旅行者腹泻的病因：巢式病例对照研究。

Aetiology of traveller's diarrhea: A nested case-control study.

机构信息

Institut of Medical Microbiology, University Hospital Münster, Münster, Germany.

Institute for Hygiene, University Hospital Münster, Münster, Germany.

出版信息

Travel Med Infect Dis. 2020 Sep-Oct;37:101696. doi: 10.1016/j.tmaid.2020.101696. Epub 2020 Apr 25.

DOI:10.1016/j.tmaid.2020.101696

PMID:32344112

Abstract

BACKGROUND

Traveller's diarrhea (TD) is the leading cause of morbidity among travelers. Recently, molecular methods have been developed to detect the causative pathogens of TD. The aim of this study was to test a multiplex-PCR approach in patients with TD and asymptomatic controls.

METHODS

In total, 91 travelers (61 TD cases, 30 asymptomatic controls) prospectively collected stool samples during travel and documented gastrointestinal symptoms. Samples were analyzed using the BioFire® FilmArray® Gastrointestinal Panel, which covers 13 enteric bacteria (e.g. diarrheagenic Escherichia coli), 4 protozoan parasites and 5 viruses.

RESULTS

TD cases had more likely a positive test (46/61, 75%) compared to controls (17/30, 57%, p = 0.07). The most common enteric pathogens were enteroaggregative E. coli (36/91, 40%), followed by enterotoxigenic E. coli (31/91, 34%) and enteropathogenic E. coli (EPEC, 29/91, 32%). The only pathogens significantly associated with TD were EPEC (p = 0.01) and ETEC (p = 0.047). Protozoan parasites were not detected.

CONCLUSION

Our results challenge the widespread use of multiplex-approaches covering numerous enteric pathogens in the diagnostic workup of TD because only few (i.e. diarrheagenic E. coli) were related to symptoms of TD.

摘要

背景

旅行者腹泻（TD）是旅行者发病率的主要原因。最近，已经开发出分子方法来检测 TD 的病原体。本研究旨在测试一种用于 TD 患者和无症状对照者的多重 PCR 方法。

方法

共 91 名旅行者（61 例 TD 病例，30 例无症状对照者）在旅行期间前瞻性采集粪便样本，并记录胃肠道症状。使用 BioFire® FilmArray® 胃肠道Panel 分析样本，该Panel 涵盖 13 种肠细菌（例如，腹泻性大肠杆菌）、4 种原生动物寄生虫和 5 种病毒。

结果

TD 病例的阳性检测结果（46/61，75%）比对照组（17/30，57%，p=0.07）更有可能。最常见的肠病原体是聚集性大肠杆菌（36/91，40%），其次是肠毒性大肠杆菌（31/91，34%）和肠致病性大肠杆菌（EPEC，29/91，32%）。唯一与 TD 显著相关的病原体是 EPEC（p=0.01）和 ETEC（p=0.047）。未检测到原生动物寄生虫。