Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Dig Dis Sci. 2018 Apr;63(4):996-1002. doi: 10.1007/s10620-018-4959-x. Epub 2018 Feb 6.
Patients with celiac disease and inflammatory bowel disease, two immune-mediated luminal conditions, have higher rates of certain infections than healthy counterparts. The prevalence of many gastrointestinal infections in these patients, however, is unknown.
Using a novel clinical stool pathogen PCR test, we investigated the hypothesis that patients with celiac disease/inflammatory bowel disease had different distributions of diarrheal pathogens than other patients.
We performed a retrospective cohort study of outpatients who underwent stool pathogen testing with the FilmArray Gastrointestinal PCR Panel (BioFire Diagnostics, Salt Lake City, UT) at our institution from January 1 to December 31, 2015. Rates of pathogens were measured in patients with or without celiac disease/inflammatory bowel disease.
Of 955 patients, 337 had positive test for any pathogen, with 465 bacterial, parasitic, or viral pathogens identified. One hundred and twenty-seven patients (13.3%) had celiac disease or inflammatory bowel disease, of which 29/127 (22.8%) had a positive test, compared to 308/828 other patients (37.2%) (p = 0.002). Patients with celiac disease/inflammatory bowel disease had significantly fewer viruses (1.6 vs. 8.1% of patients; p = 0.008) and parasites (0 vs. 3.3%; p = 0.039), with nonsignificant trend toward fewer bacteria (21.3 vs. 29.2%; p = 0.063). Escherichia coli species were most common in both populations.
Stool PCR identified numerous pathogens in patients with or without celiac disease/inflammatory bowel disease. Patients with celiac disease/inflammatory bowel disease were significantly less likely to have any pathogen identified, and had significantly fewer viruses and parasites. In this population, knowledge of common pathogens can guide diagnostic evaluation and offer opportunities for treatment.
乳糜泻和炎症性肠病患者的两种免疫性腔道疾病，比健康人群更容易感染某些特定病原体。然而，目前尚不清楚这两种疾病患者中许多胃肠道感染的患病率。
使用一种新型临床粪便病原体 PCR 检测方法，我们假设乳糜泻/炎症性肠病患者的腹泻病原体分布与其他患者不同。
我们对 2015 年 1 月 1 日至 12 月 31 日在我院进行 FilmArray 胃肠道 PCR 检测（美国犹他州盐湖城的生物火诊断公司）的门诊患者进行了回顾性队列研究。在患有或不患有乳糜泻/炎症性肠病的患者中，测量了病原体的发生率。
在 955 例患者中，有 337 例患者的任何病原体检测均为阳性，共鉴定出 465 种细菌、寄生虫或病毒病原体。127 例患者（13.3%）患有乳糜泻或炎症性肠病，其中 29/127 例（22.8%）检测结果阳性，而 828 例其他患者（37.2%）中有 308 例阳性（p=0.002）。患有乳糜泻/炎症性肠病的患者病毒感染显著减少（1.6%与 8.1%的患者；p=0.008）和寄生虫感染（0 与 3.3%；p=0.039），而细菌感染有减少的趋势（21.3%与 29.2%；p=0.063）。两种人群中最常见的病原体均为大肠杆菌属。
粪便 PCR 检测鉴定出了患有或不患有乳糜泻/炎症性肠病患者的多种病原体。患有乳糜泻/炎症性肠病的患者更不易检出任何病原体，且病毒和寄生虫感染明显减少。在该人群中，了解常见病原体有助于指导诊断评估并提供治疗机会。
