A Study on the Epidemiology and Aetiology of Acute Gastroenteritis in Adult Patients Presenting at the Infectious Diseases Hospital in Tirana, Albania

Abstract

_Acute gastroenteritis remains a common cause of hospital emergency room visits in Albania. However, the aetiology of severe gastroenteritis leading to hospitalization in adults frequently remains unclear. Aims_ Our objective was to study the epidemiology and causes of community-acquired, acute gastroenteritis in adult patients presenting to hospital. Study Design_ Cross sectional study. Methods_ A prospective study was conducted from January 2010 to January 2012, among patients ≥15 years old with community-acquired gastroenteritis presenting to the emergency room of the University Hospital “Mother Theresa” in Tirana, Albania. Stool samples and rectal swabs were collected from the patients for microbiological testing. Results_ The median age of the study patients was 33 (15-88) years and 577 (58%) were females. The median age of males was 35 (15-87) years. The vast majority of cases occurred in urban area (849, 85%), p_0.01. Patients were admitted throughout the year with peak admissions for patients infected by bacterial pathogens in summer and those affected by viral pathogens in autumn. A total of 917 (91.7%) patients underwent a laboratory examination. The overall isolation rate was 51%. Bacterial pathogens were found in 29%, viral pathogens in 19% and protozoal pathogens in 2.5% of patients. No aetiological agent or other cause of acute diarrhoea was found in 449 (49%) patients. Twenty-nine (3.2%) patients were hospitalized. Conclusion_ Despite extensive laboratory investigations, enteropathogens were detected in only 51% of adult patients who presented to the hospital ER with acute gastroenteritis. Viral infections ranked as the second most common cause of gastroenteritis in adults_

Keywords

• Aetiology, diarrhoea, enteropathogens, epidemiology

References

1. 1. World Health Organization. The Global Burden of Disease: 2004 update. Geneva, Switzerland: World Health Organization, 2008. Available from: http://www.who.int/healthinfo/global burden disease/GBD report 2004update full. pdf. Accessed 3 March 2013
2. 2. World Health Organization. Water Sanitation and Health. Geneva, Switzerland: World Health Organization, 2004. Available from: http://www. who.int/water sanitation health/monitoring/jmpfinal. pdf. Accessed 25 February 2013
3. 3. World Health Organization. The treatment of diarrhoea, a manual for physicians and other senior health workers. - 4th revision. Geneva, Switzerland: World Health Organization, 2005. Available from: http:// whqlibdoc.who.int/publications/2005/9241593180.pdf. Accessed 20 February 2013
4. 4. World Health Organization. Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1. Geneva, Switzerland: World Health Organization, 2005. Available from: http://whqlibdoc. who.int/publications/2005/9241592330.pdf. Accessed 20 February 2013
5. 5. World Health Organization. Cholera outbreak: Assessing the outbreak response and improving preparedness. Geneva, Switzerland: World Health Organization, 2004. Available from: https://icvanetwork.org/system/files/versions/doc00003922.pdf. 20 February 2013
6. 6. Walker CL, Black RE. Diarrhoea morbidity and mortality in older children, adolescents, and adults. Epidemiol Infect 2010;138:1215-26. [CrossRef]
7. 7. Greco D, Luizzi I, Sallabanda A, Dibra A, Kakarricy E, Shapo L. Cholera in the Mediterranean: Outbreak in Albania. Euro Surveill 1995;1-2.
8. 8. World Health Organization. Diarrhea. WHO. Available from: http:// www.who.int/topics/diarrhoea/en/

9. 9. Forsberg BC, Petzold MG, Tomsona G, Allebeck P. Diarrhoea case management in low - and middle-income countries - an unfinished agenda. Bull World Health Organ 2007;85:42-8. [CrossRef]
10. 10. Jamison DT, Breman JG, Measham AR, et al., editors. Disease control priorities in developing countries. 2nd edition. Washington (DC): World Bank; 2006.
11. 11. Dupont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Guidelines on acute infectious diarrhea in adults. Am J Gastroenterol 1997;92:1962-75.
12. 12. Cheng AC, McDonald JR, Thielman NM. Infectious diarrhea in developed and developing countries. J Clin Gastroenterol 2005;39:757-73. [CrossRef]
13. 13. Thielman NM, Guerrant RL. Clinical practice. Acute infectious diarrhea. N Engl J Med 2004;350:38-47. [CrossRef]
14. 14. World Gastroenterology Organization practice guideline: Acute diarrhea March 2008. Available from: http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/01_acute_diar rhea.pdf
15. 15. Svenungsson B, Lagergren A, Ekwall E, Evengård B, Hedlund KO, Kärnell A, et al. Enteropathogens in adult patients with diarrhea and healthy control subjects: A 1-year prospective study in a Swedish clinic for infectious diseases. Clin Infect Dis 2000;30:770-8. [CrossRef]
16. 16. Andreas J, Klaus S, Jan K, Eckart S, Ralf I, Oliver L, et al. Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: A prospective cohort study. BMC Infect Dis 2008;8:143. [CrossRef]
17. 17. Bresee JS, Marcus R, Venezia RA, Keene WE, Morse D, Thanassi M, et al. US Acute Gastroenteritis Etiology Study Team. J Infect Dis 2012;205:1374-81. [CrossRef]