Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics, National University of Rwanda, Kigali, Rwanda.
Clin Microbiol Infect. 2014 Dec;20(12):O1128-35. doi: 10.1111/1469-0691.12698. Epub 2014 Aug 11.
Acute gastroenteritis is a main cause of disease and death among children in low-income countries. The causality rates and pathogenic characteristics of putative aetiological agents remain insufficiently known. We used real-time PCR targeting 16 diarrhoeagenic agents to analyse stool samples from children ≤5.0 years old with acute diarrhoea in Rwanda. Among the 880 children (median age 14.2 months; 41% female) at least one pathogen was detected in 92% and two or more agents in 63% of cases. Rotavirus was detected in 36.9%, adenovirus in 39.7%, enterotoxigenic Escherichia coli (ETEC) with genes for labile (eltB) or stable (estA) toxin in 31.3% and 19.0%, E. coli with eae or bfpA genes in 25.2% and 14.2%, Shigella in 17.5% and Cryptosporidium in 7.8%. Rotavirus and ETEC-estA were associated with more severe dehydration than diarrhoea due to other causes. Shigella was associated with bloody stools and higher CRP. Microbial loads (Ct values) of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms. Rotavirus, ETEC-estA and E. coli with bfpA were associated with younger age, Shigella with older age. Antibiotic treatment was given to 42% and was associated with dehydration, fever and CRP, but not with pathogen. We conclude that rotavirus and ETEC-estA were the most important causes of diarrhoea with dehydration, that Shigella caused bloody diarrhoea but less severe dehydration, that microbial loads of rotavirus, ETEC-estA and Shigella were associated with severity of symptoms, and that antibiotic use was frequent and in poor agreement with microbiological findings.
急性肠胃炎是低收入国家儿童发病和死亡的主要原因。潜在病因的因果率和发病特征仍知之甚少。我们使用针对 16 种致腹泻病原体的实时 PCR 分析了卢旺达 880 名年龄≤5 岁的急性腹泻儿童的粪便样本。在至少检测到一种病原体的 92%儿童和两种或更多病原体的 63%儿童中，轮状病毒的检出率为 36.9%，腺病毒为 39.7%，产肠毒素性大肠杆菌（ETEC）中携带不稳定（eltB）或稳定（estA）毒素基因的检出率为 31.3%和 19.0%，带有 eae 或 bfpA 基因的大肠杆菌的检出率为 25.2%和 14.2%，志贺菌的检出率为 17.5%，隐孢子虫的检出率为 7.8%。轮状病毒和 ETEC-estA 与其他原因引起的腹泻相比，更容易导致严重脱水。志贺菌与血便和 CRP 升高有关。轮状病毒、ETEC-estA 和志贺菌的微生物负荷（Ct 值）与症状严重程度有关。轮状病毒、ETEC-estA 和带有 bfpA 的大肠杆菌与年龄较小有关，志贺菌与年龄较大有关。42%的儿童接受了抗生素治疗，与脱水、发热和 CRP 有关，但与病原体无关。我们的结论是，轮状病毒和 ETEC-estA 是导致脱水性腹泻的最重要原因，志贺菌引起血性腹泻，但脱水程度较轻，轮状病毒、ETEC-estA 和志贺菌的微生物负荷与症状严重程度有关，抗生素的使用很普遍，但与微生物学发现的一致性很差。
