A Pilot Study to Determine the Effectiveness of Probiotic Use in Elderly Patients with Antibiotic-Associated Diarrhea

Long-term care settings have the majority of their patients on multiple antibiotics, and outbreaks of antibiotic-associated diarrhea and Clostridium difficile are common. Probiotics have been used with these patients to reduce these side effects. Probiotics can re-establish the composition of intestinal microflora, enhance immune response, and clear pathogens from the host which may reduce the symptoms of antibiotic-associated diarrhea. Therefore, the goal of this study was to conduct a retrospective study of the effectiveness of using probiotic in elderly patients in a long-term care facility in a Midwestern city who suffered from antibiotic-associated diarrhea. The probiotic, CulturelleTM had been administered once a day to eight males and twelve female patients who were taking antibiotics and stool consistency and number were recorded. Out of the original group, seven of the patients receiving the probiotic appeared to have positive effects while two patients had negative effects on stools. Thirteen patients showed no change in stool consistency and number. It was difficult to determine the effects of the probiotic due to the use by the facility of a bowel movement protocol for preventing constipation and impaction, and the lack of dietary records. Published studies in patients in long-term facilities vary greatly in terms of trial design, type and dose of probiotic and duration of treatment, which may explain why probiotics work for some patients and not for others. Probiotic use is becoming more accepted with antibiotic-associated diarrhea but due to the lack of definitive evidence about efficacy and the safety of probiotic use, more studies need to be conducted. Advisors: Kaye Stanek Krogstrand and Julie Albrecht

INFLUENCE OF TYPE 2 BOVINE VIRAL DIARRHEA VIRUS NPRO ON ENHANCEMENT OF BOVINE RESPIRATORY SYNCYTIAL VIRUS REPLICATION MEDIATED BY ANTAGONISM OF HOST CELL INTERFERON TYPE I RESPONSES

Bovine viral diarrhea virus (BVDV) is a member of the genus Pestivirus, Family Flaviviridae. The virus can infect many species of animals of the order Artiodactyla. The BVDV genome encodes an auto protease, Npro, that degrades interferon regulatory factor-3 (IRF-3) reducing type I interferon (IFN-I) production from host cells. Bovine respiratory syncytial virus (BRSV) is a member of the genus Pneumovirus, Family Paramyxoviridae. Concurrent infection with BVDV and BRSV causes more severe respiratory and enteric disease than infection with either virus alone. Our hypothesis was that Npro modulates the innate immune responses to BVDV infection and enhances replication of BVDV or BRSV co-infection. The noncytopathic BVDV2 viruses NY93/c N- Npro 18 EGFP (a mutant with modified Npro fused with enhanced green fluorescent protein), NY93 infectious clone (NY93/c), wild-type NY93-BVDV2 (NY93-wt), and BRSV were evaluated in this study. The objectives of this study were: (1) to characterize the replication kinetics and IFN-I induction in Madin-Darby bovine kidney (MDBK) cells following infection with each of the BVDV isolates, and (2) to characterize the influence of BVDV-mediated IFN-I antagonism on enhancement of BRSV replication in bovine turbinate (BT) cells. NY93/c N- Npro 18 EGFP replicated 0.4 – 1.6 TCID50 logs lower than NY93-wt in MDBK cells. NY93/c N- Npro 18 EGFP-infected MDBK cells synthesized IFN-I significantly higher than NY93/c- and NY93-wt-infected MDBK cells. BT cells co-infected with NY93/c N- Npro 18 EGFP/BRSV or NY93-wt/BRSV were evaluated to determine the effects of co-infection on BRSV replication and IFN-I induction in BT cells. BRSV RNA levels in NY93-wt/BRSV co-infected BT cells were 2.49, 2.79, and 2.89 copy number logs significantly greater than in NY93/c N- Npro 18 EGFP/BRSV co-infected BT cells on days 5, 7, and 9 post-infection, respectively. BVDV RNA levels in NY93/c N- Npro 18 EGFP-infected BT cells were 1.64 – 4.38 copy number logs lower than in NY93-wt-infected BT cells. NY93/c N- Npro 18 EGFP single and co-infected BT cells synthesized IFN-I significantly higher than NY93-wt single and co-infected BT cells. In summary, these findings suggest: (1) NY93/c N- Npro 18 EGFP BVDV2 induced higher levels of IFN-I than BVDV2-wt and may be useful as a safer, replicating BVDV vaccine, and (2) Enhancement of BRSV infection by BVDV co-infection is mediated by antagonism of IFN-I.

Echinococcus Infections in Man and Animals in Kenya

1. Hydatid cysts are found in more than 30 per cent of all cattle, sheep and goats in Kenya, but the disease is prevalent in man only in the semi-desert area of Turkana. Up to the time of the present investigation the life-cycle of the parasite in East Africa had not been studied, but it was suggested that wild carnivores, such as hyenas and jackals, might be the main hosts of the adult worms. 2. One hundred and forty-three carnivores, representing 23 species, have been examined. Echinococcus adults were found in 27 out of 43 domestic dogs (Canis familiaris), in three out of four hunting dogs (Lycaon pictus), in one out of nine jackals (Thos mesomelas), and in three out of 19 hyaenas (Crocuta crocuta). 3. A detailed morphological study was made of the Kenya material. After comparison with specimens from other parts of the world, it was concluded that the only species occurring in Kenya was E. granulosus, but it is possible that the minor morphological and biological differences are evidence of distinct strains. Further laboratory studies are necessary to compare the parasite from man and animals in different parts of Kenya with material from elsewhere. 4. A search was made for larval hydatids in 92 ungulates representing 18 species, and in a miscellaneous collection of nearly 2,000 rodents and primates representing a further 31 species. Only one animal was positive, a wildebeest (Gorgon taurinus). 5. The infections in the wild carnivores were all very light; only domestic dogs were heavily infected. It is concluded that the main cycle of transmission in Kenya is between dogs and domestic livestock. 6. Turkana tribesmen are the most heavily infected people in Kenya, either because the strain of parasite is more pathogenic to man in that area, or, more probably, because of the intimate contact between children and the large number of infected dogs. A particularly dangerous custom in the area is the use of dogs to clean the face and anal regions of babies when they vomit or have diarrhea. No satisfactory explanation can be given for the rarity of the disease in man in many of the other areas of Kenya where hydatids are very common in domestic animals. 7. The control of the disease will depend upon an active health-education campaign, together with the destruction of all unregistered dogs and improvement in meat hygiene.