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Persistent protein losing enteropathy in post measles diarrhoea
Insights
Children with diarrhea, especially after measles, show elevated fecal alpha 1 antitrypsin. This indicates increased intestinal protein loss, particularly in post-measles shigellosis during acute illness.
Area of Science:
- Pediatrics
- Gastroenterology
- Infectious Diseases
Background:
- Diarrheal diseases are a major cause of childhood morbidity.
- Measles can predispose children to secondary bacterial and viral infections.
- Protein-losing enteropathy (PLE) is a condition characterized by excessive loss of plasma proteins into the gastrointestinal tract.
Purpose of the Study:
- To investigate fecal alpha 1 antitrypsin clearance in children with diarrhea, comparing those with and without a history of measles.
- To assess the impact of different etiological agents (Shigella, enterotoxigenic E. coli, rotavirus) on fecal alpha 1 antitrypsin levels.
- To evaluate the relationship between measles, specific infections, and the severity of protein loss during acute and recovery stages of diarrhea.
Main Methods:
- Faecal alpha 1 antitrypsin levels were measured in two groups of children (6 months to 6 years) during acute and recovery phases of diarrhea.
- Group 1: 19 children with recent measles history.
- Group 2: 15 children with diarrhea without recent measles history. Etiological agents were identified.
Main Results:
- Children with rotavirus diarrhea exhibited transiently high fecal alpha 1 antitrypsin during the acute stage.
- Post-measles diarrhea cases showed significantly higher fecal alpha 1 antitrypsin than controls in both acute and recovery stages.
- Faecal alpha 1 antitrypsin was significantly higher in the acute stage compared to the recovery stage for both groups. Highest levels were seen in post-measles shigellosis, suggesting prolonged PLE.
Conclusions:
- Diarrhea, particularly following measles, is associated with increased intestinal protein loss, as indicated by elevated fecal alpha 1 antitrypsin.
- Post-measles diarrhea, especially shigellosis, may lead to prolonged protein-losing enteropathy.
- Fecal alpha 1 antitrypsin serves as a useful marker for assessing intestinal protein loss in pediatric diarrhea, with distinct patterns observed based on etiology and preceding illness.
Abstract:
Faecal alpha 1 antitrypsin was measured in two groups of children with diarrhoea aged 6 months to 6 years during the acute and recovery stages of the illness. Group 1 comprised 19 children with a history of measles in the two weeks preceding admission to hospital. In this group there were six cases of Shigella species, six enterotoxigenic Escherichia coli, and five rotavirus, and two did not yield an aetiologic agent. Group 2 comprised 15 children with diarrhoea only. In this group there were five cases of Shigella species, five enterotoxigenic Escherichia coli, and five rotavirus. Children with rotavirus diarrhoea belonging to both groups showed a transient high faecal clearance of alpha 1 antitrypsin during the acute stage. Post measles cases of diarrhoea showed significantly higher faecal clearance of alpha 1 antitrypsin than group 2 subjects in both the acute and recovery stages. The faecal clearance of alpha 1 antitrypsin in both groups was significantly higher during the acute stage compared with the recovery stage. Highest faecal clearances of alpha 1 antitrypsin were observed in children with post measles shigellosis in the acute stage and they also had persistently raised concentrations, thus suggesting prolonged protein losing enteropathy.