Newman R D, Sears C L, Moore S R, Nataro J P, Wuhib T, Agnew D A, Guerrant R L, Lima A A
Health Alliance International, Seattle, WA 98105, USA.
J Infect Dis. 1999 Jul;180(1):167-75. doi: 10.1086/314820.
A prospective, 4-year cohort study of children born in an urban slum in northeastern Brazil was undertaken to elucidate the epidemiology of Cryptosporidium infection in an endemic setting, describe factors associated with Cryptosporidium-associated persistent diarrhea, and clarify the importance of copathogens in symptomatic cryptosporidiosis. A total of 1476 episodes of diarrhea, accounting for 7581 days of illness (5.25 episodes/child-year), were recorded: of these, 102 episodes (6.9%) were persistent. Cryptosporidium oocysts were identified in 7.4% of all stools, and they were found more frequently in children with persistent diarrhea (16.5%) than in those with acute (8.4%) or no (4.0%) diarrhea (P<.001). Low-birth-weight children and those living in densely crowded subdivisions were at greater risk for symptomatic infection. Disease course was highly variable and was not associated with the presence of copathogens. Recurrent Cryptosporidium infection and relapsing diarrhea associated with it were moderately common. In light of these data, the applicability of the current World Health Organization diarrheal definitions to Cryptosporidium-associated diarrheal episodes may need to be reconsidered.
在巴西东北部一个城市贫民窟对出生儿童开展了一项为期4年的前瞻性队列研究，以阐明地方流行环境中隐孢子虫感染的流行病学特征，描述与隐孢子虫相关的持续性腹泻有关的因素，并阐明共病原体在有症状隐孢子虫病中的重要性。共记录了1476次腹泻发作，累计患病7581天（每名儿童每年5.25次发作）：其中102次发作（6.9%）为持续性腹泻。在所有粪便样本中，7.4%检测出隐孢子虫卵囊，持续性腹泻儿童中隐孢子虫卵囊检出率（16.5%）高于急性腹泻儿童（8.4%）或无腹泻儿童（4.0%）（P<0.001）。低体重儿童和居住在人口密集分区的儿童发生有症状感染的风险更高。病程变化很大，且与共病原体的存在无关。隐孢子虫反复感染及其相关的复发性腹泻较为常见。鉴于这些数据，可能需要重新考虑世界卫生组织目前腹泻定义对隐孢子虫相关腹泻发作的适用性。
