RESUMO
Almost two of three tourists developed traveller's diarrhoea during 2-week stays at high-risk destinations. Large differences in infection rates between hotels were seen. Patients with milder forms of diarrhoea show a similar chronology to those more severely affected. Although enterotoxigenic Escherichia coil was the most frequent cause, viral pathogens were detected more often than in other studies.
Assuntos
Diarreia/epidemiologia , Diarreia/etiologia , Viagem , Brasil/epidemiologia , Culinária , Estudos Transversais , Diarreia/classificação , Diarreia/prevenção & controle , Fezes/microbiologia , Microbiologia de Alimentos , Humanos , Índia/epidemiologia , Jamaica/epidemiologia , Quênia/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
CONTEXT: Traveler's diarrhea (TD) can incapacitate travelers. Characteristics of TD could be helpful in identifying individuals who might benefit from a vaccine against TD. OBJECTIVE: To determine epidemiology, etiology, and impact of TD in Jamaica. Design Two-armed, cross-sectional survey conducted between March 1996 and May 1997. SETTING: Sangster International Airport and 10 hotels in Montego Bay area, Jamaica. SUBJECTS: To investigate epidemiology and impact, 30369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts. To investigate etiology, 322 patients (hotel guests) with TD provided stool samples. MAIN OUTCOME MEASURES: Attack and incidence rates of reported diarrhea and of classically defined TD (> or =3 unformed stool samples in 24 hours and > or =1 accompanying symptom), incapacity, risk factors, and etiology. RESULTS: The attack rate for diarrhea was 23.6% overall, with 11.7% having classically defined TD. For a mean duration of stay of 4 to 7 days, the incidence rate was 20.9% (all TD) and 10.0% (classic TD). Among airport respondents, the incapacity lasted a mean of 11.6 hours. Less than 3% of all travelers avoided potentially high-risk food and beverages. The most frequently detected pathogens were enterotoxigenic Escherichia coli, Rotavirus, and Salmonella species. CONCLUSIONS: A realistic plan for reducing TD is needed. Preventive measures such as the improvement of hygienic conditions at the destination, and/or the development of vaccines against the most frequent pathogens associated with TD may contribute toward achieving this goal.
Assuntos
Diarreia/epidemiologia , Viagem , Adolescente , Adulto , Efeitos Psicossociais da Doença , Estudos Transversais , Diarreia/economia , Diarreia/etiologia , Diarreia/terapia , Feminino , Humanos , Incidência , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
A PCR technique to differentiate pathogenic enteric Escherichia coli strains in a field setting was evaluated. Among 76 children with acute diarrhea, this technique identified 12 children (16%) with enterotoxigenic E. coli, 6 (8%) with enteropathogenic E. coli, and 1 (1%) with enteroinvasive E. coli infection. Compared with the conventional assays, the PCR method proved to be simpler, more rapid, and inexpensive and therefore suitable for application in a developing-country field setting.
Assuntos
Escherichia coli/genética , Reação em Cadeia da Polimerase/métodos , Técnicas Bacteriológicas , Sequência de Bases , Brasil/epidemiologia , Pré-Escolar , Primers do DNA/genética , DNA Bacteriano/genética , Diarreia/epidemiologia , Diarreia/microbiologia , Escherichia coli/classificação , Escherichia coli/patogenicidade , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Estudos de Avaliação como Assunto , Humanos , Lactente , Recém-Nascido , Epidemiologia Molecular , Dados de Sequência Molecular , Especificidade da EspécieRESUMO
A 40-year-old man with grade II sarcoidosis went on a two-week visit to Ecuador. Afterwards he was treated with low-dose corticosteroids because of slight deterioration on the X-ray film. Unilateral hilar enlargement followed by bouts of high fever and a greatly increased erythrocyte sedimentation rate, suggested an acute exacerbation of the sarcoidosis and was, therefore, treated with an increase in steroid dosage plus azathioprine. Bronchoalveolar lavage fluid and tissue samples from lung, bone-marrow and spleen were suggestive of an infection with Histoplasma capsulatum. There was now bilateral hilar enlargement with right upper lobe infiltration, marked hepatosplenomegaly and thrombocytopenia (17,000/microliters), but serological tests remained negative. The fulminant course with dissemination could not be arrested despite administration of fluconazole (400 mg/d) and amphotericin B (total dosage 1.14 g). Histoplasma capsulatum was cultured from lung and spleen tissue post-mortem.