1921
Volume 101, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Acute diarrhea is an important public health issue. Here, we focused on the differences of enteropathogens in acute diarrhea between urban and rural areas in southeast China. Laboratory- and sentinel-based surveillance of acute diarrhea (≥ 3 loose or liquid stools/24 hours) was conducted at 16 hospitals. Fecal specimens were tested for bacterial ( sp., sp., diarrheagenic , , non-typhoidal , sp., sp., and sp.) and viral (adenovirus, astrovirus, , , and ) pathogens. Descriptive statistics were used. Between January 1, 2010, and December 31, 2014, 4,548 outpatients with acute diarrhea were enrolled (urban, = 3,220; rural, = 1,328). Pathogens were identified in 2,074 (45.6%) patients. Norovirus (25.7%), (10.2%), enteroaggregative (EAEC) (8.8%), group A (7.0%), and enterotoxigenic (ETEC) (5.6%) were the most common pathogens. Enteropathogens were less common in urban than in rural areas (42.0% versus 54.4%, < 0.001). In urban areas, EAEC and ETEC were more common in high-income than in middle-income regions. Interventions targeting the most common enteropathogens can substantially reduce the burden of acute diarrhea in southeast China.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0171
2019-06-17
2020-09-26
Loading full text...

Full text loading...

/deliver/fulltext/14761645/101/2/tpmd190171.html?itemId=/content/journals/10.4269/ajtmh.19-0171&mimeType=html&fmt=ahah

References

  1. GBD Diarrhoeal Diseases Collaborators, 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the global burden of disease study 2015. Lancet Infect Dis 17: 909948.
    [Google Scholar]
  2. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O’Brien KL, Campbell H, Black RE, 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.
    [Google Scholar]
  3. Qiao N et al., 2017. Variation analysis of Norovirus among children with diarrhea in rural Hebei Province, North of China. Infect Genet Evol 53: 199205.
    [Google Scholar]
  4. Wang XY et al., 2005. Incidence of diarrhea caused by Rotavirus infections in rural Zhengding, China: prospective, population-based surveillance. J Infect Dis 192 (Suppl 1): S100S105.
    [Google Scholar]
  5. Qin S, Duan R, Jing HQ, Wang X, 2018. Etiology of bacterial diarrhea in large cities, mid-sized/small cities and rural areas of China. Zhonghua Liu Xing Bing Xue Za Zhi 39: 651655.
    [Google Scholar]
  6. Wang X, Wang J, Sun H, Xia S, Duan R, Liang J, Xiao Y, Qiu H, Shan G, Jing H, 2015. Etiology of childhood infectious diarrhea in a developed region of China: compared to childhood diarrhea in a developing region and adult diarrhea in a developed region. PLoS One 10: e0142136.
    [Google Scholar]
  7. Section on Breastfeeding, 2012. Breastfeeding and the use of human milk. Pediatrics 129: e827e841.
    [Google Scholar]
  8. World Health Organization, 2018. Infant and Young Child Feeding. Geneva, Switzerland: WHO.
    [Google Scholar]
  9. Shane AL et al., 2017. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis 65: 19631973.
    [Google Scholar]
  10. Management Office of National Science and Technology Major Project of China, 2011. Diarrheal Syndrome Surveillance Protocol (2012 Version). Beijing, China: Chinese Center for Disease Control and Prevention.
    [Google Scholar]
  11. Yan H, Nguyen TA, Phan TG, Okitsu S, Li Y, Ushijima H, 2004. Development of RT-multiplex PCR assay for detection of adenovirus and group A and C rotaviruses in diarrheal fecal specimens from children in China. Kansenshogaku Zasshi 78: 699709.
    [Google Scholar]
  12. Liu X et al., 2015. Etiological epidemiology of viral diarrhea on the basis of sentinel surveillance in children younger than 5 years in Gansu, northwest China, 2009–2013. J Med Virol 87: 20482053.
    [Google Scholar]
  13. Zheng S et al., 2016. Enteropathogens in children less than 5 years of age with acute diarrhea: a 5-year surveillance study in the Southeast Coast of China. BMC Infect Dis 16: 434.
    [Google Scholar]
  14. Muller D, Greune L, Heusipp G, Karch H, Fruth A, Tschape H, Schmidt MA, 2007. Identification of unconventional intestinal pathogenic Escherichia coli isolates expressing intermediate virulence factor profiles by using a novel single-step multiplex PCR. Appl Environ Microbiol 73: 33803390.
    [Google Scholar]
  15. Brenner F, Villar R, Angulo F, Tauxe R, Swaminathan B, 2000. Salmonella nomenclature. J Clin Microbiol 38: 24652467.
    [Google Scholar]
  16. Wang X, Cui Z, Jin D, Tang L, Xia S, Wang H, Xiao Y, Qiu H, Hao Q, Kan B, 2009. Distribution of pathogenic Yersinia enterocolitica in China. Eur J Clin Microbiol Infect Dis 28: 12371244.
    [Google Scholar]
  17. National Bureau of Statistics of China, 2008. Statistic Provisions for Dividing Urban and Rural Areas. Beijing, China: National Bureau of Statistics of China.
    [Google Scholar]
  18. The World Bank, 2018. World Bank Country and Lending Groups. Washington, DC: The World Bank.
    [Google Scholar]
  19. Li J, Pan H, Xiao WJ, Gong XH, Zhuang Y, Kuang XZ, Wu HY, Yuan ZA, 2017. Epidemiological and etiological surveillance study of infectious diarrhea in Shanghai in 2013–2015. Zhonghua Yu Fang Yi Xue Za Zhi 51: 11131117.
    [Google Scholar]
  20. Chen C-J, Wu F-T, Huang Y-C, Chang W-C, Wu H-S, Wu C-Y, Lin J-S, Huang F-C, Hsiung CA, 2015. Clinical and epidemiologic features of severe viral gastroenteritis in children: a 3-year surveillance, multicentered study in Taiwan with partial Rotavirus immunization. Medicine 94: e1372.
    [Google Scholar]
  21. Operario DJ et al., 2017. Etiology of severe acute watery diarrhea in children in the global Rotavirus surveillance network using quantitative polymerase chain reaction. J Infect Dis 216: 220227.
    [Google Scholar]
  22. Podkolzin AT et al., 2009. Hospital-based surveillance of Rotavirus and other viral agents of diarrhea in children and adults in Russia, 2005–2007. J Infect Dis 200 (Suppl 1): S228S233.
    [Google Scholar]
  23. Zhang J et al., 2015. Rotavirus-specific and overall diarrhea mortality in Chinese children younger than 5 years: 2003 to 2012. Pediatr Infect Dis J 34: e233e237.
    [Google Scholar]
  24. Ahmed SM, Hall AJ, Robinson AE, Verhoef L, Premkumar P, Parashar UD, Koopmans M, Lopman BA, 2014. Global prevalence of Norovirus in cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infect Dis 14: 725730.
    [Google Scholar]
  25. Glass RI, Parashar UD, Estes MK, 2009. Norovirus gastroenteritis. New Engl J Med 361: 17761785.
    [Google Scholar]
  26. O’Brien SJ, Donaldson AL, Iturriza-Gomara M, Tam CC, 2016. Age-specific incidence rates for Norovirus in the community and presenting to primary healthcare facilities in the United Kingdom. J Infect Dis 213 (Suppl 1): S15S18.
    [Google Scholar]
  27. Patel MM, Hall AJ, Vinje J, Parashar UD, 2009. Noroviruses: a comprehensive review. J Clin Virol 44: 18.
    [Google Scholar]
  28. Zhang ZK, Lai SJ, Yu JX, Geng QB, Yang WQ, Chen Y, Wu JG, Jing HQ, Yang WZ, Li ZJ, 2017. Etiology of acute diarrhea in the elderly in China: a six-year observational study. Plos One 12: 10.
    [Google Scholar]
  29. Canizalez-Roman A, Flores-Villaseñor HM, Gonzalez-Nuñez E, Velazquez-Roman J, Vidal JE, Muro-Amador S, Alapizco-Castro G, Díaz-Quiñonez JA, León-Sicairos N, 2016. Surveillance of diarrheagenic Escherichia coli strains isolated from diarrhea cases from children, adults and elderly at Northwest of Mexico. Front Microbiol 7: 1924.
    [Google Scholar]
  30. Zhou Y et al., 2018. Bacterial pathogen spectrum of acute diarrheal outpatients in an urbanized rural district in Southwest China. Int J Infect Dis 70: 5964.
    [Google Scholar]
  31. Zhou Y, Zhu X, Hou H, Lu Y, Yu J, Mao L, Mao L, Sun Z, 2018. Characteristics of diarrheagenic Escherichia coli among children under 5 years of age with acute diarrhea: a hospital based study. BMC Infect Dis 18: 63.
    [Google Scholar]
  32. Chen Y et al., 2014. Serotypes, genotypes and antimicrobial resistance patterns of human diarrhoeagenic Escherichia coli isolates circulating in Southeastern China. Clin Microbiol Infect 20: 5258.
    [Google Scholar]
  33. Nataro JP, Mai V, Johnson J, Blackwelder WC, Heimer R, Tirrell S, Edberg SC, Braden CR, Morris JG, Hirshon JM, 2006. Diarrheagenic Escherichia coli infection in Baltimore, Maryland, and New Haven, Connecticut. Clin Infect Dis 43: 402407.
    [Google Scholar]
  34. Zhang S-X et al., 2016. Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China. Infect Dis Poverty 5: 64.
    [Google Scholar]
  35. Satter SM, Gastanaduy PA, Islam K, Rahman M, Rahman M, Luby SP, Heffelfinger JD, Parashar UD, Gurley ES, 2017. Hospital-based surveillance for Rotavirus gastroenteritis among young children in Bangladesh: defining the potential impact of a Rotavirus vaccine program. Pediatr Infect Dis J 36: 168172.
    [Google Scholar]
  36. Li Y et al., 2014. Nontyphoidal Salmonella infection in children with acute gastroenteritis: prevalence, serotypes, and antimicrobial resistance in Shanghai, China. Foodborne Pathog Dis 11: 200206.
    [Google Scholar]
  37. Gorkiewicz G, 2009. Nosocomial and antibiotic-associated diarrhoea caused by organisms other than Clostridium difficile. Int J Antimicrob Agents 33: S37S41.
    [Google Scholar]
  38. Sears CL, 2009. Enterotoxigenic Bacteroides fragilis: a rogue among symbiotes. Clin Microbiol Rev 22: 349369.
    [Google Scholar]
  39. Woo PC, Lau SK, Teng JL, Que T-L, Yung RW, Luk W-K, Lai RW, Hui W-T, Wong SS, Yau H-H, 2004. Association of Laribacter hongkongensis in community-acquired gastroenteritis with travel and eating fish: a multicentre case-control study. Lancet 363: 19411947.
    [Google Scholar]
  40. Guo Y, Duan Z, Qian Y, 2013. Changes in human parechovirus profiles in hospitalized children with acute gastroenteritis after a three-year interval in Lanzhou, China. PLoS One 8: e68321.
    [Google Scholar]
  41. Lasure N, Gopalkrishna V, 2017. Molecular epidemiology and clinical severity of human bocavirus (HBoV) 1–4 in children with acute gastroenteritis from Pune, Western India. J Med Virol 89: 1723.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0171
Loading
/content/journals/10.4269/ajtmh.19-0171
Loading

Data & Media loading...

Supplemental tables

  • Received : 28 Feb 2019
  • Accepted : 13 May 2019
  • Published online : 17 Jun 2019
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error