Factores asociados a la diarrea del viajero en Quito, Provincia de Pichincha, Ecuador / Factors associated with traveler's diarrhea in Quito, Pichincha Province, Ecuador

La diarrea del viajero (DV) es la complejidad más común y su repercusión varía en función de muchas variables: edad, lugar de destino, estación del año, tipo de residencia, origen del viajero y, por supuesto, la dieta durante el viaje, en definición es la emisión de heces sueltas tres o más veces al día, se adquiere mayormente al consumir alimentos y bebidas contaminados con patógenos que ocasionen diarrea. A nivel mundial, las causas más comunes de DV son dos patotipos de Escherichia coli (enterotoxigénica y enteroagregativa) y Campylobacter, aunque existen variaciones significativas según el área geográfica visitada. Algunos autores han detectado la presencia de diarrea en más de la mitad de los viajeros a países en vías de desarrollo. Se realizó un estudio descriptivo de corte transversal en 15 hospitales centinelas de la zona 9 del Sistema de Vigilancia de la resistencia antimicrobiana, en la provincia de Pichincha Quito, Ecuador entre enero 2019 a enero 2020, con el objeto de caracterizar los eventos de DV. 517 registros, solo en 298 se asento la procedencia, pudiendo atribuirse a ese 42,34% la procedencia por nacionalidad, se estimó que 108 casos presentaron infección mixta de al menos una bacteria y otro tipo de agresor, lo que representa 36,24%, siendo el agente causal principalmente involucrado ETEC, seguida de E. coli H7:O157 (N=60)(AU)

Traveler's diarrhea (DV) is the most common complexity and its impact varies depending on many variables: age, place of destination, season of the year, type of residence, origin of the traveler and, of course, the diet during the trip, In definition, it is the emission of loose stools three or more times a day, it is acquired mostly by consuming food and beverages contaminated with pathogens that cause diarrhea. Worldwide, the most common causes of DV are two Escherichia coli pathotypes (enterotoxigenic and enteroaggregative) and Campylobacter, although there are significant variations depending on the geographic area visited. Some authors have detected the presence of diarrhea in more than half of the travelers to developing countries. A descriptive cross-sectional study was carried out in 15 sentinel hospitals in zone 9 of the Antimicrobial Resistance Surveillance System, in the province of Pichincha Quito, Ecuador between January 2019 and January 2020, in order to characterize VD events. 517 records, only in 298 the origin was established, and that 42.34% can be attributed the origin by nationality, it was estimated that 108 cases presented mixed infection of at least one bacterium and another type of aggressor, which represents 36.24% , the causative agent being mainly involved ETEC, followed by E. coli H7: O157 (N = 60). Likewise, ETEC is responsible for the greatest severity in clinical pictures, being responsible for 50.00% of the cases in this category(AU)

Progress of researches on traveler’s diarrhea caused by parasitic infections / 中国血吸虫病防治杂志

With the rapid development of global tourism, traveling gradually becomes an important part of daily lives, and travelers’health is paid more and more attention. Traveler’s diarrhea (TD) is one of the most common diseases among international or trans-regional travelers, which causes great disease and economic burdens. Currently, there is still a lack of systematic studies on the correlation between parasites and TD. The review mainly summarizes intestinal protozoa and helminth infections among patients with TD, so as to provide insights into the development of the control measures for parasitic diseases associated with TD and the prevention of risk factors before the journey to and during the journey of the areas endemic for parasitic diseases.

Características sociodemográficas y clínico-epidemiológicas de los pacientes adultos ingresados por diarrea del viajero en la Clínica Internacional Trinidad, 2015-2017 / Sociodemographic and clinical-epidemiological characteristics of patients admitted for traveler's diarrhea to Trinidad International Clinic, 2015-2017

Introducción: La diarrea del viajero es causa frecuente de hospitalización en turistas internacionales. Objetivo: Describir las características sociodemográficas y clínico-epidemiológicas de los pacientes adultos ingresados por diarrea del viajero en la Clínica Internacional de Trinidad durante los años 2015 al 2017. Métodos: Estudio descriptivo de los 699 pacientes adultos con diarrea del viajero que requirieron de ingreso en el periodo de estudio. Se revisaron sus historias clínicas para analizar la frecuencia en que estuvieron presentes algunas variables sociodemográficas y clínico-epidemiológicas. Para analizar los datos se utilizó la estadística descriptiva con distribución de frecuencias y porcentajes. Resultados: El grupo etario entre 19 y 40 años tuvo un 60,52 por ciento de pacientes afectados; el 58,23 por ciento en el sexo femenino, con una incidencia mayor en los meses de julio (12,88 por ciento) y febrero (12,44 por ciento). Los viajeros procedentes de países europeos representaron el 76,97 por ciento ; el 74,96 por ciento se hospedó en casas particulares. El 1,85 por ciento de los afectados presentaba antecedentes de enfermedad gastrointestinal; el 76,11 por ciento requirió de 1 a 6 h de observación, con deshidratación leve (59,66 por ciento) y moderada (21,75 por ciento). El vómito y las náuseas se presentaron en el 58,37 por ciento de los pacientes y en el 60,73 por ciento la causa no fue precisada. Conclusiones: Las variables sociodemográficas y clínico-epidemiológicas seleccionadas permitieron describir características de los pacientes adultos ingresados por diarrea del viajero. Se recomienda profundizar en el estudio para contribuir a su prevención y optimizar la atención(AU)

Introduction: Traveler's diarrhea is a frequent cause of hospitalization of international tourists. Objective: Describe the sociodemographic and clinical-epidemiological characteristics of adult patients admitted for traveler's diarrhea to Trinidad International Clinic in the period 2015-2017. Methods: A descriptive study was conducted of the 699 adult patients with traveler's diarrhea who required hospitalization in the study period. The patients' medical records were reviewed to analyze the frequency of some sociodemographic and clinical-epidemiological variables. Data analysis was based on descriptive statistics with frequency and percentage distribution. Results: 60.52 percent of the patients affected were in the 19-40 years age group, 58.23 percent were female, and the highest incidence was observed in the months of July (12.88 percent) and February (12.4 4 percent ). Travelers from European countries represented 76.97 percent, and 74.96 percent were staying in private dwellings. Of the patients affected, 1.85 percent had a history of gastrointestinal disease; 76.11percent required 1-6 hours of observation; dehydration was mild in 59.66 percent and moderate in 21.75 percent. Vomiting and nausea were present in 58.37 percent of the patients; in 60.73 percent the cause was not determined. Conclusions: The sociodemographic and clinical-epidemiological variables selected made it possible to characterize the adult patients admitted for traveler's diarrhea. Further research is recommended to contribute to the prevention this disease. Further research is recommended to contribute to the prevention this disease and optimize care(AU)

Development of Molecular Diagnosis Using Multiplex Real-Time PCR and T4 Phage Internal Control to Simultaneously Detect Cryptosporidium parvum, Giardia lamblia, and Cyclospora cayetanensis from Human Stool Samples

This study aimed to develop a new multiplex real-time PCR detection method for 3 species of waterborne protozoan parasites (Cryptosporidium parvum, Giardia lamblia, and Cyclospora cayetanensis) identified as major causes of traveler's diarrhea. Three target genes were specifically and simultaneously detected by the TaqMan probe method for multiple parasitic infection cases, including Cryptosporidium oocyst wall protein for C. parvum, glutamate dehydrogenase for G. lamblia, and internal transcribed spacer 1 for C. cayetanensis. Gene product 21 for bacteriophage T4 was used as an internal control DNA target for monitoring human stool DNA amplification. TaqMan probes were prepared using 4 fluorescent dyes, FAM™, HEX™, Cy5™, and CAL Fluor Red® 610 on C. parvum, G. lamblia, C. cayetanensis, and bacteriophage T4, respectively. We developed a novel primer-probe set for each parasite, a primer-probe cocktail (a mixture of primers and probes for the parasites and the internal control) for multiplex real-time PCR analysis, and a protocol for this detection method. Multiplex real-time PCR with the primer-probe cocktail successfully and specifically detected the target genes of C. parvum, G. lamblia, and C. cayetanensis in the mixed spiked human stool sample. The limit of detection for our assay was 2×10 copies for C. parvum and for C. cayetanensis, while it was 2×10³ copies for G. lamblia. We propose that the multiplex real-time PCR detection method developed here is a useful method for simultaneously diagnosing the most common causative protozoa in traveler's diarrhea.

Use of Oral Antibiotics in Elderly Gastrointestinal Patients

Oral antibiotics are usually prescribed for geriatric patients for the treatment of infectious diarrhea and management of hepatic encephalopathy. But oral antibiotics have systemic adverse events, so many doctors face the issue of choosing the right antibiotics. Rifaximin, an intestinal topical antibiotic that exhibits a wide antimicrobial activity against both aerobic and anaerobic bacteria, has various indications, such as acute bacterial diarrhea caused by Gram positive and negative bacteria, traveler's diarrhea, small intestine bacterial overgrowth, prevention of infection after gastrointestinal surgery, and the management of hepatic encephalopathy with hyperammoniemia. But there are few clinical trial data on the geriatric population. Hence we reviewed the clinical study data that included geriatric patients in their clinical trials. Based on our literature searches, only one clinical trial on acute bacterial diarrhea was performed only for geriatric patients. Other clinical trials for various indications usually recruited elderly patients, but the number of elderly patients was limited. However, generally speaking, rifaximin showed good efficacy and safety profile in acute bacterial diarrhea caused by Gram positive and negative bacteria, traveler's diarrhea, small intestine bacterial overgrowth, prevention of infection after gastrointestinal surgery, and the management of hepatic encephalopathy with hyperammoniemia; and there were no differences in efficacy and safety, compared to the nongeriatric population. We concluded that rifaximin is a good therapeutic option for various gastrointestinal indications, and shows good efficacy and an excellent safety profile, compared to other oral agents. For more evidence on the geriatric population, we propose clinical trials on elderly patients for each indication.

The prevalence of enterotoxigenic E. coli isolated from the stools of children aged 0-10 years with diarrhea in mid-anatolia region, Turkey

The stool samples from 245 patients with diarrhea were tested for heat labile toxin (LT) and heat stable toxins (ST) by passive latex agglutination and enzyme immunoassay methods respectively. Twelve (4.9 percent) enterotoxigenic E. Coli ETEC strains were isolated. Five strains (2 percent) expressed ST, and 7 (2.8 percent) expressed LT.

Effect of Probiotics on Intestinal Infections

Probiotics are defined as live microorganisms that confer a health benefit on the host when consumed in adequate amounts, such as Lactobacillus, Streptococcus, Enterococcus, Lactococcus, Bifidobacterium, Bacillus, Clostridium, Saccharomyces, Aspergillus, and Escherichia coli species. Previous studies have reported beneficial effects of probiotics on intestinal infections, including Clostridium difficile antibiotic-associated diarrhea, rotavirus infection, traveler's diarrhea, and other bacterial enteric diseases. Although few studies have reported serious adverse effects from probiotics, more evidence-based research is required for an in-depth evaluation of probiotics in medical science.

Infección por Cyclospora cayetanensis: Revisión a propósito de tres casos de diarrea del viajero / Cyclospora cayetanensis infection: Updated review a propos of three cases of traveler's diarrhea

Human infection by Cyclospora cayetanensis, namely cyclosporiasis, can cause a wide range of symptoms in immunocompetent patients, from mild to severe diarrhea. Immunocompromised patients can present with chronic diarrhea and it has been recognized as a cause of traveler's diarrhea. We report three patients who traveled from Chile to Peru, who presented upon returning with prolonged traveler's diarrhea. A literature review about cyclosporiasis is presented, with emphasis on the clinical, epidemiological, diagnostic and therapeutic aspects of this disease.

Detection of the Causative Agents of Traveler's Diarrhea Using a Real-Time PCR Screening Method / 대한임상미생물학회지

BACKGROUND: The incidence of infectious diarrheal disease in Korea has decreased over the past decade, but traveler's diarrhea (TD) is increasing in frequency. We therefore investigated the distribution of the causative agents of TD. METHODS: A total of 132 rectal swab specimens were acquired from TD patients who entered the country via Gimhae International Airport. The specimens were screened for 12 bacterial pathogens by real-time PCR, and target pathogens were isolated from the PCR positive specimens using conventional microbiological isolation methods. RESULTS: A total of 93 specimens (70.5%) showed positive PCR screening results, and of these specimens, nine species and 50 isolates (37.9%), including Vibrio parahaemolyticus (18 isolates) and ETEC (17 isolates), were isolated. No specimens were PCR positive for Listeria monocytogenes or Campylobacter jejuni, and no pathogenic Bacillus cereus were isolated. CONCLUSION: Even though viruses and EAEC were not included as target pathogens, the high isolation rate of these pathogens in this study provides indirect evidence that most cases of pathogen-negative TD are caused by undetected bacterial agents. Furthermore, our study results confirm the effectiveness of real-time PCR-based screening methods. This study is the first report in Korea to demonstrate that ETEC and V. parahaemolyticus are the major causative pathogens of TD, and this knowledge can be used to help treat and prevent TD.

Behaviors and Perceptions of Japanese Tourists Affecting Diarrheal Illness and Health Care Need Assessment: A Questionnaire Study

Objectives: To measure the prevalence rate of, and determine the association between food and drink related behaviors and diarrheal illness among Japanese tourists, and assess their health care needs. Methods: Eligible Japanese tourists (1,480) aged ≥15 years traveling in Chiangmai Province in the north, Ayutthaya Province in the center, Kanchanaburi Province in the west, Pattaya City in the east, and Krabi Province in the south of Thailand were enrolled in the study. Of these tourists, 1,318 consented to participate in this study and completed questionnaires in Japanese, giving a response rate of 89.1%. Results: Among these Japanese tourists 21.3% had diarrheal illness, and of these tourists, 5.0% had classical travelers' diarrhea (TD), 11.8% had mild TD, 3.3% had good food and drink related behaviors, and 75.4% had moderate level of perception of diarrhea related to drinking and eating. Multiple logistic regression analysis indicated three significant diarrheal illness predictors: large number of previous visits to Thailand, longer stay in Thailand, and the experience of visiting other countries. Furthermore, 56.9% suggested providing an adequate number of toilets at tourist destinations; 53.9% suggested providing a 24-hour emergency call facility for a public ambulance; and 51.9% suggested providing garbage bins and garbage disposal facilities at tourist destinations. Conclusions: TD still affects experienced Japanese tourists who visit Thailand. Although the proportions of the good levels of food and drink related behaviors were low, there were indications that Japanese tourists perceived the risk of contracting TD.

Health advice for international travelers / 대한내과학회지

No abstract available.

Behaviors and perceptions of Japanese tourists affecting diarrheal illness and health care need assessment: A questionnaire study

<p><b>OBJECTIVES</b>To measure the prevalence rate of, and determine the association between food and drink related behaviors and diarrheal illness among Japanese tourists, and assess their health care needs.</p><p><b>METHODS</b>Eligible Japanese tourists (1,480) aged ≥15 years traveling in Chiangmai Province in the north, Ayutthaya Province in the center, Kanchanaburi Province in the west, Pattaya City in the east, and Krabi Province in the south of Thailand were enrolled in the study. Of these tourists, 1,318 consented to participate in this study and completed questionnaires in Japanese, giving a response rate of 89.1%.</p><p><b>RESULTS</b>Among these Japanese tourists 21.3% had diarrheal illness, and of these tourists, 5.0% had classical travelers' diarrhea (TD), 11.8% had mild TD, 3.3% had good food and drink related behaviors, and 75.4% had moderate level of perception of diarrhea related to drinking and eating. Multiple logistic regression analysis indicated three significant diarrheal illness predictors: large number of previous visits to Thailand, longer stay in Thailand, and the experience of visiting other countries. Furthermore, 56.9% suggested providing an adequate number of toilets at tourist destinations; 53.9% suggested providing a 24-hour emergency call facility for a public ambulance; and 51.9% suggested providing garbage bins and garbage disposal facilities at tourist destinations.</p><p><b>CONCLUSIONS</b>TD still affects experienced Japanese tourists who visit Thailand. Although the proportions of the good levels of food and drink related behaviors were low, there were indications that Japanese tourists perceived the risk of contracting TD.</p>