title: Bacterial etiologies of five core syndromes: laboratory-based syndromic surveillance conducted in Guangxi, China.
abstract: BACKGROUND
  Under the existing national surveillance system in China for selected infectious diseases, bacterial cultures are performed for only a small percentage of reported cases. We set up a laboratory-based syndromic surveillance system to elucidate bacterial etiologic spectrum and detect infection by rare etiologies (or serogroups) for five core syndromes in the given study area.
  
  
  METHODS
  Patients presenting with one of five core syndromes at nine sentinel hospitals in Guagnxi, China were evaluated using laboratory-based syndrome surveillance to elucidate bacterial etiologies. We collected respiratory and stool specimens, as well as CSF, blood and other related samples for bacterial cultures and pulse field gel electrophoresis (PFGE) assays.
  
  
  RESULTS
  From February 2009 to December 2011, 2,964 patients were enrolled in the study. Etiologies were identified in 320 (10.08%) patients. Streptococcus pneumonia (37 strains, 24.18%), Klebsiella pneumonia (34, 22.22%), Pseudomonas aeruginosa (19, 12.42%) and Haemophilus influenza (18, 11.76%) were the most frequent pathogens for fever and respiratory syndrome, while Salmonella (77, 81.05%) was most often seen in diarrhea syndrome cases. Salmonella paratyphi A (38, 86.36%) occurred in fever and rash syndrome, with Cryptococcus neoformans (20, 35.09%), Streptococcus pneumonia (5, 8.77%), Klebsiella pneumonia (5, 8.77%),streptococcus suis (3, 5.26%) and Neisseria meningitides group B (2, 3.51%) being the most frequently detected in encephalitis-meningitis syndrome. To date no pathogen was isolated from the specimens from fever and hemorrhage patients.
  
  
  CONCLUSIONS
  In addition to common bacterial pathogens, opportunistic pathogens and fungal infections require more attention. Our study contributes to the strengthening of the existing national surveillance system and provides references for other regions that are similar to the study area.
authors.affiliation: Department of Emergency Response, Guagnxi Zhuang Autonomous Region Health Bureau, Nanning, Guangxi, China.
authors.forename: Baiqing
authors.initials: B
authors.lastname: Dong
authors.affiliation: Divsion of Bacterial Infectious Disease Control, Guagnxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Dabin
authors.initials: D
authors.lastname: Liang
authors.affiliation: Divsion of Bacterial Infectious Disease Control, Guagnxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Lin
authors.affiliation: Divsion of Bacterial Infectious Disease Control, Guagnxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Mingliu
authors.initials: M
authors.lastname: Wang
authors.affiliation: Divsion of Bacterial Infectious Disease Control, Guagnxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Divsion of Bacterial Infectious Disease Control, Guagnxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Hezhuang
authors.initials: H
authors.lastname: Liao
authors.affiliation: Divsion of Bacterial Infectious Disease Control, Guagnxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Divsion of Bacterial Infectious Disease Control, Guagnxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Huang
authors.affiliation: School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.affiliation: COMDIS Health Services Delivery Research Consortium, China Program, Nuffield Centre for International Health and Development, University of Leeds, Shenzhen, China.
authors.forename: Guanyang
authors.initials: G
authors.lastname: Zou
authors.affiliation: National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China and State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Huaiqi
authors.initials: H
authors.lastname: Jing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000254:growth & development / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D046508:Culture Techniques; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007753:Laboratories; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D055815:Young Adult