Diarrhea in the returned traveller: Difference between revisions
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| − | == |
+ | == Background == |
| + | === Microbiology === |
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* Bacteria |
* Bacteria |
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** [[Escherichia coli]] (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause |
** [[Escherichia coli]] (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause |
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** [[Strongyloides stercoralis]] |
** [[Strongyloides stercoralis]] |
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* [[CiteRef::shah2009gl]] |
* [[CiteRef::shah2009gl]] |
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| + | |||
| + | === Epidemiology === |
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| + | * Usually defined as diarrhea (3 or more unformed stools per day), plus one of abdominal cramps, tenesmus, nausea, vomiting, fever, or fecal urgency, either while travelling |
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| + | * Incidence among travellers from rich countries is 10 to 40% |
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| + | |||
| + | === Risk Factors === |
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| + | * Beach vacations are protective compared to VFR, adventure tours, or all-inclusive hotels |
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| + | * Cruise ships are associated with explosive outbreaks of [[norovirus]] |
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| + | * Lower rates in winter; higher during rainy seasons |
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| + | * Higher rates of diarrhea requiring hospitalization in infants and toddlers |
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| + | |||
| + | == Investigations == |
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| + | * Blood cultures (if febrile) |
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| + | * Stool culture or PCR for bacteria |
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| + | * Stool for ova & parasites |
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| + | |||
| + | == Management == |
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| + | * If mild (1-3 stools daily with mild enteric symptoms), can treat with bismuth subsalicylate or loperamide |
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| + | ** Avoid loperamide in patients less than 2 years, if febrile, or if bloody stools |
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| + | * May benefit from antibiotics if diarrhea is severe, there are systemic symptoms, or it is interfering with their activities |
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| + | ** Can decrease duration of diarrhea by about a day and a half |
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| + | * Empiric treatment depends on country of origin |
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| + | ** [[Is treated by::Ciprofloxacin]] 500 mg PO bid for 3 days, for countries with lower rates of resistance |
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| + | ** [[Is treated by::Azithromycin]] 500 to 1000 mg PO daily for 3 days |
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| + | |||
| + | == Further Reading == |
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| + | * Steffen R, Hill DR, and DuPont HL. Traveler's Diarrhea: A Clinical Review. ''JAMA''. 2015;313(1):71-80. doi: [https://doi.org/10.1001/jama.2014.17006 10.1001/jama.2014.17006] |
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[[Category:Returned travellers]] |
[[Category:Returned travellers]] |
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Revision as of 10:55, 2 December 2019
Background
Microbiology
- Bacteria
- Escherichia coli (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause
- Usually afebrile
- Diffusely adherent E. coli (DAEC) also exists
- Campylobacter jejuni: more common in SE Asia
- Salmonella species (non-typhoidal)
- Shigella species
- Plesiomonas species (unclear if cause of diarrhea)
- Vibrio cholerae
- Aeromonas species
- Escherichia coli (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause
- Viruses
- Parasites
- 1
Epidemiology
- Usually defined as diarrhea (3 or more unformed stools per day), plus one of abdominal cramps, tenesmus, nausea, vomiting, fever, or fecal urgency, either while travelling
- Incidence among travellers from rich countries is 10 to 40%
Risk Factors
- Beach vacations are protective compared to VFR, adventure tours, or all-inclusive hotels
- Cruise ships are associated with explosive outbreaks of norovirus
- Lower rates in winter; higher during rainy seasons
- Higher rates of diarrhea requiring hospitalization in infants and toddlers
Investigations
- Blood cultures (if febrile)
- Stool culture or PCR for bacteria
- Stool for ova & parasites
Management
- If mild (1-3 stools daily with mild enteric symptoms), can treat with bismuth subsalicylate or loperamide
- Avoid loperamide in patients less than 2 years, if febrile, or if bloody stools
- May benefit from antibiotics if diarrhea is severe, there are systemic symptoms, or it is interfering with their activities
- Can decrease duration of diarrhea by about a day and a half
- Empiric treatment depends on country of origin
- Ciprofloxacin 500 mg PO bid for 3 days, for countries with lower rates of resistance
- Azithromycin 500 to 1000 mg PO daily for 3 days
Further Reading
- Steffen R, Hill DR, and DuPont HL. Traveler's Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi: 10.1001/jama.2014.17006
References
- ^ Nipam Shah, David J. Ramsey, Herbert L. DuPont. Global Etiology of Travelers’ Diarrhea: Systematic Review from 1973 to the Present. The American Journal of Tropical Medicine and Hygiene. 2009;80(4):609-614. doi:10.4269/ajtmh.2009.80.609.
