Rennels M B, Levine M M
Pediatr Infect Dis. 1986 Jan-Feb;5(1 Suppl):S91-100.
Impressive advancements in our understanding of the mechanisms of diarrhea production and of the epidemiologic importance of these "classical" bacterial enteropathogens have been accomplished, but many areas are in need of further exploration. The recent development of gene probes and enzyme-linked immunosorbent assays for the identification of EPEC, ETEC and EIEC will enhance immeasurably the ability to carry out large scale epidemiologic studies which are still needed to clarify the global importance of these pathogens in infantile diarrhea. For some of these organisms pathogenic mechanisms remain incompletely understood and the role of antibiotics is not well-established. The delineation of virulence factors, immunity and the construction of attenuated strains through DNA recombination technology are bringing the worthy goal of prevention through vaccination into view. These advances should not, however, detract attention from the primary reason that these bacteria continue to be a major cause of childhood morbidity and mortality in the developing world, which is lack of adequate sanitation. Efforts to provide clean water, safe waste disposal and hygiene education need to proceed in conjunction with development of vaccines.
在我们对腹泻产生机制以及这些“经典”细菌性肠道病原体的流行病学重要性的理解方面已经取得了令人瞩目的进展，但仍有许多领域需要进一步探索。用于鉴定肠致病性大肠杆菌（EPEC）、肠产毒性大肠杆菌（ETEC）和肠侵袭性大肠杆菌（EIEC）的基因探针和酶联免疫吸附测定法的最新发展，将极大地提高开展大规模流行病学研究的能力，而此类研究对于阐明这些病原体在婴儿腹泻中的全球重要性仍然是必要的。对于其中一些病原体，其致病机制仍未完全了解，抗生素的作用也尚未明确确立。通过DNA重组技术对毒力因子、免疫以及减毒株构建的描述，正使通过接种疫苗进行预防这一有价值的目标变得清晰可见。然而，这些进展不应转移人们对这些细菌在发展中世界仍然是儿童发病和死亡主要原因这一主要问题的关注，即缺乏足够的卫生设施。提供清洁水、安全的废物处理和卫生教育的努力需要与疫苗的开发同步进行。
