Acute diarrhea historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Historical Perspective
The historical perspective of the acute diarrhea is as follows:
- The word "diarrhea" was coined by Hippocrates.
- Diarrhea is derived from the Greek term "to flow through." Diarrhea is a common manifestation of the gastrointestinal disease.
- In 1898, Kioshi Shiga provided the first description of Shigella dysenteriae type 1 the bacteria for the epidemic bacterial dysentery.
- In 1903, Conradi reported that extracts of Shiga's bacillus in paralyzed and killed rabbits.
- Similar findings were published independently by Neisser and Shiga (11).
- The research in the next 70 years showed the following
- The endotoxic activity associated with Shiga's bacillus from the activity of the protein Stx
- The partial purification of Stx
- The discovery that high iron concentrations inhibit Stx synthesis
- The seminal observation by Bridgwater et al. and Howard that Stx appears to target vascular endothelium in the brain
- The discovery by Vicari et al. that Stx is lethal for certain epithelial cells in culture.
- Although these findings were of interest to toxicologists, none of the results proved a direct role for Stx in the pathogenesis of shigellosis.
- Only decades later, S. dysenteriae type 1, was it clear that production of Stx by the organism exacerbates the severity of the intestinal and systemic lesions in human subjects and increases the intestinal pathology in primate hosts.
- The ultimate proof of a role for Stx in shigellosis due to Shiga's bacillus was the establishment of a connection between the production of this and related toxins with the subsequent development of the hemolytic uremic syndrome.
- In 1972, Keusch and colleagues made the significant finding that Stx alone caused fluid accumulation and enteritis in ligated rabbit intestinal segments.
- The above research revealed that Stx can contribute to the intestinal phase of bacillary dysentery, i.e., bloody diarrhea.
- Brown and colleagues, and Donohue-Rolfe and coworkers and the subsequent testing of that material for all three bioactivities.
- Olsnes and Eiklid demonstrated the purification os Stx the same molecule responsible for its cytotoxic and lethal activities.