A 1-year prospective study was conducted to identify enteropathogens in adults with diarrhea (n=851) and in healthy control subjects (n=203) by use of conventional laboratory methods. Virulence factor genes for diarrheagenic Escherichia coli were detected by polymerase chain reaction. Enteropathogens were identified in 56% of patients and 16% of control subjects. The isolation rate was 65% for patients with symptoms for <1 week and for travelers; >1 pathogen was found in 11% of patients. The most frequent enteropathogens were Campylobacter (13% of patients), Clostridium difficile (13%), enterotoxigenic Escherichia coli (8%), Salmonella (7%), Shigella (4%), Blastocystis hominis (4%), calicivirus (3%), rotavirus (3%), enteroaggregative E. coli (2%), Aeromonas (2%), Giardia intestinalis (2%), Cryptosporidium (2%), and astrovirus (2%). Less frequently isolated (< or =1% of patients) were verotoxigenic E. coli, enteropathogenic E. coli, enteroinvasive E. coli, Entamoeba histolytica/Entamoeba dispar, microsporidia, and adenovirus. Fifty percent of the patients were hospitalized, and 43% needed intravenous fluids. The median duration of diarrhea was 14 days. Clinical features were not helpful for predicting the etiology of diarrhea.

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Empiric treatment reduced the intensity and, to some extent, the duration of symptoms of acute diarrhea. The effect was restricted to patients who had bacterial enteropathogens or who were severely ill. The clinical usefulness of this treatment is limited by the fact that norfloxacin seems to delay the elimination of salmonella and to induce resistance in campylobacter.

Serum antibody responses to shigella lipopolysaccharide (LPS) and invasion plasmid-coded antigens (Ipa) were studied in 74 Swedish patients with culture verified bacillary dysentery using class-specific enzyme immunoassay (EIA). Anti-LPS responses were found in 80% and 79% serum samples, respectively, from S. flexneri and S. sonnei infected patients and anti-Ipa responses in 60% and 43%, respectively. The mean anti-Ipa IgG antibody titres in S. flexneri infected patients remained high for 4-6 months after onset while the anti-LPS IgG antibody titres had dropped to normal levels. The specificity of EIA for shigella Ipa was 90% and for S. dysenteriae, S. flexneri and S. sonnei LPSs it varied between 84% and 90%. No close correlations between the anti-LPS and anti-Ipa antibody responses were observed indicating that they may be differently regulated. The dynamics of the serum antibody responses indicates that an anti-LPS response is a good indicator of a recent shigella infection and an anti-Ipa IgG response a good indicator of a previous infection.