Travelers' diarrhea
Travelers' diarrhea is a common gastrointestinal issue characterized by watery, loose stools, often caused by bacterial or viral infections encountered while traveling, especially to less developed countries. Most cases resolve spontaneously within one to two days, and approximately 90% resolve within a week. The primary source of infection is typically the consumption of contaminated food or water, with common pathogens including various bacteria and viruses. Risk factors for developing this condition include the travel destination, age (particularly in young children), and pre-existing health conditions such as diabetes or a weakened immune system.
Symptoms may include abdominal cramping, frequent loose stools, nausea, vomiting, fever, and bloating. Diagnosis usually involves a medical history review, physical examination, and stool sample analysis. Treatment options range from over-the-counter medications like loperamide or bismuth subsalicylate to antibiotics for bacterial infections. Preventative measures include avoiding certain foods and beverages, practicing good hygiene, and being cautious about the source of food and water consumed while traveling. Understanding these aspects can help travelers mitigate their risk and manage symptoms effectively if they arise.
Travelers' diarrhea
- ANATOMY OR SYSTEM AFFECTED: Abdomen, gastrointestinal system, stomach
- ALSO KNOWN AS: Montezuma’s revenge, turista
Definition
Watery, loose stools (diarrhea) are most often caused by bacterial or viral infection in persons traveling to international destinations, particularly in less developed countries. Most cases of travelers’ diarrhea resolve within one to two days without treatment, and 90 percent resolve within one week. To ease symptoms, one can take over-the-counter medications. If travelers’ diarrhea does not resolve independently in about one week, one should consult a doctor.
Causes
The primary cause of travelers’ diarrhea is ingestion of food or water contaminated with fecal matter. The common pathogens include bacteria (such as Escherichia coli, Campylobacter, Shigella, Salmonella, and Yersinia) and viruses such as rotavirus, norovirus, and enterovirus.
Risk Factors
The most important risk factor for contracting travelers’ diarrhea is destination. Underdeveloped countries with contaminated water supplies pose the highest risk. The following factors increase the chance of developing travelers’ diarrhea: age (children two years or younger), people with weak immune systems, people with diabetes or inflammatory bowel disease, and those taking acid blockers or antacids (such as those for heartburn). Additional risk factors include risky dietary choices while traveling, traveling to rural areas, taking antibiotics, and genetic predisposition.
Symptoms
Symptoms of travelers’ diarrhea include increased frequency and volume of stool, frequent loose stools (four to five watery bowel movements a day), abdominal cramping, nausea, vomiting, fever, and bloating.
Screening and Diagnosis
A doctor will ask about symptoms and medical history, perform a physical exam, and take a stool sample from the patient to identify the pathogen.
Treatment and Therapy
Treatment for travelers’ diarrhea includes the use of antimotility agents such as loperamide (Imodium), diphenoxylate (Lomotil), and opiates, all of which reduce muscle spasms in the gastrointestinal tract, slow transit time, and thus increase absorption. Infants and those with bloody diarrhea cannot use antimotility agents. Another treatment is bismuth subsalicylate (Pepto-Bismol), an over-the-counter medication that decreases the frequency of stools. This medication should not be used by children, pregnant women, or people who have allergies to aspirin or salicylates. In addition, this medication should not be used by persons currently taking aspirin or similar drugs, such as salicylates.
Another treatment is antibiotics, such as ciprofloxacin, norfloxacin, ofloxacin, doxycycline, and trimethoprim-sulfamethoxazole, which are the most common antibiotics for treating travelers’ diarrhea. Antibiotics are effective only in treating a bacterial infection. Additional treatments can include oral rehydration solutions, traditional hydration methods such as increasing water intake, probiotics, and zinc supplements.
Prevention and Outcomes
To help reduce the chance of getting travelers’ diarrhea, one should avoid eating foods from street vendors or unclean eating establishments, raw or undercooked meat or seafood, fully cooked and served hot foods, salads or unpeeled fruits, and only fruits and vegetables (such as bananas or oranges) that one has peeled oneself.
One should also avoid drinking tap water or using ice cubes, drink only bottled water or, if necessary, local water that one boils for ten minutes or treats with iodine or chlorine, and drink, as an alternative to tap water, bottled carbonated beverages, steaming hot tea or coffee, wine, or beer. Finally, observing proper hygiene tactics, such as washing hands often, are essential to preventing travelers' diarrhea.
Bibliography
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Guerrant, R. L., et al. "Practice Guidelines for the Management of Infectious Diarrhea." Clinical Infectious Diseases, vol. 32, 2001, pp. 331-350.
"Infectious Diarrheal Diseases and Bacterial Food Poisoning." Harrison’s Principles of Internal Medicine, edited by Joan Butterton. 17th ed., New York: McGraw-Hill, 2008.
Johnson, Leonard R., editor. Gastrointestinal Physiology. 7th ed., Philadelphia: Mosby/Elsevier, 2007.
Juckett, G. "Prevention and Treatment of Travelers' Diarrhea." American Family Physician, vol. 60, 1999, pp. 119-136.
"Traveler's Diarrhea." Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/travelers-diarrhea. Accessed 2 Oct. 2024.
"Traveler's Diarrhea: What It Is, Treatment & Causes." Cleveland Clinic, 22 Apr. 2022, my.clevelandclinic.org/health/diseases/7315-travelers-diarrhea. Accessed 2 Oct. 2024.
Yates, J. "Travelers' Diarrhea." American Family Physician, vol. 71, 2005, pp. 2095-2100, 2107-2108.