Travelers diarrhea

Travelers Diarrhea

Traveler's Diarrhea is a description of acute onset of diarrhea in travelers. It is the most common disease affecting travelers, and can be caused by bacteria, viruses, or parasites. Most commonly, the cause is enteric bacteria (i.e. E. coli, Shigella, and Camptylobacter bacteria) and what most people think of when referring to traveler's diarrhea.

Early Treatment of Traveler's Diarrhea

Peptobismol -may be used for mild symptoms, similar to the doses for preventing traveler's diarrhea.

Immodium - (2mg four times per day)

This is used to stop cramping and retain fluids. This prevents dehydration, which can be critical in hot climates. It is important not to overdo immodium as rebound constipation can occur.

Antibiotics -are recommended for short-term treatment. Ciprofloxacin (500mg twice daily for 1-2 days) is a first line treatment. Cipro is not recommended for children under 15 years. This should significantly decrease symptoms.

Both hepatitis A and typhoid are vaccine preventable. Similar vaccines against regular traveler's diarrhea are being developed.

Other Causes of Diarrhea

Diarrhea or other changes in the stool could be a sign of inflammatory bowel disease (Crohn's disease, Ulcerative colitis) or bowel cancer. Diarrhea that does not respond promptly to reasonable treatment should be further investigated.

Prevention of Diarrhea

Travelers are advised to be careful of their diet. Avoiding food that has not been cooked, or prepared properly. Traditionally dietary mistakes have been felt to be the main reason for illness, but individuals who are very careful may become sick anyway. Contamination can occur anytime the food is prepared, through unclean facilities and poor general observation of hygiene, of which are beyond traveler's control.

Early Prevention of Symptoms

Peptobismol -Taking 2 peptobismol tablets, four times per day, starting 1 day before and continuing for up to 2 weeks, has been shown to help prevent traveler's diarrhea. People allergic to aspirin or pregnant women should not take peptobismol because of its salicylate content. The tongue and stool may become black form peptobismal. Children may take a reduced dose as well.

Antibiotics -Are generally not recommended to PREVENT symptoms but may sometimes be used for high risk individuals (people with compromised immune symptoms or severe digestive problems).

Other antibiotics can be used as well but septra, which had been used for years, has limited effects because of resistances.

Children should also be treated for traveler's diarrhea. With their smaller size they are more affected by diarrhea. They should be examined carefully since other illnesses (appendiutis) can present early as diarrhea or abdominal pain. Antibiotics should cause a fast improvement in symptoms. If someone is very ill or not improving, they should be reviewed by a physician. Contacting a local Canadian Embassy can find you local help. Returning traveler's who are still ill should be evaluated further.

Other Considerations

Vaccines -A vaccine against traveler's diarrhea is being developed although vaccines for Hepatitis A and Typhoid are available. One available vaccine, Dukoral acts against some of the common ecoli caused travellers diarrhea.

Charcoal -Activated charcoal is not currently recommended for traveler's diarrhea.

Lactobacillus -Studies are ongoing to test the benefits of taking lactobacillus to prevent diarrhea. This is safe to take but evidence of its benefit is questionable .

Other Causes of Diarrhea in Travelers

Viruses - Diarrhea from viruses are hard to distinguish from bacterial causes. Good hygiene is the best way to control this infection.

Giardia Lambia - This parasite is found in contaminated water, has a gradual on set, and can lead to long lasting symptoms before the correct diagnosis is made. It is frequent in outdoor enthusiasts and is also called “beaver fever”

Cyclospora - This parasite (found in Nepal) is resistant to regular antibiotics, but sensitive to septra.

Enteroamoeba histolytica - Infections with this parasite can be severe and life threatening with liver abscesses. If blood is present in the stools (dysentery) this infection should be suspected.

Cholera - Cholera is extremely rare in travelers (2 per million). The vaccination is not available in Canada (it was discontinued because it had significant side effects and did not work well).

Parasitic worms - Diarrhea from parasitic worms usually occurs at least a few weeks after infection as it takes time for the worms to grow. Some people prefer to take an anti-helmetic (anti-worm) medication after arriving from a high-risk area, to deworm themselves before symptoms develop. Expatriates living abroad at high risk may deworm themselves every few months to reduce their accumulated “wormload”.

Hepatitis A - This viral infection of the liver may cause diarrhea, jaundice, and death.

Typhoid - A bacterial infection that causes severe illness with diarrhea.

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