International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
PLoS Negl Trop Dis. 2011 Apr 5;5(4):e999. doi: 10.1371/journal.pntd.0000999.
In Bangladesh, increases in cholera epidemics are being documented with a greater incidence and severity. The aim of this prospective study was to identify the prevalence and importance of V. cholerae O1 and enterotoxigenic Escherichia coli (ETEC) as causal agents of severe diarrhea in a high diarrhea prone urban area in Dhaka city.
Systematic surveillance was carried out on all diarrheal patients admitted from Mirpur between March 2008 to February 2010 at the ICDDR, B hospital. Stool or rectal swabs were collected from every third diarrheal patient for microbiological evaluation.
Of diarrheal patients attending the hospital from Mirpur, 41% suffered from severe dehydration with 39% requiring intravenous rehydration therapy. More diarrheal patients were above five years of age (64%) than those below five years of age (36%). About 60% of the patients above five years of age had severe dehydration compared with only 9% of patients under five years of age. The most prevalent pathogen isolated was Vibrio cholerae O1 (23%) followed by ETEC (11%). About 8% of cholera infection was seen in infants with the youngest children being one month of age while in the case of ETEC the rate was 11%. Of the isolated ETEC strains, the enterotoxin type were almost equally distributed; ST accounted for 31% of strains; LT/ST for 38% and LT for 31%.
V. cholerae O1 is the major bacterial pathogen and a cause of severe cholera disease in 23% of patients from Mirpur. This represents a socioeconomic group that best reflects the major areas of high cholera burden in the country. Vaccines that can target such high risk groups in the country and the region will hopefully be able to reduce the disease morbidity and the transmission of pathogens that impact the life and health of people.
在孟加拉国，霍乱疫情的发病率和严重程度都有所增加。本前瞻性研究的目的是确定霍乱弧菌 O1 血清型和肠产毒性大肠杆菌（ETEC）作为达卡市米尔普尔地区高腹泻风险城市中严重腹泻的病原体的流行率和重要性。
对 2008 年 3 月至 2010 年 2 月期间在 ICDDR，B 医院就诊的所有米尔普尔腹泻患者进行系统监测。每 3 例腹泻患者中采集 1 份粪便或直肠拭子标本，进行微生物学评估。
从米尔普尔到医院就诊的腹泻患者中，有 41%患有严重脱水，其中 39%需要静脉补液治疗。年龄大于 5 岁的患者（64%）多于年龄小于 5 岁的患者（36%）。60%以上的 5 岁以上患者出现严重脱水，而 5 岁以下患者只有 9%出现严重脱水。分离出的最常见病原体是霍乱弧菌 O1（23%），其次是肠产毒性大肠杆菌（ETEC）（11%）。霍乱感染在婴儿中的发生率约为 8%，最小的婴儿为 1 个月大，而在肠产毒性大肠杆菌的情况下，这一比例为 11%。分离出的肠产毒性大肠杆菌菌株中，肠毒素类型几乎均匀分布；ST 占 31%；LT/ST 占 38%，LT 占 31%。
霍乱弧菌 O1 是主要的细菌病原体，在米尔普尔地区 23%的患者中引起严重霍乱疾病。这反映了该国和该地区霍乱负担最高的主要人群。能够针对该国和该地区高风险人群的疫苗有望降低疾病发病率和病原体传播，从而影响人们的生活和健康。
