Enteropathogens in adult patients with diarrhea and healthy control subjects: A 1-year prospective study in a Swedish clinic for infectious diseases

A 1-year prospective study was conducted to identify enteropathogens in adu lts with diarrhea (n = 851) and in healthy control subjects (n = 203) by us e of conventional laboratory methods. Virulence factor genes for diarrheage nic Escherichia coli were detected by polymerase chain reaction. Enteropath ogens were identified in 56% of patients and 16% of control subjects. The i solation rate was 65% for patients with symptoms for <1 week and for travel ers; >1 pathogen was found in 11% of patients, The most frequent enteropath ogens were Campylobacter (13% of patients), Clostridium difficile (13%), en terotoxigenic Escherichia coli (8%), Salmonella (7%), Shigella (4%), Blasto cystis hominis (4%), calicivirus (3%), rotavirus (3%), enteroaggregative E. coli (2%), Aeromonas (2%), Giardia intestinalis(2%), Cryptosporidium (2%), and astrovirus (2%). Less frequently isolated (less than or equal to 1% of patients) were verotoxigenic E. coli, enteropathogenic E. coli, enteroinva sive E. coli, Entamoeba histolytica/Entamoeba dispar microsporidia, and ade novirus. Fifty percent of the patients were hospitalized, and 43% needed in travenous fluids. The median duration of diarrhea was 14 days. Clinical fea tures were not helpful for predicting the etiology of diarrhea.