Ronsmans C, Bennish M L, Wierzba T
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Lancet. 1988 Sep 3;2(8610):552-5. doi: 10.1016/s0140-6736(88)92669-4.
To develop guidelines for community health workers in the treatment of patients with diarrhoea, diarrhoea prevalence was actively surveyed for a year in a remote rural community of 915,000 persons, and the enteric pathogens and clinical features associated with diarrhoeal illness were determined in a sample of 300 patients. Bloody diarrhoea accounted for 39% of all diarrhoea episodes and 62% of diarrhoea-associated deaths. 51 (50%) of 101 patients with a history of bloody diarrhoea had Shigella infection, compared with 31 (16%) of 199 patients with other types of diarrhoea. A history of bloody diarrhoea was as predictive of the presence of shigella infection (positive predictive value 50%, negative predictive value 86%) as more complex prediction schemes incorporating other clinical features or stool microscopic examination. In the area of Bangladesh where the study was done reduction of diarrhoea-related morbidity and mortality will depend on control and treatment of shigellosis, and community health workers have been instructed to provide antibiotics for patients with a history of bloody dysentery.
为制定社区卫生工作者治疗腹泻患者的指南，在一个有91.5万人口的偏远农村社区对腹泻患病率进行了为期一年的积极调查，并在300例患者样本中确定了与腹泻疾病相关的肠道病原体和临床特征。血性腹泻占所有腹泻发作的39%，占腹泻相关死亡的62%。101例有血性腹泻病史的患者中，51例（50%）感染志贺菌，而199例其他类型腹泻患者中，31例（16%）感染志贺菌。血性腹泻病史对志贺菌感染的预测能力（阳性预测值50%，阴性预测值86%）与纳入其他临床特征或粪便显微镜检查的更复杂预测方案相当。在开展该研究的孟加拉国地区，降低腹泻相关的发病率和死亡率将取决于志贺菌病的控制和治疗，并且已指示社区卫生工作者为有血性痢疾病史的患者提供抗生素。
