4/100 PM vs 11.5/100 PM). A review of the literature on diarrhea among long-term travelers (military or not) by Riddle and colleagues previously reported the increase of incidence rates of diarrhea by a factor of up to six between self-reported data and

epidemiological surveillance systems.10 The rate in our prospective study (8.9/100 PM) is close to the median rate of 6–7/100 PM from clinical or passive surveillance according to Riddle’s review. Our self-reported incidence rate is also similar (27.4/100 PM compared to 29/100 PM).10 The proportion of soldiers self-reporting diarrhea was similar to that observed among military forces deployed during Operation Desert Shield in 1991.6 Similarly, the proportions of soldiers seeking medical care (around 40%) selleck chemicals llc or unable to work (around 26%) were also equivalent.6 The well-known phenomenon of low self-limitation due to diarrhea,1 confirmed in our study (0.5 days loss of duty per episode;

ie, 173 days/318 diarrheal episodes), could partly explain the low frequency of medical consultation, as well as the sub-optimal therapy reported when seeking Protein Tyrosine Kinase inhibitor care. Personal physiological susceptibility to diarrhea also reported for protozoa, bacteria, or virus infections may explain why some soldiers experienced diarrhea early and more than once during the same stay.11–13 Patients with recurrence could also have developed intestinal functional post-infectious disorders as sequela of their early acute infections during the early phase of development. However, they may also have had risky behaviors not investigated

in the retrospective self-questionnaire. Furthermore, the later experience of diarrhea by soldiers with a single diarrheal episode may be due to a tendency to get lax with prevention measures over time among Branched chain aminotransferase people less susceptible to pathogens.14 Systematic prophylaxis by antibiotics has been proposed for diarrhea prevention, as well as availability of some antibiotics for travelers’ self-therapy.11,12 In our study, no one reported antibiotics as self-treatment for diarrhea, but French soldiers had the facilities to seek medical care due to the presence of military physicians on the field. Nonetheless, antibiotics were rarely prescribed (10%) and hospitalization concerned around one in six cases. It is thus not obvious that differential health seeking behaviors were due to the severity of symptoms. It seems more likely that soldiers seek care for the first episode and then self-treat subsequent episodes with the medication provided the first time, or reassured by the evolution of the first episode, they just “wait and see.” On the other hand, the one third still consulting for secondary episodes may be those with severe symptoms or self-treatment failure.