Persistent digestive disorders in the tropics: causative infectious pathogens and reference diagnostic tests
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
BMC Infectious Diseases 2013, 13:37 doi:10.1186/1471-2334-13-37Published: 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.