Travelers' Diarrhea in Thailand: A Quantitative Analysis Using TaqMan® Array Card

Area of Science:

• Infectious Diseases
• Molecular Diagnostics
• Gastroenterology

Background:

• Travelers' diarrhea (TD) affects 6-16% of travelers to developing countries like Thailand.
• Existing TD data often excludes general traveler populations, focusing primarily on military personnel.
• Understanding TD etiology in diverse traveler groups is crucial for public health.

Purpose of the Study:

• To investigate the prevalence and clinical relevance of enteropathogens causing TD in Bangkok, Thailand.
• To compare the efficacy of a molecular diagnostic method with conventional techniques for TD pathogen detection.
• To establish pathogen-disease and symptom associations for key enteropathogens in TD cases.

Main Methods:

• A TD surveillance study was conducted at Bumrungrad International Hospital from 2012-2014.
• Enteropathogen identification utilized both conventional methods and the TaqMan® array card (TAC) real-time PCR assay.
• Statistical analyses determined pathogen-disease associations and attributable fractions for diarrheal cases.

Main Results:

• The TAC identified a broader range of pathogens per sample compared to conventional methods.
• Campylobacter spp. were the most prevalent, followed by diarrheagenic Escherichia coli and norovirus GII.
• Significant associations were found between specific pathogens (e.g., Campylobacter spp., Shigella spp.) and clinical outcomes like dysentery.

Conclusions:

• The TaqMan® array card (TAC) offers a comprehensive, quantifiable, and comparable pan-molecular diagnostic approach for TD pathogens.
• This method reduces variability and improves the determination of clinical and geographical relevance of diarrhea-causing agents in Thailand.
• Enhanced diagnostic capabilities facilitate a better understanding of TD epidemiology and inform targeted interventions.