Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019
Journal
Journal of Travel Medicine
ISSN
1195-1982
Date Issued
2024
Author(s)
Ashley Brown
Cecilia Perret
Ralph Huits
Lin Chen
Daniel T Leung
Karin Leder
Bradley A Connor
Marta D Menéndez
Hilmir Asgeirsson
Eli Schwartz
Fernando Salvador
Denis Malvy
Mauro Saio
Alexandre Duvignaud
Stephen Vaughan
Marielle Glynn
Carsten Schade Larsen
Christian Wejse
Martin P Grobusch
Abraham Goorhuis
Emmanuel Bottieau
Marc Shaw
Annemarie Hern
Watcharapong Piyaphanee
Wasin Matsee
Jose Muñoz
Israel Molina
Frank Mockenhaupt
Francesco Castelli
Alberto Matteelli
Christina Coyle
Paul Kelly
Cosmina Zeana
Simin Aysel Florescu
Corneliu Petru Popescu
Stephen Vaughan
Susan Kuhn
Susan Anderson
Kunjana Mavunda
Carmelo Licitra
Francois Chappuis
Gilles Eperon
Jesse Waggoner
Henry Wu
Sabine Jordan
Johnnie Yates
Phi Truong Hoang Phu
Prativa Pandey
Michael Beadsworth
Jose Perez-Molina
Philippe Gautret
Emilie Javelle
Noreen Hynes
Elizabeth Barnett
Dan Bourque
Ann Settgast
Christina Greenaway
Sapha Barkati
Cedric Yansouni
Arpita Chakravarti
Camilla Rothe
Mirjam Schunk
Federico Gobbi
Nancy Piper Jenks
Marina Rogova
John Cahill
Ben Wyler
Frank Patterson
Anne McCarthy
Eric Caumes
Oula Itani
Els van Nood
Hedvig Glans
Mugen Ujiie
Satoshi Kutsuna
Shaun Morris
Kescha Kazmi
Terri Sofarelli
Katherine Plewes
Yazdan Mirzanejad
Pierre Plourde
Jacquie Shackel
Yukihiro Yoshimura
Natsuo Tachikawa
Patricia Schlagenhauf
Annelies Zinkernage
Kristina M Angelo
Type
journal-article
Abstract
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007–December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18–30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007–December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18–30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.</jats:p>
</jats:sec>
Cite this document
Weitzel, T., Brown, A., Libman, M., Perret, C., Huits, R., Chen, L., Leung, D. T., Leder, K., Connor, B. A., Menéndez, M. D., Asgeirsson, H., Schwartz, E., Salvador, F., Malvy, D., Saio, M., Norman, F. F., Amatya, B., Duvignaud, A., Vaughan, S., … Angelo, K. M. (2024). Intestinal protozoa in returning travellers: A GeoSentinel analysis from 2007 to 2019. Journal of Travel Medicine, 31(4), taae010. https://doi.org/10.1093/jtm/taae010
Funding(s)
Centers for Disease Control and Prevention
Subjects
Cryptosporidium
;
Cyclospora
;
gastrointestinal diseases
;
Giardia
;
surveillance
;
Travel