Please enable JavaScript.
Coggle requires JavaScript to display documents.
Traveler's Diarrhea, References:, Connor, B. (2019). Travelers'…
Traveler's Diarrhea
Causes
Bacterial
enterotoxigenic Escherichia coli
Campylobacter jejuni
Shigella spp., and Salmonella spp.
Enteroaggregative and other E. coli pathotypes are also commonly found
increasing discussion of Aeromonas spp., Plesiomonas spp.
newly recognized pathogens Acrobacter, Larobacter, enterotoxigenic Bacteroides fragilis are potential causes
Viral
norovirus
rotavirus
astrovirus
Parasites
Giardia is the main protozoal pathogen found
Entamoeba histolytica and Cryptosporidium is a relatively uncommon
Cyclospora is highly geographic and seasonal: Nepal, Peru, Haiti, and Guatemala.
Dientamoeba fragilis is a flagellate occasionally associated
Recommendations
boil it, cook it, peel it, or forget it
food and beverage selection
avoid raw or uncooked meat, sea food, unwashed vegetables and fruits, avoid salads, unpeeled fruit, unpasteurized beverages,, avoid street vendors
tap water in some places may be unsafe for drinking, preparing food and beverages, making ice, cooking, and brushing teeth
beverages made with water that has just been boiled, such as tea and coffee, are generally safe to drink
using agents other than antimicrobial drugs for prophylaxis
bismuth subsalicylate (BSS), which is the active ingredient in adult formulations of Pepto-Bismol and Kaopectate
take daily as either 2 oz. of liquid or 2 chewable tablets 4 times per day to reduce the incidence of TD by approximately 50%, but it may cause blackening of the tongue and stool, nausea, constipation, and rarely tinnitus.
use of probiotics, such as Lactobacillus GG and Saccharomyces boulardii
using prophylactic antibiotics
fluoroquinolones have been the most effective antibiotics for the prophylaxis and treatment of bacterial TD pathogens
alternative considerations include azithromycin, rifaximin, and rifamycin SV
prophylactic antibiotics should not be recommended for most travelers; the risks associated with the use of prophylactic antibiotics should be weighed against the benefit of using prompt,
prophylactic antibiotics may be considered for travelers who are high-risk hosts like immunosuppressed or with significant medical comorbidities
carefully washing hands with soap where available
Carrying small containers of alcohol-based hand sanitizers (containing ≥60% alcohol) may make it easier for travelers to clean their hands before eating when handwashing is not possible
wash their hands with soap and water before preparing food and eating, after using the bathroom or changing diapers, before and after caring for someone who is ill, and after contact with animals or their environments.
No vaccines are available for most pathogens
refer to the Cholera, Hepatitis A, and Typhoid & Paratyphoid Fever regarding vaccines
Epidemiology
30-70% of travelers
depends on season and destination
bacterial pathogens are the predominant risk
up to 80%–90% of TD
intestinal viruses account for at least 5%–15% of illnesses
parasite infections account for approximately 10% of diagnoses in longer-term travelers
protozoal pathogens are slower to manifest symptoms
“food poisoning” involves the ingestion of preformed toxins in food
highest risk in Asia, Africa and Latin America
Treatment
Oral Rehydration Therapy
fluids and electrolytes are lost during TD, and replenishment is important, especially in young children or adults with chronic medical illness
for severe fluid loss, replacement is best accomplished with oral rehydration solution (ORS) prepared from packaged oral rehydration salts
in mild cases, rehydration can be maintained with any palatable liquid (including sports drinks), although overly sweet drinks, such as sodas, can cause osmotic diarrhea if consumed in quantity.
Antimotility Agents
symptomatic relief
synthetic opiates, such as loperamide and diphenoxylate, can reduce frequency of bowel movements
Antibiotics
first-line antibiotics are fluoroquinolones, such as ciprofloxacin (750 mg single dose) or levofloxacin (500 mg daily for 1 to 3 days)
a potential alternative is azithromycin in a single dose of 1,000 mg or divided twice in a day to avoid adverse reactions
Treatment of TD Caused by Protozoa
for Giardia metronidazole, tinidazole, and nitazoxanide
nitazoxanide for cryptosporidiosis
Cyclosporiasis is treated with trimethoprim-sulfamethoxazole
for amebiasis use metronidazole or tinidazole, followed by treatment with a luminal agent such as iodoquinol or paromomycin
References:
Connor, B. (2019). Travelers' Diarrhea. Centers for Disease Control and Prevention. Retrieved from:
https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea
Griffin, P. & Hill, V. (2019). Food & Water Precautions. Centers for Disease Control and Prevention. Retrieved from:
https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/food-and-water-precautions
