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

Details

• Alternative Title:
  J Travel Med
• Personal Author:
  Weitzel, Thomas ; Brown, Ashley ; Libman, Michael ; Perret, Cecilia ; Huits, Ralph ; Chen, Lin ; Leung, Daniel T. ; Leder, Karin ; Connor, Bradley A. ; Menéndez, Marta D. ; Asgeirsson, Hilmir ; Schwartz, Eli ; Salvador, Fernando ; Malvy, Denis ; Saio, Mauro ; Norman, Francesca F. ; Amatya, Bhawana ; Duvignaud, Alexandre ; Vaughan, Stephen ; Glynn, Marielle ; Angelo, Kristina M.
• Corporate Authors:
  On behalf of the GeoSentinel Network
• Description:
  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 < 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.
  
  
• Subjects:
  Adolescent Adult Aged Child Child, Preschool Cryptosporidiosis Cryptosporidium Cyclospora Cyclosporiasis Diarrhea Female Giardia Lamblia Giardiasis Humans Male Middle Aged Sentinel Surveillance Travel Young Adult

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• Keywords:
  Gastrointestinal Diseases Giardia Surveillance
• Source:
  J Travel Med. 31(4)
• Pubmed ID:
  38245913
• Pubmed Central ID:
  PMC11285061
• Document Type:
  Journal Article
• Funding:
  Public Health Agency of Canada/ ; U01 CK000632/CK/NCEZID CDC HHSUnited States/ ; US Centers for Disease Control and Prevention/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; APP11550055/Australian National Health and Medical Research Council/ ; 1 U01CK000632-01-00/International Society of Travel Medicine/ ; CC/CDC HHSUnited States/
• Volume:
  31
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:b1623db43576d92b866e15d723746589e3457460c37aa74fcbccba0de6fa04b25cea495de83c90e7571ac0937fe5e4cba25daf35ff2824f17dfd733bb452feb6
• Download URL:
  https://stacks.cdc.gov/view/cdc/159468/cdc_159468_DS1.pdf
• File Type:
  [PDF - 828.55 KB ]