Taylor D N, Houston R, Shlim D R, Bhaibulaya M, Ungar B L, Echeverria P
Department of Bacteriology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
JAMA. 1988 Sep 2;260(9):1245-8.
A bacterial pathogen was isolated from 47% of 328 expatriate patients with diarrhea seen at two medical clinics in Nepal in 1986. Enterotoxigenic Escherichia coli (24%), Shigella (14%), and Campylobacter species (9%) were isolated most frequently. Enteroinvasive and adherence factor-positive E coli were isolated from 2% and 1% of patients, respectively. Giardia lamblia was detected in 12% of patients, rotavirus in 8%, and Cryptosporidium and Entamoeba histolytica each in 5%. Blastocystis hominis was present in 33% of patients but in only 9% of those who took trimethoprim-sulfamethoxazole. More than one enteropathogen was detected in 17% of patients. Patients with prolonged symptoms (longer than two weeks) were more likely to have Giardia (27%) and less likely to have Shigella (5%) than were patients with acute symptoms. The isolation rates of bacterial pathogens decreased with length of stay in Nepal. A wide variety of enteropathogens were detected in travelers to Nepal, and Shigella and protozoa were particularly important. Length of time abroad and duration of symptoms were important diagnostic considerations.
1986年，在尼泊尔两家诊所就诊的328名腹泻外派患者中，47%的患者分离出一种细菌病原体。最常分离出的是产肠毒素大肠杆菌（24%）、志贺氏菌（14%）和弯曲杆菌属（9%）。分别从2%和1%的患者中分离出侵袭性大肠杆菌和黏附因子阳性大肠杆菌。12%的患者检测出蓝氏贾第鞭毛虫，8%检测出轮状病毒，5%检测出隐孢子虫和溶组织内阿米巴。33%的患者存在人芽囊原虫，但在服用甲氧苄啶 - 磺胺甲恶唑的患者中仅为9%。17%的患者检测出不止一种肠道病原体。与急性症状患者相比，症状持续时间较长（超过两周）的患者更易感染蓝氏贾第鞭毛虫（27%），感染志贺氏菌的可能性较小（5%）。细菌病原体的分离率随在尼泊尔停留时间的延长而降低。在前往尼泊尔的旅行者中检测出多种肠道病原体，志贺氏菌和原生动物尤为重要。在国外的时间长短和症状持续时间是重要的诊断考虑因素。
