Traveller’s Diarrhea: A quick overview with flashcards

This interesting post has flashcards related to Traveller’s diarrhea.
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Diarrhea occurs in 20 – 60% of people who travel from a resource-rich to a resource-poor region.

1. Which is the most common pathogen responsible for Traveller’s diarrhea?

Enterotoxigenic Escherichia coli (ETEC)

Gram Negative, facultative anaerobe, rod

2. Which are the high-risk regions?

South Asia, Central and South America, Africa

3. Can you name a few other organisms that can cause Traveler’s diarrhea?

In addition to ETEC, other common pathogens include Giardia, Shigella and Campylobacter jejuni.

4. What is the usual duration of onset after getting infected?

Most diarrheas occur during the first week of infection

5. What is the typical duration of diarrhea?

Most diarrheas last for < 1 week. 10 % cases may last >1 week.

6. What are the symptoms? Can symptoms help in diagnosing the aetiology?

Symptoms vary according to the etiological agent but are unreliable indicators of etiology.

  • Enterotoxigenic E. coli, may cause watery diarrhea preceded by cramps and nausea.
  • Giardia lamblia may predominantly lead to upper GI symptoms, e.g., bloating and belching.
  • Campylobacter jejuni and Shigella mainly causes colitis symptoms, urgency and cramps.

7. Is there prophylaxis for Traveler’s diarrhea?

Prophylactic antibiotic use is generally not recommended as severe disease and long-term sequelae are rare, and there is risk of C. difficile infection.

Prophylaxis is however considered in immunosuppressed patients (transplant, HIV, chemotherapy), GI diseases (like IBD, ileostomy, short-bowel), or patients at risk of disease deterioration with dehydration (e.g., sickle cell disease, CKD).

8. What is the treatment for Traveler’s diarrhea?

  1. Oral rehydration. Mainstay of treatment is rehydration with clear fluids or oral rehydration salts.
  2. Antimotility agents, (e.g., loperamide, bismuth subsalicylates) can be used for watery and mild diarrhea. However, avoid using these if symptoms are indicative of invasive colitis like severe pain, fever or bloody diarrhea. 
  3. Antibiotics: Antibiotics use is usually not indicated. Considered only if rapid cessation of diarrhea needed, there is limited access to sanitation and healthcare. Options include Ciprofloxacin 500mg BD for 3d, Rifaximin 200mg TDS for 3d, Azithromycin 1g single dose or 500mg OD for 3d.

9. What is Persistent diarrhea and how to assess it?

If diarrhea last for > 14 days or if there is dysentery, investigate.

Do Complete blood counts (CBC), U&E, LFT, inflammatory markers, stool microscopy for ova/cysts/parasites, molecular testing for specific microbes if indicated.

10. How to prevent Traveler’s diarrhea?

Prevention is done by

– Hand washing with soap

– Using boiled water

– Thoroughly cooking food

– Using peeled fruits and vegetables

– Avoiding ice, salads, shellfish

– Drinking with a straw

11. What is the differential diagnosis of persistent diarrhea?

– Giardiasis is the most common differential. Send PCR

– Entamoeba histolytica

– Shigella

– Post-infectious irritable bowel syndrome can occur in 30% cases. However, it is a diagnosis of exclusion.

– Malaria

– HIV

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