Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
J Infect Dis. 2012 May 1;205(9):1374-81. doi: 10.1093/infdis/jis206. Epub 2012 Mar 27.
Acute gastroenteritis (AGE) remains a common cause of clinic visits and hospitalizations in the United States, but the etiology is rarely determined.
We performed a prospective, multicenter emergency department-based study of adults with AGE. Subjects were interviewed on presentation and 3-4 weeks later. Serum samples, rectal swab specimens, and/or whole stool specimens were collected at presentation, and serum was collected 3-4 weeks later. Fecal specimens were tested for a comprehensive panel of viral, bacterial, and parasitic pathogens; serum was tested for calicivirus antibodies.
Pathogens were detected in 25% of 364 subjects, including 49% who provided a whole stool specimen. The most commonly detected pathogens were norovirus (26%), rotavirus (18%), and Salmonella species (5.3%). Pathogens were detected significantly more often from whole stool samples versus a rectal swab specimen alone. Nine percent of subjects who provided whole stool samples had >1 pathogen identified.
Viruses, especially noroviruses, play a major role as agents of severe diarrhea in adults. Further studies to confirm the unexpectedly high prevalence of rotaviruses and to explore the causes of illness among patients from whom a pathogen cannot be determined are needed. Studies of enteric pathogens should require the collection of whole stool samples.
在美国，急性肠胃炎（AGE）仍然是导致门诊和住院的常见原因，但病因很少确定。
我们对患有 AGE 的成年人进行了一项前瞻性、多中心的急诊室基础研究。受试者在就诊时和 3-4 周后进行了访谈。在就诊时采集血清样本、直肠拭子标本和/或全粪便标本，在 3-4 周后采集血清。粪便标本检测全面的病毒、细菌和寄生虫病原体；血清检测杯状病毒抗体。
在 364 名受试者中，有 25%检测到病原体，其中 49%提供了全粪便标本。最常检测到的病原体是诺如病毒（26%）、轮状病毒（18%）和沙门氏菌属（5.3%）。从全粪便样本中检测到病原体的比例明显高于单独直肠拭子样本。9%提供全粪便样本的受试者有>1种病原体被检出。
病毒，尤其是诺如病毒，在成人严重腹泻中起主要作用。需要进一步研究以证实轮状病毒的高发病率，并探讨无法确定病原体的患者的病因。肠病原体的研究应要求采集全粪便样本。
