PREVENTION High-Risk Areas: All developing countries in Latin America, Africa, the Middle East and Asia.
Means of Transmission:
Fecal-oral contamination by bacterial pathogens and less frequently by parasites (about 10%) or viruses (about 10%). One of the most commonly identified causes is infection with the bacterium, enterotoxigenic Escherichia coli (ETEC).
Principal Precautions:
eat only fruits washed and peeled by yourself avoid uncooked vegetables, meat and seafood avoid creams, dairy products, pastries, ice creams and ice cubes eat preferably recently cooked and hot-served food that has not been handled by others wash hands before eating and do not dry them with towels used by others if bottled water is unavailable: use a water filter, water treated with iodine tablets or iodine solution, or boiled water (most reliable). See "Disinfection of Water [Handout]".
SELF-TREATMENT
The goals of self-treatment of travelers' diarrhea (usually defined as passage of 3 or more unformed stools in a 24-hour period) are to prevent dehydration and reduce the symptoms and duration of the diarrheal illness. See General Approaches to Self-Treatment (below) which are directed at common bacterial causes of travelers' diarrhea. Infections caused by viruses or parasites (about 10-15% of all cases) will not improve with empirical antibacterial antibiotic treatment. Most adults are able take an antidiarrheal/antimotility agent (such as loperamide) which slows diarrhea and fluid loss and are also able to take in an adequate amount of standard fluids by mouth; thus, true dehydration seldom results and the need for specific fluid and electrolyte replacement (as described next) is not frequent in adults.
Early control of dehydration:
tea or mineral water with sugar (3 tablespoons/liter) and/or orange juice, salt (1 teaspoon/liter) or salted food, soup, or an oral rehydration solution, such as WHO Oral Rehydration Salts (ORS) solution. Solutions prepared with packets of rehydration salts, especially for children and the elderly, are available at stores or pharmacies throughout the developing world. - Oral Rehydration Solution (ORS), according to WHO, should contain sodium chloride 3.5 g, trisodium citrate dihydrate 2.9 g, potassium chloride 1.5 g, and glucose 20 g or sucrose 40 g dissolved in 1 liter of drinking water. Drink within 12 hours at room temperature or 24 hours if refrigerated: < 6 kg: 200 to 400 ml; 6-9 kg: 400 to 600 ml; 9-13 kg: 600 to 800 ml; 13-20 kg: 800 to 1000 ml; 20-43 kg: 1000 to 2000 ml; > 43 kg: 2000 to 4000 ml.
GENERAL APPROACHES TO SELF-TREATMENT Mild diarrhea (1-3 stools/24 hours; mild or no other symptoms): no treatment or loperamide or bismuth preparation.
Moderate diarrhea (more than 3 stools/24 hours; with or without nausea, bloating, abdominal cramps and/or pain): loperamide alone or if symptoms worsen and diarrhea persists (and certainly if diarrhea becomes severe), consider taking antibiotic treatment.
Severe diarrhea (more than 6 stools/24 hours and/or fever or bloody stools or stools with mucus): antibiotic treatment
PERSISTENT DIARRHEA
Untreated, the median duration of diarrhea is 3-4 days; 90% of cases of travelers' diarrhea resolve on their own within 7 days. If diarrheal illness persists beyond one week or lasts longer than several days after self-treatment or is severe to begin with, competent medical assistance should be sought.
Additional information:
CDC Health Information for International Travel 2018, Travelers' Diarrhea, p. 114-121.
Comments