Etiology of diarrhea among travelers and foreign residents in Nepal.
A bacterial pathogen was isolated from 47% of 328 expatriate patients with diarrhea seen at two medical clinics in Nepal in 1986. Enterotoxigenic Escherichia coli (24%), Shigella (14%), and Campylobacter species (9%) were isolated most frequently. Enteroinvasive and adherence factor-positive E coli were isolated from 2% and 1% of patients, respectively. Giardia lamblia was detected in 12% of patients, rotavirus in 8%, and Cryptosporidium and Entamoeba histolytica each in 5%. Blastocystis hominis was present in 33% of patients but in only 9% of those who took trimethoprim-sulfamethoxazole. More than one enteropathogen was detected in 17% of patients. Patients with prolonged symptoms (longer than two weeks) were more likely to have Giardia (27%) and less likely to have Shigella (5%) than were patients with acute symptoms. The isolation rates of bacterial pathogens decreased with length of stay in Nepal. A wide variety of enteropathogens were detected in travelers to Nepal, and Shigella and protozoa were particularly important. Length of time abroad and duration of symptoms were important diagnostic considerations.
Taylor
D N
DN
Department of Bacteriology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
Houston
R
R
Shlim
D R
DR
Bhaibulaya
M
M
Ungar
B L
BL
Echeverria
P
P
D000328:Adult; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology; D003967:Diarrhea / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D006801:Humans; D009390:Nepal; D011528:Protozoan Infections / Q000150:complications / Q000453:epidemiology; D012400:Rotavirus Infections / Q000150:complications / Q000453:epidemiology; D012621:Seasons; D013997:Time Factors; D014195:Travel