Etiología infecciosa e indicadores de malabsorción o daño intestinal en diarrea infantil

Adson Santos Martins, Samara Alves Santos, Cláudia Alves da Silva Lisboa, Tânia Fraga Barros, Tereza Cristina Medrado Ribeiro, Hugo da Costa-Ribeiro, Ângela Peixoto de Mattos, Patrícia Silva de Almeida Mendes, Carlos Maurício Cardeal Mendes, Edna Lúcia Souza, Ana Lúcia Moreno Amor, Neci Matos Soares, Márcia Cristina Aquino Teixeira, .

Palabras clave: diarrea infecciosa, niños, enterobacterias, enterovirus, Entamoeba histolytica, Giardia duodenalis, Blastocystis rotavirus, esteatocrito

Resumen

Introducción. La etiología multifactorial de la gastroenteritis enfatiza la necesidad de usar diferentes métodos de laboratorio para identificar o excluir agentes infecciosos y evaluar la gravedad de la enfermedad diarreica.
Objetivo. Diagnosticar la etiología infecciosa de la diarrea en niños y evaluar algunos marcadores fecales asociados con la integridad intestinal.
Materiales y métodos. Se estudiaron 45 niños con enfermedad diarreica, en los cuales se evaluaron la presencia de enteropatógenos y los marcadores de malabsorción. Se analizaron las muestras fecales de 76 niños, mediante las pruebas de esteatocrito tradicional y esteatocrito ácido, para la cuantificación de la grasa.
Resultados. Se observó diarrea aguda en el 80 % de los niños y diarrea persistente en el 20 %. De los individuos con diarrea, el 40 % fue positivo para enteropatógenos; los más diagnosticados fueron rotavirus (13,3 %) y Giardia duodenalis (11,1 %). Entre los pacientes infectados, la sangre oculta fue más evidente en aquellos portadores de bacterias patógenas (40 %) o enterovirus (40%), mientras que la esteatorrea se observó en infecciones por el protozoo G. duodenalis (35,7 %). Los niños con diarrea excretaron significativamente más lípidos en las heces que aquellos sin diarrea, según lo determinado por los métodos de esteatocrito tradicional (p<0,0003) y esteatocrito ácido (p<0,0001).
Conclusiones. La diarrea infantil puede provocar deficiencias graves de nutrientes. La esteatorrea es distintiva de la malabsorción intestinal y puede detectarse mediante la estimación del esteatocrito ácido. Esta prueba podría utilizarse de forma rutinaria como una herramienta de laboratorio para la evaluación semicuantitativa de la malabsorción de grasas en niños con diarrea.

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Referencias bibliográficas

Brandt KG, Antunes MMC, Silva GAP. Acute diarrhea: Evidence-based management. J Pediatr (Rio J). 2015;91(Supp.1):S36-43. https://doi.org/10.1016/j.jped.2015.06.002

Global Burden of Diseases, Injuries, and Risk Factors Study. Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: A systematic analysis for the global burden of disease study 2016. Lancet Infect Dis. 2018;18:1211-28. https://doi.org/10.1016/S14733099(18)30362-1

Flórez ID, Niño-Serna LF, Beltrán-Arroyave CP. Acute infectious diarrhea and gastroenteritis in children. Curr Infect Dis Rep. 2020;22:4. https://doi.org/10.1007/s11908-020-0713-6

Pereira IV, Cabral IE. Diarréia aguda em crianças menores de um ano: subsídios para o delineamento do cuidar. Esc Anna Nery Rev Enferm. 2008;12:224-9. https://doi.org/10.1590/S1414-81452008000200004

Behera DK, Mishra S. The burden of diarrhea, etiologies, and risk factors in India from 1990 to 2019: Evidence from the global burden of disease study. BMC Public Health. 2022;22:92. https://doi.org/10.1186/s12889-022-12515-3

World Health Organization. Diarrhoeal disease. Accessed: 18 January 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

Cohen AL, Platts-Mills JA, Nakamura T, Operario DJ, Antoni S, Mwenda JM, et al. Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: Findings from the Global Pediatric Diarrhea Surveillance network. BMJ Glob Health. 2022;7:e009548. https://doi.org/10.1136/bmjgh-2022-009548

Merino VR, Nakano V, Delannoy S, Fach P, Alberca GGF, Farfan MJ, et al. Prevalence of enteropathogens and virulence traits in Brazilian children with and without diarrhea. Front Cell Infect Microbiol. 2020;10:549919. https://doi.org/10.3389/fcimb.2020.549919

Keller J, Layer P. The pathophysiology of malabsorption. Viszeralmedizin. 2014;30:150-4. https://doi.org/10.1159/000364794

Khouri MR, Huang G, Shia YF. Sudan stain of fecal fat: New insight into an old test. Gastroenterol. 1989;96:421-7. https://doi.org/10.1016/0016-5085(89)91566-7

Maranhão HS, Wehba J. Steatocrit and Sudan III in the study of steatorrhea in children: Comparison with the van de Kamer method. Arq Gastroenterol. 1995;32:140-5.

Sugai E, Srur G, Vázquez H, Benito F, Mauriño E, Boerr LA, et al. Steatocrit: A reliable semiquantitative method for detection of steatorrhea. J Clin Gastroenterol. 1994;19:206-9. https://doi.org/10.1097/00004836-199410000-00007

Cueto Rua EA, Nanfito G, Guzmán L. La enfermedad celíaca. Ludovica Pediátr. 2006;8:85-99.

Castro-Rodriguez JA, Salazar-Lindo E, León-Barúa R. Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements. Arch Dis Child. 1997;77:201-5. https://doi.org/10.1136/adc.77.3.201

Phuapradit P, Narang A, Mendonça P, Harris DA, Baum JD. The steatocrit: A simple method for estimating stool fat content in newborn infants. Arch Dis Child. 1981;56:725-7. https://doi.org/10.1136/adc.56.9.725

Tran M, Forget P, van Den Neucker A, Strik J, van Kreel B, Kuijten R. The acid steatocrit: A much improved method. J Pediatr Gastroenterol Nutr. 1994;19:299-303. https://doi.org/10.1097/00005176-199410000-00007

Faust EC, D’antoni JS, Odom V, Miller MJ, Peres C, Sawitz W, et al. A critical study of clinical laboratory technics for the diagnosis of protozoan cysts and helminth eggs in feces I. Preliminary communication. Am J Trop Med. 1938;18:169-83.

Pacheco FT, Silva RK, Martins AS, Oliveira RR, AlcântaraNeves NM, Silva MP, et al. Differences in the detection of Cryptosporidium and Isospora (Cystoisospora) oocysts according to the fecal concentration or staining method used in a clinical laboratory. J Parasitol. 2013;99:1002-8. https://doi.org/10.1645/12-33.1

Henriksen SA, Pohlenz JF. Staining of cryptosporidia by a modified Ziehl-Neelsen technique. Acta Vet Scand. 1981;22:594-6. https://doi.org/10.1186/BF03548684

Semrad CE. Approach to the patient with diarrhea and malabsorption. Goldman’s Cecil Medicine. 2012;1:895-913. https://doi.org/10.1016/B978-1-4377-1604-7.00142-1

Andrade JAB, Fagundes-Neto U. Diarréia persistente: ainda um importante desafio para o pediatra. J Pediatr (Rio J), 2011;87:199-205. https://doi.org/10.2223/JPED.2087

Motta MEFA, Silva GAP. Diarréia por parasitas. Rev Bras Saúde Mater Infant. 2002;2:117-27. https://doi.org/10.1590/S1519-38292002000200004

Pedraza DF, Queiroz D, Sales MC. Doenças infecciosas em crianças pré-escolares brasileiras assistidas em creches. Ciên Saúde Colet. 2014;19:511-28. https://doi.org/10.1590/1413-81232014192.09592012

Reis LB, Santos RS, Mota LH, Jesus JS, Oliveira JM, Andrade RS, et al. Enteroparasites, demographic profile, socioeconomic status and education level in the rural population of the Recôncavo of Bahia, Brazil. J Trop Pathol. 2019;48:197-210.

Ferreira ALC, Carvalho FF, Nihei OK, Nascimento IA, Shimabuku Junior RS, Fernandes RD, et al. Prevalence of intestinal parasites in children from public preschool in the Triple Border Brazil, Argentina, and Paraguay. ABCS Health Sci. 2021;46:e021205.

Burnett E, Parashar UD, Tate JE. Global impact of rotavirus vaccination on diarrhea hospitalizations and deaths among children <5 years old: 2006-2019. J Infect Dis. 2020;222:1731-9. https://doi.org/10.1093/infdis/jiaa081

Cauás RC, Falbo AR, Correia JB, Oliveira KMM, Montenegro FMU. Diarréia por rotavírus em crianças desnutridas hospitalizadas no Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Rev Bras Saúde Mater Infant. 2006;6:77-83. https://doi.org/10.1590/S1519-38292006000500011

Silva ML, Souza JR, Melo MMM. Prevalência de rotavírus em crianças atendidas na rede pública de saúde do estado de Pernambuco. Rev Soc Bras Med Trop. 2010;43:548-51. https://doi.org/10.1590/S0037-86822010000500015

Muller ECA, Morais MAA, Gabbay Y, Linhares AC. Ocorrência de adenovírus em crianças com gastrenterite aguda grave na Cidade de Belém, Pará, Brasil. Rev Pan-Amaz Saúde. 2010;1:49-55. https://doi.org/10.5123/S2176-62232010000300007

Morillo SG, Timenetsky MCST. Norovírus: uma visão geral. Rev Assoc Med Bras. 2011;57:453-8. https://doi.org/10.1590/S0104-42302011000400023

Wale M, Gedefaw S. Prevalence of intestinal protozoa and soil transmitted helminths infections among schoolchildren in Jaragedo Town, South Gondar Zone of Ethiopia. J Trop Med. 2022;2022:ID 5747978. https://doi.org/10.1155/2022/5747978

Sebaa S, Behnke JM, Baroudi D, Hakem A, Abu-Madi MA. Prevalence and risk factors of intestinal protozoan infection among symptomatic and asymptomatic populations in rural and urban areas of southern Algeria. BMC Infect Dis. 2021;21:888. https://doi.org/10.1186/s12879-021-06615-5

Belloto MVT, Santos Junior JE, Macedo EA, Ponce A, Galisteu KJ, Castro E, et al. Enteroparasitoses numa população de escolares da rede pública de ensino do Município de Mirassol, São Paulo, Brasil. Rev Pan-Amaz Saúde. 2011;2:37-44. https://doi.org/10.5123/S2176-62232011000100004

Newman RD, Moore SR, Lima AAM, Nataro JP, Guerrant RL, Sears CL. A longitudinal study of Giardia lamblia infection in northeast Brazilian children. Trop Med Int Health. 2001;6:624-34. https://doi.org/10.1046/j.1365-3156.2001.00757.x

Wu Y, Yao L, Chen H, Zhang W, Jiang Y, Yang F, et al. Giardia duodenalis in patients with diarrhea and various animals in northeastern China: Prevalence and multilocus genetic characterization. Parasit Vectors. 2022;15:165. https://doi.org/10.1186/s13071-022-05269-9

Silva RKNR, Pacheco FTF, Martins AS, Menezes JF, Costa-Junior HR, Ribeiro TCR, et al. Performance of microscopy and ELISA for diagnosing Giardia duodenalis infection in different pediatric groups. Parasitol Int. 2016;65:635-40. https://doi.org/10.1016/j.parint.2016.08.012

Pacheco FTF, Silva RKNR, Carvalho SS, Rocha FC, Chagas GMT, Gomes DC, et al. Predominance of Giardia duodenalis. AII sub-assemblage in young children from Salvador, Bahia, Brazil. Biomédica. 2020;40:557-68. https://doi.org/10.7705/biomedica.5161

Ocaña-Losada C, Cuenca-Gómez JA, Cabezas-Fernández MT, Vázquez-Villegas J, Soriano-Pérez MJ, Cabeza-Barrera I, et al. Clinical and epidemiological characteristics of intestinal parasite infection by Blastocystis hominis, Rev Clin Española. 2018;218:115-20. https://doi.org/10.1016/j.rceng.2018.01.008

Dourado A, Maciel A, Aca IS. Ocorrência de Entamoeba histolytica/Entamoeba dispar em pacientes ambulatoriais de Recife, PE. Rev Soc Bras Med Trop. 2006;39:388-9. https://doi.org/10.1590/S0037-86822006000400015

Soares NM, Azevedo HC, Pacheco FTF, Souza JN, Del-Rey RP, Teixeira MCA, et al. A cross-sectional study of Entamoeba histolytica/dispar/moshkovskii complex in Salvador, Bahia, Brazil. Biomed Res Int. 2019;2019:7523670. https://doi.org/10.1155/2019/7523670

Santos FLN, Goncalves MS, Soares NM. Validation and utilization of PCR for differential diagnosis and prevalence determination of Entamoeba histolytica/ Entamoeba dispar in Salvador City, Brazil. Braz J Infect Dis. 2011;15:119-25. https://doi.org/10.1016/S1413-8670(11)70156-8

Franzolin MR, Alves RCB, Kellertânia R, Gomes TAT, Beutin L, Barreto ML, et al. Prevalência de Escherichia coli diarreica em crianças com diarréia em Salvador, Bahia, Brasil. Mem Inst Oswaldo Cruz. 2005;100:359-63. https://doi.org/10.1590/S0074-02762005000400004

Moura MR, Mello MJG, Calábria WB, Germano EM, Maggi RR, Correia JB. Frequência de Escherichia coli e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarréia aguda. Rev Bras Saúde Mater Infant. 2012;12:173-82. https://doi.org/10.1590/S1519-38292012000200008

Lopes AIG, Trindade E, Pereira F, Antunes H, Dias JÁ, Ferreira R, et al. Gastrenterologia Pediátrica: aspectos práticos. Editor: Pereira F, SPED. Serviço de Gastrenterologia Pediátrica. Hospital Maria Pia. Centro Hospitalar do Porto, 2010. Accessed: 15 January 2023. Available: https://www.sped.pt/images/Publicacoes_SPED/LivroGastroPediatrica_Jul10.pdf

Hendrawati LD, Firmansyah A, Darwis D. Macronutrient malabsorption in acute diarrhea: Prevalence and affecting factors. Paediatr Indones. 2005;45:207-10.

Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, Tilburg M. Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterol. 2006;130:1527-37. https://doi.org/10.1053/j.gastro.2005.08.063

van der Neucker A, Kerkvliet EM, Theunissen PMVM, Forget PPH. Acid steatocrit: A reliable screening tool for steatorrhea. Acta Paediatr. 2007;90:873-5. https://doi.org/10.1111/j.1651-2227.2001.tb02448.x

Mendes PS, Ribeiro Junior HC, Mendes CM. Tendência temporal da mortalidade geral e morbidade hospitalar por doença diarreica em crianças brasileiras menores de cinco anos no período de 2000 a 2010. J Pediatr (Rio J). 2013; 89:315-25. https://doi.org/10.1016/j.jped.2012.10.002

Cómo citar
1.
Martins AS, Santos SA, Lisboa CA da S, Barros TF, Ribeiro TCM, da Costa-Ribeiro H, et al. Etiología infecciosa e indicadores de malabsorción o daño intestinal en diarrea infantil. biomedica [Internet]. 31 de marzo de 2024 [citado 15 de junio de 2024];44(1):80-91. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/6913
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2024-03-31
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