孟加拉国常见肠道原生动物寄生虫与腹泻之间关联的前瞻性病例对照研究。
Prospective case-control study of the association between common enteric protozoal parasites and diarrhea in Bangladesh.
作者信息
Haque Rashidul, Mondal Dinesh, Karim Anwarul, Molla Imarot Hossain, Rahim Abdur, Faruque Abu S G, Ahmad Nooruddin, Kirkpatrick Beth D, Houpt Eric, Snider Cynthia, Petri William A
机构信息
International Centre for Diarrhoeal Disease Research, Bangladesh.
出版信息
Clin Infect Dis. 2009 May 1;48(9):1191-7. doi: 10.1086/597580.
BACKGROUND
The parasitic causes of diarrhea have historically been identified by use of microscopy; however, the use of this technique does not allow one to distinguish between subspecies or genotypes of parasites. Our objective was to determine, by use of modern diagnostic methods, the proportion of diarrhea cases in Bangladesh attributable to Cryptosporidium hominis, Cryptosporidium parvum, Entamoeba histolytica, and Giardia lamblia assemblages A and B.
METHODS
A prospective case-control study was performed involving 3646 case patients (both children and adults) who presented with diarrhea to the Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, and 2575 control subjects with asymptomatic infection. Parasitic infection was detected by use of a stool parasite antigen test, and the parasite load and the species and/or genotypes were determined by use of polymerase chain reaction (PCR).
RESULTS
Cryptosporidium species and E. histolytica were more prevalent in patients with acute diarrhea than in healthy control subjects, for all ages (2.1% vs. 1.4%; P = .039) and, specifically, for those 0-12 months of age (2.2% vs. 0.4%; P = .009). G. lamblia assemblage A was also more prevalent in case patients with diarrhea than in healthy control subjects (20% vs. 5%; P = .001). For case patients with diarrhea, the parasite load in feces, as measured by quantitative real-time PCR cycle threshold, was not higher that that for control subjects with asymptomatic infection. Case patients with diarrhea and cryptosporidiosis were less likely to have abdominal pain, compared with control subjects (15% vs. 37%; P = .001); case patients with amebiasis more likely to have visible blood in stool, compared with control subjects (8% vs. 1.6%; P = .001); and case patients with giardiasis more likely to be dehydrated, compared with control subjects (81% vs. 71%; P = .001).
CONCLUSION
E. histolytica, C. hominis, C. parvum, and G. lamblia assemblage A infections are important causes of diarrheal illness in Bangladesh.
背景
腹泻的寄生虫病因一直通过显微镜检查来确定；然而，使用这种技术无法区分寄生虫的亚种或基因型。我们的目标是通过现代诊断方法确定在孟加拉国，由人隐孢子虫、微小隐孢子虫、溶组织内阿米巴以及贾第虫A和B群引起的腹泻病例比例。
方法
开展了一项前瞻性病例对照研究，纳入了3646例腹泻患者（包括儿童和成人），这些患者前往孟加拉国腹泻疾病国际研究中心达卡医院就诊，以及2575例无症状感染的对照者。通过粪便寄生虫抗原检测来检测寄生虫感染，并使用聚合酶链反应（PCR）来确定寄生虫载量以及种类和/或基因型。
结果
在所有年龄段中，隐孢子虫属和溶组织内阿米巴在急性腹泻患者中比在健康对照者中更为普遍（2.1%对1.4%；P = 0.039），特别是在0至12个月大的人群中（2.2%对0.4%；P = 0.009）。贾第虫A群在腹泻病例患者中也比在健康对照者中更为普遍（20%对5%；P = 0.001）。对于腹泻病例患者，通过定量实时PCR循环阈值测量的粪便中的寄生虫载量并不高于无症状感染的对照者。与对照者相比，腹泻合并隐孢子虫病的病例患者腹痛的可能性较小（15%对37%；P = 0.001）；与对照者相比，阿米巴病病例患者粪便中出现可见血液的可能性更大（8%对1.6%；P = 0.001）；与对照者相比，贾第虫病病例患者脱水的可能性更大（81%对71%；P = 0.001）。
结论
溶组织内阿米巴、人隐孢子虫、微小隐孢子虫和贾第虫A群感染是孟加拉国腹泻疾病的重要病因。
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