RESUMO
A study of acute diarrhea was conducted from 1985 to 1987 among U.S. military personnel participating in routine shipboard exercises in South America and West Africa and ground troops deployed to coastal Ecuador. An enteropathogen was identified in 146 (51%) of 289 acute cases of diarrhea. Enterotoxigenic Escherichia coli, found in 50 (17%) patients with diarrhea, was the most commonly identified enteropathogen. Viral enteropathogens were also found in a high percentage of acute cases of diarrhea: rotavirus was detected in 11% of the patients and Norwalk virus infection in 10%. Most enteric pathogens were acquired in equal frequencies in South America and West Africa, except for rotavirus infection which was identified more often in West Africa and enteroaggregative E. coli infection which was identified more often in South America. Bacterial enteropathogens were frequently resistant to trimethoprim/sulfamethoxazole, but no resistance to quinolone drugs was observed, indicating that quinolone drugs have become important agents for the treatment of diarrhea in South America and West Africa.
Assuntos
Diarreia/etiologia , Militares , Doença Aguda , África Ocidental , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Diarreia/microbiologia , Diarreia/parasitologia , Resistência Microbiana a Medicamentos , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/etiologia , Infecções por Escherichia coli/microbiologia , Fezes/química , Fezes/microbiologia , Fezes/parasitologia , Humanos , Vírus Norwalk/isolamento & purificação , Rotavirus/isolamento & purificação , Infecções por Rotavirus/etiologia , Infecções por Rotavirus/microbiologia , América do Sul , Viagem , Estados Unidos , Viroses/etiologia , Viroses/microbiologiaRESUMO
A retrospective epidemiological study was conducted in connection with an outbreak of paratyphoid fever at a Peruvian naval installation in Callao. The study sought to determine the magnitude of the outbreak, the source of infection, the attack rates, the persistence of bacilli excretion, and the clinical picture of the disease. The source of Salmonella paratyphi B infection had been a meal of chicken and rice served to around 400 members of the naval police. Over a period of three weeks, 21 persons were hospitalized and 52 received outpatient treatment at the naval hospital. In addition, through a questionnaire it was revealed that 86 unreported cases of diarrhea related to the outbreak had occurred. The most common clinical manifestations were fever, headache, weakness, anorexia, abdominal pain, and diarrhea. The general attack rate was 39.8%. In a follow-up survey carried out 37 days after exposure, fecal cultures indicated that 8.5% of the persons affected continued to excrete the microorganism. The high rates of attack and transmission of S. paratyphi B in this outbreak point up the considerable pathogenicity and virulence of some strains of the microorganism and their impact on public health. It is suggested that preventive measures be taken at naval and other similar installations, including the education of workers who handle and prepare food, in order to ensure proper hygiene.
Assuntos
Surtos de Doenças , Militares , Febre Paratifoide/epidemiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella paratyphi B/isolamento & purificação , Adulto , Animais , Galinhas , Humanos , Masculino , Carne , Febre Paratifoide/etiologia , Febre Paratifoide/microbiologia , Peru , Prevalência , Estudos Retrospectivos , Intoxicação Alimentar por Salmonella/etiologiaRESUMO
A randomized treatment trial of travelers' diarrhea was carried out among U.S. military personnel participating in routine exercises in several port cities in South America and West Africa. A 5-day, twice daily course of either norfloxacin (400 mg) or trimethoprim/sulfamethoxazole (TMP/SMX, 160/800 mg) was given to 142 volunteers. At the end of 5 days of treatment, diarrhea had resolved in 100% of 73 patients receiving norfloxacin and 97.1% (67/69) receiving TMP/SMX. A probable bacterial pathogen was determined in 44% of 142 subjects: 49% of the norfloxacin group and 39% of the TMP/SMX group. The most common pathogens detected were enterotoxigenic Escherichia coli in 20% of cases and rotavirus in 15%. Resistance to TMP/SMX was present in 20 (27%) bacterial isolates, while no resistance to norfloxacin was found. Eight of 10 patients in the TMP/SMX treatment group who had TMP/SMX-resistant bacterial enteropathogens improved clinically. Both norfloxacin and TMP/SMX were clinically effective in the treatment of travelers' diarrhea in this military population.
Assuntos
Diarreia/tratamento farmacológico , Militares , Norfloxacino/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Doença Aguda , Adolescente , Adulto , África Ocidental , Infecções Bacterianas/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Fezes/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , América do Sul , Inquéritos e Questionários , Viagem , Estados Unidos , Viroses/tratamento farmacológicoRESUMO
During 1984-1989, 655 diarrheic and 287 nondiarrheic stool specimens from adult U.S. citizens living in Lima, Peru were tested for presence of bacterial enteropathogens. Frequencies of isolation among diarrheic specimens were: Shigella 9.8%; Campylobacter 6.1%; enterotoxigenic Escherichia coli (ETEC) 6.0%; Plesiomonas 2.0%; Salmonella 1.4%; and Vibrio 0.6%. Isolates recovered from non-diarrheic stools were: Shigella 4.5%; Campylobacter 2.1%; Salmonella 1.0%; ETEC 0.7%; Plesiomonas 0.7%; and Vibrio 0.3%. Aeromonas, an unproven cause of diarrhea, was isolated from 9.2% of cases and 3.5% of controls. Disease occurrence was strongly associated with isolation of Shigella, ETEC, Campylobacter, or Aeromonas (p less than or equal to 0.01). During the 6-year period of study, shifts in the dominant phenotypes of Shigella and Campylobacter occurred which may have important implications for vaccine development and intervention strategies.
Assuntos
Diarreia/microbiologia , Adolescente , Adulto , Idoso , Fezes/microbiologia , Humanos , Pessoa de Meia-Idade , Peru , Viagem , Estados Unidos/etnologiaRESUMO
Two 01 Vibrio cholerae, E1 Tor strains, serogroup Ogawa were isolated from diarrheal stool material of two North American males residing or visiting in Peru. No other enteric pathogens were found. These strains did not produce cholera toxin as detected by enzyme-linked immunosorbent and Y1 adrenal cell assays, nor did they hybridize with an oligonucleotide probe for heat-labile (LT) toxin of Escherichia coli. These two cases are the first reports of 01 V. cholerae isolated from clinical specimens in South America.
Assuntos
Cólera/microbiologia , Diarreia/microbiologia , Vibrio cholerae/patogenicidade , Adulto , Enterotoxinas/análise , Ensaio de Imunoadsorção Enzimática , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Vibrio cholerae/classificaçãoRESUMO
Several studies have demonstrated the usefulness of 32P-labeled recombinant DNA probes for identifying enterotoxigenic Escherichia coli (ETEC). The use of radioisotopes and X-ray development, however, severely handicaps the utility of DNA probes in most clinical laboratories. In this study, enzyme-labeled oligonucleotide probes for ETEC LT (heat-labile toxin) and ST (heat-stable toxin) genes were compared with the standard Y1 adrenal cell and suckling mouse assays for their ability to identify ETEC in a population of American adults experiencing acute episodes of diarrhea in South America and West Africa. The LT probe hybridized with 12% (64 of 529) of the E. coli colonies tested, whereas 11% (57 of 529) were positive by Y1 adrenal cell assay. DNA from 9% (47 of 529) of the E. coli colonies tested hybridized with the ST probe, whereas only 5% (28 of 529) produced ST as measured by the suckling mouse bioassay. For the patient samples tested, correlation between probe and bioassay for LT was 97%, or three discrepancies in 111 patients tested. Overall concordance of the ST probe and bioassay was 95%, or five discrepancies in 111 patients. Enzyme-labeled oligonucleotide probes represent a major advance in the diagnosis of ETEC-associated diarrheal disease and may be used in laboratories with minimal equipment.