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Global Etiology of Travelers’ Diarrhea: Systematic Review from 1973 to the Present

Fifty-one published studies of travelers’ diarrhea (TD) were examined to look for regional differences in pathogens identified. Enterotoxigenic E. coli was detected in 1,678/5,518 (30.4%) of TD cases overall, with rates in Latin America/Caribbean (L. America), Africa, south Asia, and Southeast Asia of 1,109/3,302 (33.6%), 389/1,217 (31.2%), 153/499 (30.6%), and 36/500 (7.2%), respectively (P < 0.001). Enteroaggregative E. coli was the second most common agent in L. America, found in 166/689 (24.1%), compared with 3/165 (1.8%) in Africa and 33/206 (16%) in south Asia (P < 0.001). Other significantly regional differences were seen for enteropathogenic E. coli, diffusely adherent E. coli, Campylobacter, Shigella spp., Salmonella, Aeromonas spp., Plesiomonas, Vibrios, rotavirus, noroviruses, Giardia, and Entoamoeba histolytica. The regional differences in pathogen identification identified will serve as a baseline for antimicrobial therapy recommendations and vaccines strategies.

Received October 3, 2008. Accepted for publication December 20, 2008.

Acknowledgment: The authors thank Judith Dunn, PhD, for providing statistical guidance.

Financial support: Discretionary funds from the University of Texas–Houston School of Public Health were used to support this study.

Disclaimer: The authors have no conflicts to declare.

^* Address correspondence to Herbert L. DuPont, 1200 Herman Pressler, Suite 733, Houston, TX 77030. E-mail: Herbert.l.Dupont{at}uth.tmc.edu

Authors’ addresses: Nipam Shah, 7900 Cambridge St., Apt. #7-2F, Houston, TX 77054. Herbert DuPont, University of Texas Health Science Center at Houston, 1200 Herman Pressler Dr. RAS-E743, Houston, TX 77030. David Ramsey, University of Texas Health Science Center at Houston, 1200 Herman Pressler Dr. RAS-E11, Houston, TX 77030.

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