Traveller's Diarrhoea
Summary: Quick notes on Traveller’s Diarrhoea.
Definition
Passage of >=3 unformed stools per day plus >=1 associated enteric symptoms such as abdominal pain or cramps
Bacterial pathogens account for 80-90%
Viruses account for 5-8%
Protozoa account for up to 10%
Bacterial Infectious Agents
Enterotoxigenic Escherichia coli
Campylobacter jejuni
Shigella spp
Salmonella spp
Aeromonas spp
Plesiomonas spp
Viral Infectious Agents
Norovirus
Rotavirus
Astrovirus
Protozoal Infectious Agents
Giardia
Entamoeba histolytica
Cryptosporidium
Cyclospora
Dientamoeba fragilis
Occurrence
Low Risk - US, Canada, Australia, NZ, Japan, Northern and Western Europe
Intermediate Risk - Eastern Europe, South Africa, Carribean
High Risk - Asia, Middle East, Africa, Central and South America
Clinical Presentation
Urgent loose stools
Abdominal pain
Fever
Vomiting
Bloody diarrhoea
Incubation Period
Bacteria and Viral - 6 to 48 hours
Protozoal - 1 to 2 weeks
Duration of Illness
Bacterial - 3 to 5 days
Viral - 2 to 3 days
Protozoal - Weeks to Months
Prevention
Food and Beverage Selection
Non-antimicrobial drugs for prophylaxis (Bismuth Subsalicylate BSS)
Prophylactic Antibiotics (Not recommended)
Treatment
Antibiotics (Single-dose or 1-day therapy of Fluoroquinolone, Azithromycin 500mg per day for 1-3 days)
Antimotility Agents - Loperamide
Oral Rehydration Therapy
Protozoal Treatment - Tinidazole / Metronidazole
Resources