Peggy Sullivan

Occurrence of Giardia lamblia in children in day care centers

We prospectively evaluated excretion of Giardia lamblia in children in day care centers in Houston by conducting two prevalence studies of 600 children enrolled in 30 DCC, day care centers, and an 18-month longitudinal study in 82 children in one center. In the two prevalence surveys, Giardia cysts were identified in 72 (21%) and 67 (26%) children, respectively, who provided stool specimens. Trophozoites were found in 15 (4%) and 8 (3%), respectively. There was no correlation between the frequency of recent diarrheal episodes and the finding of Giardia. Stool specimens containing cysts were significantly (P less than 0.0001) more frequent in the 13- to 30-month-old children than in children younger than 12 months. Children attending day care centers for more than 3 months were more likely to be excreting Giardia than those attending for less than 3 months. In the longitudinal study, cysts were detected in stool specimens from 27 (33%) of the 82 children at least once during the survey. Twelve children had Giardia cysts in weekly stool specimens for a mean of 6.2 +/- 1.2 months and trophozoites for 3.3 +/- 1.2 months. The number of enteric symptoms observed in children and the classification of nutritional status based on monthly height and weekly weight measurements did not differ significantly when infected and noninfected children were compared. Asymptomatic Giardia excretion in children younger than 36 months is common and appears to be well tolerated.

Longitudinal study of occurrence of diarrheal disease in day care centers.

Sixty day care centers (DCC) randomly selected from 736 licensed child care facilities in Harris County (Houston), Texas were surveyed for the incidence of diarrhea by periodic visits and weekly telephone calls over two years. A total of 2,708 episodes of diarrhea were reported in 3,800 children under 6 years of age, and 84 cases occurred in center staff. Overall incidence was 0.44 episodes/person/year among children and 0.14 among staff. Attack rates among the 60 DCC ranged from none to 3.64 cases/year in each child. The incidence for children under 36 months of age was 17 times higher than for the older group. Characteristics of DCC associated with higher rates of disease among children were the presence of young, non-bowel trained children, staff who both diapered infants and prepared food on a regular basis, DCC for profit management, and DCC whose only guidelines were provided by the State. The socioeconomic burden associated with DCC disease, its transmission, and control is considerable and needs to be further addressed.

Prevention of Travelers' Diarrhea With Trimethoprim-Sulfamethoxazole and Trimethoprim Alone

One hundred forty-five students from the United States enrolled in a study designed to look at the protective effect of trimethoprim-sulfamethoxazole or trimethoprim alone in preventing diarrhea during study in Mexico. A highly significant difference (p

Failure to demonstrate effectiveness of an anticholinergic drug in the symptomatic treatment of acute travelers' diarrhea.

Seventy adults in the United States with acute diarrhea who were attending classes in Guadalajara, Mexico, enrolled in a double-blind placebo-controlled treatment study of an anticholinergic drug, mepenzolate bromide (MZB). Thirty-five patients received MZB (50 mg) and 35 received placebo each taken 4 times daily for 48 hours. No significant difference was detected between the MZB- and placebo-treated patients in symptoms or in the frequency or character of stools. Recovery rates of 24.1% and 31% for placebo- and MZB-treated patients were similar. Despite the occurrence of anticholinergic side effects in 51% of MZB- versus 14% of placebo-treated patients (P less than 0.001), therapeutic efficacy was not detected. We do not recommend anticholinergic drugs for therapy in acute infectious diarrhea.

Efficacy of Bicozamycin in Treatment of Acute Diarrhea Caused by Enterotoxigenic Escherichia Coli

Bicozamycin is a new antibiotic first reported by Miyoshi, et al., in 1972.(1) Bicozamycin is poorly absorbed from the gastrointestinal tract. Its spectrum of activity includes many enteropathogens including Escherichia coli in which bicozamycin appears to interfer with biosynthesis of lipoprotein and its incorporation into peptidoglycan in the cell wall.(2) Bicozamycin has no apparent activity against gram-positive, anaerobic organisms, Proteus or Pseudomonas. Finally, plasmid-mediated resistance has been looked for, but only chromosomal resistance to bicozamycin has so far been demonstrated. In view of these features of bicozamycin, a prospective, randomized, double-blind, placebo controlled study of bicozamycin in the empiric treatment of acute diarrhea in a population of U.S. adults newly arrived in Guadalajara, Mexico, was conducted.