Traveler's diarrhea: Difference between revisions
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==Background== | ==Background== | ||
*Most respond to antibiotics | |||
*as duration of diarrhea increases, higher chance of parasitic cause | |||
==DDx== | ==DDx== | ||
# | #See DDx [[Diarrhea]] | ||
#Giardia | |||
#Cryptosporidiosis | |||
#Entamoeba | |||
#Cyclospora | |||
==Diagnosis== | ==Diagnosis== |
Revision as of 19:45, 7 December 2011
Background
- Most respond to antibiotics
- as duration of diarrhea increases, higher chance of parasitic cause
DDx
- See DDx Diarrhea
- 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