Abstract
BackgroundAcute diarrhea is one of the major public health problems worldwide. Most of studies on acute diarrhea have been made on infants aged below 5 years and few efforts have been made to identify the etiological agents of acute diarrhea in people over five, especially in China.Methods271 diarrhea cases and 149 healthy controls over 5 years were recruited from four participating hospitals between June 2014 and July 2015. Each stool specimen was collected to detect a series of enteric pathogens, involving five viruses (Rotavirus group A, RVA; Norovirus, NoV; Sapovirus, SaV; Astrovirus, As; and Adenovirus, Ad), seven bacteria (diarrheagenic Escherichia coli, DEC; non-typhoidal Salmonella, NTS; Shigella spp.; Vibrio cholera; Vibrio parahaemolyticus; Aeromonas spp.; and Plesiomonas spp.) and three protozoa (Cryptosporidium spp., Giardia lamblia, G. lamblia, and Blastocystis hominis, B. hominis). Standard microbiological and molecular methods were applied to detect these pathogens. Data was analyzed using Chi square, Fisher-exact tests and logistic regressions.ResultsThe prevalence of at least one enteric pathogen was detected in 29.2% (79/271) acute diarrhea cases and in 12.1% (18/149) in healthy controls (p < 0.0001). Enteric viral infections (14.4%) were the most common in patients suffering from acute diarrhea, followed by bacteria (13.7%) and intestinal protozoa (4.8%). DEC (12.5%) was the most common causative agent in diarrhea cases, followed by NoV GII (10.0%), RVA (7.4%) and B. hominis (4.8%). The prevalence of co-infection was statistically higher (p = 0.0059) in the case group (7.7%) than in the healthy control (1.3%). RVA–NoV GII (3.0%) was the most common co-infection in symptomatic cases.ConclusionsDEC was the most predominant pathogen in diarrhea cases, but it was largely overlooked because the lack of laboratory capacities. Because of the high prevalence of co-infections, it is recommended the urgent development of alternative laboratory methods to assess polymicrobial infections. Such methodological improvements will result in a better prevention and treatment strategies to control diarrhea illness in China.Electronic supplementary materialThe online version of this article (doi:10.1186/s13099-016-0141-1) contains supplementary material, which is available to authorized users.
Highlights
Acute diarrhea is one of the major public health problems worldwide
The main enteric pathogens include a wide range of bacteria, virus and enteric parasites (e.g. Cryptosporidium spp.; Giardia lamblia, G. lamblia; Entamoeba histolytica and Blastocystis hominis, B. hominis) [3,4,5,6,7,8]
The diarrhea cases from urban areas accounted for 67.9%, and the non-diarrhea patients accounted for 66.4% (χ2 = 1.240, p = 0.538)
Summary
Acute diarrhea is one of the major public health problems worldwide. Diarrheal illness is still a serious public health problem that affects individuals in middle and low income countries [1]. 1,400,000 million deaths are caused by diarrhea across all age groups, of which 700,000 deaths are over 5 years [1, 2]. Co-infection is of particular human health importance because pathogen species can interact within the host. Interactions within the host can have either positive or negative effects on each of the co-infecting enteric pathogen species. Under positive enteric pathogen interactions, diarrheal disease transmission and progression are enhanced [6, 12, 14, 15]
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