The Short-term Effects of Temperature on Infectious Diarrhea among Children under 5 Years Old in Jiangsu,China:A Time-series Study(2015-2019)

The association between meteorological factors and infectious diarrhea has been widely studied in many countries.However,investigation among children under 5 years old in Jiangsu,China remains quite limited.Data including infectious diarrhea cases among children under five years old and daily meteorological indexes in Jiangsu,China from 2015 to 2019 were collected.The lag-effects up to 21 days of daily maximum temperature(Tmax)on infectious diarrhea were explored using a quasi-Poisson regression with a distributed lag non-linear model(DLNM)approach.The cases number of infectious diarrhea was significantly associated with seasonal variation of meteorological factors,and the burden of disease mainly occurred among children aged 0-2 years old.Moreover,when the reference value was set at 16.7°C,Tmax had a significant lag-effect on cases of infectious diarrhea among children under 5 years old in Jiangsu Province,which was increased remarkably in cold weather with the highest risk at 8℃.The results of DLNM analysis implicated that the lag-effect of Tmax varied among the 13 cities in Jiangsu and had significant differences in 8 cities.The highest risk of Tmax was presented at 5 lag days in Huaian with a maximum RR of 1.18(95% CI:1.09,1.29).Suzhou which had the highest number of diarrhea cases(15830 cases),had a maximum RR of 1.04(95%CI:1.03,1.05)on lag 15 days.Tmax is a considerable indicator to predict the epidemic of infectious diarrhea among 13 cities in Jiangsu,which reminds us that in cold seasons,more preventive strategies and measures should be done to prevent infectious diarrhea.

Efficacy of stool multiplex polymerase chain reaction assay in adult patients with acute infectious diarrhea

BACKGROUND Recently,stool multiplex polymerase chain reaction(PCR)tests have been developed for identifying diarrhea-causing bacterial pathogens.Furthermore,fecal calprotectin is a well-known effective marker for intestinal mucosal inflammation.AIM To evaluate the efficacy of stool multiplex PCR and fecal calprotectin in acute infectious diarrhea.METHODS Overall,400 patients with acute infectious diarrhea were enrolled from Kangdong Sacred Heart Hospital(January 2016 to December 2018).Multiplex PCR detected 7 enteropathogenic bacteria including Salmonella,Campylobacter,Shigella,Escherichia coli O157:H7,Aeromonas,Vibrio,and Clostridium difficile.We reviewed clinical and laboratory findings using stool multiplex PCR.RESULTS Stool multiplex PCR test detected considerably more bacterial pathogens than stool culture(49.2%vs 5.2%),with Campylobacter as the most common pathogen(54%).Patients with positive stool PCR showed elevated fecal calprotectin expression compared to patients with negative stool PCR(1124.5±816.9 mg/kg vs 609±713.2 mg/kg,P=0.001).C-reactive protein(OR=1.01,95%CI:1.001-1.027,P=0.034)and sigmoidoscopy-detected colitis(OR=4.76,95%CI:1.101-20.551,P=0.037)were independent factors in stool PCR-based detection of bacterial pathogens.Sensitivity and specificity of calprotectin were evaluated to be 70.5%and 60.9%,respectively(adjusted cut-off value=388 mg/kg).CONCLUSION Stool multiplex PCR test has increased sensitivity in detecting pathogens than conventional culture,and it is correlated with calprotectin expression.Stool multiplex PCR and calprotectin may be effective in predicting clinical severity of infectious diarrhea.

Antibacterial and anti-parasitic activities of Terfezia claveryi methanolic extract against some common pathogenic agents of infectious diarrhea

Objective:To assess the antidiarrheal effects of Terfezia claveryi methanolic extract against Escherichia coli,Salmonella typhimurium,Shigella flexneri,and Giardia lamblia.Methods:Antibacterial effects of the Terfezia claveryi methanolic extract were carried out by determining the minimum inhibitory concentration(MIC)and minimum bactericidal concentration through micro broth dilution technique.Furthermore,reactive oxygen species production and protein leakage were evaluated.To evaluate the in vitro anti-giardial effects of Terfezia claveryi methanolic extract,Giardia lamblia WB(ATCC®30957)trophozoites were treated with various concentrations of Terfezia claveryi methanolic extract for 10-360 min.In addition,the plasma membrane permeability of trophozoites treated with Terfezia claveryi methanolic extract was determined.The cytotoxicity effects of Terfezia claveryi methanolic extract against normal(HEK293T)and cancer(MCF-7)cells were also assessed using the MTT assay.Results:The MIC and minimum bactericidal concentration of Terfezia claveryi methanolic extract against bacterial strains were in the range of 0.52-1.04 and 1.04-2.08 mg/mL,respectively.The results revealed that reactive oxygen species production and protein leakage were significantly increased after the bacteria were treated with the Terfezia claveryi methanolic extract,especially at 1/3 and 1/2 MICs(P<0.001).Furthermore,Terfezia claveryi methanolic extract decreased the viability of Giardia lamblia trophozoites in a dose-dependent manner.Terfezia claveryi methanolic extract at 1,2,and 4 mg/mL resulted in 100%mortality in Giardia lamblia trophozoites after 360,240,and 120 min,respectively.Moreover,Terfezia claveryi methanolic extract altered the permeability of plasma membrane of Giardia lamblia trophozoites by increasing the concentration.MTT assay revealed that the 50%cytotoxic concentrations values for HEK293T and MCF-7 cells were 4.32 mg/mL and 6.40 mg/mL,respectively,indicating that Terfezia claveryi methanolic extract had greater cytotoxicity against cancer cells than normal cells.Conclusions:Terfezia claveryi methanolic extract had potent in vitro antibacterial and anti-parasitic effects on Escherichia coli,Salmonella typhimurium,Shigella flexneri,and Giardia lamblia by affecting cell membrane permeability and reactive oxygen species generation with no significant cytotoxicity on normal cells.

Culture and Sensitivity Patterns of Various Antibiotics Used for the Treatment of Pediatric Infectious Diarrhea in Children under 5 Years of Age: A Tertiary Care Experience from Karachi

Background and objective: Infectious diarrhea is one of the most common infections and a significant cause of morbidity and mortality in children under 5 years of age. Frequent and irrational use of antibiotics has resulted in increased bacterial resistance. The aim of our study was to determine the culture and sensitivity patterns of antibiotics used for the treatment of diarrhea in children less than 5 years of age in a tertiary care hospital of Karachi, Pakistan. Methodology: This cross sectional study was conducted for a period of six months in the children of ages ranging between 6 months and 5 years. Stool samples were obtained from the patients presented with signs and symptoms of diarrhea in OPD or being referred to microbiology department for stool C/S (culture and sensitivity). Data were analyzed on SPSS version 19.0. Results: A total number of 325 stool samples were collected, out of which 152 samples were positive for pathogens. The most common pathogen isolated was E. coli 92 (60%), followed by Klebsiella 56 (37%) and Salmonella 4 (3%). All 152 isolates were highly resistant to majority of the standard antibiotics. Conclusion: Infectious diarrhea is highly prevalent among children under 5 years of age. E. coli was found to be the most frequent pathogen isolated in stool samples of the patients presenting with diarrhea and was highly resistant to many of the commonly used standard antibiotics in our clinical set up. Male children were predominantly affected by infectious diarrhea as compared to female children. Therefore, injudicious use of antibiotics should be stopped as well as should not be prescribed empirically for the treatment of all cases of pediatric diarrhea.

The mediatory role of water quality on the association between extreme precipitation events and infectious diarrhea in the Yangtze River Basin,China

Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change,it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies.Water quality may be the most important mediator,while relevant empirical evidence is limited.This study aimed to examine the role of water quality in the process of infectious diarrhea caused by extreme precipitation.Weekly infectious diarrhea cases,meteorological factors and water quality data in Yangtze River Basin in China between October 29,2007 to February 19,2017 were obtained.Two-stage statistical models were used to estimate city-specific extreme precipitation,water quality and infectious diarrhea relationships that were pooled to derive regional estimates.A causal mediation analysis was used to assess the mediation effect of water quality.In Yangtze River Basin,extreme precipitation events had a significant impact on infectious diarrhea(Incidence Rate Ratios[IRR]:1.027,95%Confidence Interval[CI]:1.013~1.041).After extreme precipitation events,the dissolved oxygen(DO)in surface water decreased(-0.123 mg/L,95%CI:-0.159 mg/L~-0.086 mg/L),while the un-ionized ammonia(NH(3)-N)increased(0.004 mg/L,95%CI:0.001 mg/L~0.006 mg/L).The combined overall effect of DO and NH(3)-N on infectious diarrhea showed that both low and high concentrations were associated with an increased risk of infectious diarrhea.The causal mediation analysis showed that the mediation proportion of the two water quality indexes(DO and NH(3)-N)is 70.54%(P<0.001).To reduce the health effects of extreme precipitation,in contrast to current population-oriented health strategies,those that take into account more direct and easy-to-intervene water quality indicators should be encouraged by future policies.

Post-infectious irritable bowel syndrome:Mechanistic insights into chronic disturbances following enteric infection

Irritable bowel syndrome(IBS)is a commonly encountered chronic functional gastrointestinal(GI)disorder.Approximately 10%of IBS patients can trace the onset of their symptoms to a previous a bout of infectious dysentery.The appearance of new IBS symptoms following an infectious event is defined as post-infectiousIBS.Indeed,with the World Health Organization estimating between 2 and 4 billion cases annually,infectious diarrheal disease represents an incredible international healthcare burden.Additionally,compounding evidence suggests many commonly encountered enteropathogens as unique triggers behind IBS symptom generation and underlying pathophysiological features.A growing body of work provides evidence supporting a role for pathogen-mediated modifications in the resident intestinal microbiota,epithelial barrier integrity,effector cell functions,and innate and adaptive immune features,all proposed physiological manifestations that can underlie GI abnormalities in IBS.Enteric pathogens must employ a vast array of machinery to evade host protective immune mechanisms,and illicit successful infections.Consequently,the impact of infectious events on host physiology can be multidimensional in terms of anatomical location,functional scope,and duration.This review offers a unique discussion of the mechanisms employed by many commonly encountered enteric pathogens that cause acute disease,but may also lead to the establishment of chronic GI dysfunction compatible with IBS.

Montezuma's revenge-the sequel: The one-hundred year anniversary of the first description of “post-infectious” irritable bowel syndrome

One-hundred years have passed since the original description of the commonly described phenomenon of persistent abdominal symptoms being triggered by an acute enteric infection. This first account was generated out of astute observations by Sir Arthur Hurst in World War I. Additional descriptions followed from military and non-military practitioners adding the evidence which has transitioned this recognized condition from association to causation. While mechanistic understanding is an area of active pursuit, this historical accounting of a centuries progress highlights important advances and contributions of military medicine and scientists to advances benefiting global populations.

2013—2022年竹山县其他感染性腹泻流行特征分析

目的:分析湖北省竹山县其他感染性腹泻流行特征,为制定控制对策提供依据。方法:从中国疾病预防控制系统导出2013—2022年竹山县其他感染性腹泻疫情数据,运用描述流行病学方法进行分析。结果:2013—2022年竹山县共报告其他感染性腹泻10006例,年均报告发病率为218.75/10万,无死亡病例报告。其中,年报告发病率以2017年最高,2022年最低,分别为328.37/10万(1514/461071)和105.54/10万(469/444363)。2013—2022年竹山县其他感染性腹泻年报告发病率呈逐年下降趋势,差异有统计学意义(χ^(2)=986.912,P<0.01)。全县各乡镇均有其他感染性腹泻病例报告;全年各月均有发病,以11月—次年1月发病例数较多,占全部报告发病例数的43.18%(4321/10006);病例主要为散居儿童,占全部报告发病例数的94.65%(9471/10006);病例以[0,3)岁儿童最多,占全部报告发病例数的92.72%(9278/10006),其他感染性腹泻发病率随年龄增长呈逐级下降趋势。男性报告发病率为238.98/10万,明显高于女性(195.20/10万),差异有统计学意义(χ^(2)=99.84,P<0.01)。结论:其他感染性腹泻防控形势依然十分严峻,应广泛开展感染性腹泻防治知识宣传,增强群众卫生防病意识,加强托幼机构和学校等集体单位饮食、饮水和环境卫生管理,建立秋冬季节感染性腹泻监测预警机制,及时发现和处置暴发苗头,并加大改水改厕力度,积极推广婴幼儿轮状病毒疫苗接种,遏制低龄儿童感染性腹泻感染和传播风险。

感染性腹泻患者肠道菌群失衡特征分析

目的研究不同病原体感染造成的感染性腹泻患者肠道菌群失衡特征,以及拟杆菌属在维持肠道内环境稳态中的作用,为后续感染性腹泻的治疗提供新思路。方法采用三代全长16S rRNA扩增子方法,测定由病毒和细菌等病原感染引起的腹泻患者肠道菌群,同时与健康人群肠道进行对比分析。按照单一细菌感染、单一病毒感染、混合感染以及艰难梭菌感染等对腹泻患者进行分组和分析。结果拟杆菌在健康人群肠道环境中占据绝对的数量和丰度水平,而感染性腹泻患者的拟杆菌门/纲/目/科/属等各分类水平的相对丰度均有下降。α多样性分析结果显示不同组别之间无统计学差异;β多样性中,NMDS和PCoA分析显示健康对照组与感染性腹泻各组中形成了明显的不同聚类群。健康人群肠道菌群的多样性水平高于各感染性腹泻组。物种差异分析表明,由不同病原体感染造成的感染性腹泻患者具有各自不同的优势肠道菌群。单一病毒感染之后以双歧杆菌属作为其优势菌群;单一细菌感染之后以链球菌属为优势菌群;混合感染组中以拉氏梭菌属为优势菌群。艰难梭菌感染组中的埃希菌属和克雷伯菌属是该组中的优势菌群。同时,健康人群肠道中的优势菌群是拟杆菌属。COG功能预测结果显示,健康对照组与各感染组形成了明显不同的聚类群。感染性腹泻各组中的防御机制功能、细胞壁合成、蛋白修饰、细胞分化以及复制和重组等功能均明显降低。结论由不同病原感染造成的感染性腹泻患者出现不同程度的菌群失调特征,肠道菌群的多样性降低,并出现各自的优势菌群。同时,拟杆菌属在维持人体肠道内环境稳态中具有关键作用,为后续感染性腹泻的治疗和研究等领域提供了新的思路。

2021~2023年北京经济技术开发区感染性腹泻病原谱及耐药性分析

目的了解北京经济技术开发区感染性腹泻患者常见的病原菌种类、流行趋势和耐药性,从而为该地区的流行病学研究及临床治疗提供科学依据。方法收集2021年1月1日至2023年12月31日就诊于首都医科大学附属北京同仁医院感染科肠道门诊、儿科、急诊科6902例感染性腹泻患者的粪便标本进行增菌、分离培养,用基质辅助激光解析电离飞行时间质谱仪(MALDI-TOF MS)鉴定菌种,用凝集试验确定血清型,用K-B纸片法测定抗菌药物敏感性。结果在6902例标本中,检出390株病原菌,总体检出率为5.65%。其中沙门菌属和副溶血弧菌是最常见的两种病原菌,分别占检出的390株病原菌的32.14%和28.32%。检测出的沙门菌属中,优势血清型为肠炎沙门氏菌。27株霍乱弧菌中非O1/O139血清群霍乱弧占92.59%,且近年呈现增长态势。不同年龄组和病原菌的检出差异具有统计学意义(P<0.001),其中21~30岁年龄组和31~40岁年龄组感染性腹泻患者最多,另外0~10岁年龄组、11~20岁年龄组和>60岁年龄组以沙门菌属为主,其余组以副溶血弧菌为主。不同月份和病原菌的检出差异具有统计学意义(P<0.001),肠道致病菌在7~8月检出率最高,而沙门菌属高发期则在6~7月。不同病原菌对各类抗菌药物的敏感性存在差异,其中氨基青霉素类抗菌药物显示出较高的耐药性。单环β-内酰胺类、喹诺酮类、氨基糖苷类药物敏感性较高,多重耐药情况也有发生。结论弧菌属和沙门菌属是北京经济技术开发区感染性腹泻的主要病原菌,各种病原菌耐药性不同,因此必须紧密关注感染性腹泻病原菌及其对各类抗菌药物的耐药性情况。

2017—2022年浙江省其他感染性腹泻病ARIMA模型预测精度分析

目的 比较分析2017—2022年浙江省其他感染性腹泻病自回归移动平均(autoregressive integrated moving average, ARIMA)模型预测精度,探索更为精准的预测模型以指导传染病防控。方法 收集2011年4月—2022年12月的浙江省其他感染性腹泻病发病率资料,将2011年4月—2021年的数据分为6个时间段,拟合优选出各数据段的最优ARIMA模型,分别对2017—2022年浙江省其他感染性腹泻病的发病率进行预测,以对应年度实际发病率验证模型,比较各数据段最优模型的年平均相对误差和月相对误差。结果 2011年4月—2022年12月,浙江省总计报告其他感染性腹泻病1 272 546例,年均发病率为186.97/10万。拟合的6个最优ARIMA模型对2017—2022年预测值与实际值的年平均相对误差分别为19.27%、28.59%、12.46%、77.87%、16.53%、40.21%,最小的月相对误差分别为0.69%、1.16%、0.57%、3.27%、0.45%、8.07%。结论 虽然ARIMA模型预测其他感染性腹泻病有时会存在较大误差,但短期预测仍可以为该病的早期精准防控提供参考依据。

整体护理干预在小儿轮状病毒感染性腹泻中的应用效果

目的分析整体护理干预在小儿轮状病毒感染性腹泻中的应用效果。方法选取2023年1月至10月滨州医学院附属医院收治的68例轮状病毒感染性腹泻患儿作为研究对象,根据就诊时间分为参比组(n=34,常规护理)与分析组(n=34,整体护理干预)。比较两组临床症状改善时间及住院时间、护理满意度及并发症发生情况。结果分析组止泻、退热、呕吐症状消失时间及住院时间均短于参比组,差异有统计学意义(P<0.05)。分析组沟通支持、尊重支持、情感支持、优质护理支持评分均高于参比组,差异有统计学意义(P<0.05)。分析组并发症总发生率低于参比组,差异有统计学意义(P<0.05)。结论小儿轮状病毒感染性腹泻中应用整体护理干预,可缩短临床症状改善时间,降低并发症发生率,提高护理满意度。

江苏省某监测点家畜来源肠致病性大肠埃希菌分离株分子特征分析

目的分析江苏省某监测点家畜来源肠致病性大肠埃希菌分离株分子特征,进而评估其潜在的致病性,为感染性腹泻的监测与防控提供依据。方法采用全基因组测序技术对江苏省某监测点分离的家畜来源的37株肠致病性大肠埃希菌(EPEC)菌株进行特征性分析。结果本地家畜来源的EPEC均为非典型EPEC(aEPEC),其血清型多样,携带多种与腹泻相关的毒力基因,有9种ST型且具有区域性流行特征,eae基因包含有5种亚型,β1为优势亚型,其在腹泻病人中也最为常见。结论aEPEC对公众健康构成潜在威胁,应在感染性腹泻的监测工作中,加强对家畜粪便及养殖环境的监测。

2018—2022年安徽省其他感染性腹泻突发公共卫生事件流行特征分析

目的分析近年来安徽省其他感染性腹泻突发公共卫生事件(简称其他感染性腹泻事件)的发生趋势和流行病学特征,为防控工作提供科学依据。方法通过中国疾病预防控制信息系统突发公共卫生事件管理信息系统,收集2018—2022年安徽省报告的其他感染性腹泻事件相关信息,对事件分级、三间分布、传播途径等特征进行描述性分析。结果2018—2022年安徽省共报告其他感染性腹泻事件115起,累计报告发病5822例,无死亡病例。以未分级事件为主(78起,占67.83%),其余为一般事件(37起,占32.17%)。事件发生总体呈现春季(3月)和秋冬季(10—12月)两个高峰,4个月份的累计事件数和发病数分别为71起(占61.74%)和3831例(占65.80%);不同年份的时间分布特征有所差异,其中2020年和2022年为单峰分布,2018年、2019年和2021年为双峰分布。报告事件数前3位的城市分别是黄山市(25起,占21.74%)、合肥市(18起,占15.65%)和芜湖市(12起,占10.43%),报告发病数前3位的分别是黄山市(1453例,占24.96%)、合肥市(976例,占16.76%)和宣城市(721例,占12.38%)。皖南、皖中和皖北地区的报告事件数构成比分别为53.04%、40.00%和6.96%,报告发病数构成比分别为58.47%、37.46%和4.07%。单一传播途径中多数为生活接触(84起,占90.32%),多种传播途径中均包括生活接触。主要发生场所为学校(101起,占87.83%)。病原体明确的事件103起,主要为诺如病毒(100起,占97.09%)。结论安徽省其他感染性腹泻突发公共卫生事件的防范应以学校为主,应进一步加强日常监测和病原检测并有针对性地开展健康教育,降低事件发生风险。

2017—2022年上海市嘉定区其他感染性腹泻病流行特征及病原学分析

目的:了解2017—2022年上海市嘉定区其他感染性腹泻病流行病学及病原学特征,为辖区其他感染性腹泻病防治提供科学依据。方法:通过中国疾病预防控制信息系统获取2017—2022年嘉定区其他感染性腹泻病的相关资料,采用描述性流行病学方法对数据进行统计分析。结果:2017—2022年嘉定区共报告1576例其他感染性腹泻病,年均发病率为15.40/10万。时间分布上,7—9月和12月—次年1月为全年发病高峰期。病例年龄以0~5岁为主(占55.14%);职业分布上,散居儿童占比最高(占51.14%)。男性发病数多于女性,性别比为1.28∶1。明确感染病原体的病例占74.87%,病毒感染以轮状病毒(占35.53%)为主,细菌感染以沙门氏菌(占20.43%)为主。夏秋季(5—10月)以细菌感染为主,差异有统计学意义(χ^(2)=30.87,P<0.05),冬春季(12月—次年3月)以病毒感染为主,差异有统计学意义(χ^(2)=56.02,P<0.05)。结论:嘉定区其他感染性腹泻病具有季节性特征,发病人群以低年龄段人群为主,轮状病毒感染为主要病原学病因,建议在该病流行季节前对居民开展针对性的健康教育,降低发病风险。

2012—2022年合肥市其他感染性腹泻流行特征及病原学检测结果分析

目的了解合肥市其他感染性腹泻(other infectious diarrhea,OID)的流行病学及病原学特征,为防治工作提供科学依据。方法从中国疾病预防控制信息系统中导出合肥市2012—2022年其他感染性腹泻病例报告数据及突发公共卫生事件资料,采用描述流行病学方法,分析报告发病率、病原体构成比、罹患率等指标,探讨三间分布和病原谱特征。结果2012—2022年合肥市共报告其他感染性腹泻病例218484例,年报告发病率范围为158.40/10万~370.50/10万,年均报告发病率245.85/10万,报告发病率总体呈先上升后下降趋势,年度内呈双峰分布,7—8月为夏季高峰,12月—次年1月为冬季高峰。报告病例中,男性123712例,女性94772例,性别比为1.31∶1,男性、女性年均报告发病率分别为271.34/10万、219.01/10万;5岁及以下人群发病141716例(占64.86%);职业分布以散居儿童为主(136294例,占62.38%)。明确病原体诊断的病例有46924例(占21.48%),主要病原体为病毒(44694例,占95.25%),其中轮状病毒感染占88.01%(39337/44694)。2012—2022年合肥市共报告其他感染性腹泻突发公共卫生事件28起,共发病1542例,波及人口62828人,总罹患率为2.45%;其中23起由诺如病毒感染引起,26起发生在学校。结论合肥市其他感染性腹泻报告发病率相对较高,5岁及以下儿童为重点防控人群,轮状病毒为主要病原体,其他感染性腹泻突发公共卫生事件以诺如病毒感染为主。应在流行高峰来临前加强对学校等重点机构和重点人群的健康教育工作,持续做好监测预警和风险评估,提高群众防病意识,落实防控措施。

2016-2022年北京市其他感染性腹泻发病影响因素及趋势分析

目的 了解新型冠状病毒感染疫情防控中公共卫生和社会措施(PHSMs)对北京市其他感染性腹泻发病的影响,为该传染病的防控工作提供参考。方法 收集2016年1月-2022年5月北京市其他感染性腹泻报告病例数据,分别应用季节性ARIMA模型和蒙特卡洛模拟预测在未发生新型冠状病毒感染疫情和未采取禁止堂食的情况下北京市其他感染性腹泻的发病情况。比较各年同时期的实际报告病例数与预测病例数,分析PHSMs对发病情况的影响。结果 2020年1月-2022年5月北京市其他感染性腹泻发病情况较新型冠状病毒感染疫情发生前显著下降。模型结果显示,2020年1月-2022年5月每年报告病例数分别是假设未发生新型冠状病毒感染疫情的35.3%、51.4%和36.3%。实施禁止堂食措施后,2022年5月的实际报告病例数比预测值下降了43.4%。结论 PHSMs能显著降低其他感染性腹泻的发病,禁止堂食的措施进一步降低了发病率。

广东鹤山地区急性腹泻婴幼儿轮状病毒感染现状及影响因素分析

目的:了解广东鹤山地区婴幼儿轮状病毒感染性腹泻的流行病学特征,为临床预防和诊疗措施提供相关的科学信息。方法:回顾2017年1月1日-2022年12月31日在广东省鹤山市人民医院就诊的0~7岁儿童腹泻患者粪便结果5153例,按不同性别、年龄、月份以及新型冠状病毒肺炎疫情(新冠疫情)前后分析儿童感染轮状病毒的情况;选择2022年12月-2023年4月腹泻儿童粪便57份,采用免疫层析法进行轮状病毒抗原检测,根据检测结果分为轮状病毒感染组与非轮状病毒感染组,并作问卷调查,分析患儿感染轮状病毒的相关因素。结果:5153例标本中共检出轮状病毒阳性标本498例,阳性率为9.66%。其中男性患儿感染率为9.38%,女性患儿感染率为10.08%,两组比较,差异无统计学意义(χ^(2)=0.693,P>0.05)。轮状病毒感染好发于出生6个月~3岁以下的婴幼儿,阳性患儿构成比达81.32%,显著高于其他年龄段,为重点预防发病对象。2017-2022年轮状病毒阳性率分别为15.1%、17.3%、5.55%、2.17%、5.66%和4.13%,2019-2022年受新冠疫情影响,轮状病毒抗原检出率显著下降,与疫情前两年相比差异均具有统计学意义(P均<0.05)。轮状病毒的暴发具有明显的季节性,在新冠疫情暴发前后,轮状病毒感染的高发期没有变化,主要以晚冬和初春时期(12月份至次年3月份)检出率最高,总检出率分别为24.7%、17.0%、16.0%、10.4%。经Logistic多因素分析,发现轮状病毒阳性病例主要以外来务工人员儿童感染为主,感染的因素主要有:饮食不注意卫生(缺乏勤洗手、地板清洁、餐具消毒),监护人对轮状病毒不了解、抗生素滥用、宠物接触等等。结论:轮状病毒感染是广东鹤山地区儿童腹泻的重要病因,其中0.5~3岁儿童是易感人群,在晚冬和初春季节发病率最高。儿童作为疫情防控重点人群,提倡在流行季节来临前做好防护工作,对存在高危感染因素的婴幼儿,采取相应预防和治疗措施,以降低患儿的感染率。

一起混合性气单胞菌引起食源性疾病暴发的病原学检测

目的探究引起细菌性食源性疾病暴发的病原学原因,了解气单胞菌污染食品引起聚集性事件的特征,为类似事件的调查处置提供参考。方法采集本起疫情患者肛拭子、食品留样、食品加工工具涂抹样,参照《食品卫生微生物学检验》《全国临床检验操作规程》(第四版)进行检验。结果在小黄鱼食物留样和两名患者肛拭子中,检出温和气单胞菌。在一份厨房用具涂抹液和其中一名患者肛拭子中,检出嗜水气单孢菌。结论这是一起罕见的混合性气单胞菌引起的食源性疾病暴发事件,提示我们在肠道感染性腹泻的诊治过程中,除了考虑常见肠道致病菌外,气单胞菌等罕见致病菌也不容忽视,以免给临床诊断和治疗带来困扰。

母乳喂养带菌致婴儿腹泻的误诊原因分析

目的探讨母乳喂养带菌致婴儿腹泻的误诊原因,以提高婴儿腹泻的早期确诊率。方法回顾分析2021年7月至2023年7月收治的18例母乳喂养带菌致婴儿腹泻患儿的临床资料,检测婴儿血液学指标、粪便菌群及母乳中细菌,分析误诊经过,总结误诊原因及防范措施。结果在18例婴儿腹泻患儿中,分别有15例(83.33%)和8例(44.44%)出现发热和呕吐。患儿血液白细胞计数和中性粒细胞计数均升高。初步诊断为病毒性腹泻,给予补盐液、蒙脱石散及益生菌调理肠道菌群后发现腹泻症状明显减轻,但在停药后依然反复,经大便常规发现白细胞数量较高。实施病毒检测提示,患儿病毒检测为阴性。考虑母乳原因,对母乳中细菌水平进行检测。根据检测结果18例均确诊为感染性腹泻。误诊时间4~6 d。18例患儿均试停母乳喂养,在此基础上有15例(83.33%)口服益生菌治疗,有3例(16.67%)给予抗生素联合肠黏膜保护剂治疗;经48 h治疗后患儿均停止腹泻,复查大便正常。结论母乳喂养带菌致婴儿腹泻的原因较多,临床上应高度重视婴儿腹泻诊断的复杂性。在诊断过程中需完成必要的常规检查,及时给予母乳细菌检查和患儿血液学检查,以降低误诊率,避免给患儿造成严重后果。