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

Joseph S. Bresee, Ruthanne Marcus, Richard A. Venezia, William E. Keene, Dale Morse, Mark Thanassi, Patrick Brunett, Sandra Bulens, R. Suzanne Beard, Leslie A. Dauphin, Laurence Slutsker, Cheryl Bopp, Mark Eberhard, Aron Hall, Jan Vinje, Stephan S. Monroe, Roger I. Glass

Research output: Contribution to journalArticlepeer-review

118 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1374-1381
Number of pages8
JournalJournal of Infectious Diseases
Issue number9
StatePublished - May 1 2012

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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