Diarrhea in Baltimore: Surveillance & Pathogen Detection

据估计，在美国，每年有7600万人因食品相关病原体而患病，325，000人住院，5，000人死亡。在这些与食物有关的疾病中，约有6200万是由于不明病原体引起的。考虑到这种疾病负担，迫切需要提高我们对食源性疾病原因的认识。因此，该提案是对国家传染病中心的提案请求的回应。 疾病作为我们以前通过先前的赠款和通过新兴感染计划哨兵站点赠款（又名：FoodNet）探索不明原因腹泻原因的工作的延续，我们这项工作的目标分为三个领域。首先，我们将继续使用最先进的，目前可用的方法来确定寻求医疗照顾的患者感染性腹泻的原因;第二，我们将确定社区中抗生素耐药肠道细菌的流行率;第三，我们将采用先进的分子技术来筛选新的病原体。这项研究将使我们能够增加对食源性疾病原因的了解。此外，它有可能转化为公共卫生实践，以减少这些疾病造成的重大发病率和死亡率。考虑到马里兰州大学现有的专业知识的深度，特别是因为它涉及到肠道病原体，我们有一个理想的环境进行这些研究。我们的三个具体目标是：1）在马里兰州医学系统内的急诊科和诊所就诊的儿科和成人人群中，从已知的肠道病原体中鉴定腹泻的原因，2）对来自患有和不患有腹泻的个体的选定肠道分离株进行抗生素敏感性测定，3）通过利用新的分子方法鉴定新的病原体（特别是变性梯度凝胶电泳（DGGE）、荧光原位杂交（FISH）和微阵列）。复杂的微生物学技术、抗生素耐药性测定和分子方法的结合为发现胃肠炎的病因提供了一种创新的方法。通过这项工作，我们希望不仅能更好地确定巴尔的摩大都会地区肠道疾病的原因，而且能确定导致食源性疾病的其他病原体。

There are an estimated 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths per year due to food-related pathogens in the United States. Of these food related illnesses, approximately 62 million are due to undetermined pathogens. Considering this burden of disease, there is a critical need to improve our understanding of the causes of foodborne illnesses. Thus, this proposal is in response to a request for proposals from the National Center for Infectious Diseases. As a continuation of our previous work in exploring the causes of unexplained diarrhea through prior grants and through the Emerging Infections Program Sentinel Site Grant (aka: FoodNet), our goals for this work fall into three areas. First, we will continue to use the most sophisticated, currently available methodologies to define the causes of infectious diarrhea in patients seeking medical attention; second, we will determine the prevalence of antibiotic resistant enteric bacteria in the community; and third we will employ advanced molecular techniques to screen for novel pathogens. This research will allow us to increase our understanding of the causes of foodborne illnesses. Additionally, it has the potential for translation into public health practice in order to decrease the significant morbidity and mortality caused by these diseases. Considering the depth of expertise available at the University of Maryland, especially as it relates to enteric pathogens, we have an ideal environment to conduct these studies. Our three specific aims are: 1) Identify causes of diarrhea from known enteric pathogens in pediatric and adult populations presenting to the emergency departments and clinics within the University of Maryland Medical System, 2) Undertake antibiotic susceptibility determinations on selected enteric isolates from individuals with and without complaints of diarrhea, 3) Identify new pathogens by utilizing novel molecular methods (specifically denaturing gradient gel electrophoresis (DGGE), fluorescent in situ hybridization (FISH), and microarrays). The combination of sophisticated microbiologic techniques, antibiotic resistance determinations, and molecular methods provides an innovative approach to discovering the causes of gastroenteritis. Through this work, we expect to not only better define the causes of diarrheal illnesses in the Baltimore Metropolitan area, but to identify other pathogens that contribute to foodborne illnesses.