多重聚合酶連鎖反應：感染性腹瀉病原之診斷利器

Multiplex Polymerase Chain Reaction: A Diagnostic Tool for Detection of Infectious Diarrhea-causing Pathogens

腹瀉一直是人類公共衛生的重要議題。感染性腹瀉的處置，傳統以症狀評估為導向，檢驗以鏡檢與培養為主。多重聚合酶連鎖反應敏感度相對較高，已有許多商業化組套供檢驗單位使用，能快速檢驗甚至同時偵測到多種病原。多重聚合酶連鎖反應也有其侷限，例如引子互相干擾、引子特異性不夠導致偽陽性、無法區分寄生或是感染，且若無菌株則無法進一步分析。多重聚合酶連鎖反應診斷工具，適合用在嚴重腹瀉甚至下痢（dysentery）、症狀持續超過三天無改善、免疫低下、男同志族群、疑似群聚或群突發事件調查，有助於抗生素管控、判斷防護等級、以及群突發或公衛疫情調查。

Diarrhea is an important public health concern. The current management of infectious diarrhea is mainly a syndromic approach using conventional diagnostic methods, including microscopic examinations and cultures. The sensitivity of multiplex polymerase chain reaction (PCR) is relatively high, and many commercial kits are available for testing, which can rapidly detect multiple pathogens simultaneously. Multiplex PCR faces some limitations, such as primer interference, the lack of specific primers leading to false positivity, and an inability to distinguish between colonization and infection. Further analyses cannot be performed without the identification of bacterial isolates. Multiplex PCR can be applied to refractory, prolonged or severe diarrhea (even dysentery), immunocompromised hosts, men who have sex with men, or any clusters or outbreaks under investigation. Multiplex PCR can improve antibiotic stewardship, inform precaution levels, and investigate outbreaks of public health concern.