Diarrhea Among International Travelers in BaliIndonesia: Clinical and Microbiological Finding

Masyeni, Sri; Sukmawati, Ni Made Hegard; Paramasatiari, Lila; Aryastuti, Anak Agung Sri Agung; Somia, Ketut Agus; Kambayana, Gede; Astika, Nyoman; Duarsa, Renny; Merati, Tuti Parwati

doi:10.15171/ijtmgh.2017.18

Cited by 9 publications

(14 citation statements)

References 17 publications

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“…The previous report showed that at least one episode of diarrhea occurs among 20-50% of travelers. Due to increased trends of overseas travel, it is estimated that 15-20 million travelers will experience diarrhea [2], [3]. Those values are related to different climate, sanitation, and hygiene practices of the destination area as well as the country of origin.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, diarrhea could manifest even after the travelers return to their country of origin. Thus, it may also trigger local outbreak [2], [5].…”

Section: Introductionmentioning

confidence: 99%

“…Although the etiological agent of diarrhea varies widely, the most common bacterial pathogen reported was Escherichia coli. E. coli also has few clinical variants associated with the different clinical picture of diarrhea [2], [3], [8]. The previous study by Masyeni et al [2] showed that E. coli was among the primary pathogen among the foreign traveler in Bali.…”

Section: Introductionmentioning

confidence: 99%

“…E. coli also has few clinical variants associated with the different clinical picture of diarrhea [2], [3], [8]. The previous study by Masyeni et al [2] showed that E. coli was among the primary pathogen among the foreign traveler in Bali. More than 95% of cases in this study were acute secretory diarrhea, with mild-tomoderate severity.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Resistance Pattern and Detection of Enterotoxigenic and Enteroaggregative Strain of Escherichia coli among Foreign Tourist with Traveler Diarrhea in Bali using Uniplex Polymerase Chain Reaction

Sukrama

Lestari

Hendrayana

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: As one of the major tourist destinations in Southeast Asia, Bali received millions of foreign tourists each year. Diarrhea consistently placed as the most often experienced health problem among travelers. Traveler diarrhea has various etiologies. The most common was Escherichia coli. The existence of several types of E. coli that are resistant to several antibiotics causes the selection of antibiotics is crucial. AIM: This preliminary study aims to understand the pattern of antibiotics sensitivity and to detect the presence of enterotoxigenic and enteroaggregative strains of E. coli from fecal samples of foreign tourists with traveler’s diarrhea in Denpasar, Bali. METHODS: A culture examination was carried out to obtain E. coli bacterial colonies. Disk diffusion Kirby–Bauer was carried out for antibiotic sensitivity testing. The confirmed colonies were tested against several common antibiotics, including the recommended first line (ciprofloxacin and azithromycin). Uniplex polymerase chain reaction (PCR) using specific primers conducted to detect the enterotoxigenic E. coli (ETEC) (elt and estA2-4) and enteroaggregative E. coli (EAEC) (CVD432) strains. RESULTS: Among 48 stool culture, 14 (29.2%) were identified as E. coli colonies. All samples were still sensitive to the antibiotics meropenem, ceftazidime, and cefixime. Despite majority of the samples (78.6%) still sensitive to ciprofloxacin, large proportion of the samples have developed resistance against the other commonly used antibiotics, doxycycline (70.4%) and azithromycin (57.1%). PCR showed that 3 (21.4%) samples shown positive for CVD432 gene, 2 (14.3%) samples positive for the elt gene, and all negative for the estA2-4 gene. CONCLUSION: An only small proportion of E. coli was EAEC or ETEC strain. Although most E. coli still sensitive to beta-lactam antibiotics, a significant proportion had shown resistance against the commonly recommended first-line antibiotics.

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Section: Introductionmentioning

confidence: 99%

“…Moreover, diarrhea could manifest even after the travelers return to their country of origin. Thus, it may also trigger local outbreak [2], [5].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Antibiotic Resistance Pattern and Detection of Enterotoxigenic and Enteroaggregative Strain of Escherichia coli among Foreign Tourist with Traveler Diarrhea in Bali using Uniplex Polymerase Chain Reaction

Sukrama

Lestari

Hendrayana

et al. 2020

Open Access Maced J Med Sci

View full text Add to dashboard Cite

show abstract

“…A large number of traveler's take empirical ciprofloxacin or azithromycin to reduce the severity and duration of traveler's diarrhea. [7][8][9][10] Effective antimicrobial therapy is required to control morbidity and mortality from typhoid fever. Until the 1960s, all Salmonella were susceptible to a wide range of antimicrobials.…”

mentioning

confidence: 99%