04471nas a2200685   4500000000100000008004100001653003200042653002400074653001400098653002400112653003400136653001300170100001300183700001400196700001300210700001300223700001700236700001500253700001500268700001200283700001600295700001400311700001300325700001300338700001300351700001600364700002000380700001300400700001400413700001400427700002100441700001400462700001500476700001600491700001200507700001200519700001100531700002200542700001600564700001400580700001500594700001300609700001500622700001100637700001500648700001400663700001500677700001000692700001000702700001000712700001500722700001500737700001500752245021600767856005800983300000801041490000701049520271501056022001403771       2015                            d10aNeglected Tropical Diseases10aIntestinal protozoa10aHelminths10aDigestive disorders10aDiagnosis-treatment algorithm10aBacteria1 aPolman K1 aBecker SL1 aAlirol E1 aBhatta N1 aBhattarai NR1 aBottieau E1 aBratschi M1 aBurza S1 aCoulibaly J1 aDoumbia M1 aHorié N1 aJacobs J1 aKhanal B1 aLandouré A1 aMahendradhata Y1 aMeheus F1 aMertens P1 aMeyanti F1 aMurhandarwati EH1 aN'Goran E1 aPeeling RW1 aRavinetto R1 aRijal S1 aSacko M1 aSaye R1 aSchneeberger PH H1 aSchurmans C1 aSilué KD1 aThobari JA1 aTraore M1 aLieshout L1 aLoen H1 aVerdonck K1 aMüller L1 aYansouni C1 aYao J1 aYao P1 aYap P1 aBoelaert M1 aChappuis F1 aUtzinger J00aDiagnosis 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.  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539676/   a3380 v153 a<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>
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