Enteropathogens in Adult Patients with Diarrhea and Healthy Control Subjects: A 1-Year Prospective Study in a Swedish Clinic for Infectious Diseases

Abstract

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.

A Study on the Epidemiology and Aetiology of Acute Gastroenteritis in Adult Patients Presenting at the Infectious Diseases Hospital in Tirana, Albania

“…A short duration of symptoms prior to sampling and frequent bowel movements should provide a higher yield. The study identified Cryptosporidium among 1% of patients, Entamoeba histolytica in 0.8% of patients and Giardia intestinalis in 0.7% of patients; these rates were low in relation to a study reporting Giardia intestinalis in 2% and Cryptosporidium in 2% (15).…”

“…The current study observed a higher prevalence of viral infection than studies conducted within industrialized countries, where rotavirus and norovirus were identified in less than 5% of patients (15,18). As well as reflecting an increased prevalence of viral infections, this may be attributed to increased utilization of sensitive detection methods (RT-PCR) within routine diagnostics involved in pathogen identification (19).…”

“…was diagnosed in 28 (3%) patients. Other studies found that 13% and 35% of the patients diagnosed by serology and by positive stool culture (15,16). This study found multiple enteropathogens in 5% of patients.…”

“…Previous studies of diarrhoea in adult patients identified enteropathogens in 56% and 82% of patients (15,16). The current study found bacterial pathogens in 29%, viral pathogens in 19% and protozoal pathogens in 2.5% of patients.…”

Antibiotic‐associated diarrhoea and Clostridium difficile> in the community

“…This low prevalence of healthy carriage in the community is in keeping with the most recent estimates in developed countries. 31 Ten patients acquired C. difficile during antibiotic therapy. Whether this acquisition was due to contamination from the home environment or to spore reactivation in the digestive tract cannot be determined from our study data.…”