Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
BMC Infect Dis. 2013 Jan 24;13:37. doi: 10.1186/1471-2334-13-37.
Persistent digestive disorders account for considerable disease burden in the tropics. Despite advances in understanding acute gastrointestinal infections, important issues concerning epidemiology, diagnosis, treatment and control of most persistent digestive symptomatologies remain to be elucidated. Helminths and intestinal protozoa are considered to play major roles, but the full extent of the aetiologic spectrum is still unclear. We provide an overview of pathogens causing digestive disorders in the tropics and evaluate available reference tests.
We searched the literature to identify pathogens that might give rise to persistent diarrhoea, chronic abdominal pain and/or blood in the stool. We reviewed existing laboratory diagnostic methods for each pathogen and stratified them by (i) microscopy; (ii) culture techniques; (iii) immunological tests; and (iv) molecular methods. Pathogen-specific reference tests providing highest diagnostic accuracy are described in greater detail.
Over 30 pathogens may cause persistent digestive disorders. Bacteria, viruses and parasites are important aetiologic agents of acute and long-lasting symptomatologies. An integrated approach, consisting of stool culture, microscopy and/or specific immunological techniques for toxin, antigen and antibody detection, is required for accurate diagnosis of bacteria and parasites. Molecular techniques are essential for sensitive diagnosis of many viruses, bacteria and intestinal protozoa, and are increasingly utilised as adjuncts for helminth identification.
Diagnosis of the broad spectrum of intestinal pathogens is often cumbersome. There is a need for rapid diagnostic tests that are simple and affordable for resource-constrained settings, so that the management of patients suffering from persistent digestive disorders can be improved.
在热带地区，持续性消化紊乱会导致相当大的疾病负担。尽管人们对急性胃肠道感染有了更深入的了解，但仍有一些重要问题需要阐明，如大多数持续性消化症状的流行病学、诊断、治疗和控制。蠕虫和肠道原生动物被认为起主要作用，但病因谱的全貌仍不清楚。我们概述了热带地区引起消化紊乱的病原体，并评估了现有的参考检测方法。
我们检索了文献，以确定可能导致持续性腹泻、慢性腹痛和/或粪便带血的病原体。我们回顾了每种病原体现有的实验室诊断方法，并按（i）显微镜检查；（ii）培养技术；（iii）免疫测试；和（iv）分子方法进行了分类。描述了具有最高诊断准确性的病原体特异性参考检测方法。
超过 30 种病原体可能导致持续性消化紊乱。细菌、病毒和寄生虫是急性和长期症状的重要病因。为了准确诊断细菌和寄生虫，需要采用粪便培养、显微镜检查和/或针对毒素、抗原和抗体检测的特异性免疫技术的综合方法。分子技术对于许多病毒、细菌和肠道原生动物的敏感诊断至关重要，并且越来越多地被用作辅助寄生虫鉴定的方法。
对广泛的肠道病原体的诊断往往很繁琐。需要简单、经济实惠的快速诊断测试，以改善资源有限环境中持续性消化紊乱患者的管理。
