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009.2 Infectious diarrhea; dysenteric diarrhea; epidemic diarrhea; traveler's diarrhea

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Global Incidence And Prevalence
Date Updated: 05/13/2011
International Incidence
WORLDWIDE: Using a conservative estimate that 50 million travelers will visit developing countries every year
and that 30% to 40% of those travelers will experience traveler's diarrhea (TD), it can be concluded that 15 to
20 million travelers will experience TD annually (i.e., 40,000 travelers daily). Developing countries are high-risk
regions, with TD rates of 20% to 90% per each 2-week stay. In contrast, visitors to low-risk areas experience TD
at rates of under 8% for each 2-week stay. Destinations with incidence rates over 8% but under 20% are
considered to be intermediate-risk regions. (Clinical Infectious Diseases; V.41; Suppl 8; 2005; pS536)
WORLDWIDE: Diarrhea is the most common illness encountered among international travelers to developing
countries, affecting 30% to 40% of individuals in the first two weeks of travel. The present study indicates that
the risk of travelers' diarrhea persists among expatriate persons living for prolonged periods of time in a country
where diarrhea is highly endemic. Expatriates surveyed in the community reported an attack rate of about 50%
per month during their first two years of living in Nepal. The high level of exposure to enteric pathogens in Nepal
is borne out by the remarkable prevalence of pathogens found in the stool of asymptomatic persons. 37% of
residents and 52% of tourists visiting the clinic for reasons other than diarrhea had a pathogen detected in
single stool collection. In contrast, in a study in Mexico, stools were collected every three days for two months
from American and Latin American students; among those who remained asymptomatic, 37% had an enteric
pathogen identified at some time during the two-month prospective surveillance period. Although it is not known
how many of the asymptomatic infections detected in Nepal represent true asymptomatic carriage (vs
incubating disease), the high point prevalence of pathogens in this study sample suggests that virtually
everyone in the community is repeatedly exposed over time. In 1993, Peace Corps volunteers working in Nepal
were reported to have the fourth highest rate of diarrhea among volunteers working in 65 developing countries
in Asia, Latin America, and Africa (192 episodes per 100 volunteers per year in Nepal compared with 64 per
100 volunteers overall). (JAMA; V.275; 2/21/96; p533)
AFRICA, ASIA, LATIN AMERICA, AND INDIA: Recent estimates by WHO indicate that in Africa, Asia
(excluding China), and Latin America, 750 million children under age 5 suffer from diarrhea each year, and 4
million to 5 million die from the condition; in India, the mortality figure is at least 1.5 million children. (J Com Dis;
V.26; 1994; p92)
U.S. Patient Visit And Discharge Trends
U.S. Hospital Inpatients
Date Updated: 07/25/2010
Notes: Visits under 5,000 per year have a relative standard error of +/-30%.
Legend: A=Primary Diagnosis; B=All Listed Diagnosis; C=Average Stay in Days

Years   2004   2005   2006   2007   2008   2009

A   1,034   2,829   1,281   3,038   1,004   2,621

B   1,507   3,774   1,606   6,460   1,829   2,918

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 C   2.4   3.5   3.6   3.7   2.7   2.0

U.S. Physician Office Visits

Date Updated: 08/01/2010
Notes: Visits under 846,000 per year have a relative standard error of +/-30%.
Legend: A=Primary Diagnosis; B=All Listed Diagnoses

Years   2004   2005   2006   2007   2008   2009

A   173,008   12,227   *   95,015   82,322   86,997

B   173,008   12,227   *   159,508   146,815   86,997

Date Updated: 08/01/2010

U.S. Emergency Department Visits
Notes: Visits under 80,000 per year have a relative standard error of +/-30%.
Legend: A=Primary Diagnosis; B=All Listed Diagnoses

Years   2004   2005   2006   2007   2008   2009

A   6,087   30,124   13,735   13,016   29,462   9,722

B   7,973   33,437   31,923   31,204   47,650   13,937

Date Updated: 08/01/2010

U.S. Hospital Outpatients
Notes: Visits under 100,000 per year have a relative standard error of +/-30%.
Legend: A=Primary Diagnosis; B=All Listed Diagnoses

Years   2004   2005   2006   2007   2008   2009

A   *   284   1,283   3,982   *   401

B   *   284   1,283   3,982   *   1,989

SEE ALSO: ICD-9 Code 009.3 (Diarrhea of presumed infectious origin; General comments covering diarrhea).
DEFINITION(S): Diarrhea is often defined as excess stool water, usually greater than 200 gm per day (or, in
infants, greater than 10 gm per kg per day).
NOTE: Acute infectious diarrhea associated with travel, referred to as traveler's diarrhea (TD), is often defined
as the passage of 3 or more loose stools in a 24-hour period. The most common cause of TD is enterotoxigenic
Escherichia coli. Associated symptoms may include nausea, vomiting, abdominal cramps, or fever. Symptoms
commonly last only 2-5 days. If lasting more than 2 weeks, the diarrhea is considered chronic and is a separate
clinical entity. The occurrence of fever with blood or mucus in the stool indicates a severe dysenteric syndrome
related to infection with a more invasive organism.
Article Review
Citation: Shah N et al; "Global Etiology of Travelers' Diarrhea: Systematic Review From 1973 to the Present."
American Journal of Tropical Medicine and Hygiene; V.80; No.4; 2009; p609
Abstract
STUDY DESIGN: This review examined the etiology of travelers' diarrhea (TD) by region of the developing
world and determined changes in frequency of enteropathogens causing TD over the three decades of study.
All studies on the etiology of TD listed by PubMed and Medline Ovid and published since 1973 were reviewed.

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In 51 published studies between 1973 and 2008, 57 different groups of travelers were evaluated for etiology of
diarrhea. The total population with TD included in this review was 30,884 persons studied in 57 separate travel
groups. For Latin America, there were 24 travel groups comprising 3302 persons with TD studied over the years
of the study. For Africa, the number of study groups was 10, with TD occurring in 1217 persons (there were no
studies carried out in the 2000s). For South Asia and Southeast Asia, the authors included 10 study groups with
etiology data in 1145 persons with TD. Finally, for the studies reporting travelers to unspecified developing
regions, 13 study groups including 25,302 persons with TD provided information on enteropathogens. One of
the studies to many but unspecified regions included 23,215 persons.
TRAVELERS' DIARRHEA BY PATHOGEN: The most common pathogen identified overall was enterotoxigenic
Escherichia coli (ETEC), which was found in 1678 of 5518 (30.4%) of the subjects studied. ETEC was most
frequently identified in travelers to Latin America and Africa, found in 1109 of 3302 (33.6%) and 380 of 1217
(31.2%) subjects in the two locations, respectively. ETEC was found in 153 of 499 (30.6%) in south Asia and in
36 of 500 (7.2%) in Southeast Asia.
Enteroaggregative E. coli (EAEC) was the second most commonly identified enteropathogen found in 202 of
1060 (19.0%) of the subjects studied. EAEC was isolated in 166 of 689 (24.1%) travelers with diarrhea while
traveling in Latin America. EAEC was identified in 33 of 206 (16.0%) of travelers with diarrhea developing while
traveling in South Asia. EAEC was relatively infrequently encountered in subjects with TD acquired in Africa; it
was found in 3 of 165 (1.8%). Campylobacter was more often found in Asia compared with Latin America and
Africa. Shigella spp. were most commonly found in TD cases occurring in Africa compared with Asia, whereas
Salmonella more often was identified in TD cases occurring in Asia than in Africa or Latin America. Aeromonas
spp. were more often found in Asia and Africa than Latin America, and Plesiomonas spp. were more often found
in Asia than the other study areas. Vibrios (non-cholera and cholera) were more common also in Asia than in
the other study groups. Noroviruses and rotavirus were more often found in Latin America and Africa and less
common in Asia. Giardia and Entamoeba histolytica were found more commonly in Asia than the other study
groups.
DISCUSSION: Insufficient studies of the incidence of TD and the relative importance of specific
enteropathogens among international travelers to various world regions are presently available. The strength of
this study is that a total review of published studies has not taken place in recent years. This study confirms the
importance of bacterial enteropathogens as causes of TD, explaining the remarkable effectiveness of
antibacterial drugs in the prevention and therapy of TD. The authors recommend more comprehensive studies
of TD.
Article Review
Citation: Steffen R; "Epidemiology of Traveler`s Diarrhea." Clinical Infectious Diseases; V.41; Suppl 8; 2005;
pS536
Abstract
DEFINITION OF TRAVELER'S DIARRHEA: Classic traveler's diarrhea (TD) is usually defined as 3 or more
unformed bowel movements occurring within 24 hours and accompanied by other symptoms, most often
cramps, nausea, fever, blood admixed to the stools, and vomiting. Fecal urgency is usually also associated with
TD. Moderate TD is defined as 1 or 2 unformed bowel movements occurring every 24 hours with additional
symptoms, or as 3 or more unformed bowel movements without additional symptoms. Mild TD is defined as 1 or
2 unformed bowel movements without any additional symptoms.
EPIDEMIOLOGY: Using a conservative estimate that 50 million travelers will visit developing countries every
year and that 30% to 40% of those travelers will experience TD, it can be concluded that 15 to 20 million
travelers will experience TD annually (i.e., 40,000 travelers daily).
Developing countries are high-risk regions, with TD rates of 20% to 90% per each 2-week stay. In contrast,
visitors to low-risk areas experience TD at rates of under 8% for each 2-week stay. Destinations with incidence

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rates over 8% but under 20% are considered to be intermediate-risk regions.
RISK GROUPS: Seasonality has only a limited relevance to rates of TD. Experts recognize that the incidence
rates of TD mirror the hygienic conditions of the places visited. As expected, the duration of exposure is also
relevant. It has already been demonstrated in previous studies that 5-star hotels tend to have a slightly higher
TD incidence rate compared with many 3- or 4-star hotels. This finding is plausible, considering that food items
are more frequently prepared by hand in higher-end hotels. The type of travel also plays a role: beach vacations
in a resort are associated with lower attack rates (28%), tours are associated with slightly higher rates (31% for
group tours and 32% for individual tours), and adventure tours are associated with the highest rates (34%). "All-
inclusive" tours tend to be associated with higher attack rates, which can hypothetically be explained by greater
consumption of alcoholic beverages by travelers on such tours.
The origin of the traveler is the most relevant host factor. It has long been known that persons from developing
countries have a very low incidence rate of TD (2% to 8%) when visiting other developing countries; this
phenomenon has been demonstrated in delegates to conventions and in students and military populations.
Similarly, various studies have demonstrated that travelers who recently visited the tropics have a diminished
incidence rates of TD, probably as a result of some developed immunity.
Various studies have demonstrated that younger age is a risk factor for TD. Infants, toddlers, and young adults
(age 15 to 30 years) are particularly prone to developing TD.
PROGNOSIS: TD usually occurs during the first week of travel abroad. The average duration of untreated TD is
about 4 days; 50% of patients who experience TD are free of symptoms within 48 hours.
Early studies have already indicated that TD persists in 1% of patients for 4 or more months. According to a
recent study, 10% of patients who have had TD thereafter experience irritable bowel syndrome. In addition, it
has been suggested that inflammatory bowel syndrome, which is uncommon in most populations indigenous to
tropical countries, may present for the first time after a trip to the tropics.
Article Review
Citation: "Epidemiology of Diarrhea Among Expatriate Residents Living in a Highly Endemic Environment."
JAMA; V.275; 2/21/96; p533
Abstract
This clinic-based case-control study sought to determine the etiology of diarrhea among expatriate residents
living in a developing country and identify risk factors for travelers' diarrhea that are difficult to evaluate in tourist
populations. A total of 69 expatriate residents with diarrhea were compared with 120 tourists with diarrhea, and
112 asymptomatic resident and tourist controls, selected systematically during a one year period at a primary
care travel medicine clinic in Kathmandu, Nepal.
PREVIOUS STUDIES: Diarrhea is the most common illness encountered among international travelers to
developing countries, affecting 30% to 40% of individuals in the first two weeks of travel. Studies of travelers'
diarrhea have focused on the etiology of these initial episodes, and studies of risk factors have relied mainly on
retrospective surveys among returning travelers. Asymptomatic controls who are evaluated microbiologically are
infrequently included. Little is known about the epidemiology of diarrhea among persons from developed
countries who establish residence in developing countries for extended periods of time. The etiology of diarrhea
in such expatriate persons has rarely been reported and has never been compared with tourists in the same
study.
EXPATRIATES VS TOURISTS: The present study indicates that the risk of travelers' diarrhea persists among
expatriate persons living for prolonged periods of time in a country where diarrhea is highly endemic.
Expatriates surveyed in the community reported an attack rate of about 50% per month during their first two
years of living in Nepal. This figure, based on a survey conducted early in the diarrhea season, was not much
lower than the attack rate reported by tourists departing Nepal during the highest-risk months. In addition, the
etiology of diarrhea was similar for residents and tourists presenting for medical treatment; enterotoxigenic

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Escherichia coli, Campylobacter, and Shigella were the predominant pathogens for both groups. Although the
risk of disease, clinical severity, and pathogen isolation rate were significantly higher among tourists than
among expatriate residents, even in the latter group diarrhea was associated with appreciable morbidity. 20% of
residents with diarrhea had symptoms for more than 2 weeks before coming to the clinic, 28% complained of 10
or more stools per day, and 22% had evidence of dysentery (fecal leukocytes). Eating out in restaurants was a
dominant risk factor for diarrhea among residents, independent of the type of foods consumed.
PATHOGEN PREVALENCE: The high level of exposure to enteric pathogens in Nepal is borne out by the
remarkable prevalence of pathogens found in the stool of asymptomatic persons. 37% of residents and 52% of
tourists visiting the clinic for reasons other than diarrhea had a pathogen detected in single stool collection. In
contrast, in a study in Mexico, stools were collected every three days for two months from American and Latin
American students; among those who remained asymptomatic, 37% had an enteric pathogen identified at some
time during the two-month prospective surveillance period. Although it is not known how many of the
asymptomatic infections detected in Nepal represent true asymptomatic carriage (vs incubating disease), the
high point prevalence of pathogens in this study sample suggests that virtually everyone in the community is
repeatedly exposed over time.
REGIONAL VARIATION: Data from other studies suggest that there are regional differences in the risk of
travelers' diarrhea, and results of the present study are likely to be most generalizable to areas where the risk is
highest. In 1993, Peace Corps volunteers working in Nepal were reported to have the fourth highest rate of
diarrhea among volunteers working in 65 developing countries in Asia, Latin America, and Africa (192 episodes
per 100 volunteers per year in Nepal compared with 64 per 100 volunteers overall).
RECOMMENDATIONS: Travelers should be informed about the ubiquitous exposure to pathogens and the fact
that the dominant risk factors for diarrhea are difficult to modify (younger age, duration of stay, seasonality, and
eating any meals in restaurants). However, it may be just as important to inform travelers that disease may
occur despite their best efforts and provide them with reassurance, knowledge about appropriate supportive
care, and the means to treat themselves. Since most diarrheal episodes are bacterial in origin, travelers to
developing countries should be given advice on how to self-diagnose and empirically treat themselves with an
antibiotic specific to their region of travel.
Article Review
Citation: "Differences in Morbidity Between Breast-Fed and Formula-Fed Infants." J Pediatr; V.126; 1995; p696
Abstract
To determine whether breast feeding is protective against infection in relatively affluent populations, morbidity
data were collected by weekly monitoring during the first 2 years of life from matched cohorts of infants who
were either breast-fed (46 subjects) or formula-fed (41 subjects) until at least 12 months of age. Results indicate
that the incidence of diarrhea is about 50% lower in breast-fed than in formula-fed infants during the first year of
life. One recent study reported a similar or greater reduction in gastrointestinal illness associated with breast-
feeding in a large prospective study in Scotland. In contrast, a study from Denmark reported no significant
relationship between type of feeding and the incidence of gastroenteritis. (This study, however, used mixed
criteria and a questionnaire format in which the response rate declined to 44% over a 12-month period.)
Article Review
Citation: J Com Dis; V.26; 1994; p92
Abstract
Diarrhea is the leading cause of morbidity and mortality in developing countries. Recent estimates by WHO
indicate that in Africa, Asia (excluding China), and Latin America, 750 million children under age 5 suffer from
diarrhea each year, and 4 million to 5 million die from the condition; in India, the mortality figure is at least 1.5
million children. About 60% to 70% of diarrhea-related mortality is caused by dehydration, which is preventable
both at home and at health care facilities.

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Article Review
Citation: J Infect Dis; V.169; 1994; p1,206
Abstract
One-third of 16 million people who travel annually from industrialized to developing countries (8 million in the
U.S.) may experience mildly as traveler's diarrhea the disease which is so devastating among children in
tropical developing areas. Frequent, sometimes life-threatening diarrhea affects 50% to 90% of 100,000 AIDS
patients in the U.S. (3 million patients worldwide) each year. Diarrhea in institutions (e.g., day care centers,
hospitals, extended care facilities) is estimated by prospective data to be at least 1.6% of the 35 million
hospitalized patients who develop nosocomial diarrhea annually.
Article Review
Citation: Current Problems in Pediatrics; V.24; 3/94; p95
Abstract
Diarrhea is defined as excess stool water, usually greater than 200 gm per day (or, in infants, greater than 10
gm per kg per day). Frequency by itself is not indicative of diarrhea, although they often coexist. Indeed, breast-
fed infants may have up to 12 stools per day, and formula fed infants may have up to 7 stools per day. The
presence of undigested food particles merely indicates fast transit. Acute infective diarrhea is usually an obvious
increase over the baseline with nausea, vomiting, fever, and abdominal pain variably present. Although most of
the episodes in children are self-limited, diarrhea continues to be a major global problem, accounting for up to
3.5 million deaths worldwide in children less than 5 years old. In the U.S., 220,000 patients are hospitalized per
year, accounting for 10.6% of admissions in this age group, whereas most of the 300 to 400 deaths per year
attributed to diarrhea occur in the first year.
Article Review
Citation: Infectious Disease Clinics of North America; V.8, N.1; 3/94; p155
Abstract
While traveling in Latin America, a resident of a highly industrialized region has a 20% to 25% risk of developing
traveler's diarrhea for each week of travel. This risk is higher in rural areas of tropical countries and lower in
urban areas of cold climate. Up to 90% of travelers become careless about prevention after the third day of
travel. Up to 50% will pass 4 to 5 liquid or loose stools per day for 3 to 5 days, 40% will see their activities
restricted, and up to 25% will need bed rest.
Article Review
Citation: Infectious Disease Clinics of North America; V.8, N.11; 3/94; p77
Abstract
Acute gastroenteritis is a major health problem in most Latin countries although the attack and mortality rates
due to diarrhea differ from country to country. The highest attack rates of diarrhea have been found in certain
rural areas of Peru and Brazil and the lowest have been reported in Costa Rica and Chile. A study of low-
income children in an urban area of Santiago, Chile found an attack rate of 2.7 diarrhea episodes in the first 2
years of life. A similar attack rate has been reported from rural communities of Mexico. Infants under 1 year
suffer the highest mortality rates, an average of 20 per 1000 children born. Mortality rates reported include: 6 in
1000 born children in Mexico; 7 in 1000 in Peru; and 3 in 1000 in Chile. Protracted diarrhea contributes to most
of the fatalities in some countries.
Article Review
Citation: Medical Clinics of North America; V.77; 9/93; p1,169
Abstract
Diarrheal illness is one of the most common out-patient infectious illnesses in the world. The U.S. is not isolated
from this illness; the mortality in children in the U.S. in the first year of life is approximately 0.25 deaths per 1000
live births. The incidence of diarrhea in children under age 5 is 2 to 2.5 episodes per child per year; among

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adults it is 1.5 to 1.7 episodes per year. Patient groups at risk for diarrhea are children younger than 5 years old
(especially in day care centers), travelers and campers, patients with AIDS or immunocompromising conditions,
patients in chronic care facilities with nosocomial infections, and military personnel assigned overseas. The
impact on the U.S. population has been estimated to vary between 25 to 99 million cases of vomiting or
diarrhea per year, with an estimated 10,000 deaths per year. Of these, 8.2 million patients seek medical advice;
250,000 patients require hospitalization.
Article Review
Citation: Pediatr Infect Dis J; V.12; 9/93; p751
Abstract
Diarrheal diseases continue to be an important public health problem in developing countries. Acute, short-lived
illnesses with dehydration can result in death unless prompt and appropriate fluid replacement is provided.
Although most diarrheal episodes resolve within the first week, a small proportion continue for 2 weeks or
longer. A WHO meeting in December 1987 recommended that persistent diarrhea be operationally defined as
an episode that begins acutely and lasts for at least 14 days. The term is not intended to encompass chronic
diarrheal disorders. Among 8 studies conducted in 5 Asian and Latin American countries, 3% to 23% of all
episodes of diarrhea persisted for longer than 2 weeks. Incidence ranges from 7 per 100 child-years to 150 per
100 child-years. It varies with age, the highest rates generally being in the first or second year of life. Recent
information from India, Bangladesh, Brazil, and Senegal indicates that acute watery diarrhea may account for
25% to 46% (mean 35%) of all deaths associated with diarrhea. The remainder was associated with dysentery
(8% to 24%; median 20%) or persistent nondysenteric diarrhea (23% to 62%; median 45%).
Article Review
Citation: American Family Physician; V.48; 10/93; p793
Abstract
Each year, 3 to 5 million Americans visit developing countries; an estimated 40% to 60% of these travelers will
contract traveler's diarrhea. Bacteria are the etiologic agents in 50% to 80% of cases. The average family
physician annually encounters 30 to 50 patients who travel to a developing country.
Article Review
Citation: Gastroenterology Clinics of North America; V.22; 9/93; p549
Abstract
Traveler's diarrhea typically occurs in international travelers 2 to 3 days after arrival at their destination. In
general, it is a mild illness with an average of 4 to 5 loose or watery stools per day. When untreated, in about
85% of patients it lasts for 3 to 4 days. A small proportion (10%) have illness lasting longer than 1 week, and
only 1% to 2% of patients have persistence of symptoms beyond 1 month. The onset of the illness may occur
soon after the return home, reflecting exposure during the previous 3 days. Diarrhea is commonly of less
inconvenience than abdominal cramps (50% to 73% of patients), malaise (50% to 58%), nausea (46% to 50%),
feverish feeling (37%), and myalgias (25%). Temperatures of greater than 38.5 degrees Centigrade (2% to
10%), bloody dysentery (2% to 10%), and vomiting (8% to 15%) are less frequent complaints. More than half
the cases are mild and do not confine the patient's activities; however, severe cases (20% of patients) may
confine the patient to bed or hotel for 2 to 3 days. An individual may have more than one attack of traveler's
diarrhea on any given trip. Diarrhea is almost never a cause of significant dehydration, except in susceptible
subjects (e.g., AIDS patients, ileostomy patients). Residents of North America, Western Europe, Australia, and
South Africa are believed to be susceptible to traveler's diarrhea, whereas residents of South America, the
Mediterranean countries, and most Asian countries are less susceptible. Susceptible travelers are at high risk
(i.e., attack rates of 20% to 50%) when visiting southern Asia, the Middle East, Africa, and Latin America. They
are at intermediate risk (i.e., attack rates of 10% to 20%) when visiting Eastern Europe, former Soviet Union
countries, Mediterranean countries, China, most of the Caribbean, Israel, and Japan. They are at lower risk (i.e.,

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attack rates of less than 8%) when visiting Canada, Northern Europe, Australia, New Zealand, and the U.S.
Surveys among various groups have defined host factors that are important in the illness. Younger travelers
have a greater risk of developing diarrhea than older travelers, possibly reflecting a difference in eating habits or
a difference in immunity. In one study of travelers to Mexico, 43% of travelers under the age of 24 had attacks,
as opposed to 18% of travelers over the age of 55. Another study from Switzerland found an attack rate of 29%
among travelers who were less than 19 years old and an attack rate of 19% among travelers over 60 years of
age. Students and tourists were at high risk; business travelers were at intermediate risk; and the lowest risk
appeared to be in travelers who were visiting relatives. The type of vacation had little influence on risk.
Enterotoxigenic Escherichia coli is the most common pathogen for traveler's diarrhea, recognized in all studies
to date. These bacteria produce a secretory diarrhea by adherence to the brush border membrane of the small
intestinal enterocyte and secretion of a heat-stable and/or a heat-labile enterotoxin. They have been found in
26% to 72% of people with traveler's diarrhea in Mexico, as many as 37% in Asia, and 36% in Africa. Shigella
spp, which are enteroinvasive, are found with a median frequency of 15% of studies on traveler's diarrhea in
Mexico and appear to be less common in other Latin American countries. They are not often identified in
travelers to Asia or Africa. On the other hand, typhoid Salmonella spp are found at a low frequency (1%) in Latin
America and are seen more frequently in Japanese travelers returning from Southern Asia. They are not found
in studies on travelers to Africa. Campylobacter jejuni is an infrequent pathogen in most studies but was
commonly identified in Thailand and Bangladesh. Rotaviruses have been demonstrated in Latin American
studies (range 0 to 36%) but are less common in Asia and Africa. Blastocystis hominis, an organism whose
pathogenicity is yet to be defined, has been isolated in large numbers from Peace Corps volunteers with
diarrhea. Infection with multiple pathogenic microorganisms is relatively uncommon but has been reported at a
range of 9% to 22% in some studies. Despite rigorous search, no pathogenic microorganisms are identifiable in
20% to 30% of cases of traveler's diarrhea.
Article Review
Citation: Med J Malaysia; V.48, N. 3; 9/93; p293
Abstract
The incidence of human cases of cryptosporidiosis appears to be highest in the tropics. A frequency of 13% in
children with diarrhea has been reported in southern and Eastern India and 7.3% in children in Thailand. In
Malaysia, 4.3% of the stool samples collected from children with diarrhea were found to be positive for
Cryptosporidium. In temperate countries, the incidence of cryptosporidiosis in children varies from 1.1% in
Spain to 1.4% in the U.K. and 2.1% in France. This study suggests that Cryptosporidium may play a role in the
etiology of diarrhea in children in Malaysia. Epidemiological surveys carried out in various parts of the world
revealed a prevalence rate of 0.6% to 20% in developed countries and 4% to 32% in underdeveloped countries.
In this study, the prevalence was comparatively lower than studies undertaken in Thailand and India.

Subject: Gastrointestinal diseases; Epidemiology; Trends; Medical statistics; Infections;

Publication title: Incidence and Prevalence Data; Capitola

Supplement: 009 Ill-defined intestinal infections

Pages: 0

Publication year: 2013

Publication date: First Quarter 2013

Publisher: Timely Data Resources, Inc.

Place of publication: Capitola

26 April 2017 Page 8 of 9 ProQuest

Country of publication: United States

Publication subject: Medical Sciences

Source type: Reports

Language of publication: English

Document type: Reports, Statistics

ProQuest document ID: 1267753498

Document URL: https://search.proquest.com/docview/1267753498?accountid=17242

Copyright: Copyright Timely Data Resources, Inc. First Quarter 2013

Last updated: 2013-01-09

Database: Health & Medical Collection,Research Library

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