@article{26445,
  keywords = {Neglected Tropical Diseases, Intestinal protozoa, Helminths, Digestive disorders, Diagnosis-treatment algorithm, Bacteria},
  author = {Polman K and Becker SL and Alirol E and Bhatta N and Bhattarai NR and Bottieau E and Bratschi M and Burza S and Coulibaly J and Doumbia M and Horié N and Jacobs J and Khanal B and Landouré A and Mahendradhata Y and Meheus F and Mertens P and Meyanti F and Murhandarwati EH and N'Goran E and Peeling RW and Ravinetto R and Rijal S and Sacko M and Saye R and Schneeberger PH H and Schurmans C and Silué KD and Thobari JA and Traore M and Lieshout L and Loen H and Verdonck K and Müller L and Yansouni C and Yao J and Yao P and Yap P and Boelaert M and Chappuis F and Utzinger J},
  title = {Diagnosis of neglected tropical diseases among patients with persistent digestive disorders (diarrhoea and/or abdominal pain ≥14 days): Pierrea multi-country, prospective, non-experimental case-control study.},
  abstract = {<p><strong>BACKGROUND: </strong>Diarrhoea still accounts for considerable mortality and morbidity worldwide. The highest burden is concentrated in tropical areas where populations lack access to clean water, adequate sanitation and hygiene. In contrast to acute diarrhoea (&lt;14&nbsp;days), the spectrum of pathogens that may give rise to persistent diarrhoea (≥14&nbsp;days) and persistent abdominal pain is poorly understood. It is conceivable that pathogens causing neglected tropical diseases play a major role, but few studies investigated this issue. Clinical management and diagnostic work-up of persistent digestive disorders in the tropics therefore remain inadequate. Hence, important aspects regarding the pathogenesis, epidemiology, clinical symptomatology and treatment options for patients presenting with persistent diarrhoea and persistent abdominal pain should be investigated in multi-centric clinical studies.</p>

<p><strong>METHODS/DESIGN: </strong>This multi-country, prospective, non-experimental case-control study will assess persistent diarrhoea (≥14&nbsp;days; in individuals aged ≥1&nbsp;year) and persistent abdominal pain (≥14&nbsp;days; in children/adolescents aged 1-18 years) in up to 2000 symptomatic patients and 2000 matched controls. Subjects from Côte d'Ivoire, Indonesia, Mali and Nepal will be clinically examined and interviewed using a detailed case report form. Additionally, each participant will provide a stool sample that will be examined using a suite of diagnostic methods (i.e., microscopic techniques, rapid diagnostic tests, stool culture and polymerase chain reaction) for the presence of bacterial and parasitic pathogens. Treatment will be offered to all infected participants and the clinical treatment response will be recorded. Data obtained will be utilised to develop patient-centred clinical algorithms that will be validated in primary health care centres in the four study countries in subsequent studies.</p>

<p><strong>DISCUSSION: </strong>Our research will deepen the understanding of the importance of persistent diarrhoea and related digestive disorders in the tropics. A diversity of intestinal pathogens will be assessed for potential associations with persistent diarrhoea and persistent abdominal pain. Different diagnostic methods will be compared, clinical symptoms investigated and diagnosis-treatment algorithms developed for validation in selected primary health care centres. The findings from this study will improve differential diagnosis and evidence-based clinical management of digestive syndromes in the tropics.</p>

<p><strong>TRIAL REGISTRATION: </strong>ClinicalTrials.gov; identifier: NCT02105714 .</p>
},
  year = {2015},
  journal = {BMC infectious diseases},
  volume = {15},
  pages = {338},
  issn = {1471-2334},
  url = {http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539676/ },
  doi = {10.1186/s12879-015-1074-x},
  language = {eng},
}