title: An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection.
abstract: Campylobacter is a leading cause of traveler's diarrhea in Thailand. Since resistance to quinolones is high among Campylobacter isolates, empiric therapy with quinolones for traveler's diarrhea may be ineffective in this region. We conducted an observational study among 169 U.S. military personnel with acute diarrhea and compared their microbiologic findings to those of 77 asymptomatic personnel deployed to Thailand in May 1998. Of 146 pathogenic bacterial isolates, the most common were nontyphoidal Salmonella (n = 31), enterotoxigenic Escherichia coli (n = 24), and C. jejuni/coli (n = 23). Campylobacter was strongly associated with disease (odds ratio = 5.9; 95% confidence interval = 1.3-37.3), with a more severe clinical presentation, and with a reduced functional ability at presentation (P = 0.02). In vitro resistance to ciprofloxacin was observed in 96% of the Campylobacter isolates. Sub-optimal treatment response to ciprofloxacin was observed in 17% of the cases of Campylobacter infection versus 6% due to other causes. These results highlight the importance of Campylobacter as a cause of severe traveler's diarrhea in Thailand and illustrates the ongoing problem with antibiotic-resistant strains and associated treatment problems.
authors.affiliation: National Naval Medical Center, Bethesda, Maryland 20889, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Sanders
authors.forename: D W
authors.initials: DW
authors.lastname: Isenbarger
authors.forename: S E
authors.initials: SE
authors.lastname: Walz
authors.forename: L W
authors.initials: LW
authors.lastname: Pang
authors.forename: D A
authors.initials: DA
authors.lastname: Scott
authors.forename: C
authors.initials: C
authors.lastname: Tamminga
authors.forename: B A
authors.initials: BA
authors.lastname: Oyofo
authors.forename: W C
authors.initials: WC
authors.lastname: Hewitson
authors.forename: J L
authors.initials: JL
authors.lastname: Sanchez
authors.forename: C
authors.initials: C
authors.lastname: Pitarangsi
authors.forename: P
authors.initials: P
authors.lastname: Echeverria
authors.forename: D R
authors.initials: DR
authors.lastname: Tribble
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D002169:Campylobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008889:Military Personnel; D013785:Thailand / Q000453:epidemiology; D014481:United States
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones