Increased antimicrobial resistance among non-typhoidal Salmonella infections in international travellers returning to the Netherlands

Highlights Increased fluoroquinolone resistance in the two most common non-typhoidal Salmonella (NTS) serotypes among travellers returning to the Netherlands.Resistant Salmonella Enteritidis infections are most likely to be acquired abroad, specifically outside Europe.This study highlights the importance of travel history when patients with NTS infections require empiric antimicrobial treatment.

Parasitic infections among patients hospitalized in the Tropical and Parasitic Clinic of Poznan University of Medical Sciences, Poland between 2015 and 2018. Is there a relationship between protozoa infection and gastrointestinal symptoms?

Introduction

Diarrhoea is a common reason for hospitalization among travellers returning from the tropics. The aetiology is predominantly bacterial, but it can also be caused by parasites such as Giardia intestinalis, Cryptosporidium spp., and Blastocystis spp.

Aim

We analysed patients from the Poznan Tropical and Parasitic Clinic to evaluate the presence of parasitic infections and to find correlations between infections, journeys, and gastrointestinal symptoms.

Material and methods

In our study we examined 2561 stool samples obtained from patients hospitalized in the Tropical and Parasitic Department of Poznan Medical University, Poland. Microscopic examinations of samples were performed based on a direct thin smear in 0.9% NaCl, which allowed the assessment of the presence of protozoa life stages.

Results

In 106 (4.14%) of the 2561 examined samples we detected parasites, mainly from people coming back from tropical areas (61.32%). Mostly we detected Blastocystis sp. and Giardia intestinalis. Fifty percent of patients suffered from gastrointestinal symptoms, so careful microscopic stool examination should be performed in every case in which intestinal pathology occurs, and certainly in travelling individuals.

Conclusions

Traveling is a real risk factor for protozoa infection. The most common parasites detected in the stool are Blastocystis sp. and Giardia intestinalis. Parasitic coinfection should be taken into consideration as a pathologic agent in patients suffering from abdominal signs and persistent diarrhoea. Prolonged protozoa infection and its role in microbiota alterations requires further investigation.

Multidrug-Resistant Lineage of Enterotoxigenic Escherichia coli ST182 With Serotype O169:H41 in Airline Waste

Enterotoxigenic Escherichia coli (ETEC) is the primary aetiologic agent of traveller’s diarrhoea and a significant cause of diarrhoeal disease and death in developing countries. ETEC O169:H41 strains are known to cause both traveller’s diarrhoea and foodborne outbreaks in developed countries and are cause for concern. Here, whole-genome sequencing (WGS) was used to assemble 46 O169:H41 (ST182) E. coli draft genomes derived from two airplane waste samples sourced from a German international airport. The ST182 genomes were compared with all 84 publicly available, geographically diverse ST182 genomes to construct a core genome-based phylogenetic tree. ST182 isolates were all phylogroup E, the majority serotype O169:H41 (n = 121, 93%) and formed five major clades. The airplane waste isolates differed by an average of 15 core SNPs (range 0–45) but their accessory genome content was diverse. While uncommon in other ST182 genomes, all airplane-derived ST182 isolates carried: (i) extended-spectrum β-lactamase gene bla_CTX–M–15 notably lacking the typical adjacent ISEcp1; (ii) qnrS1 and the S83L mutation in gyrA, both conferring resistance to fluoroquinolones; and (iii) a class 1 integron structure (IS26-intI1_Δ648-dfrA17-aadA5-qacEΔ1-sul1-ORF-srpC-padR-IS6100-mphR-mrx-mphA-IS26) identified previously in major extraintestinal pathogenic E. coli STs but not in ETEC. ST182 isolates carried ETEC-specific virulence factors STp + CS6. Adhesin/invasin tia was identified in 89% of aircraft ST182 isolates (vs 23%) and was located on a putative genomic island within a hotspot region for various insertions including PAI I₅₃₆ and plasmid-associated transposons. The most common plasmid replicons in this collection were IncFII (100%; F2:A-:B-) and IncB/O/K/Z (89%). Our data suggest that potentially through travel, E. coli ST182 are evolving a multidrug-resistant profile through the acquisition of class 1 integrons and different plasmids.