Case-Case Analysis Using 7 Years of Travelers' Diarrhea Surveillance Data: Preventive and Travel Medicine Applications in Cusco, Peru.
AbstractIn Cusco, Peru, and South America in general, there is a dearth of travelers' diarrhea (TD) data concerning the clinical features associated with enteropathogen-specific infections and destination-specific risk behaviors. Understanding these factors would allow travel medicine providers to tailor interventions to patients' risk profiles and travel destination. To characterize TD etiology, evaluate region-specific TD risk factors, and examine relationships between preventive recommendations and risk-taking behaviors among medium- to long-term travelers' from high-income countries, we conducted this case-case analysis using 7 years of prospective surveillance data from adult travelers' presenting with TD to a physician in Cusco. At the time of enrollment, participants provided a stool sample and answered survey questions about demographics, risk behaviors, and the clinical features of illness. Stool samples were tested for norovirus (NV), bacteria, and parasites using conventional methods. Data obtained were then analyzed using case-case methods. NV (14%), enterotoxigenicEscherichia coli(11%), andCampylobacter(9%), notably ciprofloxacin-resistantCampylobacter, were the most frequently identified pathogens among adults with TD. Coinfection with multiple enteropathogens occurred in 5% of cases. NV caused severe disease relative to other TD-associated pathogens identified, confining over 90% of infected individuals to bed. Destination-specific risk factors include consumption of the local beverage "chicha," which was associated withCryptosporidiuminfection. Preventive interventions, such as vaccines, directed against these pathogens could significantly reduce the burden of TD.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Preventive Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Mary Carol
MC
Jennings
Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru.
Drake H
DH
Tilley
Parasitology Department, Naval Medical Research Unit No. 6, Lima, Peru.|Asociación Benéfica PRISMA, Lima, Peru.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sarah-Blythe
SB
Ballard
Hematology Department, Hospital Universitario de la Princesa, Madrid, Spain.
Miguel
M
Villanueva
Department of Epidemiology, Royal Tropical Institute, Amsterdam, The Netherlands.
Fernando Maldonado
FM
Costa
Collaborative Research Center, Universidad Peruana Cayetano Heredia, Cusco, Peru.|Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
Martha
M
Lopez
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Hannah E
HE
Steinberg
Virology Department, Naval Medical Research Unit No. 6, Lima, Peru.
C Giannina
CG
Luna
Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru.
Rina
R
Meza
Virology Department, Naval Medical Research Unit No. 6, Lima, Peru.
Maria E
ME
Silva
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Robert H
RH
Gilman
Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru.
Mark P
MP
Simons
Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California.|Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru.
Ryan C
RC
Maves
Collaborative Research Center, Universidad Peruana Cayetano Heredia, Cusco, Peru.|Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
Miguel M
MM
Cabada
D000293:Adolescent; D000328:Adult; D000368:Aged; D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D054307:Enterotoxigenic Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D029322:Norovirus / Q000302:isolation & purification; D010568:Peru / Q000453:epidemiology; D062486:Public Health Surveillance; D012309:Risk-Taking; D014195:Travel; D057236:Travel Medicine