161-73.

This is an interesting piece of Colonial history, compiled, one presumes, from official reports. It cannot satisfactorily be summarized. The author deals with his subject under various heads: hospitals, health legislation, dangerous infectious diseases, prevailing diseases, beriberi, fever and malaria, dysentery, and diarrhoea, influenza and enteric fever. In a table are given the numbers of cases of smallpox, cholera, plague, beriberi, dysentery, diarfhoea and fevers reported each year from 1890 to 1939. The only one of these to show steady reduction is beriberi, which began to decline from figures over 2,000 per annum before the 1914-18 war to 69-444 per annum from 1930 to 1939. Plague was never common and neither cholera nor smallpox was responsible for large numbers of cases. The author does not give any systematic accounts of the outstanding investigations made during the period, but rather quotes opinions expressed by Government servants, medical or lay, in their reports. Charles Wilcocks.

Matched MeSH terms: Diarrhea
Fulltext A case of neonatal diarrhoea caused by congenital glucose-galactose malabsorption

Lee WS, Tay CG, Nazrul N, Paed M, Chai PF

Med J Malaysia, 2009 Mar;64(1):83-5.
PMID: 19852331 MyJurnal

A five-month-old Indian girl, product of consanguineous marriage, presented with diarrhoea with an onset within two days after birth, severe malnutrition and metabolic acidosis. The diarrhoea persisted even with lactose-free formula, amino acid-based formula and glucose-containing oral rehydration solution, but stopped when fasted. She required prolonged parenteral nutrition. Fructose and glucose tolerance tests were performed, confirming the child was able to absorb and metabolize fructose but not glucose, indicating a diagnosis of glucose-galactose malabsorption. This case illustrate how simple and pertinent clinical observations and laboratory investigations is sufficient to allow a firm diagnosis to be made.

Matched MeSH terms: Diarrhea/etiology*
Fulltext A case of rectal cancers in teenager: A conundrum of genetics and clinical medicine

Kumar M, Tata MD, Sahid Nik Lah NA

Ann Med Surg (Lond), 2021 May;65:102353.
PMID: 34007446 DOI: 10.1016/j.amsu.2021.102353

Introduction: Signet cell carcinoma (SRCC)of the rectum is a rare subtype of the rectum cancer which accounts for only 0.8% of colorectal cancer in adolescents and young adults (AYAs) which spread aggressively to other organs and peritoneum.
Case presentation: We present a case of 15-year-old boy from rural area, presented with chronic diarrhea and per rectal bleeding for 3 months. The diagnosis was determined by colonoscope which revealed a fungating mass identified at 10cm from anal verge. Histological examination confirmed diagnosis of signet ring cell adenocarcinoma. CT scan of the abdomen showed thickening involving the recto-sigmoid colon and rectal mass, without evidence of distant metastatic disease. The patient's carcinoembryonic antigen level was within the normal range. He underwent a colostomy and was subjected to neoadjuvant CCRT and surgery.
Discussion: This CASE highlights the importance and challenges in achieving early diagnosis and surgical intervention of signet-ring cell carcinoma in adolescents, as most cases are detected at an advanced stage coupled with the scarcity of information on these rarer subtypes which leads to a poor prognosis.
Conclusion: In managing Signet cell carcinoma of the colorectal, physician have to know that it has a poor prognosis in patients of any age. However, in young teenagers delayed diagnosis and treatment option are narrowed to palliative management. Genetic profiling of family members and similar environment population may be a key to early detection.

Matched MeSH terms: Diarrhea
Fulltext A case of sprue or psilosis

Dane R

Journal of the Straits Medical Association, 1893;4:63-5.

Matched MeSH terms: Diarrhea
A case report of Blastocystis infection and Steven Johnson's syndrome

Singh A, Priyadarshi K, Raj T, Banerjee T

Trop Biomed, 2019 Dec 01;36(4):987-992.
PMID: 33597468

Blastocystis species (spp.) is an emerging pathogen. There are several unsolved issues linked to this parasite ranging from its nomenclature, commensal status, standardization of laboratory diagnostic methods, genotypes and treatment. Recently, there has been an increase in reports of Blastocystis spp. from symptomatic cases which provide enough evidence of its pathogenic potential. A range of signs and symptoms, from gastro-intestinal to cutaneous manifestations have been attributed to Blastocystis infection. Few reports have established an association between intestinal infection with Blastocystis spp. and skin manifestations in form of urticaria, palmoplantar pruritus and allergy with complete resolution of cutaneous lesions with eradication of the parasite. In this report, we describe a case of Steven Johnson's syndrome (SJS) in a 6 years old girl along with infection with Blastocystis spp. marked by diarrhea and abdominal pain. Stool examination revealed the presence of all forms of the parasite with subsequent decrease in parasite burden and diarrhea over a period of time. Interestingly, the clearance of Blastocystis spp. from stool was followed by recovery from skin lesions and other symptoms. In this case, the course of SJS was clearly associated with Blastocystis infection. Though skin manifestation with Blastocystis infection has been previously reported, this is the first report of its association with SJS. This report indicates newer insights of the parasite that are less well studied.

Matched MeSH terms: Diarrhea/parasitology
A colonic amoebic abscess mimicking colonic carcinoma

Tan LP, Foong KK, Yvonne Ai LL

Med J Malaysia, 2018 10;73(5):334-335.
PMID: 30350818 MyJurnal

Amebiasis is one of the major causes of diarrhea in the developing countries and it can present with a wide range of gastrointestinal symptoms depending on the phase of infection. We described a case of 50 year-old male patient who presented with abdominal pain, diarrhea and vomiting. After right hemicolectomy for appendicular abscess with tumour over the ileum, histopathological examinations revealed numerous trophozoites of Entamoeba histolytica in a background of inflammations (Figure 1). Following resection of the ameboma, he received intravenous metronidazole treatment for total of two weeks duration.

Matched MeSH terms: Diarrhea
A comparative study of four methods for detecting Giardia lamblia in children with diarrheal disease and malabsorption

Kamath KR, Murugasu R

Gastroenterology, 1974 Jan;66(1):16-21.
PMID: 4809494
Matched MeSH terms: Diarrhea/microbiology*
Fulltext A double-edged sword: a case report on liver injury side-effect of anti-tuberculosis drug on liver tuberculosis patient

Azlina Ibrahim, Alvin Oliver Payus

Borneo Journal of Medical Sciences, 2020;14(1):49-53.
MyJurnal

Hepatic involvement in extra-pulmonary tuberculosis (TB) is rare, even in the endemic area. It has a high mortality rate as it can easily be misdiagnosed due to its rarity and non-specific presentations, and the treatment can be challenging for its hepatotoxic side-effect. A 55-year old man who was newly diagnosed with AIDS and pulmonary TB which complicated with anti-TB-induced transaminitis, presented with a few weeks history of fever and persistent diarrhoea. It was initially treated as microsporidia infection but the symptoms persisted despite given antiparasitic agent for more than a week. He was subjected to computed tomography (CT) scan of the abdomen and noted multiple hypoechoic lesion at multiple segments of the liver, which later confirmed to be liver TB by liver biopsy. As he could not tolerate Akurit-4 (Rifampicin 150 mg, Isoniazid 75 mg, Pyrazinamide 400 mg and Ethambutol 275 mg), the second-line treatment was given instead. He is currently well on regular clinic appointment. The objective of this case report is to share the rare occurrence of hepatic TB and the difficulty to treat it as the hepatotoxic effect of anti-TB medications complicate the liver damage due to the infection.

Matched MeSH terms: Diarrhea
A new medical device applied in a case of acute fecal impaction with overflow diarrhea: a case report

Huang Q, Zheng F, Wang H, Yang Y, Ma C, Zhu L

J Med Case Rep, 2024 Mar 06;18(1):89.
PMID: 38444013 DOI: 10.1186/s13256-024-04407-4

BACKGROUND: Fecal impaction is a digestive system disease, that is most common in the elderly population and becomes more prevalent with increasing age. Manual removal can successfully remove the impaction in 80% of fecal impaction cases. In severe cases, endoscopy and surgery may be necessary.
CASE PRESENTATION: A 78-year-old Han Chinese man living in a nursing home was diagnosed with fecal impaction; his initial symptom was overflow diarrhea, which is a rare occurrence with regard to fecal impaction. Nevertheless, we were able to effectively treat this situation by employing a new medical device that presents a novel method for addressing fecal impaction.
CONCLUSION: Early identification of fecal impaction with atypical symptoms is crucial to provide proper emergency management. A safe and noninvasive treatment method, especially for elderly patients with fecal impaction, should be chosen.

Matched MeSH terms: Diarrhea/etiology; Diarrhea/therapy
Fulltext A one year community-based study on the incidence of diarrhoea and rotavirus infection in urban and suburban Malaysian children

Yap KL, Yasmin AM, Wong YH, Ooi YE, Tan SC, Jegathesan M, et al.

Med J Malaysia, 1992 Dec;47(4):303-8.
PMID: 1303484

A 1 year longitudinal study of 156 Malaysian children from urban and suburban areas in the Klang Valley revealed that the incidence rate of diarrhoea was 23.6 per 100 person-year with abnormal faeces reported on 0.26% of the total days of observation. Diarrhoea cases were detected in children from all socioeconomic classes. Rotavirus was isolated from 12% of the diarrheic children and asymptomatic rotavirus infection occurred in 3.2% of the children. All rotaviruses isolated were group A rotaviruses with long electrophoretypic pattern.

Matched MeSH terms: Diarrhea/epidemiology*
Fulltext A pentaplex PCR assay for the detection and differentiation of Shigella species

Ojha SC, Yean Yean C, Ismail A, Singh KK

Biomed Res Int, 2013;2013:412370.
PMID: 23509722 DOI: 10.1155/2013/412370

The magnitude of shigellosis in developing countries is largely unknown because an affordable detection method is not available. Current laboratory diagnosis of Shigella spp. is laborious and time consuming and has low sensitivity. Hence, in the present study, a molecular-based diagnostic assay which amplifies simultaneously four specific genes to identify invC for Shigella genus, rfc for S. flexneri, wbgZ for S. sonnei, and rfpB for S. dysenteriae, as well as one internal control (ompA) gene, was developed in a single reaction to detect and differentiate Shigella spp. Validation with 120 Shigella strains and 37 non-Shigella strains yielded 100% specificity. The sensitivity of the PCR was 100 pg of genomic DNA, 5.4 × 10(4) CFU/ml, or approximately 120 CFU per reaction mixture of bacteria. The sensitivity of the pentaplex PCR assay was further improved following preincubation of the stool samples in gram-negative broth. A preliminary study with 30 diarrhoeal specimens resulted in no cross-reaction with other non-Shigella strains tested. We conclude that the developed pentaplex PCR assay is robust and can provide information about the four target genes that are essential for the identification of the Shigella genus and the three Shigella species responsible for the majority of shigellosis cases.

Matched MeSH terms: Diarrhea/microbiology
A strain of urease-producing Vibrio parahaemolyticus isolated in Malaysia

Jegathesan M, Paramasivam T

J Diarrhoeal Dis Res, 1985 Sep;3(3):162.
PMID: 3833915
Matched MeSH terms: Diarrhea/microbiology*
Fulltext A survey of mothers' knowledge about childhood diarrhoea and its management among a marginalised community of Morang, Nepal

Mukhtar A, Mohamed Izham MI, Pathiyil RS

Australas Med J, 2011;4(9):474-9.
PMID: 23393537 DOI: 10.4066/AMJ.2011.821

Diarrhoea, a common disease, is one of the major determinants of childhood morbidity and mortality in Nepal.

Matched MeSH terms: Diarrhea
Fulltext Abdominal tuberculosis: a presumptive diagnosis

Ramanathan M, Wahinuddin S, Safari E, Sellaiah SP

Singapore Med J, 1997 Sep;38(9):364-8.
PMID: 9407759

Abdominal tuberculosis (TB) is common. But the diagnosis of abdominal TB is fraught with difficulties as it is often not possible to get a microbiological confirmation of the infection. We therefore undertook this study to highlight those pertinent clinical and laboratory features which would enable one to make a provisional diagnosis of abdominal TB early, to pave way for a trial of anti-tuberculosis chemotherapy.

Matched MeSH terms: Diarrhea/etiology
Fulltext Acute abdomen: unmasked the bleeding site in severe haemophilia A

Wan Suriana Wan Ab Rahman, Zefarina Zulkafli, Mohd Nazri Hassan, Wan Zaidah Abdullah, Azlan Husin, Anani Aila Mat Zain

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):345-347.
MyJurnal

Haemophilia A is an inherited bleeding disorder, commonly involve soft tissues and joints. Gastrointestinal tract
bleeding, are not uncommon but seldom highlighted. A 23-year-old male with underlying severe haemophilia A was
presented with a generalised abdominal pain for 2 days, abdominal distension, diarrhoea and vomiting. He did not
have any trauma to the abdomen. Abdominal examination revealed generalized tenderness with sign of guarding
on palpation. Laboratory investigations revealed isolated, prolonged activated partial thromboplastin time (APTT)
with normal total white blood cell count and haemoglobin level. In view of acute abdomen, which was not resolved
by conservative treatment, an emergency laparotomy was done with FVIII concentrate and recombinant factor VII
(rFVII) coverage. Intraoperative findings noted patchy gangrenous spots of about 30 cm in length in the small bowel.
Histopathology examination revealed an evidence of haemorrhage within the submucosal and intramuscularis layer
from the resected specimen. This case highlighted the possibility of gastrointestinal bleeding without prior trauma,
which can be presented as acute abdomen in severe haemophilia patient.

Matched MeSH terms: Diarrhea
Acute diarrhoea

Matched MeSH terms: Diarrhea
Fulltext Acute gastroenteritis among indigenous paediatric patients – a descriptive study in a rural district hospital, Sarawak

Cheah, W. L., Lee, P. Y., Kamarudin, K., Syed Alwi, S. A. R., Albela, H., Lau, E. H., et al.

Malaysian Journal of Medicine and Health Sciences, 2011;7(2):3-7.
MyJurnal

Introduction: Acute gastroenteritis (AGE) is one of the frequent causes of hospitalization in children under the age of five, particularly in a rural setting. This study was conducted to determine the epidemiology of acute gastroenteritis in indigenous children admitted to a rural district hospital in Sarawak. Methods: A retrospective review of indigenous paediatrics cases of acute gastroenteritis
admitted to the ward of Serian District Hospital, a rural district hospital in Sarawak, between the years
2006-2007. The data was collected from the patients’ case notes, obtained with permission from the
hospital management. Data was entered and analyzed using SPSS version 16. Results: During the study period, 234 indigenous children with acute gastroenteritis were admitted with the highest prevalence in 2006 (53.4%). The findings showed higher prevalence was found in children aged 3 years and below (76.5%) and male (56.4%) The minimum duration of hospital stay is 1 day, and the maximum stay is 5 days. The clinical findings showed that the majority of the cases presented with vomiting, diarrhea, dry mouth and tongue, sunken eye, with the majority (76%) reported having mild dehydration. The most common treatment used is oral rehydration solutions (85.4%), followed by intravenous bolus or drip (82.3%), paracetamol (79%) and antibiotic (36.2%). Peak incidence of admissions was between November to January. About 38.5% of the AGE cases admitted were found to be underweight (weight for- age below -2SD). Conclusion: The findings indicated children aged 3 years and below are the most vulnerable to AGE and malnutrition could be one of the predisposing factors. The peak incidence during the raining season at the end of the year indicated a possible relationship between AGE and seasonal type of virus infection. Prevention in the form of proper hygiene at the household level probably will prove to be useful.

Matched MeSH terms: Diarrhea
Fulltext Acute gastroenteritis in Kinta

Lili, Z.M., Noridah, O.

Journal of Health Management, 2008;4(1):61-72.
MyJurnal

Acute Gastroenteritis (AGE) is common world wide and is a major health problem. The commonest cause is from contaminated water or food. Common infective agents are Rotavirus, Staph. aureus and Bacillus cereus. There was an AGE outbreak in Ipoh City from late August till early October 2006. Epidemiological and laboratory investigations were done. Fresh stool samples were taken from symptomatic patients. Water and food sampling were also done. Descriptive analysis of the outbreak was done. A total of 170 patients, mostly between 1 - 5 years of age, were affected. The highest incidents were seen in Bercham. Fever and diarrhea were the prominent features. Two stool samples (13.3%) were positive for E.coli and rotavirus respectively. Twelve of the twenty (60%) water samples taken were contaminated with coliform and fecal matter. Twenty-one of the eighty ((26.3%) food samples taken grew either E.coli, Staph. aureus or Bacillus cereus. It was concluded that a general source was responsible for this problem. The water supply to Ipoh City and the surrounding area is the most likely source. Novovirus was suspected as the organism involved because of the self-limiting and mild nature of the illness that occurred in this outbreak.
The AGE outbreak in Kinta District in September 2006 is due to contaminated
water supply from two water treatment

Matched MeSH terms: Diarrhea

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