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Observational Study
. 2017 Mar 21;12(3):e0173881.
doi: 10.1371/journal.pone.0173881. eCollection 2017.

Etiology of acute diarrhea in the elderly in China: A six-year observational study

Zike Zhang  1   2   3 , Shengjie Lai  3   4 , Jianxing Yu  3   5 , Qibin Geng  3   6 , Wanqi Yang  3   6 , Yu Chen  1   2 , Jianguo Wu  6 , Huaiqi Jing  7 , Weizhong Yang  3 , Zhongjie Li  3
Affiliations
Observational Study

Etiology of acute diarrhea in the elderly in China: A six-year observational study

Zike Zhang et al. PLoS One. .

Abstract

Acute diarrhea leads to a substantial disease burden among the elderly worldwide. However, in the context of increasingly aging trend in China, the prevalence of etiological agents among elderly diarrheal patients was undetermined. This study aimed to explore the major enteropathogens of acute diarrhea among outpatients older than 65 years in China, and also the epidemiological features of the pathogens. Demographic and clinical data for acute diarrhea among outpatients older than 65 years were collected from 213 participating hospitals from 2009 to 2014. Stool specimens were collected and tested for 13 enteric viruses and bacteria. The proportion of outpatients positive for targeted pathogens was analyzed by residential areas and seasonal patterns. Among the 7,725 patients enrolled, 1,617 (20.9%)were positive for any one of the 13 study pathogens. The predominant pathogen was norovirus (9.0%), followed by diarrheagenic Escherichia coli (DEC) (5.5%), rotavirus (3.9%), non-typhoidal Salmonella (NTS) (2.9%), and Shigella spp. (2.5%). The prevalence of Shigella spp. among rural patients (6.9%) was higher than that among urban patients (1.6%) (p < 0.001), with opposite trend for DEC (3.6% versus 5.9%, p = 0.007). An obvious seasonal pattern was observed for major pathogens, with peak for norovirus in autumn, rotavirus in winter and DEC, NTS, and Shigella spp. in summer. A wide variety of enteropathogens were detected among the elderly with acute diarrhea in China, with norovirus and DEC being the most commonly isolated pathogens. A strong seasonal pattern was observed for major pathogens of acute diarrhea among the elderly.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Positive proportion of predominant enteropathogens by stool type, 2009–2014.
DEC = Diarrhea-genic Escherichia coli; NTS = Non-typhoidal Salmonella spp.
Fig 2
Fig 2. Seasonal pattern of predominant enteropathogens in the elderly with acute diarrhea in China, 2009–2014.
DEC = Diarrhea-genic Escherichia coli; NTS = Non-typhoidal Salmonella spp.
See this image and copyright information in PMC

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