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Persistent digestive disorders in the tropics: causative infectious pathogens and reference diagnostic tests

Sören L Becker123, Jürg Vogt12, Stefanie Knopp12, Marcus Panning4, David C Warhurst5, Katja Polman6, Hanspeter Marti27, Lutz von Müller3, Cedric P Yansouni89, Jan Jacobs9, Emmanuel Bottieau9, Moussa Sacko10, Suman Rijal11, Fransiska Meyanti12, Michael A Miles5, Marleen Boelaert13, Pascal Lutumba1415, Lisette van Lieshout16, Eliézer K N’Goran1718, François Chappuis19 and Jürg Utzinger12*

Author Affiliations

1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland

2 University of Basel, Basel, Switzerland

3 Institute of Medical Microbiology and Hygiene, University of Saarland Hospital, Homburg/Saar, Germany

4 Department of Virology, University of Freiburg, Freiburg, Germany

5 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

6 Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium

7 Department of Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, Basel, Switzerland

8 J.D. MacLean Centre for Tropical Diseases, and Divisions of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Canada

9 Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium

10 Institut National de Recherche en Santé Publique, , Bamako, Mali

11 Department of Internal Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal

12 Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

13 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

14 Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo

15 Université de Kinshasa, Kinshasa, Democratic Republic of the Congo

16 Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands

17 Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire

18 Département Environnement et Santé, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire

19 Division of Humanitarian and International Medicine, Geneva University Hospitals, Geneva, Switzerland

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BMC Infectious Diseases 2013, 13:37  doi:10.1186/1471-2334-13-37

Published: 24 January 2013



Persistent digestive disorders account for considerable disease burden in the tropics. Despite advances in understanding acute gastrointestinal infections, important issues concerning epidemiology, diagnosis, treatment and control of most persistent digestive symptomatologies remain to be elucidated. Helminths and intestinal protozoa are considered to play major roles, but the full extent of the aetiologic spectrum is still unclear. We provide an overview of pathogens causing digestive disorders in the tropics and evaluate available reference tests.


We searched the literature to identify pathogens that might give rise to persistent diarrhoea, chronic abdominal pain and/or blood in the stool. We reviewed existing laboratory diagnostic methods for each pathogen and stratified them by (i) microscopy; (ii) culture techniques; (iii) immunological tests; and (iv) molecular methods. Pathogen-specific reference tests providing highest diagnostic accuracy are described in greater detail.


Over 30 pathogens may cause persistent digestive disorders. Bacteria, viruses and parasites are important aetiologic agents of acute and long-lasting symptomatologies. An integrated approach, consisting of stool culture, microscopy and/or specific immunological techniques for toxin, antigen and antibody detection, is required for accurate diagnosis of bacteria and parasites. Molecular techniques are essential for sensitive diagnosis of many viruses, bacteria and intestinal protozoa, and are increasingly utilised as adjuncts for helminth identification.


Diagnosis of the broad spectrum of intestinal pathogens is often cumbersome. There is a need for rapid diagnostic tests that are simple and affordable for resource-constrained settings, so that the management of patients suffering from persistent digestive disorders can be improved.

Bacteria; Clinical microbiology; Diagnosis; Digestive disorders; Gastroenterology; Helminths; Intestinal protozoa; Persistent diarrhoea; Virus