A millennium update on pediatric diarrheal illness in the developing world.
A millennium update on pediatric diarrheal illness in the developing world.
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DOI：
10.1053/j.spid.2005.12.008
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发表时间：
2005-04-01
期刊：
影响因子：
--
通讯作者：
Pickering, Larry K
中科院分区：
文献类型：
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作者：
O'Ryan, Miguel;Prado, Valeria;Pickering, Larry K
在社会经济发展中国家，每年有超过 10 亿例 5 岁以下儿童发生腹泻，导致 2 至 250 万人死亡。目前有二十多种病毒、细菌和寄生虫肠道病原体与急性腹泻有关。轮状病毒和致泻性大肠杆菌是导致儿童急性腹泻的最常见病原体；志贺氏菌属、沙门氏菌属、空肠弯曲杆菌/大肠杆菌、霍乱弧菌、气单胞菌属和邻单胞菌属。多发生在贫困地区，原虫和蠕虫感染主要发生在环境卫生严重恶化的地区。对腹泻儿童的初步临床评估应侧重于准确评估水合和营养状况。评估粪便特征（例如，液体非血便与痢疾或血便）是确定引起急性腹泻发作的潜在病原体的关键特征。文章中讨论了诊断指南。所有腹泻患者的主要治疗干预包括液体和电解质治疗。当抗菌治疗合适时，应根据病原体的敏感性模式或局部敏感性模式的信息来选择特定的药物。本文提供了目前进行适当抗菌治疗的指南。预防措施包括注意个人卫生，尤其是提倡洗手。讨论了目前或即将推出的针对伤寒沙门氏菌血清型、霍乱预防和轮状病毒的免疫接种。
More than one billion diarrhea episodes occur every year among children younger than 5 years of age in socioeconomically developing countries causing 2 to 2.5 million deaths. More than twenty viral, bacterial, and parasitic enteropathogens are currently associated with acute diarrhea. Rotavirus and diarrheagenic Escherichia coli are the most common pathogens responsible for acute diarrhea episodes in children; Shigella spp., Salmonella spp, Campylobacter jejuni/coli, Vibrio cholerae, Aeromonas spp, and Plesiomonas spp. occur more commonly in poorer areas and infections caused by protozoa and helminthes occur mainly in areas where environmental sanitation is significantly deteriorated. Initial clinical assessment of a child with diarrhea should focus on obtaining an accurate evaluation of hydration and nutritional status. Assessment of stool characteristics (e.g., liquid non-bloody stools vs. dysenteric or bloody stools) is a key feature in determining potential pathogens causing an acute diarrhea episode. Diagnostic guidelines are discussed in the article. The major therapeutic intervention for all individuals with diarrhea consists of fluid and electrolyte therapy. When antimicrobial therapy is appropriate, selection of a specific agent should be made based upon susceptibility patterns of the pathogen or information on local susceptibility patterns. Current guidelines for administering appropriate antimicrobial treatment are provided in the article. Preventive measures include careful personal hygiene, especially promotion of hand washing. Immunizations currently or soon to be available for Salmonella serotype Typhi, cholera prevention, and rotavirus are discussed.