lactoferrin and Diarrhea--Infantile

Much has been learned in recent years about the mechanisms by which breastfeeding improves child health and survival. However, there has been little progress in using these insights to improve pediatric care. Factors that are important for protecting the breast fed infant might be expected to decrease the adverse effects of weaning on diarrhea, growth, and development. Lactoferrin, an iron-binding protein with multiple physiological functions (anti-microbial, anti-inflammatory, and immunomodulatory), is one of the most important proteins present in mammalian milk. Protection against gastroenteritis is the most likely biologically relevant activity of lactoferrin. Multiple in vitro and animal studies have shown a protective effect of lactoferrin on infections with enteric microorganisms, including rotavirus, Giardia, Shigella, Salmonella and the diarrheagenic Escherichia coli. Lactoferrin has two major effects on enteric pathogens: it inhibits growth and it impairs function of surface expressed virulence factors thereby decreasing their ability to adhere or to invade mammalian cells. Thus, lactoferrin may protect infants from gastrointestinal infection by preventing the attachment by enteropathogens in the gut. Recently several clinical trials in children have started to address this issue. Whether lactoferrin can prevent a significant portion of diarrheal disease remains to be determined.

Topics: Diarrhea, Infantile; Enterobacteriaceae; Enterovirus; Humans; Infant; Infant, Newborn; Intestinal Diseases, Parasitic; Lactoferrin

Topics: Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Cattle; Complement System Proteins; Diarrhea, Infantile; Digestive System; Female; Humans; Immunity, Cellular; Immunoglobulins; Infant; Lactoferrin; Lactoperoxidase; Milk; Milk, Human; Muramidase; Phagocytosis; Pregnancy; Saliva

To determine the effect of bovine lactoferrin (bLF) on prevention of diarrhea in children.. We conducted a community-based randomized double-blind placebo controlled trial comparing supplementation with bLF vs placebo. Previously weaned children were enrolled at 12-18 months and followed for 6 months with daily home visits for data collection and supplement administration. Anthropometric measures were done monthly.. Five hundred fifty-five children were randomized: 277 to bLF and 278 to placebo; 65 dropped out; 147 894 doses were administered (92% compliance). Overall there were 91 446 child-days of observation and 1235 diarrhea episodes lasting 6219 days. The main pathogens isolated during diarrheal episodes were norovirus (35.0%), enteropathogenic E coli (11.4%), Campylobacter (10.6%), enteroaggregative E coli (8.4%), enterotoxigenic E coli (6.9%), and Shigella (6.6%). The diarrhea incidence was not different between groups: 5.4 vs 5.2 episodes/child/year for bLF and placebo, respectively (P = .375). However, the diarrhea longitudinal prevalence was lower in the bLF group vs placebo (6.6% vs 7.0%, P = .017), as well as the median duration of episodes (4.8 vs 5.3 days, P = .046), proportion of episodes with moderate or severe dehydration (1.0% vs 2.6%, P = .045), and liquid stools load (95.0 vs 98.6) liquid stools/child/year, P < .001). There were no adverse events related to the intervention.. Although there was no decrease in diarrhea incidence, longitudinal prevalence and severity were decreased with LF.

Topics: Animals; Cattle; Diarrhea, Infantile; Double-Blind Method; Female; Humans; Infant; Lactoferrin; Male

Cryptosporidium is an important cause of infectious diarrhoea worldwide, but little is known about the course of illness when infected with different species. Over a period of 5 years, Cryptosporidium was identified in the stools of 58 of 157 children prospectively followed from birth in an urban slum (favela) in northeast Brazil. Forty isolates were available for quantification and 42 for speciation (24 Cryptosporidium hominis and 18 C. parvum). Children with C. hominis shed significantly more oocysts/ml of stool (3.5 x 10(6) vs. 1.7 x 10(6)perml; P=0.001), and oocyst counts were higher among symptomatic children (P=0.002). Heavier C. parvum shedding was significantly associated with symptoms (P=0.004), and symptomatic C. parvum-infected children were significantly more likely than asymptomatic children to be lactoferrin-positive (P=0.004). Height-for-age (HAZ) Z-scores showed significant declines within 3 months of infection for children infected with either C. hominis (P=0.028) or C. parvum (P=0.001). However, in the 3-6 month period following infection, only C. hominis-infected children continued to demonstrate declining HAZ score and asymptomatic children showed even greater decline (P=0.01). Cryptosporidium hominis is more common than C. parvum in favela children and is associated with heavier infections and greater growth shortfalls, even in the absence of symptoms.

Topics: Animals; Anthropometry; Child, Preschool; Cryptosporidiosis; Cryptosporidium; Cryptosporidium parvum; Diarrhea, Infantile; Feces; Host-Parasite Interactions; Humans; Infant; Lactoferrin; Nutritional Status; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Prospective Studies; Species Specificity; Urban Health

Topics: Diarrhea, Infantile; Fluid Therapy; Humans; Infant; Infant, Newborn; Lactoferrin; Milk Proteins; Milk, Human; Muramidase; Rehydration Solutions; Rotavirus Infections; Viral Vaccines

Topics: Animals; Cattle; Child, Preschool; Diarrhea, Infantile; Female; Gastroenteritis; Humans; Infant; Infant, Newborn; Lactoferrin; Male; Rotavirus Infections; Treatment Outcome; Vomiting

Topics: Bacterial Adhesion; Bacterial Outer Membrane Proteins; Cells, Cultured; Diarrhea, Infantile; Erythrocytes; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Infant; Lactoferrin

Estimate under "real life" conditions the operating characteristics of several stool tests for determining whether a diarrheal episode is invasive-inflammatory.. Determination of operating characteristics of diagnostic tests against a standard in a prospectively gathered sample.. The emergency room of the largest Social Security Pediatric Hospital in Colombia serving referred and nonreferred patients.. Stool samples from children attending the emergency room because of acute diarrhea (three or more loose stools per day lasting <7 days). Patients receiving antibiotics or antiparasitic medications were excluded.. Samples were collected in sterile containers and examined immediately for protozoa, fecal leukocytes, occult blood and lactoferrin. Specimens were inoculated onto culture media for common bacterial fecal pathogens except enteroinvasive Escherichia coli and Clostridium difficile.. Sensitivity, specificity and likelihood ratios of several cutoff levels for fecal lactoferrin, fecal leukocytes and occult blood.. Stool samples from 500 infants and children with diarrhea were collected. Patients' median age was 2.66 years (range, 0.5 to 13 years), and 261 (52.2%) were males. In 155 (31%) cases enteroinvasive bacteria and/or Entamoeba histolytica were documented. Fecal leukocytes >5 had the best sensitivity (63.2%; 95% confidence interval, 55.4 to 70.5) and specificity (84.3%; 95% confidence interval, 80.2 to 87.9), although not statistically or clinically significantly different from lactoferrin.. No single test or combination had satisfactory operating characteristics. Nevertheless the use of likelihood ratios derived here can help clinicians identify invasive-inflammatory diarrheal episodes in many instances.

Topics: Acute Disease; Child; Child, Preschool; Clinical Laboratory Techniques; Colombia; Developing Countries; Diarrhea; Diarrhea, Infantile; Feces; Female; Humans; Infant; Lactoferrin; Leukocyte Count; Likelihood Functions; Male; Occult Blood; Prospective Studies; Sensitivity and Specificity

Topics: Agglutination Tests; Bacterial Infections; Breast Feeding; Child; Child, Preschool; Developing Countries; Diarrhea, Infantile; Feces; Helminthiasis; Humans; Infant; Intestinal Diseases, Parasitic; Lactoferrin; Leukocytes; Nicaragua

Topics: Adenocarcinoma; Animals; Breast Feeding; Colonic Neoplasms; Depression, Chemical; Diarrhea, Infantile; Endotoxins; Female; Humans; Immunity, Maternally-Acquired; Immunoglobulin A, Secretory; Infant, Newborn; Interleukin-6; Lactoferrin; Lipopolysaccharides; Lymphoma, Large B-Cell, Diffuse; Mice; Mice, Inbred C3H; Milk, Human; Pregnancy; Spleen; Tumor Cells, Cultured; Weight Loss

The survival of breast-milk secretory-IgA and lactoferrin has been investigated in 23 Gambian children aged 1.5, 3 and 17 months. Endogenous excretion of these immune proteins was measured in 7 weaned 34-month-old children. Defaecation rate was the prime determinant of faecal secretory-IgA and lactoferrin outputs, indicating that partial degradation occurs in the large intestine. Calculations showed that at least 30% of IgA and 2% of lactoferrin ingested from breast-milk must survive in the small intestine. Variations in faecal immune protein outputs were related to differences in intake and defaecation rate and were not affected by age or solid food consumption. The raised faecal outputs of 5 children with diarrhoea were a consequence of their high stool frequencies. IgA disappearance in the large intestine proceeded twice as fast in Gambian breast-fed children as in comparable Cambridge infants, suggesting that differences in gut flora may influence IgA survival. Thus breast-feeding, irrespective of age or additional food, can deliver significant quantities of these antimicrobial proteins to the small intestine but differences in defaecation rate and gut flora may affect their protective potential in the large intestine.

Topics: Breast Feeding; Diarrhea, Infantile; Dietary Proteins; Feces; Gambia; Humans; Immunoglobulin A; Infant; Infant, Newborn; Intestine, Small; Lactoferrin; Lactoglobulins; Milk, Human; Rural Population