Long-term features of norovirus gastroenteritis in the elderly
Long-term features of norovirus gastroenteritis in the elderly
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DOI：
10.1016/j.jhin.2004.07.001
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发表时间：
2004-12-01
影响因子：
6.9
通讯作者：
Marshall, JA
中科院分区：
文献类型：
--
作者：
Goller, JL;Dimitriadis, A;Marshall, JA
诺如病毒是人类胃肠炎散发和暴发的重要病原体。诺如病毒可以在各种环境中影响所有年龄段的个体，但在老年护理设施中是胃肠炎的特别重要原因。临床症状和诺如病毒排泄之间的关系以及老年人无症状携带诺如病毒的可能机制尚不清楚。本研究检查了老年护理机构中与诺如病毒爆发相关的老年人的症状和诺如病毒排泄。招募了10名年龄在79 - 94岁之间的人进行研究。9人出现症状，1人为无症状接触者，随后出现肠胃炎。在为期三周的研究期间，对10名参与者进行了两到六次关于其临床症状的采访。在同一时期从所有参与者中收集一个或多个连续粪便样本，并通过逆转录聚合酶链反应检测诺如病毒的存在。在所有10名研究参与者的粪便样本中均检测到诺如病毒，并且通常在成形粪便中检测到。在9名有症状的参与者中，腹泻和呕吐等急性症状在患病的第三天或第四天基本上得到解决，但头痛，口渴和眩晕等非特异性症状可能持续长达19天。急性和非特异性症状似乎在一些参与者中消退和复发。在有症状的受试者（N = 5）中，诺如病毒的中位排泄时间为8.6天（范围2 - 15天）。诺如病毒排泄的持续时间与急性或非特异性症状的持续时间之间没有一般关系。在胃肠炎症状开始前一天从无症状接触者采集的粪便样本对诺如病毒呈阳性，表明诺如病毒的前驱排泄。本研究的结果表明，感染控制指南应考虑诺如病毒的长期排泄和前驱排泄，以及形成的粪便可能含有诺如病毒的可能性。此外，对从诺如病毒感染中恢复的老年人的护理应考虑长期非特异性临床症状。(C)2004年医院感染学会。由爱思唯尔有限公司出版。保留所有权利。
Noroviruses are important pathogens in both sporadic cases and outbreaks of gastroenteritis in humans. Noroviruses can affect individuals of all ages in a variety of settings, but are a particularly important cause of gastroenteritis in aged-care facilities. The relationship between clinical symptoms and norovirus excretion and the possible rote of asymptomatic carriage of norovirus in the elderly are poorly understood. This study examined symptoms and norovirus excretion in elderly individuals associated with a norovirus outbreak in an aged-care facility. Ten individuals aged 79-94 years were recruited for the study. Nine were symptomatic and one was an asymptomatic contact who subsequently developed gastroenteritis. The 10 participants were interviewed regarding their clinical symptoms between two and six times over a three-week study period. One or more sequential faecal samples were collected from all participants over the same period and tested by reverse transcription-polymerase chain reaction for the presence of norovirus. Norovirus was detected in faecal samples from all 10 study participants and was commonly detected in formed stools. In the nine symptomatic participants, acute symptoms such as diarrhoea and vomiting had largely resolved by the third or fourth day of illness, but nonspecific symptoms such as headache, thirst and vertigo could persist for as long as 19 days. Both acute and non-specific symptoms appeared to resolve and recur in some participants. The median excretion time for norovirus was 8.6 days (range 2-15 days) in symptomatic participants (N = 5). There was no general relationship between the duration of norovirus excretion and the duration of either acute or non-specific symptoms. A faecal sample collected from the asymptomatic contact the day before gastroenteritis symptoms began was positive for norovirus, demonstrating prodromal excretion of norovirus. The results of this study indicate that infection control guidelines should consider both long-term excretion and prodromal excretion of norovirus, and the possibility that formed stools can contain norovirus. Furthermore, the care of elderly individuals recovering from a norovirus infection should take tong-term non-specific clinical symptoms into account. (C) 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.