Travelers’ diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30-70% of travelers, depending on the destination and season of travel.
What is it due to?
80-90% Bacteria
Most common= enterotoxigenic Escherichia coli, followed by Campylobacter jejuni, Shigella spp., and Salmonella spp.
Symptoms usually within hours
Lasts 3–7 days
5-15% Viruses
Most common= Norovirus, rotavirus, and astrovirus
Lasts 2–3 days
10% Parasites
Most common= Giardia
Usually presents 1-2 weeks later
Lasts weeks to months
Also: “food poisoning” = eating preformed toxins in food. In this syndrome, vomiting and diarrhea may both be present, but symptoms usually resolve spontaneously within 12 hours.
adapted from nature.com
adapted from nature.com
Risk factors
Poor hygiene practice in local restaurants is likely the largest contributor to the risk of traveler’s diarrhea
Seasonal— higher risk in hotter months
Where are you going??? Check out the map to see if you are going to a high risk area.
Prevention!
Food and beverage selection
Avoid raw or undercooked, unpasteurized food
In areas where hygiene and sanitation are inadequate or unknown, avoid salads; uncooked vegetables; raw, unpeeled fruits; and unpasteurized fruit juices
Avoid street vendors
Avoid tap water and ice
Hygiene
Carefully wash hands with soap
Consider alcohol-based hand sanitizers (containing ≥60% alcohol)
Prophylactic meds
2 tablets of Pepto Bismol (Bismuth subsalicylate), taken 4 times a day
Has been shown to cut the risk of traveler’s diarrhea by more than 60— dropping the risk from 40% to only 14%.
There is a dose-dependent effect: If you take 1 tablet 4 times a day you reduced the risk by 40% – not as good as 60% but still worth it!
How does it work? Bismuth is known to have antimicrobial properties, and forms a protective layer on top of the gut wall .
If you do get sick, bismuth can shorten the duration of diarrhea, and is a good alternative to antibiotics.
FYI: Pepto causes a black tongue + stool and may have other side effects so talk to your gut doctor!
Prophylactic antibiotics
Consider for short-term travelers who are high-risk ( immunosuppressed or significant medical comorbidities) or if taking important trips where you can’t get sick or not around dependable health care.
Vaccines
Hepatitis A if going to a high risk area (hepatitis A may cause terrible gut symptoms like nausea and diarrhea with no obvious liver symptoms!)
So you got sick..
– Hydrate, hydrate, hydrate! Water, broths, electrolyte drinks…
– Do not force yourself to eat. Wait until you are hungry. Then start with safe foods like crackers or toast with your broth. Stay away from dairy for 6 weeks (at least!)
– Bismuth (see above)
– IMODIUM® anti-motility medication if you are desperate! But read the fine print:
Initial: 4 mg after first loose stool, followed by 2 mg after each subsequent stool (maximum dose: 16 mg/day. Only take for ≤48 hours. FYI there is a US Boxed warning of Torsades de pointes and sudden death: Cases of torsades de pointes, cardiac arrest, and death have been reported with the use of a higher than recommended dosage of loperamide.
Do NOT use loperamide in cases of dysentery (visible blood or mucus)
– Antibiotics? Your body will naturally fight off bacterial diarrhea in 3-7 days. But if you’re running to the bathroom several times a day — or have bloody stools — then consider antibiotics which will make you feel better in 6-24 hours.
We know that gut infections can ravage the gut + microbiome leaving people with microbiome dysbiosis, motility problems, SIBO, food intolerances and more— which can be tough to fix! So instead let’s PREVENT travelers diarrhea from happening in the first place!
#gutlove: Protect your gut.
Source https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea