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

Abstract

BackgroundData 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.MethodsThe 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.ResultsDuring 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.ConclusionsDuring 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0574-4) contains supplementary material, which is available to authorized users.

Waterborne Viruses and F-Specific Coliphages in Mixed-Use Watersheds: Microbial Associations, Host Specificities, and Affinities with Environmental/Land Use Factors

“…Environmental occurrences of and infections by NoV, AdV, RV, and astrovirus have been associated with cooler seasons (45,(82)(83)(84). In this work, we observed increased levels of detection of NoV GI, GII, and GIV in summer, while GIII was highest in spring, which could be related to agricultural practices, such as bovine manure applications on fields.…”

Determinants and risk factors of gastroenteritis in the general population, a web-based cohort between 2014 and 2017 in France

“…This association is still discussed and not systematically highlighted. Surprisingly, having possible contacts "at risk" during the day (contacts with children, with elderly , with a large group of people and with patients) were never associated with an AGE episode, whereas such associations have been found in several previous studies (5,28,29). The formulation of some survey questions might be too imprecise and induced misinterpretation from participants, for instance the word "contact" is not de ned at any time in the survey, as well as the duration of such contact.…”

“…Some risk factors associated with an AGE episode in our study are less expected, like having pets at home. This risk factor has been previously studied (5,34), but it has never been signi cantly associated with AGE episode. Most of the pets, such as cats, dogs, rodents or reptiles are known to carry some bacteria responsible for acute diarrhoea (35), which could partly explain this association, although the study took place during winter, when AGE are more frequently due to viral agent.…”

“…We did not nd this association in previous published literature. On the contrary, it was found that having AGE is positively associated with living with young children (4,5,28) or even living with more than 2 other people (4). This discrepancy may partly be explained by the age difference: people living alone had an average age of 58 years, compared to 52 years for those living with other adults or children, (p<0.001, Student-T test).…”

Household presentation of acute gastroenteritis in a primary care sentinel network: retrospective database studies

“…A final study enrolled adult index cases with AGE and looked for household spread. If the household had a child aged 2 years or younger the OR of incident was 2.57 [35]. A study of norovirus spread did not confirm these findings [36].…”