Norfloxacin for the prophylaxis of travelers' diarrhea in U.S. military personnel.

Norfloxacin, an oral fluoroquinolone (dose 400 mg daily), was compared to a placebo in a double blinded randomized trial for the prophylaxis of travelers' diarrhea. The study was of U.S. Navy and Marine Corps personnel on shore leave in Alexandria, Egypt. A total of 222 subjects were available (105 norfloxacin, 117 placebo). In the placebo group, 26% (30/117) developed acute diarrhea vs. 2% (2/105) in the norfloxacin group. There were no significant side effects in either group.

Etiology of acute diarrhea among United States Embassy personnel and dependents in Cairo, Egypt.

The purpose of this study was to identify the enteropathogens causing acute diarrheal disease in Americans living in the North Africa/Middle East region during a 34-month period from February 12, 1985 to December 30, 1987 to guide preventive and therapeutic measures. Stool specimens were examined and an epidemiologic questionnaire was administered to patients with acute diarrhea at the Outpatient Health Unit of the United States Embassy in Cairo, Egypt. The subjects consisted of 126 American employees and dependents of the U. S. Embassy in Cairo, Egypt with diarrhea of less than two-weeks duration. Subjects received routine medical care administered by the U.S. Embassy Medical staff. A possible etiologic agent was detected in 41% of the subjects. Enteroadherent Escherichia coli was the most commonly isolated enteropathogen. A high degree of antimicrobial resistance was noted among the bacterial isolates, but all were susceptible to the quinolone antibiotics. Episodes of acute diarrhea occurring among American expatriates in Cairo, Egypt were primarily of bacterial etiology, but only a small portion were caused by the bacterial pathogens routinely identified in a standard clinical bacteriology laboratory. Most of the diarrheal episodes were due to noninvasive enteroadherent E. coli that may cause prolonged disease requiring antimicrobial therapy.

Chlamydia trachomatis associated with chronic dysuria among patients with Schistosoma haematobium.

Eighty-seven Egyptians with Schistosoma haematobium infection (current or past) and chronic dysuria seen at the Theodor Bilharz Research Institute outpatient urology clinic in Imbaba, Cairo, Egypt were investigated for Chlamydia trachomatis infection. Direct fluorescent antibody tests (DFAT) showed 30 urethral swabs (35%) and 40 urine sediments (46%) were positive for Chlamydia. Indirect fluorescent antibody testing showed 29 (34%) serum samples and 25 (29%) urethral smears were positive for Chlamydia. There was a highly significant association between patients with active Schistosoma infection and those with urine and urethral specimens positive for Chlamydia by DFAT (P < 0.01).

Diarrheal disease aboard a U.S. Navy ship after a brief port visit to a high risk area.

In August 1988, a study was conducted to determine the etiology and risk factors associated with travelers' diarrhea among U.S. military personnel after a 5-day port visit to Alexandria, Egypt. Twenty-one percent of the 2,747 evaluated crew members of the USS John F. Kennedy reported an episode of acute diarrhea, which led to 155 sick-call visits and at least 110 lost man-days. The most common pathogen identified was enterotoxigenic Escherichia coli, and all isolated bacterial enteropathogens were sensitive to quinolone drugs. Independent risk factors for the development of diarrhea included: (1) consuming any meal ashore and specifically eating meats, desserts, or a buffet meal; and (2) a recent history of travelers' diarrhea. These data indicate that even brief port visits to developing countries pose a major threat to the health of U.S. shipboard personnel.

Travelers' diarrhea among United States military personnel during joint American-Egyptian armed forces exercises in Cairo, Egypt.

A study was conducted of travelers' diarrhea in a United States military population on deployment in Cairo, Egypt, during July and August 1987. Acute diarrhea requiring medical attention developed in 183 (4%) of 4,500 troops. A possible etiologic agent was identified in 49% of all diarrhea cases. Enteric pathogens associated with cases of diarrhea included: Enterotoxigenic Escherichia coli (17% ST-producers, 13% LT-producers, and 3% LT/ST-producers); Shigella (9%); Campylobacter spp. (2%); Salmonella (2%); and Vibrio cholerae non-01 serogroup (2%). Other enteric pathogens isolated from one episode each of diarrhea included Aeromonas hydrophila group, Plesiomonas shigelloides, and Bacillus cereus. Yersinia enterocolitica, enteroinvasive E. coli, intoxications by Clostridium perfringens and Clostridium difficile, and pathogenic enteric parasites were not found in any of the 183 patients with diarrhea. A survey of military personnel not requesting medical care indicated that up to 40% of troops may have had diarrhea during this deployment. Acute gastroenteritis is a potential cause of substantial morbidity in U.S. military personnel deployed to Egypt.

[Aeromonas hydrophila in the drinking water in Djibouti: commensal germ or diarrhea-causing agent?]. / Aeromonas hydrophila dans les eaux de boisson a Djibouti: germe commensal ou agent de diarrhée?

To investigate the bacteriological quality of drinking water used by inhabitants of the Republic of Djibouti who were not supplied with piped running water, we analysed 16 fresh-water samples from various sources. Only 3 samples were sterile; they were taken from village pumps and from a water-truck. Eleven samples yielded colonies of Aeromonas hydrophila too numerous to be counted; they were taken from water tanks, metal barrels, or wells dug in either dry river beds or along the seashore. We speculate that this high isolation frequency of Aeromonas hydrophila in fresh water samples may be related to conditions that are exceptionally favourable for the growth of the bacterium (e.g. high temperature and elevated concentrations of certain salts and minerals in the fresh water of Djibouti). We wonder nevertheless whether the infected water supplies were a source of diarrhoea for humans. Indeed, antibiotic resistance patterns were dissimilar when the 11 environmental strains were compared to 7 strains of Aeromonas hydrophila isolated from diarrhoeal patients in Djibouti during the same period. More studies are needed to determine if Aeromonas hydrophila is always a commensal inhabitant of fresh water in Djibouti, or if it can be a cause of infectious diarrhoea. Accordingly, Public Health authorities in Djibouti will be able to decide if water from wells and tanks is safe for drinking, or if it needs disinfection before consumption.

Observations on sexually transmitted diseases in promiscuous males in Djibouti.

Observations are reported on 7 sexually transmitted diseases in a heterosexual population of 105 promiscuous males in Djibouti, East Africa. Neisseria gonorrhoeae was cultured from urethral swabs from 34 subjects. Six isolates were beta lactamase positive (18%). High levels of resistance to antimicrobials were noted with penicillin, spectinomycin and cotrimoxazole, while tetracyclines and erythromycin were unvariably effective. Six patients had Chlamydia urethritis, one of whom had concomitant gonococcal urethritis. Half of the sera reacted positive for antibodies to Chlamydia. A total of 31 subjects had a positive treponemal FTA-Abs test; of these, only 14 had a reactive RPR test. Nineteen individuals were positive for HBsAg. One subject had a western blot confirmed HIV-1 infection, while none had antibodies to HIV-2 or HTLV-I.

Epidemiology of bacterial pathogens associated with infectious diarrhea in Djibouti.

During a survey examining the causes of diarrhea in the East African country of Djibouti, 140 bacterial pathogens were recovered from 209 diarrheal and 100 control stools. The following pathogens were isolated at comparable frequencies from both diarrheal and control stools: enteroadherent Escherichia coli (EAEC) (10.6 versus 13%), enterotoxigenic E. coli (ETEC) (11 versus 10%), enteropathogenic E. coli (EPEC) (7.7 versus 12%), Salmonella spp. (2.9 versus 3%), and Campylobacter jejuni-C. coli (3.3 versus 5%). Surprisingly, the EAEC strains isolated did not correspond to well-recognized EPEC serogroups. No Yersinia spp., enteroinvasive E. coli, or enterohemorrhagic E. coli were isolated during the course of this study. Only the following two genera were recovered from diarrheal stools exclusively: Shigella spp. (7.7%) and Aeromonas hydrophila group organisms (3.3%). Shigella flexneri was the most common Shigella species isolated. Patients with Shigella species were of a higher average age than were controls (27 versus 13 years), while subjects with Campylobacter or Salmonella species belonged to younger age groups (2.6 and 1.6 years, respectively). Salmonella cases were more often in females. Shigella diarrhea was associated with fecal blood or mucus and leukocytes. ETEC was not associated with nausea or vomiting. Anorexia, weight loss, and fever were associated with the isolation of Salmonella and Aeromonas species. EAEC, ETEC, EPEC, and Shigella species were resistant to most drugs used for treating diarrhea in Africa, while the antibiotic most active against all bacteria tested was norfloxacin. We conclude that in Djibouti in 1989, Shigella and Aeromonas species must be considered as potential pathogens whenever they are isolated from diarrheal stools and that norfloxacin should be considered the drug of choice in adults for treating severe shigellosis and for diarrhea prophylaxis in travelers.

Rapid diagnosis of tuberculous meningitis by frequency-pulsed electron-capture gas-liquid chromatography detection of carboxylic acids in cerebrospinal fluid.

The frequency-pulsed electron-capture gas-liquid chromatography technique described previously by Brooks et al. was modified and applied to the studies of coded and routine clinical specimens. Uncentrifuged cerebrospinal fluid (2 ml) was extracted under acidic conditions, derivatized, and analyzed by frequency-pulsed electron-capture gas-liquid chromatography on large-bore fused silica polar and nonpolar capillary columns. The frequency-pulsed electron-capture gas-liquid chromatography profile of carboxylic acids (C2 through C22) along with identification of tuberculostearic acid, established by retention time comparison of derivatized tuberculostearic acid and derivatized sample extract, strongly suggests the presence of Mycobacterium tuberculosis in patients with lymphocytic meningitis. Results from 41 coded cases and 75 clinical cases showed that the frequency-pulsed electron-capture gas-liquid chromatography test had a specificity of 91% and a sensitivity of 95%.

Re-examination of Rattus norvegicus as an animal model for Aeromonas-associated enteritis in man.

We have developed an oral feeding model for Aeromonas hydrophila enteritis using Rattus norvegicus with clindamycin pretreatment. All animals in the clindamycin group developed a self-limited, loose stool by day four of feeding. Intestinal examination revealed evidence of enteritis. Moreover, antibiotic usage may be a predisposing risk factor to infection.