Ciprofloxacin- and Azithromycin-Resistant Campylobacter Causing Traveler's Diarrhea in U.S. Troops Deployed to Thailand in 1994

Murphy, Gerald S.; Echeverria, Peter; Jackson, Lyle R.; Arness, M K; Lebron, Carlos; Pitarangsi, Chittima

doi:10.1093/clinids/22.5.868

Cited by 67 publications

(36 citation statements)

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“…[10][11][12] Additionally, the clinical data obtained from patients with diarrhea are in agreement with the findings of Mattila 24 that, like Shigella infections, C. jejuni-C. coli infections are associated with a more severe form of travelers' diarrhea than is caused by other enteropathogens. The serological examination of pre-and postexposure blood samples from study volunteers shows that pretravel anti-Campylobacter IgA titers Ն 450 in healthy adults are strongly associated with reduced risk of contracting Campylobacter diarrhea while visiting Thailand.…”

Section: Discussionsupporting

confidence: 86%

“…In studies conducted in 1990, 1993, and 1994, C. jejuni or C. coli were detected in 41, 58, and 52%, respectively of stool samples obtained from military personnel contracting diarrhea while deployed to Thailand. [10][11][12] The high risk of people visiting Thailand acquiring a Campylobacter infection reflects the fact that it is hyperendemic among the local pediatric population. 13 In their report on diarrhea among children in Thailand, Taylor and others 14 found an inverse correlation between rising serum antibody (immunoglobulin [Ig] G, IgM, and IgA) and falling rates of infection.…”

Section: Introductionmentioning

confidence: 99%

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Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

Walz¹,

Baqar

Beecham

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. Diarrhea history questionnaires were administered to 369 U.S. military volunteers before and after deployment to Thailand. Additionally, blood samples obtained from a subset of 221 volunteers 1-3 weeks previously and 3-4 weeks after their deployment were tested by enzyme-linked immunosorbent assay for immunoglobulin A to Campylobacter jejuni. Stool samples from personnel (including volunteers) contracting diarrhea in Thailand were cultured for enteric pathogens. Overall, 35.2% (130 of 369) of questionnaire respondents reported one or more diarrhea episodes during their trip. Volunteers with pretravel anti-C. jejuni reciprocal titers Յ 450 were 1.6 times as likely to have had diarrhea during their stay in Thailand compared with those with pretravel titers Ͼ 450 (39.7% versus 25.3%; P ϭ 0.05). The symptomatic seroconversion, or attributable Campylobacter diarrhea attack rate, for the 1-month exercise was 12.7% (28 of 221). The symptomatic seroconversion rate in nonimmune (titer Յ 450) volunteers was 17.1%, whereas that in immune volunteers was only 4.0% (P ϭ 0.002). Campylobacter jejuni or C. coli were recovered from 32.9% (56 of 170) of stool samples cultured and were the most commonly identified enteropathogens. Campylobacter diarrhea was associated with elevated temperatures, fecal red cells, and fecal white blood cells. The results of this study show that Campylobacter continues to represent a significant health threat to Western travelers to Thailand, but many of these travelers have preexisting Campylobacter immunity that protects them from clinically significant Campylobacter enteritis.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

Walz¹,

Baqar

Beecham

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…Rapid, technically simple diagnostic tests need to be evaluated to determine their accuracy and acceptability in field settings. In Thailand, numerous surveys among deployed U.S. military personnel have shown that enteropathogenic Campylobacter species, Campylobacter jejuni and C. coli, account for as many as 60% of diarrheal cases (2,4,8,27,30,34,42), a very high prevalence compared to the prevalence detected in similar studies conducted in other regions (35). On the basis of this observation, the pathogen-specific diagnostic tests used in this study focused on Campylobacter.…”

mentioning

confidence: 99%

Diagnostic Approach to Acute Diarrheal Illness in a Military Population on Training Exercises in Thailand, a Region of Campylobacter Hyperendemicity

et al. 2008

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High rates of Campylobacter fluoroquinolone resistance highlight the need to evaluate diagnostic strategies that can be used to assist with clinical management. Diagnostic tests were evaluated with U.S. soldiers presenting with acute diarrhea during deployment in Thailand. The results of bedside and field laboratory diagnostic tests were compared to stool microbiology findings for 182 enrolled patients. Campylobacter jejuni was isolated from 62% of the cases. Clinical and laboratory findings at the time of presentation were evaluated to determine their impact on the posttest probability, defined as the likelihood of a diagnosis of Campylobacter infection. Clinical findings, the results of tests for inflammation (stool occult blood testing [Hemoccult], fecal leukocytes, fecal lactoferrin, plasma C-reactive protein), and the numbers of Campylobacter-specific antibodysecreting cells in peripheral blood failed to increase the posttest probability above 90% in this setting of Campylobacter hyperendemicity when these findings were present. Positive results by a Campylobacter-specific commercial enzyme immunoassay (EIA) and, less so, a research PCR were strong positive predictors. The negative predictive value for ruling out Campylobacter infection, defined as a posttest probability of less than 10%, was similarly observed with these Campylobacter-specific stool-based tests as well the fecal leukocyte test. Compared to the other tests evaluated, the Campylobacter EIA is a sensitive and specific rapid diagnostic test that may assist with diagnostic evaluation, with consideration of the epidemiological setting, logistics, and cost.Military personnel are frequently affected by short-term morbidity related to diarrheal diseases, with a potential adverse impact on the operational mission (24, 37). The use of empirical therapy without supplemental laboratory data is a feasible option; however, refinement of the management strategy by using laboratory testing may increase the cost-effectiveness and allow specific adjustments in antibiotic selection on the basis of regional susceptibility patterns. During military operations, the availability of a field laboratory with a microbiological testing capability is variable. Rapid, technically simple diagnostic tests need to be evaluated to determine their accuracy and acceptability in field settings. In Thailand, numerous surveys among deployed U.S. military personnel have shown that enteropathogenic Campylobacter species, Campylobacter jejuni and C. coli, account for as many as 60% of diarrheal cases (2,4,8,27,30,34,42), a very high prevalence compared to the prevalence detected in similar studies conducted in other regions (35). On the basis of this observation, the pathogen-specific diagnostic tests used in this study focused on Campylobacter. This study of military personnel presenting with acute diarrhea during deployment in Thailand evaluated the clinical findings in concert with bedside stool characterization and the results of field laboratory rapid diagnostic tests as compo...

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“…In developing countries, Campylobacter enteritis incidence rates as high as 0.4 episode per child per year have been reported (8,9,19,30). C. jejuni or Campylobacter coli organisms were isolated from approximately 50% of stool samples obtained from military personnel exhibiting diarrhea while deployed in Thailand (16,18,20).…”

mentioning

confidence: 99%

New World Monkey Aotus nancymae as a Model for Campylobacter jejuni Infection and Immunity

et al. 2006

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Ciprofloxacin- and Azithromycin-Resistant Campylobacter Causing Traveler's Diarrhea in U.S. Troops Deployed to Thailand in 1994

Cited by 67 publications

References 0 publications

Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

Diagnostic Approach to Acute Diarrheal Illness in a Military Population on Training Exercises in Thailand, a Region of Campylobacter Hyperendemicity

New World Monkey Aotus nancymae as a Model for Campylobacter jejuni Infection and Immunity

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