Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers: a prospective, multi-centre study Travel Medicine and Infectious Disease
Investigation article published in Travel Medicine and Infectious Disease
October 1st, 2019
Background:
We studied the geographic distribution of diarrhoeagenic Escherichia coli virulence genes (DEC VGs) acquisition in travellers and investigated if they acquired highly virulent EAEC/STEC hybrid strains.
Methods:
From the prospective, multicentre COMBAT study among 2,001 Dutch travellers, a subset of 491 travellers was were selected based on travel destination to 7 subregions. Faecal samples taken directly before and after travel were screened for nine DEC VGs with real-time PCR. Incidence proportions and rates were calculated for each gene and subregion.
Results:
479 travellers were analysed. 21.8% acquired aggR (EAEC), with the highest acquisition rates in Northern and Western Africa and 15.3% acquired eae (STEC/EPEC) with the highest rates in travellers to Western and Eastern Africa. ETEC (elt or est gene) was acquired by 4.2% of travellers and acquisition of est was associated with traveller’s diarrhoea. Overall, the risk of acquiring DEC VGs was low in Southern Africa and South America. Although the combination of aggR (EAEC) and stx1/2 (STEC) was acquired by 3 travellers, these genes could not be detected together in a single E. coli strain.
Conclusions:
The risk of acquisition of DEC VGs strongly depends on the travel destination, with those travelling to Africa - except Southern Africa - having a higher risk
Van Hattem JM., Cabal A., Arcilla MS., Alvarez J., de Jong MD., Melles DC., Penders J., COMBAT Consortium., Gortazar C. and Schultsz C.
 | Department of Medical Microbiology. Academic Medical Center. University of Amsterdam. |
 | Centro de Vigilancia Sanitaria Veterinaria (VISAVET). Universidad Complutense (UCM). |
 | Sanidad y Biotecnología (SaBio). Instituto de Investigación en Recursos Cinegéticos (IREC). Consejo Superior de Investigaciones Científicas (CSIC). Universidad de Castilla La Mancha (UCLM). Gobierno de Castilla-La Mancha (JCCM). |
 | Department of Medical Microbiology and Infectious Diseases. Erasmus Medical Center (Erasmus MC). |
| Departamento de Sanidad Animal. Facultad de Veterinaria. Universidad Complutense (UCM). |
 | Department of Medical Microbiology. Maastricht University. |
| School for Nutrition and Translational Research in Metabolism (NUTRIM) & Care and Public Health Research Institute (Caphri). Maastricht University. |
| Department of Global Health-Amsterdam-Institute for Global Health and Development. Academic Medical Center. University of Amsterdam. |
 | Julius Centre for Health Sciences and Primary Care. Universitair Medisch Centrum Utrecht (UMC Utrecht). |
 | Department of Mathematics. Faculty of Science. Utrecht University (UU). |
 | Department of Internal Medicine. Havenziekenhuis - Institute for Tropical Diseases. |
| Center of Tropical Medicine and Travel Medicine. Academic Medical Center. University of Amsterdam. |
