Department of Internal Medicine.
Curr Opin Infect Dis. 2019 Oct;32(5):461-467. doi: 10.1097/QCO.0000000000000586.
This review will focus on the epidemiology and cause of diarrheal illness in solid organ transplant and stem-cell transplant population recipients with a specific focus on the role of advanced multiplex technology in the diagnosis of diarrhea within this patient population.
A wide range of infectious and noninfectious causes of diarrhea have been described in immunocompromised patients. The most common infections noted are Clostridioides difficile, norovirus, and cytomegalovirus, whereas immunosuppressive drugs and mucositis are the most common noninfectious causes of diarrhea. Historically, diagnostic evaluation has been limited to an array of single pathogen assays. Newer multiplex assays have become available that allow rapid, sensitive detection of a wide range of pathogens in a single assay. These assays have improved the number of patients with a diagnosed pathogen but may identify colonizing pathogens that are not pathogenic. Studies are needed to inform the discrimination and optimal use of these newer assays.
Diarrhea is a common complication in immunocompromised patients and is associated with greater morbidity and rare mortality. New diagnostics facilitate detection of recognized pathogens and may allow for improved outcomes through the use of pathogen-targeted therapy.
本篇综述重点关注实体器官移植和造血干细胞移植受者腹泻病的流行病学和病因，特别关注高级多重技术在该患者人群腹泻诊断中的作用。
免疫功能低下患者腹泻的病因范围广泛，包括感染性和非感染性病因。最常见的感染包括艰难梭菌、诺如病毒和巨细胞病毒，而免疫抑制药物和黏膜炎是最常见的非感染性腹泻病因。传统上，诊断评估仅限于一系列单病原体检测。现在已经有新的多重检测方法问世，可以在单次检测中快速、敏感地检测出广泛的病原体。这些检测方法提高了诊断出病原体的患者数量，但可能会识别出定植病原体而非致病性病原体。需要进行研究以告知这些新检测方法的鉴别和最佳使用。
腹泻是免疫功能低下患者的常见并发症，与更高的发病率和罕见的死亡率相关。新的诊断方法有助于检测出已识别的病原体，并可能通过使用针对病原体的治疗来改善预后。
