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2.
PLoS One ; 15(11): e0242813, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33253257

RESUMO

Acute gastroenteritis is one of the major health problems in children aged <5 years around the world. Rotavirus A (RVA) is an important pathogen of acute gastroenteritis. The burden of rotavirus disease in the pediatric population is still high in Bangladesh. This study investigated the prevalence of group A, B, and C rotavirus (RAV, RBV, RCV), norovirus, adenovirus (AdV) and human bocavirus (HBoV) infections in children with acute gastroenteritis in Bangladesh from February 2014 to January 2019. A total of 574 fecal specimens collected from children with diarrhea in Bangladesh during the period of February 2014-January 2019 were examined for RAV, RBV and RCV by reverse transcriptase- multiplex polymerase chain reaction (RT- multiplex PCR). RAV was further characterized to G-typing and P-typing by RT-multiplex PCR and sequencing method. It was found that 24.4% (140 of 574) fecal specimens were positive for RVA followed by AdV of 4.5%. RBV and RCV could not be detected in this study. Genotype G1P[8] was the most prevalent (43%), followed by G2P[4] (18%), and G9P[8] (3%). Among other genotypes, G9P[4] was most frequent (12%), followed by G1P[6] (11%), G9P[6] (3%), and G11P[25] (3%). We found that 7% RVA were nontypeable. Mutations at antigenic regions of the VP7 gene were detected in G1P[8] and G2P[4] strains. Incidence of rotavirus infection had the highest peak (58.6%) during November to February with diarrhea (90.7%) as the most common symptom. Children aged 4-11 months had the highest rotavirus infection percentage (37.9%). By providing baseline data, this study helps to assess efficacy of currently available RVA vaccine. This study revealed a high RVA detection rate, supporting health authorities in planning strategies such as introduction of RVA vaccine in national immunization program to reduce the disease burden.


Assuntos
Gastroenterite/epidemiologia , Epidemiologia Molecular , Infecções por Rotavirus/epidemiologia , Rotavirus/patogenicidade , Adolescente , Adulto , Bangladesh/epidemiologia , Criança , Pré-Escolar , Monitoramento Epidemiológico , Gastroenterite/diagnóstico , Gastroenterite/virologia , Humanos , Lactente , Pessoa de Meia-Idade , Filogenia , Rotavirus/genética , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/virologia , Vacinas/uso terapêutico , Adulto Jovem
3.
Medicine (Baltimore) ; 99(48): e23439, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235129

RESUMO

Benign convulsions with mild gastroenteritis (CwG) and febrile seizures (FS) associated with mild gastroenteritis are 2 different diseases in the spectrum of seizures associated with mild gastroenteritis. However, specific and useful indicators for the identification of the 2 diseases are lacking. A retrospective analysis was performed to compare the serum neuronal-specific enolase (NSE) and S100B protein levels between patients with these 2 diseases to evaluate the value of NSE and S100B for differential diagnosis between these 2 diseases.The clinical data and NSE and S100B protein levels of 81 children with seizure-associated mild gastroenteritis were collected. According to the axillary temperature at the time of convulsions, all patients were classified into an afebrile seizure (AFS) group, hereafter called the CwG group (n = 46), and a febrile seizure group (FS group, n = 35).The serum NSE level was higher in the CwG group than in the FS group (14.046 (11.095, 19.266) pg/ml and 9.034 (7.158, 12.165) pg/ml, respectively, P < .001); however, the serum S100B protein levels in the CwG and the FS group were not significantly different (P > .05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for NSE was 0.806, P = .000, which was statistically significant. The Youden index was largest (0.605) for a serum NSE cut-off value of 10.460 pg/ml, which yielded a sensitivity and specificity of 89% and 71%, respectively, for prediction of a CwG diagnosis.NSE may contribute to the differential diagnosis of CwG and FS associated with mild gastroenteritis.


Assuntos
Gastroenterite/diagnóstico , Fosfopiruvato Hidratase/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Convulsões Febris/diagnóstico , Convulsões/diagnóstico , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
4.
Braz J Infect Dis ; 24(6): 575-579, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33157032

RESUMO

Human astrovirus (HAstV) 1-8 and highly divergent HAstVMLB1-3 genotypes have been detected in children both with and without acute gastroenteritis (AGE). One hundred and seventy fecal samples from children (≤5 years old) living in the Amazon region were evaluated for the presence of HAstV1-8, HAstV MLB1-3 and HAstVVA1-3, using an usual RT-PCR protocol and a new protocol with specific primers designed to detect HAstVMLB1-3. HAstVMLB1 and HAstV MLB2, as well as the HAstV3 and 5 genotypes were detected. HAstVMLB1-2 genotype was detected for the first time in Brazil at a frequency of 3.5% (6/170).


Assuntos
Infecções por Astroviridae , Gastroenterite , Mamastrovirus , Infecções por Astroviridae/diagnóstico , Infecções por Astroviridae/epidemiologia , Brasil , Criança , Fezes , Gastroenterite/diagnóstico , Genótipo , Humanos , Lactente , Mamastrovirus/genética , Filogenia , Reação em Cadeia da Polimerase Via Transcriptase Reversa
5.
PLoS One ; 15(10): e0240021, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031389

RESUMO

BACKGROUND: Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. METHODS: This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011-June 2013) and 3 years post (July 2013-June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. RESULTS: During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0-4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8% of visits to 6% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16% to 3-10% of ED visits per week. CONCLUSIONS: ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Programas de Imunização , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Lactente , Análise de Séries Temporais Interrompida , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções por Rotavirus/patologia , Infecções por Rotavirus/prevenção & controle , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/imunologia , Estações do Ano , Vigilância de Evento Sentinela , Reino Unido/epidemiologia , Adulto Jovem
7.
Int J Food Microbiol ; 333: 108787, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32702583

RESUMO

Human noroviruses (HuNoVs) are the primary non-bacterial pathogens causing acute gastroenteritis worldwide. Here we reported a co-infection of HuNoVs with different genotypes during an outbreak of gastroenteritis in travelers. The aim was to trace the source and transmission patterns of the infections using next-generation sequencing (NGS). An investigation was conducted on a cross-border travel group who came back to China from Thailand for symptoms of gastroenteritis. Anal swabs were collected from 23 people and samples were analyzed using RT-qPCR. A total of 11 samples tested positive for HuNoVs. All samples tested negative for bacterial pathogens in the surveillance list. Positive samples for HuNoVs were further analyzed using NGS. Seven out of 11 positive samples were sequenced and 16 viral genome sequences for 10 different strains of HuNoVs were obtained. We demonstrated that the outbreak was associated with co-infection of multiple genotypes of HuNoVs and the source of infections was probably contaminated water or food. Besides, four different HuNoVs genotypes (GI.5[P12], GIX.1[GII·P15], GI.7[P7] and GII.8[P8]) were identified in one patient. Co-infection with both genogroup GI and GII, and co-infection with two different P types ([P10] and [P13]) of genotype GI.3 were identified in different patients. Findings from this study show that individuals can be simultaneously infected with multiple strains of HuNoVs and NGS can help investigating these issues. Further, this study shows that food and water are potential vehicles for transmission of multiple foodborne viruses.


Assuntos
Infecções por Caliciviridae/diagnóstico , Doenças Transmitidas por Alimentos/virologia , Gastroenterite/diagnóstico , Norovirus/genética , Norovirus/isolamento & purificação , Adolescente , Adulto , Sequência de Bases , Infecções por Caliciviridae/virologia , Criança , China/epidemiologia , Surtos de Doenças , Feminino , Gastroenterite/virologia , Genoma Viral/genética , Genótipo , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Metagenômica , Pessoa de Meia-Idade , Filogenia , Reação em Cadeia da Polimerase em Tempo Real , Tailândia , Viagem , Adulto Jovem
8.
Arch Virol ; 165(10): 2335-2340, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32719956

RESUMO

Sapoviruses are increasingly being recognized as pathogens associated with gastroenteritis in humans. Human sapoviruses are currently assigned to 18 genotypes (GI.1-7, GII.1-8, GIV.1, and GV.1-2) based on the sequence of the region encoding the major structural protein. In this study, we evaluated 11 polymerase chain reaction (PCR) assays using published and newly designed/modified primers and showed that four PCR assays with different primer combinations amplified all of the tested human sapovirus genotypes using either synthetic DNA or cDNA prepared from human sapovirus-positive fecal specimens. These assays can be used as improved broadly reactive screening tests or as tools for molecular characterization of human sapoviruses.


Assuntos
Infecções por Caliciviridae/virologia , Primers do DNA/química , Gastroenterite/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Sapovirus/genética , Proteínas Estruturais Virais/genética , Sequência de Bases , Infecções por Caliciviridae/diagnóstico , Primers do DNA/genética , Fezes/virologia , Gastroenterite/diagnóstico , Expressão Gênica , Genótipo , Humanos , Tipagem Molecular/métodos , Filogenia , Sapovirus/classificação , Sapovirus/isolamento & purificação , Alinhamento de Sequência
9.
Medicine (Baltimore) ; 99(28): e21175, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664157

RESUMO

To analyze the clinical characteristics of intestinal tuberculosis (ITB), pay attention to the diagnostic value of endoscopy and mucosal biopsy, improve the recognition of atypical manifestations of ITB under endoscopy, and reduce misdiagnosis and missed diagnosis.The clinical data of 10 patients who were hospitalized in Changzhou second people's Hospital and finally diagnosed as ITB from January 1, 2015 to present were analyzed retrospectively. The basic information, medical history, clinical manifestations and computed tomography (CT), endoscopy of the patients was analyzed retrospectively. The results of pathological examination were analyzed and sorted out.Among the 10 patients, the ratio of male to female was 7:3, 10 (100%) had abdominal pain, 3 (30%) had diarrhea and 2 (20%) had bloody stool. The positive rate of tuberculosis T cell test was 75% (6/8), the diagnostic rate of chest high resolution CT was 60%, and the abnormal rate of abdominal high-resolution CT was 66.7% (6/9). Colonoscopy showed that the lesions mainly involved ileocecum (70%) and ascending colon (60%). Most of the lesions were intestinal stenosis (60%) and circular ulcer (50%). In a few cases, cold abscess (20%) and scar diverticulum (10%). Most of the pathological manifestations were granuloma formation and multinucleated giant cells (60%). The detection rate of caseous granuloma was 20%.The general condition and clinical manifestations of patients with ITB are not specific. Endoscopy and mucosal biopsy are of great significance for its diagnosis. The clinical manifestations and endoscopy of some patients showed atypical signs. Therefore, the combination of multi-disciplinary team models and the enhancement of clinician's recognition of the characteristics of endoscopic examination of ITB can improve us the diagnosis level of ITB.


Assuntos
Dor Abdominal/diagnóstico , Endoscopia Gastrointestinal , Gastroenterite/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Dor Abdominal/microbiologia , Adolescente , Adulto , Idoso , Biópsia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Gastroenterite/microbiologia , Humanos , Intestino Delgado/microbiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Ann Biol Clin (Paris) ; 78(2): 181-186, 2020 04 01.
Artigo em Francês | MEDLINE | ID: mdl-32319946

RESUMO

A 70-year-old woman with no relevant medical history presented banal clinical signs of infectious gastroenteritis on her return from a trip to the Republic of the Union of Myanmar. The appearance of her stools and clinical findings were not suggestive of a typical case of cholera, but Vibrio cholerae was nevertheless isolated from her stools in the laboratory. The National reference center (NRC) for vibrios and cholera identified a Vibrio cholerae serogroup O1 (serotype Inaba) strain. The health authorities were notified of an imported case of cholera, identified on the basis of clinical, biological and epidemiological data. The diagnostic strategy used in the laboratory was based on a two-step algorithm involving molecular biological screening followed by culture on selective media for species identification. It was this approach, benefiting from the complementarity of the different techniques, that made it possible to reach a reliable rapid biological diagnosis of this atypical, but frequent form of the disease. The diagnosis of imported cases is of the utmost importance, because the mandatory signaling and notification of cases trigger investigations to check for additional cases among other exposed individuals or contacts of the patient, even though the risk of secondary transmission appears to be low in France. It also supplies data to international surveillance networks for cholera, which remains a serious disease and a major problem globally. This case highlights the importance of interactions between the various biological personnel and clinicians.


Assuntos
Cólera/diagnóstico , Gastroenterite/diagnóstico , Doença Relacionada a Viagens , Idoso , Diagnóstico Diferencial , Feminino , França , Humanos , Testes de Sensibilidade Microbiana , Mianmar , Fenótipo , Síndrome , Vibrio cholerae O1/isolamento & purificação
11.
Emerg Med Pract ; 22(3): 1-24, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32115934

RESUMO

There are approximately 178 million cases of acute gastroenteritis annually in the United States, resulting in 473,000 hospitalizations and 5000 deaths. The vast majority of these cases are of viral etiology, self-limited, and require only supportive care; nonetheless, patients at high risk due to extremes of age or immunosuppression often require specific therapy to ensure resolution of symptoms. With this common ED presentation, there are many potential decisions related to resource utilization and management. This review provides a best-evidence approach to diagnosis and management supported by recent guidelines from the American College of Gastroenterology and the Infectious Diseases Society of America.


Assuntos
Gastroenterite/diagnóstico , Gastroenterite/terapia , Serviço Hospitalar de Emergência/organização & administração , Hidratação/métodos , Gastroenterite/fisiopatologia , Humanos
13.
Sci Rep ; 10(1): 3686, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111893

RESUMO

Campylobacter is the major bacterial agent of human gastroenteritis worldwide and represents a crucial global public health burden. Species differentiation of C. jejuni and C. coli and phylogenetic analysis is challenged by inter-species horizontal gene transfer. Routine real-time PCR on more than 4000 C. jejuni and C. coli field strains identified isolates with ambiguous PCR results for species differentiation, in particular, from the isolation source eggs. K-mer analysis of whole genome sequencing data indicated the presence of C. coli hybrid strains with huge amounts of C. jejuni introgression. Recombination events were distributed over the whole chromosome. MLST typing was impaired, since C. jejuni sequences were also found in six of the seven housekeeping genes. cgMLST suggested that the strains were phylogenetically unrelated. Intriguingly, the strains shared a stress response set of C. jejuni variant genes, with proposed roles in oxidative, osmotic and general stress defence, chromosome maintenance and repair, membrane transport, cell wall and capsular biosynthesis and chemotaxis. The results have practical impact on routine typing and on the understanding of the functional adaption to harsh environments, enabling successful spreading and persistence of Campylobacter.


Assuntos
Infecções por Campylobacter/genética , Campylobacter coli/genética , Campylobacter jejuni/crescimento & desenvolvimento , Gastroenterite/genética , Variação Genética , Genoma Bacteriano , Recombinação Genética , Animais , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/microbiologia , Campylobacter coli/patogenicidade , Campylobacter jejuni/patogenicidade , Gastroenterite/diagnóstico , Gastroenterite/microbiologia , Humanos , Sequenciamento Completo do Genoma
14.
Chest ; 157(2): e41-e45, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32033660

RESUMO

CASE PRESENTATION: A 72-year-old man presented to our ED less than 24 hours following the acute onset of nausea, vomiting, and diarrhea. Within 12 hours of symptom onset, he noted bilateral lower extremity pain and swelling. His pain was associated with a new violaceous irregular rash on the anterior aspect of both feet and legs. There was no history of inciting trauma or recent wounds. In addition, there was no history of consumption of raw or undercooked food (including seafood) or recent change in food source. There was accompanying fever and chills for the same duration and painful swelling of his left thumb. His comorbidities included stage IIIb classical Hodgkin lymphoma diagnosed 4 months prior. His last dose of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy was 4 days before presentation. He had previously failed anti-CD30 monoclonal therapy resulting from attributed pancolitis.


Assuntos
Celulite (Flegmão)/diagnóstico , Gastroenterite/diagnóstico , Doença de Hodgkin/imunologia , Hospedeiro Imunocomprometido , Miosite/diagnóstico , Sepse/diagnóstico , Vibrioses/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Celulite (Flegmão)/imunologia , Celulite (Flegmão)/terapia , Desbridamento , Gastroenterite/imunologia , Gastroenterite/terapia , Doença de Hodgkin/complicações , Doença de Hodgkin/tratamento farmacológico , Humanos , Dermatoses da Perna , Masculino , Miosite/imunologia , Miosite/terapia , Músculo Quadríceps/diagnóstico por imagem , Sepse/imunologia , Sepse/terapia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/imunologia , Infecções dos Tecidos Moles/terapia , Tomografia Computadorizada por Raios X , Vibrioses/imunologia , Vibrioses/terapia , Vibrio vulnificus
15.
PLoS One ; 15(2): e0228596, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027698

RESUMO

OBJECTIVES: Conventional routine PCR testing for gastrointestinal infections is generally based on pathogen related panels specifically requested by clinicians and can be erroneous and time consuming. The BioFire FilmArray gastrointestinal (GI) panel combines 22 pathogens into a single cartridge-based test on a random-access system, thereby reducing the turnaround time to less than 2 hours. We described the clinical impact of implementing the BioFire FilmArray on patients with gastroenteritis in our hospital. METHODS: Patients attending a Dutch tertiary care center (Radboud University Medical Center), from whom stool samples were obtained, were eligible for inclusion. The clinicians selected one or a combination of different routinely performed PCR panels (bacterial panel, viral panel, clostridium testing, and three parasitic panels) based on clinical history and symptoms. All samples were in parallel tested with the FilmArray. We retrospectively collected patient data regarding infection control and patient management to assess the potential impact of implementing the FilmArray. RESULTS: In total 182 patients were included. Routine PCR detected one or more pathogens in 52 (28.6%) patients compared to 72 (39.6%) using the FilmArray. Turnaround time (including transport) decreased from median 53 hours for the routine PCR to 16 hours for the FilmArray. Twenty-six patients could have been removed from isolation 29 hours sooner, 3.6 antibiotic days could have been saved and in five patients additional imaging testing (including colonoscopies) could have been prevented. CONCLUSION: The theoretical implementation of the BioFire FilmArray GI panel in patients with clinical suspicion of gastroenteritis resulted in a significant better patient management.


Assuntos
Gastroenterite/diagnóstico , Controle de Infecções/métodos , Técnicas de Diagnóstico Molecular/métodos , Assistência ao Paciente/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Fezes/microbiologia , Gastroenterite/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/instrumentação , Países Baixos , Reação em Cadeia da Polimerase/métodos , Centros de Atenção Terciária , Fatores de Tempo , Adulto Jovem
17.
Sensors (Basel) ; 20(3)2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32028629

RESUMO

Since the norovirus is the main cause of acute gastroenteritis all over the world, its fast detection is crucial in medical diagnostics. In this work, a rapid, sensitive, and selective optical fiber biosensor for the detection of norovirus virus-like particles (VLPs) is reported. The sensor is based on highly sensitive long-period fiber gratings (LPFGs) coated with antibodies against the main coat protein of the norovirus. Several modification methods were verified to obtain reliable immobilization of protein receptors on the LPFG surface. We were able to detect 1 ng/mL norovirus VLPs in a 40-min assay in a label-free manner. Thanks to the application of an optical fiber as the sensor, there is a possibility to increase the user's safety by separating the measurement point from the signal processing setup. Moreover, our sensor is small and light, and the proposed assay is straightforward. The designed LPFG-based biosensor could be applied in both fast norovirus detection and in vaccine testing.


Assuntos
Anticorpos/isolamento & purificação , Técnicas Biossensoriais , Gastroenterite/genética , Norovirus/isolamento & purificação , Gastroenterite/diagnóstico , Gastroenterite/imunologia , Gastroenterite/virologia , Humanos , Norovirus/patogenicidade , Proteínas Virais/imunologia , Proteínas Virais/isolamento & purificação
19.
Trop Doct ; 50(2): 135-138, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31964279

RESUMO

Amatoxin poisoning is the main cause of death from accidental ingestion of poisonous mushrooms and a mortality rate of 27.3% has been reported in Thailand. Symptoms of mushroom ingestion are often confused with food poisoning; thus, gastroenteritis is not recognised as the first phase of poisoning. Our study assessed the efficacy of N-acetylcysteine (NAC) as a treatment for amatoxin poisoning. We retrospectively analysed 74 medical records over 12 years. The majority (70/74) were treated successfully with NAC; death in the remaining 4 (5.4%) patients was attributed to late presentation in three and advanced alcoholic cirrhosis in one.


Assuntos
Intoxicação Alimentar por Cogumelos/diagnóstico , Intoxicação Alimentar por Cogumelos/terapia , Acetilcisteína/uso terapêutico , Amanitinas/envenenamento , Feminino , Gastroenterite/diagnóstico , Gastroenterite/etiologia , Gastroenterite/terapia , Humanos , Masculino , Intoxicação Alimentar por Cogumelos/etiologia , Estudos Retrospectivos , Tailândia/epidemiologia , Resultado do Tratamento
20.
PLoS One ; 15(1): e0227890, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31935271

RESUMO

BACKGROUND: Norovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Additionally, lack of knowledge of the burden of disease may inhibit provider vaccine recommendations, which could affect coverage rates and ultimately the impact of the vaccine. Our objectives were to understand physicians' stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction. METHODS: Internet and mail survey on AGE, norovirus, and future norovirus vaccines conducted January to March 2018 among national networks of primary care pediatricians, family practice and general internal medicine physicians. RESULTS: The response rate was 59% (820/1383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5-33%) of their outpatients with AGE. Stool tests were reported as more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6-33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Pediatricians 80%, Family Practice 86%, General Internal Medicine 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Pediatricians 51%, Family Practice 66%, General Internal Medicine 62%). Concerns cited as major barriers to implementing a future norovirus vaccine included if the vaccine is not covered by insurance (General Internal Medicine 64%, Pediatricians 67%, Family Practice 74%) and lack of adequate reimbursement for vaccination (Pediatricians 43%, General Internal Medicine 46%, Family Practice 50%). Factors that providers believed were 'not at all a barrier' or 'minor barrier' to new vaccine introduction included the belief that "my patients won't need this vaccine" (General Internal Medicine 78%, Family Practice 86%, Pediatricians 90%) and "my patients already get too many vaccines" (Family Practice 89%, General Internal Medicine 92%, Pediatricians 95%). CONCLUSIONS: Primary care physicians had few concerns regarding future norovirus vaccine introduction, but have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Also, physicians infrequently order stool tests for outpatients with AGE, which limits surveillance estimates that rely on physician-ordered stool diagnostics. Closing physician knowledge gaps on norovirus burden and transmission can help support norovirus vaccine introduction.


Assuntos
Atitude do Pessoal de Saúde , Gastroenterite/epidemiologia , Norovirus/isolamento & purificação , Médicos de Atenção Primária/psicologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/patologia , Gastroenterite/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Norovirus/patogenicidade , Médicos/psicologia , Vacinas/uso terapêutico
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