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Article
September 2, 1988

Etiology of Diarrhea Among Travelers and Foreign Residents in Nepal

Author Affiliations

From the Department of Bacteriology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand (Drs Taylor and Echeverria); US Peace Corps (Dr Houston) and the CIWEC Clinic (Dr Shlim), Kathmandu, Nepal; the Department of Parasitology, Siriraj Hospital, Bangkok, Thailand (Dr Bhaibulaya); and the Division of Tropical Public Health, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Ungar).

From the Department of Bacteriology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand (Drs Taylor and Echeverria); US Peace Corps (Dr Houston) and the CIWEC Clinic (Dr Shlim), Kathmandu, Nepal; the Department of Parasitology, Siriraj Hospital, Bangkok, Thailand (Dr Bhaibulaya); and the Division of Tropical Public Health, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Ungar).

JAMA. 1988;260(9):1245-1248. doi:10.1001/jama.1988.03410090077034
Abstract

A bacterial pathogen was isolated from 47% of 328 expatriate patients with diarrhea seen at two medical clinics in Nepal in 1986. Enterotoxigenic Escherichia coli (24%), Shigella (14%), and Campylobacter species (9%) were isolated most frequently. Enteroinvasive and adherence factor-positive E coli were isolated from 2% and 1% of patients, respectively. Giardia lamblia was detected in 12% of patients, rotavirus in 8%, and Cryptosporidium and Entamoeba histolytica each in 5%. Blastocystis hominis was present in 33% of patients but in only 9% of those who took trimethoprim-sulfamethoxazole. More than one enteropathogen was detected in 17% of patients. Patients with prolonged symptoms (longer than two weeks) were more likely to have Giardia (27%) and less likely to have Shigella (5%) than were patients with acute symptoms. The isolation rates of bacterial pathogens decreased with length of stay in Nepal. A wide variety of enteropathogens were detected in travelers to Nepal, and Shigella and protozoa were particularly important. Length of time abroad and duration of symptoms were important diagnostic considerations.

(JAMA 1988;260:1245-1248)

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