印度2岁以下儿童肠套叠的感染病因：一项配对病例对照分析。

Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis.

作者信息

Praharaj Ira, Reddy Samarasimha Nusi, Nair Nayana Prabhakaran, Tate Jacqueline Elizabeth, Giri Sidhartha, Thiyagarajan Varunkumar, Mohan Venkata Raghava, Revathi Rajendiran, Maheshwari Kalaivanan, Hemavathy Priya, Kumar Nirmal, Gupte Mohan Digambar, Arora Rashmi, Senthamizh Sowmiya, Mekala Suhasini, Goru Krishna Babu, Pamu Padmalatha, Badur Manohar, Pradhan Subal, Dash Mrutunjay, Mohakud Nirmal Kumar, Ray Rajib Kumar, Gathwala Geetha, Gupta Madhu, Kanojia Ravi, Gupta Rajkumar, Goyal Suresh, Sharma Pramod, Mathew Mannancheril Abraham, Kochukaleekal Jacob Tarun John, Sundaram Balasubramanian, Girish Kumar Chethrapilly Purusothaman, Dorairaj Priyadarshini, Pitchumani Ramasubramaniam, Maniam Raghul, Kumaravel Sambandan, Jain Hemant, Goswami Jayanta Kumar, Wakhlu Ashish, Gupta Vineeta, Liu Jie, Houpt Eric R, Parashar Umesh D, Kang Gagandeep

机构信息

The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.

ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India.

出版信息

Gut Pathog. 2024 Oct 23;16(1):61. doi: 10.1186/s13099-024-00659-z.

DOI:10.1186/s13099-024-00659-z

PMID:39444015

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11515542/

Abstract

BACKGROUND

Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens.

METHODS

In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception.

RESULTS

The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06-2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05-2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% - 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% - 24.1%) had the highest population attributable fraction for intussusception.

CONCLUSION

Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception.

摘要

背景

据推测，肠道感染与儿童肠套叠有关。在某些情况下，接种轮状病毒疫苗后肠套叠的发生率略有上升。我们在印度引入轮状病毒疫苗Rotavac后，对其进行了上市后肠套叠监测，并评估了肠套叠与肠道病原体的关联。

方法

在印度一项基于大型哨点医院的监测项目中的病例对照研究中，对272名因肠套叠入院的2岁以下儿童和272名年龄、性别和地点匹配的对照的粪便样本，采用基于Taqman阵列卡的分子检测方法，以检测肠道病毒、细菌性肠道病原体和寄生虫。采用条件逻辑回归进行匹配病例对照分析，评估肠道病原体与肠套叠的关联。计算与肠套叠显著相关的肠道病原体的人群归因分数（PAF）。

结果

病例组和对照组中最常见的肠道病原体是聚集性大肠杆菌、腺病毒40/41、腺病毒C血清型和肠道病毒。与对照组相比，肠套叠患儿更易感染腺病毒C血清型（校正比值比（aOR）=1.74；95%置信区间（CI）1.06-2.87）和肠道病毒（aOR=1.77；95%CI 1.05-2.97）。轮状病毒与肠套叠风险增加无关。腺病毒C（PAF=16.9%；95%CI 4.7%-27.6%）和肠道病毒（PAF=14.7%；95%CI 4.2%-24.1%）在肠套叠的人群归因分数中最高。