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ncidence Rates of Traveler's Diarrhea in the Initial 2 Weeks of Stay in Various Regions of the World Among Visitors Residing in Industrialized Countries, 1996-2008
Source publication
Acute diarrhea is the most common illness that affects travelers to low-income regions of the world. Although improved hygiene has reduced the risk of traveler's diarrhea in many destinations, the risk remains high in others.
To review the current state of knowledge on the etiology, risk factors, prevention, and management of traveler's diarrhea.
A...
Citations
... Campylobacter jejuni is the leading cause of acute diarrhea worldwide [2]. C. jejuni is a Gram-negative bacillus that predominantly causes infection after contact with and ingestion of contaminated or undercooked meat. ...
Background
Campylobacter is known to be the leading cause of foodborne illness. Campylobacter jejuni, specifically, most commonly causes self-limiting enterocolitis, but infection can lead to extraintestinal manifestations, including rare yet severe cardiac complications, such as myocarditis and/or pericarditis. This review aims to determine whether a relationship exists between the timing of a positive stool culture and the overall clinical course in patients with Campylobacter jejuni-associated myocarditis and/or pericarditis.
Methods
A systematic search was conducted using PubMed, MEDLINE, CINAHL Ultimate, Academic Search Premier, and Nursing and Allied Health Premium databases. A gray literature search was also performed. Covidence.org was used to screen, select, and extract data by two independent reviewers. Following a full-text evaluation, the quality of each study was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.
Results
The search resulted in 434 records, of which 7 case reports met the inclusion criteria, each study including one patient. The average number of days from hospital presentation to obtaining a stool sample was 1.7. The average number of days from stool culture obtainment to clinical course improvement was 3.3, with four case studies reporting a range of 2–4 days.
Conclusion
This systematic review raises awareness regarding the manifestations of Campylobacter jejuni, specifically the severe cardiac symptoms that may present in young individuals. Given the significant sequelae that can develop, providers must elicit a thorough history consisting of questions related to recent travel, food consumption, and gastrointestinal symptoms, especially among young individuals presenting with cardiac complaints.
... ETEC accounted for approximately 100 million diarrhoea episodes and 60,000 mortalities in 2015 [34]. ETEC is also the major cause of travellers' diarrhoea, affecting travellers visiting developing countries of the world [36]. In underdeveloped nations, where there is no infrastructure for the collection of human waste and the supply of clean drinking water, ETEC infections are caused by consuming contaminated food and water. ...
Escherichia coli is a gram-negative commensal bacterium living in human and animal intestines. Its pathogenic strains lead to high morbidity and mortality, which can adversely affect people by causing urinary tract infections, food poisoning, septic shock, or meningitis. Humans can contract E. coli by eating contaminated food—such as raw or undercooked raw milk, meat products, and fresh produce sold in open markets—as well as by coming into contact with contaminated settings like wastewater, municipal water, soil, and faeces. Some pathogenic strains identified in Nigeria, include Enterohemorrhagic (Verotoxigenic), Enterotoxigenic, Enteropathogenic, Enteroinvasive, and Enteroaggregative E. coli. This causes acute watery or bloody diarrhoea, stomach cramps, and vomiting. Apart from the virulence profile of E. coli, antibiotic resistance mechanisms such as the presence of blaCTX-M found in humans, animals, and environmental isolates are of great importance and require surveillance and monitoring for emerging threats in resource-limited countries. This review is aimed at understanding the underlying mechanisms of evolution and antibiotic resistance in E. coli in Nigeria and highlights the use of improving One Health approaches to combat the problem of emerging infectious diseases.
... Chronic diarrhea, which lasts for over 4 weeks, may arise from non-infectious causes such as chronic inflammatory diseases, irritable bowel syndrome, or malabsorption disorders [4]. Traveler's diarrhea is a form of acute diarrhea often triggered by consuming contaminated food or water during travel to regions with inadequate sanitation and is commonly associated with bacterial pathogens such as Escherichia coli [5]. Infectious agents, including viruses, bacteria, and parasites, are the most common causes of diarrhea, which can be transmitted through contaminated food or water or from person to person due to poor hygiene practices. ...
Background: Diarrheal disease remains a significant public health issue, particularly affecting young children and older adults. Despite efforts to control and prevent these diseases, their incidence continues to be a global concern. Understanding the trends in diarrhea incidence and the factors influencing these trends is crucial for developing effective public health strategies. Objective: This study aimed to explore the temporal trends in diarrhea incidence and associated factors from 1990 to 2019 and to project the incidence for the period 2020–2040 at global, regional, and national levels. We aimed to identify key factors influencing these trends to inform future prevention and control strategies. Methods: The eXtreme Gradient Boosting (XGBoost) model was used to predict the incidence from 2020 to 2040 based on demographic, meteorological, water sanitation, and sanitation and hygiene indicators. SHapley Additive exPlanations (SHAP) value was performed to explain the impact of variables in the model on the incidence. Estimated annual percentage change (EAPC) was calculated to assess the temporal trends of age-standardized incidence rates (ASIRs) from 1990 to 2019 and from 2020 to 2040. Results: Globally, both incident cases and ASIRs of diarrhea increased between 2010 and 2019. The incident cases are expected to rise from 2020 to 2040, while the ASIRs and incidence rates are predicted to slightly decrease. During the observed (1990–2019) and predicted (2020–2040) periods, adults aged 60 years and above exhibited an upward trend in incidence rate as age increased, while children aged < 5 years consistently had the highest incident cases. The SHAP framework was applied to explain the model predictions. We identified several risk factors associated with an increased incidence of diarrhea, including age over 60 years, yearly precipitation exceeding 3000 mm, temperature above 20 °C for both maximum and minimum values, and vapor pressure deficit over 1500 Pa. A decreased incidence rate was associated with relative humidity over 60%, wind speed over 4 m/s, and populations with above 80% using safely managed drinking water services and over 40% using safely managed sanitation services. Conclusions: Diarrheal diseases are still serious public health concerns, with predicted increases in the incident cases despite decreasing ASIRs globally. Children aged < 5 years remain highly susceptible to diarrheal diseases, yet the incidence rate in the older adults aged 60 plus years still warrants additional attention. Additionally, more targeted efforts to improve access to safe drinking water and sanitation services are crucial for reducing the incidence of diarrheal diseases globally.
... ETEC accounts for about 100 million diarrhoea episodes and 60,000 mortalities in 2015 [29]. ETEC is also the major cause of traveller's diarrhoea affecting travellers visiting developing countries of the world [31]. In underdeveloped nations, where there is no infrastructure for the collection of human waste and the supply of clean drinking water, ETEC infections are caused by consuming contaminated food and 4 water. ...
Escherichia coli is a gram-negative commensal bacterium living in human and animal intestines. Its pathogenic strains are cause of high morbidity which can adversely affect people by causing urinary tract infections, food poisoning, septic shock, or meningitis. Humans can contract E. coli by eating contaminated food—such as raw or undercooked raw milk, meat products, and fresh produce sold in open markets—as well as by coming into contact with contaminated settings like wastewater, municipal water, soil, and faeces. Some pathogenic strains of E. coli have been identified in Nigeria such as enterohemorrhagic (EHEC), as well as enterotoxigenic (ETEC), enteropathogenic (EPEC), enteroinvasive (EIEC), enteroaggregative (EAEC), and verotoxigenic (VTEC). This causes acute watery or bloody diarrhoea, stomach cramps, and vomiting. Apart from the virulence profile of E. coli, antibiotic resistance mechanisms such as the presence of blaCTX-M found in humans, animals and environmental isolates which are of great importance and require surveillance and monitoring for emerging threats in resource-limited countries. This review is aimed at understanding the underlying mechanisms of evolution and antibiotic resistance in E. coli in Nigeria and highlighting the use of improving One Health approaches to combat the problem of emerging infectious diseases.
... • Bacillus cereus (2) -Sadece destek tedavisi • Campylobacter jejuni (2,4) -Hafif: Yalnızca destekleyici bakım-antibiyotikler direnci indükleyebilir. (2,4,5) -Hafif vakalarda tedavi yok. ...
... Çoğu enfeksiyon kendi kendini sınırlar ve 4-5 gün içinde düzelir. Orta ila şiddetli turist ishalinde antibiyotik verilirse süre 1.5 güne kadar kısalabilir (5). ...
... Traveler's diarrhea is a common medical condition that affects at least 60% of people who travel (Ng et al., 2017;Riddle et al., 2017). While it is usually non-fatal and self-healing, it can cause severe symptoms such as fever, vomiting, abdominal pain or cramps, and dehydration, which can disrupt travel plans or require hospitalization (Steffen et al., 2015;Giddings et al., 2016). ...
Background: Bismuth subsalicylate (BSS), probiotics, rifaximin, and vaccines have been proposed as preventive modalities for patients with travelers’ diarrhea (TD), but their comparative effectiveness for prevention has rarely been studied. We aimed to perform a systematic review and network meta-analysis to test whether one of these modalities is more effective than the others in reducing the incidence of TD.
Methods: We searched Pubmed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinical registries from inception of the databases through 18 November 2023, without language restriction, for randomized controlled trials (RCTs) evaluating the efficacy of BSS, probiotics, rifaximin, and vaccines in preventing TD. The primary outcome was the incidence of TD and the safety outcome was the incidence of adverse events. The relative ratio (RR) was used to assess the effect of the modalities, and RR estimates between any two of the modalities were calculated and pooled using a frequentist network meta-analysis model.
Results: Thirty-one studies (recruiting 10,879 participants) were included in the analysis. Sixteen were judged to have a low risk of bias. In the aggregate analysis, BSS and rifaximin were more effective than placebo and other treatment modalities, which was further confirmed in the individual analysis. The comparison between rifaximin and placebo achieved high confidence, while the comparisons between BSS and placebo, ETEC and probiotics, and rifaximin and vaccines achieved moderate confidence. BSS had a higher rate of adverse events compared with other treatments.
Conclusion: Rifaximin had a relative lower TD incidence and lower adverse event rate, and the evidence was with moderate confidence.
Systematic Review Registration: https://osf.io/dxab6, identifier.
... Antimicrobials that have been used for prophylaxis for traveler's diarrhea include doxycycline, ciprofloxacin, and rifaximin [10][11][12][13]. Others have been used for treatment including quinolones, azithromycin, cotrimoxazole, and rifaximin [14]. Fluoroquinolone-resistant E. coli has been increasingly reported during the last decade in both the hospital environment and the community, which has limited the utility of these broad-spectrum agents [15]. ...
... Fluoroquinolone-resistant E. coli has been increasingly reported during the last decade in both the hospital environment and the community, which has limited the utility of these broad-spectrum agents [15]. The antimicrobial treatment of traveler's diarrhea has altered over the years due to increasing antimicrobial resistance [14]. In the last decade, resistance against commonly used drugs for the treatment of enteric infections in travelers, including ampicillin, tetracycline, and cotrimoxazole, has increased among diarrheagenic E. coli [16]. ...
Antimicrobial resistance (AMR) is an unprecedented global health challenge, involving the transfer of bacteria and genes between humans and the environment. We simultaneously and longitudinally determined the AMR of enterotoxigenic Escherichia coli (ETEC) strains isolated from diarrheal patients and an aquatic environment over two years from two geographically distinct locations, Coastal Mathbaria and Northern Chhatak in Bangladesh. A total of 60% and 72% of ETEC strains from the patients in Mathbaria and Chhatak, respectively, were multi-drug resistant (MDR) with a high proportion of ETEC resistant to nalidixic acid (80.7%), macrolides (49.1–89.7%), ampicillin (57.9–69%), and trimethoprim/sulfamethoxazole (55.2%). From the surface water, 68.8% and 30% of ETEC were MDR in Mathbaria and Chhatak, respectively, with a high proportion of ETEC strains resistant to macrolides (87.5–100%), ampicillin (50–75%), ceftriaxone (62.5%), and nalidixic acid (40%). Notably, 80–100% of the ETEC strains were susceptible to tetracycline and quinolones (ciprofloxacin and norfloxacin), both in clinical and aquatic ETEC. The AMR varied by the ETEC toxin types. The patterns of excessive or limited consumption of drugs to treat diarrhea over time in Bangladesh were reflected in the ETEC AMR from the patients and the environment. The high prevalence of MDR-ETEC strains in humans and the environment is of concern, which calls for vaccines and other preventative measures against ETEC.
... In the EU in 2021, most travel-related infections were acquired in Southern Europe (with 28% of cases originating from Spain) [1]. In Southeast Asia, on the other hand, Campylobacter is known to cause a larger proportion of traveler's diarrhea cases compared to other regions of the world [53]. Our results are in line with these previous studies. ...
Campylobacteriosis causes a significant disease burden in humans worldwide and is the most common type of zoonotic gastroenteritis in Finland. To identify infection sources for domestic Campylobacter infections, we analyzed Campylobacter case data from the Finnish Infectious Disease Register (FIDR) in 2004–2021 and outbreak data from the National Food- and Waterborne Outbreak Register (FWO Register) in 2010–2021, and conducted a pilot case-control study (256 cases and 756 controls) with source attribution and patient sample analysis using whole-genome sequencing (WGS) in July–August 2022. In the FIDR, 41% of the cases lacked information on travel history. Based on the case-control study, we estimated that of all cases, 39% were of domestic origin. Using WGS, 22 clusters of two or more cases were observed among 185 domestic cases, none of which were reported to the FWO register. Based on this case-control study and source attribution, poultry is an important source of campylobacteriosis in Finland. More extensive sampling and comparison of patient, food, animal, and environmental isolates is needed to estimate the significance of other sources. In Finland, campylobacteriosis is more often of domestic origin than FIDR notifications indicate. To identify the domestic cases, travel information should be included in the FIDR notification, and to improve outbreak detection, all domestic patient isolates should be sequenced.
... Thus, collecting antimicrobial therapy data would be beneficial as it could encourage the reduction of unnecessary antibiotic administration in the future, suppressing resistant bacterial strains. Generally, TD is self-limiting without antimicrobial therapy (1). In this study, 58/731 patients (8%) with unknown causative organisms were prescribed antimicrobial drugs. ...
Traveler's diarrhea (TD) is a global problem, and identifying the causative organisms of TD is important for adequate treatment. Therefore, this study retrospectively analyzed TD cases in patients who returned to Japan after traveling abroad to determine the causative organisms by travel region. We included patients with a final diagnosis of TD registered in the Japan Registry for Infectious Diseases from Abroad database from September 25, 2017, to September 1, 2022, from 14 medical institutions. A total of 919 patients were analyzed; the causative TD pathogen was identified in 188 cases (20%), of which 154 were caused by diarrheagenic bacteria, the most common being Campylobacter spp. (64%). A 2.2 mg/dL C-reactive protein concentration cutoff value had some predictive ability for bacterial TD (negative predictive value, 89%). Therefore, the C-reactive protein level may help rule out bacterial diarrhea and prevent unnecessary antimicrobial administration when patients cannot provide a stool specimen.
... The exhibition of catches for commercialization in trays with no incline and with water-ice that does not comply with norm NOM 251-SSA1-2009 [20] can be another source of contamination of the octopuses. Even in boiled octopus, our analyses found values for TC and FC that exceeded allowable levels, therefore representing a risk for human health when consumed, which, according to Steffen et al. [38], can cause gastrointestinal infections. While the study did not apply a confirmatory test for the presence of Escherichia coli and, thus, the MPN could pertain to this species or some other in the group of thermotolerant bacteria, the presence of fecal coliforms is an indicator of anthropogenic contamination that must be addressed. ...
Simple Summary
The contamination of coastal waters, unhealthy conditions and inadequate handling practices tend to reduce the sanitary quality of fishery products, thus impacting its marketing. With this in mind, we investigate the microbiological quality of the Octopus insularis in each stage of the production chain, comprehending capture, post-capture, processing and commercialization, in terms of the presence of total and fecal coliforms at the Veracruz Reef System, Gulf of Mexico. The environmental and anthropogenic influence on the space–temporal concentration of coliforms were analyzed in sea water, fresh octopus, fresh water, ice and octopus, both packed in ice and boiled. Most relevant results indicated that coliforms are present in the octopus production chain, being highest in the marketing stage. The coliform concentration increased during the rainy season and was highest in the reefs closer to the coast, which has a major anthropogenic influence. These results point out the urgent need to implement an efficient cold chain with adequate handling practices to try to reverse these microbiological conditions and improve the octopus quality and food safety.
Abstract
Coliforms are relatively common in aquatic environments, but their concentrations can be increased by environmental changes and anthropogenic activities, thus impacting fisheries resources. To determine the microbiological quality in the octopus production chain (capture, post-capture, processing and commercialization), total (TC) and fecal (FC) coliforms were quantified in sea water, fresh octopus, fresh water, ice and octopus in two presentations: packed in ice and boiled. Samples came from fishing zones Enmedio, Chopa and La Gallega at the Veracruz Reef System (VRS) during dry, rainy and windy seasons. The coliforms were determined using the most probable number technique (MPN). The most relevant results indicated that octopus packed in ice coming from the commercialization stage had FC levels >540 MPN/100 g, which exceeded the permissible limits (230 MPN/100 g). Therefore, these products present a risk for human consumption. Differences in FC were observed in octopuses between the three fishing zones (H = 8.697; p = 0.0129) and among the three climatic seasons, increasing during the rainy season, highlighting La Gallega with 203.33 ± 63 MPN (H = 7.200; p = 0.0273). The results provide evidence of the environmental and anthropogenic influences on coliform concentrations and the urgent need to implement an efficient cold chain throughout octopus production stages with adequate handling practices to reverse this situation.
