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

Traveller’s Diarrhoea on CDC


 
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