White Alice E, Ciampa Nadia, Chen Yingxi, Kirk Martyn, Nesbitt Andrea, Bruce Beau B, Walter Elaine Scallan
Department of Epidemiology, Colorado School of Public Health, Aurora.
Public Health Agency of Canada, Centre for Foodborne, Environmental, and Zoonotic Infectious Disease, Guelph, Ontario.
Clin Infect Dis. 2019 Oct 15;69(9):1545-1552. doi: 10.1093/cid/ciy1142.
The early detection of enteric infections in older adults is challenging because typical signs and symptoms of disease may be less common, absent, or overlooked. Understanding illness characteristics of enteric infections among older adults could improve the timeliness and accuracy of clinical diagnoses, thereby improving patient outcomes and increasing cases reported to surveillance.
Here, we describe illness characteristics (percentage reporting bloody diarrhea, fever, vomiting, abdominal pain; percentage hospitalized; duration of hospitalization; and duration of illness) among older adults (≥65 years) with acute gastroenteritis and culture-confirmed Campylobacter and nontyphoidal Salmonella infections in Australia, Canada, and the United States and compare these characteristics with those among younger people (<5 years, 5-24 years, and 25-64 years).
A significant negative correlation was found between all symptoms and increasing age group, except for bloody diarrhea in cases of acute gastroenteritis. Adults aged ≥85 years reported bloody diarrhea in only 9% of nontyphoidal Salmonella and 4% of Campylobacter infections compared with 59% and 55% among children aged <5 years. Conversely, a greater percentage of older adults (≥65) than younger persons (<5, 5-24, 25-64) reported being hospitalized, with an increasing linear relationship in age groups 65 years and older.
Although older adults are more likely to have severe illness and be hospitalized, we found that the proportion of persons reporting symptoms typically associated with enteric infections decreases with age. These findings have implications for clinical recognition and treatment of gastrointestinal illness, as well as for public health research.
在老年人中早期发现肠道感染具有挑战性，因为疾病的典型体征和症状可能不太常见、不存在或被忽视。了解老年人肠道感染的疾病特征可以提高临床诊断的及时性和准确性，从而改善患者预后并增加向监测部门报告的病例数。
在此，我们描述了澳大利亚、加拿大和美国患有急性肠胃炎且经培养确诊为弯曲杆菌和非伤寒沙门氏菌感染的老年人（≥65岁）的疾病特征（报告血性腹泻、发热、呕吐、腹痛的百分比；住院百分比；住院时间；以及病程），并将这些特征与年轻人（<5岁、5 - 24岁和25 - 64岁）的特征进行比较。
除急性肠胃炎病例中的血性腹泻外，所有症状与年龄增长组之间均存在显著负相关。85岁及以上的成年人中，只有9%的非伤寒沙门氏菌感染和4%的弯曲杆菌感染报告有血性腹泻，而<5岁儿童中的这一比例分别为59%和55%。相反，与年轻人（<5岁、5 - 24岁、25 - 64岁）相比，老年人（≥65岁）住院的比例更高，在65岁及以上年龄组中呈线性增加关系。
尽管老年人更有可能患重病并住院，但我们发现报告通常与肠道感染相关症状的人群比例随年龄下降。这些发现对胃肠道疾病的临床识别和治疗以及公共卫生研究具有启示意义。
