Dissertationen zum Thema „Diarrhea – therapy“

Dissertação de Mestrado Integrado em Medicina Veterinária
A criptosporidiose é uma das mais importantes causas de diarreia neonatal bovina, sendo uma potencial ameaça à produção e uma importante causa de prejuízos económicos. Vitelos recém-nascidos e até ao desmame são especialmente susceptíveis à infecção e desenvolvimento de sinais clínicos pelo parasita protozoário Cryptosporidium parvum, já que nascem quase completamente desprovidos de mecanismos de imunidade naturais. Este parasita é considerado existente mundialmente, ubiquitário, sem especificidade ao hospedeiro e oportunista. Os efeitos da infecção, nomeadamente a diarreia, desidratação e desequilibrios electrolíticos, juntamente com acidose metabólica, enfraquecem os animais e podem originar elevados níveis de morbilidade e mortalidade moderada, especialmente quando associado a outros agentes. Actualmente não é conhecido nenhum tratamento específico completamente eficaz no combate à criptosporidiose bovina. O tratamento baseia-se na terapia de suporte por meio de fluidoterapia oral e endovenosa. Medidas preventivas assentes em melhorias de higiene e administração correcta de colostro são consideradas as mais importantes. O potencial zoonótico do parasita, especialmente em indivíduos imuno-deprimidos, levanta preocupações de saúde pública. No presente trabalho, foram elaborados 2 estudos clínicos, tentando confirmar a existência, prevalência e sinais clínicos de criptosporidiose em regiões na Alemanha e em Portugal. Na Universidade Justus-Liebig em Giessen, Alemanha, 35 vitelos foram examinados tendo em conta os seus sinais clínicos. Vinte e dois dos animais examinados demonstraram sinais de diarreia e, entre estes, 36% excretavam oocistos. Seguiu-se um exame mais detalhado dos animais infectados, incluindo o estudo dos sinais clínicos e dos valores laboratoriais. Os sinais clínicos e laboratoriais detectados confirmaram os esperados (característicos da criptosporidiose), incluindo diarreia fluida, desidratação, fraqueza e hipotermia; acidose metabólica, aumento dos níveis de lactato e hiponatremia. Todos os vitelos recuperaram após fluidoterapia, controlo da acidose e antibioterapia. Lactato de halofuginona foi administrado em alguns animais mas não demonstrou efeitos evidentes. Em Portugal, 30 vitelos foram examinados numa exploração de engorda na área do Ribatejo, considerando os seus sinais clínicos e a presença de oocistos após análise pela técnica de Ziehl-Neelsen modificada. A prevalência foi elevada (43%). Os sinais clínicos variaram e a excreção de oocistos nem sempre estava acompanhada de diarreia (portadores assintomáticos). A evolução de quinze vitelos re-examinados variou, evidenciando por um lado a existência do carácter autolimitante (3 vitelos melhoraram) e por outro um possível aumento da mortalidade (2 vitelos morreram) associados à doença.
ABSTRACT - Cryptosporidiosis in pre-weaned calves – Observations in Germany and Portugal - Cryptosporidiosis is one of the most important causes of bovine neonatal diarrhea, being considered an important threat to bovine production and a cause of economical losses. Pre-weaned, neonatal calves are particularly prone to the infection and development of clinical signs due to the protozoan parasite Cryptosporidium parvum, as they are born almost completely deprived of natural immunity. This parasite is a worldwide existing, ubiquitous, non host specific and opportunistic agent of diarrhea. Dehydration and electrolyte imbalances, coupled with metabolic acidosis, weaken the animals and may cause high morbidity rates and moderate mortality, especially when occurring in combination with other infectious agents. No completely effective specific treatment for calf cryptosporidiosis is known to this date. Treatment is mainly based on supportive care by oral and intravenous fluid therapy. Prevention by hygiene measures, correct colostral administration and management seem to be most important. Public health concerns arise due to its zoonotic potential, especially in immune compromised individuals. In the present dissertation, two case studies were developed, trying to confirm the existence, prevalence and clinical signs of cryptosporidiosis in Germany and Portugal. In the Clinics for Obstetrics, Gynecology and Andrology with veterinary ambulance from the Justus Liebig University Giessen, Germany, 35 calves were examined for their clinical signs. 22 of the examined calves showed diarrhea and of these, 36% were positively excreting oocysts. A more detailed examination of the infected calves was performed and clinical signs and laboratory values studied. Detected clinical and laboratory signs could be confirmed by the expected (characteristic signs of cryptosporidiosis), including watery to thin mushy diarrhea, dehydration, weakness and hypothermia; metabolic acidosis, increased levels of lactate and hypernatremia. All calves recovered after alkalinizing fluid therapy and antibiotherapy. Halofuginone lactate was administered to some animals but it was not clear if it caused a major improvement in the recovery. In Portugal, 30 calves were examined in a fattening unit in the Ribatejo area concerning their clinical signs and presence of oocysts after modified Ziehl-Neelsen technique. Prevalence was high with 43% of animals showing oocysts in the faeces. Clinical signs varied and excretion was not always accompanied by diarrhea (assympthomatic carriers). Fifteen of the examined calves were reexamined one month later. Results varied greatly, evidencing on one hand the self-limiting character of the disease (3 calves improved) and, on the other hand, the possible connection of the disease to an increased mortality (2 calves died).

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As taxas de morbimortalidade se elevam quando a diarreia està associada à desnutriÃÃo. Entretanto, os mecanismos pelos quais as deficiÃncias nutricionais afetam o intestino sÃo em grande parte desconhecidos. O objetivo desse trabalho foi avaliar alteraÃÃes morfomÃtricas, nas proteÃnas transportadoras de substratos e no transporte intestinal de eletrÃlitos e Ãgua em modelo de desnutriÃÃo em camundongos. Objetivamos ainda, analisar o efeito da toxina do cÃlera (TC) associada ou nÃo à desnutriÃÃo, sobre as proteÃnas transportadoras de substratos, sobre o transporte hidroeletrolÃtico em camundongos e por fim, avaliamos os efeitos de soluÃÃes de reidrataÃÃo oral (SRO) da OMS (SGli) e modificadas com glutamina (SGln), alanil-glutamina(SAla-Gln) e arginina (SArg) nesse transporte. Camundongos (n=20) receberam por 7 dias uma raÃÃo deficiente em proteÃnas, gorduras e minerais (DBR). Segmentos de Ãleo foram obtidos antes e no 7 dia da dieta, para estudos de morfometria, imunohistoquÃmica para as proteÃnas: SGTL-1, PepT-1, CAT-1 e SN-2 e avaliaÃÃo por RT-qPCR da expressÃo RNAm dessas proteÃnas transportadoras. O modelo de perfusÃo intestinal por 75 min em camundongos (n=6) foi utilizado para avaliar o transporte intestinal de Ãgua e eletrÃlitos e para avaliar o papel de soluÃÃes de reidrataÃÃo oral em camundongos nutridos e desnutridos expostos ou nÃo à toxina do cÃlera (1Âg/ml). Animais desnutridos apresentaram perda ponderal, atrofia dos vilos e reduÃÃo na expressÃo por imunofluorescÃncia da SGTL-1. A desnutriÃÃo causou ainda reduÃÃo na expressÃo do RNAm da SGTL-1 e PEPT-1 e aumento na expressÃo do RNAm para o SN-2 no ileo de camundongos. No modelo de perfusÃo intestinal, a desnutriÃÃo aguda aumentou a secreÃÃo intestinal de eletrÃlitos e Ãgua. A TC aumentou a secreÃÃo de eletrÃlitos e Ãgua em modelo de perfusÃo intestinal de camundongos. A TC aumentou a transcriÃÃo para o RNAm dos transportadores intestinais SGTL-1, PEPT-1 e CAT-1, mas nÃo aumentou a transcriÃÃo para o SN-2. As soluÃÃes de reidrataÃÃo com glicose (SGli), glutamina (SGln), alanil-glutamina (SAla-Gln) e arginina (SArg) diminuÃram a secreÃÃo de eletrÃlitos induzida pela TC. Apenas a SGln nÃo conseguiu diminuir significativamente a secreÃÃo de Ãgua induzida pela TC. Apenas a SGli reduziu a secreÃÃo de Ãgua induzida pela TC. SGli, SAla-Gln e SArg, mas nÃo SGln, diminuÃram a secreÃÃo de sÃdio e cloreto induzida pela TC. A desnutriÃÃo associada à diarreia pela TC causou reduÃÃo na transcriÃÃo para o RNAm dos transportadores intestinais SGTL-1, PEPT-1, CAT-1 e SN-2. A desnutriÃÃo associada à TC aumentou a secreÃÃo de Ãgua quando comparado ao grupo nutrido exposto à TC. SGli, SAla-Gln e SArg, mas nÃo SGln, diminuÃram a secreÃÃo de Ãgua induzida pela desnutriÃÃo associada à TC. Todas as soluÃÃes diminuÃram a secreÃÃo de sÃdio e cloreto induzida pela desnutriÃÃo associada à TC.
The morbidity and mortality rates rise when diarrhea is associated with malnutrition. However, the mechanisms by which nutritional deficiencies affect the gut are largely unknown. The aim of this study was to evaluate morphological changes in transport proteins and substrates in intestinal transport of electrolytes and water in malnutrition model in mice. We aim to further analyze the effect of cholera toxin (CT) with or without malnutrition on the carrier proteins substrates on electrolyte transport in mice and finally, we evaluate the effects of oral rehydration solutions (ORS) of OMS (SGli) e modified with glutamine (SGln), alanyl-glutamine (SAla-Gln) and arginine (SArg) in this transport. Mice (n=20) received for 7 days a diet deficient in protein, fat and minerals (DBR). Segments of ileum were obtained before and on day 7 of the diet, for studies of morphology, immunohistochemistry for proteins: SGTL-1, PEPT-1, CAT-1 and SN-2 and evaluated by RT-qPCR of mRNA expression of these transport proteins. The model of intestinal perfusion for 75 min in mice (n=6) was used to evaluate the intestinal transport of water and electrolytes and to evaluate the role of oral rehydration solutions in mice exposed nourished and malnourished or without cholera toxin (1Âg/ml). Malnourished animals showed weight loss, atrophy of the villi and reduced expression by immunofluorescence of SGTL-1. Malnutrition also caused a reduction in mRNA expression SGTL-1 and PEPT-1 and increased mRNA expression for SN-2 in mice ileum. In the model of intestinal perfusion, acute malnutrition increased intestinal secretion of electrolytes and water. CT increased the secretion of electrolytes and water into the intestinal perfusion model mice. SGli, SGln, SAla-Gln and SArg decreased secretion of electrolytes induced by CT. Just SGln failed to significantly decrease water secretion induced by CT. CT increased mRNA transcription for intestinal transporters SGTL-1, PEPT-1 and CAT-1 but not to increased transcription SN -2. Only SGli reduced water secretion induced by CT. SGli, SAla-Gln and SArg, but not SGln , decreased secretion of sodium and chloride induced by CT. The malnutrition associated with diarrhea caused by TC reduction in the transcription of mRNA for intestinal transporters SGT -1, PEPT-1, CAT-1 and SN-2. Malnutrition associated with CT increased the secretion of water when compared to the group fed exposed to TC. SGli , SAla-Gln and SArg, but not SGln, decreased water secretion induced by malnutrition associated with TC. All solutions decreased secretion of sodium and chlorid induced malnutrition associated with TC.

O objetivo deste trabalho foi avaliar o efeito da utilização de sucedâneo lácteo com alto conteúdo proteico de origem vegetal no desempenho e saúde de bezerros, e avaliar métodos de reidratação para o tratamento de diarreias. No primeiro estudo foram utilizados 33 bezerros da raça Holandês distribuídos nos tratamentos: 1) Alto volume e baixa proteína (AV/BP): 8 litros, 21,4% PB; 2) Alto volume e alta proteína (AV/AP): 8 litros, 23,7% PB e 3) Baixo volume e alta proteína (BV/AP): 6 litros, 23,7% PB. Os bezerros foram alojados em abrigos individuais, com livre acesso a água e concentrado. Não houve efeito dos tratamentos para o desempenho animal (P>0,05). Os tratamentos AV/BP e AV/AP resultaram em maior consumo de sucedâneo (P<0,05), mas não afetaram o consumo de concentrado nem o consumo total (P>0,05). O escore fecal foi maior (P>0,05) para animais nos tratamentos AV/AP e BV/AP. Os animais nos tratamentos AV/BP permaneceram maior número de dias em diarreia (P<0,05), em comparação aqueles aleitados com BV/AP, os quais tiveram menos dias com vida (P<0,05). A concentração de lactato foi maior (P<0,05) para animais nos tratamentos AV/BP e AV/AP enquanto a concentração de proteína total foi maior (P<0,05) nos tratamentos AV/BP e BV/AP. Sucedâneos com elevado conteúdo de proteína de origem vegetal afetam negativamente o desempenho de bezerros podendo levar o animal a morte. No segundo estudo foram comparados três soluções de hidratação oral quanto a sua eficiência em repor eletrólitos e água, além de manter o desempenho de bezerros. Foram utilizados 42 bezerros mestiços Holandês-Jersey, distribuídos nos tratamentos: 1) Soro comum, 2) Glutellac® e 3) Soro comum + Aminogut®. Os animais foram aleitados com 4 L/d de sucedâneo lácteo até a oitava semana de vida quando foram desaleitados de forma abrupta. As terapias de reidratação foram oferecidas quando os animais apresentavam escore fecal >= 3 na escala de 1 a 5. Não houve efeito das terapias de reidratação no desempenho nem em metabólitos sanguíneos (P>0,05). O consumo voluntário de água foi maior para os animais reidratados com Glutellac®, mas o consumo total maior para os animais reidratados com Soro comum. As concentrações de HCO3 e Na+ foram maiores para os animais no tratamento Glutellac® (P=0,088 e P=0,073 respectivamente), sendo a concentração de glicose também afetada pelo protocolo de hidratação (P<0,05). A concentração de HCO3 aumentou do primeiro para o segundo dia, a de K+ e glicose diminuíram do primeiro para o segundo dia, enquanto que o Beecf teve um comportamento variável segundo a terapia de reidratação utilizada. Houve efeito da interação tratamento x dia de avaliação apenas para a concentração de BUN (P<0,05). O pH, a concentração de Na+ e Beecf foram maiores em animais mais velhos, enquanto K+, hematócrito e hemoglobina, foram menores (P<0,05). O consumo voluntário de água foi maior em animais reidratados com Glutellac®, o que junto com a simplicidade de uso, representam as principais vantagens deste método de reidratação.
The objective of this study was to evaluate the effect of milk replacer with high inclusion of vegetable protein in regard to performance and health of dairy calves, and evaluate rehydration methods for the treatment of diarrhea. In the first study 33 Holstein calvesdistributed in the treatments: 1) High volume and low protein (HV/LP): 8L/d, 21.4% CP; 2) High volume and high protein (HV/HP): 8L/d, 23.7% CP and 3) low volume and high protein (LV/HP): 6L/d, 23.7% CP. The calves were housed in individual shelters, with free access to water and starter concentrate. There was no effect of the treatments for animal performance (P>0.05). The treatments HV/LP and HV/HP resulted in higher milk replacer intake (P<0.05), but did not affect concentrate intake, neither the total dry matter intake (P>0.05). The fecal score was higher (P>0.05) for animals in treatments HV/HP and LV/HP. The animals in the treatments HV/LP remained more days in diarrhea (P<0.05), compared to LV/HP animals, which had fewer days with life (P<0.05). Lactate concentration was higher (P<0.05) for animals in treatments HV/LP and HV/HP while the concentration of total protein was higher (P<0.05) in treatments HV/LP and LV/HP. The use of milk replacer with high contents of vegetal protein, negatively affects the performance of calves and could lead to animals´ death. In the second study, three oral rehydration protocols were compared in regard to their efficiency in replace electrolytes and water, and in the maintenance of calves performance. Forty-two crossbred calves were used Holstein-Jersey, distributed in the treatments: 1) Common electrolytes oral solution, 2) Glutellac® and 3) Common electrolytes oral solution + Aminogut®. Calves were feed with 4 L/d of milk replacer until the eighth week of life when they were abruptly weaned. The rehydration therapy were offered when the animals presented fecal score >= 3 in a scale of 1 to 5. There was no effect of rehydration therapies for the variables related to animal\'s performance neither for blood metabolites (P>0.05). Voluntary water intake was greater for the animals that were rehydrated with Glutellac®, however total intake was higher for animals rehydrated with a common electrolytes oral solution. HCO3 and Na+ concentration were higher for the animals in the treatment Glutellac® (P=0.088 and p=0.073, respectively) being the glucose concentration also affected by protocol of rehydration (P<0.05). The HCO3 was increased from the first to the second day, the K+ and glucose reduced from the first to the second day, while the Beecf was variable according to rehydration therapy used. There was a significant interaction treatment x day only for the concentration of BUN (P<0.05). pH, concentration of Na+ and Beecf, were higher for older animals, while K+, hematocrit and hemoglobin, were lower (P<0.05). The voluntary water intake was significantly greater in animals rehydrated with Glutellac®, which together with simplicity of use, form the main advantages of this rehydrating.

Includes abstract.
Includes bibliographical references (leaves 44-58).
Thirty years ago, oral rehydration therapy (ORT) was hailed as potentially the most significant medical advance of the century. Dehydration from diarrhoea killed approximately 5 million children per year in the late 1970's. ORT is a simple and inexpensive means of treating diarrhoeal dehydration. Today 25% of the world's children have access to ORT, and it is estimated that every year it saves 500,000 lives (Drucker 1988).

Master of Public Health - MPH
This mini-thesis, assessed the use of ORT as a treatment for childhood diarrhoea in primary health care facilities in the Cape Metropole from the caregivers' perspective. Awareness and knowledge of oral rehydration therapy (ORT) and the preparation abilities of sugar salt solution (SSS) by caregivers of children younger than 5 years attending the health facilities were assessed. The availability of resources and utensils for the use of ORS packets and SSS and the accessibility to health facilities by caregivers were also determined. Using a cross sectional descriptive study design, a baseline situation review was carried out. Primary health care facilities in three heath districts namely; Khayelitsha, Nyanga and Oostenberg were purposely selected. Ninety-two caregivers in 12 facilities participated in the study. Basic analyses of quantitative data were done using Epi-Info 2002 software. Qualitative data were analysed manually. The study found that according to caregivers, all facilities used ORS packets as their immediate treatment for uncomplicated diarrhoea, and recommended sugar salt Diarrhoea Management in PHC Facilities solution as home treatment. Ninety-one percent of caregivers used ORT at home before they presented to the health facility.Of the caregivers who were advised by the health worker to use SSS at home, 60.7%, 55.8% and 60.2% in Oostenberg, Khayelitsha and Nyanga districts respectively remembered the correct ingredients and quantities to make the solution at home. Of those given ORS packets, 94.5%, 99.0% and 98.5% respectively, remembered the quantity of water to be mixed with each packet. Packets were found to be convenient and were preferred by many caregivers as compared to SSS. The advice or health education messages given to caregivers were often unclear, and there were language barriers in Brighton and Bloekombos clinics in the Oostenberg district. A litre bottle was available in 47% of caregivers' homes, 82 % had a teaspoon and all of them had access to running water. Twelve percent and 11 % admitted to not having sugar and salt respectively when they wanted to make SSS. Eighty-eight percent walked to the health facility and 12% used taxis or buses. The study concludes that ORT is widely used in primary health care facilities for diarrhoeal disease treatment, however caregiver's knowledge and preparation abilities of SSS is still limited. The resources and utensils to prepare ORT at home were fairly available in many homes, which makes SSS preparation at home feasible and acceptable.

Durchfallerkrankungen unterschiedlicher Genese sind eine der häufigsten Vorstellungsgründe in der Kleintierpraxis. Neben den Folgen für das betroffene Tier selbst, ist die Erkrankung oft auch eine enorme Belastung für den Besitzer. Im Rahmen der vorliegenden Arbeit wurden erste grundlegende Erkenntnisse zum Einsatz des probiotisch wirksamen Escherichia coli Stamm Nissle 1917 (EcN) als Arzneimittel bei gastrointestinalen Störungen mit der Leitsymtomatik "Diarrhöe" bei der Tierart Hund gewonnen. Aus den vorliegenden Ergebnissen lässt sich ableiten, dass EcN in der Lage ist, die Magen-Darm-Passage bei solch erkrankten Hunden lebensfähig zu überwinden. Es wurde weiter gezeigt, dass EcN einem Placebo in der Behandlung eines akuten Durchfalls bei der Tierart Hund signifikant überlegen ist.

1 Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, Department of Clinical Microbiology and Infectious Diseases, National Health Laboratory Service and University of the Witwatersrand, Johannesburg
Background: Clostridium difficile is a common cause of healthcare-associated diarrhoea. Laboratory testing for C. difficile infection (CDI) remains an area of confusion as there is not a single accepted reference standard or a single best test. Aim: To analyse the impact of different diagnostic methods on reported CDI rates. In addition, CDI incidence rates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) were determined. Method: Results of stool samples submitted for C. difficile testing at CMJAH from 1 January 2014 to 31 August 2017 were reviewed. From January 2014 to July 2016, samples were tested by polymerase chain reaction (PCR) or toxin immunoassay, and from August 2016 to August 2017 algorithm-based testing (glutamate dehydrogenase and toxin immunoassay followed by PCR) was performed. Results: A total of 4829 samples were submitted. For the first period, toxin immunoassay and PCR showed a positivity rate of 11.4% and 21.1%, respectively, with an overall positivity rate of 18.7% (95% CI: 15.6 – 21.9). For the second period, the positivity rate was 15.9% (95% CI: 11.3 – 17.7). This rate included samples that were GDH positive and either showed toxin production or had a positive Xpert® result. CDI incidence for the two periods was different, with an incidence rate of 8.8 and 6.1 per 10 000 patient-days for the first and second periods, respectively. Conclusion: The choice of laboratory testing method has a major impact on the diagnosis of CDI, and therefore on the reported rates of CDI. Standardisation of laboratory testing and incidence rate reporting is required in order to obtain robust and reliable data.
E.K. 2019

Abstract Objectives: Diarrheal disease is a global health challenge that assumes gigantic importance with regard to child health in developing countries like Pakistan. Prompt medical attention and proper use of Oral Re-hydration Therapy (ORT) by mothers helps prevent dehydration and secondary complications among affected children. However, ORT use among mothers in Pakistan is low. This study seeks to examine how various socio-demographic factors impact the use of ORT and dispensary treatment among mothers of children affected with diarrhea. Methods:Data from Pakistan Demographic Health Survey (2012-2013) was used for the study. The study sample consisted of women aged 15-49 years old resident in Punjab region (N= 505) with children under five years old who had diarrhea within two weeks of the survey. Chi-square tests and logistic regression analyses were used to determine relationships between maternal socio-demographic characteristics and use of ORT and dispensary care. P-values Results: After controlling for place of residence, educational level and frequency of watching television, caregivers whose children had fever with diarrheal episodes had nearly two-fold increased odds of using ORT treatment [OR= 1.9, (95% CI: 1.28-2.82)], compared to those whose children did not have fever. Similarly poor and middle class socioeconomic status (SES) participants had 3 times increased odds [OR= 2.76, [95% CI: 1.1 -6.89)] of using dispensary treatment when compared to upper class mothers. Place of residence was not a significant predictor of ORT or dispensary use. Discussion: These findings are consistent with other studies that show that mothers’ socioeconomic status are a good indicator of their knowledge about ORT use, and health care seeking behavior. On the other hand, maternal place of residence was not a significant predictor of ORT use, or consultation at a dispensary, even though other studies have found significant associations. Conclusion: Interventions aimed at improving low-income mothers’ knowledge about diarrhea management can include lay medical personnel, such as dispensers, who are often the easily accessible medical resource to this population. Therefore, dispensers should be provided with further training to increase their knowledge and skills in treating children with diarrhea. Future studies that are more rigorous should be conducted to examine this public health issue.

Vitamin A has well recognised benefits for the reduction in severity of diarrhoeal episodes but the impact of therapeutic doses given during diarrhoea on the biochemical and clinical outcomes is less clear. In this study these potential therapeutic benefits were investigated to establish the optimum time for vitamin A supplementation to improve vitamin A status. Establishing the optimum time for vitamin A supplementation during an infectious stage would improve cost effectiveness and clinical benefit. Young children (174) between the ages of 3 and 60 months with severe diarrhoea were randomised in a double - blinded placebo controlled trial into one of 2 groups. The 1 st group received 60 mg of retinol as retinyl palmitate on admission during the acute diarrhoeal stage. The 2nd group received the same dose of vitamin A once symptoms had resolved, usually between 3 - 7 days. At each of these two time points, children not receiving vitamin A were given an identical placebo dose. Baseline (day 0) and day 3 serum samples were collected for vitamin A, retinol binding protein (RBP) and other biochemical markers. At four and eight weeks after discharge both morbidity and weight gain were recorded. The modified dose response test (MRDR) was conducted at the eight - week follow - up to estimate vitamin A liver stores. Initially, most of the children presented with watery diarrhoea and dehydration and were clinically very ill. At day 3 plasma retinol concentrations improved in both groups viz. from 0.57umol/L to 0.97umol/L in the 1st group and from 0.49umol/L to 0.90umol/L in the 2nd group. Similar improvements were found in retinol binding protein viz. 21.28 mg/L to 31.06 mg/L in the 1st group and 17.05 mg/L to 24.80 mg/L in the 2nd group. At 8 weeks there was also no significant difference between the two groups either for serum retinol (0.69umol/L and 0.73umol/L respectively) nor for MRDR ratios (0.036 and 0.049 respectively). The MRDR results at 8 weeks indicated that these children did not have depleted vitamin A liver stores and that the low serum retinol levels seen at baseline were probably due to the acute phase response during an infectious episode. The results of these analyses showed no significant difference between the two treatment groups thus indicating that there was no benefit to giving vitamin A on recovery from an infectious episode instead of on admission, as is currently practised.
Thesis (M.Med.Sc.)-University of Natal, Durban, 2001.

Durchfallerkrankungen unterschiedlicher Genese sind eine der häufigsten Vorstellungsgründe in der Kleintierpraxis. Neben den Folgen für das betroffene Tier selbst, ist die Erkrankung oft auch eine enorme Belastung für den Besitzer. Im Rahmen der vorliegenden Arbeit wurden erste grundlegende Erkenntnisse zum Einsatz des probiotisch wirksamen Escherichia coli Stamm Nissle 1917 (EcN) als Arzneimittel bei gastrointestinalen Störungen mit der Leitsymtomatik "Diarrhöe" bei der Tierart Hund gewonnen. Aus den vorliegenden Ergebnissen lässt sich ableiten, dass EcN in der Lage ist, die Magen-Darm-Passage bei solch erkrankten Hunden lebensfähig zu überwinden. Es wurde weiter gezeigt, dass EcN einem Placebo in der Behandlung eines akuten Durchfalls bei der Tierart Hund signifikant überlegen ist.

Analyse der fäkalen Mikrobiota beim Pferd unter Einwirkung einer antibiotischen Therapie und eines Präbiotikums. Mit der Methode der Fluoreszenz-in-situ-Hybridisierung soll über ausgewählte Oligonukleotidsonden spezifisch ausgewählte enterale Bakterien quantifiziert werden bei darmgesunden Pferden und Pferden mit systemisch entzündlicher Erkrankung vor und nach Antibiotikatherapie und nach Applikation eines Präbiotikums.