2014年无锡市感染性腹泻的病原学分析

Etiological analysis of infectious diarrhea in Wuxi,2014

目的：了解无锡市感染性腹泻的病原谱及流行特征。方法连续采集2014年1至12月无锡市腹泻监测哨点医院门诊腹泻病例的粪便样本，采用实时荧光聚合酶链反应（PCR）检测诺如病毒、轮状病毒、肠道腺病毒、人星状病毒和札如病毒的核酸，采用传统的分离培养方法检测致泻性大肠埃希菌、沙门菌、志贺菌、副溶血性弧菌和霍乱弧菌，分析病原构成、季节变化和人群分布。结果全年共监测粪便样本915例。病毒核酸阳性率为14.4%，诺如病毒（9.4%）和轮状病毒（3.4%）的流行有明显的季节分布特点，冬、春季为发病高峰。0-5岁组患儿病毒感染率显著高于其他年龄组患者。细菌检测阳性率为15.0%，集中在6至9月检出，以沙门菌为主（6.0%），优势菌型为肠炎沙门菌和鼠伤寒沙门菌，其次为致泻性大肠埃希菌（4.6%）。结论无锡市冬、春季节腹泻以病毒性感染为主，诺如病毒和轮状病毒是主要病原；夏季腹泻主要为细菌性感染，沙门菌和致泻性大肠埃希菌感染多见。应加强监测优势病原型别的变化。5岁以下儿童是病毒性腹泻的重点防控人群。

Objective To understand the pathogen spectrum and epidemiological characteristics of infectious diarrhea in Wuxi. Methods The stool specimens from outpatients with diarrhea were collected from sentinel hospitals from January to December 2014. The nucleic acid of norovirus,rotavirus,enteric adenovirus,human astrovirus and sapovirus was determined by real-time fluorescence polymerase chain reaction（PCR）. Diarrheagenic Escherichia coli,Salmonella spp,Shigella spp,Vibrio parahaemolyticus and Vibrio cholerae were identified by conventional culture methods. Pathogenic composition,seasonal variation and population distribution were analyzed. Results A total of 915 specimens were monitored. The positive rate of viral nucleic acid was 14.4%,and norovirus（9.4%） and rotavirus（3.4%） showed obvious seasonal distribution characteristics with the peak incidence occurring in winter and spring. The infection rate of children of 0-5 years old was higher than those of the other age groups. Bacteria,with the positive rate 15.0%,were isolated from June to September. Salmonella spp（6.0%） was the main isolate whose predominant serotypes were Salmonella enteritidis and Salmonella typhimurium,and the second was diarrheagenic Escherichia coli（4.6%）. Conclusions The viral diarrhea deserves attention in winter and spring,norovirus and rotavirus are the common pathogens. The bacterial diarrhea is given priority in summer,whose dominant pathogens are Salmonella spp and diarrheagenic Escherichia coli. Children under 5 years old are main for the prevention and control of viral diarrhea.