• Traveler’s Diarrhea

    Definition

    Traveler's diarrhea is diarrhea in people who travel to international destinations. It often happens in less developed countries.

    Causes

    The primary cause of traveler’s diarrhea is ingesting food or water that contains feces. The substance carries a bacteria, virus, or parasite that causes the diarrhea. Examples of agents that can cause the diarrhea include:
      Bacteria (most common cause)
      • Escherichia coli , especially Enterotoxigenic E. coli (ETEC)
      • Campylobacter
      • Shigella
      • Salmonella
      Viruses
      • Rotavirus
      • Norwalk virus
      Parasites
      • Giardia lambli
      • Entamoeba histolytica
    Virus Attacking Cell
    Virus
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    The pathogen that causes the infection will partly depend on the area of travel.

    Risk Factors

    The most important risk factor for getting traveler’s diarrhea is the destination. Underdeveloped countries with unsafe water supplies pose the highest risk. The following factors increase your chance of getting traveler’s diarrhea. If you have any of these risk factors and plan to travel internationally, tell your doctor:
    Inflammatory Bowel Disease
    Crohn's Disease
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    Symptoms

    Symptoms can include:
    • Increased frequency and volume of stool
    • Frequent loose stools (4-5 watery bowel movements a day)
    • Abdominal cramping
    • Nausea
    • Vomiting
    • Fever
    • Bloating

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done.
    A stool sample may be taken. This will allow your doctor to identify the pathogen.
    Your doctor may direct you to self-treat if you are travelling to certain countries and have sudden moderate to severe diarrhea.

    Treatment

    Talk with your doctor about the best treatment plan for you. People who get traveler's diarrhea usually get better within 3-5 days even without treatment. Treatment options include the following:

    Hydration

    It is important for people who have diarrhea to make sure they are drinking plenty of clear fluids. This will replace the fluids lost in the diarrhea. Some people may need to use an oral rehydration solution such as children and older adults who are more likely to become dehydrated.

    Antibiotics

    Antibiotics may reduce how long symptoms last by 1-2 days. These antibiotics are only helpful for treating infections caused by a bacteria.

    Antimotility Agents

    Antimotility agents may help relieve symptoms of diarrhea. Examples of these medicines include:
    • Loperamide (Immodium)—Should not be used in children less than 2 years old, people with fever over 101.3 degrees F (38.5 degrees Celsius), and people with bloody diarrhea.
    • Bismuth subsalicylate (Pepto-Bismol)—Should not be used in children, pregnant women, people with allergies to aspirin or salicylates.
    If you are diagnosed with traveler's diarrhea, follow your doctor's instructions .

    Prevention

    To help reduce your chance of getting traveler’s diarrhea, take the following steps:
    • Avoid eating foods from street vendors or unsanitary eating establishments.
    • Avoid raw or undercooked meat or seafood.
    • Eat foods that are fully cooked and served hot.
    • Avoid salads or unpeeled fruits. Have only fruits and vegetables that you peel yourself, such as bananas or oranges.
    • Do not drink tap water or add ice cubes made from tap water.
    • Drink only bottled water with a sealed cap or, if necessary, local water that you have boiled for 10 minutes or treated with iodine or chlorine.
    • Bottled carbonated beverages, steaming hot tea or coffee, wine, and beer are all okay to drink.

    RESOURCES

    American Gastroenterological Association http://www.gastro.org/

    Centers for Disease Control and Prevention http://www.cdc.gov/

    CANADIAN RESOURCES

    Canadian Partnership for Consumer Food Safety Education http://www.canfightbac.org/

    Health Canada http://www.hc-sc.gc.ca

    References

    Acute diarrhea in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 20, 2012. Accessed December 17, 2012.

    Acute diarrhea in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 20, 2012. Accessed December 17, 2012.

    Guerrant RL. Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases . 2001:32:331-350.

    Juckett G. Prevention and treatment of traveler’s diarrhea. Am Fam Physician . 1999;60:119-136.

    Travelers' diarrhea. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea%5Fg.htm . Updated november 21, 2006. Accessed December 17, 2012.

    Traveler's diarrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated May 27, 2010. Accessed December 17, 2012.

    Yates J. Traveler’s diarrhea. Am Fam Physician . 2005;71:2095-2100,2107-2108.

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