Traveler's diarrhea

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Background

  1. most respond to antibiotics
  2. as duration of diarrhea increases, higher chance of parasitic cause

DDx

  1. giardia, cryptosporidiosis, entamoeba, cyclospora

Diagnosis

  1. dysentery if stool bloody, fvr or wbc in stool- invasive inflamm enteropathy
  2. has abrupt onset, metastatic lesions, reactive arthopathies, or campylobacter assoc guillain barre- maybe flouroquinolone resis esp in SE Asia
  3. amoebic dysentery insidious and can get amoebic liver abscess
  4. if do not find infc cause of dysentery, eval pt for IBD or CA
  5. prolonged diarrhea and malabsorption- giardia or tropical sprue- does not respond to removal of gluten from diet- tx with tetra and folate
  6. also consider postinfectious disaccharidase deficiency or irritable bowel dz
  7. if diarrhea starts >1 mo after travel- not caused by travel

Treatment

  1. regular travelers diarrhea with fluids, antimotility agents, abx- fluoro or macrolide
  2. invasive enteropathy- bloody/ fvr- same but no antimotility agents
  3. if bloody stool but no fvr, consider enterhemorrhagic E coli- do not give abx since will get hemolytic uremic syndrome in kids
  4. examine stool if diarrhea invasive, persistent, unresponsive to standard tx or immune compromised
  5. if persistent diarrhea, give empiric flouro or macrolide or consid metronidazole for giardia- most common parasite
  6. try lactose free diet
  7. chronic diarrhea usually self limited within 1 yr

See Also

Travel Medicine