More tourists presented for diarrhea than residents: 1,397 ZD1839 mouse (33%) versus 766 (16%) (relative risk 1.99; 95% CI 1.85–2.16, p < 0.001). In total, 390 cases and 185 controls

were enrolled with 381 cases and 176 controls eligible for analysis. Eighteen persons were excluded from the analysis due to incomplete information, wrong nationality, or inability to submit a stool sample. The mean age for cases was significantly younger than that for controls: 33.4 years (SD = 11.4, median = 30) versus 40.4 years (SD = 12.0, median = 39) (p < 0.001). There was no difference in gender with 203 (53%) female cases versus 101 (57%) female controls (p = 0.36). Most enrollees were from Europe (64% of cases vs 57% of controls), with the remainder from North America (25 and 32%, respectively), Australia/New Zealand (6 and 10%), and Japan (5 and 1%) (p = 0.02). More cases (56%) than controls (37%)

were tourists (p < 0.001). More cases had been in Nepal for <30 days than controls (p = 0.001). A significant portion of cases, n = 53 (14%), and just three controls selleck compound had taken an FQ prior to presentation. The likelihood of identifying a bacterial pathogen was less if the patient reported taking an FQ [odds ratio (OR) = 0.38, p = 0.003], whereas no significant association was observed if the patient reported taking an antimotility drug or other medication. The likelihood of identifying a bacterial pathogen was greater if the patient reported watery diarrhea (OR = 2.04, p = 0.022), fever (OR = 1.84, p = 0.004), and microscopic white blood cells (WBCs) and red blood cells (RBCs) when found in stool (OR = 3.35 and 4.24, respectively, p < 0.001). Seasonality did not affect finding of bacterial pathogens (Table 1). Reported use of an oxyclozanide antimotility drug was significantly associated for finding a viral pathogen (OR = 4.24, p = 0.001) and if the patient reported vomiting (OR = 2.99, p = 0.004). Viral pathogens were less likely to be found in the months of April to June (OR = 0.26, p = 0.037).

Cases in whom a protozoan pathogen was found were less likely to report sudden onset of diarrhea (OR = 0.27, p < 0.001) or abdominal pain (OR = 0.37, p = 0.001) and less likely that microscopic WBCs and RBCs were found in stool (OR = 0.42, p = 0.001 and OR = 0.31, p = 0.008, respectively). Interestingly, all pathogens, particularly protozoa, were more likely to be found in April to September, and Japanese were more likely than any other nationality to have protozoan pathogens (p = 0.009). At least one enteric pathogen was identified in 263 of 381 (69%) cases and 47 of 176 (27%) controls (p≤ 0.001; Table 2). Cases were 12 times more likely to have multiple pathogens detected than controls (p < 0.001). Among cases, multiple pathogens were more common among tourists (32%) than residents (18%) (p = 0.002). Campylobacter was the most prevalent pathogen isolated in cases (17%) and the second most common among controls (5%; p = 0.002).