Please enable JavaScript.
Coggle requires JavaScript to display documents.
Travelers Diarrhea, Bibliografía: Steffen, R., MD. (2015, 6 enero).…
Travelers Diarrhea
Treatment
Avoid Dehydratation
Mitigate the symptoms
Diarrhea
Abdominal Cramps
Nausea/Vomit
Prevent any interruption to travel plans
When symptoms are mild
Use a non antiobiotic agent
Bismuth subsalicylate
Loperamide
For Sever nausea/vomiting
Ondansetron
Domperidone
Promethazine
Clinical manifestations
3 or more uniformend stools in 24 with at least one of these symptoms
Abdominal Cramps
Fecal urgency
Tenesmus
Fever
Nausea
Vomiting
Dysentery
Pathogens invate the intestinal mucosae
Systemic disease
Gross blood mixed with stools and/or fever
Duration
Untreated
4 to 5 days
Passage of more than 10 unformed stools per 24h is reported in only 3% of cases
Long term complications
Postinfectious irritable bowel syndrome
3-17% of cases
Chronic GI symptoms
Microbiological Etiology
Bacterial enteropathogens
Escherichia coli
Enterotoxigenic
Enteroaggregative
Diffusely Adherent
Other bacterias
Aeromonas
Campylobacter
Shigella
Salmonella
Virus
Norovirus
Rotavirus
Parasites
Giardia duodenalis
Cryptosporidium
Entamoeba histolytica
Microsporidium
Risk Groups
Environmental Factors
Quality of hotels
Increased incidence in buffet style food in warm conditions
Beach vacations
Lower rates of travelers diarrhea
Cruise-Based package holidays
Related with bunkered water
Risk of norovirus and ETEC outbreakes
Host Factors
Young travelers
Infants and toddlers have more severe disease
More likely to require hospitalization
More risk factors
More ingestion of food that results in larger inoculation
Inflammatory bowel disease
Higher incidence of travelers diarrhea
Depends on the location
Progression of symptoms
Longer duration of diarrhea and abdominal pain
Inmunossupresive patients
No diference in the incidence or duration or diarrhea
Prevention
It depends of the pation but it has 2 possibilities
Dietary Precautions
Follow Rule
Boil it
Cook it
Peel it
Forget it
Cooking considerations
Enteropathogens are killed at 100°
Most food items are served piping hot at 60° are safe
Preventive medication
Antibiotic chemopropylaxiis
Appropiate for high risk travelers that might have complications from diarrhea
Maximun 2-3 weeks
Bismuth subsalicylate
Provides modest protection
Adverse efects
Turns tongue and stools black
Should be avoided in long term anticoagulated patients
Rifaximin
Significantly reduces incidence of noninvasive diarrhea
Helpfull with E.coli infections
Bibliografía: Steffen, R., MD. (2015, 6 enero). Traveler’s Diarrhea: A Clinical Review. Gastroenterology | JAMA | JAMA Network.
https://jamanetwork.com/journals/jama/articleabstract/2088858