Lima A A, Moore S R, Barboza M S, Soares A M, Schleupner M A, Newman R D, Sears C L, Nataro J P, Fedorko D P, Wuhib T, Schorling J B, Guerrant R L
Clinical Research Unit-HUWC, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Cear¿a, 3390-Sala 90, Porangabussu, Fortaleza, CE, Brazil-CEP 60.436-160.
J Infect Dis. 2000 May;181(5):1643-51. doi: 10.1086/315423. Epub 2000 May 15.
Persistent diarrhea (PD; duration >/=14 days) is a growing part of the global burden of diarrheal diseases. A 45-month prospective cohort study (with illness, nutritional, and microbiologic surveillance) was conducted in a shantytown in northeastern Brazil, to elucidate the epidemiology, nutritional impact, and causes of PD in early childhood (0-3 years of age). A nested case-control design was used to examine children's diarrhea burden and nutritional status before and after a first PD illness. PD illnesses accounted for 8% of episodes and 34% of days of diarrhea. First PD illnesses were preceded by a doubling of acute diarrhea burdens, were followed by further 2.6-3.5-fold increased diarrhea burdens for 18 months, and were associated with acute weight shortfalls. Exclusively breast-fed children had 8-fold lower diarrhea rates than did weaned children. PD-associated etiologic agents included Cryptosporidium, Giardia, enteric adenoviruses, and enterotoxigenic Escherichia coli. PD signals growth shortfalls and increased diarrhea burdens; children with PD merit extended support, and the illness warrants further study to elucidate its prevention, treatment, and impact.
持续性腹泻（PD；持续时间≥14天）在全球腹泻病负担中所占比例日益增加。在巴西东北部的一个棚户区开展了一项为期45个月的前瞻性队列研究（包括疾病、营养和微生物监测），以阐明幼儿期（0至3岁）PD的流行病学、营养影响及病因。采用巢式病例对照设计，研究首次发生PD疾病前后儿童的腹泻负担和营养状况。PD疾病占腹泻发作次数的8%，腹泻天数的34%。首次发生PD疾病前，急性腹泻负担增加一倍，之后18个月腹泻负担进一步增加2.6至3.5倍，且与急性体重不足有关。纯母乳喂养儿童的腹泻率比断奶儿童低8倍。与PD相关的病原体包括隐孢子虫、贾第虫、肠道腺病毒和产肠毒素大肠杆菌。PD预示着生长发育迟缓以及腹泻负担增加；患有PD的儿童需要长期支持，该疾病值得进一步研究，以阐明其预防、治疗及影响。
