Enteropathogenic Escherichia coli and life threatening chronic diarrhoea

Article Abstract:

Escherichia coli is a bacillus (a type of bacteria) found throughout the gastrointestinal tract, predominantly in the colon, in humans. Ordinary forms of E. coli do not cause any adverse gastrointestinal symptoms; however certain varieties (enteropathogenic strains) are known to be responsible for 'traveler's diarrhea', resulting from the ingestion of contaminated or uncooked foods. It is not well recognized that enteropathogenic strains of E. coli (EPEC) can be responsible for conditions more severe than the temporary inconvenience of traveler's diarrhea. Evidence is presented from patients admitted to a London hospital over a three-year period (1984 to 1987) that infestation with EPEC can cause diarrhea that is life-threatening. During this time period, 790 children were admitted to the hospital with one form or another of gastroenteritis (inflammation of the stomach or intestine); 26 of these patients had EPEC infestation. Six of the infected patients (23 percent) developed chronic, severe diarrhea. In contrast, only 2 of 42 (5 percent) children with other forms of gastroenteritis (unrelated to EPEC infection) developed chronic diarrhea. The clinical picture and medical history of the EPEC-infected patients included previous good health, no evidence of immunodeficiency, and three of the six had recently traveled abroad (most to the Indian subcontinent). All patients with chronic diarrhea were given hypoallergenic foods, two were fed intravenously, and three were treated with intravenous antibiotics. All patients eventually recovered. It is concluded that EPEC infection is a relatively common, treatable cause of life-threatening chronic diarrhea in young children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Escherichia coli, Diarrhea, Escherichia coli infections, Medical bacteriology

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Management of intractable epilepsy

Article Abstract:

Intractable epilepsy is epilepsy that does not respond to conventional antiepileptic drugs. If a child appears to have intractable epilepsy a complete reevaluation of the case should be performed. This process should begin by asking the question does the patient have epilepsy? Several studies have reported that 20 to 30 percent of the patients who are suspected of having intractable epilepsy actually do not have epilepsy. Many of these patients have anoxic seizures (seizures resulting from a lack of oxygen to the brain) or syncope (transient loss of consciousness due to inadequate blood flow to the brain). The second question to ask is what is the cause of the seizures? Computed tomography (CAT scan) and magnetic resonance imaging (MRI) should be performed in all cases of intractable epilepsy. If the diagnosis of epilepsy is confirmed then it is important to determine if it truly is intractable. It has been reported that only 10 to 20 percent of childhood epilepsies are intractable. In deciding if the epilepsy is intractable the patient's medical history should be reviewed. In cases where drug treatment failed it may be possible that the drug was not tried for a long enough period of time or that the right combination of drugs were not used. However, in some cases, antiepileptic drugs can aggravate the seizures and the medication should be reduced. There are several options available for treating intractable epilepsy including surgery, special diets, steroids, and immunoglobulins. Attempts should be made to identify all factors or stimuli that aggravate the seizures and these factors should be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Epilepsy in children, Pediatric epilepsy, Spasms, Infantile, Infantile spasms

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