Enterotoxigenic Escherichia coli degrades the host MUC2 mucin barrier to facilitate critical pathogen-enterocyte interactions in human small intestine.

Enterotoxigenic Escherichia coli (ETEC) are a genetically diverse pathologic variant of E. coli defined by the production of heat-labile (LT) and/or heat-stable (ST) toxins. ETEC are estimated to cause hundreds of millions of cases of diarrheal illness annually. However, it is not clear that all strains are equally equipped to cause disease and asymptomatic colonization with ETEC is common in low-middle income regions lacking basic sanitation and clean water where ETEC are ubiquitous. Recent molecular epidemiology studies have revealed a significant association between strains which produce EatA, a secreted autotransporter protein, and the development of symptomatic infection. Here, we demonstrate that LT stimulates production of MUC2 mucin by goblet cells in human small intestine, enhancing the protective barrier between pathogens and enterocytes. In contrast, using explants of human small intestine as well as small intestinal enteroids, we show that EatA counters this host defense by engaging and degrading the MUC2 mucin barrier to promote bacterial access to target enterocytes and ultimately toxin delivery suggesting that EatA plays a crucial role in the molecular pathogenesis of ETEC. These findings may inform novel approaches to prevention of the acute diarrheal illness as well as the sequelae associated with ETEC and other pathogens that rely on EatA and similar proteases for efficient interaction with their human hosts.

Enterotoxigenic Escherichia coli degrades the host MUC2 mucin barrier to facilitate critical pathogen-enterocyte interactions in human small intestine.

Enterotoxigenic Escherichia coli (ETEC) are a genetically diverse pathologic variant of E. coli defined by the production of heat-labile (LT) and/or heat-stable (ST) toxins. ETEC are estimated to cause hundreds of millions of cases of diarrheal illness annually. However, it is not clear that all strains are equally equipped to cause disease and asymptomatic colonization with ETEC is common in low-middle income regions lacking basic sanitation and clean water where ETEC are ubiquitous. Recent molecular epidemiology studies have revealed a significant association between strains which produce EatA, a secreted autotransporter protein, and the development of symptomatic infection. Here, we demonstrate that LT stimulates production of MUC2 mucin by goblet cells in human small intestine, enhancing the protective barrier between pathogens and enterocytes. In contrast, using explants of human small intestine as well as small intestinal enteroids, we show that EatA counters this host defense by engaging and degrading the MUC2 mucin barrier to promote bacterial access to target enterocytes and ultimately toxin delivery suggesting that EatA plays a crucial role in the molecular pathogenesis of ETEC. These findings may inform novel approaches to prevention of the acute diarrheal illness as well as the sequelae associated with ETEC and other pathogens that rely on EatA and similar proteases for efficient interaction with their human hosts.

Does attitude towards wife beating determine infant feeding practices during diarrheal illness in sub-Saharan Africa?

Background Inappropriate feeding practices of children during illness remains a public health problem globally, particularly in sub-Saharan Africa (SSA). One strategy to improve child health outcomes is through women empowerment—measured by wife beating attitude. However, the role of attitude towards wife beating in child feeding practices has not been comprehensively studied. Therefore, we investigated the association between women's attitude towards wife beating and child feeding practices during childhood diarrhea in 28 countries in SSA. Methods We analyzed data from the Demographic and Health Survey on 40,720 children under 5 years. Bivariate and multivariate binary logistic regression analyses were applied to assess the association between women's attitude towards wife beating and child feeding practices. The results were presented using adjusted odds ratio (aOR) with 95% confidence intervals (CIs). Results The pooled results showed that appropriate feeding practices during diarrheal illness among under-five children was 9.3% in SSA, varying from 0.4% in Burkina Faso to 21.1% in Kenya. Regarding regional coverage, the highest coverage was observed in Central Africa (9.3%) followed by East Africa (5.5%), Southern Africa (4.8%), and West Africa (4.2%). Women who disagreed with wife-beating practices had higher odds of proper child feeding practices during childhood diarrhea compared to those who justified wife-beating practices (aOR = 2.02, 95% CI; 1.17–3.48). Conclusion The findings suggest that women’s disagreement with wife beating is strongly associated with proper child feeding practices during diarrheal illness in SSA. Proactive measures and interventions designed to change attitudes towards wife-beating practices are crucial to improving proper feeding practices in SSA.

Infectious Diarrhea, as a Valid Medical and Public, Worldwide Health Problematic

Acute diarrhea of infec­tious etiology, referred to gastroenteri­tis and is associated with clinical signs and symptoms including: nausea, vomiting, abdomi­nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur­gency disorders [10]. Diarrheal illness is a problem worldwide, with substantial regional variation in the prevalence of specific pathogens [8]. In fact, Infectious diarrheal diseases, are the second leading cause of morbidity and mortality worldwide and can cause real public health problems. Such diarrhea was studied as a medical disorder, in a 3 year period, 2017-2020, in Transylvania region from Romania. It was found 3577 number of cases, almost during July to August. The case incidence for the disease arrived at 65%, in the entire summer season. The data were transmitted by 12 district Sanitary Polices, to the Public Health Center. This all were mostly diagnosed by the territorial family doctors and more than 50% , have need some days of hospitalization, because of several disease disorders. For this disorders it was used a specific adequate fluid and electrolyte replacement as key of the treatment, to managing diarrheal illnesses. Even so, 3 children under 5 year’s age died, because of severe complications. Organic failed was estimate to be the cause of their deaths. Clinical and epidemiological evaluation defined the severity and type of this illnesses. The detected infectious etiology for the acute diarrhea, where determined in authorized Microbiology laboratories, and there were identified: Shigella spp, Salmonella spp, Campylobacter spp, Yersinia spp, Rotavirus, Giardia. Most number of cases appeared in children in 63%, followed by elderly or adult people in 17% each, all data as quantified number of determined infectious diarrheas. Acute diarrheal illness had to be considered a major public health issue, against which control efforts are needed. Public health surveillance of infectious acute diarrhea, includes obligatory strategies of infection control. Good hygiene, hand washing, safe food preparation, and access to clean water are key factors in preventing diarrheal illness

Infectious Diarrhea, a Public Health Problem in Population

Infec­tious etiology in acute diarrhea, referred several gastrointestinal diseases, Most are gastroenteri­tis associated with clinical signs and symptoms including: nausea, vomiting, abdomi­nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur­gency disorders. Diarrheal illness is a large worldwide public health problem, with substantial regional variation, in the prevalence of medical signs by being caused by specific pathogens. Infectious diarrheal diseases, are the second leading cause of morbidity and mortality worldwide and can cause real public health concerns. Such diarrhea was studied as a medical disorder, in a 3 years period, 2017 to 2020, in Transylvania a large region in Romania. It was found there, 3577 number of diarrheal diseases cases, appeared almost during July to August. The case incidence for the disease arrived at 65%, in the entire summer season. The cases data were transmitted by 12 district Sanitary Polices, to the Public Health Center Cluj. Cases were almost diagnosed by the family doctors of the region, in more then 50%. Few of this have need some days of hospitalization, because of several disease disorders, in which case it was used a specific adequate fluid and electrolyte replacement as key of the treatment, for managing diarrheal illnesses. Even so, 3 children under 5 years age died, because of severe complications. It was remarked so, organic failed who was estimate to be the cause of their deaths. Clinical and epidemiological evaluations were done and even defined the severity and type of this mentioned illnesses. The detected infectious etiology for the acute diarrheas, where determined in authorized Microbiology laboratories, where were identified: Shigella spp, Salmonella spp, Campylobacter spp, Yersinia spp, Rotavirus, Giardia. Most number of cases appeared in children, being suggestive in 63%, followed by elderly or adult people in 17% each. Acute diarrheal illness had to be considered a major public health issue, against which some determined control efforts are needed. Public health surveillance of infectious acute diarrhea, includes obligatory done strategies for a correct infection control.

Infectious Diarrhea, a Public Health Problem in Population

Infec­tious etiology in acute diarrhea, referred several gastrointestinal diseases, Most are gastroenteri­tis associated with clinical signs and symptoms including: nausea, vomiting, abdomi­nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur­gency disorders. Diarrheal illness is a large worldwide public health problem, with substantial regional variation, in the prevalence of medical signs by being caused by specific pathogens. Infectious diarrheal diseases, are the second leading cause of morbidity and mortality worldwide and can cause real public health concerns. Such diarrhea was studied as a medical disorder, in a 3 years period, 2017 to 2020, in Transylvania a large region in Romania. It was found there, 3577 number of diarrheal diseases cases, appeared almost during July to August. The case incidence for the disease arrived at 65%, in the entire summer season. The cases data were transmitted by 12 district Sanitary Polices, to the Public Health Center Cluj. Cases were almost diagnosed by the family doctors of the region, in more then 50%. Few of this have need some days of hospitalization, because of several disease disorders, in which case it was used a specific adequate fluid and electrolyte replacement as key of the treatment, for managing diarrheal illnesses. Even so, 3 children under 5 years age died, because of severe complications. It was remarked so, organic failed who was estimate to be the cause of their deaths. Clinical and epidemiological evaluations were done and even defined the severity and type of this mentioned illnesses. The detected infectious etiology for the acute diarrheas, where determined in authorized Microbiology laboratories, where were identified: Shigella spp, Salmonella spp, Campylobacter spp, Yersinia spp, Rotavirus, Giardia. Most number of cases appeared in children, being suggestive in 63%, followed by elderly or adult people in 17% each. Acute diarrheal illness had to be considered a major public health issue, against which some determined control efforts are needed. Public health surveillance of infectious acute diarrhea, includes obligatory done strategies for a correct infection control.

Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings

Introduction: Although water, sanitation, and hygiene interventions are effective in reducing diarrhea, there are methodological issues regarding the research tools used to evaluate their health impact. Moreover, there is limited research on individuals' subjective interpretations of diarrheal illness which may introduce further limitations in relying on self-reported data. Therefore, we conducted a study that aims to understand adolescents' perceptions of diarrheal illness in rural Tamil Nadu, India. Next, we wish to explore the acceptability of the Bristol Stool Form Scale to assess self-reported diarrhea in water, sanitation, and hygiene interventions involving adolescent participants in low-resource settings.Materials and Methods: The study was conducted as part of the formative research phase in the cultural adaptation of Project SHINE, a school-based educational water, sanitation, and hygiene intervention in Thirumalaikodi, Tamil Nadu, India. A convergent parallel mixed-methods study design with a purposive sampling strategy was used. Qualitative data included 10 in-depth interviews with student participants aged 13–14. Quantitative data were collected through interviewer-administered face-to-face surveys (n = 14) and one-week stool diaries (n = 14). Each data set was analyzed separately and compiled during the interpretation of the findings.Results: Across all data sets, diarrhea was reported to be perceived as unhealthy and an irregular occurrence among participants. Participants also reported diarrheal-taboos, local methods to cure or control diarrhea, and discussed how diarrheal illness can lead to absenteeism or withdrawal from school and social activities. Moreover, participants were able to understand and answer questions about their stool using the Bristol Stool Form Scale, suggesting that is an acceptable tool.Discussion: Visual tools demonstrate promise in improving self-reported diarrheal illness among adolescents in low-resource settings in India. However, until we address diarrhea-related taboos it will be difficult to address methodological issues in the assessment and reporting of diarrheal illness among adolescents.