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Review: chronic and persistent diarrhea with a focus in the returning traveler.

Abstract

BACKGROUND

Travelers' diarrhea is a common malady afflicting up to 50% of travelers after a 2-week travel period. An appreciable percentage of these cases will become persistent or chronic. We summarized the published literature reporting persistent/chronic diarrhea in travelers elucidating current understanding of disease incidence, etiology and regional variability.

METHODS

We searched electronic databases (Medline, Embase, and Cochrane database of clinical trials) from 1990 to 2015 using the following terms: "chronic or persistent diarrh* and (returning) travel* or enteropathogen, GeoSentinel, and travel-associated infection. Included studies published in the English language on adult returning travelers (duration < 3-months) reporting denominator data. Point estimates and standard 95% confidence intervals were calculated for incidence using a random-effects model. Study incidence heterogeneity rates were assessed using x2 heterogeneity statistics, graphically represented with Forest plots.

RESULTS

We identified 19 studies meeting the inclusion criteria (all published after 1999). 18 studies reported upon the incidence of persistent/chronic diarrhea as a syndromic diagnosis in returning travelers; one study reported adequate denominator data from which to assess pathogen specific etiology. Giardiasis comprise an appreicaible percentage of infectious mediated persistent/chronic diarrhea in returning travelers. The overall estimate of persistent/chronic diarrhea incidence was 6% (0.05-0.07) in 321,454, travelers; with significant heterogeniety observed across regions. The total number of regional travelers, and point estimates for incidence (95% CI) for Latin American, African, and Asian travelers were [15816 (0.09 [0.07-0.11]), 42290 (0.06 [0.05-0.07]), and 27433 (0.07 [0.06-0.09])] respectively. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Persistent/chronic diarrhea ranked fourth as a syndromic diagnosis in all regions.

CONCLUSIONS

Persistent/Chronic diarrhea is a leading syndromic diagnosis in returning travelers across all regions. The 6% incidence [proportionate morbidity (PM) of 60] observed in over >300,000 global travelers is comparable to prior estimates. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Giardiasis comprises an appreciabile percentatge of travel-associated infectious mediated persistent/chronic diarrhea. There's a dearth of published data characterizing the incidence of specific enteropathogenic etiologies for persistent/chronic diarrhea in returning travelers.

Authors+Show Affiliations

Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA.Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA.Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910 USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28883979

Citation

Duplessis, Christopher A., et al. "Review: Chronic and Persistent Diarrhea With a Focus in the Returning Traveler." Tropical Diseases, Travel Medicine and Vaccines, vol. 3, 2017, p. 9.
Duplessis CA, Gutierrez RL, Porter CK. Review: chronic and persistent diarrhea with a focus in the returning traveler. Trop Dis Travel Med Vaccines. 2017;3:9.
Duplessis, C. A., Gutierrez, R. L., & Porter, C. K. (2017). Review: chronic and persistent diarrhea with a focus in the returning traveler. Tropical Diseases, Travel Medicine and Vaccines, 3, 9. https://doi.org/10.1186/s40794-017-0052-2
Duplessis CA, Gutierrez RL, Porter CK. Review: Chronic and Persistent Diarrhea With a Focus in the Returning Traveler. Trop Dis Travel Med Vaccines. 2017;3:9. PubMed PMID: 28883979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Review: chronic and persistent diarrhea with a focus in the returning traveler. AU - Duplessis,Christopher A, AU - Gutierrez,Ramiro L, AU - Porter,Chad K, Y1 - 2017/05/04/ PY - 2015/06/20/received PY - 2017/04/18/accepted PY - 2017/9/9/entrez PY - 2017/9/9/pubmed PY - 2017/9/9/medline KW - Chronic diarrhea KW - Enteropathogens KW - GeoSentinel surveillance KW - Giardiasis KW - Persistent diarrhea KW - Post-infectious irritable bowel syndrome KW - Travelers’ diarrhea SP - 9 EP - 9 JF - Tropical diseases, travel medicine and vaccines JO - Trop Dis Travel Med Vaccines VL - 3 N2 - BACKGROUND: Travelers' diarrhea is a common malady afflicting up to 50% of travelers after a 2-week travel period. An appreciable percentage of these cases will become persistent or chronic. We summarized the published literature reporting persistent/chronic diarrhea in travelers elucidating current understanding of disease incidence, etiology and regional variability. METHODS: We searched electronic databases (Medline, Embase, and Cochrane database of clinical trials) from 1990 to 2015 using the following terms: "chronic or persistent diarrh* and (returning) travel* or enteropathogen, GeoSentinel, and travel-associated infection. Included studies published in the English language on adult returning travelers (duration < 3-months) reporting denominator data. Point estimates and standard 95% confidence intervals were calculated for incidence using a random-effects model. Study incidence heterogeneity rates were assessed using x2 heterogeneity statistics, graphically represented with Forest plots. RESULTS: We identified 19 studies meeting the inclusion criteria (all published after 1999). 18 studies reported upon the incidence of persistent/chronic diarrhea as a syndromic diagnosis in returning travelers; one study reported adequate denominator data from which to assess pathogen specific etiology. Giardiasis comprise an appreicaible percentage of infectious mediated persistent/chronic diarrhea in returning travelers. The overall estimate of persistent/chronic diarrhea incidence was 6% (0.05-0.07) in 321,454, travelers; with significant heterogeniety observed across regions. The total number of regional travelers, and point estimates for incidence (95% CI) for Latin American, African, and Asian travelers were [15816 (0.09 [0.07-0.11]), 42290 (0.06 [0.05-0.07]), and 27433 (0.07 [0.06-0.09])] respectively. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Persistent/chronic diarrhea ranked fourth as a syndromic diagnosis in all regions. CONCLUSIONS: Persistent/Chronic diarrhea is a leading syndromic diagnosis in returning travelers across all regions. The 6% incidence [proportionate morbidity (PM) of 60] observed in over >300,000 global travelers is comparable to prior estimates. We identified lower published rates of chronic diarrhea from Sub-Saharan Africa relative to [North Africa, South Central Asia, and Central America]. Giardiasis comprises an appreciabile percentatge of travel-associated infectious mediated persistent/chronic diarrhea. There's a dearth of published data characterizing the incidence of specific enteropathogenic etiologies for persistent/chronic diarrhea in returning travelers. SN - 2055-0936 UR - https://www.unboundmedicine.com/medline/citation/28883979/full_citation L2 - https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-017-0052-2 DB - PRIME DP - Unbound Medicine ER -
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