Etiology of Childhood Infectious Diarrhea in a Developed Region of China: Compared to Childhood Diarrhea in a Developing Region and Adult Diarrhea in a Developed Region

Abstract

In China, great differences in economy, social characteristics and hygiene exist between developing and developed regions. A comparative study of infectious diarrhea between two regions was needed. Three groups of diarrheal patients were collected: children ≤5 year-olds from Beijing (developed region) and Henan Province (developing region), and adults over 18 year-olds from Beijing. A questionnaire was used to survey and feces samples were examined for 16 enteropathogens. We enrolled 1422 children and 1047 adults from developed region and 755 children from developing region. Virus positive rates were 32.98% for children and 23.67% for adults in developed region. The most prevalent pathogen for children was rotavirus whereas for adults was norovirus. Bacterial isolation rates were 13.92% for children from developed region, while 29.14% for children from the developing regions. For the greatest difference, Shigella accounted for 50.79% and was the dominant pathogen in the developing region, whereas in the developed region it was only 1.45%. There was no significant relationship between the local levels of development with diarrheogenic Escherichia coli (DEC) categories. But it was seen the notable differences between the population with different age: enteropathogenic E.coli (EPEC) and enteroaggregative E.coli (EAggEC) were the primary classes of DEC in children from both regions, whereas it was enterotoxigenic E.coli (ETEC) in adults. The symptoms of Shigella and Salmonella infection, such as bloody stools, white blood cells (WBC) and red blood cells (RBC) positivity and fever were similar in children, which may lead to the misidentification. Yersinia enterocolitica and shiga toxin-producing E.coli (STEC) infections were firstly reported in Beijing. There was a large difference in etiology of bacterial diarrhea between children in developing and developed regions of China.

Prevalence and clinical profile of rotavirus A infection among diarrhoeal children and phylogenetic analysis with vaccine strains in Chengdu, West China, 2009–2014

“…In this study, 18.88% of RVA-positive cases were codetected with other gastroenteritis viruses including NoV, EADV, HAstV and SLV. Similar multiviral detection rates were reported in Beijing (15.1%) and Shanghai (14.9%) [19,26]. Diarrhoea frequency in the RVA coinfected group was higher than in RVA-monoinfected patients.…”

“…However, the study 20 years ago ran over a short period of only 3 months from October 1998 to January 1999 and mainly in winter, which may have resulted in a higher detection rate. The RVA-positive rate in our study was higher than in Beijing, which was 12.59% from 2011 to 2014 [19]. The variation in detection rates between studies may be related to study period, patient inclusion/exclusion criteria, climate or economic status [6].…”

Molecular and Phylogenetic Characterization of Non-O157 Shiga Toxin-Producing Escherichia coli Strains in China

“…Additionally, we recovered 11 isolates from 870 diarrheal patients. These samples had a positive rate of 1.26%, which was lower than the rate for animal samples, but slightly higher than the rate reported in other studies in China (0.1–0.57%) (Chen et al, 2014; Wang et al, 2015; Yu et al, 2015). This is the first investigation of STEC prevalence in healthy human population in China.…”

“…In our previous study, we investigated STEC in some domestic and wild animals, as well as foodstuffs of animal origin, in China (Bai et al, 2013, 2015, 2016; Meng et al, 2014). STEC strains have also been isolated from diarrheal patients in China (Xiong et al, 2012; Chen et al, 2014; Wang et al, 2015; Yu et al, 2015). However, little knowledge is available on the molecular and phylogenetic properties of non-O157 STEC from various sources in China, and the role of animal reservoirs or animal-derived foodstuffs in causing human non-O157 STEC infections remains unknown.…”

Aspectos epidemiológicos das enteroinfecções bacterianas em menores de 5 anos de idade em Rio Branco, estado do Acre, Brasil*

“…No Brasil, os agentes etiológicos de maior relevância clínica e epidemiológica são: Escherichia coli diarreiogênicas, rotavírus, Salmonella spp., Shigella spp., Campylobacter jejuni e Campylobacter coli, Cryptosporidium spp., Entamoeba histolytica e Giardia lamblia. No entanto, a etiologia das bactérias causadoras de diarreia difere dependendo da área geográfica e dos diferentes níveis de desenvolvimento econômico entre as regiões 4,5,6,7,8 .…”