Travelers Diarrhea

Approximately 40% of travelers to developing regions of the world will develop diarrhea. Bacteria are responsible for approximately 80% of diarrhea acquired by travelers. Other important causes include viruses and parasites. The onset of the majority of cases of travelers' diarrhea is usually within 5 to 15 days after arrival. The presentation is typically a noninflammatory, nonbloody diarrhea associated with abdominal discomfort, fever, nausea, or vomiting. The duration is usually 1 to 5 days.

Enterotoxigenic E. coli is responsible for approximately 30% of travelers' diarrhea. Enteroaggregative E. coli is the second most common bacterial agent and causes 20% of cases. Salmonella, Shigella, and Campylobacter spp. are less often detected but are important causes of dysentery, particularly in Asia and Africa. Dysentery is severe inflammatory diarrhea manifested by fever and bloody stools. Most cases of travelers' diarrhea are self-limited, but chronic postinfectious irritable bowel syndrome may occur in up to 10% of those who experience diarrhea.

Prevention of travelers' diarrhea is an important component of pretravel counseling for high-risk countries. Food should be boiled, cooked, or peeled and water boiled to avoid consumption of fecal contamination. If a person develops travelers' diarrhea, a short course of antibiotics with rifaximin, ciprofloxacin, or azithromycin can shorten the duration of illness by 1 to 3 days. Antibiotic therapy is recommended for persons with bloody diarrhea or fever. Rifaximin, a nonab-sorbed antibiotic, is not effective against invasive pathogens

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