Jones Anna, Ahmed Sharia M, Platts-Mills James A, Kotloff Karen L, Levine Adam C, Nelson Eric J, Pavia Andrew T, Khan Ashraful I, Leung Daniel T
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Open Forum Infect Dis. 2024 Oct 11;11(11):ofae619. doi: 10.1093/ofid/ofae619. eCollection 2024 Nov.
Severe dehydration due to acute infectious diarrhea remains a leading cause of death among young children worldwide. Diarrhea with severe dehydration is a clinical syndrome with distinct management per the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) and the WHO Global Task Force on Cholera Control (GTFCC) guidelines. We sought to characterize the pathogens causing severe dehydration using data from the Global Enteric Multicenter Study.
We used the IMCI and GTFCC guidelines to define severe dehydration and quantitative polymerase chain reaction-based attribution models to assign the etiology of diarrhea associated with severe dehydration.
The IMCI or GTFCC guidelines classified 2284 of the 5304 (43%) cases with moderate-to-severe diarrhea as having severe dehydration. In one-third of the cases with severe dehydration, no pathogens were attributed. The top pathogens attributed to children with guidelines-classified severe dehydration varied by age and were similar among those requiring intravenous hydration and hospitalization. Rotavirus (30.9%), (12.0%), and heat-stable (ST) enterotoxigenic (ETEC) (10.3%) were the most common pathogens for ages 0-11 months, while /enteroinvasive (EIEC) (25.8%), rotavirus (19.3%), and ST-ETEC (10.9%) were the most common for ages 12-23 months. /EIEC (25.9%), (10.4%), and rotavirus (9.2%) were the most common among ages 24-59 months.
The findings inform prioritization of pathogens, in addition to , that cause severe dehydration for future preventive and treatment efforts. The schema for prioritization is driven primarily by age stratifications.
急性感染性腹泻导致的严重脱水仍是全球幼儿死亡的主要原因。根据世界卫生组织（WHO）的《儿童疾病综合管理》（IMCI）和WHO霍乱控制全球专题小组（GTFCC）的指南，伴有严重脱水的腹泻是一种具有独特管理方法的临床综合征。我们试图利用全球肠道多中心研究的数据来描述导致严重脱水的病原体特征。
我们使用IMCI和GTFCC指南来定义严重脱水，并使用基于定量聚合酶链反应的归因模型来确定与严重脱水相关的腹泻病因。
在5304例中重度腹泻病例中，IMCI或GTFCC指南将2284例（43%）归类为严重脱水。在三分之一的严重脱水病例中，未发现病原体。根据指南分类为严重脱水的儿童中，主要病原体因年龄而异，在需要静脉补液和住院治疗的儿童中相似。轮状病毒（30.9%）、[此处原文缺失一种病原体名称]（12.0%）和热稳定（ST）产肠毒素性大肠杆菌（ETEC）（10.3%）是0至11个月龄儿童最常见的病原体，而[此处原文缺失一种病原体名称]/肠侵袭性大肠杆菌（EIEC）（25.8%）、轮状病毒（19.3%）和ST-ETEC（10.9%）是12至23个月龄儿童最常见的病原体。[此处原文缺失一种病原体名称]/EIEC（25.9%）、[此处原文缺失一种病原体名称]（10.4%）和轮状病毒（9.2%）是24至59个月龄儿童中最常见的病原体。
这些发现为除[此处原文缺失一种病原体名称]之外导致严重脱水的病原体的优先排序提供了信息，以便未来开展预防和治疗工作。优先排序方案主要由年龄分层驱动。
