Traveler’s diarrhea

Definition: Traveler’s diarrhea (TD) is defined as the passage of ≥3 unformed stools in 24 hours, often accompanied by abdominal cramps, nausea, vomiting, or fever, typically occurring within the first 2 weeks of travel to endemic areas. –

Etiology:

Bacterial (70–80%): E. coli (ETEC, EPEC, EIEC, EHEC), Campylobacter, Shigella, Salmonella, Aeromonas, Plesiomonas. – Viral (10–20%): Norovirus, rotavirus, adenovirus. – Parasitic (5–10%): Giardia, Cryptosporidium, Entamoeba histolytica. –

Risk Factors:
Destination (high-risk: Latin America, Africa, South Asia). – Season (warmer months). – Dietary habits (street food, raw produce, contaminated water). –

Prevention:
Vaccination: No widely available vaccine; consider Dukoral (cholera vaccine) for high-risk travelers. – Chemoprophylaxis: Not routinely recommended; consider for high-risk groups (e.g., immunocompromised, inflammatory bowel disease). –

Rationale: Risk of resistance and side effects outweigh benefits for most travelers. – Behavioral: Food/water precautions (avoid ice, uncooked foods, unpeeled fruits; drink bottled/boiled water). –

Diagnosis:
Clinical: Based on symptoms; stool culture not routinely needed unless severe (bloody diarrhea, fever, systemic symptoms). –

Laboratory: Stool culture, PCR, or microscopy if symptoms persist >72 hours or severe.
Traveler’s diarrhea (TD) is defined as ≥3 unformed stools in 24 hours with at least one symptom (abdominal pain, cramps, fever, nausea, vomiting). –

Severity classification:
Mild: <4 stools/day, no fever, no blood. – Moderate: 4–5 stools/day, mild fever, no blood. – Severe: ≥6 stools/day, fever ≥38°C, blood, or severe dehydration. –

Management : Oral Rehydration and Salt Intake Essential for all cases; use oral rehydration solutions (ORS) or salty broths. –

Rationale: Prevents dehydration, maintains electrolyte balance. –

Treatment Options Mild cases: Symptomatic management (loperamide, bismuth subsalicylate). – Loperamide (4 mg initial, then 2 mg after each loose stool, max 16 mg/day). – Bismuth subsalicylate (2 tablets 4x/day). –

Moderate/severe cases: Antibiotics (azithromycin 500 mg single dose, or ciprofloxacin 500 mg single dose). –

Rationale: Reduces duration and severity; azithromycin preferred due to fluoroquinolone resistance in some regions. –

Antibiotic Prophylaxis: Not routinely recommended; reserved for high-risk travelers (e.g., immunocompromised, inflammatory bowel disease). –

Options: Rifaximin 200 mg/day or azithromycin 500 mg/week. – Special Considerations Children: Same as adults but adjust doses (e.g., azithromycin 10 mg/kg single dose). –

Pregnancy: Avoid fluoroquinolones; use azithromycin or loperamide. –

Bloody diarrhea: Stool culture indicated; consider invasive pathogens (e.g., Campylobacter, Shigella). –

Prevention Food/water precautions: Avoid tap water, unpeeled fruits, undercooked meat. –

Vaccination: No specific vaccine; consider typhoid vaccine for high-risk areas. –

Follow-Up Persistent diarrhea (>1 month) warrants evaluation for parasitic infections (e.g., Giardia, Cryptosporidium)