Acute diarrhea in adults consulting a general practitioner in France during winter: incidence, clinical characteristics, management and risk factors

Abstract

BackgroundData describing the epidemiology and management of viral acute diarrhea (AD) in adults are scant. The objective of this study was to identify the incidence, clinical characteristics, management and risk factors of winter viral AD in adults.MethodsThe incidence of AD in adults during two consecutive winters (from December 2010 to April 2011 and from December 2011 to April 2012) was estimated from the French Sentinelles network. During these two winters, a subset of Sentinelles general practitioners (GPs) identified and included adult patients who presented with AD and who filled out a questionnaire and returned a stool specimen for virological examination. All stool specimens were tested for astrovirus, group A rotavirus, human enteric adenovirus, and norovirus of genogroup I and genogroup II. Age- and sex-matched controls were included to permit a case–control analysis with the aim of identifying risk factors for viral AD.ResultsDuring the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 French adults (95% CI [2,321 – 3,997]). The most reported clinical signs were abdominal pain (91.1%), watery diarrhea (88.5%), and nausea (83.3%). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% (95% CI [57 – 73]) of patients with AD with a predominance of noroviruses (49%). Having been in contact with a person who has suffered from AD in the last 7 days, whether within or outside the household, and having a job (or being a student) were risk factors significantly associated with acquiring viral AD.ConclusionsDuring the winter, AD of viral origin is a frequent disease in adults, and noroviruses are most often the cause. No preventable risk factor was identified other than contact with a person with AD. Thus, at the present time, reinforcement of education related to hand hygiene remains the only way to reduce the burden of disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0574-4) contains supplementary material, which is available to authorized users.

Acute gastroenteritis in primary care: a longitudinal study in the Swiss Sentinel Surveillance Network, Sentinella

“…The risk of transmission seems to play a subordinate role as a reason for inability to work. Similar findings were reported in a French study where 79% of working patients were on sick leave for a median duration of 3 days [ 35 ]. In a Danish study, only 35% of patients with AG reported having missed work or school as a result of illness [ 34 ].…”

“…It is well known that some pathogens causing AG are easily transmitted from human-to-human, especially viruses, and contact with diarrhoea patients has been described as a risk factor for AG previously [ 35 , 36 ]. In our study, 28.6% (95% CI 24.9–32.6) of the patients had contact to other people suffering from similar signs and symptoms in the 7 days preceding symptom onset.…”

Clinical and virological factors associated with gastrointestinal symptoms in patients with acute respiratory infection: a two-year prospective study in general practice medicine

“…There are several possible explanations for the observed GI symptoms during an ARI. First, each winter, ARIs and gastroenteritis outbreaks overlap, creating a spurious association between ARI and GI symptoms, maybe caused by a co-infection between respiratory agents and enteroviruses [16]. Second, GI symptoms may be a side effect of drug treatment (antibiotic or antiviral) [17,18] or food consumption (ex: raw shellfish and molluscs) [19].…”

Norovirus gastroenteritis outbreak transmitted by food and vomit in a high school

“…In addition, person-to-person transmission by contact or from aerosols generated by vomit presents an added difficulty [21][22][23]. This is consistent with the relatively high incidence of norovirus in the population and its periodic emergence [2,[24][25][26][27][28]. The involvement of exposure to vomit shown in the multivariate analysis is explained by the episodes of vomiting experienced by many affected students in the school restrooms, classrooms, and corridors.…”