Persistent digestive disorders in the tropics: causative infectious pathogens and reference diagnostic tests

BMC Infectious Diseases

Jürg Utzinger^1,11  François Chappuis⁴  Eliézer K N’Goran^1,12  Lisette van Lieshout^1,14  Pascal Lutumba³  Marleen Boelaert⁸  Michael A Miles⁷  Fransiska Meyanti²  Suman Rijal^1,13  Moussa Sacko⁵  Emmanuel Bottieau⁹  Jan Jacobs⁹  Cedric P Yansouni⁹  Lutz von Müller^1,15  Hanspeter Marti¹  Katja Polman^1,10  David C Warhurst⁷  Marcus Panning⁶  Stefanie Knopp^1,11  Jürg Vogt^1,11  Sören L Becker^1,15 

[1] Department of Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, Basel, Switzerland;Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia;Université de Kinshasa, Kinshasa, Democratic Republic of the Congo;Division of Humanitarian and International Medicine, Geneva University Hospitals, Geneva, Switzerland;Institut National de Recherche en Santé Publique, , Bamako, Mali;Department of Virology, University of Freiburg, Freiburg, Germany;Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom;Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;University of Basel, Basel, Switzerland;Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire;Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal;Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands;Institute of Medical Microbiology and Hygiene, University of Saarland Hospital, Homburg/Saar, Germany

关键词: Virus;    Persistent diarrhoea;    Intestinal protozoa;    Helminths;    Gastroenterology;    Digestive disorders;    Diagnosis;    Clinical microbiology;    Bacteria;   

Others  :  1158517
DOI  :  10.1186/1471-2334-13-37

 received in 2012-09-17, accepted in 2013-01-14,  发布年份 2013

【 摘 要 】

Background

Persistent digestive disorders account for considerable disease burden in the tropics. Despite advances in understanding acute gastrointestinal infections, important issues concerning epidemiology, diagnosis, treatment and control of most persistent digestive symptomatologies remain to be elucidated. Helminths and intestinal protozoa are considered to play major roles, but the full extent of the aetiologic spectrum is still unclear. We provide an overview of pathogens causing digestive disorders in the tropics and evaluate available reference tests.

Methods

We searched the literature to identify pathogens that might give rise to persistent diarrhoea, chronic abdominal pain and/or blood in the stool. We reviewed existing laboratory diagnostic methods for each pathogen and stratified them by (i) microscopy; (ii) culture techniques; (iii) immunological tests; and (iv) molecular methods. Pathogen-specific reference tests providing highest diagnostic accuracy are described in greater detail.

Results

Over 30 pathogens may cause persistent digestive disorders. Bacteria, viruses and parasites are important aetiologic agents of acute and long-lasting symptomatologies. An integrated approach, consisting of stool culture, microscopy and/or specific immunological techniques for toxin, antigen and antibody detection, is required for accurate diagnosis of bacteria and parasites. Molecular techniques are essential for sensitive diagnosis of many viruses, bacteria and intestinal protozoa, and are increasingly utilised as adjuncts for helminth identification.

Conclusions

Diagnosis of the broad spectrum of intestinal pathogens is often cumbersome. There is a need for rapid diagnostic tests that are simple and affordable for resource-constrained settings, so that the management of patients suffering from persistent digestive disorders can be improved.

【 授权许可】

   
2013 Becker et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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