Viral diarrhea in adults: etiological structure and clinical and laboratory diagnostic criteria at the present stage
Relevance. Despite the success of modern medicine, acute intestinal infections (ACI) remain a common pathology in the practice of doctors of various specialties. These diseases are found everywhere, are caused by a variety of pathogens, some of them are highly contagious and are not always easily controlled, which is why their timely diagnosis is so important. Molecular biological methods such as polymerase chain reaction (PCR) are considered promising methods for early detection of intestinal pathogens. The use of this technique in many regions of Russia has expanded the range of detected pathogens of AKI, including viral diarrhea (VD). To date, the pathogenicity of many virus families has been confirmed for humans: rotaviruses of groups A, B, C, noroviruses, astroviruses of serotypes 1-8, adenoviruses of types 40, 41, enteroviruses, etc. Goal. To study the structure and clinical and epidemiological features of viral diarrhea in adult patients for timely diagnosis and use of adequate therapy. Methods. A retrospective analysis of 245 case histories of patients of the 2nd infectious (intestinal) Department of the Voronezh regional clinical hospital (VOKIB) who were treated in 2018 was performed.inclusion Criteria: the presence of a clinical picture of acute intestinal infection and laboratory confirmation of the viral nature of the disease. In addition to traditional bacteriological and serological methods, PCR was used to determine the etiology of the disease. Results. During the analysis of medical histories, it was revealed that viral diarrhea accounted for 45.5% of patients with laboratory-verified AKI. The etiological structure of VD was dominated by noroviruses (45.7 %) and rotaviruses (44.9%), adenoviruses made up 5.7 %, astroviruses - 3.7% of patients. The group nature of the disease and mixed infections occurred in a small part of patients (17.9% and 10.2%, respectively). VD in adults did not have a certain seasonality and was recorded year - round: rotavirus infection is more common in spring and summer, norovirus infection-in autumn and winter. The topological diagnosis in the vast majority of patients was gastroenteritis (84.9%), which led to exicosis in 53.1% of cases, and fever was absent in 65.7% of patients. Respiratory syndrome were detected in adults is quite rare (15.6 per cent). The clinical course of the disease had a mostly favorable outcome regardless of age and premorbid background. There were no significant, diagnostically significant changes in General clinical analyses. Most of the patients received antibiotic therapy (86.5%) prescribed in the emergency Department. Conclusion. The introduction of molecular genetic methods (PCR) into the complex of examination of patients with AKI allowed us to significantly expand our understanding of the frequency of VD in adults and optimize a differentiated approach to the appointment of adequate therapy.