Traveler's diarrhea: Difference between revisions
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==See Also== | ==See Also== | ||
*[[Diarrhea]] | *[[Diarrhea]] | ||
[[Travel Medicine]] | *[[Diarrhea (Peds)]] | ||
*[[Travel Medicine]] | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:TropMed]] | [[Category:TropMed]] |
Revision as of 19:42, 7 December 2011
Background
- most respond to antibiotics
- as duration of diarrhea increases, higher chance of parasitic cause
DDx
- giardia, cryptosporidiosis, entamoeba, cyclospora
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
- regular travelers diarrhea with fluids, antimotility agents, abx- fluoro or macrolide
- invasive enteropathy- bloody/ fvr- same but no antimotility agents
- if bloody stool but no fvr, consider enterhemorrhagic E coli- do not give abx since will get hemolytic uremic syndrome in kids
- examine stool if diarrhea invasive, persistent, unresponsive to standard tx or immune compromised
- if persistent diarrhea, give empiric flouro or macrolide or consid metronidazole for giardia- most common parasite
- try lactose free diet
- chronic diarrhea usually self limited within 1 yr