Lima A A, Fang G, Schorling J B, de Albuquerque L, McAuliffe J F, Mota S, Leite R, Guerrant R L
Department of Medicine, University of Virginia School of Medicine, Charlottesville.
Acta Paediatr Suppl. 1992 Sep;381:39-44. doi: 10.1111/j.1651-2227.1992.tb12370.x.
With the improved control of acute diarrheal illness mortality with oral rehydration therapy, persistent diarrhea is now emerging as a major cause of childhood mortality in tropical developing areas like the impoverished populations in Brazil's Northeast. "Graveyard surveillance" in the rural community of Guaiuba in northeastern Brazil revealed fully half of the 70% diarrhea mortality was due to persistent diarrheal illnesses. Furthermore, 11% of 14 or more diarrheal illnesses per child per year in an urban slum in Fortaleza persisted beyond 14 days, a definition that clearly identified the high risk children for heavy diarrhea burdens. Not only did heavy diarrhea burdens ablate the key "catch-up" growth seen in severely malnourished children and in children following previous diarrheal illnesses, but malnutrition significantly predisposed children to a greater incidence and duration of diarrhea as well as a greater incidence of persistent diarrhea. Etiologic studies of 37 children presenting with persistent diarrhea to Hospital das Clinicas in Fortaleza revealed that Cryptosporidium (in 13%) and enteroadherent E. coli (36% with aggregative, 29% with diffuse and 13% with localized adherence to HEp-2 cells) were the predominant potential pathogens found in the stool or upper small bowel. These findings suggest that persistent diarrhea is emerging as an important health problem in Brazil's Northeast, that it identifies a high risk child for heavy diarrhea burdens, that important interactions occur with malnutrition and that Cryptosporidium and enteroadherent E. coli warrant further study as potential etiologies of this major cause of morbidity and mortality.
随着口服补液疗法对急性腹泻病死亡率控制的改善，持续性腹泻如今正成为热带发展中地区儿童死亡的主要原因，比如巴西东北部的贫困人群。巴西东北部瓜伊巴农村社区的“墓地监测”显示，腹泻死亡率中有70%的半数完全是由持续性腹泻病所致。此外，福塔莱萨一个城市贫民窟中，每年每个儿童出现14次或更多腹泻病的病例中，有11%的腹泻持续超过14天，这一定义明确识别出了腹泻负担重的高危儿童。严重腹泻负担不仅消除了重度营养不良儿童以及先前患过腹泻病的儿童中出现的关键“追赶性”生长，而且营养不良还显著使儿童更易出现腹泻的更高发病率和更长病程以及持续性腹泻的更高发病率。对福塔莱萨临床医院37例持续性腹泻患儿的病因学研究显示，隐孢子虫（13%）和肠道黏附性大肠杆菌（聚集性黏附于HEP - 2细胞的占36%，弥漫性黏附的占29%，局限性黏附的占13%）是在粪便或上段小肠中发现的主要潜在病原体。这些发现表明，持续性腹泻正成为巴西东北部一个重要的健康问题，它识别出了腹泻负担重的高危儿童，营养不良与之存在重要相互作用，并且隐孢子虫和肠道黏附性大肠杆菌作为这一发病和死亡主要原因的潜在病因值得进一步研究。
