Traveler's diarrhea
Background
- Most respond to antibiotics
- as duration of diarrhea increases, higher chance of parasitic cause
Differential Diagnosis
Acute diarrhea
Infectious
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (non-typhi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
- Inflammatory bowel disease
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[1]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
- Giardia lamblia
- Cryptosporidiosis
- Entamoeba histolytica
- Cyclospora
- Clostridium perfringens
- Listeriosis
- Helminth infections
- Marine toxins
- Ciguatera
- Scombroid poisoning
- Paralytic shellfish poisoning
- Neurotoxic shellfish poisoning
- Diarrheal shellfish poisoning
Diagnosis
- dysentery if stool bloody, fvr or wbc in stool- invasive inflamm enteropathy
- has abrupt onset, metastatic lesions, reactive arthopathies, or campylobacter assoc guillain barre- maybe flouroquinolone resis esp in SE Asia
- amoebic dysentery insidious and can get amoebic liver abscess
- if do not find infc cause of dysentery, eval pt for IBD or CA
- prolonged diarrhea and malabsorption- giardia or tropical sprue- does not respond to removal of gluten from diet- tx with tetra and folate
- also consider postinfectious disaccharidase deficiency or irritable bowel dz
- if diarrhea starts >1 mo after travel- not caused by travel
Treatment
Antibiotics
- Ciprofloxacin 750mg PO once daily x 1-3 days[2]
- First choice for use except in South and Southeast Asia[3]
- Azithromycin 500mg PO q24h x 3 days OR 1000mg PO x 1[4]
- Rifaximin 200mg PO TID x 3 days[7]
- Ineffective against mucosally invasive pathogens (Shigella, Salmonella, Campylobacter)
- Considered very safe as it is not absorbed
Antimotility agent
- Only for nonpregnant adults with no fever or blood in stool
- Loperamide 4mg PO after each loose stool (Max: 16mg/day)
Pediatrics
Antibiotic Options:
- Avoid fluroquinolones
- Azithromycin 10mg/kg/day once daily x 3 days OR[8]
- Ceftriaxone 50mg/kg/day once daily x 3 days
See Also
Source
- ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
- ↑ Hoge CW. et al. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis. 1998;26:341–5
- ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
- ↑ Sanders JW. et al. An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection. Am J Trop Med Hyg. 2002;67:533–8
- ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
- ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
- ↑ DuPont HL. et al. Rifaximin versus ciprofloxacin for the treatment of traveler’s diarrhea: a randomized, double-blind clinical trial. Clin Infect Dis. 2001;33:1807–15
- ↑ Stauffer WM, Konop RJ, Kamat D. Traveling with infants and young children. Part III: travelers’ diarrhea. J Travel Med. 2002;9:141–50