Epidemiology of travelers' diarrhea and relative importance of various pathogens.
Each year 12 million persons travel from an industrialized country to a developing country in the tropics or subtropics. These travelers experience a high rate of diarrhea caused by a wide variety of enteric pathogens acquired by ingestion of contaminated food or water. One or more pathogens can be found in the stool of a majority of ill individuals. Enterotoxigenic Escherichia coli generally are the most frequently identified pathogens, having been found in a median of 42% of travelers' diarrheal episodes in studies in Latin America, 36% in Africa, and 16% in Asia. Other pathogens that cause diarrhea in a smaller fraction of ill travelers include Shigella species, Salmonella species, Campylobacter jejuni, Vibrio, Aeromonas hydrophila, Entamoeba histolytica, Giardia lamblia, rotavirus, and 27-nm viruses, including Norwalk virus. Other organisms that may cause a fraction of the episodes of travelers' diarrhea include Plesiomonas shigelloides, enteroadherent E. coli, adenovirus or other viruses, and Cryptosporidium. Mixed infections of two or more of these pathogens also occur.
Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205.
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D003906:Developing Countries; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology; D005506:Food Contamination; D006801:Humans; D014195:Travel; D014871:Water Microbiology