Objective To analyze the pathogenic spectrum of diarrhea among preschool children (under 5 years old) in Tianjin from 2015 to 2017, and to compare the differences of clinical characteristics under different pathogenic spectrum, so as to provide evidence for prevention, control and clinical treatment of diarrhea.
Methods The stool samples and clinical characteristics of children with diarrhea in hospital were collected and monitored. The enteropathogenic bacteria and enteroviruses were detected and the results and clinical characteristics were analyzed.
Results Among 455 stool samples of preschool diarrhea cases, 150 were positive, the positive rate was 32.97%. 126, 21 and 3 samples were detected for one, two and three pathogens, the positive rate was 84.00%, 14.00% and 2.00%, respectively. 72 single bacteria were detected, the positive rate was 15.82%, Citrobacter, Pseudomonas aeruginosa and Morgan fungus were the main bacteria. 54 single viruses were detected, the positive rate was 11.87%, Norovirus and rotavirus were the main viruses. Among the 21 strains which detected two pathogens, 10 strains were co–infected with Norovirus, accounting for 47.62%. Age distribution showed that the positive rate gradually increased with age. The highest positive rate was found in the over 48–month–old population. The positive rate of children over 6 months old was significantly higher than that of children under 6 months old. The 4 times of diarrhea per day, vomiting symptoms and the percentage of white blood cells in stool routine were higher in single virus cases than in single bacteria cases, with statistical significance ( P<0.05). The incidence of diarrhea more than four times a day, vomiting and fever in the cases with multiple pathogens were higher than those with single pathogen, and the difference was statistically significant ( P<0.05).
Conclusion The main pathogenic spectrum of diarrhea in preschool children is Citrobacter, Pseudomonas aeruginosa, Norovirus and rotavirus. Norovirus co–infection was the main cause of multiple pathogenic infections. The level of infection increases with age. Children over 6 months of age and their nurses should be trained in their hygienic habits and awareness of protection. The clinical manifestations and stool routine of diarrhea caused by viral and bacterial infections are different. It is suggested that clinicians should strengthen differential diagnosis and put forward reasonable treatment plans.
摘要： 目的 分析天津市2015—2017年5岁以下儿童腹泻感染谱, 比较不同病原下的临床特征的差异,为儿童腹泻的防治提供依据。 方法 收集监测医院腹泻儿童粪便标本进行肠道致病菌和肠道病毒检测, 并对检测结果和临床特征资料进行分析。 结果 455例5岁以下腹泻病例的粪便标本中, 检出阳性的病例为150例, 感染率32.97%, 检出一种、两种和三种病原的病例数分别为126例、21例和3例,占比分别为84.00%、14.00%和2.00%。72例病例感染单一细菌, 感染率为15.82%, 以柠檬酸杆菌、铜绿假单胞菌和摩氏摩根菌为主。检出单一病毒的54例, 感染率为11.87%, 以诺如病毒和轮状病毒为主。在21例检出两种病原的病例中, 诺如病毒混合感染的有10例, 占比为47.62%。随年龄增长感染率逐渐上升, 48月龄以上病例感染率最高, 6月龄以上病例感染率高于6月龄以下病例。检出单一病毒病例每日腹泻次数4次以上、出现呕吐症状和便常规中检出白细胞的比例均高于检出单一细菌的病例, 差异有统计学意义( P<0.05)。检出多病原的病例每日腹泻次数4次以上、出现呕吐和发热症状的比例均高于检出单一病原的病例, 差别均有统计学意义( P<0.05)。 结论 5岁以下腹泻病例主要感染谱为柠檬酸杆菌、铜绿假单胞菌、诺如病毒和轮状病毒。多病原感染以诺如病毒合并感染为主。感染水平随年龄增长呈上升趋势, 应引导6月龄以上儿童及其护理人员养成良好的卫生习惯和疾病防护意识。病毒和细菌感染导致的腹泻在临床表现及便常规方面都有所不同, 建议临床医生加强鉴别诊断。