Aetiology of traveller's diarrhea: A nested case-control study

Area of Science:

• Infectious Diseases
• Molecular Diagnostics
• Gastroenterology

Background:

• Traveller's diarrhea (TD) is a significant health concern for international travelers.
• Molecular diagnostic methods, including multiplex PCR, are increasingly used to identify TD pathogens.
• This study evaluated a multiplex PCR panel for diagnosing TD.

Purpose of the Study:

• To assess the utility of a multiplex PCR panel in identifying causative agents of traveler's diarrhea.
• To compare pathogen detection rates between TD patients and asymptomatic controls.

Main Methods:

• A prospective study involving 91 travelers (61 TD cases, 30 controls) who provided stool samples.
• Analysis of samples using the BioFire® FilmArray® Gastrointestinal Panel, detecting bacteria, viruses, and parasites.
• Statistical analysis to determine associations between pathogens and TD.

Main Results:

• A higher positive test rate was observed in TD cases (75%) compared to controls (57%), though not statistically significant (p=0.07).
• Enteroaggregative E. coli, enterotoxigenic E. coli (ETEC), and enteropathogenic E. coli (EPEC) were the most common pathogens.
• EPEC (p=0.01) and ETEC (p=0.047) were significantly associated with TD; protozoa were not detected.

Conclusions:

• The study suggests that broad multiplex PCR panels may not be cost-effective for routine TD diagnosis.
• Only specific diarrheagenic E. coli strains demonstrated a significant association with TD symptoms.
• Diagnostic strategies for TD should focus on pathogens with proven clinical relevance.