Diarrhea in the returned traveller: Difference between revisions

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==Background==
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= Differential Diagnosis =
  
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===Microbiology===
   
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* Bacteria
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*Bacteria
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** ''Escherichia coli'' (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause
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**[[Escherichia coli]] (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause
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*** Usually afebrile
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***Usually afebrile
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*** Diffusely adherent E. coli (DAEC) also exists
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***Diffusely adherent E. coli (DAEC) also exists
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** ''Campylobacter jejuni'': more common in SE Asia
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**[[Campylobacter jejuni]]: more common in SE Asia
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** ''Salmonella'' (non-typhoidal)
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**[[Salmonella]] (non-typhoidal)
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** ''Shigella''
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**[[Shigella]]
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** ''Plesiomonas'' (unclear if cause of diarrhea)
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**[[Plesiomonas]] (unclear if cause of diarrhea)
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** ''Vibrio cholerae''
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**[[Vibrio cholerae]]
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**[[Aeromonas]]
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* Viruses
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*Viruses
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** Noroviruses: most common virus
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**[[Norovirus]]: most common virus
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* Parasites
  
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**[[Rotavirus]]
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** ''Giardia lamblia'': usually afebrile
  
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**[[Enterovirus]]
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** ''Entamoeba histolytica''
  
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*Parasites
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** ''Cyclospora cayetanensis''
  
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**[[Giardia lamblia]]: usually afebrile
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** ''Cryptosporidium''
  
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**[[Entamoeba histolytica]]
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** ''Strongyloides stercoralis''
  
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**[[Cyclospora cayetanensis]]
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**[[Cryptosporidium]]
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**[[Strongyloides stercoralis]]
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*And others [[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 they are febrile, or if their stools are bloody
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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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*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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*Statement on Travellers' Diarrhea by the Committee to Advise on Tropical Medicine and Travel (CATMAT) ([https://www.canada.ca/en/public-health/services/catmat/statement-travellers-diarrhea.html available online])
   
 
[[Category:Returned travellers]]
  
[[Category:Returned travellers]]
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[[Category:Gastrointestinal infections]]

Latest revision as of 22:47, 7 February 2022

Background

Microbiology

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 they are febrile, or if their stools are bloody
  • 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

  • Traveler's Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi: 10.1001/jama.2014.17006
  • Statement on Travellers' Diarrhea by the Committee to Advise on Tropical Medicine and Travel (CATMAT) (available online)

References

  1. ^  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.

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