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Open Access 01-12-2016 | Research

Case–control study of diarrheal disease etiology in individuals over 5 years in southwest China

Authors: Shun-Xian Zhang, Chun-Li Yang, Wen-Peng Gu, Lin Ai, Emmanuel Serrano, Pin Yang, Xia Zhou, Shi-Zhu Li, Shan Lv, Zhi-Sheng Dang, Jun-Hu Chen, Wei Hu, Li-Guang Tian, Jia-Xu Chen, Xiao-Nong Zhou

Published in: Gut Pathogens | Issue 1/2016

Abstract

Background

Acute 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.

Methods

271 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.

Results

The 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.

Conclusions

DEC 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.

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Title: Case–control study of diarrheal disease etiology in individuals over 5 years in southwest China
Authors: Shun-Xian Zhang
Chun-Li Yang
Wen-Peng Gu
Lin Ai
Emmanuel Serrano
Pin Yang
Xia Zhou
Shi-Zhu Li
Shan Lv
Zhi-Sheng Dang
Jun-Hu Chen
Wei Hu
Li-Guang Tian
Jia-Xu Chen
Xiao-Nong Zhou
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Gut Pathogens / Issue 1/2016
Electronic ISSN: 1757-4749
DOI: https://doi.org/10.1186/s13099-016-0141-1

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Abstract

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