Acute diarrhea in adults consulting a general practitioner in France during winter: incidence, clinical characteristics, management and risk factors

Christophe Arena,Nathalie Jourdan-Da Silva,Cécile Souty,Laurent Varesi,Roxane Chikhi-Brachet,Thomas Hanslik,Alessandra Falchi,Jean-François Arrighi ,V. Vaillant ,Jean Pierre Amoros ,Thierry Blanchon,Katia Ambert-Balay

doi:10.1186/preaccept-1129034223134684

Abstract

Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. The objective of this study was to identify the incidence, clinical characteristics, management and risk factors of winter viral AD in adults. The incidence of AD in adults during two consecutive winters (from December 2010 to April 2011 and from December 2011 to April 2012) was estimated from the French Sentinelles network. During these two winters, a subset of Sentinelles general practitioners (GPs) identified and included adult patients who presented with AD and who filled out a questionnaire and returned a stool specimen for virological examination. All stool specimens were tested for astrovirus, group A rotavirus, human enteric adenovirus, and norovirus of genogroup I and genogroup II. Age- and sex-matched controls were included to permit a case–control analysis with the aim of identifying risk factors for viral AD. During the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 French adults (95% CI [2,321 – 3,997]). The most reported clinical signs were abdominal pain (91.1%), watery diarrhea (88.5%), and nausea (83.3%). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% (95% CI [57 – 73]) of patients with AD with a predominance of noroviruses (49%). Having been in contact with a person who has suffered from AD in the last 7 days, whether within or outside the household, and having a job (or being a student) were risk factors significantly associated with acquiring viral AD. During the winter, AD of viral origin is a frequent disease in adults, and noroviruses are most often the cause. No preventable risk factor was identified other than contact with a person with AD. Thus, at the present time, reinforcement of education related to hand hygiene remains the only way to reduce the burden of disease.

Highlights

Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant
Incidence rates in general practice During the two winters studied, 370 general practitioner (GP) participated in the electronic surveillance, and 10,415 AD cases were reported
The median age of adult patients seen by the Sentinelles GPs over the two consecutive winters was 37 years (IQ = [27 – 52]) and 36 years (IQ = [27 – 51]), respectively; the proportion of men was 46.2% and 45.4% over the two winters, respectively

Summary

Introduction

Data describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. During the 1995–1996 winter, risk factors shown to be associated with AD in France included contact with a person with AD, living with a child ≤2 years of age, and recent treatment with oral penicillin or cephalosporin [5]. In the Netherlands, hand hygiene and contact with a sick person were identified as risk factors for viral gastroenteritis related to caliciviruses and group A rotavirus infections, but approximately 90% of the included patients were

Objectives

Methods

Results

Discussion

Conclusion