Chronic Health Consequences of Acute Enteric Infections in the Developed World

摘要

Acute enteric infections cause significant disease burden globally. However, advances in the treatment and management of the acute illness have enabled a transition in focus from mortality to morbidity in much of the developed world, a significant public health success. In doing so, the measurement of disease burden has also evolved, and studies of disability and quality adjusted life years are common place and enable policy makers to directly compare diseases across diverse severity and incidence spectra. Despite these advances, increasing evidence implicating acute enteric infections as a risk factor for several post-infectious sequelae across a range of body systems may require a reconsideration of the overall disease morbidity. This review summarizes the literature to date supporting a causal association with many of the reported post-infectious sequelae of acute enteric infection. These sequelae include those that are attributed to specific enteric pathogens with clear disease mechanisms, those with strong epidemiologic data and supportive animal models, as well as those for which data are evolving. We have framed the potential burden of disease using estimates of enteric infections in the United States and published estimates of sequelae risk. Importantly, numerous gaps exist in our understanding the post-infectious sequelae of acute enteric infection. Expanded epidemiologic studies, animal models, and basic science advances are needed to better understand these chronic outcomes and transition from association to causation. As the appreciation and strength of causation for these post-infectious sequelae increases, there will be an increased appreciation that disease morbidity encompasses more than the acute illness.