Sire Jean-Marie, Garin Benoit, Chartier Loic, Fall Ndeye Khota, Tall Adama, Seck Abdoulaye, Weill François-Xavier, Breurec Sébastien, Vray Muriel
Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, France.
Paediatr Int Child Health. 2013 Aug;33(3):139-44. doi: 10.1179/2046905512Y.0000000046.
In sub-Saharan Africa, infectious diarrhoea is a major cause of childhood morbidity and mortality. A cross-sectional study was undertaken to document the pathogens potentially involved in community-acquired childhood diarrhoea in Dakar, the capital of Senegal.
Between September 2007 and March 2008, 176 children aged 1 month to 5 years were recruited consecutively from a primary health care institution in an urban area. Clinical data were recorded and stool samples were collected. Bacterial pathogens were identified using conventional methods and/or PCR assays. Rotaviruses and adenoviruses were detected by a rapid immunochromatographic test. Intestinal parasites were diagnosed by microscopy.
Rotavirus was the most common enteric pathogen, detected in 27% of patients, followed by Shigella (12%), diarrhoeagenic Escherichia coli (8%), enteric adenovirus (8%), Salmonella (4%), Campylobacter jejuni (3%) and Plesiomonas shigelloides (2%). Mixed bacterial/viral infections were detected in 6% of cases. Parasites, mostly protozoa, were detected in 14% of children. Using ipaH PCR, 30% of samples were positive for Shigella/entero-invasive E. coli. Detection of rotavirus was more frequently associated with younger age groups (<24 months), whereas bacterial diarrhoea was isolated more often in children over 1 year of age. Detection of bacterial pathogens was significantly associated with malnutrition. Antibiotics were prescribed for 77% of children who attended for consultation. No pathogen was found in 36% of them, whereas a virus was detected without any other associated bacterial or parasitic pathogen in 23% of patients.
In developing countries, there is a need to develop reliable, easy-to-use, inexpensive rapid diagnostic tests to guide the management of diarrhoea in infants and children and thereby prevent over-use of antimicrobial agents.
在撒哈拉以南非洲地区，感染性腹泻是儿童发病和死亡的主要原因。开展了一项横断面研究，以记录在塞内加尔首都达喀尔社区获得性儿童腹泻中可能涉及的病原体。
2007年9月至2008年3月期间，从市区一家初级卫生保健机构连续招募了176名年龄在1个月至5岁的儿童。记录临床数据并收集粪便样本。使用传统方法和/或聚合酶链反应（PCR）检测细菌病原体。通过快速免疫层析试验检测轮状病毒和腺病毒。通过显微镜检查诊断肠道寄生虫。
轮状病毒是最常见的肠道病原体，在27%的患者中检测到，其次是志贺菌（12%）、致泻性大肠杆菌（8%）、肠道腺病毒（8%）、沙门菌（4%）、空肠弯曲菌（3%）和类志贺邻单胞菌（2%）。6%的病例检测到混合细菌/病毒感染。14%的儿童检测到寄生虫，主要是原生动物。使用ipaH PCR，30%的样本志贺菌/肠侵袭性大肠杆菌呈阳性。轮状病毒的检测在较年轻年龄组（<24个月）中更常见，而细菌性腹泻在1岁以上儿童中更常分离到。细菌病原体的检测与营养不良显著相关。77%前来就诊的儿童使用了抗生素。其中36%未发现病原体，而23%的患者检测到病毒且无任何其他相关细菌或寄生虫病原体。
在发展中国家，需要开发可靠、易用、廉价的快速诊断测试，以指导婴幼儿腹泻的管理，从而防止抗菌药物的过度使用。
