Evidence of pathogens associated with travelers' diarrhea in Thailand: a systematic review

Thailand, a major tourist destination, exhibits variations in sanitation and food safety practices that can lead to cases of travelers' diarrhea (TD) caused by a plethora of pathogens. This systematic review synthesizes data on the pathogens associated with TD in Thailand, providing valuable insights into pathogen diversity and distribution, traveler profiles, and geographical regions of concern.

This systematic review followed the PRISMA guidelines and was registered in PROSPERO (CRD42022346014). A comprehensive search was conducted across PubMed, Embase, Scopus, MEDLINE, and Journals@Ovid databases. The search included terms related to "diarrhea," "travelers," and "Thailand," without restrictions on publication date. Eligible studies focused on travelers to Thailand who developed diarrhea with identified specific pathogens. Data was extracted and synthesized using a narrative approach. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

A total of 15 studies met the eligibility criteria, identifying that pathogens related to TD in Thailand were bacteria, particularly enterotoxigenic Escherichia coli (ETEC) (80%), followed by Campylobacter jejuni (33.3%) and Salmonella spp. (40%). Viral pathogens such as rotavirus and norovirus were also notable, with Giardia spp. being the most identified parasite. Pathogen distribution varied across different regions of Thailand, with tourism hubs such as Bangkok, Chiang Mai, Phuket, and Krabi reporting a broader range of infections.

This systematic review highlights the diverse range of pathogens associated with TD in Thailand, with bacterial pathogens, specifically ETEC, being the predominant cause in most studies. The findings underscore the importance of preventive measures, such as improved hygiene practices and food safety awareness, especially in high-risk tourist areas. Further research is needed to understand better the risk factors contributing to TD and to develop targeted interventions for prevention.