art GEBA

Etiology of Diarrhea in Older Children, Adolescents and Adults: A Systematic Review Christa L. Fischer Walker*, David Sack, Robert E. Black Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America Abstract Background: Diarrhea is an important cause of morbidity and mortality in all regions of the world and among all ages, yet little is known about the fraction of diarrhea episodes and deaths due to each pathogen. Methodology/P rincipal Findings: We conduc ted a sys tematic lite rat ure review to identif y all papers reporti ng the proportion of diarrhea episodes with positive laboratory tests for at least one pathogen in inpatient, outpatient and community settings that met our inclusion and exclusion criteria. We identified a total of 25,701 papers with possible etiology data and after final screening included 22 papers that met all inclusion and exclusion criteria. Enterotoxigenic Escherichia coli and V. cholerae O1/O139 were the leading causes of hospitalizations. In outpatient settings, Salmonella spp., Shigella spp., and E. histolytica were the most frequently isolated pathogens. Conclusions/Significance: This is the first systematic review which has considered the relative importance of multiple diarrhe a pathogens. The few studies identified suggest that there is a great need for additi onal prospecti ve studies around the world in these age groups to better understand the burden of disease and the variation by region. Citation: Fischer Walker CL, Sack D, Black RE (2010) Etiology of Diarrhea in Older Children, Adolescents and Adults: A Systematic Review. PLoS Negl Trop Dis 4(8): e768. doi:10.1371 /journal.pntd.00 00768 Editor: Richard (Dick) L. Guerrant, University of Virginia, United States of America Received December 8, 2009; Accepted June 16, 2010; Published August 3, 2010 Copyright: ß 2010 Fischer Walker et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was undertaken as a part of the Global Burden of Diseases, Injuries, and Risk Factors Study. A grant from the Bill and Melinda Gates Foundation supported the Study’s core activities and partially supported the epidemiologic reviews in this paper. This work was jointly funded by the World Health Organization - Foodborne Disease Burden Epidemiology Reference Group. 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. * E-mail: [email protected] Introduction Diarrhea is an important cause of morbidity and mortality in all regions of the world and among all ages [1,2]. For children 5 years of age and ol der , ado le scents, and adul ts mi ld to moderate diarrhea can lead to absenteeism from school or work and may require treatment by a health care provider. More severe diarrhea can lead to hospitalization; serious sequelae such as Guillain Barre’ syndrome and hemoly tic ure mic syndrome; and in some cases death [3,4] . Though most diarrhea episodes are self limiting and dehydra- tion can usuall y be contro lled with oral rehydra tion therapy, it would be ideal to be able to prevent diarrhea, especially the more severe episodes which have a higher likelihood of progressing to compli cat ions or dea th. Some pre vention strate gie s suc h as improv ed water and sanitation and basic hygien e practices are generaliz abl e and thus do not requ ire know ledge of dia rrhea etiology, but others such as vaccines would benefit greatly from a comprehensive understanding of the overall burden of pathogen- specific diarrheal disease. Recent advances have led to the development of an effective rotavirus vaccine which is now recommended for young children as part of the routine immunization schedule [5]. A vaccine for cholera that could be useful in some settings in all ages has been available for several years, and is now recommended by the WHO for persons living in endemic areas [6]. The number of pathogens that are responsible for diarrheal disease goes far beyond rotavirus and Vibrio cholerae ; however, the fraction of diarrhea episodes and deaths due to each pathogen is unclear, and thus uncertainty may inhibit prioritization of funding for research and disease control programs. The re hav e bee n nume rous stud ies cond ucte d in coun tri es around the world to determine the pre sence of one or more path oge ns in dia rrheal stools . Whi le iso lat ed stud ies prov ide important pieces of information, it is difficult to draw conclusions wit h reg ard to the importance of var ious pat hog ens wit hout looking at a comple te spe ctrum of age nts simulta neousl y. We cond ucte d a sys temati c lit erature rev iew of dia rrhea eti ology studies to better understa nd the likely distributio n of pathogen- specific diarrhea episodes and deaths in older children, adolescents and adults. To our knowledge this is the first systematic review designed to compile the data from multiple pathogens which might be applied to annual incidence and mortality rates in these age groups. Methods We sea rche d PubMed/Medl ine , CAB abs trac ts, Sys tem for Information on Grey Literature in Europe (SIGLE), and all World Hea lth Org anization (WHO) Reg ional Dat aba ses for studies published from January 1, 1980 through December 31, 2008 using al l combi nati ons of the foll owing sear ch and MeSH terms: www.plosntds.org 1 August 2010 | Volume 4 | Issue 8 | e768

art GEBA

Documents

Transcript of art GEBA