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Gross M. [Travelers diarrhea]. MMW Fortschr Med 2016; 158:41-44. [PMID: 27155705 DOI: 10.1007/s15006-016-8205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Manfred Gross
- Internistische Klinik Dr. Müller, Am Isarkanal 12, D-81379, München, Deutschland.
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Paulke-Korinek M, Kollaritsch H. Treatment of Traveler’s Diarrhea. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2013. [DOI: 10.1007/s40506-013-0002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guevara CP, Luiz WB, Sierra A, Cruz C, Qadri F, Kaushik RS, Ferreira LCS, Gómez-Duarte OG. Enterotoxigenic Escherichia coli CS21 pilus contributes to adhesion to intestinal cells and to pathogenesis under in vivo conditions. MICROBIOLOGY-SGM 2013; 159:1725-1735. [PMID: 23760820 DOI: 10.1099/mic.0.065532-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Colonization surface antigens (CSs) represent key virulence-associated factors of enterotoxigenic Escherichia coli (ETEC) strains. They are required for gut colonization, the first step of the diarrhoeal disease process induced by these bacteria. One of the most prevalent CSs is CS21, or longus, a type IV pili associated with bacterial self-aggregation, protection against environmental stresses, biofilm formation and adherence to epithelial cell lines. The objectives of this study were to assess the role of CS21 in adherence to primary intestinal epithelial cells and to determine if CS21 contributes to the pathogenesis of ETEC infection in vivo. We evaluated adherence of a CS21-expressing wild-type ETEC strain and an isogenic CS21-mutant strain to pig-derived intestinal cell lines. To determine the role of CS21 in pathogenesis we used the above ETEC strains in a neonatal mice challenge infection model to assess mortality. Quantitative adherence assays confirmed that ETEC adheres to primary intestinal epithelial cells lines in a CS21-dependent manner. In addition, the CS21-mediated ETEC adherence to cells was specific as purified LngA protein, the CS21 major subunit, competed for binding with the CS21-expressing ETEC while specific anti-LngA antibodies blocked adhesion to intestinal cells. Neonatal DBA/2 mice died after intra-stomach administration of CS21-expressing strains while lack of CS21 expression drastically reduced the virulence of the wild-type ETEC strain in this animal model. Collectively these results further support the role of CS21 during ETEC infection and add new evidence on its in vivo relevance in pathogenesis.
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Affiliation(s)
- C P Guevara
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA, USA
| | - W B Luiz
- Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, 05508-000 São Paulo, Brazil
| | - A Sierra
- Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, USA
| | - C Cruz
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA, USA
| | - F Qadri
- International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - R S Kaushik
- Departments of Biology and Microbiology, and Veterinary and Biomedical Sciences, South Dakota State University, Brookings, SD, USA
| | - L C S Ferreira
- Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, 05508-000 São Paulo, Brazil
| | - O G Gómez-Duarte
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA, USA
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Hachiya M, Kikuchi H, Mizoue T. Descriptive epidemiology of travel-associated diarrhea based on surveillance data at Narita International Airport. J Travel Med 2010; 17:105-10. [PMID: 20412177 DOI: 10.1111/j.1708-8305.2009.00386.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although travelers' diarrhea is one of the most common health problems among international travelers, current findings depend largely on hospital and clinic-based information. To better understand the disease epidemiology and to identify specific subpopulations with increased risks, denominator data covering a large traveler population are needed. METHODS We conducted a questionnaire survey of all travelers at the quarantine station, Narita International Airport, and retrospectively reviewed records from January 2001 to December 2005. The Immigration Bureau database was used as denominator data on travel patterns during the same period. To elucidate the risks of contracting diarrhea, we estimated incidence according to age, sex, month of travel, and travel destination. RESULTS A total of 7,937,654 people voluntarily submitted questionnaires; 9,836 had travelers' diarrhea. Travelers of both sexes aged 20 to 29 years reported the disease most frequently. Men aged 20 to 24 had the highest estimated incidence compared with any other age and sex group. The incidence was higher in March, August, and September than other months, mainly due to the influx of young adult travelers. Travel to south-central Asia, Southeast Asia, and North Africa was associated with higher risks than that to other areas. CONCLUSIONS Risks of contracting travelers' diarrhea are dependent on age, sex, season, and destination of travel. Incidence of diarrhea in all four seasons varies with age. Some destinations are associated with increased risks regardless of age. To prevent travelers from contracting diarrhea, adequate measures should focus on specific subpopulations.
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Affiliation(s)
- Masahiko Hachiya
- Quarantine Station, Narita International Airport, Ministry of Health, Labour and Welfare, Tokyo, Japan.
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Page SJ. Current issue in tourism: The evolution of travel medicine research: A new research agenda for tourism? TOURISM MANAGEMENT 2009; 30:149-157. [PMID: 32287728 PMCID: PMC7115677 DOI: 10.1016/j.tourman.2008.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 04/03/2008] [Indexed: 05/04/2023]
Abstract
There has been considerable growth in interest in the field of travel medicine and the intersection with Tourism Studies since the 1990s. Yet this interest from a medical perspective is not new as a review of The Lancet, one of the most well-established medical journals, shows. What is new is the way in which the interest in travel medicine has developed across the science-social science divide and has now become one strand of a wider practitioner and academic interest in tourist well-being. With the exception of studies on technology and tourism and environmental science and tourism (e.g. climate change), this science-social science intersection has been comparatively absent from research in Tourism Studies. For this reason, this current issue's paper seeks to broadly outline the evolution of this area of study and some of the influential studies published to date along with some of the research agendas now emerging in this new area of study.
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Castelli F, Capone S, Pedruzzi B, Matteelli A. Antimicrobial prevention and therapy for travelers' infection. Expert Rev Anti Infect Ther 2008; 5:1031-48. [PMID: 18039086 DOI: 10.1586/14787210.5.6.1031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
International journeys are increasing and more than 70 million people from industrialized countries cross the borders of tropical countries every year. More than 50% of them will suffer from some form of infectious illness, ranging from mild travelers' diarrhea to severe dengue fever to fatal malaria, with a wide spectrum of microbiological entities. Travel-related respiratory infections, including TB, and sexually transmitted infections are also increasingly reported. Awareness of travel-related risk is not always adequate among international travelers. Specific training on travel medicine-related issues, as well as better diagnostic facilities for imported diseases, is crucial for physicians and nurses in industrialized countries.
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Affiliation(s)
- Francesco Castelli
- University of Brescia, Unit for Tropical and Imported Diseases, Spedali Civili General Hospital, Piazza Spedali Civili, 1 25123 Brescia, Italy.
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Mera V, López T, Serralta J. Take traveller's diarrhoea to heart. Travel Med Infect Dis 2007; 5:202-3. [PMID: 17448951 DOI: 10.1016/j.tmaid.2006.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 10/30/2006] [Accepted: 11/09/2006] [Indexed: 12/17/2022]
Abstract
Diarrhoea is a common health problem among travellers worldwide. We focus attention on the recognition of the postinfectious complications of traveller's diarrhoea. An English traveller, aged 43, attended a hospital in Benidorm (Spain) complaining of chest pain. A week previously, fever and severe diarrhoea were present. The electrocardiogram and cardiac enzymes were not normal. The coproculture yielded Campylobacter jejunii. Acute myocarditis can be an exceptional complication of gastroenteritis masquerading as acute myocardial infarction or leading to congestive heart failure.
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Affiliation(s)
- Vicente Mera
- Clínica Benidorm, Internal Medicine, Av Alfonso Puchades, 8, 03500 Benidorm, Alicante, Spain.
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Toovey S, Moerman F, van Gompel A. Special infectious disease risks of expatriates and long-term travelers in tropical countries. Part II: infections other than malaria. J Travel Med 2007; 14:50-60. [PMID: 17241254 DOI: 10.1111/j.1708-8305.2006.00092.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A wide range of viral, bacterial, and protozoal diseases pose risk to long-term tropical travelers. Risk varies geographically and with lifestyle. For some infections, risk increases with duration of stay, coming to resemble that of the local population. Risk management strategies include vaccination, chemoprophylaxis, avoidance measures, and screening, where appropriate. Vaccination against hepatitis A and B, typhoid, and rabies is recommended for all long-term travelers to (sub-)tropical areas. Lowering of the vaccination threshold for Japanese encephalitis is suggested. Meningococcal disease is rare in travelers, but vaccination is safe and acceptable. The efficacy of Bacillus Calmette-Guérin (BCG) is uncertain; immunological testing avoids BCG's confounding of tuberculin testing. Diarrhea is common, and self-treatment may be recommended. Sexually transmitted infections including human immunodeficiency virus (HIV) are serious risks; education, screening, and HIV postexposure prophylaxis following involuntary exposure are recommended. Many infections are chronic or asymptomatic, and appropriate screening is recommended on return or after prolonged exposure.
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Johnson JYM, McMullen LM, Hasselback P, Louie M, Saunders LD. Travelers' knowledge of prevention and treatment of travelers' diarrhea. J Travel Med 2006; 13:351-5. [PMID: 17107428 DOI: 10.1111/j.1708-8305.2006.00070.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Information regarding the prevention and treatment of travelers' diarrhea (TD) is available to the public from various sources, such as medical personnel, travel clinics, personal contacts, and the Internet. This type of information may help travelers avoid this illness or help those afflicted minimize its duration. METHODS We collected questionnaire data from 104 travelers at departure gates for flights to Mexico from Calgary, Alberta on their knowledge of symptoms and treatment of TD and food risks associated with this illness and sources of information used. RESULTS Almost half reported they received some information on travel-related diseases and on TD prior to the flight. When education level was controlled for, the mean score for people who had obtained information on TD was significantly higher than that for those who did not have such information. College or university-educated travelers scored better than did other travelers. A high proportion of travelers correctly identified risk levels associated with specific foods consumed during travel, and many recognize that they are at an increased risk of acquiring diarrheal illness while traveling in a developing country. CONCLUSIONS Information on TD appears to improve the level of knowledge on its prevention and treatment among travelers from southern Alberta.
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Affiliation(s)
- Julie Y M Johnson
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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Affiliation(s)
- Juan Juarez
- Assistant Professor of Pediatric Emergency Medicine, Children's Medical Center of Dallas, Dallas, TX, USA
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Behaviors and perceptions of Japanese tourists affecting diarrheal illness and health care need assessment: A questionnaire study. Environ Health Prev Med 2006; 11:184-90. [PMID: 21432378 PMCID: PMC2723290 DOI: 10.1007/bf02905277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 04/13/2006] [Indexed: 11/27/2022] Open
Abstract
Objectives To measure the prevalence rate of, and determine the association between food and drink related behaviors and diarrheal illness among Japanese tourists, and assess their health care needs. Methods Eligible Japanese tourists (1,480) aged ≥15 years traveling in Chiangmai Province in the north, Ayutthaya Province in the center, Kanchanaburi Province in the west, Pattaya City in the east, and Krabi Province in the south of Thailand were enrolled in the study. Of these tourists, 1,318 consented to participate in this study and completed questionnaires in Japanese, giving a response rate of 89.1%. Results Among these Japanese tourists 21.3% had diarrheal illness, and of these tourists, 5.0% had classical travelers’ diarrhea (TD), 11.8% had mild TD, 3.3% had good food and drink related behaviors, and 75.4% had moderate level of perception of diarrhea related to drinking and eating. Multiple logistic regression analysis indicated three significant diarrheal illness predictors: large number of previous visits to Thailand, longer stay in Thailand, and the experience of visiting other countries. Furthermore, 56.9% suggested providing an adequate number of toilets at tourist destinations; 53.9% suggested providing a 24-hour emergency call facility for a public ambulance; and 51.9% suggested providing garbage bins and garbage disposal facilities at tourist destinations. Conclusions TD still affects experienced Japanese tourists who visit Thailand. Although the proportions of the good levels of food and drink related behaviors were low, there were indications that Japanese tourists perceived the risk of contracting TD.
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Abstract
Traveller's diarrhoea affects over 50% of travellers to some destinations and can disrupt holidays and business trips. This review examines the main causes and epidemiology of the syndrome, which is associated with poor public health infrastructure and hygiene practices, particularly in warmer climates. Although travellers may be given common sense advice on avoidance of high-risk foods and other measures to prevent traveller's diarrhoea, adherence to such advice is sometimes difficult and the evidence for its effectiveness is contradictory. However, non-antimicrobial means for prevention of traveller's diarrhoea are favoured in most settings. A simple stepwise approach to the management of traveller's diarrhoea includes single doses or 3-day courses of antimicrobials, often self administered. The antibiotics of choice are currently fluoroquinolones or azithromycin, with an emerging role for rifaximin. In the long term, there will be greater benefit and effect on the health of local inhabitants and travellers from improving public health and hygiene standards at tourist destinations.
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Affiliation(s)
- Seif S Al-Abri
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK.
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Diagnostik und Management der wichtigsten Reiseund Tropenkrankheiten. REISEMEDIZIN 2005. [PMCID: PMC7156010 DOI: 10.1016/b978-343721511-7.50037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cartwright R. The role of hygiene and public health programs in reducing the incidence of travelers' diarrhea. Comment on consensus paper by Steffen et al. J Travel Med 2004; 11:189-90; author reply 190. [PMID: 15710064 DOI: 10.2310/7060.2004.18465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Reinthaler FF, Feierl G, Beubler E, Kollaritsch H, Ruckenbauer G, Klem G, Wendelin I, Marth E. Treatment of travelers' diarrhea among Austrian tourists. J Travel Med 2004; 11:66-8. [PMID: 14769292 DOI: 10.2310/7060.2004.13527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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