title: Seasonal variation in etiology of travelers' diarrhea. Finnish-Moroccan Study Group.
abstract: The etiology of travelers' diarrhea was studied in 579 adult Finnish tourists participating in two packaged tours to Morocco in the winter (n = 233) and fall (n = 346) of 1989. A research team accompanied the travelers, and a laboratory for enteric pathogens was established in Agadir. At least one pathogen was found in 62% of the 60 diarrhea cases in winter and in 58% of the 111 diarrhea cases in fall. Multiple pathogens were found less often in winter (8%) than in fall (21%, P less than .05). Campylobacter strains were the leading cause of travelers' diarrhea in winter, found alone or with other pathogens in 28% of the cases (but in only 7% in fall), whereas enterotoxigenic Escherichia coli (ETEC) was the most common pathogen in fall, present in 32% of the cases (8% in winter). Both differences are highly significant (P less than .001). Salmonella enterica was almost as common as ETEC in fall (25% of diarrhea cases) but rare in winter (10%, P less than .05). Thus, the etiology of travelers' diarrhea varied according to the season in the same tourist destination. This finding has relevance to both antimicrobial treatment and prophylaxis.
authors.affiliation: First Department of Medicine, Helsinki University Hospital, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Mattila
authors.forename: A
authors.initials: A
authors.lastname: Siitonen
authors.forename: H
authors.initials: H
authors.lastname: Kyrönseppä
authors.forename: I
authors.initials: I
authors.lastname: Simula
authors.forename: P
authors.initials: P
authors.lastname: Oksanen
authors.forename: M
authors.initials: M
authors.lastname: Stenvik
authors.forename: P
authors.initials: P
authors.lastname: Salo
authors.forename: H
authors.initials: H
authors.lastname: Peltola
mesh_terms: D000293:Adolescent; D000328:Adult; D000333:Aeromonas / Q000302:isolation & purification; D000368:Aged; D000369:Aged, 80 and over; D002169:Campylobacter Infections / Q000453:epidemiology / Q000382:microbiology*; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D005387:Finland; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009018:Morocco; D012400:Rotavirus Infections / Q000453:epidemiology / Q000382:microbiology; D012480:Salmonella Infections / Q000453:epidemiology / Q000382:microbiology*; D012621:Seasons; D014195:Travel