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Traveler's diarrhea

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Table of contents
OverviewUnderstanding Traveler’s DiarrheaWho is at risk of Traveller’s diarrheaSymptoms of Traveler’s diarrheaTreatment options for Traveler’s diarrheaPreventive measures for Traveler’s diarrheaVaccination for Traveler’s diarrheaTreating Travellers’ DiarrhoeaPost-infectious complicationsConclusionSources
Navin Khosla NowPatientGreen tick
Medically reviewed by Navin Khosla, BPharm and written by Rajive Patel, BPharm - Updated on 26 Jan 2024
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Travelling to new and exciting destinations can be a thrilling experience, but it’s not without its risks. Traveler’s diarrhea is a common and unpleasant ailment that can occur during travel, particularly in resource-limited destinations. It is estimated to affect a significant percentage of travelers, ranging from 30% to 70% of travellers during a two-week period, depending on the destination and season of travel. While the condition is usually mild and self-resolving, it can cause discomfort and disrupt travel plans. In severe cases, it can lead to complications such as dehydration and post-infectious irritable bowel syndrome. It is caused by consuming contaminated food and water, and it can quickly put a damper on your travel plans. In this comprehensive guide, we will explore the causes of traveler’s diarrhea, symptoms, discuss prevention strategies, and outline the most effective treatment options.

Understanding Traveler’s Diarrhea

Traveler’s diarrhea is a gastrointestinal illness characterized by loose or watery stools that occur within 10 days of travel to an area with poor public hygiene. Travellers’ diarrhoea is a clinical syndrome that results from various intestinal pathogens, and is primarily caused by the ingestion of food or water contaminated with bacteria, viruses, or parasites. Bacteria are the main culprits, accounting for 80% to 90% of cases. The most common bacterial pathogens responsible for traveler’s diarrhea include enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Shigella spp., and Salmonella spp. Viruses, such as astrovirus, norovirus, and rotavirus, contribute to 5% to 15% of cases. Protozoa parasites, including Giardia duodenalis, Entamoeba histolytica, Cyclospora cayetanensis and Cryptosporidium, are responsible for approximately 10% of traveler’s diarrhea diagnoses in longer-term travelers.

The most common cause of travellers’ diarrhoea is primarily ingesting food and water contaminated with disease-causing microbes. Poor hygiene practices in local restaurants and deficiencies in hygiene and sanitation infrastructure are major contributors to the risk of traveler’s diarrhea.

Who is at risk of Traveller’s diarrhea

Travellers’ diarrhoea can affect anyone, but certain factors increase the risk of contracting the illness. Young adults and young children are more susceptible to travellers’ diarrhoea compared to older travellers. The risk is also higher for individuals traveling to destinations where sanitation and hygiene measures may not meet the same standards as developed countries. Seasonal variations in diarrhoea risk can occur, with increased risk of outbreaks reported in high risk destinations such as South Asia, the Middle East, Africa, Mexico, Central and South America, during the hot months preceding the monsoon. Traveler’s diarrhea is lower in North and West Europe, Canada, Japan, Singapore, New Zealand, Australia, and the United States.

Symptoms of Traveler’s diarrhea

The onset of symptoms of traveler’s diarrhea typically occurs within six to 24 hours after exposure to the causative agent. The main symptom is the sudden onset of loose or watery stools, with three or more bowel movements in a 24-hour period. Other common symptoms include abdominal cramping, nausea, vomiting, bloating, fever, and fatigue. In most cases, the symptoms improve within a few days without specific treatment, although severe cases may last longer and require medical intervention.

Treatment options for Traveler’s diarrhea

In mild cases of traveler’s diarrhea, rest and fluid replacement are often sufficient for recovery. It is essential to prevent dehydration by drinking plenty of fluids, such as water, diluted fruit juices, or oral rehydration solutions. Anti-diarrheal medications, such as loperamide, can be used to alleviate symptoms and provide temporary relief. However, these medications should be used with caution and under the guidance of a healthcare professional, as they may not be suitable for everyone and can worsen certain types of infections.

Preventive measures for Traveler’s diarrhea

Prevention is key in avoiding traveler’s diarrhea, starting with adopting good hygiene practices and making careful choices when it comes to food and beverages. While it may not be possible to eliminate the risk entirely, following simple hygiene and dietary precautions can significantly reduce the risk of becoming ill during your travels. Here are some essential preventive measures to consider:

Hand hygiene

Proper hand hygiene is crucial in preventing the transmission of disease-causing bacteria and viruses. Wash your hands frequently with soap and clean water, especially before eating or preparing food and after using the toilet. If soap and water are not available, use alcohol-based hand sanitizers that contain at least 60% alcohol. Avoid touching your face, particularly your mouth, nose, and eyes, to minimize the risk of transferring pathogens.

Food and water precautions

Carefully selecting the food and beverages you consume can significantly reduce the risk of traveler’s diarrhea. Avoid eating raw or undercooked foods, especially meat, seafood, and eggs. Opt for fruits and vegetables that can be peeled or have a protective outer layer, and ensure that raw fruits and vegetables are washed thoroughly with clean water or peeled before consumption.

To minimize the risk of consuming contaminated water, it is important to take precautions with the water and beverages you consume. Choose only beverages from factory-sealed containers or bottled water from reputable sources, or use water purification methods such as filtering, boiling, or using water disinfection tablets and avoid consuming beverages with ice (these may be made using local tap water) unless you are confident that it is made from safe water. Be cautious when consuming street food and ensure that it is freshly prepared, as they may not adhere to proper hygiene standards. Consume only cooked food that is served hot. Avoid eating food that has been sitting on a buffet or street stalls.

If you have the opportunity to prepare your own meals, ensure that you follow proper food handling and preparation practices. Thoroughly wash your hands before handling food, and clean all utensils, cutting boards, and countertops with hot soapy water. Cook food thoroughly, especially meat and seafood, to kill any potential bacteria or parasites. Also, use only safe water for brushing your teeth.

Probiotics

Probiotics, such as Lactobacillus GG and Saccharomyces boulardii, have been studied as a potential preventive measure for traveler’s diarrhea. While the results are inconclusive, some studies have shown a reduction in the incidence of traveler’s diarrhea with the use of probiotics. However, more research is needed to determine their effectiveness and optimal dosage.

Prophylactic antibiotics

The use of antibiotics for self treatment or prophylaxis is generally not recommended for the treatment of travellers as traveller’s diarrhoea is mild and often self-limiting. Also, the risks associated with antibiotic treatment outweighs the benefits. However, in certain high-risk situations, such as immunocompromised individuals or those with significant medical comorbidities, prophylactic antibiotics may be considered. It is important to consult with a healthcare professional before considering this option.

Additional preventive measures

  • Bismuth subsalicylate, found in products like Pepto-Bismol, has been studied for its effectiveness in preventing traveler’s diarrhea. Taking two chewable tablets or two ounces of liquid four times a day has been shown to reduce the incidence of traveler’s diarrhea by approximately 50%. However, this method may cause side effects such as constipation, nausea, and blackening of the tongue and stool
  • Avoid eating foods from unknown sources and refrain from consuming unpasteurized dairy products, raw meat, shellfish, and fish caught in tropical reefs
  • Use drinking straws when consuming beverages to minimize direct contact with glasses or cups

Vaccination for Traveler’s diarrhea

Currently, there are no licensed vaccines available in the UK specifically targeting traveler’s diarrhea. However, vaccines for other foodborne and waterborne infections, such as cholera, hepatitis A, and typhoid fever, may be recommended depending on your travel destination and individual circumstances.

Treating Travellers’ Diarrhoea

Despite taking preventive measures, travellers’ diarrhoea can still occur. If your symptoms of traveler’s diarrhea are severe or persist for more than a few days, it is important to seek medical attention. Severe symptoms of travellers’ diarrhoea, include loose stools, high fever, severe abdominal pain, dehydration and nausea.

A healthcare professional can provide appropriate treatment, including intravenous fluids for dehydration and antibiotics if necessary. Treatment options for travellers’ diarrhoea include:

Fluid Replacement

Oral rehydration therapy (ORT) is crucial in managing travellers’ diarrhoea. Replace lost fluids and electrolytes by drinking plenty of water, clear broths, and oral rehydration solutions (ORS). ORS packets can be purchased at pharmacies and mixed with boiled or treated water according to the instructions. Avoid consuming caffeine, alcohol, and sugary beverages, as they can worsen dehydration.

Antimicrobial Treatment

In some cases, antimicrobial treatment may be necessary to alleviate the symptoms of travellers’ diarrhoea. The choice of antibiotic depends on the suspected enteric pathogen and its antibiotic sensitivity. Azithromycin and fluoroquinolones, such as ciprofloxacin or levofloxacin, have traditionally been used to treat bacterial travellers’ diarrhoea. However, increasing resistance to fluoroquinolones limits their effectiveness in certain regions. Newer options, such as rifamycin SV and rifaximin, have shown promise in treating noninvasive strains of E. coli.

Antimotility Agents

Antimotility agents, such as loperamide, can help control diarrhoea symptoms and provide relief. These medications work by slowing down the movement of the intestines, reducing the frequency of bowel movements. However, antimotility agents should not be used in cases of bloody diarrhoea or when fever is present. It is important to follow the recommended dosage and consult a healthcare professional before using these medications.

Post-infectious complications

In some cases, individuals may experience post-infectious complications following an episode of traveler’s diarrhea. This can include post-infectious irritable bowel syndrome (PI-IBS), which is characterized by persistent gastrointestinal symptoms even after the infection has resolved. If you continue to experience symptoms such as prolonged diarrhea, abdominal pain, or bloating, it is advisable to consult a healthcare professional for further evaluation and management.

Conclusion

Travellers’ diarrhoea is a common and unpleasant condition that can disrupt your travel plans. By understanding the causes, symptoms, treatment options, and preventive measures discussed in this guide, you can take proactive steps to minimize the risk of developing traveler’s diarrhea during your travels.

Remember to prioritize hand hygiene, practice safe food and water precautions, and seek medical attention if your symptoms worsen or persist. Also, consult with a healthcare professional for personalized advice and recommendations based on your specific travel circumstances. With these strategies in place, you can enjoy your travels with peace of mind and a healthier gut.

By following proper hygiene practices, making careful food and beverage choices, and taking necessary precautions, you can significantly reduce your risk of contracting traveler’s diarrhea and continue enjoying your travel adventures. If you do develop symptoms, it is important to seek appropriate treatment, which may include fluid replacement and antimicrobial therapy. With the right precautions and prompt treatment, you can minimize the impact of traveler’s diarrhea

Additional Information

  • Traveller’s diarrhoea is a well-known condition that affects many travellers worldwide
  • Always consult with a healthcare professional or travel health practitioner for personalized advice based on your specific travel plans and individual health status
  • It is important to stay informed about the causes, prevention strategies, and available treatments to minimize the risk of contracting traveler’s diarrhea and to effectively manage the condition if it occurs. Check with reputable sources such as the NHS, Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) for the most current information
  • Keep in mind that prevention is key, but even with precautions, there is still a risk of developing traveler’s diarrhea. Be prepared by packing essential medications and supplies, such as oral rehydration salts and anti-diarrheal medications, in your travel medical kit
  • Adopt good hygiene practices, make wise food and beverage choices, and seek appropriate medical care when needed. Doing this can significantly reduce the impact of traveler’s diarrhea on your travel experiences

Sources

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