Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD 20910-7500, USA.
Diagn Microbiol Infect Dis. 2010 Mar;66(3):241-7. doi: 10.1016/j.diagmicrobio.2009.10.002. Epub 2009 Nov 10.
This study evaluated travelers' diarrhea among US military personnel on short-term deployment to Incirlik Air Base, Turkey, from June through September 2002. Upon reporting for care for travelers' diarrhea, subjects were enrolled into the study and completed a series of questionnaires and provided stool specimens for pathogen identification and antimicrobial susceptibility testing. Fifty-three percent of the 202 participating subjects had a pathogen isolated from their stool. Enterotoxigenic Escherichia coli (ETEC) was the predominant pathogen (41%), followed by Campylobacter spp. (12%). The most common ETEC phenotype recovered was stable toxin (ST) CS6 (47% of all ETEC). Most (91.1%) of the cases presented with water diarrhea regardless of isolated pathogen. However, there were some differences in nongastrointestinal symptoms among subjects with Campylobacter spp. All illnesses were well managed with antibiotics with or without loperamide with a median time to the last unformed stool of 9 h (interquartile range, 1-32 h). We found no food or environmental factors associated with a differential risk of infection with a specific pathogen. Travelers' diarrhea among a US military population in and around Incirlik, Turkey, can commonly be attributed to ETEC and Campylobacter spp. The high proportion of ST-only-producing CS6 ETEC in this region highlights the pathogen's worldwide diversity. Future studies of travelers' diarrhea in this population should adapt more novel microbiologic techniques such as polymerase chain reaction and enhanced culture methods to increase the likelihood of identifying pathogenic E. coli.
本研究评估了 2002 年 6 月至 9 月期间短期部署到土耳其因切尔利克空军基地的美国军事人员中的旅行者腹泻。在因旅行者腹泻寻求治疗时，研究对象被纳入研究并完成了一系列问卷，并提供粪便标本进行病原体鉴定和抗菌药物敏感性测试。在 202 名参与研究的对象中，有 53%的人从粪便中分离出病原体。肠产毒性大肠杆菌（ETEC）是主要病原体（41%），其次是弯曲菌属（12%）。恢复的最常见 ETEC 表型是稳定毒素（ST）CS6（所有 ETEC 的 47%）。无论分离出的病原体如何，大多数（91.1%）病例均表现为水样腹泻。然而，在弯曲菌属病例中，非胃肠道症状存在一些差异。所有疾病均通过抗生素（无论是否使用洛哌丁胺）进行了良好的管理，最后一次不成形粪便的中位数时间为 9 小时（四分位间距，1-32 小时）。我们没有发现与特定病原体感染风险差异相关的食物或环境因素。在土耳其因切尔利克及其周边地区的美国军事人群中，旅行者腹泻通常可归因于 ETEC 和弯曲菌属。该地区 ST 仅产生 CS6 ETEC 的高比例突出了该病原体在全球范围内的多样性。在该人群中进行旅行者腹泻的未来研究应采用更新型的微生物学技术，如聚合酶链反应和增强的培养方法，以提高鉴定致病性大肠杆菌的可能性。
