Andreasson Thomas, Gustavsson Lars, Lindh Magnus, Bergbrant Ing-Marie, Raner Christina, Ahrén Christina, Westin Johan, Andersson Lars-Magnus
From the Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
Scand J Infect Dis. 2014 Aug;46(8):561-5. doi: 10.3109/00365548.2014.914242. Epub 2014 May 16.
To our knowledge no clinical criteria for the identification of community onset viral gastroenteritis in individual patients have been evaluated systematically with modern PCR-based diagnostic assays as gold standard.
The aim of this study was to identify factors independently associated with the detection of virus by PCR in rectal swab samples from patients with acute community onset gastroenteritis.
A prospective observational study was conducted from December 2010 through March 2011 at the emergency department (ED) of a large teaching hospital. All patients who reported vomiting and/or diarrhoea up to 48 h prior to their visit to the ED were asked to participate. A rectal swab sample was obtained from each patient. Symptoms, date of onset, and epidemiological data were recorded. Samples were analysed with a multiple real-time PCR targeting 6 viral agents (astrovirus, adenovirus, rotavirus, sapovirus, and norovirus GI and GII).
Two hundred and five patients fulfilled the inclusion criteria, of whom 66 agreed to participate; their median (IQR) age was 65 (38-84) y and 43 (65%) were females. Thirty-one (47%) were positive by PCR for at least 1 of the agents examined (26 norovirus, 2 sapovirus, 2 rotavirus, and 1 adenovirus). Diarrhoea and a short duration of symptoms (≤ 2 days) were independently associated with a positive rectal swab sample, with odds ratios of 7.5 (95% confidence interval (CI) 2.0-28) and 10.4 (95% CI 1.9-56), respectively (p < 0.01 for both). A multivariate model including these 2 variables had a sensitivity of 81% (25/31) and a specificity of 69% (24/35).
Diarrhoea and a short duration of symptoms were the only anamnestic criteria independently associated with acute community onset viral gastroenteritis confirmed by PCR.
据我们所知，尚无针对个体患者社区获得性病毒性胃肠炎的临床诊断标准通过以现代基于PCR的诊断检测作为金标准进行系统评估。
本研究旨在确定在急性社区获得性胃肠炎患者的直肠拭子样本中，与通过PCR检测到病毒独立相关的因素。
2010年12月至2011年3月在一家大型教学医院的急诊科进行了一项前瞻性观察研究。所有在就诊急诊科前48小时内出现呕吐和/或腹泻的患者均被邀请参与。从每位患者获取直肠拭子样本。记录症状、发病日期和流行病学数据。样本采用针对6种病毒病原体（星状病毒、腺病毒、轮状病毒、札幌病毒以及诺如病毒GI和GII）的多重实时PCR进行分析。
205例患者符合纳入标准，其中66例同意参与；他们的年龄中位数（四分位间距）为65（38 - 84）岁，43例（65%）为女性。31例（47%）通过PCR检测至少一种检测病原体呈阳性（26例诺如病毒、2例札幌病毒、2例轮状病毒和1例腺病毒）。腹泻和症状持续时间短（≤2天）与直肠拭子样本阳性独立相关，比值比分别为7.5（95%置信区间（CI）2.0 - 28）和10.4（95%CI 1.9 - 56）（两者p均<0.01）。包含这两个变量的多变量模型灵敏度为81%（25/31），特异度为69%（24/35）。
腹泻和症状持续时间短是与PCR确诊的急性社区获得性病毒性胃肠炎独立相关的仅有的既往史标准。
