Global Etiology of Travelers’ Diarrhea: Systematic Review from 1973 to the Present

Abstract

Fifty-one published studies of travelers' diarrhea (TD) were examined to look for regional differences in pathogens identified. Enterotoxigenic E. coli was detected in 1,678/5,518 (30.4%) of TD cases overall, with rates in Latin America/Caribbean (L. America), Africa, south Asia, and Southeast Asia of 1,109/3,302 (33.6%), 389/1,217 (31.2%), 153/499 (30.6%), and 36/500 (7.2%), respectively (P < 0.001). Enteroaggregative E. coli was the second most common agent in L. America, found in 166/689 (24.1%), compared with 3/165 (1.8%) in Africa and 33/206 (16%) in south Asia (P < 0.001). Other significantly regional differences were seen for enteropathogenic E. coli, diffusely adherent E. coli, Campylobacter, Shigella spp., Salmonella, Aeromonas spp., Plesiomonas, Vibrios, rotavirus, noroviruses, Giardia, and Entoamoeba histolytica. The regional differences in pathogen identification identified will serve as a baseline for antimicrobial therapy recommendations and vaccines strategies.

Enterotoxigenic Escherichia coli associated with childhood diarrhoea in Colombia, South America

“…Several countries in the world report ETEC as the most common cause of diarrhoea among all E. coli intestinal pathotypes, among them Bangladesh, Egypt and Mexico [36][37][38]. In addition, ETEC is known to be the most frequent cause of traveller's diarrhoea [39][40][41]. In other countries in Latin America, however, ETEC may not be as frequent as in Colombia.…”

Traveler's Diarrhea in Foreign Travelers in Southeast Asia: A Cross-Sectional Survey Study in Bangkok, Thailand

“…2 It should be noted that pathogen-negative diarrhea was also common in travelers. 2,16,18 Food poisoning or food intolerance might be another cause of diarrhea among this group.…”

Characteristics of the enteroaggregative Shiga toxin/verotoxin-producing Escherichia coli O104:H4 strain causing the outbreak of haemolytic uraemic syndrome in Germany, May to June 2011

“…Further, the role of EAggEC as an important pathogen in AIDS patients continues to develop, and EAggEC now ranks among the most important enteric pathogens in this population group [36,37]. In a recent review of all published studies of traveller's diarrhoea, EAggEC was in aggregate second only to ETEC as the most common pathogen [38]. The first reported EAggEC outbreaks occurred in Mexico City before 1993 (year unpublished) where persistent diarrhoea was reported.…”