Etiology of Travelers’ Diarrhea on a Caribbean Island

Authors

  • Patricia Paredes,

    1. Patricia Paredes, MD, John J. Mathewson, PhD, and Zhi-Dong Jiang: Center for Infectious Diseases, The University of Texas-Houston, Houston, Texas.
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  • Sheila Campbell-Forrester,

    1. Sheila Campbell-Forrester, MD, David Ashley, PhD, and Sharon Thompson, MSc: Cornwall Regional Hospital and Western Health Area Administration, Ministry of Health, Montego Bay, Jamaica.
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  • John J. Mathewson,

    1. Sheila Campbell-Forrester, MD, David Ashley, PhD, and Sharon Thompson, MSc: Cornwall Regional Hospital and Western Health Area Administration, Ministry of Health, Montego Bay, Jamaica.
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  • David Ashley,

    1. Sheila Campbell-Forrester, MD, David Ashley, PhD, and Sharon Thompson, MSc: Cornwall Regional Hospital and Western Health Area Administration, Ministry of Health, Montego Bay, Jamaica.
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  • Sharon Thompson,

    1. Sheila Campbell-Forrester, MD, David Ashley, PhD, and Sharon Thompson, MSc: Cornwall Regional Hospital and Western Health Area Administration, Ministry of Health, Montego Bay, Jamaica.
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  • Robert Steffen,

    1. Robert Steffen, MD: Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
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  • Zhi-Dong Jiang,

    1. Patricia Paredes, MD, John J. Mathewson, PhD, and Zhi-Dong Jiang: Center for Infectious Diseases, The University of Texas-Houston, Houston, Texas.
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  • Ann-Mari Svennerholm,

    1. Ann-Mari Svennerholm, MD, PhD: Department of Medical Microbiology and Immunology, University of Goteborg, Goteborg, Sweden.
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  • Herbert L. DuPont

    Corresponding author
    1. Herbert L. Dupont, MD: Center for Infectious Diseases, The University of Texas and Internal Medicine Service, St. Luke's Episcopal Hospital, Houston, Texas.
      Reprint requests; Herbert L. DuPont, MD: St. Luke's Episcopal Hospital, 6720 Bertner Ave., MC 1-164, Houston, TX 77030
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Reprint requests; Herbert L. DuPont, MD: St. Luke's Episcopal Hospital, 6720 Bertner Ave., MC 1-164, Houston, TX 77030

Abstract

Background: Between December 6, 1994 and March 10, 1996, a study of the etiology of diarrhea was carried out among 332 travelers to five all-inclusive hotels in Negril, Jamaica.

Methods: Stool specimens were collected and sent to Montego Bay for laboratory analysis. Escherichia coli strains isolated at the Jamaican laboratory were sent to Houston for toxin testing.

Results: A recognized enteropathogen was found in 118 of the 332 (35.5%) cases. Enterotoxigenic E. coli (ETEC) were the most commonly identified pathogen (87/332; 26.2%) followed by Salmonella (4.2%) and Shigella (4.2%). Clustering of etiologically defined cases was studied at each hotel. A cluster was defined as 2 or more cases with the same pathogen identified in the same hotel within 7 days. In the 3 hotels with the highest number of cases of diarrhea, enteropathogens were part of a cluster in 65 of 99 cases (65.7%) of diarrhea of which an etiologic agent was identified. In the other 2 hotels, only 4 of 20 cases (20%) occurred in clusters.

Conclusions: A total of 25 clusters of travelers’ diarrhea cases was detected at the five hotels during the study period. Seventeen of 25 (68%) ETEC isolations occurred as part of a clustering of diarrhea cases. The largest outbreak of pathogen-identified diarrhea consisted of 7 cases of ETEC producing both heat-stable and heat-labile enterotoxins. In the Jamaican hotels with all inclusive meal packages most diarrhea cases occurred as small clusters, presumably as the result of foodborne outbreaks.

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