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High number of diarrhoeal co-infections in travellers to Benin, West Africa.

Lääveri T, Pakkanen SH, Antikainen J, Riutta J, Mero S, Kirveskari J, Kantele A - BMC Infect. Dis. (2014)

Bottom Line: Using routine techniques, the aetiology mostly remains unresolved, whereas modern molecular methods enable reducing the number of equivocal cases considerably.Two (8%) samples remained negative: both patients had taken antimicrobials for TD.EPEC, EAEC and ETEC were the most common findings. 79% of the cases had a co-infection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, PO Box 348, 00029 HUS Helsinki, Finland. anu.kantele@hus.fi.

ABSTRACT

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.

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The study protocol.
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Figure 1: The study protocol.

Mentions: The participants were recruited from among 96 travellers (Figure 1) destined for Grand Popo, Benin, West Africa in November 2009. They were each given questionnaires and test tubes for stool samples either at an information session or a health care appointment before the journey; they also received brochures on pertinent health issues, including detailed instructions on preventive measures against TD. The participants were asked to provide stool samples prior to departure and on return, and to fill in the questionnaires before (Q1) and immediately after (Q2) the trip, and a third one (Q3) three weeks later. As the initial number of volunteers providing Q1 and pre-travel stool samples proved quite low (20/96), the researchers went to meet the returning travellers at the airport not only to remind the volunteers of the study but also to ask for new ones to participate. On that occasion 44 new subjects were included in the research despite lacking pre-travel samples, 17 of whom failed to return both stool sample and questionnaire. Of the initial 20 participants who had provided the first faecal sample before the journey, two (10%) did not give the second one after it. The 19 subjects (2 recruited at start, 17 at airport) failing to provide post-travel samples were considered dropouts. Of the 45 who gave a second stool sample and answered Q2, 27 also returned Q3. Thus, 18 pre-travel and 45 post-travel samples were analyzed for pathogens with qPCR.


High number of diarrhoeal co-infections in travellers to Benin, West Africa.

Lääveri T, Pakkanen SH, Antikainen J, Riutta J, Mero S, Kirveskari J, Kantele A - BMC Infect. Dis. (2014)

The study protocol.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928613&req=5

Figure 1: The study protocol.
Mentions: The participants were recruited from among 96 travellers (Figure 1) destined for Grand Popo, Benin, West Africa in November 2009. They were each given questionnaires and test tubes for stool samples either at an information session or a health care appointment before the journey; they also received brochures on pertinent health issues, including detailed instructions on preventive measures against TD. The participants were asked to provide stool samples prior to departure and on return, and to fill in the questionnaires before (Q1) and immediately after (Q2) the trip, and a third one (Q3) three weeks later. As the initial number of volunteers providing Q1 and pre-travel stool samples proved quite low (20/96), the researchers went to meet the returning travellers at the airport not only to remind the volunteers of the study but also to ask for new ones to participate. On that occasion 44 new subjects were included in the research despite lacking pre-travel samples, 17 of whom failed to return both stool sample and questionnaire. Of the initial 20 participants who had provided the first faecal sample before the journey, two (10%) did not give the second one after it. The 19 subjects (2 recruited at start, 17 at airport) failing to provide post-travel samples were considered dropouts. Of the 45 who gave a second stool sample and answered Q2, 27 also returned Q3. Thus, 18 pre-travel and 45 post-travel samples were analyzed for pathogens with qPCR.

Bottom Line: Using routine techniques, the aetiology mostly remains unresolved, whereas modern molecular methods enable reducing the number of equivocal cases considerably.Two (8%) samples remained negative: both patients had taken antimicrobials for TD.EPEC, EAEC and ETEC were the most common findings. 79% of the cases had a co-infection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, PO Box 348, 00029 HUS Helsinki, Finland. anu.kantele@hus.fi.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus