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The etiology of diarrhea among American adults living in Peru
G Pazzaglia1, J Escamilla, R Batchelor
1U.S. Naval Medical Research Institute Detachment (Lima, Peru), A.P.O., Miami, FL 34031.
Abstract:
During 1984-1989, 655 diarrheic and 287 nondiarrheic stool specimens from adult U.S. citizens living in Lima, Peru were tested for presence of bacterial enteropathogens. Frequencies of isolation among diarrheic specimens were: Shigella 9.8%; Campylobacter 6.1%; enterotoxigenic Escherichia coli (ETEC) 6.0%; Plesiomonas 2.0%; Salmonella 1.4%; and Vibrio 0.6%. Isolates recovered from non-diarrheic stools were: Shigella 4.5%; Campylobacter 2.1%; Salmonella 1.0%; ETEC 0.7%; Plesiomonas 0.7%; and Vibrio 0.3%. Aeromonas, an unproven cause of diarrhea, was isolated from 9.2% of cases and 3.5% of controls. Disease occurrence was strongly associated with isolation of Shigella, ETEC, Campylobacter, or Aeromonas (p less than or equal to 0.01). During the 6-year period of study, shifts in the dominant phenotypes of Shigella and Campylobacter occurred which may have important implications for vaccine development and intervention strategies.
Insights
This study identified common bacterial causes of diarrhea in US adults in Lima, Peru, including Shigella, Campylobacter, and enterotoxigenic E. coli (ETEC). Shifts in pathogen prevalence over time suggest evolving intervention and vaccine development needs.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Diarrheal diseases remain a significant global health concern, particularly in developing regions.
- Understanding the specific enteropathogens causing illness in expatriate populations is crucial for targeted health interventions.
Purpose of the Study:
- To identify and quantify the prevalence of bacterial enteropathogens in diarrheic and non-diarrheic stool specimens from US adults in Lima, Peru.
- To assess the association between specific bacterial isolates and diarrheal disease.
- To observe temporal trends in pathogen isolation over a six-year period.
Main Methods:
- Prospective study analyzing 655 diarrheic and 287 non-diarrheic stool samples from US adults in Lima, Peru (1984-1989).
- Bacteriological culture techniques were employed to isolate and identify common enteropathogens.
- Statistical analysis was used to determine disease associations and temporal shifts.
Main Results:
- Shigella, Campylobacter, and enterotoxigenic Escherichia coli (ETEC) were the most frequent bacterial enteropathogens isolated from diarrheic stools.
- Aeromonas species were also frequently isolated and showed a significant association with diarrheal disease.
- Higher isolation rates of Shigella, ETEC, Campylobacter, and Aeromonas were observed in diarrheic compared to non-diarrheic specimens (p ≤ 0.01).
Conclusions:
- Shigella, ETEC, Campylobacter, and Aeromonas are significant bacterial causes of diarrhea in US adults residing in Lima, Peru.
- Observed shifts in dominant Shigella and Campylobacter phenotypes over the study period highlight the dynamic nature of infectious disease epidemiology.
- Findings have implications for the development of vaccines and targeted public health interventions.