OBJECTIVEThe aim of this study was to investigate the prevalence of Clostridium difficile (C. difficile) infection and the risk factors for acquisition of C. difficile-associated diarrhea (CDAD) among cancer patients who received chemotherapy or radiation therapy.

METHODSWe analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital. Stool C. difficile toxin A/B test, stool culture for C. difficile and routine stool examination were performed. In addition, the risk factors for CDAD were investigated in a set of 41 C. difficile toxin-positive cancer patients and 82 matched C. difficile toxin-negative controls by univariate analysis and multivariate analysis.

RESULTSOut of a total of 277 cancer patients with diarrhea, 41 (14.8%) were C. difficile toxin-positive. Among these 41 cases, 11 (26.8%, 11/41) were C. difficile culture-positive. Univariate analysis showed that antibiotics use (P = 0.853), proton pump inhibitor use (P = 0.718), hypoproteinemia (P = 0.139) and white blood cell count (P = 0.454) did not appear to be associated with acquisition of CDAD in cancer patients. However, receiving chemotherapy (P = 0.023), receiving radiotherapy (P = 0.003), a positive fecal occult blood test result (P = 0.005) and the presence of fecal leukocytes (P = 0.007) showed close association with acquisition of CDAD in cancer patients. Multivariate analysis showed that receiving chemotherapy (OR, 8.308; 95% CI, 1.997-34.572; P = 0.004) and a positive result of fecal occult blood test (OR, 8.475; 95% CI, 1.463-49.109; P = 0.017) were independent risk factors for acquisition of CDAD among cancer patients.

CONCLUSIONSOur results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients. Cancer patients who are at high-risk for CDAD should take stool C. difficile toxin A/B test and stool culture for C. difficile regularly and prevention of CDAD.

Clostridium difficile ; Diarrhea ; epidemiology ; microbiology ; Enterocolitis, Pseudomembranous ; epidemiology ; Humans ; Neoplasms ; epidemiology ; microbiology ; Risk Factors

Diarrhea ; epidemiology ; microbiology ; Humans ; Infant ; Salmonella Infections ; epidemiology ; microbiology ; Salmonella typhimurium

Age Distribution ; Child, Preschool ; China ; epidemiology ; Diarrhea ; epidemiology ; microbiology ; Dysentery ; epidemiology ; Female ; Humans ; Incidence ; Infant ; Male

The large contribution of diarrhoea to morbidity and mortality rates in Papua New Guinea (PNG) warrants a significant response to diagnosing aetiology, determining appropriate management and reducing risk factors that facilitate transmission of enteric pathogens. We conducted a review of literature to assess the extent of research published on the aetiology of diarrhoea in PNG between 1995 and 2012. Of 54 peer-reviewed articles that were selected for review, 25 pertained to aetiology. While the majority of articles described typhoid fever and non-typhoid salmonellosis, shigellosis, rotavirus, pigbel and cholera were also represented in the literature reviewed.
Diagnostic Tests, Routine ; Diarrhea/epidemiology/*microbiology ; Humans ; Papua New Guinea/epidemiology ; Risk Factors

OBJECTIVETo analyze the epidemiological and etiological characteristics of diarrheal disease among children under 5 years of age in Guangdong province, in 2012.

METHODS64 hospitals in 21 cities were chosen as the diarrheal syndromic surveillance sites, of which 14 hospitals were selected to carry out etiological surveillance among children under 5 years of age, including isolation and culture of both Vibrio cholera and Shigella as well as nucleic acid detection of rotavirus and norovirus by PCR. Descriptive method was used to analyze data from syndromic and etiological surveillance programs on diarrheal, from 1932 parents of the children.

RESULTSIn 2012, the outpatient attendance rate on diarrheal among children under 5 years was 0.8%. The proportion of diarrheal in children under 5-year-olds was 63.5%, among the total number of diarrheal outpatients at the outpatient clinics under surveillance program. The morbidity of infectious diarrhea was 1454.5/10 million in children under 5 years of age. A total number of 1932 specimens were collected from children under 5 years of age, in the outpatient department. Among these specimens,Vibrio cholera appeared all negative but one was Shigella positive and proved to be Sh. sonnei. The positive rates of rotavirus and norovirus were 14.1% (273/1932)and 16.9% (326/1932). Both rotavirus and norovirus were found in 24 specimens, with a positive rate as 1.2% . 112 specimens were successfully gene sequenced for rotavirus, of which 33.9% as G1[P8] genotype, 25.9% as G9[P8], 12.5% as G2[P4] and 9.8% as G3[P8] respectively. 90 specimens were successfully gene-sequenced for norovirus, of which 76.7% as G II.4 genotype. Genetic subtypes of G II. 4/2006b, accounted for 50.0% and could be detected around the year except for June and December. New G II. 4/Sydney Strain_2012 was first detected in August and became the predominant in December. In addition, 5 specimens belonged to G I genotype with other 16 subtypes of G II.

CONCLUSIONResults from our study proved that children under 5 years of age belonged to high-risk group for diarrheal disease in Guangdong province. Rotavirus and norovirus were both diverse in terms of genome.

Caliciviridae Infections ; epidemiology ; Child, Preschool ; China ; epidemiology ; Diarrhea ; epidemiology ; microbiology ; virology ; Female ; Genotype ; Humans ; Infant ; Male ; Rotavirus Infections ; epidemiology

OBJECTIVETo analysis the etiological and epidemiological characteristics of the reported infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) cases in China in 2011.

METHODSA total of 836 591 reported infectious diarrhea cases were collected from "China Information System for Disease Prevention and Control" since first week to fifty-second weeks in 2011, 59 929 out of which were laboratory-confirmed. The information of thirty public health emergencies relevant with infectious diarrhea was collected from "Emergency Public Reporting System" between first week and fifty-second weeks in 2011. The epidemiological characteristics of reported cases, confirmed cases and outbreaks, and the pathogenic spectrum of confirmed cases were then analyzed.

RESULTSIn 2011, 836 591 infectious diarrhea cases (other than cholera, dysentery, typhoid and paratyphoid) were reported, and the incidence rate was 62.39/100 000. More than half patients were children aged under 5 year-old, accounting for 52.13% (436 098/836 591) and the incidence rate was 447.06/100 000 (436 098 cases). Most of the ill children were scattered, accounting for 50.53% (422 752/836 591). Reported cases showed two incidence peaks, with a summer peak from twenty-third weeks to thirty-fifth weeks, accounting for 34.33% (287 231/836 591) and a winter peak from forty-third weeks to fifty-second weeks, accounting for 23.54% (196 939/836 591). Cases distributed all over China, the incidence in Beijing (253.00/100 000 (49 619 cases)), Tianjin (244.34/100 000 (31 614 cases)), Zhejiang (204.42/100 000 (111 257 cases)), Ningxia (132.16/100 000 (9328 cases)) and Guangdong (127.40/100 000 (132 880 cases)) ranked the top five. Among the 30 public health emergencies, 5 outbreaks had lab tested pathogenic results, including 4 were norovirus-induced. Laboratory-confirmed cases accounted for 7.16% (59 929/836 591) of the case reported, including 56 687 viral cases and 3242 bacterial cases. Rotavirus cases took the highest proportion of viral cases, at 97.35% (53 612/55 185); and 97.15% (53 612/55 185) of which were children aged under 5 year-old. 82.42% (45 480/55 185) of the cases distributed in Guangdong and Zhejiang province, with the incidence peak from fiftieth weeks to fifty-first weeks, accounting for 15.42% (8508/55 185) of the whole year cases. The main pathogens of bacterial diarrhea were Salmonella, Vibrio parahaemolyticus and Escherichia coli, accounting for 48.43% (1570/3242), 32.20% (1044/3242) and 8.57% (278/3242) respectively, with the incidence peak from thirty-first weeks to thirty-fifth weeks, accounting for 23.01% (746/3242). Salmonella infection patients were mainly from Shanghai, Guangdong and Zhejiang province (91.59% (1438/1570)), Vibrio parahaemolyticus patients were mainly from Shanghai (80.94% (845/1044)), and Escherichia coli patients were mainly from Guangdong province (84.17% (234/278)). Salmonella patients were concentrated in 0-9 years group, accounting for 42.36% (665/1570), while Vibrio parahaemolyticus patients in 20-39 years group, accounting for 81.99% (856/1044), and Escherichia coli patients in under 1 year old and 20-39 years group, accounting for 63.67% (177/278).

CONCLUSIONIn China, children aged under 5 year-old should be the priority population in surveillance of infectious diarrhea. Rotavirus is the main pathogen causing infectious diarrhea. The lab-testing and case-reporting capabilities differed greatly among areas.

Child, Preschool ; China ; epidemiology ; Cholera ; epidemiology ; Diarrhea ; epidemiology ; microbiology ; virology ; Dysentery ; epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Rotavirus Infections ; epidemiology ; Typhoid Fever ; epidemiology

Enterotoxigenic Escherichia coli (ETEC) causes neonatal and post-weaning diarrhea in pigs. In order to determine the risk factors, rectal/fecal swabs and visceral organs obtained from pig farms in two regions of South Africa were analyzed microbiologically against risk variables. Seventy-two percent of young pigs were found to be positive for ETEC toxin genes; estB (38.9%), estB/STAP (25%), and estB/LT (13.9%) were dominant. Risk factors for ETEC-diarrhea in pigs include: leaving sick piglets in a pen with healthy piglets [odds ratio (OR) = 33.52; P < 0.0001]; water spillage in pen (OR = 42.87; P < 0.0001); hypothermic piglets (OR = 7.29; P < 0.0001); runt piglets in pen with healthy littermates (OR = 3.65; P < 0.0001); and prolonged use of antibiotics (OR = 3.05; P = 0.05).
Animals ; Animals, Newborn ; Diarrhea ; epidemiology ; microbiology ; Escherichia coli ; genetics ; isolation & purification ; Escherichia coli Infections ; epidemiology ; microbiology ; veterinary ; Genes, Bacterial ; Prevalence ; Rectum ; microbiology ; Risk Factors ; South Africa ; Swine ; Swine Diseases ; epidemiology ; microbiology ; Weaning

OBJECTIVETo investigate the infection status and virulent genes of Aeromonas in patients with acute diarrhea in Pudong New Area, Shanghai.

METHODSIn 2012, stool samples were collected from diarrhea patients in 12 sentinel hospitals in Pudong for the detections of 13 pathogens causing diarrhea, and the detections of 5 diarrhea related virulent genes were conducted for Aeromonas isolates.

RESULTSA total of 101 patients were infected with Aeromonas in 2533 patients (4.0%). A total of 101 Aeromonas strains were isolated, including 17 Aeromonas hydrophila strains (18.8%), 44 Aeromonas veronii biovar sobria strains (52.5%) and 12 Aeromonas caviae strains (29.7%). And 44 coinfections with other pathogens were detected. Aeromonas infection mainly occurred in summer and in people aged ≥20 years. Among the patients infected with Aeromonas, 71 (70.3%) had watery diarrhea, 20 (19.8%) had vomiting and 11 (10.9%) had fever. Virulent genes detection showed that 95.0% of the Aeromonas. strains carried virulent genes, and the detection rates of hlyA, aerA, act, alt, and ast genes were 5.9%, 6.9%, 67.3%, 42.6% and 13.9%, respectively.

CONCLUSIONSHigh incidence of Aeromonas infection was found in the patients with acute diarrhea in Pudong, and a high proportion of coinfections with other pathogens was detected too. Most Aeromonas strains carried virulent genes, and the distribution varied.

Aeromonas ; genetics ; Aeromonas hydrophila ; genetics ; China ; epidemiology ; Diarrhea ; microbiology ; Gram-Negative Bacterial Infections ; epidemiology ; microbiology ; Humans ; Seasons ; Virulence ; genetics ; Young Adult

OBJECTIVETo know the molecular characteristic of Shigella flexneri 4c isolates from patients in two food-poisoning outbreaks and one sporadic diarrhea case in Hangzhou, China.

METHODSS. flexneri isolates from patients in two food-poisoning outbreaks (outbreak 1 and outbreak 2, n = 13 and n = 12, respectively) and one sporadic diarrhea patient (n = 1) in Hangzhou during 2003 and 2005 were serotyped. Antibiotic resistances of these isolates were measured by the Kirby-Bauer method. Invasive plasmid antigen gene ipaH was examined by PCR. Pulse field gel electrophoresis (PFGE) was performed for molecular typing.

RESULTSIn outbreak 1, all 13 isolates were S. flexneri 4c, of them 6 isolates tested were quite different in PFGE patterns with dice coefficient from 0.78 to 0.92. In outbreak 2, 10 isolates were S. flexneri 4c and 2 isolates were S. flexneri X, however their PFGE patterns were almost identical (dice coefficient > 0.8). Compared to the two outbreaks isolates, the sporadic isolate was demonstrated with a distinct PFGE pattern (dice coefficient < 0.8). The antibiotic resistance patterns with 14 kinds of antibiotics had a little difference among the isolates from outbreak 1, outbreak 2 and sporadic diarrhea patient, but the same pattern was found among 10 isolates of S. flexneri 4c and 2 isolates of S. flexneri X from outbreak 2.

CONCLUSIONSPFGE might distinguish the isolates from these two outbreaks and the sporadic diarrhea patient. Some differences in PFGE patterns, serotypes and antibiotic resistance patterns might occur among S. flexneri 4c isolates during an outbreak.

Bacterial Typing Techniques ; methods ; Diarrhea ; epidemiology ; microbiology ; Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Foodborne Diseases ; epidemiology ; microbiology ; Humans ; Microbial Sensitivity Tests ; Shigella flexneri ; classification ; drug effects ; isolation & purification

Antigens, Bacterial ; immunology ; Antigens, Surface ; immunology ; China ; epidemiology ; Diarrhea ; microbiology ; Escherichia coli Infections ; epidemiology ; microbiology ; Escherichia coli O157 ; classification ; immunology ; isolation & purification ; Humans