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

• Published in: Clinical infectious diseases Vol. 30; no. 5; pp. 770 - 778
• Main Authors: Svenungsson, Bo, Lagergren, Åsa, Ekwall, Erik, Evengård, Birgitta, Hedlund, Kjell Olof, Kärnell, Anders, Löfdahl, Sven, Svensson, Lennart, Weintraub, Andrej
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.05.2000; University of Chicago Press
• Subjects: Adolescent; Adult; Aeromonas; Aged; Aged, 80 and over; Animals; Bacteria - classification; Bacteria - isolation & purification; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Biological and medical sciences; Blastocystis hominis; Campylobacter; Case-Control Studies; Clinical Articles; Clostridium difficile; Cryptosporidium; Diarrhea; Diarrhea - microbiology; Diarrhea - parasitology; Diarrhea - virology; Epidemiology; Escherichia coli; Etiology; Eukaryota - classification; Eukaryota - isolation & purification; Feces - microbiology; Feces - parasitology; Feces - virology; Female; Giardia intestinalis; Human bacterial diseases; Humans; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Pathogens; Polymerase chain reaction; Prospective Studies; Protozoan Infections - epidemiology; Protozoan Infections - parasitology; Salmonella; Shigella; Sweden; Sweden - epidemiology; Virus Diseases - epidemiology; Virus Diseases - virology; Viruses; Viruses - classification; Viruses - isolation & purification; Sweden; Human; Microbiological investigation; Etiology; Diarrhea; Digestive diseases; Intestinal disease; Adult; Traveler disease
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/313770

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 (≤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.