Lanata C F, Black R E, Maúrtua D, Gil A, Gabilondo A, Yi A, Miranda E, Gilman R H, León-Barúa R, Sack R B
Instituto de Investigación Nutricional, Lima, Perú.
Acta Paediatr Suppl. 1992 Sep;381:32-8. doi: 10.1111/j.1651-2227.1992.tb12369.x.
In a longitudinal study of acute and persistent diarrhea in 677 children less than three years old in a peri-urban community of Lima, Perú, during 27 months of surveillance, stools were cultured at the beginning of each diarrheal episode and on each subsequent week of illness. Analyzing stool cultures only from children who had not received antibiotic treatment in the 48 h prior to the culture, no association was found between any enteropathogen and persistent diarrhea. We did not find any increase in mixed infections in persistent diarrhea episodes as compared with acute diarrhea, controlling for age, season and anthropometric status. The isolation rate for any given enteropathogen was similar during the first, second, third or later week of illness, but when the presence of a specific enteropathogen was sought in sequential stools within a single episode, no evidence of persistent infection was found. This study shows that in developing countries with a high incidence of diarrheal diseases frequent re-infections with enteropathogens prevalent in the population are one reason for prolonged illnesses. Host factors that increase susceptibility to infection or decrease recovery from illness may also play a role. Further studies of these factors, such as micronutrient deficiencies, are needed to identify a public health intervention to control persistent diarrhea, a condition associated with mortality in many developing countries.
在秘鲁利马一个城郊社区对677名3岁以下儿童进行的急性和持续性腹泻纵向研究中，在27个月的监测期内，每次腹泻发作开始时以及患病后的每一周都对粪便进行培养。仅分析在培养前48小时内未接受抗生素治疗的儿童的粪便培养物，未发现任何肠道病原体与持续性腹泻之间存在关联。在控制年龄、季节和人体测量状况的情况下，与急性腹泻相比，我们未发现持续性腹泻发作时混合感染有所增加。在患病的第一周、第二周、第三周或更晚周次，任何特定肠道病原体的分离率相似，但在单次发作的连续粪便中寻找特定肠道病原体时，未发现持续感染的证据。这项研究表明，在腹泻疾病高发的发展中国家，人群中普遍存在的肠道病原体频繁重复感染是疾病持续时间延长的一个原因。增加感染易感性或降低疾病恢复能力的宿主因素也可能起作用。需要对这些因素（如微量营养素缺乏）进行进一步研究，以确定控制持续性腹泻的公共卫生干预措施，持续性腹泻在许多发展中国家与死亡率相关。
