Zhang Zike, Lai Shengjie, Yu Jianxing, Geng Qibin, Yang Wanqi, Chen Yu, Wu Jianguo, Jing Huaiqi, Yang Weizhong, Li Zhongjie
Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.
PLoS One. 2017 Mar 21;12(3):e0173881. doi: 10.1371/journal.pone.0173881. eCollection 2017.
Acute diarrhea leads to a substantial disease burden among the elderly worldwide. However, in the context of increasingly aging trend in China, the prevalence of etiological agents among elderly diarrheal patients was undetermined. This study aimed to explore the major enteropathogens of acute diarrhea among outpatients older than 65 years in China, and also the epidemiological features of the pathogens. Demographic and clinical data for acute diarrhea among outpatients older than 65 years were collected from 213 participating hospitals from 2009 to 2014. Stool specimens were collected and tested for 13 enteric viruses and bacteria. The proportion of outpatients positive for targeted pathogens was analyzed by residential areas and seasonal patterns. Among the 7,725 patients enrolled, 1,617 (20.9%)were positive for any one of the 13 study pathogens. The predominant pathogen was norovirus (9.0%), followed by diarrheagenic Escherichia coli (DEC) (5.5%), rotavirus (3.9%), non-typhoidal Salmonella (NTS) (2.9%), and Shigella spp. (2.5%). The prevalence of Shigella spp. among rural patients (6.9%) was higher than that among urban patients (1.6%) (p < 0.001), with opposite trend for DEC (3.6% versus 5.9%, p = 0.007). An obvious seasonal pattern was observed for major pathogens, with peak for norovirus in autumn, rotavirus in winter and DEC, NTS, and Shigella spp. in summer. A wide variety of enteropathogens were detected among the elderly with acute diarrhea in China, with norovirus and DEC being the most commonly isolated pathogens. A strong seasonal pattern was observed for major pathogens of acute diarrhea among the elderly.
急性腹泻在全球老年人中导致了沉重的疾病负担。然而，在中国老龄化趋势日益加剧的背景下，老年腹泻患者中病原体的流行情况尚不确定。本研究旨在探讨中国65岁以上门诊急性腹泻患者的主要肠道病原体及其流行病学特征。收集了2009年至2014年期间来自213家参与医院的65岁以上门诊急性腹泻患者的人口统计学和临床数据。采集粪便标本并检测13种肠道病毒和细菌。按居住地区和季节模式分析目标病原体阳性门诊患者的比例。在纳入的7725例患者中，1617例（20.9%）对13种研究病原体中的任何一种呈阳性。主要病原体为诺如病毒（9.0%），其次是致泻性大肠杆菌（DEC）（5.5%）、轮状病毒（3.9%）、非伤寒沙门菌（NTS）（2.9%）和志贺菌属（2.5%）。农村患者中志贺菌属的患病率（6.9%）高于城市患者（1.6%）（p<0.001），而DEC的情况则相反（3.6%对5.9%，p = 0.007）。主要病原体呈现明显的季节性模式，诺如病毒在秋季达到高峰，轮状病毒在冬季，DEC、NTS和志贺菌属在夏季。在中国老年急性腹泻患者中检测到多种肠道病原体，诺如病毒和DEC是最常见的分离病原体。老年急性腹泻主要病原体呈现强烈的季节性模式。
