What is Travelers Diarrhea?
Travelers’ diarrhea is a common illness experienced by people visiting countries with limited resources. It is estimated to impact almost half to over half of all travelers, depending on their destination, making it the most frequent health condition associated with travel. This illness can be caused by bacterial, viral, or parasitic infections, but bacteria are often the most common cause. Although travelers’ diarrhea usually improves on its own, it can cause dehydration and, in severe cases, serious complications.
What Causes Travelers Diarrhea?
The most common bacteria found to cause traveler’s diarrhea is enterotoxigenic Escherichia coli (ETEC), a type of bacteria, which is believed to be responsible for nearly 30% of cases. Other usual bacterial causes of traveler’s diarrhea include Campylobacter jejuni, Shigella, and Salmonella species.
In terms of viruses, Norovirus is the most common culprit, while Rotavirus can also cause infection. For parasites, Giardia intestinalis is often found in cases of traveler’s diarrhea. Other parasites like Cryptosporidium and Entamoeba histolytica can also lead to traveler’s diarrhea. It’s important to know that the most common cause can differ depending on the region and is rarely identified in less severe cases.
Traveler’s diarrhea can affect both short and long-term travelers, and unfortunately, having it once doesn’t make you immune to getting it again in the future. It appears to be most common in warmer climates, in areas with poor sanitation and lack of refrigeration. Additionally, unsafe water and rushed food preparation are significant risk factors. However, in areas where food handling education is provided, rates of traveler’s diarrhea are noticed to be low.
Risk Factors and Frequency for Travelers Diarrhea
Travelers’ diarrhea affects between 30% to 60% of visitors to regions that lack many resources. The rate and type of this illness can differ based on where you travel. The majority of cases are reported in sub-Saharan Africa, but Latin America, the Middle East, and South Asia also see a high number of cases. The main reasons for this illness usually revolve around poor hygiene in areas with limited resources.
- Poor food handling and preparation practices
- Inadequate electrical supply leading to lack of refrigeration
- Poor food storage practices
In addition to these, other factors that can be controlled include the use of proton pump inhibitors (medications that reduce stomach acid production), recent use of antibiotics, and unsafe sexual practices. Certain people, such as pregnant individuals, the very young or old, those with chronic gastrointestinal conditions, or people with weakened immune systems, are more at risk for severe complications.
Signs and Symptoms of Travelers Diarrhea
Travelers’ diarrhea typically begins 1 to 2 weeks after arriving in a region with limited resources, but can also start during the trip or just after arrival. The condition is defined as having three or more loose bowel movements within 24 hours, or having a significant increase from your usual bowel habits. The symptoms often start suddenly and can include stomach cramps, fever, and feelings of nausea or vomiting. It’s important for patients to report if they notice any blood in their stool, fever, or any other symptoms. Doctors need to know the details of the patient’s travel, such as their schedule and destinations, what they ate, what they drank, if others they travelled with fell ill, and if they had any unprotected sexual encounters.
In mild cases of travelers’ diarrhea, a doctor’s exam might reveal slight tenderness spread across the belly. The doctor will also check for symptoms of dehydration, such as loose skin (poor skin turgor) and sluggish filling of the smallest blood vessels (poor capillary refill). In more severe cases, patients might experience intense abdominal pain, high fever, and signs of low blood volume like rapid heart rate (tachycardia) and low blood pressure (hypotension).
Testing for Travelers Diarrhea
In many cases, medical tests in the lab aren’t usually necessary. However, if certain symptoms such as high fever, blood in the stool, or constant urge to have a bowel movement are present, tests on a stool sample might be required. These tests can include stool culture, fecal leukocytes, and lactoferrin tests that check for inflammation and infectious bacteria. If the problem has been going on for a while, the stool might be checked for eggs and parasites. New types of advanced tests that can check for multiple stool pathogens all at once are starting to become available, but they are costly, not readily available everywhere and might not affect how the patient is treated.
Just like lab tests, imaging tests like x-rays or CT scans are not usually needed. However, in severe cases, an x-ray of the kidneys, ureters, and bladder may be taken to check for sudden serious issues in the abdomen or signs of perforation (a hole). An abdominal CT scan can also provide images of the abdomen to check for serious issues in severe cases.
Treatment Options for Travelers Diarrhea
Before traveling, it’s important to learn how to reduce your risk of getting sick. This includes not drinking tap water or using ice made from it, washing your hands often, avoiding unpeeled fruits and salads, and steering clear of street food. One way to prevent traveler’s diarrhea is to take an over-the-counter medication called bismuth subsalicylate four times a day. This can cut your chances of getting sick by about half. However, this medication should not be used by children or pregnant women due to possible side effects.
In certain high-risk short trips, starting antibiotics as a precaution might be a good idea. But this is generally avoided for longer trips. Rifaximin, an antibiotic that isn’t absorbed well by the body and has few side effects, is often used as a preventive measure.
The main treatment for diarrhea is to make sure you’re drinking enough liquids. In mild cases, water is usually enough. Sports drinks and other drinks containing electrolytes can also be helpful. For children, a rehydration solution like Pedialyte can be used. Milk and juices should be avoided because they can make diarrhea worse. In more severe cases, oral rehydration salts can help ensure your body gets enough water and salts. If you’re severely dehydrated, you may need to receive fluids intravenously (directly into your vein).
In mild to moderate cases, treatment is usually supportive, meaning it’s aimed at relieving your symptoms. Loperamide is a medication that can be used to ease symptoms of diarrhea.
In addition, travelers can be given antibiotics to take if they start having diarrhea symptoms. Ciprofloxacin is a commonly used antibiotic for this, but it’s not often given to travelers to Asia due to the fact that one common bacterium that causes diarrhea can often resist its effects. As a result, a different antibiotic called azithromycin is usually preferred. It can also be given to pregnant travelers and children. Azithromycin is typically taken once a day for three days, though there is evidence that a single dose may work slightly better. Parents can be given a powder form of azithromycin with instructions to mix it with water when needed. Another option is rifaximin, a minimally absorbed antibiotic that is safe for older children and pregnant travelers.
What else can Travelers Diarrhea be?
Here are some conditions that may be diagnosed precisely with relevant symptoms:
- Pseudomembranous colitis
- Ischemic colitis
- Vipoma
- Radiation-induced colitis
- Food poisoning
What to expect with Travelers Diarrhea
In most cases, people suffering from traveler’s diarrhea tend to recover well. However, severe cases can sometimes lead to dehydration, which might require hospital admission.
Possible Complications When Diagnosed with Travelers Diarrhea
- Drying out of the body
- Body’s inability to absorb nutrients from food
- Full body infection
- Condition that affects kidneys and blood
- Joint diseases triggered by infection
Recovery from Travelers Diarrhea
Most patients can handle their treatment at home and should do the following:
* Keep hydrated
* Wash hands frequently
* Only use medications to slow or stop diarrhea if ordered by your doctor
* Keep up with personal hygiene
* If diarrhea continues for more than 10 days, schedule a follow-up appointment with your main doctor
Preventing Travelers Diarrhea
It’s important to maintain good hygiene and food safety for your health. This includes washing your hands often and ensuring that all food items are properly washed before you consume them. When it comes to shellfish, make sure to only eat those that come from clean, safe waters. Contaminated water can lead to health problems.
If you’re traveling, it’s a good idea to drink bottled water instead of tap water, as it’s usually safer. Also, try to stick to dry foods and drinks that are carbonated. Be careful about water and ice that you might find on the street – it may not be safe to consume.
When it comes to poultry and eggs, avoid consuming them raw as they may carry harmful bacteria. Lastly, avoid drinking water directly from lakes and rivers as they may also be contaminated.
