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Article Type

Original Study

Abstract

Introduction Diarrhea may be acute, which subsides by 7–14 days and is related to infections (bacterial or viral) or reaction to medications, or chronic, which lasts more than 2 weeks and is mainly caused by inflammatory bowel disease, functional bowel disorder, food allergies, or parasitic infestations. The infective etiologies may be noninvasive or invasive pathogens that have the capacity to invade intestinal mucosa and stimulate local inflammatory response [by activated neutrophils that secrete lactoferrin (LF)] and sometimes cause ulceration, hemorrhage, and systemic inflammatory response. Stool culture is the standard method for the diagnosis of invasive diarrhea; however, it is laborious and time consuming. LF is a major constituent of the secondary granules of neutrophils. It activates innate immunity and has microbicidal and anticancer effects. It is stable in feces for several days at room temperature and resistant to proteolysis. The presence of LF in the intestinal lumen is proportional to the flux of neutrophils, and its assessment can provide a reliable biomarker for inflammation and intestinal invasion. Aim The aim was to evaluate the clinical usefulness of fecal lactoferrin (FL) assay in differentiating invasive from noninvasive types of acute diarrhea. Patients and methods This cross-sectional study was performed on 90 children with acute diarrhea (≤1 week). Their ages ranged 4–168 months, with a mean of 48.18 ± 39.89 months. The patients were divided into two groups: group 1 included 31 patients with invasive diarrhea, and group 2 included 59 patients with noninvasive diarrhea. Results Serum C-reactive protein was significantly higher in group 1 than group 2 (28.46 and 9.7 mg/l, respectively; t = 2.7, P<0.005*). Moreover, the neutrophilic count of white blood cells was significantly higher in group 1 than group 2 (9.2 × 103 and 3.8 × 103/dl, respectively; t = 1.79, P<0.05*). FL was significantly higher in group 1 than group 2 (16.8 and 6.4 ng/ml, respectively; t = 1.99, P<0.05*). There was a significant positive correlation between FL and neutrophilic count of white blood cells (r = 0.71 and P<0.005*) in group 1 and (r = 0.58 and P<0.005*) in group 2], and a strong significant positive correlation between FL and serum C-reactive protein [in group 1, r = 0.8 and P less than 0.0001* and in group 2, r = 0.62 and P less than 0.0005*). Conclusion FL testing is a good useful noninvasive test in differentiating invasive from noninvasive acute diarrhea.

Keywords

Diarrhea, fecal lactoferrin, neutrophilic count

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