Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Finland.
Helsinki University Hospital Laboratory (HUSLAB), Department of Bacteriology, Finland.
Travel Med Infect Dis. 2021 Mar-Apr;40:101957. doi: 10.1016/j.tmaid.2020.101957. Epub 2020 Dec 25.
The diagnostics of travellers' diarrhoea (TD) has been revolutionised by multiplex qPCR assays. While mostly of bacterial aetiology, viruses and parasites account for the disease among 10-20% of travellers. Despite this, prospective studies applying qPCR assays remain scarce that cover not only bacteria, such as the various diarrhoeagenic Escherichia coli (DEC), but also viral and parasitic pathogens.
We analysed by qPCR pre- and post-travel stool samples of 146 Finnish travellers for bacterial, viral and parasitic pathogens: enteropathogenic (EPEC), enteroaggregative (EAEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC), and enteroinvasive (EIEC) E. coli; Shigella, Campylobacter, Salmonella, Yersinia and Vibrio cholerae; norovirus G1 and G2, rotavirus, enteroviruses, and sapovirus; and Giardia lamblia, Entamoeba histolytica, and Cryptosporidium. Symptoms and medication data during travel were collected by questionnaires.
We detected bacterial pathogens in 102/146 samples (69.9%; EAEC, EPEC, ETEC most common), viral ones in 13 (8.9%; norovirus most common), and parasitic ones in one (0.7%; Giardia). Noroviruses were associated with severe symptoms (23.5% versus non-severe 4.9%). In the TD group, 41.7% (5/12) of those with viral pathogens (vs. 13.3%; 11/83 without) took antibiotics.
Viral pathogens, particularly noroviruses, prevail in severe TD. The symptoms of viral disease are often severe and lead to unwarranted use of antibiotics.
旅行者腹泻（TD）的诊断已经被多重 qPCR 检测方法所革新。尽管旅行者腹泻 10-20%的病因是病毒和寄生虫，但这些病原体主要是细菌引起的，如各种致腹泻性大肠杆菌（DEC）。然而，应用 qPCR 检测方法的前瞻性研究仍然很少，这些研究不仅涵盖细菌，如肠致病性（EPEC）、肠聚集性（EAEC）、肠毒性（ETEC）、肠出血性（EHEC）和肠侵袭性（EIEC）大肠杆菌，还涵盖病毒和寄生虫病原体。
我们通过 qPCR 分析了 146 名芬兰旅行者旅行前后的粪便样本，以检测细菌、病毒和寄生虫病原体：肠致病性（EPEC）、肠聚集性（EAEC）、肠毒性（ETEC）、肠出血性（EHEC）和肠侵袭性（EIEC）大肠杆菌；志贺氏菌、弯曲菌、沙门氏菌、耶尔森氏菌和霍乱弧菌；诺如病毒 G1 和 G2、轮状病毒、肠道病毒和星状病毒；以及蓝氏贾第鞭毛虫、溶组织内阿米巴和隐孢子虫。旅行期间通过问卷调查收集症状和用药数据。
我们在 146 个样本中的 102 个（69.9%；EAEC、EPEC、ETEC 最常见）中检测到细菌病原体，在 13 个（8.9%；诺如病毒最常见）中检测到病毒病原体，在 1 个（0.7%；蓝氏贾第鞭毛虫）中检测到寄生虫病原体。诺如病毒与严重症状相关（23.5%比非严重症状 4.9%）。在 TD 组中，12 名有病毒病原体的患者中有 41.7%（5/12）（vs. 83 名无病毒病原体的患者中有 13.3%（11/83））服用了抗生素。
病毒病原体，特别是诺如病毒，在严重 TD 中占主导地位。病毒疾病的症状通常很严重，导致不必要地使用抗生素。
