Traveler’s Diarrhea

 

Definition:

The passage of 3 or more unformed stool within a 24 hour period, in conjunction with other gastrointestinal symptoms of nausea, vomiting, abdominal pain, tenesmus or passage of blood or mucus with the stool

  • – Traveler’s diarrhea typically occurs in persons who reside inb industrialized region and travel to developing country
  • – Symptoms most often develop 2-10 days after arrival of the traveler but may occur at any time during foreign exposure as this period encompasses the incubatyion period of most entrropathogens
  • – Diarrhoea is the most common medical complaint of travelers
  • – 90% cases are brief, self-limiting
  • – 5-10% cases develop dysentery
  • – Bacteria is identified in 60-80% cases of diarrhea
  • – E.coli (particularly ETEC, EAEC) is responsible 50-75% cases

 

Risk factors depends upon

  • – Host’s susceptibility: immunosuppressed state, hypochlorhydria due to PPI, gastric surgery are especially vulnerable
  • – Travel and eating habit
  • – Length of stay
  • – Destination
  • 3 antibiotics are recommended for traveler’s diarrhea
  •               • Ciprofloxacin
  •               Azithromycin for febrile/dysentery
  •               Rifaximine

 

Preventive measures: 

Avoid water that has not been thoroughly boiled, filtered with iodine containing filter or chemically treated with bleach or tincture iodine

  • – Avoid drinks, especially those with ice
  • – Teeth should be brushed with bottled or treated water
  • – Avoid water ingestion during showering
  • – Eat only thoroughly cooked vegetables, fish, shellfish and meat
  • – Fruits, unless frershly peeled should not be eaten
  • – Fruit, vegetable and meat containing salads should be avoided
  • – Bismuth subsalicylate (2 tab or 30 ml of the liquid preparation 4times daily) can be taken as prophylaxis
  • – Antibiotic prophylaxis is justified for immunocompromised, IBD patients

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