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BioMed Research International
Volume 2015 (2015), Article ID 573904, 15 pages
Research Article

Surveillance of Food- and Smear-Transmitted Pathogens in European Soldiers with Diarrhea on Deployment in the Tropics: Experience from the European Union Training Mission (EUTM) Mali

1Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, 20359 Hamburg, Germany
2Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
3Sub-Department VI.2, Department A, Military Medical Command, 56070 Koblenz, Germany
4Department II (Veterinary Medicine), Central Institute of the German Armed Forces Medical Service Kiel-Kronshagen, 24119 Kiel-Kronshagen, Germany
5Deployment Health Surveillance Capability/NATO MilMed COE, 80637 Munich, Germany
6Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, 20359 Hamburg, Germany

Received 2 December 2014; Revised 5 June 2015; Accepted 8 June 2015

Academic Editor: Pierre Colin

Copyright © 2015 Hagen Frickmann et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Since 2013, European soldiers have been deployed on the European Union Training Mission (EUTM) in Mali. From the beginning, diarrhea has been among the most “urgent” concerns. Diarrhea surveillance based on deployable real-time PCR equipment was conducted between December 2013 and August 2014. Material and Methods. In total, 53 stool samples were obtained from 51 soldiers with acute diarrhea. Multiplex PCR panels comprised enteroinvasive bacteria, diarrhea-associated Escherichia coli (EPEC, ETEC, EAEC, and EIEC), enteropathogenic viruses, and protozoa. Noroviruses were characterized by sequencing. Cultural screening for Enterobacteriaceae with extended-spectrum beta-lactamases (ESBL) with subsequent repetitive sequence-based PCR (rep-PCR) typing was performed. Clinical information was assessed. Results. Positive PCR results for diarrhea-associated pathogens were detected in 43/53 samples, comprising EPEC (), ETEC (), EAEC (), Norovirus (), Shigella spp./EIEC (), Cryptosporidium parvum (), Giardia duodenalis (), Salmonella spp. (), Astrovirus (), Rotavirus (), and Sapovirus (). ESBL-positive Enterobacteriaceae were grown from 13 out of 48 samples. Simultaneous infections with several enteropathogenic agents were observed in 23 instances. Symptoms were mild to moderate. There were hints of autochthonous transmission. Conclusions. Multiplex real-time PCR proved to be suitable for diarrhea surveillance on deployment. Etiological attribution is challenging in cases of detection of multiple pathogens.