Abstract
In Cusco, Peru, and South America in general, there is a dearth of travelers' diarrhea (TD) data concerning the clinical features associated with enteropathogen-specific infections and destination-specific risk behaviors. Understanding these factors would allow travel medicine providers to tailor interventions to patients' risk profiles and travel destination. To characterize TD etiology, evaluate region-specific TD risk factors, and examine relationships between preventive recommendations and risk-taking behaviors among medium- to long-term travelers' from high-income countries, we conducted this case–case analysis using 7 years of prospective surveillance data from adult travelers' presenting with TD to a physician in Cusco. At the time of enrollment, participants provided a stool sample and answered survey questions about demographics, risk behaviors, and the clinical features of illness. Stool samples were tested for norovirus (NV), bacteria, and parasites using conventional methods. Data obtained were then analyzed using case–case methods. NV (14%), enterotoxigenic Escherichia coli (11%), and Campylobacter (9%), notably ciprofloxacin-resistant Campylobacter, were the most frequently identified pathogens among adults with TD. Coinfection with multiple enteropathogens occurred in 5% of cases. NV caused severe disease relative to other TD-associated pathogens identified, confining over 90% of infected individuals to bed. Destination-specific risk factors include consumption of the local beverage “chicha,” which was associated with Cryptosporidium infection. Preventive interventions, such as vaccines, directed against these pathogens could significantly reduce the burden of TD.
Highlights
Current health-related guidelines and dietary precautions have little evidence of effect on the incidence of travelers’ diarrhea (TD).[5,6,7] most patients with TD experience spontaneous symptom resolution, some may experience symptoms for weeks,[8] and up to half of travelers change travel plans as a result of symptoms.[5]Of note, immunocompromised patients from high-income countries are traveling at increasing rates, and their increased risk for developing disease highlights the importance of providing effective preventive recommendations and measures for such complex patients.[9]
During the 7-year passive surveillance period, 230 adults (66% female) aged 18–76 years with diarrhea were enrolled in the study (Table 1)
During the week before presenting with diarrhea, 47% of participants ate the majority of meals in a restaurant, 15.2% in a friend’s home, 13% in a hotel, and 24.8% in an “other” location (Table 1)
Summary
Current health-related guidelines and dietary precautions have little evidence of effect on the incidence of TD.[5,6,7]. In Cusco, and South America in general, the specific etiologies of TD have not been well evaluated, and the clinical features associated with pathogen-specific infections, along with destination-specific risk behaviors, remain largely uncharacterized. Understanding these factors would allow travel medicine providers to tailor interventions to patients’ risk profiles and travel destination.[2]. JENNINGS AND OTHERS describe the etiology of medically attended TD, evaluate regional risk factors, and examine relationships between preventive recommendations and risk-taking behaviors among medium- to long-term travelers from high-income countries, we conducted this case–case analysis of 7 years of prospective surveillance data from adults presenting to a physician in Cusco with TD
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