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Travelers Diarrhea

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Overview of travelers Diarrhea

Between 20 and 50% of those who travel to the developing countries will developat least one episode of diarrhea every year, thus making it the most commonmedical ailment afflicting travelers.1 Although most cases of travelers diarrhea (TD) are mild and of short duration, it can result in significant morbidity.1

Occurence of travelers diarrhea in different groups:
Travel destination is the most important risk factor for travelers diarrhea. Regions with the highest risk are Africa, South Asia, Latin America and Middle East.3 The host risk factors associated with increased susceptibility to diarrhea include young age, lack of previous travel to high-risk areas in the past 6 months, immunocompromised state, indiscriminate food and beverage consumption and host genetics.4


Causes of travelers diarrhea

The most important etiologic agents of travelers diarrhea are bacterial pathogens. Bacteria such as Escherichia coli, Campylobacter, Salmonella, and Shigella are common causes of travelers diarrhea, whereas parasites and viruses are less common etiologies. The toxin produced by these organisms activates a series of intestinal reactions leading to secretory type of diarrhea.


Symptoms of travelers Diarrhea

Traveler’s diarrhea is usually characterized by the passage of at least three unformed stools within a 24-h period, associated with gastrointestinal problems such as nausea and vomiting, fever, abdominal pain, tenesmus or the passage of bloody or mucoid stools. In most cases, the symptoms developwithin the first week of travel and last for 3–4 days before resolving spontaneously.

Severe diarrhea can result in water and electrolyte losses,leading to significant dehydration, electrolyte imbalancesand impairment of renal function.


Management of travelers Diarrhea

Fluid replacement remains the first step in the treatment of travelers diarrhea. As antibiotics reduce the duration and severity of travelers diarrhea and generally are well tolerated, providing empiric antibiotic therapy can effectively reduce morbidity from the condition. Early empirical therapy with rifaximin, fluoroquinolone or azithromycin, had been shown to decrease the duration of illness.1 However, where the diarrhea is severe, bloody or prolonged, laboratory investigation is necessary.

In short term, uncomplicated diarrhea, antimotility or antisecretory agents such as loperamide or bismuth subsalicylate may help reduce symptoms, but should not be given to patients with fever or bloody diarrhea. Dietary recommendations including intake of oral rehydration solution are essential, especially in children.


Prevention of travelers Diarrhea

Immunization plays an almostaninsignificant role in the prevention of travelers diarrhea, as many vaccinesare not yet commercially available. Avoiding high-risk foods and adventuresome eating habits may reduce the ingestion of pathogens or prevent the development of other enteric diseases such as hepatitis A and typhoid.

Antibiotic prophylaxis is generally recommended only for certain high-risk individuals as it can lead to drug-resistant organisms and may give a false sense of security. Prophylaxis with fluoroquinolones had been shown to be up to 90% effective.1


Precautions need to be taken while travelling

Travelers to developing countries have diarrhea due to consumption of contaminated food or water.

If you are traveling to developing countries you are advised to carry anti diarrheal medication and thermometer to check the body temperature.
You need to consult the doctor about medications required before you start travel and have an advice about what to in case you have diarrhea.
Here are some of the things which help in controlling the diarrhea while you travel.
  • Only eat foods and drink fluids which do not cause diarrhea like
    1. Fruit you peel your self
    2. Cooked vegetables
    3. Boiled or bottled water
    4. Pasteurized milk
  • Avoid foods which likely cause diarrhea
    1. Un cooked (raw) vegetables.
    2. Under cooked meat or fish
    3. Unpeeled fruit
    4. Food from street vendors.
  • Wash your hands, especially before you eat.
  • Avoid drinking water while swimming.


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Written by: Healthplus24 team
Date last updated: March 25, 2013

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