title: The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States.
abstract: 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.
authors.affiliation: Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. jbresee@cdc.gov
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Bresee
authors.forename: Ruthanne
authors.initials: R
authors.lastname: Marcus
authors.forename: Richard A
authors.initials: RA
authors.lastname: Venezia
authors.forename: William E
authors.initials: WE
authors.lastname: Keene
authors.forename: Dale
authors.initials: D
authors.lastname: Morse
authors.forename: Mark
authors.initials: M
authors.lastname: Thanassi
authors.forename: Patrick
authors.initials: P
authors.lastname: Brunett
authors.forename: Sandra
authors.initials: S
authors.lastname: Bulens
authors.forename: R Suzanne
authors.initials: RS
authors.lastname: Beard
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Dauphin
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bopp
authors.forename: Mark
authors.initials: M
authors.lastname: Eberhard
authors.forename: Aron
authors.initials: A
authors.lastname: Hall
authors.forename: Jan
authors.initials: J
authors.lastname: Vinje
authors.forename: Stephan S
authors.initials: SS
authors.lastname: Monroe
authors.forename: Roger I
authors.initials: RI
authors.lastname: Glass
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002139:Caliciviridae / Q000302:isolation & purification / Q000472:pathogenicity; D017250:Caliciviridae Infections / Q000150:complications; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D004636:Emergency Service, Hospital; D005243:Feces / Q000382:microbiology / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012475:Salmonella / Q000302:isolation & purification / Q000472:pathogenicity; D012480:Salmonella Infections / Q000150:complications; D013048:Specimen Handling / Q000379:methods; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult