4 years ago

A prospective study of travellers’ diarrhoea – analysis of pathogen findings by destination in various (sub)tropical regions

Eighty million travellers visiting (sub)tropical regions contract travellers’ diarrhoea (TD) each year, yet prospective data comparing the prevalence of TD pathogens in various geographical regions are scarce. Our recent study employing modern molecular methods found enteropathogenic (EPEC) and enteroaggregative (EAEC) Escherichia coli to be the most frequent pathogens, followed by enterotoxigenic E. coli (ETEC) and Campylobacter. We revisited our data to compare the findings by geographical region. Methods A total of 459 prospectively recruited travellers provided stool samples and completed questionnaires before and after visiting destinations in various geographical regions. A multiplex qPCR assay was used to analyse Salmonella, Yersinia, Campylobacter jejuni /Campylobacter coli, Shigella, Vibrio cholerae, EPEC, EAEC, ETEC, EHEC (enterohaemorrhagic E. coli) and EIEC (enteroinvasive E. coli). Results TD was contracted by 69% (316/459) of the subjects; EPEC and EAEC outnumbered ETEC and Campylobacter in all regions. Multiple pathogens were detected in 42% (133/316) of the samples. The proportions of all pathogens varied by region. The greatest differences were seen for Campylobacter: while relatively frequent in South Asia (n=11; 20% of those 55 with TD during travel) and Southeast Asia (15/84; 15%), it was less common in East and West Africa (5/71; 7% and 1/57; 2%), and absent in South America and the Caribbean (0/40; 0%). Conclusion EPEC and EAEC outnumbered ETEC and Campylobacter everywhere, yet the proportions of pathogen findings varied by region, ETEC and Campylobacter rates showing the greatest differences. The high frequency of multibacterial findings in many regions indicates a need for further investigating the clinical role of each pathogen.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X1730633X

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