BMC Infectious Diseases | |
High number of diarrhoeal co-infections in travellers to Benin, West Africa | |
Anu Kantele4  Juha Kirveskari1  Sointu Mero1  Jukka Riutta5  Jenni Antikainen1  Sari H Pakkanen2  Tinja Lääveri3  | |
[1] Helsinki University Hospital Laboratory (HUSLAB), Bacteriology, PO Box 400, 00029 HUS Helsinki, Finland;Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, PO Box 2100014 Helsinki, Finland;Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, PO Box 348, 00029 HUS Helsinki, Finland;Department of Clinical Medicine, University of Helsinki, PO Box 20, 00014 Helsinki, Finland;Aava Travel Clinic, Medical Centre Aava, Annankatu 34, 00100 Helsinki, Finland | |
关键词: Salmonella; Campylobacter; qPCR; West Africa; EPEC; ETEC; EAEC; TD; Traveller’s diarrhoea; | |
Others : 1134655 DOI : 10.1186/1471-2334-14-81 |
|
received in 2013-08-12, accepted in 2014-02-10, 发布年份 2014 | |
【 摘 要 】
Background
Travellers’ diarrhoea (TD) is the most frequent health problem among travellers to the tropics. Using routine techniques, the aetiology mostly remains unresolved, whereas modern molecular methods enable reducing the number of equivocal cases considerably. While many studies address the aetiology of TD in Asian, Central American and North African tourist resorts, only few focus on Western Africa.
Methods
Stool samples from 45 travellers travelling in Benin, West Africa, were analyzed by a new multiplex qPCR assay for Salmonella, Yersinia, Campylobacter, Vibrio cholerae, Shigella or enteroinvasive (EIEC), enterohaemorrhagic (EHEC), enterotoxigenic (ETEC), enteroaggregative (EAEC), and enteropathogenic Escherichia coli (EPEC).
Results
All 18 pre-travel samples proved negative for bacterial pathogens. Of the 39/45 (87%) travellers having had TD, EPEC was detected in post-travel samples in 30 (77%) cases, EAEC in 23 (59%), ETEC in 22 (56%), Shigella or EIEC in 7 (18%), EHEC in two (5%), and Salmonella in one (3%). In 31(79%) of the TD cases two or more bacterial pathogens were identified. Two (8%) samples remained negative: both patients had taken antimicrobials for TD.
Conclusions
EPEC, EAEC and ETEC were the most common findings. 79% of the cases had a co-infection. As modern diagnostics reveals in most patients a multitude of pathogens, the role of each pathogen should be re-evaluated.
【 授权许可】
2014 Lääveri et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150306025638163.pdf | 313KB | download | |
Figure 1. | 37KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Antikainen J, Kantele A, Pakkanen SH, Lääveri T, Riutta J, Vaara M, Kirveskari J: A quantitative polymerase chain reaction assay for rapid detection of 9 pathogens directly from stools of travelers with diarrhea. Clin Gastroenterol Hepatol 2013. doi: 10.1016/j.cgh.2013.03.037
- [2]Hill DR, Ryan ET: Management of travellers’ diarrhoea. BMJ 2008, 337:a1746.
- [3]Shah N, DuPont HL, Ramsey DJ: Global etiology of travelers’ diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg 2009, 80(4):609-614.
- [4]Riddle MS, Sanders JW, Putnam SD, Tribble DR: Incidence, etiology, and impact of diarrhea among long-term travelers (US military and similar populations): a systematic review. Am J Trop Med Hyg 2006, 74(5):891-900.
- [5]Pandey P, Bodhidatta L, Lewis M, Murphy H, Shlim DR, Cave W, Rajah R, Springer M, Batchelor T, Sornsakrin S, Mason CJ: Travelers’ diarrhea in Nepal: an update on the pathogens and antibiotic resistance. J Travel Med 2011, 18(2):102-108.
- [6]Meraz IM, Jiang ZD, Ericsson CD, Bourgeois AL, Steffen R, Taylor DN, Hernandez N, DuPont HL: Enterotoxigenic Escherichia coli and diffusely adherent E. coli as likely causes of a proportion of pathogen-negative travelers’ diarrhea – a PCR-based study. J Travel Med 2008, 15(6):412-418.
- [7]Jiang ZD, Dupont HL, Brown EL, Nandy RK, Ramamurthy T, Sinha A, Ghosh S, Guin S, Gurleen K, Rodrigues S, Chen JJ, McKenzie R, Steffen R: Microbial etiology of travelers’ diarrhea in Mexico, Guatemala, and India: importance of enterotoxigenic Bacteroides fragilis and Arcobacter species. J Clin Microbiol 2010, 48(4):1417-1419.
- [8]Paschke C, Apelt N, Fleischmann E, Perona P, Walentiny C, Loscher T, Herbinger KH: Controlled study on enteropathogens in travellers returning from the tropics with and without diarrhoea. Clin Microbiol Infect 2011, 17(8):1194-1200.
- [9]Paredes-Paredes M, Okhuysen PC, Flores J, Mohamed JA, Padda RS, Gonzalez-Estrada A, Haley CA, Carlin LG, Nair P, DuPont HL: Seasonality of diarrheagenic Escherichia coli pathotypes in the US students acquiring diarrhea in Mexico. J Travel Med 2011, 18(2):121-125.
- [10]Steffen R, Mathewson JJ, Ericsson CD, DuPont HL, Helminger A, Balm TK, Wolff K, Witassek F: Travelers’ diarrhea in West Africa and Mexico: fecal transport systems and liquid bismuth subsalicylate for self-therapy. J Infect Dis 1988, 157(5):1008-1013.
- [11]Bourgeois AL, Gardiner CH, Thornton SA, Batchelor RA, Burr DH, Escamilla J, Echeverria P, Blacklow NR, Herrmann JE, Hyams KC: Etiology of acute diarrhea among United States military personnel deployed to South America and west Africa. Am J Trop Med Hyg 1993, 48(2):243-248.
- [12]Gascon J, Ruiz L, Canela J, Mallart M, Corachan M: Epidemiology of traveler’s diarrhea in Spanish tourists travelling in developing countries. Med Clin (Barc) 1993, 100(10):365-367.
- [13]Pommier de Santi V, Nicand E, Lagathu G, Michel R, Rosenmayr G, Raingeval JB, Samy J, Boutin JP, Marimoutou C: Incidence, etiology, and determinants associated with acute diarrhea among French forces deployed to Chad. J Travel Med 2011, 18(2):115-120.
- [14]World Health Organization (WHO)http://www.who.int/topics/diarrhoea/en/ webcite. Accessed July 16, 2013
- [15]Mattila L, Salo E: Turistiripuli. Matkailijan terveysopas 2013. (Updated 12 September, 2013). [http://www.terveyskirjasto.fi/terveyskirjasto/ktl.mat?p_selaus=54728 webcite] Accessed 12 February, 2014
- [16]Kainulainen K, Nohynek H, Pekkanen E, Roivainen M, Siikamäki H, Turtiainen P: Malarianesto, keltakuumerokotus ja muut suositeltavat ja harkittavat rokotukset maittain. Matkailijan terveysopas 2013. (Updated 20 December, 2013). [http://www.terveyskirjasto.fi/terveyskirjasto/ktl.mat?p_selaus=25407 webcite] Accessed 12 February, 2014
- [17]Greenwood Z, Black J, Weld L, O’Brien D, Leder K, Von Sonnenburg F, Pandey P, Schwartz E, Connor BA, Brown G, Freedman DO, Torresi J: GeoSentinel Surveillance Network: gastrointestinal infection among international travelers globally. J Travel Med 2008, 15(4):221-228.
- [18]Belderok SM, van den Hoek A, Kint JA, van der Loeff MF S, Sonder GJ: Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics. BMC Infect Dis 2011, 11:295. BioMed Central Full Text
- [19]Pitzurra R, Steffen R, Tschopp A, Mutsch M: Diarrhoea in a large prospective cohort of European travellers to resource-limited destinations. BMC Infect Dis 2010, 10:231. BioMed Central Full Text
- [20]Steffen R, Tornieporth N, Clemens SA, Chatterjee S, Cavalcanti AM, Collard F, De Clercq N, DuPont HL, von Sonnenburg F: Epidemiology of travelers’ diarrhea: details of a global survey. J Travel Med 2004, 11(4):231-237.
- [21]Mattila L, Siitonen A, Kyrönseppä H, Simula II, Peltola H: Risk behavior for Travelers’ diarrhea among Finnish travelers. J Travel Med 1995, 2(2):77-84.
- [22]Shlim DR: Looking for evidence that personal hygiene precautions prevent traveler’s diarrhea. Clin Infect Dis 2005, 41(Suppl 8):S531-S535.
- [23]Tribble DR, Sanders JW, Pang LW, Mason C, Pitarangsi C, Baqar S, Armstrong A, Hshieh P, Fox A, Maley EA, Lebron C, Faix DJ, Lawler JV, Nayak G, Lewis M, Bodhidatta L, Scott DA: Traveler’s diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Clin Infect Dis 2007, 44(3):338-346.
- [24]Ekdahl K, Andersson Y: Regional risks and seasonality in travel-associated campylobacteriosis. BMC Infect Dis 2004, 4(1):54. BioMed Central Full Text
- [25]Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, Wu Y, Sow SO, Sur D, Breiman RF, Faruque AS, Zaidi AK, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ochieng JB, Omore R, Oundo JO, Hossain A, Das SK, Ahmed S, Qureshi S, Quadri F, Adegbola RA, Antonio M, Hossain MJ, Akinsola A, Mandomando I, Nhampossa T, Acacio S, Biswas K, O’Reilly CE, Mintz ED, Berkeley LY, Muhsen K, Sommerfelt H, Robins-Browne RM, Levine MM: Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case–control study. Lancet 2013, 382(9888):209-222.
- [26]Natchu UC, Bhatnagar S: Diarrhoea in children: identifying the cause and burden. Lancet 2013, 382(9888):184-186.
- [27]Ochoa TJ, Contreras CA: Enteropathogenic escherichia coli infection in children. Curr Opin Infect Dis 2011, 24(5):478-483.
- [28]Keskimäki M, Mattila L, Peltola H, Siitonen A: Prevalence of diarrheagenic Escherichia coli in finns with or without diarrhea during a round-the-world trip. J Clin Microbiol 2000, 38(12):4425-4429.
- [29]Gismero-Ordoñez J, Dall’Agnol M, Trabulsi LR, Girón JA: Expression of the bundle-forming pilus by enteropathogenic Escherichia coli strains of heterologous serotypes. J Clin Microbiol 2002, 40(6):2291-2296.