The Epidemiology of Travelers' Diarrhea in Incirlik, Turkey: A Region with a Predominance of Heat-Stabile Toxin Producing Enterotoxigenic Escherichia coli
NAVAL MEDICAL RESEARCH CENTER SILVER SPRING MD ENTERIC DISEASES DEPT
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This study evaluated travelers diarrhea among US military personnel on short term deployment to lncirlik Air Base. Turkey from June through September 2002. Upon reporting for care for travelersdiarrhea, subjects were enrolled into the study and completed a series of questionnaires and provided stool specimens for pathogen identification and antimicrobial susceptibility testing. Fifty-three percent of the 202 participating subjects had a pathogen isolated from their stool. Entcrotoxigenic Escherichia coli ETEC was the predominant pathogen 41. followed by Campylobacter spp. 12. The most common ETEC phenotype recovered was stable toxin ST CS6 47 of all ETEC. Most 91.1 of the cases presented with water diarrhea regardless of isolated pathogen. llowever, there were some differences in nongastrointestinal symptoms among subjects with Campylobacter spp. All illnesses were well managed with antibiotics with or without operamide with a median time to the last unformed stool of 9h interquanilc range, 1- 32 h. We found no food or environmental factors associated with a differential risk of infection with a specific pathogen. Travelersdiarrhea among a US military population in and around lncirlik, Turkey, can commonly be attributed to ETEC and Campvlobacter spp. The high proponion of ST-only producing CS6 ETEC in this region highlights the pathogen s worldwide diversity. Future studies of travelersdiarrhea in this population should adapt more novel microbiologic techniques such as polymerase chain reaction and enhanced culture methods to increase the likelihood of identifying pathogenic E. coli.
- Medicine and Medical Research