Bacterial travellers’ diarrhoea: A narrative review of literature published over the past 10 years

• Published in: Travel medicine and infectious disease 2022-05, Vol.47, p.102293-102293, Article 102293
• Main Authors: López-Vélez, Rogelio, Lebens, Michael, Bundy, Leah, Barriga, Juan, Steffen, Robert
• Format: Article
• Language: English
• Subjects: Aetiology; Africa; Africa south of the Sahara; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; antibiotic resistance; Antibiotics; Antimicrobial agents; Antimicrobial resistance; Arcobacter; Bacteria; bacterial infection; Bacterial infections; Bacterial Infections - drug therapy; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; bacterium detection; bacterium identification; Bacteroides fragilis; Campylobacter; Caribbean; central Asia; Clostridioides difficile; Diarrhea; Diarrhea - epidemiology; Diarrhea - microbiology; diarrheagenic Escherichia coli; Diarrhoea; disease duration; E coli; enteroaggregative Escherichia coli; enteropathogenic Escherichia coli; Enterotoxigenic Escherichia coli; Epidemiology; Etiology; Europe; family relation; Far East; Feces - microbiology; fluoroquinolone resistance; friendship; Geographical distribution; global health; human; humanitarian aid; Humans; immunocompromised patient; infection complication; Infectious diseases; Infectious Medicine; Infektionsmedicin; Irritable bowel syndrome; Microbiology in the medical area; Mikrobiologi inom det medicinska området; military personnel; molecular diagnosis; nonhuman; Pathogens; Prevention and control; quinolone derivative; Review; Salmonella; Shigella; South and Central America; South Asia; Southeast Asia; Travel; Travel medicine; traveller diarrhea; western Asia; Western Hemisphere
• ISSN: 1477-8939; 1873-0442
• DOI: 10.1016/j.tmaid.2022.102293

Travellers’ diarrhoea (TD) is the most frequent illness experienced by international travellers to lower-income countries with bacterial agents considered to account for 80–90% of cases. In this review, we summarise evidence published on bacterial TD over the past 10 years, focusing on the epidemiology and aetiology of TD. Diarrhoeagenic Escherichia coli (DEC) continue to be the most commonly implicated bacteria in TD, although Enteropathogenic E. coli (EPEC) and Enteroaggregative E. coli (EAEC) now appear to be predominant where Enterotoxigenic E. coli (ETEC) was previously considered most prevalent globally. Where fluroquinolone resistance had primarily been documented for Campylobacter in Southeast Asia, widespread resistance has been observed in most regions of the world for multiple enteropathogens, including Shigella, Salmonella, ETEC and EAEC. Implementation of novel molecular methods for pathogen detection has led to identification of bacterial pathogens, including Clostridium difficile (with and without the use of prior antibiotics), Arcobacter species and Bacteroides fragilis, as aetiological agents in TD. The widespread resistance to first-line antibiotics in multiple bacterial enteropathogens warrants continued surveillance and re-evaluation of current treatment practices. Further investigations are required to determine the prevalence and geographical distribution of bacterial enteropathogens that have been more recently implicated in TD.