Kramme Stefanie, Dähne Theo, Fomenko Alexey, Panning Marcus
Institute for Infection Prevention and Hospital Epidemiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
Institute of Virology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany.
Trop Med Infect Dis. 2022 May 19;7(5):80. doi: 10.3390/tropicalmed7050080.
Acute gastroenteritis (AGE) contributes to increased morbidity and mortality worldwide. In particular, children in resource-poor settings suffer from frequent episodes of diarrhea. A variety of pathogens, including bacteria, viruses, fungi, and protozoa, can cause AGE. Common viruses associated with AGE are norovirus, rotavirus, astrovirus, adenovirus, and sapovirus. Due to their similar clinical presentation, AGE pathogens cannot be distinguished on clinical grounds rendering the etiological diagnosis challenging. However, reliable diagnosis is essential for individual and public health reasons, e.g., to limit transmission, for appropriate antibiotic use, prognostic appreciation, and vaccination programs. Therefore, high-quality data derived by accurate diagnostics are important to improve global health. In Western industrialized countries, diagnosis relies on microbiological testing, including culture methods, microscopy, immunochromatography, and single-target molecular methods. Recently, multiplex PCR or syndromic panels have been introduced, which simultaneously analyze for multiple pathogens in a very short time. A further technological advancement is cartridge-based syndromic panels, which allow for near patient/point-of-care testing independently from a laboratory. In resource-poor tropical regions, however, laboratory diagnosis is rarely established, and there are little routine laboratory data on the epidemiology of viral AGE pathogens. Limiting factors for the implementation of syndromic panels are high costs, sophisticated equipment, and the need for trained personnel. In addition, pilot studies have shown a large number of viral (co-)detections among healthy controls, thus further challenging their clinical utilization. Hence, there are little evidence-based data on the impact of multiplex syndromic panels from resource-limited regions. Here, we aim to provide a brief overview of what is known about the use of syndromic panels for virus-associated AGE in tropical regions and to address future challenges.
急性胃肠炎（AGE）在全球范围内导致发病率和死亡率上升。特别是，资源匮乏地区的儿童经常腹泻。多种病原体，包括细菌、病毒、真菌和原生动物，均可引起AGE。与AGE相关的常见病毒有诺如病毒、轮状病毒、星状病毒、腺病毒和札幌病毒。由于它们的临床表现相似，无法根据临床症状区分AGE病原体，这使得病因诊断具有挑战性。然而，出于个人和公共卫生原因，如限制传播、合理使用抗生素、评估预后和开展疫苗接种计划，可靠的诊断至关重要。因此，通过准确诊断获得的高质量数据对于改善全球健康非常重要。在西方工业化国家，诊断依赖于微生物检测，包括培养方法、显微镜检查、免疫层析和单靶点分子方法。最近，多重聚合酶链反应（PCR）或综合征检测板已被引入，可在极短时间内同时分析多种病原体。进一步的技术进步是基于试剂盒的综合征检测板，可在无需实验室的情况下实现床旁/即时检测。然而，在资源匮乏的热带地区，很少进行实验室诊断，关于病毒性AGE病原体流行病学的常规实验室数据也很少。综合征检测板实施的限制因素包括成本高、设备复杂以及需要训练有素的人员。此外，试点研究表明，健康对照人群中存在大量病毒（共）检测结果，这进一步挑战了它们的临床应用。因此，来自资源有限地区的关于多重综合征检测板影响的循证数据很少。在此，我们旨在简要概述热带地区综合征检测板用于病毒相关AGE的已知情况，并应对未来挑战。
