Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019

WEITZEL, THOMASTHOMASWEITZELAshley BrownMichael LibmanCecilia PerretRalph HuitsLin ChenDaniel T LeungKarin LederBradley A ConnorMarta D MenéndezHilmir AsgeirssonEli SchwartzFernando SalvadorDenis MalvyMauro SaioFrancesca F NormanBhawana AmatyaAlexandre DuvignaudStephen VaughanMarielle GlynnCarsten Schade LarsenChristian WejseMartin P GrobuschAbraham GoorhuisEmmanuel BottieauMarc ShawAnnemarie HernWatcharapong PiyaphaneeWasin MatseeJose MuñozIsrael MolinaFrank MockenhauptFrancesco CastelliAlberto MatteelliChristina CoylePaul KellyCosmina ZeanaSimin Aysel FlorescuCorneliu Petru PopescuStephen VaughanSusan KuhnSusan AndersonKunjana MavundaCarmelo LicitraFrancois ChappuisGilles EperonJesse WaggonerHenry WuSabine JordanJohnnie YatesPhi Truong Hoang PhuPrativa PandeyMichael BeadsworthJose Perez-MolinaPhilippe GautretEmilie JavelleNoreen HynesElizabeth BarnettDan BourqueAnn SettgastChristina GreenawaySapha BarkatiCedric YansouniArpita ChakravartiCamilla RotheMirjam SchunkFederico GobbiNancy Piper JenksMarina RogovaJohn CahillBen WylerFrank PattersonAnne McCarthyEric CaumesOula ItaniEls van NoodHedvig GlansMugen UjiieSatoshi KutsunaShaun MorrisKescha KazmiTerri SofarelliKatherine PlewesYazdan MirzanejadPierre PlourdeJacquie ShackelYukihiro YoshimuraNatsuo TachikawaPatricia SchlagenhaufAnnelies ZinkernageKristina M Angelo2024-10-102024-10-102024Weitzel, 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/taae010https://investigadores.udd.cl/handle/123456789/1007910.1093/jtm/taae0102-s2.0-85194400053WOS:00116389110000138245913Abstract Background 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. Methods 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. Results 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 &lt; 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. Conclusions 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. CryptosporidiumCyclosporagastrointestinal diseasesGiardiasurveillanceTravelIntestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019journal-article