Diarrhea is a significant health issue in low- and middle-income countries. There is an urgent need to identify and implement actions aimed at reducing the associated mortality and morbidity. The aim of this study was to determine the frequency and determinants of home use of oral rehydration solution (ORS) and antibiotics for the treatment of diarrheal diseases in the Far North and Littoral regions of Cameroon. This was a cross-sectional study using sentinel surveillance data collected from four health facilities in the cities of Kousseri and Douala in Cameroon. The study targeted patients seeking consultations for diarrhea at these health facilities. Patients were selected through consecutive sampling. Data were collected using a questionnaire administered face-to-face by a trained nurse, which included questions about the reason for consultation, socio-demographic characteristics, and prior exposure to ORS and antibiotics before arriving at the health facility. A total of 1,065 patients with diarrhea agreed to participate in the study, including 160 (15.0%) from Kousseri and 905 (85.0%) from Douala. Of the 1,065 participants, 215 (20.2%) and 637 (59.8%) reported using ORS and antibiotics at home as part of their diarrhea treatment prior to arriving at the health facility. The most used antibiotics were metronidazole (31.9%), amoxicillin (3.6%), doxycycline (3.6%), and ciprofloxacin (2.6%).The use of ORS was associated with place of residence (aOR = 0.20; 95% CI [0.10 - 0.40]), and duration of diarrhea (aOR = 0.51; 95% CI [0.33 - 0.78]) were associated with home use of ORS among patients with diarrhea. The city of residence (aOR = 3.06, 95% CI = 1.85 - 5.05) and the absence of ORS use at home (aOR = 2.17; 95% CI = 1.30-3.62); having diarrhea for less than 24 h (aOR = 0.36, 95% CI = [0.24 - 0.54]) and traveling less than one hour to reach the health facility (aOR = 0.44, 95% CI = [0.21 - 0.91]) were associated with home use of antibiotics among patients with diarrhea. The frequency of antibiotic use in the community is significantly high, while the utilization of ORS remains low. More efforts are required to enhance community management of diarrhea effectively.

We present two clinical cases of intestinal amoebiasis. The first case was asymptomatic, with colonic ulcers incidentally detected during colonoscopy. The second case presented with diarrhea and a hepatic abscess, also associated with colonic ulcers. Both patients showed a favorable clinical outcome following treatment. Amoebiasis is caused by the parasite Entamoeba histolytica. It is transmitted via the fecal-oral route and is more common among travelers, immunocompromised individuals, and men who have sex with men. Clinically, it can range from asymptomatic infection to severe colitis and hepatic abscess formation. Diagnosis is established through stool microbiological tests, serology, and intestinal biopsies. In invasive cases, treatment consists of metronidazole or tinidazole, followed by a luminal amoebicide such as paromomycin. In cases of large abscesses, drainage may be required.

Strongyloides stercoralis is a soil-transmitted helminth that is increasingly reported in dogs across Europe. While most infections are subclinical, hyperinfection syndrome, marked by excessive larval proliferation and systemic spread, can occur in immunocompromised hosts. An 11-year-old male Boston Terrier dog, originating from southern France with a history of chronic diarrhoea and recent splenectomy was presented with severe regenerative anaemia, thrombocytopenia, and a degenerative left shift. Haemotropic Mycoplasma haemocanis infection was diagnosed, and doxycycline therapy was initiated. During hospitalisation, the dog developed dyspnoea, pneumonia, and progressive pleural effusion containing motile nematode larvae. Strongyloides stercoralis infection was diagnosed by morphological identification of larvae in pleural effusion (third-stage larvae) and faeces (first- and third-stage larvae) and confirmed by PCR targeting mitochondrial cox1 and nuclear 18S rDNA hypervariable regions (HVR) I and IV), followed by sequencing, which revealed the haplotypes HP16 (cox1), VI (HVR-I) and A (HVR-IV). The HVR-IV haplotype A is found in both dogs and humans, characterizing the zoonotic population of S. stercoralis. Respiratory signs worsened despite combined fenbendazole and escalating ivermectin treatment, requiring euthanasia. Post-mortem examination revealed chronic granulomatous pneumonia, a pulmonary carcinomatous nodule, lymphoplasmacytic enterocolitis, and glomerulonephritis. This case represents the first report of S. stercoralis hyperinfection in an adult splenectomised dog. It highlights the importance of including strongyloidiasis in differential diagnoses of dogs with respiratory and gastrointestinal signs, particularly in animals with compromised immunity or relevant travel history.

Lurbinectedin in combination with irinotecan showed synergistic antitumor activity in preclinical studies. A phase I/II trial (NCT02611024) evaluated this combination in patients with advanced solid tumors. The phase II stage evaluated the antitumor activity of the recommended dose (RD) (lurbinectedin 2.0 mg/m[2] on Day (D)1 plus irinotecan 75 mg/m[2] on D1 and D8 q3wk with primary granulocyte colony-stimulating factor prophylaxis) in five tumor-specific cohorts. This pooled analysis describes the safety profile of this combination from 233 patients with different advanced solid tumors treated at the RD. Adverse events (AEs) and laboratory abnormalities were graded using NCI-CTCAE v.4. The most frequent AEs (any grade) related to treatment were fatigue (71% of patients/25% of cycles), diarrhea (62%/17%), nausea (59%/18%), vomiting (35%/7%) and decreased appetite (32%/6%); the most common grade ≥ 3 AEs were fatigue (14%/2%), diarrhea (14%/2%) and febrile neutropenia (9%/1%). The most common grade ≥ 3 laboratory abnormality regardless of relationship was neutropenia (53%). The rate of discontinuation due to treatment-related AEs was 3% (n = 7 patients). There was one treatment-related death (0.4%) involving a 63-year-old male patient (0.4%) diagnosed with metastatic NEN who died due to grade 5 staphylococcal bacteremia. In conclusion, this pooled analysis shows a predictable and manageable safety profile for lurbinectedin in combination with irinotecan in patients with advanced solid tumors, with myelosuppression, fatigue and gastrointestinal disorders being the main toxicities observed.Trial code: ClinicalTrials.gov identifier: NCT02611024.

Salmonella enterica serotype Typhi (S. Typhi) primarily causes typhoid fever but can rarely lead to severe neurological complications. We report a 16-month-old boy who developed encephalopathy with Guillain-Barré Syndrome (GBS) following extensively drug-resistant (XDR) S. Typhi infection after travel to Pakistan. Initially presenting with diarrhea and low-grade fever, he was treated with oral cefixime, but deteriorated with high-grade fever. Blood cultures revealed XDR S. Typhi resistant to multiple antibiotics and sensitive only to meropenem and azithromycin. On admission, he became drowsy and experienced a seizure; lumbar puncture was unremarkable. High-dose dexamethasone was initiated for encephalopathy. He subsequently developed flaccid limb weakness and autonomic dysfunction, and nerve conduction studies confirmed axonal polyneuropathy consistent with GBS. Intravenous immunoglobulin (IVIG) was administered alongside supportive care, and a 21-day course of IV meropenem plus oral azithromycin was completed. The patient gradually regained motor function, and three months post-discharge, he was walking independently. This case illustrates a rare combination of encephalopathy and GBS due to XDR S. Typhi in a pediatric patient, highlighting the importance of early recognition, appropriate antimicrobial therapy, corticosteroids, and IVIG. Clinicians should remain vigilant for neurological complications in children from endemic regions, emphasizing timely diagnosis, tailored therapy, and preventive strategies.

Background/Objectives: Enterotoxigenic Escherichia coli (ETEC) is a leading cause of diarrheal illness worldwide, resulting in approximately 380,000 deaths annually, with significant morbidity in children and travelers to endemic regions. ETEC infection begins with the attachment of the bacterium to the small intestine via filamentous colonization factors (CF), followed by the production of heat-labile (LT) and heat-stable (ST) toxins that induce watery diarrhea. Targeting CF to prevent ETEC attachment is challenging due to strain heterogeneity. Methods: In previous studies, we developed a class-switched human monoclonal antibody, 68-90, expressed as secretory IgA (SIgA) in rice for cost-effective and stable storage. Rice-produced SIgA exhibited comparable binding efficiency to CfaE, a component of CF, compared to CHO-produced SIgA in vitro. Results: In this work, we showed that oral administration of 68-90 SIgA to Aotus nancymaae did not alter gut microbiome distribution or show signs of systemic exposure. Conclusions: These findings suggest that oral delivery of ETEC-specific SIgA is safe and does not disrupt the gut microbial population, highlighting its potential as an effective and targeted therapeutic strategy.

Giardia duodenalis infection is a common cause of diarrhoea in returning travellers from low-income regions. The increasing prevalence of resistance to nitroimidazoles, as first-line therapy, are of global concern. The interaction between Giardia and the host's gut microbiota plays a crucial role in the pathophysiology of giardiasis. Yet, longitudinal data assessing the course of the infection are scarce, and non-existent in patients refractory to treatment. Here, we provide the first longitudinal bacterial community study, carried out in two Giardia-infected Spanish adult patients refractory to treatment after travelling to India, a Giardia-hyperendemic country, which offers insights into the gut microbiota's response to infection and therapy over time. A significant reduction in alpha diversity was evidenced during and post-infection, accompanied by changes in bacterial taxa contribution, with an important individual effect. We evidenced microbial shifts that may be associated with infection, treatment effectiveness or microbial restoration after infection, which can potentially be used to monitor disease evolution and adjust the therapeutic strategy.

Amyloidosis is a rare, heterogeneous condition characterized by extracellular deposition of misfolded protein fibrils, resulting in organ dysfunction. Gastrointestinal amyloidosis (GIA), an uncommon manifestation, is often underdiagnosed due to its nonspecific symptoms, such as weight loss, abdominal pain, and diarrhea. Early recognition and accurate amyloid typing are crucial, as treatment strategies depend on the specific subtype involved. We report a case of a 42-year-old African male presenting with chronic epigastric pain, significant weight loss (BMI: 17.1), and a history of GERD. He had recently traveled to Equatorial Guinea. His symptoms, including nausea, decreased appetite, constipation, and persistent epigastric pain, were unresponsive to proton pump inhibitors. On examination, he was hypotensive and tachycardic. Laboratory workup revealed hyponatremia and elevated troponin T. Imaging showed fecal impaction and pyloric edema. Upper endoscopy and colonoscopy with biopsies confirmed amyloid deposition in the stomach, duodenum, ileum, and colon. Congo red staining demonstrated classic apple-green birefringence under polarized light. Cardiac evaluation revealed reduced global longitudinal strain. Serum studies showed elevated free lambda light chains and an IgG-lambda monoclonal band, while the urine protein/creatinine ratio was 361 mg/g, consistent with proteinuria. Chronic hepatitis B infection with detectable HBV DNA and elevated gamma/delta T cells on the lymphoma panel raised concerns for an underlying T-cell lymphoproliferative disorder. This case highlights the diagnostic complexity of gastrointestinal amyloidosis with multisystem involvement. The patient's presentation, along with elevated free light chains and monoclonal gammopathy, raised suspicion for AL amyloidosis, though chronic hepatitis B and possible lymphoproliferative disease kept AA amyloidosis in the differential. Consistent with the literature, vague gastrointestinal (GI) symptoms often delay diagnosis, underscoring the role of Congo red staining and mass spectrometry for confirmation and subtype identification. Recent trials support daratumumab for AL and patisiran/inotersen for ATTR amyloidosis. Early, accurate diagnosis is key to initiating appropriate therapy and improving outcomes, with multidisciplinary involvement crucial for optimal care.