TRAVELER’S DIARRHEA

18

Traveler’s diarrhea is a common gut infection caused by consuming contaminated food or water, particularly when food handlers fail to practice proper hygiene like handwashing after using the restroom.

Where’s the highest risk?

This infection is most prevalent in developing regions across Africa, the Middle East, Latin America, and Asia. The likelihood of contracting it varies depending on exposure, with lower risks associated with consuming hot, cooked meals and sealed beverages compared to higher risks from raw fruits, vegetables, and tap water.

The primary culprit behind traveler’s diarrhea is a bacterium known as E.coli.

Identifying Symptoms

The symptoms of traveler’s diarrhea typically include:

• Sudden onset of diarrhea
• Fever
• Nausea and vomiting
• Abdominal bloating
• Urgency to use the bathroom
• General discomfort or weakness (malaise)
• Painful and excessive gas
• Stomach cramps
• Reduced appetite

Duration and Severity

Traveler’s diarrhea typically lasts 3–7 days and rarely poses a serious threat. However, dehydration can become a concern, especially for young children.

Effective Treatment Strategies for Traveler’s Diarrhea

When dealing with traveler’s diarrhea, it’s always wise to seek advice from a healthcare professional rather than attempting self-treatment, especially for pregnant women and children.

1. Pepto-Bismol:

This medication, taken as either 2 ounces four times daily or two tablets four times daily, helps reduce diarrhea and shortens its duration. It can also serve as a preventive measure, although it’s not recommended for use for more than three weeks at a time. Be mindful of potential side effects such as temporary discoloration of the tongue and stools, occasional nausea, constipation, and, rarely, ringing in the ears. Avoid Pepto-Bismol if you have certain conditions like aspirin allergy, renal insufficiency, or if you’re taking specific medications.

2. Oral Rehydration Solution (ORS):

Vital for replenishing lost fluids and salts due to diarrhea, ORS is easily prepared by adding one packet to boiled or treated water. These packets are widely available in stores or pharmacies across developing countries. Follow packet instructions diligently to ensure proper mixing, and consume or discard the solution within 12 hours at room temperature or 24 hours if refrigerated.

3. Antidiarrheal Medications:

While drugs like Lomotil or Imodium can decrease the frequency of diarrhea, they may complicate matters for individuals with severe infections or high fever. It’s advised to avoid these medications in such cases.

4. Antibiotics:

Certain antibiotics like ciprofloxacin, norfloxacin, rifamycin, and sulfamethoxazole-trimethoprim may shorten the illness duration. However, the CDC generally doesn’t recommend routine antibiotic use for preventing traveler’s diarrhea, except for rifaximin. Azithromycin is commonly prescribed to treat traveler’s diarrhea. Always consult a healthcare provider before taking these medications.

5. Treatment for Children:

It’s crucial to consult a doctor when treating diarrhea in children and infants, as some medications may not be suitable for them. Dehydration poses the greatest risk, especially for infants; hence, prompt treatment with an ORS solution is essential. Breastfed infants should continue nursing, while bottle-fed ones should be given lactose-free or lactose-reduced formulas mixed with boiled water. Older children consuming solid foods should maintain their usual diet unless otherwise advised. Seek immediate medical attention if signs of moderate to severe dehydration or other concerning symptoms appear.

Remember, seeking professional medical advice is key to effectively managing traveler’s diarrhea, especially when it comes to vulnerable populations like pregnant women and children.

Knowing When to Seek Medical Help for Traveler’s Diarrhea

It’s important to contact a healthcare provider regarding traveler’s diarrhea under the following circumstances:

1. Severe or Persistent Symptoms: If diarrhea is severe, contains blood, or persists beyond a few days despite home remedies, medical attention is warranted.
2. Accompanying Fever and Chills: When diarrhea is accompanied by fever and chills, it suggests a more serious condition that requires medical evaluation.
3. Difficulty Staying Hydrated: Inability to keep fluids down due to vomiting or excessive diarrhea can lead to dehydration, necessitating prompt medical intervention.

Preventing Traveler’s Diarrhea: Key Strategies

To safeguard against traveler’s diarrhea, follow these preventive measures:

1. Safe Beverage Choices: In areas with poor sanitation, opt for beverages like boiled water, hot drinks made with boiled water (such as coffee or tea), canned or bottled carbonated drinks, beer, or wine. Avoid ice, as it may be made from contaminated water.
2. Choosing Safe Containers: Drink from unopened cans or bottles rather than questionable containers. Wipe and dry the area of the can or bottle that will touch your mouth, as water on the surface may be contaminated. Refrain from brushing teeth with tap water in areas where the quality of the water is questionable.

Ensuring Water Safety

To make water safe for consumption, employ these methods:

1. Boiling: Boiling water vigorously is the most effective method. Let it cool before drinking without adding ice. At high altitudes, either boil water for a few minutes or use chemical disinfectants like iodine or chlorine. Iodine typically offers better disinfection.
2. Chemical Disinfection: Use tincture of iodine or tetraglycine hydroperiodide tablets, following the manufacturer’s instructions. If water is cloudy, strain it and double the disinfectant tablets. In cold water, warm it or allow extra time for the disinfectant to work. Adding a pinch of salt or transferring water between containers can improve taste.
3. Avoid Portable Filters: Portable water filters lack independently verified effectiveness and aren’t recommended.
4. Last Resort: If safe water isn’t available, uncomfortably hot tap water may be safer than cold tap water, although boiling or proper disinfection is still advised due to potential survival of disease-causing organisms.

Taking Food Precautions While Traveling

When it comes to food safety during travel, it’s crucial to be selective. Here are some precautions to follow:

Foods to Avoid:

• Salads: Skip salads, as they often contain raw vegetables that may be contaminated.
• Uncooked Vegetables and Fruit: While fruits you peel yourself are generally safe, avoid unpeeled fruits and raw vegetables.
• Unpasteurized Milk and Dairy Products: Opt for pasteurized milk and dairy to minimize the risk of bacterial contamination.
• Raw Meat and Shellfish: Steer clear of raw or undercooked meat and shellfish, as they can harbor harmful bacteria.
• Certain Fish: Although properly cooked hot food is generally safe, exercise caution with certain types of fish. Tropical reef fish like barracuda and pufferfish may contain toxins, even when cooked. Additionally, fish from specific regions, such as the islands of the West Indies and the tropical Pacific and Indian Oceans, may pose a higher risk of toxin contamination.

Additional Considerations:

• Hot, Cooked Food: Opt for food that has been thoroughly cooked and is still hot, as this reduces the risk of contamination.
• Toxicity in Fish: Be aware that certain fish species, such as tropical reef fish, red snapper, amberjack, grouper, and sea bass, may contain toxins at unpredictable times, particularly if caught on tropical reefs. Exercise caution when consuming these types of fish.

Sources:

• Centers for Disease Control and Prevention (CDC)
• National Institute of Health, “Traveller’s diarrhea”