Diarrhea in the International Traveler

Severe cytomegalovirus colitis with hemolytic anemia mimicking travelers' diarrhea

A case of cytomegalovirus (CMV) colitis mimicking travelers' diarrhea following short-term travel is reported. The patient was a Croatian man visiting Korea for work. He presented with fever and severe bloody diarrhea. He was diagnosed with a primary CMV infection complicated with CMV colitis and hemolytic anemia and recovered with antiviral therapy and concomitant steroid therapy.

Rationale in diagnosis and screening of atrophic gastritis with stomach-specific plasma biomarkers

BACKGROUND AND AIMS

Atrophic gastritis (AG) results most often from Helicobacter pylori (H. pylori) infection. AG is the most important single risk condition for gastric cancer that often leads to an acid-free or hypochlorhydric stomach. In the present paper, we suggest a rationale for noninvasive screening of AG with stomach-specific biomarkers.

METHODS

The paper summarizes a set of data on application of the biomarkers and describes how the test results could be interpreted in practice.

RESULTS

In AG of the gastric corpus and fundus, the plasma levels of pepsinogen I and/or the pepsinogen I/pepsinogen II ratio are always low. The fasting level of gastrin-17 is high in AG limited to the corpus and fundus, but low or non-elevated if the AG occurs in both antrum and corpus. A low fasting level of G-17 is a sign of antral AG or indicates high intragastric acidity. Differentiation between antral AG and high intragastric acidity can be done by assaying the plasma G-17 before and after protein stimulation, or before and after administration of the proton pump inhibitors (PPI). Amidated G-17 will rise if the antral mucosa is normal in structure. H. pylori antibodies are a reliable indicator of helicobacter infection, even in patients with AG and hypochlorhydria.

CONCLUSIONS

Stomach-specific biomarkers provide information about the stomach health and about the function of stomach mucosa and are a noninvasive tool for diagnosis and screening of AG and acid-free stomach.

Clostridium difficile-associated diarrhea after antibiotic treatment for traveler's diarrhea

Diarrhea commonly affects international travelers. Episodes are usually short-lasting, but in some patients, symptoms may persist. Clostridium difficile infection should be excluded in travelers with prolonged disease. We report what is, to our knowledge, the first reported study of patients with C. difficile-associated diarrhea after receipt of antibiotic treatment for traveler's diarrhea.

Polymicrobial infections in children with diarrhoea in a rural area of Jordan

Polymicrobial infections associated with diarrhoea are common in developing countries. Stool specimens were collected from 220 patient children and 100 controls. Potential pathogenic agents isolated from 143 (65%) children were identified by molecular and standard microbiological methods. Co-infections with two or more agents were detected in 50 (35%) cases. Escherichia coli, Shigella dysenteriae, Giardia and Entamoeba histolytica were found to be predominant. The etiologic agents could not be determined in 77 (35%) cases. The most significant risk factors were the age, the education level of the mother and the use of non-chlorinated water. The high infection rate of diarrhoeal diseases is a strong indication that these pathogens circulate easily through the population.