Gastroenteritis in a Taipei emergency department: aetiology and risk factors

Abstract

A matched case-control study was used to determine pathogens and risk factors associated with gastroenteritis in a Taipei Emergency Department. Viruses (40.0%) were the leading cause of gastroenteritis, with noroviruses the most prevalent (33.2%). Bacteria were found in 26.0% of all cases, mostly suspected diarrheagenic E. coli (22.2%), followed by Salmonella spp. (5.4%) and Vibrio parahaemolyticus (4.2%). Giardia lamblia was identified in 16.4% of all cases. Statistical significance was noted for seven risk factors: taking antacids before gastroenteritis (OR = 3.91; 95% CI, 2.13, 7.15), other household members with gastroenteritis (OR = 5.18; 95% CI, 2.09, 12.85), attending a banquet (OR = 1.93; 95% CI, 1.25, 2.98), eating out (OR = 2.35; 95% CI, 1.30, 4.23), drinking bottled water (OR = 1.72; 95% CI, 1.07, 2.75), eating honey peaches (OR = 3.26; 95% CI, 1.24, 8.58), and eating raw oysters (OR = 3.24; 95% CI, 1.02, 10.28). Eating out was identified as the highest risk behavior, as measured by population attributable risk fraction (PAR) (50.9%). Respective PAR values for drinking bottled water, attending a banquet and taking antacids before illness were 19.7%, 19.6% and 17.6%. Of these, additional research on bottled water appears to be the highest priority, because this is the first time it has been identified as a risk factor for gastroenteritis.

Risk Factors for Salmonella Gastroenteritis in Children Less Than Five Years of Age in Taiwan

“…20 The significant association between consumption of purchased groundwater and the increased risk of salmonellosis strongly suggest the groundwater pollution by Salmonella. The speculation was supported by a recent study involving adult 21 Salmonella spp. were identified in 5.4% of the diarrhea cases.…”

Prevalence and characterization of enterotoxigenic Bacteroides fragilis and toxigenic Clostridium difficile in a Taipei emergency department

“…Stool specimens were tested for recognized enteropathogens, including viruses (norovirus, rotavirus, and astrovirus), parasites (Giardia lamblia and Entamoeba histolytica), and bacteria (suspected diarrheagenic E. coli, Salmonella spp., Shigella spp., Vibrio spp., Campylobacter spp., Aeromonas spp., and Staphylococcus aureus with related enterotoxins). 1 …”

“…The primary case definitions were as follows: (1) at least three loose stools or three instances of vomiting; or (2) either diarrhea and/or vomiting plus two or more additional symptoms, including abdominal pain, fever, nausea, blood in the stool, or stool mucus. 1 Patients were excluded from the study if they were younger than 15 years, exhibited coughing, a sore throat, or runny nose, or were bedridden. Patients aged >65 years were excluded from the control group.…”

“…and Vibrio parahaemolyticus. 1 The major microfloral populations of the human gut are not only E. coli and other fecal facultative microbes but also obligate anaerobes. 2 However, due to the time-consuming culture technique and the difficulties of bacterial identification, the routine testing of these pathogenic anaerobes is difficult, and approximately 70e80% are unculturable from symptomatic patients.…”

The aetiology of acute gastro-enteritis in infants and young children

“…The combination of microscopy, culture, including selection and enrichment, antigen detection and genome detection resulted in a pathogen(s) being detected in 60% of symptomatic children. This compares with an enteric pathogen identified in 57.9% of cases in a similar study in Burkina Faso, 2 in 62.4% of children admitted to an emergency department of a hospital in Taipei, 3 in 81.35% of cases in infants aged 0-43 months in south-eastern Nigeria between October 2005 and March 2006 4 and in 88% of cases aged 1-4 years in a case-control study in the UK in which molecular detection methods were used to identify enteric bacteria, viruses and parasites. 5 Sire et al 1 employed molecular methods to detect and characterise Shigella spp.…”