背景:胃肠炎是全球发病率和死亡率的常见原因。它的原因包括一系列的代理人,包括病毒,细菌,寄生虫,毒素,和毒品。在所有年龄组的胃肠炎病例中,病毒占相当大的一部分,通常表现为恶心等症状,呕吐,腹泻,脱水,厌食症,和减肥。虽然发生了零星的病例,病毒性肠胃炎更常见于日托机构等紧密联系社区的暴发中,疗养院,和游轮。因此,有必要确定医疗保健提供者何时应在鉴别诊断中考虑这种情况,并制定最有效的策略来确认诊断。
方法:使用患者队列浏览器,在五年的时间内收集胃肠炎患者的去识别数据,密西西比大学医学中心的电子健康记录。验证性实验室测试采用BioFire®FilmArray®多重聚合酶链反应治疗胃肠道病原体。在与胃肠炎相关的22种最常见的药物中,只有病毒病原体,特别是腺病毒,星状病毒,诺如病毒,轮状病毒,和萨波病毒,包括在分析中。如果可用,回顾了组织病理学。
结果:在胃肠炎的各种原因中,传染性和非传染性,我们的研究结果显示,25.46%的病例与病毒病原体有关。与成人(27.07%)相比,儿科患者的比例(72.73%)明显更高,p值为0.015。诺如病毒I型和II型是所有年龄组中最常见的病毒,在成年人中患病率很高。没有观察到明显的基于性别的差异。组织病理学发现包括炎症,溃疡,侵蚀,建筑扭曲,以及与腺病毒相关的致病病毒包涵体。
结论:我们对病毒性胃肠炎病例的综合分析突出了这种情况的巨大负担,尤其是儿科患者。诺如病毒成为流行的罪魁祸首,强调了警惕监测和及时诊断的重要性,尤其是在爆发很常见的环境中。
BACKGROUND: Gastroenteritis is a common cause of morbidity and mortality globally. Its cause encompasses a spectrum of agents, including viruses, bacteria, parasites, toxins, and drugs. Viruses account for a considerable portion of gastroenteritis cases across all age groups, typically presenting with symptoms like nausea, vomiting, diarrhea, dehydration, anorexia, and weight loss. While sporadic cases occur, viral gastroenteritis is more frequently observed in outbreaks within closely knit communities such as daycare facilities, nursing homes, and cruise ships. Therefore, it becomes necessary to determine when healthcare providers should consider this condition in their differential diagnosis and to develop the most effective strategy to confirm the diagnosis.
METHODS: De-identified data of patients with gastroenteritis were collected over a five-year period utilizing the Patient Cohort Explorer, an electronic health record at the University of Mississippi Medical Center. Confirmatory laboratory tests employed the BioFire® FilmArray® multiplex polymerase chain reaction for gastrointestinal pathogens. Out of the 22 most common agents associated with gastroenteritis, only viral pathogens, specifically adenovirus, astrovirus, norovirus, rotavirus, and sapovirus, were included in the analysis. When available, histopathology was reviewed.
RESULTS: Among the various causes of gastroenteritis, both infectious and non-infectious, our findings revealed that 25.46% of the cases were linked to viral pathogens. This included a significantly higher percentage of pediatric patients (72.73%) when compared to adults (27.07%), with a p-value of 0.015. Norovirus genogroups I and II emerged as the most frequently detected viruses across all age groups, with a significant prevalence among adults. No discernible gender-based differences were observed. The histopathological findings included inflammation, ulceration, erosion, architectural distortion, and the pathognomonic viral inclusion bodies associated with adenovirus.
CONCLUSIONS: Our comprehensive analysis of viral gastroenteritis cases highlights the substantial burden of this condition, particularly among pediatric patients. Norovirus emerges as a prevalent culprit which emphasizes the importance of vigilant surveillance and timely diagnosis, especially in settings where outbreaks are common.