Diarrhea in the returned traveller: Difference between revisions
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+ | ==Background== |
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β | = Differential Diagnosis = |
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+ | ===Microbiology=== |
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β | * |
+ | *Bacteria |
β | ** |
+ | **[[Escherichia coli]] (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause |
β | *** |
+ | ***Usually afebrile |
β | *** |
+ | ***Diffusely adherent E. coli (DAEC) also exists |
β | ** |
+ | **[[Campylobacter jejuni]]: more common in SE Asia |
β | ** |
+ | **[[Salmonella]] (non-typhoidal) |
β | ** |
+ | **[[Shigella]] |
β | ** |
+ | **[[Plesiomonas]] (unclear if cause of diarrhea) |
β | ** |
+ | **[[Vibrio cholerae]] |
+ | **[[Aeromonas]] |
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β | * |
+ | *Viruses |
β | ** |
+ | **[[Norovirus]]: most common virus |
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+ | **[[Rotavirus]] |
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+ | **[[Enterovirus]] |
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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]) |
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[[Category:Returned travellers]] |
[[Category:Returned travellers]] |
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+ | [[Category:Gastrointestinal infections]] |
Latest revision as of 22:47, 7 February 2022
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 (non-typhoidal)
- Shigella
- Plesiomonas (unclear if cause of diarrhea)
- Vibrio cholerae
- Aeromonas
- Escherichia coli (entero-hemorragic (EHEC), entero-toxigenic (ETEC)): most common cause
- Viruses
- Norovirus: most common virus
- Rotavirus
- Enterovirus
- Parasites
- And others 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 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
- ^ Nipam Shah, David J. Ramsey, Herbert L. DuPont. Global Etiology of Travelersβ 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.