Diarrhea Traveler ( TD ) is an infection of the stomach and intestines. TD is defined as part of an unformed stool (one or more by several definitions, three or more by others) on the go. Can be accompanied by abdominal cramps, nausea, fever, and bloating. Sometimes bloody diarrhea can occur. Most travelers recover within four days with little or no treatment. About 10% of people may have symptoms for a week.
Bacteria are responsible for more than half of cases. The enterotoxigenic bacteria Escherichia coli (ETEC) is usually the most common except in Southeast Asia, where Campylobacter is more prominent. Approximately 10% to 20% of cases are caused by norovirus. Protozoa such as Giardia can cause long-term illness. The risk is greatest in the first two weeks of travel and among young adults. People affected more often than developed countries.
Recommendations for prevention include eating only cleaned and properly cooked foods, drinking bottled water, and frequently washing hands. The cholera oral vaccine, while effective for cholera, is a questionable use for travelers' diarrhea. Preventive antibiotics are generally not recommended. Primary treatments include drinking plenty of fluids and replacing lost salts (oral rehydration therapy). Antibiotics are recommended for significant or persistent symptoms, and may be taken with loperamide to reduce diarrhea. Hospitalization is required in less than 3% of cases.
Estimated percentage of affected people ranges from 20 to 50% among travelers to developing countries. TD is very common among people who travel to Asia (except Japan), the Middle East, Africa, Mexico, and Central and South America. The risks are moderate in Southern Europe, Russia, and China. TD has been associated with irritable bowel syndrome and Guillain-Barrà © Å © syndrome. It has everyday language known by a number of names, including Montezuma retaliation and belly Delhi .
Video Traveler's diarrhea
Signs and symptoms
Onset of TD usually occurs within the first week of travel, but can occur anytime while traveling, and even after returning home, depending on the incubation period of the infectious agent. TD bacteria usually start suddenly, but Cryptosporidium may hatch for seven days, and Giardia for 14 days or more, before symptoms develop. Usually, a traveler experiences four to five bowel movements that are loose or watery each day. Other symptoms that are usually associated are abdominal cramps, bloating, fever, and malaise. Appetite can decrease significantly. Although unpleasant, most cases of TD are mild, and resolve within days without medical intervention.
Blood or mucus in diarrhea, significant abdominal pain, or high fever suggests a more serious cause, such as cholera, characterized by rapid onset of weakness and a watery diarrhea with mucus spots (described as "stool water"). Medical care should be sought in such cases; dehydration is a serious consequence of cholera, and can trigger serious sequelae - including, in rare cases, death - as soon as 24 hours after onset if not treated promptly.
Maps Traveler's diarrhea
Cause
Infectious agents are a major cause of traveler's diarrhea. Bacterial enteropathogenes account for about 80% of cases. Viruses and protozoa are the largest part of the rest.
The most common causative agents isolated in the countries surveyed were enterotoxigenic Escherichia coli (ETEC). Enteroaggregative E. coli is becoming known. Shigella spp. and Salmonella spp. is another common pathogenic bacteria. Campylobacter , Yersinia , Aeromonas , and Plesiomonas spp. more rarely found. The mechanism of action varies: some bacteria release toxins that bind the intestinal wall and cause diarrhea; others damage their own intestines by their direct presence.
Although viruses are associated with less than 20% of adult traveler diarrhea cases, they may be responsible for nearly 70% of cases in infants and children. Diarrhea due to viral agents is not affected by antibiotic therapy, but is usually limited. Protozoa such as Giardia lamblia , Cryptosporidium and Cyclospora cayetanensis can also cause diarrhea. Pathogens commonly involved in traveler's diarrhea appear in the table in this section.
The subtypes of traveler diarrhea that attack pedestrians and campers, sometimes known as diarrhea in the wilderness, may have somewhat different pathogen distribution frequencies.
Risk factors
The main source of infection is ingestion of fecally contaminated food or water. The number of attacks is similar for men and women.
The most important determinant of risk is the purpose of travel. High-risk objectives include developing countries in Latin America, Africa, the Middle East, and Asia. Among backpackers, additional risk factors include drinking untreated surface water and failure to maintain personal hygiene practices and clean cooking utensils. Campsites often have very primitive sanitation facilities (if any), making them potentially as dangerous as any developing country.
Although travelers' diarrhea usually disappears within three to five days (average duration: 3.6 days), in about 20% of cases, the disease is severe enough to require sleeping in bed, and within 10%, the duration of the disease exceeds one week. For those vulnerable to serious infections, such as bacillary dysentery, amoebic dysentery, and cholera, TD can sometimes be life-threatening. Others at higher risk than average include young adults, immunosuppressed people, people with inflammatory bowel disease or diabetes, and those who use H2 blockers or antacids.
Immunity
Travelers are often diarrhea from eating and drinking foods and drinks that have no adverse effects on the locals. This is due to the growing immunity with persistent recurrent exposure to pathogenic organisms. The rate and duration of exposure required to obtain immunity have not been determined; it may vary with each organism. A study among expatriates in Nepal shows that immunity can take up to seven years to develop - perhaps in adults who avoid deliberate exposure to pathogens. In contrast, the immunity gained by American students while living in Mexico disappeared, in one study, as early as eight weeks after discontinuation of exposure.
Prevention
Sanitation
Recommendations include avoiding questionable foods and drinks, assuming that TD is essentially a sanitation failure, which causes bacterial contamination from drinking water and food. Although the effectiveness of this strategy is questionable, given that travelers have little or no control over sanitation in hotels and restaurants, and little evidence supports the notion that food precautions reduce the risk of contracting TD, the guidelines continue to recommend a basic, common sense precaution when making food choices and drinks:
- Keep good hygiene and use only safe water for drinking and brushing.
- Safe drinks include bottled water, bottled carbonated beverages, and water boiled or treated appropriately by travelers (as described below). Caution should be made with tea, coffee, and other hot beverages that may be just heated, not boiled.
- In the restaurant, insist that bottled water will be opened in front of you; reports the locals fill empty bottles with untreated tap water and resell it because pure water has appeared. If in doubt, carbonated soft drinks are the safest option, as it is difficult to simulate carbonation when refilling used bottles.
- Avoid ice, which may not be made with safe water.
- Avoid green salads, as lettuce and other raw materials can not be washed with safe water.
- Avoid eating raw fruits and vegetables unless they are cleaned and peeled.
If handled properly, fresh food and properly cooked packaged food are usually safe. Raw meat and seafood or semi-cooked foods should be avoided. Unpasteurized milk, dairy products, mayonnaise, and pastry icing are associated with an increased risk of TD, such as food and beverages purchased from street vendors and other companies where unhygienic conditions may be present.
Water
Although safe bottled water is now widely available in most remote areas, travelers can treat their own water if necessary, or as an extra precaution. Techniques include boiling, filtering, chemical treatment, and ultraviolet light; boiling is by far the most effective of these methods. Boiling quickly kills all active bacteria, viruses, and protozoa. Old boil is usually unnecessary; most microorganisms are killed in seconds at water temperatures above 55-70 ° C (130-160 ° F). The second most effective method is to combine chemical filtration and disinfection. The filter eliminates most of the bacteria and protozoa, but not the virus. Chemical treatments with halogens - chlorine bleach, iodine tincture, or commercial tablets - have low to moderate effectiveness against protozoa such as Giardia , but work well against bacteria and viruses. UV rays are effective against viruses and cellular organisms, but only work in clear water, and are ineffective unless manufacturer instructions are carefully followed for maximum water depth/distance from UV sources, and for dose/exposure time. Other claimed benefits include short maintenance time, elimination of need for boiling, no flavor change, and long-term cost reduction compared to bottled water. The effectiveness of UV devices is reduced when water is muddy or cloudy; Since UV is a kind of light, every suspended particle creates a shadow that hides the microorganism from UV exposure.
Drugs
Other preventive options include antidiarrheal and antibiotic products that are sold freely.
Bismuth subsalicylate four times a day reduces travelers' diarrhea levels. Although many travelers find the regimen four times a day uncomfortable, lower doses have not proven effective. Potential side effects include black tongue, black stools, nausea, constipation, and ringing in the ears. Bismuth subsalicylate should not be taken by those who are allergic to aspirin, kidney disease, or gout, or along with certain antibiotics such as quinolones, and should not be taken continuously for more than three weeks. Some countries do not recommend it because of the risk of rare but serious side effects.
A hyperimmune cow colostrum to be drunk is marketed in Australia for the prevention of ETEC-induced TD. To date, no studies have shown efficacy in actual travel conditions.
Although effective, antibiotics are not recommended for prevention of BP in most situations because of the risk of allergies or adverse reactions to antibiotics, and because preventive antibiotic intake may decrease the effectiveness of such drugs if serious infections develop further. Antibiotics can also cause vaginal yeast infections, or overgrowth of the Clostridium difficile bacterium , which causes pseudomembranous colitis and is associated with severe diarrhea that is unrelenting.
Prophylactic antibiotics may be justified in special situations where the benefits outweigh the above risks, such as immunocompromised diseases, chronic intestinal disorders, multiple recurrent TD recurrences, or scenarios in which the onset of diarrhea may prove to be very inconvenient. Options for prophylactic treatment include quinolone antibiotics (such as ciprofloxacin), azithromycin, and trimethoprim/sulfamethoxazole, although the latter has proven to be ineffective in recent years. Rifaximin may also be useful. Quinolone antibiotics may bind to a metallic cation such as bismuth, and should not be taken together with bismuth subsalicylate. Trimethoprim/sulfamethoxazole should not be taken by anyone with a history of sulfa allergy.
Vaccinations
Cholera oral vaccine, while effective for cholera prevention, is a questionable use for TD prevention. A 2008 review finds tentative useful evidence. The 2015 review suggests that it may be natural for those at high risk of complications from TD. Some vaccine candidates targeting ETEC or Shigella are in various stages of development.
Probiotics
One 2007 review found that probiotics may be safe and effective for TD prevention, while other reviews found no benefit. The 2009 review confirms that more studies are needed, as evidence to date varies.
Treatment
Most cases of TD are mild and resolve within days without treatment, but severe or prolonged cases can result in significant fluid loss and dangerous electrolyte imbalances. Dehydration due to diarrhea can also alter the effectiveness of drugs and contraceptive drugs. Adequate fluid intake (oral rehydration therapy) is a high priority. Commercial rehydration drinks are widely available; Alternatively, purified water or other transparent liquids are recommended, along with salted biscuits or oral rehydration salts (available in stores and pharmacies in most countries) to fill lost electrolytes. Carbonated water or soda, left open to allow carbonation dissipation, is useful when nothing else is available. In severe or protracted cases, professional medical supervision is recommended.
Antibiotics
If the diarrhea becomes severe (usually defined as three or more loose stools in an eight-hour period), especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in the stools, medical care should be sought. Such patients may benefit from antimicrobial therapy. A literature review of 2000 found that antibiotic treatment shortened the duration and severity of BP; most of the side effects are reported to be small, or resolved to stop antibiotics.
Fluoroquinolone antibiotics are the drug of choice. Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high levels of resistance to these agents. Antibiotics are usually given for three to five days, but a single dose of azithromycin or levofloxacin has been used. Rifaximin is approved in the US for the treatment of TD caused by ETEC. If diarrhea persists despite therapy, travelers should be evaluated for strains of bacteria that are resistant to prescribed antibiotics, possibly viral or parasitic infections, bacterial or amoebic dysentery, Giardia , worms, or cholera.
Antimotility agent
Antimotility drugs such as loperamide and diphenoxylate reduce the symptoms of diarrhea by slowing transit time in the gut. They may be taken to slow the frequency of the stool, but not enough to stop intestinal movements completely, which delay the expulsion of the organism causing the intestines. They should be avoided in patients with fever, bloody diarrhea, and possible inflammatory diarrhea. Adverse reactions may include nausea, vomiting, abdominal pain, hives or rashes, and loss of appetite. An antimotility agent should not, as a rule, be taken by children under the age of two.
Epidemiology
An estimated 10 million people - 20 to 50% of international travelers - develop TD each year. This is more common in developing countries, where tariffs exceed 60%, but have been reported in some form in almost every travel destination in the world.
Society and culture
Montezuma Retaliation (var. Retaliation of Moctezuma ) is a day-to-day term for diarrhea travelers who are contracted in Mexico. His name refers to Moctezuma II (1466-1520), the Tlatoani (ruler) of Aztec civilization who was overthrown by the Spanish conqueror HernÃÆ'¡n Cortà © in the early 16th century, thereby bringing most of what is now Mexico and Central America under power Spanish crown.
Wilderness diarrhea
Wilderness diarrhea, also called wilderness-acquired diarrhea (WAD) or inland diarrhea, refers to diarrhea among backpackers, pedestrians, campers and other outdoor recreation in the wilderness or inland situations, whether at home or abroad. This is due to the same fecal microorganisms as other forms of traveler's diarrhea, usually bacteria or viruses. Since wilderness campsites rarely provide access to sanitation facilities, the risk of infection is similar to that in any developing country. Water treatment, good hygiene, and dishwashing have all been shown to reduce the incidence of WAD.
References
This article incorporates public domain material from websites or documents from the Centers for Disease Control and Prevention.
External links
Source of the article : Wikipedia
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