Transcription:
Identifying Diarrhea and Intestinal Parasites in Children

Melanie Cole (Host): Viruses, bacteria, and parasites are living organisms that are found all around us. They're in the water, in soil, and on the surfaces of the foods that we eat. They're also on surfaces that we touch, such as countertops in the bathroom or kitchen. Some bacteria live in and on our bodies and don't cause problems. Others are not so innocent. My guest today is Dr. Asuncion Soriano. She's a pediatric gastroenterologist and a member of the medical staff at Doctors Hospital of Laredo. Welcome to the show, Dr. Soriano. What are viruses, bacteria, and parasites? Explain how we get those. Really what are they?

Dr. Asuncion Soriano (Guest): Well, those are all organisms that cause infection and disease whether it's gastrointestinal or pulmonary or any organ system. In particular, we have to focus ourselves on bacteria and parasitic diseases as these are the infectious agents that need treatment and increased surveillance. Viral diseases by definition have a very self-limiting course, unless of course we talk about the deadly viruses which is not the topic for now, but for intestinal diseases, viruses are quite mild, self-limiting. They don't go to chronicity. It's the bacterial and the parasitic diseases that have long-term sequelae.

Melanie: So, Dr. Soriano, how does a child usually come in contact with a bacteria or a parasite that could cause something like diarrhea?

Dr. Soriano: Well, there are very easy ways or common ways which we don't recognize. We can -- first is contaminated water -- if we are in an area where the child is in the pool; there was a fecal accident of another baby -- soiled or even any other person who by chance had soiling of that pool or water supply. That's a source. Secondly, daycare. That's quite common, and you've heard the stories of moms saying that one child was sick in the daycare so then another one got ill so, it just follows like a chain reaction. The parent can be infected themselves and unless you are really very cognizant of handwashing -- very, very careful and aware that you can pass it on because these are microscopic agents. You don't see them. You just have to be aware of them. Not only parents, caregivers -- anybody that changes diapers or comes from the bathroom and then you did not soap your hands, and you can be an asymptomatic carrier and that alone will pass it on to the next child or person.

Melanie: So, let's talk about some of these intestinal parasites and what are the most common ones that you see as a pediatric gastroenterologist, and what should parents look for as far as red flags -- something that would signal -- whoa, something's going on, and I need to get this child to the doctor?

Dr. Soriano: Well, we're approaching summer, and Giardia is number one on the list. It's a very common parasite that has outbreaks during the summer. As what I said any common source: water, pool, swimming in lakes, anywhere even in the daycare if the person came from a contaminated area, so, Giardia's number one on the list. Cryptosporidium has been noted in big outbreaks like there was this problem in Minnesota way back. That occurs in clusters, but then my area in south Texas, it's Giardia and that’s something that we have to have a heightened awareness.

Melanie: So, there are some other things that we know about like rotavirus and even people here in the media hear Salmonella and bacteria E. coli. So what do you want people to know about these things, and you mentioned handwashing? What are some things that we can do as parents and teach our children to do to avoid some of these things that might be around?

Dr. Soriano: Well, apart from handwashing and I'm talking about strict handwashing, just not with water -- it's a little bit funny to think that some people just think it's just putting water and that's it, but soap and water, at least to rub your hands and then for any -- in and out of the toilet, doorknobs, you know, even telephones and of course, whatever is the source of water in your area. For instance, my area in south Texas is quite known for having a poor water source or reservoir. There is a map that was released by the Centers for Disease Control, and they do send it out every year showing areas where there is an increased surveillance of all of these parasitic diseases, and south Texas is in that area just because of our proximity to the Rio Grande River, to Mexico where there is, you know, water and parasites that are not treated.

Melanie: So, what do we do? If our child starts to come up with diarrhea, and we notice that there is something going on -- we take them to the doctor and find out whether it's a virus or a bacteria. Is there anything that can be done?

Dr. Soriano: Well, certainly, you have to take the child away from the daycare. She is going to be a contaminant. The best way to stop the symptoms from progressing any worse is to get treatment. There are so many diagnostic tests available, but in my practice of 20 some years in Laredo, a lot of these stool studies are non-diagnostic. It is very difficult to isolate these parasites, especially if they are not picked up by an astute diagnostician or a laboratory technician. So, a pediatric gastroenterologist or a pediatrician who's very attuned to these disease can initiate treatment and there is really nothing wrong in initiating empiric treatment for these common parasites.

Melanie: And what would some of that treatment entail?

Dr. Soriano: Well, one would be metronidazole. It's an anti-parasitic agent that's been around for a very long time, but my experience in our community is that a lot of my patients have this resistant strain. They do not respond to the initial treatment, so they come back to me. They may have some relief, but then it recurs. The other agent that I have used with a greater degree of success is nitazoxanide, marketed as Alinia, and it's really been very effective, and it's a very short treatment of three days and somehow it is best to just initiate that treatment, and it affects a lot of the common parasites and bacteria, and it gets the mom back to work, gets the child back to the daycare.

Melanie: You mentioned resistant strains, Dr. Soriano. When we're cleaning those surfaces and spraying Lysol all over the place, are we over sanitizing and then making it so that our bodies are less able to in our immune system and in our gut are we less able to fight off some of these parasites and bacteria and viruses that seem to be all over the place?

Dr. Soriano: Well, it's been written that somehow the more you aggressively sanitize you create more mutant strains. Soap and water is just a general rule. We don't overdo stuff. We don't cause any carcinogenic risk with using a lot of these powerful agents. So, basic handwashing with soap and water is okay. Alcohol is not as effective. It's basically soap and water.

Melanie: So what do you want people to know about trying to avoid these parasites -- bacteria and viruses -- and these places like common water, swimming -- how do you know if there's been a baby in there that has done that, and is it just wishful thinking that it's going to be clean all the time? What do you want to tell listeners about recognizing the red flags, spotting this, and getting their child the help they need and possibly prevention of transmission all together?

Dr. Soriano: Well, first of all, you can't predict if the swimming pool or any of these lakes are going to be contaminated. I would just say heightened awareness. If you feel that the public pool is frequented and it's overcrowded, I would stay away. Parents can ask how often these pools are -- the waters are changed. Bear in mind, chlorine doesn't kill these parasites. It does not.
Secondly, if you are in a pool that you think is clean or you are swimming in the lake, you are a backpacker, do not swallow the water. I know that is difficult, but you just have to impress it on the child they cannot swallow the water. They can swim with their goggles on and keep their mouths closed. Really, it's ingesting it orally, and only ten cysts can you know -- cyst: c-y-s-t, those are the eggs of these parasites -- can cause a GI problem, so truly the only way for it to come in is through the mouth. That's a common portal of entry or in an open wound, and we know that open wounds -- we can't really swim with open wounds, but to ingest it by mouth -- that's a common way for it to come into their intestinal tract -- if you feel that you need to swim, or you think that the pool is clean.

Melanie: And tell us about your team at Doctors Hospital of Laredo.

Dr. Soriano: Well, I'm a pediatric gastroenterologist. I’m a sub-specialist of pediatrics. Pediatrics by definition is from birth to age 21. I take care of diseases from the oropharyngeal area that's not up to the intestinal tract which all the way is to the rectum. For those patients that do not get any relief for treatment from a lot of these diseases to their usual medication given by the pediatrician, then the patient gets referred to me, and like what I said, it's the chronicity of the symptoms that makes the pediatrician refer the patients to me, and when I say chronic symptoms, by definition is symptoms more than 2 weeks, 14 days. However, if the parent feels that it's not getting better after a week, certainly they can ask for your pediatrician to refer their child to me. The symptoms can be anywhere from having difficulty with eating, a lot of nausea, vomiting, abdominal pain, a lot of cramping, a lot of gas, diarrhea. Whether it's once a day or twice a day, but it's persistent, watery -- something out of the ordinary -- those are red flags, and, of course, the ultimate visible sign is the patient is losing weight. So, that alone triggers a referral to a pediatric gastroenterologist.

Melanie: And what would you like parents to do at home with their children while they're getting treated for whatever parasite? What can they be feeding, how should they be giving them liquids, even if the child is having trouble keeping them down to make sure that they stay hydrated?

Dr. Soriano: Certainly any soft foods is important as long as it doesn't require the digestive tract to exert a lot of work in processing that food. Non-acidic foods, non-fried foods. To avoid dehydration, certainly lots of fluids oral or rehydration solutions with a lot of the electrolytes. The Gatorades are good with that, or you can just buy the Pedialyte. There's a lot of fruit-flavored Pedialyte around, popsicles. They make it so enticing that the child can take them without being coerced to drink. Bananas are good. Any of the BRAT diet that we’ve been told and taught way back when those are good. Anything that's not so sugary because sugar can induce more diarrhea. We have to go bland. We have to go soft, and basically just any calories that we can give to the child so they don't get dehydrated any further or lose weight any further, as long as it's not irritating those are good.

Melanie: Thank you so much, Dr. Soriano for being with us today. You're listening to Doctors Hospital Health News with Doctors Hospital of Laredo. For more information, you can go to ichoosedoctorshospital.com. That's ichoosedoctorshospital.com. Physicians are independent practitioners who are not employees or agents of Doctors Hospital of Laredo. The hospital shall not be liable for actions or treatments provided by physicians. Doctors Hospital of Laredo is directly or indirectly owned by a partnership that includes physician owners including certain members of the hospital medical staff. This is Melanie Cole, thanks so much for listening.