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Travel Health – Traveler’s Diarrhea
Montezuma’s Revenge – Aztec Two Step – whatever nickname it may be called, if you’ve experienced it, you know exactly what I’m talking about. Traveler’s diarrhea (TD) is the most common medical problem that people complain about while traveling in less developed countries.
High-risk destinations (attack rates up to 60% during the first 2 weeks) include Mexico, the Dominican Republic and Haiti, and the developing countries of Africa, South and Central America, the Middle East and Asia. Lower risk countries include Australia, countries in Europe, Japan, South Africa and countries in North America.
Traveler’s diarrhea is not a specific disease, but describes the symptoms caused by certain microorganisms that are transmitted via contaminated food and water. Bacteria are by far the most common cause of TD with about 85% of cases being bacterial. Parasites and viruses are causes of TD 10% and 5% respectively.
Bacterial causes of TD include; Salmonella, Shigella, Campylobacter, various strains of E. coli and Vibrio (the cause of cholera).
Parasitic causes include Giardia and Entamoeba histolytica (amoebiasis). Viruses such as rotavirus and norovirus have been implicated.
TD is commonly seen with the following symptoms; a sudden onset of soft, watery or semi-formed stools associated with abdominal cramps and rectal urgency. Other symptoms such as nausea, swelling and fever may also be present. Vomiting can occur in 15% of those affected. Travelers diarrhea is usually self-limiting and lasts 3-4 days even without treatment.
How can you prevent TD on your next overseas trip? Here are some common sense tips:
o Don’t buy food from street vendors.
o Avoid raw foods. In particular, salads, uncooked vegetables, and unpasteurized milk and milk products such as cheese, and to eat only food that has been cooked and is still hot or fruits that can be peeled by the traveler personally (bananas and oranges ).
o Also avoid raw or undercooked meat, fish or shellfish.
o Do not use tap water to wash fruits and vegetables or to make ice cubes. Avoid fruit juices reconstituted with tap water.
o When in areas where the water is not chlorinated; Bottled water is a safe alternative as long as the bottle is unopened and sealed.
o Use bottled water to brush your teeth.
o Keep your mouth closed while showering.
o Make sure eating utensils and plates are clean and dry before use.
o Boiling water is the best way to make water safe to drink. Leave on high for at least a minute.
o The use of iodine or chlorine tablets is effective against most pathogens. However, they are ineffective against certain parasites such as Cryptosporidium.
o The use of water filters is effective against most pathogens.
o The use of prophylactic antibiotics may be particularly useful for short-term travelers. Quinolones and Rifaximin are commonly prescribed antibiotics for this reason.
o Pepto-Bismol may reduce your chances of having TD.
o In Europe and Canada there is an approved cholera vaccine that can be administered before travel.
o Hand washing and hand sanitizer gels reduce the incidence of diarrhea (as well as respiratory illnesses).
Most cases of TD do not require treatment and resolve spontaneously. However, in cases where there is bloody diarrhea and or high fever, antibiotic treatment should be given. If you have TD, drink lots of fluids. Some infections such as cholera can be life-threatening due to fluid loss. IV fluid replacement may be necessary in some cases.
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