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Fecal alpha-1-antitrypsin excretion in acute diarrhea: relationship with causative pathogens
Insights
Infants with acute diarrhea show increased fecal alpha-1-antitrypsin (AT) levels, indicating protein loss. This loss is particularly high in Rotavirus and Salmonella infections, highlighting the need for prompt nutritional support.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Chemistry
Background:
- Acute diarrhea is a common pediatric illness.
- Assessing intestinal protein loss is crucial for managing pediatric gastroenteritis.
- Alpha-1-antitrypsin (AT) is a stable marker for intestinal protein loss.
Purpose of the Study:
- To measure fecal alpha-1-antitrypsin (AT) concentrations in infants with acute diarrhea.
- To compare AT levels between infants with diarrhea and healthy controls.
- To investigate the relationship between specific pathogens and AT levels.
Main Methods:
- Fecal samples were collected from 68 infants with acute diarrhea and 32 healthy controls.
- Alpha-1-antitrypsin (AT) concentrations were determined using quantitative assays.
- Statistical analysis compared AT levels based on diagnosis and causative agent.
Main Results:
- Mean fecal AT levels were significantly higher in infants with diarrhea (2.07 mg/g dry stool) compared to controls (1.29 mg/g dry stool).
- Elevated AT levels were primarily observed in infants with Rotavirus or Salmonella infections.
- Fecal AT was highest in Salmonella infections and in cases with macroscopic intestinal bleeding, but pathogen type was a stronger determinant.
Conclusions:
- Acute diarrhea in infants leads to increased intestinal protein loss, as indicated by elevated fecal alpha-1-antitrypsin (AT).
- The degree of protein loss is influenced by the causative pathogen, with Salmonella and Rotavirus showing higher levels.
- Prompt nutritional intervention is essential in managing pediatric acute diarrhea to address protein loss and support recovery.
Abstract:
Concentrations of alpha-1-antitrypsin (AT) in random fecal samples from 68 infants (92.7% outpatients) with acute diarrhea and 32 healthy controls were determined. The mean +/- s.d. for AT in infants with diarrhea was 2.07 +/- 1.88 mg/g dry stool (mg/g d.s.) compared with 1.29 +/- 0.72 mg/g d.s. (p less than 0.05) in controls. Fecal AT was significantly greater than that of the controls only for diarrhea caused by Rotavirus or Salmonella. Salmonella patients also had significantly higher fecal levels of AT than patients with diarrhea caused by Campylobacter. Fifty percent of the infants with Salmonella infections excreted more than 2.73 mg/g d.s. AT, which is above the control mean + 2 s.d. Fecal excretion of AT was highest in patients with macroscopic intestinal bleeding, but it still depended more on the causative agent than on bleeding per se. This finding of increased intestinal protein loss during acute diarrhea, even in the less severe diseases, emphasizes the necessity to rapidly restart adequate nutritional intake.