title: High number of diarrhoeal co-infections in travellers to Benin, West Africa.
abstract: BACKGROUND
  Travellers' diarrhoea (TD) is the most frequent health problem among travellers to the tropics. Using routine techniques, the aetiology mostly remains unresolved, whereas modern molecular methods enable reducing the number of equivocal cases considerably. While many studies address the aetiology of TD in Asian, Central American and North African tourist resorts, only few focus on Western Africa.
  
  
  METHODS
  Stool samples from 45 travellers travelling in Benin, West Africa, were analyzed by a new multiplex qPCR assay for Salmonella, Yersinia, Campylobacter, Vibrio cholerae, Shigella or enteroinvasive (EIEC), enterohaemorrhagic (EHEC), enterotoxigenic (ETEC), enteroaggregative (EAEC), and enteropathogenic Escherichia coli (EPEC).
  
  
  RESULTS
  All 18 pre-travel samples proved negative for bacterial pathogens. Of the 39/45 (87%) travellers having had TD, EPEC was detected in post-travel samples in 30 (77%) cases, EAEC in 23 (59%), ETEC in 22 (56%), Shigella or EIEC in 7 (18%), EHEC in two (5%), and Salmonella in one (3%). In 31(79%) of the TD cases two or more bacterial pathogens were identified. Two (8%) samples remained negative: both patients had taken antimicrobials for TD.
  
  
  CONCLUSIONS
  EPEC, EAEC and ETEC were the most common findings. 79% of the cases had a co-infection. As modern diagnostics reveals in most patients a multitude of pathogens, the role of each pathogen should be re-evaluated.
authors: Tinja
authors: T
authors: Lääveri
authors: Sari H
authors: SH
authors: Pakkanen
authors: Jenni
authors: J
authors: Antikainen
authors: Jukka
authors: J
authors: Riutta
authors: Sointu
authors: S
authors: Mero
authors: Juha
authors: J
authors: Kirveskari
authors: Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, PO Box 348, 00029 HUS Helsinki, Finland. anu.kantele@hus.fi.
authors: Anu
authors: A
authors: Kantele
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D001541:Benin; D002167:Campylobacter; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology*; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D012475:Salmonella; D012760:Shigella; D014195:Travel; D014734:Vibrio cholerae; D015007:Yersinia; D055815:Young Adult