Gastroenteritis Attributable to 16 Enteropathogens in Children Attending Day Care

Enserink, Remko; Wijngaard, Cees van den; Bruijning-Verhagen, Patricia; Asten, Liselotte van; Mughini‐Gras, Lapo; Duizer, Erwin; Kortbeek, Titia; Scholts, Rianne; Nagelkerke, Nico; Smit, Henriëtte A.; Kooistra-Smid, Mirjam; Pelt, Wilfrid van

doi:10.1097/inf.0000000000000472

Cited by 32 publications

(17 citation statements)

References 33 publications

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“… 24 However, norovirus displayed a broader seasonality peaking around autumn and winter (significantly winter vs summer OR 8.00) in this study and a study in Netherlands. 9 Bacterial infections, included V. parahaemolyticus , DEC and Salmonella spp, showed a yearly seasonality peaking in summer (often in August), with significantly summer vs winter OR 25.00, 11.11 and 2.78, respectively. This was similar in Enserink’s study, 9 whereas autumn peak of bacterial infections was observed in some studies.…”

Section: Discussionmentioning

confidence: 98%

“… 9 Bacterial infections, included V. parahaemolyticus , DEC and Salmonella spp, showed a yearly seasonality peaking in summer (often in August), with significantly summer vs winter OR 25.00, 11.11 and 2.78, respectively. This was similar in Enserink’s study, 9 whereas autumn peak of bacterial infections was observed in some studies. 25 37 The seasonality of infectious diarrhoea may be due to the climate, biological characteristics of pathogens and people’s diet habit of Shanghai.…”

Section: Discussionmentioning

confidence: 98%

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Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study

Gong

et al. 2018

BMJ Open

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ObjectivesThis study aimed to identify the epidemiology, clinical characteristics, aetiology and seasonality of sporadic infectious diarrhoea in adults in Shanghai.SettingThis study was based on a city-wide, active continuous hospital-based diarrhoea surveillance network established by Shanghai Municipal Center for Disease Control and Prevention. There were 22 sentinel hospitals in all 16 districts (9 primary-level hospitals, 6 secondary-level hospitals and 7 tertiary-level hospitals) which were selected using probability proportionate to size sampling method.ParticipantsFrom 1 May 2012 to 31 May 2016, 90 713 patients were included in this study. Among 8797 patients whose stool samples were collected and detected, 4392 patients were male.ResultsThe positive rate was 47.96%. Bacterial and viral infections accounted for 27.19% and 69.07% separately. Norovirus was the most common pathogen (43.10%), followed by rotavirus, Vibrio parahaemolyticus, diarrhoeagenic Escherichia coli (DEC) and Salmonella spp. Patients between 30–44 and 45–59 years were more likely to have infectious diarrhoea and viral diarrhoea. Those aged 30–44 years were the most likely to get infected with V. parahaemolyticus (adjusted OR, aOR vs 60+ years: 2.04, 95% CI 1.47 to 2.78) and norovirus (aOR vs 60+ years: 1.32, 95% CI 1.12 to 1.56). Bacterial (except V. parahaemolyticus) diarrhoea was characterised by fever, abdominal pain and loose stool; while viral diarrhoea was characterised by nausea, vomiting and watery stool. A seasonal distribution of infectious diarrhoea was observed with larger peaks in winter and smaller peaks in summer. Winter peaks were mainly due to norovirus and rotavirus, and summer peaks were due to bacterial infections. An emerging spring peak of norovirus around March was observed in the past 3 years.ConclusionViral infections were predominant, and norovirus played a leading role. A seasonal distribution was observed and an emerging spring peak of norovirus was noted. Our findings highlight the necessity for conducting an active, comprehensive surveillance in adults, to monitor changing dynamics in the epidemiology and aetiology of infectious diarrhoea.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study

Gong

et al. 2018

BMJ Open

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“…Because the parasite is environmentally ubiquitous, can persist for prolonged periods in the environment as hardy cysts, is capable of propagating through both anthroponotic [ 12 ] and zoonotic [ 13 – 19 ] reservoirs, and has an infectious dose as low as 10 cysts [ 20 ], Giardia exposures can also occur in resource-abundant settings [ 21 – 25 ]. In the United States, for example, infection is characterized by seasonal and recreational waterborne transmission [ 22 , 23 ] and clustered daycare outbreaks [ 26 ]. Transmission through food sources, such as leafy green vegetables and culinary bivalves harboring G. lamblia shed from coastal and marine life [ 27 – 29 ], is also possible.…”

Section: Introductionmentioning

confidence: 99%

Advances in understanding Giardia: determinants and mechanisms of chronic sequelae

Bartelt¹,

Sartor²

2015

F1000Prime Rep

124

129

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Giardia lamblia is a flagellated protozoan that is the most common cause of intestinal parasitic infection in children living in resource-limited settings. The pathogenicity of Giardia has been debated since the parasite was first identified, and clinical outcomes vary across studies. Among recent perplexing findings are diametrically opposed associations between Giardia and acute versus persistent diarrhea and a poorly understood potential for long-term sequelae, including impaired child growth and cognitive development. The mechanisms driving these protean clinical outcomes remain elusive, but recent advances suggest that variability in Giardia strains, host nutritional status, the composition of microbiota, co-infecting enteropathogens, host genetically determined mucosal immune responses, and immune modulation by Giardia are all relevant factors influencing disease manifestations after Giardia infection.

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“…Most human cryptosporidiosis cases worldwide are caused by Cryptosporidium parvum and C . hominis [15], although other species in domesticated and wild animals can infect humans and cause high morbidity and mortality in children, travellers and immunocompromised individuals [11, 16–21]. It has been suggested that Cryptosporidium can be found in 1% of stools of immunocompetent hosts from high-income countries and 5–10% of hosts from low-resource settings but recent molecular studies suggest an underestimation of the reported frequency of infection and the global burden of the disease [16, 22].…”

Section: Introductionmentioning

confidence: 99%

Local and global genetic diversity of protozoan parasites: Spatial distribution of Cryptosporidium and Giardia genotypes

et al. 2017

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Cryptosporidiosis and giardiasis are recognized as significant enteric diseases due to their long-term health effects in humans and their economic impact in agriculture and medical care. Molecular analysis is essential to identify species and genotypes causing these infectious diseases and provides a potential tool for monitoring. This study uses information on species and genetic variants to gain insights into the geographical distribution and spatial patterns of Cryptosporidium and Giardia parasites. Here, we describe the population heterogeneity of genotypic groups within Cryptosporidium and Giardia present in New Zealand using gp60 and gdh markers to compare the observed variation with other countries around the globe. Four species of Cryptosporidium (C. hominis, C. parvum, C. cuniculus and C. erinacei) and one species of Giardia (G. intestinalis) were identified. These species have been reported worldwide and there are not unique Cryptosporidium gp60 subtype families and Giardia gdh assemblages in New Zealand, most likely due to high gene flow of historical and current human activity (travel and trade) and persistence of large host population sizes. The global analysis revealed that genetic variants of these pathogens are widely distributed. However, genetic variation is underestimated by data biases (e.g. neglected submission of sequences to genetic databases) and low sampling. New genotypes are likely to be discovered as sampling efforts increase according to accumulation prediction analyses, especially for C. parvum. Our study highlights the need for greater sampling and archiving of genotypes globally to allow comparative analyses that help understand the population dynamics of these protozoan parasites. Overall our study represents a comprehensive overview for exploring local and global protozoan genotype diversity and advances our understanding of the importance for surveillance and potential risk associated with these infectious diseases. Author summaryInfectious diseases threaten the health and well-being of wildlife, livestock and human populations and contribute to significant economic impact in agriculture and medical Funding: This research was funded by the New Zealand Ministry of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests:The authors have declared that no competing interests exist.care. Cryptosporidium and Giardia are enteric protozoan pathogens that cause diarrhea and nutritional disorders on a global level. Using molecular analysis and a review framework we showed that species and genetic variants within genera Cryptosporidium and Giardia (including two species recently infecting humans) found in an island system are not different from other parts of the world. This similarity is likely due to high gene flow of historical and current human activity (travel and trade) and persistence of large host population sizes, such as cattle and people. We also show that, although species...

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Gastroenteritis Attributable to 16 Enteropathogens in Children Attending Day Care

Abstract: We demonstrate that circulating viruses and parasites, rather than bacteria, contribute to seasonal GE experienced by children in day care.

Cited by 32 publications

References 33 publications

Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study

Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study

Advances in understanding Giardia: determinants and mechanisms of chronic sequelae

Local and global genetic diversity of protozoan parasites: Spatial distribution of Cryptosporidium and Giardia genotypes

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