2008年全国其他感染性腹泻报告病例信息分析

Clinical and etiological characteristics of bacterial infectious diarrhea: Analysis of 216 cases

AIM

To investigate the clinical and etiological characteristics of bacterial infectious diarrhea.

METHODS

The clinical and etiological characteristics of 216 cases of infectious diarrhea collected in the First Affiliated Hospital of Xinjiang Medical University from 2012 to 2014 were analyzed retrospectively. Count data were compared using χ² test.

RESULTS

Of 3215 infectious diarrhea patients treated over the three years, 216 had positive fecal bacterial culture, including 112 cases of pathogenic Escherichia coli (E. coli) infection (51.8%), 64 cases of Shigella infection (29.6%), 23 cases of Vibrio parahaemolyticus infection (10.6%), and 17 cases of Salmonella infection (7.8%). Diarrhea patients were seen more commonly in May and October each year. The clinical manifestations of pathogenic E. coli infection were abdominal pain, diarrhea, nausea, vomiting, and dehydration, while those of Shigella infection were fever, abdominal pain, diarrhea, and tenesmus.

CONCLUSION

The positive rate of fecal bacteria culture in patients with infectious diarrhea is low, and the diarrhea is caused mainly by E. coli and Shigella. There are differences in clinical manifestations between E. coli and Shigella infections.

Diagnosis and treatment of diarrhea in preschool children in a hospital

AIM: To investigate the prevalence of diarrhea in preschool children and explore risk factors for severe diarrhea.

METHODS: A total of 368 preschool children with diarrhea treated at our hospital between January 2014 and December 2015 were enrolled for the study and divided into a severe group (≥11 points, n = 50) and a mild group (<11 points, n = 318) according to the Vesikari Scale. Gender, age, census register, household source, address, season, time from onset to see a doctor and virus infection were compared between the two groups. Multivariate logistics regression analysis was performed to screen out the factors related to severe diarrhea.

RESULTS: There were no significant differences in age distribution between the two groups regardless of boys or girls (P > 0.05). The rates of agricultural household, nonlocal registered permanent residence, living in the suburbs, winter and spring seasons, time from onset to see a doctor ≤ 24 h, and rotavirus infection in the severe group were significantly higher than those of the mild group (P < 0.05). Multivariate logistics regression analysis showed that agricultural household, winter and spring seasons, time from onset to see a doctor ≤ 24 h, and rotavirus infection were independent risk factors for severe diarrhea (P < 0.05).

CONCLUSION: Preschool children is at high risk for severe diarrhea. Particular prevention and treatment should be given to cases with risk factors such as agricultural household, winter and spring seasons, time from onset to see a doctor ≤ 24 h, or rotavirus infection

Impacts of tropical cyclones and accompanying precipitation on infectious diarrhea in cyclone landing areas of Zhejiang Province, China

Background: Zhejiang Province, located in southeastern China, is frequently hit by tropical cyclones. This study quantified the associations between infectious diarrhea and the seven tropical cyclones that landed in Zhejiang from 2005–2011 to assess the impacts of the accompanying precipitation on the studied diseases. Method: A unidirectional case-crossover study design was used to evaluate the impacts of tropical storms and typhoons on infectious diarrhea. Principal component analysis (PCA) was applied to eliminate multicollinearity. A multivariate logistic regression model was used to estimate the odds ratios (ORs) and the 95% confidence intervals (CIs). Results: For all typhoons studied, the greatest impacts on bacillary dysentery and other infectious diarrhea were identified on lag 6 days (OR = 2.30, 95% CI: 1.81–2.93) and lag 5 days (OR = 3.56, 95% CI: 2.98–4.25), respectively. For all tropical storms, impacts on these diseases were highest on lag 2 days (OR = 2.47, 95% CI: 1.41–4.33) and lag 6 days (OR = 2.46, 95% CI: 1.69–3.56), respectively. The tropical cyclone precipitation was a risk factor for both bacillary dysentery and other infectious diarrhea when daily precipitation reached 25 mm and 50 mm with the largest OR = 3.25 (95% CI: 1.45–7.27) and OR = 3.05 (95% CI: 2.20–4.23), respectively. Conclusions: Both typhoons and tropical storms could contribute to an increase in risk of bacillary dysentery and other infectious diarrhea in Zhejiang. Tropical cyclone precipitation may also be a risk factor for these diseases when it reaches or is above 25 mm and 50 mm, respectively. Public health preventive and intervention measures should consider the adverse health impacts from tropical cyclones.

Epidemiological investigation of Campylobacte jejuni and its detection in patients with summer diarrhea

AIM: To analyze the detection of Campylobacte jejuni in patients with diarrhea.

METHODS: The detection of Campylobacte jejuni in patients with diarrhea was analyzed retrospectively. The clinical characteristics including patient sex, age, area for examination, and month distribution were analyzed.

RESULTS: The positive rate of Campylobacte jejuni was higher than that of Campylobacter coli in the years of 2012 and 2013 (6.14% vs 0.16%, 6.20% vs 0.14, P < 0.05). There was no significant difference for the detection rate of Campylobacte jejuni between the years of 2012 and 2013 (6.14% vs 6.20%, P > 0.05). The positive rates of Campylobacte jejuni in males were higher than those in females in patients with summer diarrhea in the years of 2012 and 2013, but the differences were not significant (6.46% vs 5.60%, 6.52% vs 5.62%, P > 0.05). The detection of Campylobacte jejuni in patients with summer diarrhea in the years of 2012 and 2013 was mainly distributed in the age groups of < 1 and 16-45 years, although there were no significant differences in the positive rates between different age groups (9.33%, 3.31%, 6.25%, 6.60% , 2.44% vs 2.17%; 9.36%, 2.84%, 6.35%, 6.72%, 1.96% vs 0.00%, P > 0.05). The positive rates of Campylobacte jejuni in the years of 2012 and 2013 were significantly higher in out-patients than in inpatients (7.56% vs 2.37%, 7.82% vs 2.40%, P < 0.05). The positive rates of Campylobacte jejuni in the years of 2012 and 2013 showed no significant differences among different months (6.00%, 6.28% vs 6.14%; 6.09%, 6.33% vs 6.17%, P > 0.05). The positive rates of Campylobacte jejuni in summer in the years of 2012 and 2013 were significantly higher than those in the winter of 2012 (1.82%, 6.14% vs 1.82%, 6.20% vs 1.82%, P < 0.05).

CONCLUSION: Campylobacte jejuni was one of the major pathogens of summer diarrhea.

Predictive significance of serum levels of gastrointestinal hormones and cytokines for disease progression in patients with rotavirus diarrhea

AIM: To assess the early predictive value of serum levels of gastrointestinal hormones and cytokines in patients with rotavirus diarrhea.

METHODS: Serum levels of 5-serotonin, vasoactive intestinal peptide (VIP), gastrin (GAS), motilin (MOT) and cytokines (endothelin, IL-10) were determined by enzyme-linked immunosorbent assay (ELISA) in 65 children with severe, moderate or mild rotavirus infection during acute or convalescent phase and 60 normal healthy children.

RESULTS: Serum levels of 5-serotonin, VIP, GAS, MOT, and endothelin were significantly higher and that of IL-10 was significantly lower in children with rotavirus infection during the acute phase than in normal control controls (all P < 0.05). Serum levels of 5-HT, VIP, MOT, and endothelin were significantly higher in patients with severe rotavirus infection than in those with moderate or mild rotavirus infection (all P < 0.05). Serum levels of GAS and IL-10 showed no significant difference between patients with moderate rotavirus infection and those with mild disease (P > 0.05). Serum levels of 5-serotonin, VIP, endothelin and IL-10 were significantly higher in patients with acute phase rotavirus infection having diarrhea >3 d than in those having diarrhea <3 d (all P < 0.05), while GAS and MOT levels were not statistically significant between the two groups (both P > 0.05).

CONCLUSION: Pathophysiological changes in rotavirus diarrhea may be associated with the changes in serum levels of gastrointestinal hormones and cytokines. The relevant gastrointestinal hormones and cytokines may be used to predict rotavirus disease progression.

Occurrence and potential health risk of Cryptosporidium and Giardia in the Three Gorges Reservoir, China

The Three Gorges Reservoir (TGR) is the biggest lake in the world and a major water source in China. There is no information about occurrence and impact of Cryptosporidium and Giardia on the aquatic ecosystem. 61 surface water samples from 23 monitoring sites and 5 treated effluent samples were collected and analyzed. Cryptosporidium oocysts and Giardia cysts were found, respectively, in 86.4% and 65.2% of a total of 66 water samples, with high concentrations in treated effluent. The mean percent recovery was 29.14% for oocysts and 34.86% for cysts. A seasonal pattern was observed, with positive samples for Cryptosporidium more frequent in flood period and positive samples for Giardia more frequent in impounding period. Counts of enterococci, fecal coliforms and total coliforms, and turbidity were significantly associated with Cryptosporidium concentration in backwater (water in a main river which is backed up by the Three Gorges Dam) areas of tributaries but not Giardia. High associations were also found between oocyst and cyst in backwater areas of tributaries and cities. The risks of infection and illness due to water consumption in four different exposure routes were estimated. The results showed that swimming in the TGR has the highest infection risk with 1.39 × 10(-3) per time (95% confidence interval (CI): 0.05-600.3 × 10(-5)) for Cryptosporidium and 2.08 × 10(-4) per time (95% CI: 0.05-878.87 × 10(-6)) for Giardia, while directly drinking unboiled tap water treated with the conventional process has the highest morbidity with 524.98 per 100,000 population per year (95% CI: 10.35-2040.26) for Cryptosporidium and 5.89 per 100,000 population per year (95% CI: 0.08-22.67) for Giardia. This study provides new useful information for drinking water plants, health care workers and managers to improve the safety of tap water and deduce the risk of surface water contamination in China.

Protective effect of Lactobacillus acidophilus on intestinal mucosa of neonatal mice infected with a human rotavirus

AIM: To investigate the possible protective effect of Lactobacillus acidophilus (L.acidophilus) on intestinal mucosa of neonatal mice infected with a human rotavirus (HRV).

METHODS: Sixty 4-day-old Kunming mice were randomly and equally divided into control group, HRV-infected group, L.acidophilus-pretreated group (treated before HRV infection) and L.acidophilus-treated group (treated after HRV infection). The symptoms in these mice were observed each day for 8 d. On day 8, nine mice of each group were sacrificed by cervical dislocation. Caecum samples were taken for bacterial isolation and culture to count bacterial colonies. Secretory IgA (sIgA) from the intestinal mucosa and serum interferon-γ (IFN-γ) and tumor necrosis factors-α (TNF-α) were detected by ELISA. The thickness of intestinal mucosa, height of villus and depth of crypt were measured using Image-Pro Plus 5.1 software.

RESULTS: The mice in the normal control group did not suffer from diarrhea, whereas the HRV-infected group showed altered intestinal flora, decreased level of intestinal sIgA, increased serum IFN-γ and TNF-α levels, and damaged intestinal mucosal barrier. Compared to the HRV-infected group, mice of the L.acidophilus-pretreated and -treated groups showed some amelioration in intestinal flora, intestinal sIgA, serum IFN-γ and TNF-α, and intestinal mucosal barrier. More obvious protective effect on intestinal mucosa was observed in the pretreatment group than in the treatment group.

CONCLUSION: L.acidophilus possesses protective effect on intestinal mucosa of HRV-infected neonatal mice. Pretreatment with L.acidophilus has better protective effect than L.acidophilus treatment.