Open Access Highly Accessed Research article

High number of diarrhoeal co-infections in travellers to Benin, West Africa

Tinja Lääveri1, Sari H Pakkanen2, Jenni Antikainen3, Jukka Riutta4, Sointu Mero3, Juha Kirveskari3 and Anu Kantele1245*

Author Affiliations

1 Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, PO Box 348, 00029 HUS Helsinki, Finland

2 Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, PO Box 2100014 Helsinki, Finland

3 Helsinki University Hospital Laboratory (HUSLAB), Bacteriology, PO Box 400, 00029 HUS Helsinki, Finland

4 Aava Travel Clinic, Medical Centre Aava, Annankatu 34, 00100 Helsinki, Finland

5 Department of Clinical Medicine, University of Helsinki, PO Box 20, 00014 Helsinki, Finland

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BMC Infectious Diseases 2014, 14:81  doi:10.1186/1471-2334-14-81

Published: 12 February 2014

Abstract

Background

Travellers’ diarrhoea (TD) is the most frequent health problem among travellers to the tropics. Using routine techniques, the aetiology mostly remains unresolved, whereas modern molecular methods enable reducing the number of equivocal cases considerably. While many studies address the aetiology of TD in Asian, Central American and North African tourist resorts, only few focus on Western Africa.

Methods

Stool samples from 45 travellers travelling in Benin, West Africa, were analyzed by a new multiplex qPCR assay for Salmonella, Yersinia, Campylobacter, Vibrio cholerae, Shigella or enteroinvasive (EIEC), enterohaemorrhagic (EHEC), enterotoxigenic (ETEC), enteroaggregative (EAEC), and enteropathogenic Escherichia coli (EPEC).

Results

All 18 pre-travel samples proved negative for bacterial pathogens. Of the 39/45 (87%) travellers having had TD, EPEC was detected in post-travel samples in 30 (77%) cases, EAEC in 23 (59%), ETEC in 22 (56%), Shigella or EIEC in 7 (18%), EHEC in two (5%), and Salmonella in one (3%). In 31(79%) of the TD cases two or more bacterial pathogens were identified. Two (8%) samples remained negative: both patients had taken antimicrobials for TD.

Conclusions

EPEC, EAEC and ETEC were the most common findings. 79% of the cases had a co-infection. As modern diagnostics reveals in most patients a multitude of pathogens, the role of each pathogen should be re-evaluated.

Keywords:
Traveller’s diarrhoea; TD; EAEC; ETEC; EPEC; West Africa; qPCR; Campylobacter; Salmonella