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A study of infectious intestinal disease in England: microbiological findings in cases and controls
D S Tompkins1, M J Hudson, H R Smith
1Leeds Public Health Laboratory. leedtomp@newphls.demon.co.uk
Abstract:
A study was undertaken to identify the microorganisms and toxins in stool specimens associated with infectious intestinal disease (IID) among cases in the community and presenting to general practitioners (GPs) and in asymptomatic controls. Population based cohorts were recruited from practice lists in 70 practices and followed for 26 weeks (cohort component). Seven hundred and sixty-one cases of IID identified from the cohorts, 2893 cases who presented to GPs in 34 of the practices (GP component), and age/sex matched control subjects (555 and 2264, respectively) submitted stool specimens by post for comprehensive microbiological examination. Campylobacter spp (12.2% of stools tested), rotavirus group A (7.7%), and small round structured virus (SRSV) (6.5%) were the organisms most commonly detected in the GP component. SRSV was identified in 7.0% of cases in the community cohort. No target microorganisms or toxins were identified in 45.1% and 63.1% of cases in the two components. Aeromonas spp, Yersinia spp, and some enterovirulent groups of Escherichia coli were detected as frequently in controls as in cases. The higher frequency of detection of campylobacter, salmonella, and rotavirus among cases who presented to GPs than among those in the community suggests that those pathogens cause more severe illness. No enteropathogens were detected from a large proportion of cases although comprehensive standard methods were used to seek them.
Insights
Common infectious intestinal disease (IID) pathogens like Campylobacter and rotavirus were identified in GP-presented cases. However, many IID cases lacked detectable pathogens, suggesting limitations in current diagnostic methods.
Area of Science:
- Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Infectious intestinal disease (IID) is a significant public health concern.
- Identifying causative agents is crucial for effective treatment and control.
- Previous studies have varied in their methodologies and scope.
Purpose of the Study:
- To comprehensively identify microorganisms and toxins in stool specimens from IID cases and asymptomatic controls.
- To compare pathogen detection rates between community-based cases, general practitioner (GP)-presented cases, and controls.
- To investigate the pathogens associated with varying severity of IID.
Main Methods:
- Population-based cohorts were recruited from 70 general practices.
- Stool specimens were collected from IID cases (community and GP-presented) and age/sex-matched controls.
- Comprehensive microbiological examination was performed on all submitted stool specimens.
Main Results:
- Campylobacter spp. (12.2%), rotavirus group A (7.7%), and small round structured virus (SRSV) (6.5%) were most common in GP-presented IID cases.
- SRSV was detected in 7.0% of community IID cases.
- No pathogens were identified in 45.1% (GP component) and 63.1% (community component) of IID cases.
- Aeromonas spp., Yersinia spp., and some enterovirulent E. coli were found equally in cases and controls.
- Campylobacter, Salmonella, and rotavirus were detected more frequently in GP-presented cases than community cases, suggesting more severe illness.
Conclusions:
- Campylobacter, rotavirus, and SRSV are key pathogens in IID, particularly in cases presenting to general practitioners.
- A significant proportion of IID cases remain without a confirmed enteropathogen diagnosis using standard methods.
- The higher detection rate of certain pathogens in GP-presented cases indicates a correlation with disease severity.