Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers: A prospective, multi-centre study

Jarne M. van Hattem; Adriana Cabal; Maris S. Arcilla; Julio Alvarez; Menno D. de Jong; Damian C. Melles; John Penders; Martin C. J. Bootsma; Perry J. van Genderen; Abraham Goorhuis; Martin Grobusch; Nicky Molhoek; Astrid M. L. Oude Lashof; Ellen E. Stobberingh; Henri A. Verbrugh; Christian Gortazar Schmidt; Constance Schultsz; COMBAT Consortium

doi:10.1016/j.tmaid.2018.12.005

Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers: A prospective, multi-centre study

Jarne M. van Hattem^*, Adriana Cabal, Maris S. Arcilla, Julio Alvarez, Menno D. de Jong, Damian C. Melles, John Penders, Martin C. J. Bootsma, Perry J. van Genderen, Abraham Goorhuis, Martin Grobusch, Nicky Molhoek, Astrid M. L. Oude Lashof, Ellen E. Stobberingh, Henri A. Verbrugh, Christian Gortazar Schmidt, Constance Schultsz, COMBAT Consortium

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: We studied geographic distribution of diarrhoeagenic Escherichia coli virulence genes (DEC VGs) acquisition in travellers and investigated if they acquired highly virulent EAEC/STEC hybrid strains.

Methods: From the prospective, multicentre COMBAT study among 2001 Dutch travellers, 491 travellers were selected based on travel destination to 7 subregions. Faecal samples taken directly before and after travel were screened for nine DEC VGs with real-time PCR. Incidence proportions and rates were calculated for each gene and subregion.

Results: 479 travellers were analysed. 21.8% acquired aggR (EAEC), with highest acquisition rates in Northern and Western Africa and 15.3% acquired eae (STEC/EPEC) with highest rates in travellers to Western and Eastern Africa. ETEC (elt or est gene) was acquired by 4.2% of travellers and acquisition of est was associated with traveller's diarrhoea. Overall, the risk of acquiring DEC VGs was low in Southern Africa and South America. Although the combination of aggR (EAEC) and stx1/2 (STEC) was acquired by 3 travellers, these genes could not be detected together in a single E. coli strain.

Conclusions: The risk of acquisition of DEC VGs strongly depends on the travel destination, with those travelling to Africa - except Southern Africa - having a higher risk.

Original language	English
Article number	101362
Number of pages	8
Journal	Travel Medicine and Infectious Disease
Volume	31
DOIs	https://doi.org/10.1016/j.tmaid.2018.12.005
Publication status	Published - 2019

Keywords

Pathogenic E. coli
Travel
Acquisition
EHEC
POLYMERASE-CHAIN-REACTION
PERSISTENT DIARRHEA
ENTEROBACTERIACEAE
PATHOTYPES
PATHOGENS
CARRIAGE

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10.1016/j.tmaid.2018.12.005

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Cite this

van Hattem, J. M., Cabal, A., Arcilla, M. S., Alvarez, J., de Jong, M. D., Melles, D. C., Penders, J., Bootsma, M. C. J., van Genderen, P. J., Goorhuis, A., Grobusch, M., Molhoek, N., Lashof, A. M. L. O., Stobberingh, E. E., Verbrugh, H. A., Gortazar Schmidt, C., Schultsz, C., & COMBAT Consortium (2019). Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers: A prospective, multi-centre study. Travel Medicine and Infectious Disease, 31, Article 101362. https://doi.org/10.1016/j.tmaid.2018.12.005

@article{c06117f5ef394857b7d4969b000bd395,

title = "Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers: A prospective, multi-centre study",

abstract = "Background: We studied geographic distribution of diarrhoeagenic Escherichia coli virulence genes (DEC VGs) acquisition in travellers and investigated if they acquired highly virulent EAEC/STEC hybrid strains.Methods: From the prospective, multicentre COMBAT study among 2001 Dutch travellers, 491 travellers were selected based on travel destination to 7 subregions. Faecal samples taken directly before and after travel were screened for nine DEC VGs with real-time PCR. Incidence proportions and rates were calculated for each gene and subregion.Results: 479 travellers were analysed. 21.8% acquired aggR (EAEC), with highest acquisition rates in Northern and Western Africa and 15.3% acquired eae (STEC/EPEC) with highest rates in travellers to Western and Eastern Africa. ETEC (elt or est gene) was acquired by 4.2% of travellers and acquisition of est was associated with traveller's diarrhoea. Overall, the risk of acquiring DEC VGs was low in Southern Africa and South America. Although the combination of aggR (EAEC) and stx1/2 (STEC) was acquired by 3 travellers, these genes could not be detected together in a single E. coli strain.Conclusions: The risk of acquisition of DEC VGs strongly depends on the travel destination, with those travelling to Africa - except Southern Africa - having a higher risk.",

keywords = "Pathogenic E. coli, Travel, Acquisition, EHEC, POLYMERASE-CHAIN-REACTION, PERSISTENT DIARRHEA, ENTEROBACTERIACEAE, PATHOTYPES, PATHOGENS, CARRIAGE",

author = "{van Hattem}, {Jarne M.} and Adriana Cabal and Arcilla, {Maris S.} and Julio Alvarez and {de Jong}, {Menno D.} and Melles, {Damian C.} and John Penders and Bootsma, {Martin C. J.} and {van Genderen}, {Perry J.} and Abraham Goorhuis and Martin Grobusch and Nicky Molhoek and Lashof, {Astrid M. L. Oude} and Stobberingh, {Ellen E.} and Verbrugh, {Henri A.} and {Gortazar Schmidt}, Christian and Constance Schultsz and {COMBAT Consortium}",

note = "Funding Information: The COMBAT-study was funded by Netherlands Organisation for Health Research and Development (ZonMw, grant number 205200003). This work is a contribution to EU FP7 ANTIGONE (project number 278976). The funder had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Funding Information: The COMBAT-study was funded by Netherlands Organisation for Health Research and Development (ZonMw, grant number 205200003 ). This work is a contribution to EU FP7 ANTIGONE (project number 278976 ). The funder had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2018 Elsevier Ltd",

year = "2019",

doi = "10.1016/j.tmaid.2018.12.005",

language = "English",

volume = "31",

journal = "Travel Medicine and Infectious Disease",

issn = "1477-8939",

publisher = "ELSEVIER SCI LTD",

}

van Hattem, JM, Cabal, A, Arcilla, MS, Alvarez, J, de Jong, MD, Melles, DC, Penders, J, Bootsma, MCJ, van Genderen, PJ, Goorhuis, A, Grobusch, M, Molhoek, N, Lashof, AMLO, Stobberingh, EE, Verbrugh, HA, Gortazar Schmidt, C, Schultsz, C & COMBAT Consortium 2019, 'Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers: A prospective, multi-centre study', Travel Medicine and Infectious Disease, vol. 31, 101362. https://doi.org/10.1016/j.tmaid.2018.12.005

TY - JOUR

T1 - Risk of acquisition of human diarrhoeagenic Escherichia coli virulence genes in intercontinental travellers

T2 - A prospective, multi-centre study

AU - van Hattem, Jarne M.

AU - Cabal, Adriana

AU - Arcilla, Maris S.

AU - Alvarez, Julio

AU - de Jong, Menno D.

AU - Melles, Damian C.

AU - Penders, John

AU - Bootsma, Martin C. J.

AU - van Genderen, Perry J.

AU - Goorhuis, Abraham

AU - Grobusch, Martin

AU - Molhoek, Nicky

AU - Lashof, Astrid M. L. Oude

AU - Stobberingh, Ellen E.

AU - Verbrugh, Henri A.

AU - Gortazar Schmidt, Christian

AU - Schultsz, Constance

AU - COMBAT Consortium

N1 - Funding Information: The COMBAT-study was funded by Netherlands Organisation for Health Research and Development (ZonMw, grant number 205200003). This work is a contribution to EU FP7 ANTIGONE (project number 278976). The funder had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Funding Information: The COMBAT-study was funded by Netherlands Organisation for Health Research and Development (ZonMw, grant number 205200003 ). This work is a contribution to EU FP7 ANTIGONE (project number 278976 ). The funder had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: © 2018 Elsevier Ltd

PY - 2019

Y1 - 2019

N2 - Background: We studied geographic distribution of diarrhoeagenic Escherichia coli virulence genes (DEC VGs) acquisition in travellers and investigated if they acquired highly virulent EAEC/STEC hybrid strains.Methods: From the prospective, multicentre COMBAT study among 2001 Dutch travellers, 491 travellers were selected based on travel destination to 7 subregions. Faecal samples taken directly before and after travel were screened for nine DEC VGs with real-time PCR. Incidence proportions and rates were calculated for each gene and subregion.Results: 479 travellers were analysed. 21.8% acquired aggR (EAEC), with highest acquisition rates in Northern and Western Africa and 15.3% acquired eae (STEC/EPEC) with highest rates in travellers to Western and Eastern Africa. ETEC (elt or est gene) was acquired by 4.2% of travellers and acquisition of est was associated with traveller's diarrhoea. Overall, the risk of acquiring DEC VGs was low in Southern Africa and South America. Although the combination of aggR (EAEC) and stx1/2 (STEC) was acquired by 3 travellers, these genes could not be detected together in a single E. coli strain.Conclusions: The risk of acquisition of DEC VGs strongly depends on the travel destination, with those travelling to Africa - except Southern Africa - having a higher risk.

AB - Background: We studied geographic distribution of diarrhoeagenic Escherichia coli virulence genes (DEC VGs) acquisition in travellers and investigated if they acquired highly virulent EAEC/STEC hybrid strains.Methods: From the prospective, multicentre COMBAT study among 2001 Dutch travellers, 491 travellers were selected based on travel destination to 7 subregions. Faecal samples taken directly before and after travel were screened for nine DEC VGs with real-time PCR. Incidence proportions and rates were calculated for each gene and subregion.Results: 479 travellers were analysed. 21.8% acquired aggR (EAEC), with highest acquisition rates in Northern and Western Africa and 15.3% acquired eae (STEC/EPEC) with highest rates in travellers to Western and Eastern Africa. ETEC (elt or est gene) was acquired by 4.2% of travellers and acquisition of est was associated with traveller's diarrhoea. Overall, the risk of acquiring DEC VGs was low in Southern Africa and South America. Although the combination of aggR (EAEC) and stx1/2 (STEC) was acquired by 3 travellers, these genes could not be detected together in a single E. coli strain.Conclusions: The risk of acquisition of DEC VGs strongly depends on the travel destination, with those travelling to Africa - except Southern Africa - having a higher risk.

KW - Pathogenic E. coli

KW - Travel

KW - Acquisition

KW - EHEC

KW - POLYMERASE-CHAIN-REACTION

KW - PERSISTENT DIARRHEA

KW - ENTEROBACTERIACEAE

KW - PATHOTYPES

KW - PATHOGENS

KW - CARRIAGE

U2 - 10.1016/j.tmaid.2018.12.005

DO - 10.1016/j.tmaid.2018.12.005

M3 - Article

C2 - 30609386

SN - 1477-8939

VL - 31

JO - Travel Medicine and Infectious Disease

JF - Travel Medicine and Infectious Disease

M1 - 101362

ER -