Skip to main content
Top
Published in: BMC Infectious Diseases 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Tinja Lääveri, Sari H Pakkanen, Jenni Antikainen, Jukka Riutta, Sointu Mero, Juha Kirveskari, Anu Kantele

Published in: BMC Infectious Diseases | Issue 1/2014

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference 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 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.
3.
go back to reference 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.PubMed 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.PubMed
4.
go back to reference 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.PubMed 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.PubMed
5.
go back to reference 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. 10.1111/j.1708-8305.2010.00475.x.CrossRefPubMed 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. 10.1111/j.1708-8305.2010.00475.x.CrossRefPubMed
6.
go back to reference 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. 10.1111/j.1708-8305.2008.00249.x.CrossRefPubMed 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. 10.1111/j.1708-8305.2008.00249.x.CrossRefPubMed
7.
go back to reference 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. 10.1128/JCM.01709-09.CrossRefPubMedPubMedCentral 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. 10.1128/JCM.01709-09.CrossRefPubMedPubMedCentral
8.
go back to reference 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. 10.1111/j.1469-0691.2010.03414.x.CrossRefPubMed 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. 10.1111/j.1469-0691.2010.03414.x.CrossRefPubMed
9.
go back to reference 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. 10.1111/j.1708-8305.2010.00488.x.CrossRefPubMedPubMedCentral 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. 10.1111/j.1708-8305.2010.00488.x.CrossRefPubMedPubMedCentral
10.
go back to reference 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. 10.1093/infdis/157.5.1008.CrossRefPubMed 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. 10.1093/infdis/157.5.1008.CrossRefPubMed
11.
go back to reference 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.PubMed 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.PubMed
12.
go back to reference 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. 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.
go back to reference 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. 10.1111/j.1708-8305.2010.00490.x.CrossRefPubMed 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. 10.1111/j.1708-8305.2010.00490.x.CrossRefPubMed
17.
go back to reference 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. 10.1111/j.1708-8305.2008.00203.x.CrossRefPubMed 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. 10.1111/j.1708-8305.2008.00203.x.CrossRefPubMed
18.
go back to reference 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: 295-10.1186/1471-2334-11-295.CrossRefPubMedPubMedCentral 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: 295-10.1186/1471-2334-11-295.CrossRefPubMedPubMedCentral
19.
go back to reference 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: 231-10.1186/1471-2334-10-231.CrossRefPubMedPubMedCentral 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: 231-10.1186/1471-2334-10-231.CrossRefPubMedPubMedCentral
20.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
21.
go back to reference 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. 10.1111/j.1708-8305.1995.tb00631.x.CrossRefPubMed 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. 10.1111/j.1708-8305.1995.tb00631.x.CrossRefPubMed
22.
go back to reference Shlim DR: Looking for evidence that personal hygiene precautions prevent traveler’s diarrhea. Clin Infect Dis. 2005, 41 (Suppl 8): S531-S535.CrossRefPubMed Shlim DR: Looking for evidence that personal hygiene precautions prevent traveler’s diarrhea. Clin Infect Dis. 2005, 41 (Suppl 8): S531-S535.CrossRefPubMed
23.
go back to reference 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. 10.1086/510589.CrossRefPubMed 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. 10.1086/510589.CrossRefPubMed
24.
25.
go back to reference 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. 10.1016/S0140-6736(13)60844-2.CrossRefPubMed 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. 10.1016/S0140-6736(13)60844-2.CrossRefPubMed
26.
go back to reference Natchu UC, Bhatnagar S: Diarrhoea in children: identifying the cause and burden. Lancet. 2013, 382 (9888): 184-186. 10.1016/S0140-6736(13)60941-1.CrossRefPubMed Natchu UC, Bhatnagar S: Diarrhoea in children: identifying the cause and burden. Lancet. 2013, 382 (9888): 184-186. 10.1016/S0140-6736(13)60941-1.CrossRefPubMed
27.
go back to reference Ochoa TJ, Contreras CA: Enteropathogenic escherichia coli infection in children. Curr Opin Infect Dis. 2011, 24 (5): 478-483. 10.1097/QCO.0b013e32834a8b8b.CrossRefPubMedPubMedCentral Ochoa TJ, Contreras CA: Enteropathogenic escherichia coli infection in children. Curr Opin Infect Dis. 2011, 24 (5): 478-483. 10.1097/QCO.0b013e32834a8b8b.CrossRefPubMedPubMedCentral
28.
go back to reference 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.PubMedPubMedCentral 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.PubMedPubMedCentral
29.
go back to reference 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. 10.1128/JCM.40.6.2291-2296.2002.CrossRefPubMedPubMedCentral 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. 10.1128/JCM.40.6.2291-2296.2002.CrossRefPubMedPubMedCentral
Metadata
Title
High number of diarrhoeal co-infections in travellers to Benin, West Africa
Authors
Tinja Lääveri
Sari H Pakkanen
Jenni Antikainen
Jukka Riutta
Sointu Mero
Juha Kirveskari
Anu Kantele
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2014
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-14-81

Other articles of this Issue 1/2014

BMC Infectious Diseases 1/2014 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.