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Traveler's diarrhea [keywords]
- Morbidity and outcomes of foreign travelers in zakynthos island, Greece: a retrospective study. [Journal Article]
- PLoS One 2014; 9(4):e94416.
Although there is satisfactory recording of diseases affecting travelers visiting developing countries, little is known regarding morbidity of travelers when visiting developed countries. We sought to evaluate the morbidity of foreign travelers in Zakynthos, a popular Greek island attracting large number of foreign tourists every summer.Data from foreign travelers that accommodated in Zakynthos and sought medical services from the private offices of Zante Medical Care from May 1 to October 30 2012 were retrospectively analyzed.Two thousand six hundred and eighty-eight patients were included in the study. The mean age (±SD) of the patients whom the age was recorded was 29.6 (±18.3) and 51.5% of them were from 18 to 40 years old. Disorders of the respiratory tract (32.7%), dermatologic conditions (21.1%), musculoskeletal injuries (16.4%), and gastrointestinal disorders (16.3%) were the four most prevalent clinical categories among patients. Ear disorder was the most common syndromic description (14.5%) among which 81.2% were ear infections; otitis externa and otitis media were diagnosed in 8.5% and 3.3% patients in total. The most common specific diagnosis was gastroenteritis (14.3%). Insect bite and sunburn were the most common diagnosis (6.5% and 3.8%, respectively) among patients with a dermatologic condition. Ear infection was the most common diagnosis in pediatric patients.Disorders mainly of the upper respiratory tract were the predominant causes of illness among foreign travelers in Zakynthos. Traveler's diarrhea was the most common specific diagnosis but the prevalence within the total population was not very high.
- Does Tropheryma whipplei contribute to travelers' diarrhea?: A PCR analysis of paired stool samples in French travelers to Senegal. [JOURNAL ARTICLE]
- Travel Med Infect Dis 2014 Feb 28.
Tropheryma whipplei was recently associated with acute infections as gastroenteritis in children. We hypothesize that T. whipplei may be a contributing microbe in traveler's diarrhea.The presence of T. whipplei was investigated by using a specific PCR on stool samples of travelers to Senegal before and after traveling, independently of the occurrence of diarrhea.A total of 59 travelers returned both stool samples before and after travel and 16 (27%) experienced diarrhea during travel. Fifty-three patients (89.8%) were negative for T. whipplei before and after travel. Two patients (3.4%) were negative before and positive after travel. Two patients (3.4%) were positive before travel and negative after travel. Finally, two patients (3.4%) were positive before and after travel. There were no carriage differences of T. whipplei, visiting Senegal or staying in France. We found no significant association of T. whipplei carriage and travel-associated diarrhea but this may have been impacted by the use of doxycycline.This is the first report of T. whipplei carriage acquired during travel to tropical area. Further study addressing this issue in larger cohorts of travelers to Senegal, including individuals visiting friends and relatives in their country of origin and the protective role of doxycycline malaria chemoprophylaxis may help to understand the potential contribution of T. whipplei to travelers' diarrhea.
- Arginine deiminase pathway is far more important than urease for acid resistance and intracellular survival in Laribacter hongkongensis: a possible result of arc gene cassette duplication. [Journal Article, Research Support, Non-U.S. Gov't]
- BMC Microbiol 2014.:42.
Laribacter hongkongensis is a Gram-negative, urease-positive bacillus associated with invasive bacteremic infections in liver cirrhosis patients and fish-borne community-acquired gastroenteritis and traveler's diarrhea. Its mechanisms of adaptation to various environmental niches and host defense evasion are largely unknown. During the process of analyzing the L. hongkongensis genome, a complete urease cassette and two adjacent arc gene cassettes were found. We hypothesize that the urease cassette and/or the arc gene cassettes are important for L. hongkongensis to survive in acidic environment and macrophages. In this study, we tested this hypothesis by constructing single, double and triple non-polar deletion mutants of the urease and two arc gene cassettes of L. hongkongensis using the conjugation-mediated gene deletion system and examining their effects in acidic environment in vitro, in macrophages and in a mouse model.HLHK9∆ureA, HLHK9∆ureC, HLHK9∆ureD and HLHK9∆ureE all exhibited no urease activity. HLHK9∆arcA1 and HLHK9∆arcA2 both exhibited arginine deiminase (ADI) activities, but HLHK9∆arcA1/arcA2 double deletion mutant exhibited no ADI activity. At pH 2 and 3, survival of HLHK9∆arcA1/arcA2 and HLHK9∆ureA/arcA1/arcA2 were markedly decreased (p < 0.001) but that of HLHK9∆ureA was slightly decreased (p < 0.05), compared to wild type L. hongkongensis HLHK9. Survival of HLHK9∆ureA/arcA1/arcA2 and HLHK9∆arcA1/arcA2 in macrophages were also markedly decreased (p < 0.001 and p < 0.01 respectively) but that of HLHK9∆ureA was slightly decreased (p < 0.05), compared to HLHK9, although expression of arcA1, arcA2 and ureA genes were all upregulated. Using a mouse model, HLHK9∆ureA exhibited similar survival compared to HLHK9 after passing through the murine stomach, but survival of HLHK9∆arcA1/arcA2 and HLHK9∆ureA/arcA1/arcA2 were markedly reduced (p < 0.01).In contrast to other important gastrointestinal tract pathogens, ADI pathway is far more important than urease for acid resistance and intracellular survival in L. hongkongensis. The gene duplication of the arc gene cassettes could be a result of their functional importance in L. hongkongensis.
- Acute diarrhea. [Journal Article]
- Am Fam Physician 2014 Feb 1; 89(3):180-9.
Acute diarrhea in adults is a common problem encountered by family physicians. The most common etiology is viral gastroenteritis, a self-limited disease. Increases in travel, comorbidities, and foodborne illness lead to more bacteria-related cases of acute diarrhea. A history and physical examination evaluating for risk factors and signs of inflammatory diarrhea and/or severe dehydration can direct any needed testing and treatment. Most patients do not require laboratory workup, and routine stool cultures are not recommended. Treatment focuses on preventing and treating dehydration. Diagnostic investigation should be reserved for patients with severe dehydration or illness, persistent fever, bloody stool, or immunosuppression, and for cases of suspected nosocomial infection or outbreak. Oral rehydration therapy with early refeeding is the preferred treatment for dehydration. Antimotility agents should be avoided in patients with bloody diarrhea, but loperamide/simethicone may improve symptoms in patients with watery diarrhea. Probiotic use may shorten the duration of illness. When used appropriately, antibiotics are effective in the treatment of shigellosis, campylobacteriosis, Clostridium difficile, traveler's diarrhea, and protozoal infections. Prevention of acute diarrhea is promoted through adequate hand washing, safe food preparation, access to clean water, and vaccinations.
- Commercializing diarrhea vaccines for travelers. [REVIEW]
- Hum Vaccin Immunother 2014 Feb 4; 10(6)
Continued growth in international travel and forecasts for a great increase in the number of people who travel from industrialized to emerging and developing countries make it necessary to develop and improve the capacity to provide health protection to travelers. Measures available to prevent some diseases include a currently limited number of marketed vaccines which represent extremely useful tools to protect travelers. Travelers very often experience diarrheal and gastrointestinal diseases for which some vaccines are available. Use of these vaccines should be evaluated based on traveler and travel destination and characteristics. Vaccines available include those against cholera, typhoid fever, hepatitis A, hepatitis E (only available in China), and rotavirus. The aim of this review is to provide an updated summary about each of the abovementioned vaccines that may be useful for making decisions regarding their use and assessing their indications in recommendations for travelers.
- Effects of pre-deployment loperamide provision on use and travelers' diarrhea outcomes among U.S. military personnel deployed to Turkey. [JOURNAL ARTICLE]
- Travel Med Infect Dis 2014 Jan 21.
This study assessed the efficacy of education and self-treatment with loperamide on diarrhea morbidity and healthcare utilization in a deployed military setting.In this prospective, controlled study, volunteers from military personnel deployed to Incirlik Air Base received either travelers' diarrhea education (non-loperamide group) or education plus a supply of loperamide (loperamide group). Volunteers were surveyed to determine frequency and outcomes of diarrheal illness.109 deployed personnel were enrolled with 48 assigned to the loperamide group, and 61 to the non-loperamide group. Overall, 41 (38%) service members had at least one diarrheal episode. Only 10 (9%) service members sought treatment from a healthcare provider and the distribution was similar in both groups. Loperamide use for self-treatment was more common in the loperamide group (85%) vs. (57%), [p = 0.02]) but use of antibiotics was similar in both groups (loperamide (30%) vs. non-loperamide (20%).Provision of loperamide and education did not significantly affect healthcare utilization or antibiotic use to manage diarrheal episodes, when compared to education alone. Further prospective studies will either need a very large patient population to power them or should use other primary end points such a functional assessment in addition to seeking care.
- Recovery of Cyclospora cayetanensis among asymptomatic rural Thai schoolchildren. [Journal Article, Research Support, Non-U.S. Gov't]
- Asian Pac J Trop Med 2014 Feb; 7(2):119-23.
To obtain the prevalence with clinical symptoms of Cyclospora cayetanensis (C. cayetanensis), a coccidian protozoan parasite, in Thailand which is the cause of an intestinal infection characterized by sporadic-to-frequent explosive diarrhea.In a field survey conducted by the Faculty of Tropical Medicine, Mahidol University, as part of the existing parasite-control program, a total of 2 540 faecal samples from villagers in Nan Province, Thailand, were collected and examined to determine the prevalence and clinical characteristics of parasitic infections.Twelve cases of C. cayetanensis infection were found during faecal examination of schoolchildren aged 5-12 years. None exhibited obvious clinical symptoms, especially evidence of diarrhea; 5 of 12 had loose faeces, one reported frequent symptoms of abdominal discomfort, and another had pale conjunctiva with low hematocrit. The children were generally asymptomatic.This finding confirms a public-health issue with potentially serious consequences whereby children can be exposed to an environment contaminated with food-and water-borne transmitted oocysts, and can hence become infected with C. cayetanensis.
- A CssA, CssB and LTB chimeric protein induces protection against Enterotoxigenic Escherichia coli. [JOURNAL ARTICLE]
- Braz J Infect Dis 2014 Jan 3.
Enterotoxigenic Escherichia coli (ETEC), a major cause of diarrhea in children under 5, is an important agent for traveler's diarrhea. Heat-labile enterotoxin (LT) and colonization factors (CFs) are two main virulence mechanisms in ETEC. CS6 is one of the most prevalent CFs consisting of two structural subunits viz., CssA, CssB, necessary for attachment to the intestinal cells.In the present research, a chimeric trivalent protein composed of CssB, CssA and LTB was constructed. The chimeric gene was synthesized with codon bias of E. coli for enhanced expression of the protein. Recombinant proteins were expressed and purified. Mice were immunized with the recombinant protein. The antibody titer and specificity of the immune sera were analyzed by ELISA and Western blotting. Efficiency of the immune sera against ETEC was evaluated.Antibody induction was followed by immunization of mice with the chimeric protein. Pretreatment of the ETEC cells with immunized animal antisera remarkably decreased their adhesion to Caco-2 cells.The results indicate efficacy of the recombinant chimeric protein as an effective immunogen, which induces strong humoral response as well as protection against ETEC adherence and toxicity.
- Cytokeratin 8 is an epithelial cell receptor for Pet, a cytotoxic serine protease autotransporter of Enterobacteriaceae. [Journal Article, Research Support, Non-U.S. Gov't]
- MBio 2013; 4(6):e00838-13.
The group of proteins known as serine protease autotransporters of Enterobacteriaceae (SPATE) is a growing family of serine proteases secreted to the external milieu by the type V secretion system. Pet toxin and some other SPATE belong to the class 1 cytotoxic SPATE, which have comparable protease strength on fodrin. Pet is internalized and is directed to its intracellular substrate by retrograde transport. However, the epithelial cell receptor for Pet has yet to be identified. We show that Pet has affinity for the epithelial cell surface until the saturation of the binding sites at 100 nM Pet. Affinity column assays and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis identified a cytokeratin (CK8) which directly binds to Pet, and both proteins colocalized on the cell surface. Interestingly, CK8 is not present in kidney cell lines, which are not susceptible to Pet. Inhibition experiments by using anti-CK8 and ck8 small interfering RNA (siRNA) blocked the cytotoxic effect induced by Pet, while exogenous CK8 expression in kidney cells made them susceptible to Pet intoxication. Recombinant CK8 showed a Pet-binding pattern similar to that seen by using fixed cells. Remarkably, Pet colocalized with CK8 and clathrin at early times (receptor-mediated endocytosis), and subsequently, Pet colocalized with CK8 and Rab5b in the early endosomes. These data support the idea that CK8 is an important receptor for Pet on epithelial cells for starting its cytotoxic effects. These data suggest that therapeutics that block Pet-CK8 interaction may improve outcome of diseases caused by Pet-secreting Enterobacteriaceae such as enteroaggregative Escherichia coli.Receptor-ligand binding is one mechanism by which cells sense and respond to external cues. Receptors may also be utilized by toxins to mediate their own internalization. Pet toxin is secreted by enteroaggregative Escherichia coli, an organism that causes persistent diarrhea in children, traveler's diarrhea, and acute and persistent diarrhea in patients with HIV. Pet is a member of the family of serine protease autotransporters of Enterobacteriaceae (SPATE). SPATE in different pathogens are virulence factors, and Pet belongs to the class 1 cytotoxic SPATE, which have comparable protease strength on their biological substrate, fodrin (a cytoskeletal protein important for maintaining cell viability). To cleave fodrin, Pet enters the cells by clathrin-mediated endocytosis. This mechanism includes receptor-mediated endocytosis (a receptor-ligand complex triggers the endocytosis). We show that CK8 is an important receptor for Pet on epithelial cells and that it may be useful for identifying molecules that block the interaction of CK8 with Pet.
- The therapeutic effect of probiotic bacteria on gastrointestinal diseases. [Journal Article, Review]
- Adv Clin Exp Med 2013 Sep-Oct; 22(5):759-66.
The cause of many gastrointestinal diseases, such as irritable bowel syndrome, chronic inflammatory bowel disease: inflammatory and necrotizing enterocolitis or diarrhea: infectious, traveler's diarrhea, and diarrhea caused by antibiotic treatment is an imbalance of intestinal microflora. Probiotics are live microorganisms, which administered in sufficient quantities, have beneficial health effects. The phenomenon of eating probiotic products started 100 years ago, when the first reports showed beneficial effects of probiotic bacteria on human health. Since then, probiotic preparations have become an essential element in the prevention and treatment of certain diseases. Currently, probiotics are of the utmost importance in supporting the treatment of gastrointestinal diseases and autoimmune disorders. Probiotic microorganisms are primarily lactic acid-producing bacteria of the general Lactobacillus, Bifidobacterium. Many studies have confirmed the beneficial effects of probiotics, particularly in the treatment of acute diarrhea. This applies in particular to diarrhea of viral etiology, especially in infants and young children.