Epidemiology of travelers' diarrhea: details of a global survey.

Background: Recent epidemiologic data on travelers' diarrhea (TD) are essential for the evaluation of conventional and future prophylactic and therapeutic measures.

Methods: To determine the epidemiology, including risk factors, impact and quality-of-life evaluation of TD, a cross-sectional survey was conducted over 12 months at the airports of Mombasa (Kenya), Goa (India), Montego Bay (Jamaica) and Fortaleza (Brazil) by distributing questionnaires to visitors just prior to their flying home. The study period was March 1996 to July 1998.

Influence of rifaximin treatment on the susceptibility of intestinal Gram-negative flora and enterococci.

The development of rifaximin- and rifampicin-resistant intestinal coliforms was studied in 27 subjects receiving rifaximin for 3 days by plating stool samples on media containing rifaximin 200 mg/L or rifampicin 64 mg/L before treatment (day 0), after treatment was completed (day 3), and after a further 2 days (day 5). The susceptibility of enterococci grown on day 0 and day 3 was also studied in 71 subjects. Significant increases in antimicrobial-resistant coliform flora were not seen in either the rifaximin-treated or the placebo-treated subjects.

Enteroaggregative Escherichia coli: an emerging pathogen in children.

Enteroaggregative Escherichia coli (EAEC) is an emerging pathogen that causes enteric and food-borne infectious diseases. Children throughout the world appear to be susceptible to EAEC infection. EAEC pathogenesis involves the following three stages: 1) adherence to the intestinal mucosa; 2) increased production and deposition of a mucus biofilm; and 3) mucosal toxicity due to inflammation and cytokine release.

The role of diet in the treatment of travelers' diarrhea: a pilot study.

A pilot study was performed to compare the effects of a restricted physiologic diet in 48 subjects with those of an unrestricted diet in 57 subjects on the duration and symptoms of acute travelers' diarrhea among US adults being treated with an antimicrobial agent in Mexico. Restricted physiologic diet was defined as the avoidance of certain foods during diarrheal illness, as specified in limited published literature. The mean duration of diarrhea (37 vs.

Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico.

Objectives: Irritable bowel syndrome (IBS) has been reported to complicate bacterial diarrhea. Because of the frequency of international travel and the common occurrence of bacterial diarrhea, we studied the occurrence of chronic gastrointestinal complaints and post-diarrhea IBS in North U.S.

Interleukin-8 response in an intestinal HCT-8 cell line infected with enteroaggregative and enterotoxigenic Escherichia coli.

This study examined the interleukin-8 (IL-8) response of the intestinal adenocarcinoma HCT-8 cell line to infection with enteroaggregative and enterotoxigenic Escherichia coli pathotypes isolated from patients with travelers' diarrhea. Individual diarrheagenic E. coli strains (enteroaggregative E.

Enteroaggregative Escherichia coli: an emerging enteric pathogen.

Enteroaggregative Escherichia coli (EAEC) represents an emerging pathogen that causes enteric and food-borne infectious diseases. Subgroups in many populations throughout the world are susceptible to EAEC infection. EAEC pathogenesis involves adherence to the intestinal mucosa; increased production and deposition of a mucus biofilm; and mucosal toxicity due to inflammation and cytokine release.

Enteroaggregative Escherichia coli diarrhea in travelers: response to rifaximin therapy.

Background And Aims: We have recently shown that enteroaggregative Escherichia coli (EAEC) strains commonly cause travelers' diarrhea. The study was designed to determine whether U.S.

Association of virulence factor-positive and -negative enteroaggregative Escherichia coli and occurrence of clinical illness in travelers from the United States to Mexico.

The objective of the study was to determine if the presence or absence of virulence factor-positive and -negative enteroaggregative Escherichia coli (EAEC) determined the occurrence of illness or sub-clinical EAEC infection in travelers from the United States to Mexico. Sixty-five newly arrived college students from the United States submitted weekly stool samples for a four-week period of time. Among EAEC-infected subjects, diarrhea occurred in those with a defined virulence factor with the following frequency: aggA, 5 of 15 (33%); aggR, 3 of 11 (27%); aafA, 3 of 8 (38%); and aspU, 1 of 6 (17%).

Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico.

Increased drug resistance among enteropathogens is an emergent problem in travelers' diarrhea. This randomized, double-blind trial was conducted in Guadalajara, Mexico, during the summers of 1999-2001 to compare azithromycin with levofloxacin for the treatment of travelers' diarrhea. A total of 217 US adults were randomized to receive a single oral dose of azithromycin (1000 mg; 108 persons) or levofloxacin (500 mg; 109 persons), with a follow-up period of 4 days.

Travel health information at commercial travel websites.

Background: Internet travel purchases accounted for 10% of the travel industry revenue generated in 2001. To ensure that travelers remain healthy during excursions to developing countries, travel health information needs to be available at commercial travel websites. We evaluated the current availability of travel health information at these websites.

Intestinal immunoglobulin a response to naturally acquired enterotoxigenic Escherichia coli in US travelers to an endemic area of Mexico.

Background: Simple methods for detecting secretory immunoglobulin A (sIgA) immune responses following natural enteric infection and oral immunization are needed.

Methods: Fourteen students from the United States acquiring enterotoxigenic Escherichia coli (ETEC) diarrhea in Mexico were studied for fecal immunoglobulin A (IgA) response to their homologous infecting ETEC and to heat-labile (LT) toxin of ETEC using Dot-Blot microfiltration and enzyme-linked immunosorbent assay (ELISA) methods. Paired stool samples were collected on the day of presentation and 5 days later.

The natural history of human immunodeficiency virus infection among adults in Mumbai.

Background: Natural history studies of untreated HIV infection are useful for clinicians, public health experts and policymakers to improve and monitor care, plan services and control, and to model the epidemic. Several natural history studies on homosexual men and intravenous drug users have been published from developed countries. A few studies have emerged on heterosexual populations from Africa.

Genetic susceptibility to enteroaggregative Escherichia coli diarrhea: polymorphism in the interleukin-8 promotor region.

Enteroaggregative Escherichia coli (EAEC) infection can be identified in 26% of travelers with diarrhea and is associated with fecal interleukin (IL)-8 production. We hypothesized that single-nucleotide polymorphisms (SNPs) in the IL-8 gene are associated with EAEC-related symptoms. Fecal IL-8 production and IL-8 SNPs at 5 loci were identified in 69 US students who remained in Mexico for 5 weeks; 23 subjects had EAEC-associated diarrhea, 7 were asymptomatic EAEC carriers, 22 had nonspecific diarrhea, and 17 were asymptomatic without an enteropathogen.

Therapy of travelers' diarrhea with rifaximin on various continents.

Objective: Our aim was to compare the efficacy and safety of rifaximin, a virtually nonabsorbed antibiotic, 600 and 1200 mg per day, with placebo in patients with travelers' diarrhea.

Methods: This was a multicenter, 1:1:1 randomized, parallel-group, double-blind study, conducted in Antigua, Guatemala; Guadalajara and Morelia, Mexico; and the coast of Kenya north and south of Mombasa. Adult patients with acute travelers' diarrhea were recruited; exclusion criteria included primarily medication that could influence the outcome.

Rate of occurrence and pathogenic effect of enteroaggregative Escherichia coli virulence factors in international travelers.

One or more putative enteroaggregative Escherichia coli (EAEC) virulence factors (aggA, aggR, aspU, or aafA) were identified in 60 (70%) of 86 EAEC isolates from travelers with diarrhea compared with a rate of 7 (8%) of 90 in patients with diarrhea who were infected with nonadherent E. coli (odds ratio, 27.36; 95% confidence interval, 11.

A double blind, randomized, placebo-controlled study of SP-303 (Provir) in the symptomatic treatment of acute diarrhea among travelers to Jamaica and Mexico.

Objective: The study was designed to evaluate the effectiveness of SP-303 (Provir), a plant-derived product with novel antisecretory properties, in the treatment of travelers' diarrhea.

Methods: A total of 184 persons from the United States who acquired diarrhea in Jamaica or Mexico were enrolled in a double-blind, placebo-controlled study examining the effectiveness of three doses of SP-303 in reducing illness. Subjects were treated with 125 mg, 250 mg, or 500 mg SP-303 or a matching placebo four times a day for 2 days.

Detection of enteroaggregative Escherichia coli with formalin-preserved HEp-2 cells.

Formalin-stored HEp-2 cells were used to assay Escherichia coli for adherence. Cells refrigerated in formalin for up to 28 days and used in a wet assay format demonstrated an assay sensitivity ranging from 94 to 98% to detect enteroaggregative E. coli (EAEC).

Enterotoxigenic Escherichia coli as cause of diarrhea among Mexican adults and US travelers in Mexico.

Background: Enterotoxigenic Escherichia coli (ETEC) is the most common pathogen identified in travelers to Mexico with diarrhea. There have been few recent studies looking at the etiology of diarrhea in travelers compared with the local resident population.

Methods: We compared enteric pathogens isolated in two populations experiencing acute diarrhea acquired in Guadalajara, Mexico and also compared clinical illness caused by the principal pathogen, ETEC.

Enteric pathogens in Mexican sauces of popular restaurants in Guadalajara, Mexico, and Houston, Texas.

Background: The transmission of traveler's diarrhea is primarily foodborne.

Objective: To examine the level of microbial contamination of tabletop sauces found in Mexican-style restaurants.

Design: Cross-sectional study of Mexican sauces.

Natural history of enteroaggregative and enterotoxigenic Escherichia coli infection among US travelers to Guadalajara, Mexico.

The natural history of enteroaggregative Escherichia coli (EAEC) and enterotoxigenic E. coli (ETEC) infection was studied among 40 US travelers who provided weekly stool samples for 4 weeks after arrival in Mexico. At enrollment, 5 subjects were colonized by EAEC and 3 by ETEC.