Traveler's Diarrhea
What is traveler's diarrhea?
Travelers from temperate regions of the world frequently experience diarrhea four days to two weeks after arriving in certain areas of the world. This illness is called travelers' diarrhea. Other colorful and humorous eponyms used to describe this illness include "Montezuma's Revenge," the "Aztec Two Step," and "Turista" in Mexico, the "Delhi Belly" in India, and the "Hong Kong Dog" in the far east.
How common is traveler's diarrhea?
Twenty to 50% of travelers may develop diarrhea depending on the region of the world they visit. In fact, diarrhea is the most common illness of travelers. Men and woman are at equal risk for developing traveler's diarrhea. Younger individuals are more commonly afflicted, perhaps because of their adventurous eating habits. In general, travelers at risk for diarrhea commonly come from industrialized nations and travel to high-risk areas that are primarily within developing or less industrialized nations of the world, including Latin America, Africa, the Middle East and Asia. Areas of lesser risk include China and some Caribbean nations. Travel to areas of the United States, Canada, Northern Europe and Australia pose the lowest risk to travelers.
What are the symptoms of traveler's diarrhea?
The symptoms of traveler's diarrhea vary. Generally, diarrhea occurs within the first week of travel and lasts up to 3-4 days. Affected individuals on average pass up to 5 loose bowel movements per day which may be associated with cramps. On occasion, individuals may experience fever or bloody stools.
What causes traveler's diarrhea?
Travelers' diarrhea usually is contracted by the ingestion of contaminated food or water. Contrary to common belief, food, not water, is primarily at fault. Most cases of travelers' diarrhea are caused by bacteria. The single most important bacterium is enterotoxigenic E. coli which has been estimated to account for up to 70% of all cases.
[Most E. Coli are harmless. However, there are five unique classes of E. coli that can cause inflammation of the stomach and bowels (gastroenteritis) and are, therefore, termed enterovirulent. They are virulent (extremely noxious) for the intestine (or, in Greek, the enteron).
Collectively, these five classes of enterovirulent E. coli are referred to as the EEC group (enterovirulent E. coli). Each class of EEC is distinct and different from the others. They are the: - Enteroinvasive E. coli (EIEC) invades (passes into) the intestinal wall to produce severe diarrhea.
- Enterohemorrhagic E. coli (EHEC): A type of EHEC, E.coli 0157:H7, can cause bloody diarrhea and the hemolytic uremic syndrome (anemia and kidney failure).
- Enterotoxigenic E. coli (ETEC), the one that causes most of traveler's diarrhea, produces a toxin that acts on the intestinal lining.
- Enteropathogenic E. coli (EPEC) can causes diarrhea outbreaks in newborn nurseries.
- Enteroaggregative E. coli (EAggEC) can cause acute and chronic (long lasting) diarrhea in children.]
Other bacterial species implicated in traveler's diarrhea include Campylobacter jejuni, Shigella, and Salmonella. Viruses (including Rotavirus , Norwalk virus and other enteric viruses) less commonly are causes of travelers' diarrhea. Parasitic infections are an uncommon cause with the exception of Giardia lamblia , which should be suspected in individuals traveling to Russia or to mountainous regions of the Northern Hemisphere. Cryptosporidia, another parasite, also has been implicated as a common cause of diarrhea in visitors to St. Petersburg, Russia.
How can traveler's diarrhea be prevented?
Since food is the major source of infection, close attention to diet is of foremost importance in the prevention of travelers' diarrhea. Foods should be well-cooked and served warm. Raw vegetables, uncooked meat or seafood, and other foods maintained at room temperature should be avoided. Dairy products, tap water and ice are also high-risk foods. Carbonated beverages, beer and wine, hot coffee and tea, fruits that can be peeled, and canned products generally are safe. The risk for developing diarrhea increases when eating at restaurants and when purchasing food from street vendors.
How is traveler's diarrhea diagnosed?
The diagnosis of traveler's diarrhea is based solely on the development of diarrhea when visiting a part of the world where this condition is common among travelers. The diarrhea usually is mild, self-limited, and resolves spontaneously. Symptoms usually can be controlled with over-the-counter medications. (See below.) Only when the diarrhea is severe or complicated, and possibly when antibiotics are contemplated, should attempts be made to identify the exact organism responsible for the diarrhea so that the correct drug therapy can be selected. (Identification may be difficult or impossible in undeveloped countries because of the lack of medical laboratories.) When laboratories are available, the stool can be examined for parasites and cultured for bacteria.
How is traveler's diarrhea treated?
Although prophylactic antibiotics are effective in preventing travelers' diarrhea, they generally are not recommended. The side effects of antibiotics, including photosensitivity (sensitivity to the sun that results in injury to the skin) and diarrhea can be major problems. Antibiotic prophylaxis can be considered in individuals with underlying medical diseases in whom diarrhea is more likely to occur or who may be profoundly affected by the diarrhea. This group includes people with previous stomach surgery, active inflammatory bowel disease, underlying immunodeficiency conditions, and other serious medical disorders. In these situations, Doxycycline , trimethoprim-sulfamethoxazole (Bactrim) or drugs of the quinolone class (Ciprofloxin, Norfloxacin) have been shown to be effective. Bismuth subsalicylate (Pepto-Bismol) in liquid or pill form also has been shown to be effective in preventing diarrhea in up to 65% of travelers although Pepto-Bismol may cause black stools and, rarely, ringing in the ears.
When treating afflicted individuals, drugs that alleviate symptoms as well as antibiotics play a role. Oral fluids are a mainstay of therapy since they are important to prevent dehydration . With moderate symptoms, the addition of Pepto-Bismol alone may suffice. Alternatively, anti-diarrheal agents such as Lomotil or Imodium can be given. With severe disease, characterized by frequent diarrhea or dehydration, or complicated by the passage of bloody stools, the addition of an antibiotic may be necessary.
Traveler's Diarrhea At A Glance - Traveler's diarrhea is a gastrointestinal illness that occurs in travelers.
- Traveler's diarrhea usually is caused by eating food contaminated with bacteria or, less commonly, with parasites or viruses.
- Traveler's diarrhea usually is mild and self-limited to a few days or a week.
- The treatment of traveler's diarrhea is usually plenty of oral liquids as well as over-the-counter medications that control diarrhea and cramps.
- Antibiotic prophylaxis (prevention) for traveler's diarrhea is available but is not recommended generally.
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