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      Prevalence and characters of Entamoeba histolytica infection in Saudi infants and children admitted with diarrhea at 2 main hospitals at south Jeddah: a re-emerging serious infection with unusual presentation

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          Abstract

          In this study, Entamoeba histolytica had high prevalence and unusual presentation by affecting high proportion of infants under 1 year; severe clinical manifestations, and laboratory findings that were known to be usually encountered in invasive amebiasis as significant leukocytosis for age, neutrophilic leukocytosis for age, and positive C-reactive protein were found among more than 50% of admitted Saudi infants and children with E. histolytica infection in our locality. E. histolytica can be a re-emerging serious infection when it finds favorable environmental conditions and host factors which are mainly attributed to inadequate breastfeeding in this study. This may occur in any other area of the world with the same risk factors, so we must be ready to tackle it with effective and more powerful preventive measures.

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          Epidemiologic and clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh.

          The epidemiology, clinical features, nutritional status, and causative agents of diarrhea were studied in 289 Bangladeshi children (147 boys and 142 girls) 2-5 years old. The use of improved diagnostic tests for amebiasis enabled for the first time analysis of the contribution of Entamoeba histolytica to total diarrheal illness in this community setting. The average incidence rate of diarrhea was 1.8/child-year, and the average number of diarrheal days was 3.7 days/child-year over an average observation period of 2.8 years/child. Seventy-five percent of the diarrheal episodes were < or = 2 days in duration. Persistent diarrhea was relatively uncommon (0.2% of the children) and chronic diarrhea was observed in only one episode. Compared with malnourished and/or stunted children, better-nourished children experienced significantly fewer diarrheal episodes. The diarrheal incidence rate for children with blood group A was significantly less that that of the children with blood groups O and AB. The most frequent bacterial enteropathogens isolated from diarrheal stool specimens were enterotoxigenic Escherichia coli (9%) and Aeromonas species (9%), followed by Plesimonas shigelloides (4%) and Shigella flexneri (3.8%). Rotavirus was the most common viral agent isolated from diarrheal stool samples (5%). Giardia lamblia, Cryptosporidium parvum, and E. histolytica were identified in 11%, 8.4%, and 8%, respectively, of the diarrheal stool specimens. Dysentery was observed in 7.7% of all diarrheal episodes. The most common pathogens isolated from dysenteric stool were S. flexneri (11.6%), Aeromonas sp. (10%), E. histolytica (8.7%), Campylobacter jejunii (5.8%), P. shigelloides (4.3%), and A. caviae (4.3%). The overall incidence rate of E. histolytica-associated diarrhea was 0.08/child-year. Visible blood and hemoccult test-detected blood loss was found in 7% and 25%, respectively, of cases of E. histolytica-associated diarrhea. Children who had recovered from a diarrheal episode with E. histolytica, but not E. dispar, had half the chance of developing subsequent E. histolytica-associated diarrhea, consistent with the development of species-specific acquired immunity. In conclusion, the use of modern diagnostic tests demonstrated that E. histolytica contributed to overall morbidity from diarrheal illness. Understanding the etiology, frequency, and consequences of acute diarrhea in children from a developing country should aid in the design of interventions to improve child health.
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            Determinants of initiation and exclusivity of breastfeeding in Al Hassa, Saudi Arabia.

            The objectives of this cross-sectional study were to define the possible determinants of early initiation and exclusivity of breastfeeding and to assess knowledge towards breastfeeding among Saudi mothers in Al Hassa, Saudi Arabia. Six hundred forty-one Saudi mothers with singleton infants approximately 24 months old attending well-baby clinics at four urban and six rural primary health care centers were selected through the multistage sampling method. Eligible mothers were invited to a personal interview using pretested questionnaires to gather data regarding sociodemographics, health-related variables, breastfeeding initiation, and current breastfeeding practices and to assess mothers' knowledge about breastfeeding. Breastfeeding was initiated by 77.8% of mothers within the first 24 hours of childbirth. Exclusive breastfeeding at birth was reported in 76.1%, which declined to 32.9% and 12.2% at the age of 2 and 6 months, respectively. Increased maternal age, multiparity (three or more children), and vaginal delivery were significant positive predictors for early breastfeeding initiation as revealed by stepwise logistic forward regression. Rural, less-educated, low-income multiparous mothers were more likely to exclusively breastfed their infants as revealed by multivariate logistic regression. Irrespective of educational status, surveyed mothers demonstrated several misconceptions towards breastfeeding. Furthermore, early initiations and exclusivity were significantly influenced by sociodemographics, especially maternal educational and employment status. The rate of initiation and exclusivity of breastfeeding in Al Hassa is far below the World Health Organization recommendations.
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              Intestinal parasitic infections in man: a review.

              Intestinal parasites of importance to man are Enterobius vermicularis, the soil-transmitted helminthes (STH)--Ascaris lumbricoides Tricburis trichiura, bookworms (Necator americans/Ancylostoma duodenale) and Strongyloides stercoralis and the protozoa Entamoeba histolytica and Giardia duodenalis. Other protozoa such as Cryptosporidium sp. and Isopora sp. are becoming important in causing prolonged diarrhea in immunocompromised patients. It is estimated that almost 1 billion, 500 million and 900 million people worldwide are infected by the major nematode species--A. lumbricoides, T. trichiura and hookworms respectively. Most of the infections are endemic and widely distributed throughout poor and socio-economically deprived communities in the tropics and subtropics. Environmental, socio-economic, demographic and health-related behavior is known to influence the transmission and distribution of these infections. In giardiasis, one study indicates that age < or = 12 years and the presence of family members infected with Giardia were risk factors for infection. Most of the infections occur in children and both genders are equally affected. Epidemiological studies of STH infections have shown that the prevalence and intensity of infection are highest among children 4-15 years of age. The frequency of distribution of STH infections is over-dispersed and highly aggregated. areas reinfection can occur as early as 2 months post-treatment, and by 4 months, almost half of the population treated become reinfected. By 6 months the intensity of infection was similar to pretreatment level.
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                Author and article information

                Contributors
                Journal
                Braz J Infect Dis
                Braz J Infect Dis
                The Brazilian Journal of Infectious Diseases
                Elsevier
                1413-8670
                1678-4391
                01 January 2013
                Jan-Feb 2013
                01 January 2013
                : 17
                : 1
                : 32-40
                Affiliations
                [a ]Department of Pediatric, Mansoura University Children's Hospital, Infectious Diseases Unit, Mansoura, Egypt
                [b ]King Abdulaziz University, Faculty of Medicine in Rabigh, Jeddah, Saudi Arabia
                [c ]Clinical Pathology Department, Ibn Sina College Hospital and Al-Jedaani Hospital, Jeddah, Saudi Arabia
                [d ]Department of Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt
                Author notes
                [* ] Corresponding author at: Mansoura University Children's Hospital, Infectious Diseases Unit, Mansoura, Egypt. Tel.: +20 1001020941, fax: +20 502234092; King Abdulaziz University, Faculty of Medicine in Rabigh, Jeddah, Saudi Arabia. Tel.: +966541368683, fax: +966026400592. mhegazi712003@ 123456yahoo.co.uk
                Article
                S1413-8670(12)00262-0
                10.1016/j.bjid.2012.08.021
                9427352
                23287546
                4874f0fd-12b7-4a78-8256-60503100bb57
                © 2013 Elsevier Editora Ltda.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 27 June 2012
                : 21 August 2012
                Categories
                Original Article

                entamoeba histolytica,saudi,infants,children
                entamoeba histolytica, saudi, infants, children

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