The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States

J Infect Dis. 2012 May 1;205(9):1374-81. doi: 10.1093/infdis/jis206. Epub 2012 Mar 27.


Background: Acute gastroenteritis (AGE) remains a common cause of clinic visits and hospitalizations in the United States, but the etiology is rarely determined.

Methods: We performed a prospective, multicenter emergency department-based study of adults with AGE. Subjects were interviewed on presentation and 3-4 weeks later. Serum samples, rectal swab specimens, and/or whole stool specimens were collected at presentation, and serum was collected 3-4 weeks later. Fecal specimens were tested for a comprehensive panel of viral, bacterial, and parasitic pathogens; serum was tested for calicivirus antibodies.

Results: Pathogens were detected in 25% of 364 subjects, including 49% who provided a whole stool specimen. The most commonly detected pathogens were norovirus (26%), rotavirus (18%), and Salmonella species (5.3%). Pathogens were detected significantly more often from whole stool samples versus a rectal swab specimen alone. Nine percent of subjects who provided whole stool samples had >1 pathogen identified.

Conclusions: Viruses, especially noroviruses, play a major role as agents of severe diarrhea in adults. Further studies to confirm the unexpectedly high prevalence of rotaviruses and to explore the causes of illness among patients from whom a pathogen cannot be determined are needed. Studies of enteric pathogens should require the collection of whole stool samples.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Caliciviridae / isolation & purification
  • Caliciviridae / pathogenicity
  • Caliciviridae Infections / complications
  • Diarrhea / epidemiology
  • Diarrhea / microbiology
  • Diarrhea / virology
  • Emergency Service, Hospital*
  • Feces / microbiology
  • Feces / virology
  • Female
  • Gastroenteritis / etiology*
  • Gastroenteritis / microbiology
  • Gastroenteritis / parasitology
  • Gastroenteritis / virology
  • Hospitalization
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Salmonella / isolation & purification
  • Salmonella / pathogenicity
  • Salmonella Infections / complications
  • Specimen Handling / methods
  • Surveys and Questionnaires
  • United States / epidemiology
  • Young Adult