Artha Medika Clinic

writen by: Dr. Putu Oka Kesumanata

What is travelers’ diarrhea?

Travelers from temperate regions of the world frequently experience diarrhea four days to two weeks after arriving in certain areas of the world. This illness is called travelers’ diarrhea. Other colorful and humorous terms used to describe this illness include “Montezuma’s Revenge, the “Delhi Belly” in India, the “Bali Belly” in Bali and the “Hong Kong Dog” in the Far East.

How common is travelers’ diarrhea?

Twenty to 50% of travelers may develop diarrhea depending on the region of the world they visit. Diarrhea is the most common illness of travelers. In general, travelers at risk for diarrhea commonly come from industrialized nations and travel to high-risk areas that are primarily within developing or less industrialized nations of the world, including Latin America, Africa, the Middle East, and Asia. Areas of lesser risk include China and some Caribbean nations. Travel to areas of the United States, Canada, Northern Europe, and Australia pose the lowest risk to travelers.

Men and women are at equal risk for developing travelers’ diarrhea. Younger individuals are more commonly afflicted, perhaps because of more adventurous eating habits. People with disorders that compromise their immune system (such as HIV, cancer, chemotherapy, steroid use), diabetics and people with underlying abdominal disorders (irritable bowel syndrome, colitis) are more susceptible to travelers’ diarrhea. Interestingly, people on acid blockers for their stomachs (like famotidine, cimetidine, omeprazole, esomeprazole) also have a higher susceptibility to travelers’ diarrhea because they have less stomach acid to protect them from the bacteria that cause the condition

What causes travelers’ diarrhea?

Travelers’ diarrhea usually is contracted by the ingestion of contaminated food or water. Contrary to common belief, food - not water - is primarily at fault. Most cases of travelers’ diarrhea are caused by bacteria. The most important bacterium is enterotoxigenic E.coli which is estimated to account for up to 70% of all cases.

Other bacterial species implicated in travelers’ diarrhea include Campylobacter jejuni, Shigella, and Salmonella. Viruses (including Rotavirus, Norwalk Virus and other enteric viruses) less commonly are causes of travelers’ diarrhea.

Parasitic infections are an uncommon cause with the exception of Giardia Lambia, which should be suspected in individuals traveling to Russia or to mountainous regions of the Northern Hemisphere. Cryptosporidia, another parasite, also has been implicated as a common cause of diarrhea in visitors to St. Petersburg, Russia.

What are the symptoms of travelers’ diarrhea?

The symptoms of travelers’ diarrhea vary. Generally, diarrhea occurs within the first week of travel and lasts up to three to four days. Affected individuals on average pass up to five loose or watery bowel movements per day which may be associated with cramps. On occasion, individuals may experience fever or bloody stools.

How to treated travelers’ diarrhea?

Although prophylactic antibiotics are effective in preventing travelers’ diarrhea, they generally are not recommended. The side effects of antibiotics, including photosensitivity and diarrhea can be major problems. Antibiotic prophylaxis can be considered in individuals with underlying medical diseases in whom diarrhea is more likely to occur or who may be profoundly affected by the diarrhea. This group includes people with previous stomach surgery, active inflammatory bowel disease, underlying immunodeficiency conditions, and other serious medical disorders. In these situations drugs of the quinolone class ciprofloxacin, levofloxacin have been shown to be effective.

When treating afflicted individuals, drugs that alleviate symptoms as well as antibiotics play a role. With moderate symptoms, the addition of Pepto-Bismol alone may suffice. Alternatively, anti-diarrheal agents such as diphenoxylate and atropine or loperamide can be given.

With severe disease, characterized by frequent diarrhea or dehydration, or complicated by the passage of bloody stools, diphenoxylate and atropine or loperamide should not be used and you should consult your doctor. Oral fluids are a mainstay of therapy since they are important to prevent dehydration.

Tips for staying hydrated are:

Children and the elderly are more susceptible to dehydration. If you feel light-headed or woozy, feel a rapid pulse or your mouth and lips are dry you should consult a physician. If a child is listless, not eating or drinking and does not make wet diapers or urinate within a few hours they also should be seen by a doctor

How can to prevent travelers’ diarrhea?

Since food is the mayor source of infection, close attention to diet is of foremost importance in the prevention of travelers’ diarrhea. Foods should be well-cooked and served warm. Raw vegetables, uncooked meat or seafood, and other foods maintained at room temperature should be avoided. Dairy products, tap water and ice (including frozen drinks not made from filtered water) are also high-risk foods. Carbonated beverages, beer and wine, hot coffee and tea, fruits that can be peeled and canned products generally are safe. The risk for developing diarrhea increases when eating at restaurants and when purchasing food from street vendors. Also, frequent hand washing with soap and clean water will decrease the likelihood of the bacteria’s spread.

Travelers’ Diarrhea

• Travelers’ diarrhea is a gastrointestinal illness that occurs in travelers.
• Travelers’ diarrhea usually is caused by eating food contaminated with bacteria or, less commonly, with parasites or viruses.
• Travelers’ diarrhea usually is mild and self-limited to a few days or a week.
• The treatment of travelers’ diarrhea is usually plenty of oral liquids as well as over-the-counter medications that control diarrhea and cramps.
• Antibiotic prophylaxis (prevention) for travelers’ diarrhea is available but is not recommended generally.