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Current Infectious Disease Reports
Published in: Current Infectious Disease Reports 3/2012

01-06-2012 | Tropical and Travel Medicine (LH Chen, Section Editor)

Pathogens for Travelers’ Diarrhea in Nepal and Resistance Patterns

Authors: Holly Murphy, Prativa Pandey

Published in: Current Infectious Disease Reports | Issue 3/2012

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Abstract

At the top of the world, Nepal leads the world in travelers’ diarrhea. A review of the rates, pathogens and resistance patterns over 3 decades reveals a persistent problem of increasing alarm. A look at root causes provides insight into this oppressive, inconvenient offense to travelers to an otherwise mystical Himalayan paradise.
Literature
1.
Department of Health Services for the Government of Nepal. Annual Report by the Nepal Ministry of Health and Population. 2009.
2.
Hoge CW, Shlim DR, Echeverria P, Rajah R, Herrmann JE, Cross JH. Epidemiology of diarrhea among expatriate residents living in a highly endemic environment. JAMA. 1996;275:533–8.PubMedCrossRef
3.
Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. 2006;354:119–30.PubMedCrossRef
4.
Steffen R, Tornieporth N, Clemens SA, et al. Epidemiology of travelers’ diarrhea: details of a global survey. J Travel Med. 2004;11:231–7.PubMedCrossRef
5.
Greenwood Z, Black J, Weld L, et al. Gastrointestinal infection among international travelers globally. J Travel Med. 2008;15:221–8.PubMedCrossRef
6.
Shlim DR, Hoge CW, Rajah R, Scott RM, Pandy P, Echeverria P. Persistent high risk of diarrhea among foreigners in Nepal during the first 2 years of residence. Clin Infect Dis. 1999;29:613–6.PubMedCrossRef
7.
Taylor DN, Houston R, Shlim DR, Bhaibulaya M, Ungar BL, Echeverria P. Etiology of diarrhea among travelers and foreign residents in Nepal. JAMA. 1988;260:1245–8.PubMedCrossRef
8.
Kean BH. The diarrhea of travelers to Mexico. Summary of five-year study. Ann Intern Med. 1963;59:605–14.PubMed
9.
Hoge CW, Shlim DR, Ghimire M, et al. Placebo-controlled trial of co-trimoxazole for Cyclospora infections among travellers and foreign residents in Nepal. Lancet. 1995;345:691–3.PubMedCrossRef
10.
Murphy Jr GS, Echeverria P, Jackson LR, Arness MK, LeBron C, Pitarangsi C. Ciprofloxacin- and azithromycin-resistant Campylobacter causing traveler’s diarrhea in U.S. troops deployed to Thailand in 1994. Clin Infect Dis. 1996;22:868–9.PubMedCrossRef
11.
Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med. 2000;7:259–66.PubMedCrossRef
12.
Shlim DR, Cohen MT, Eaton M, Rajah R, Long EG, Ungar BL. An alga-like organism associated with an outbreak of prolonged diarrhea among foreigners in Nepal. Am J Trop Med Hyg. 1991;45:383–9.PubMed
13.
Hoge CW, Shlim DR, Rajah R, et al. Epidemiology of diarrhoeal illness associated with coccidian-like organism among travellers and foreign residents in Nepal. Lancet. 1993;341:1175–9.PubMedCrossRef
14.
••Pandey P, Bodhidatta L, Lewis M, et al. Travelers’ diarrhea in Nepal: an update on the pathogens and antibiotic resistance. J Travel Med 2011;18:102–8.PubMedCrossRef
15.
Bern C, Martines J, de Zoysa I, Glass RI. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ. 1992;70:705–14.PubMed
16.
Shlim DR. Looking for evidence that personal hygiene precautions prevent traveler’s diarrhea. Clin Infect Dis. 2005;41 Suppl 8:S531–5.PubMedCrossRef
17.
Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis. 1998;26:341–5.PubMedCrossRef
18.
Sanders JW, Isenbarger DW, Walz SE, et al. An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection. Am J Trop Med Hyg. 2002;67:533–8.PubMed
19.
Vlieghe ER, Jacobs JA, Van Esbroeck M, Koole O, Van Gompel A. Trends of norfloxacin and erythromycin resistance of Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers, 1994 to 2006. J Travel Med. 2008;15:419–25.PubMedCrossRef
20.
Jain D, Sinha S, Prasad KN, Pandey CM. Campylobacter species and drug resistance in a north Indian rural community. Trans R Soc Trop Med Hyg. 2005;99:207–14.PubMedCrossRef
21.
Butt F, Sultan F. In vitro activity of azithromycin in Salmonella isolates from Pakistan. J Infect Dev Ctries. 2011;5:391–5.PubMed
22.
Kansakar P, Baral P, Malla S, Ghimire GR. Antimicrobial susceptibilities of enteric bacterial pathogens isolated in Kathmandu, Nepal, during 2002–2004. J Infect Dev Ctries. 2011;5:163–8.PubMedCrossRef
23.
Bhattacharya S, Khanal B, Bhattarai NR, Das ML. Prevalence of Shigella species and their antimicrobial resistance patterns in Eastern Nepal. J Health Popul Nutr. 2005;23:339–42.PubMed
24.
Rabold JG, Hoge CW, Shlim DR, Kefford C, Rajah R, Echeverria P. Cyclospora outbreak associated with chlorinated drinking water. Lancet. 1994;344:1360–1.PubMedCrossRef
25.
Diarrhoeal diseases. Gastroenteritis and cholera epidemic, 1991. Wkly Epidemiol Rec. 1992;67:273–6.
26.
Ise T, Pokharel BM, Rawal S, Shrestha RS, Dhakhwa JR. Outbreaks of cholera in Kathmandu Valley in Nepal. J Trop Pediatr. 1996;42:305–7.PubMedCrossRef
27.
Pal SC. Dysentery: an overview. Still problems to resolve. Dialogue Diarrhoea 1986:4.
28.
Marfin AA, Moore J, Collins C, et al. Infectious disease surveillance during emergency relief to Bhutanese refugees in Nepal. JAMA. 1994;272:377–81.PubMedCrossRef
29.
Hoge CW, Shlim DR, Echeverria P. Cyanobacterium-like cyclospora species. N Engl J Med. 1993;329:1504–5.PubMedCrossRef
30.
Amatya R, Poudyal N, Gurung R, Khanal B. Prevalence of cryptosporidium species in paediatric patients in Eastern Nepal. Trop Doct. 2011;41:36–7.PubMedCrossRef
31.
Hoge CW, Echeverria P, Rajah R, et al. Prevalence of Cyclospora species and other enteric pathogens among children less than 5 years of age in Nepal. J Clin Microbiol. 1995;33:3058–60.PubMed
32.
Kimura K, Rai SK, Rai G, et al. Study on cyclospora cayetanensis associated with diarrheal disease in Nepal and Loa PDR. Southeast Asian J Trop Med Public Health. 2005;36:1371–6.PubMed
33.
Chu DM, Sherchand JB, Cross JH, Orlandi PA. Detection of Cyclospora cayetanensis in animal fecal isolates from Nepal using an FTA filter-base polymerase chain reaction method. Am J Trop Med Hyg. 2004;71:373–9.PubMed
34.
Mendez E, Arias CF. Astrovirus. In: Knipe DM, Howley PM, editors. Fields Virology. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 981–1000.
35.
Monroe SS, Carter MJ, Herrmann J, Mitchel DK, Sanchez-Fauquier A. Astroviridae. In: Fauquet CM, Mayo MA, Maniloff J, Desselberger U, Ball LA, editors. Virus Taxonomy. Eith Report of the International Committee on Taxonomy of Viruses. Amsterdam: Elsevier; 2005. p. 859–64.
36.
Kapoor A, Li L, Victoria J, et al. Multiple novel astrovirus species in human stool. J Gen Virol. 2009;90:2965–72.PubMedCrossRef
37.
Shlim DR, Hoge CW, Rajah R, Rabold JG, Echeverria P. Is Blastocystis hominis a cause of diarrhea in travelers? A prospective controlled study in Nepal. Clin Infect Dis. 1995;21:97–101.PubMedCrossRef
38.
de la Cabada Bauche J, Dupont HL. New Developments in Traveler’s Diarrhea. Gastroenterol Hepatol (N Y). 2011;7:88–95.
39.
Islam Z, Jacobs BC, van Belkum A, et al. Axonal variant of Guillain-Barre syndrome associated with Campylobacter infection in Bangladesh. Neurology. 2010;74:581–7.PubMedCrossRef
40.
Gorthi SP, Kapoor L, Chaudhry R, et al. Guillain-Barre syndrome: association with Campylobacter jejuni and Mycoplasma pneumoniae infections in India. Natl Med J India. 2006;19:137–9.PubMed
41.
Prasad KN, Dixit AK, Ayyagari A. Campylobacter species associated with diarrhoea in patients from a tertiary care centre of north India. Indian J Med Res. 2001;114:12–7.PubMed
42.
Koide T, Yamazaki M, Onishi Y, Saito K, Yuki N. A case of Guillain-Barre syndrome after the travel in southeast Asia–isolation of Campylobacter jejuni PEN 5 serotype. Rinsho Shinkeigaku. 1997;37:41–3.PubMed
43.
Khan FY, Kamha AA, Abbas MT, Miyares F, Elshafie SS. Guillain-Barre syndrome associated with Salmonella paratyphi A. Clin Neurol Neurosurg. 2007;109:452–4.PubMedCrossRef
44.
Yates JA, Stetz LC. Reiter’s syndrome (reactive arthritis) and travelers’ diarrhea. J Travel Med. 2006;13:54–6.PubMedCrossRef
45.
Murdoch DR. Symptoms of infection and altitude illness among hikers in the Mount Everest region of Nepal. Aviat Space Environ Med. 1995;66:148–51.PubMed
46.
Adhikari RP, Kalpana KC, Shears P, Sharma AP. Antibiotic resistance conferred by conjugative plasmid in Escherichia coli isolated from community ponds of Kathmandu Valley. J Health Popul Nutr. 2000;18:57–9.PubMed
47.
Bhatta DR, Bangtrakulnonth A, Tishyadhigama P, et al. Serotyping, PCR, phage-typing and antibiotic sensitivity testing of Salmonella serovars isolated from urban drinking water supply systems of Nepal. Lett Appl Microbiol. 2007;44:588–94.PubMedCrossRef
48.
Smith KE, Besser JM, Hedberg CW, et al. Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992–1998. Investigation Team N Engl J Med. 1999;340:1525–32.
49.
Unicomb L, Ferguson J, Riley TV, Collignon P. Fluoroquinolone resistance in Campylobacter absent from isolates, Australia. Emerg Infect Dis. 2003;9:1482–3.PubMed
50.
Shrestha A, Regmi P, Dutta RK, et al. First report of antimicrobial resistance of Salmonella isolated from poultry in Nepal. Vet Microbiol. 2010;144:522–4.PubMedCrossRef
51.
Bhandari S, Singh S. Annual consumption of veterinary medicines and feed supplement in Nepal. Nepalese Veterinary Journal. 2004;28:25–32.
52.
Chandrasekar PH. Urgent need for formal medical training in infectious diseases in India. Lancet Infect Dis. 2011;11:809–10.PubMedCrossRef
53.
Cave W, Pandey P, Chatterjee S. Irrational prescribing in South Asia: a case of fluoroquinolone-associated phototoxicity. J Travel Med. 2003;10:290–2.PubMed
54.
Hazra A, Tripathi SK, Alam MS. Prescribing and dispensing activities at the health facilities of a non-governmental organization. Natl Med J India. 2000;13:177–82.PubMed
55.
Shankar PR, Upadhyay DK, Mishra P, Subish P, Dubey AK, Saha AC. Fluoroquinolone utilization among inpatients in a teaching hospital in western Nepal. J Pak Med Assoc. 2007;57:78–82.PubMed
Metadata
Title
Pathogens for Travelers’ Diarrhea in Nepal and Resistance Patterns
Authors
Holly Murphy
Prativa Pandey
Publication date
01-06-2012
Publisher
Current Science Inc.
Published in
Current Infectious Disease Reports / Issue 3/2012
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-012-0253-9

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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.

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