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. 2024 Dec 31;13(12):2118-2133.
doi: 10.21037/tp-24-257. Epub 2024 Dec 27.

Impact of Re-Du-Ning enema treatment on the intestinal microflora in pediatric patients with hand, foot, and mouth disease

Kun-Quan Tang  1 , Miao-Yuan Li  1 , Qin-Yuan Guo  1 , Juan Wang  1 , Huo-Qing Lu  1 , Bei Wang  1
Affiliations

Impact of Re-Du-Ning enema treatment on the intestinal microflora in pediatric patients with hand, foot, and mouth disease

Kun-Quan Tang et al. Transl Pediatr. .

Abstract

Background: Hand, foot, and mouth disease (HFMD) is a prevalent infectious condition in children. This study aimed to assess the regulatory effects of Re-Du-Ning on the intestinal microflora of pediatric patients with HFMD.

Methods: Fecal samples were collected from children affected by HFMD, who were diagnosed at the traditional Chinese medicine pediatrics outpatient and emergency departments of Liuzhou Women and Children's Healthcare Hospital, as well as from healthy children undergoing physical examinations at the same hospital during the same period. DNA was extracted from these samples and subjected to 16S ribosome DNA amplicon sequencing. The sequenced data were categorized, quantified, and compared. Analyses involved creating relative abundance bar graphs, constructing unweighted pair-group method with arithmetic mean clustering trees, and generating heatmaps of clustering to evaluate the variations in abundance and diversity across different groups. The analysis of molecular variance and t-test were used to analyze structural differences in microbial flora between groups, and linear discriminant analysis was used to identify significant differences in microbial genera between the groups.

Results: A total of 67 fecal samples were collected from children with HFMD (13 in the intravenous group, 40 in the enema group) and from healthy children (14 in the healthy group). When compared with the healthy group, the intestinal microflora diversity and similarity were highest after enema treatment, although the microbial structure exhibited significant changes (weighted_unifrac, P<0.05). The composition of species relative abundance was comparable between the healthy group and the post-enema group.

Conclusions: Re-Du-Ning enema treatment regulated the intestinal microflora in these children, significantly increasing the abundance of probiotics like Bifidobacteria and reducing the abundance of opportunistic pathogens like Enterobacter.

Keywords: Children; Re-Du-Ning; enema; hand, foot, and mouth disease (HFMD); intestinal microflora.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-24-257/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Species-relative abundance bar graph. Health, the healthy group; Enema1, the enema group before treatment; VEIN1, the intravenous group before treatment; Enema2, the enema group after treatment; VEIN2, the intravenous group after treatment.
Figure 2
Figure 2
UPGMA clustering tree. Health, the healthy group; Enema1, the enema group before treatment; VEIN1, the intravenous group before treatment; Enema2, the enema group after treatment; VEIN2, the intravenous group after treatment; UPGMA, unweighted pair-group method with arithmetic mean.
Figure 3
Figure 3
Heatmap of abundance among groups. Health, the healthy group; Enema1, the enema group before treatment; VEIN1, the intravenous group before treatment; Enema2, the enema group after treatment; VEIN2, the intravenous group after treatment.
Figure 4
Figure 4
T-test graph comparing healthy children (Health) and children with HFMD (E1V1). *, P<0.05; **, P<0.01. Health, the healthy group; VEIN1, the intravenous group before treatment; HFMD, hand, foot, and mouth disease.
Figure 5
Figure 5
T-test graph prior to (Enema1) and following (Enema2) enema treatment. *, P<0.05; **, P<0.01. Enema1, the enema group before treatment; Enema2, the enema group after treatment.
Figure 6
Figure 6
T-test graph prior to (VEIN1) and following (VEIN2) intravenous treatment. VEIN1, the intravenous group before treatment; VEIN2, the intravenous group after treatment.
Figure 7
Figure 7
LEfSe graph comparing healthy children (Health) and children with HFMD (E1V1). Health, the healthy group; Enema1, the enema group before treatment; VEIN1, the intravenous group before treatment; HFMD, hand, foot, and mouth disease; LEfSe, linear discriminant analysis effect size; LDA, linear discriminant analysis.
Figure 8
Figure 8
LEfSe graph prior to (Enema1) and following (Enema2) enema treatment. Enema1, the enema group before treatment; Enema2, the enema group after treatment; LEfSe, linear discriminant analysis effect size; LDA, linear discriminant analysis.
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