Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20249, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany.
Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20249, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany.
Travel Med Infect Dis. 2020 Sep-Oct;37:101706. doi: 10.1016/j.tmaid.2020.101706. Epub 2020 Apr 27.
Travelers' diarrhea (TD) is the most common illness experienced by travelers to developing regions of the world and may be caused by bacterial, parasitic or viral pathogens. The available diagnostic tests include stool microscopy for parasitic infections, culture-dependent methods for bacterial infections and molecular methods for bacterial, parasitic and viral infections.
We retrospectively evaluated demographic, clinical and microbiological data of patients presenting with TD at our travel clinic between 2009 and 2017.
Among 676 patients with TD included in our study, at least one etiologic agent was found in 21% (n = 145) of cases. In total, 195 enteropathogens were detected of which 110 were bacteria, 70 protozoa and 15 helminths. Bacterial infections were significantly more common when symptoms were present less than 14 days and travel duration did not exceed 29 days. Protozoa and helminths were predominantly detected in patients with longer lasting complaints. After stool culture was replaced by a multiplex-PCR gastrointestinal pathogen panel (GPP) at our center, significantly more intestinal bacterial pathogens were detected.
Our results support an individualized approach in the diagnostic workup of patients with TD taking host and travel characteristics into account to avoid unnecessary diagnostic testing. Molecular culture-independent diagnostic stool tests provide better coverage of the variety of etiological agents than traditional stool culture and have the benefit of rapid detection. However, the high sensitivity bears challenges differentiating colonization from infection.
旅行者腹泻（TD）是前往世界发展中地区的旅行者最常见的疾病，可能由细菌、寄生虫或病毒病原体引起。现有的诊断检测方法包括寄生虫感染的粪便显微镜检查、细菌感染的基于培养的方法和细菌、寄生虫和病毒感染的分子方法。
我们回顾性评估了 2009 年至 2017 年期间在我们旅行诊所就诊的 TD 患者的人口统计学、临床和微生物学数据。
在我们的研究中，676 例 TD 患者中，至少有 1 种病原体在 21%（n=145）的病例中被发现。总共检测到 195 种肠病原体，其中 110 种为细菌，70 种为原生动物，15 种为寄生虫。当症状持续不到 14 天且旅行时间不超过 29 天时，细菌感染更为常见。持续时间较长的患者主要检测到寄生虫和寄生虫。在我们中心用多重 PCR 胃肠道病原体检测试剂盒（GPP）替代粪便培养后，显著增加了肠道细菌病原体的检测数量。
我们的结果支持根据宿主和旅行特征对 TD 患者进行个体化诊断，以避免不必要的诊断检测。与传统粪便培养相比，分子培养独立的诊断性粪便检测能更好地覆盖各种病原体，但高敏感性带来了区分定植和感染的挑战。
