Traveler's diarrhea

What is it?

Traveler's diarrhea is an infection of the intestines that affects up to 50% of people who visit the developing world. It comes from eating contaminated food or drinking contaminated water.

Traveler's diarrhea usually is caused by viruses (especially norovirus) and bacteria (most commonly E. coli or Campylobacter). It also can be caused by parasites. The diarrhea is usually not serious and goes away without treatment. However, when diarrhea is very watery and occurs often, dehydration may occur. Dehydration is the biggest danger of traveler's diarrhea.

Symptoms

Most episodes of traveler's diarrhea occur in the first or second week of the trip. Symptoms vary depending on what organism causes the problem. People have at least three loose stools per day and often a lot more. They also may experience fatigue, decreased appetite, abdominal cramps, nausea, and vomiting. Usually there is no blood in the stool (feces).

Diagnosis

People know they have traveler's diarrhea based on their symptoms. If symptoms last longer than five days or if you develop fever or severe abdominal pain, see a doctor. Your blood and stool may be tested for evidence of infection. In some cases, a doctor might be able to identify the infecting organism, which could lead to a specific treatment.

Expected duration

Traveler's diarrhea usually improves on its own within five days.

Prevention

Many cases of traveler's diarrhea can be prevented. Keep the following rules in mind, even in expensive resorts and hotels:

• Alcohol does not sterilize water, so be cautious about contaminated water (including ice) used in mixed drinks.
• Carbonated beverages and bottled water are usually safe to drink, but don't use ice, which could be contaminated. Drink from the bottle with a straw, rather than out of a glass. The glass may have been washed with contaminated water.
• Purify water by boiling it for at least three minutes or using a water purification system.
• Hot coffee and tea usually are usually safe to drink, but be sure the water has been boiled.
• Don't eat fruits and vegetables unless they can be peeled, and peel them yourself to make sure that they are not contaminated after they are peeled.
• Avoid dairy products, unless you are sure they have been pasteurized, and avoid undercooked meat and fish.
• Wash your hands with the cleanest water available, or disinfect them with alcohol wipes before eating.
• You can decrease your chance of getting diarrhea by taking two tablets of bismuth subsalicylate (Pepto-Bismol) four times a day, although you shouldn't do this for more than three weeks.

Common side effects of bismuth subsalicylate include black stools and a temporary black discoloration of your tongue. If you develop ringing in the ears, stop taking the medication because you may be developing salicylate toxicity. Aspirin and bismuth subsalicylate contain the same active ingredient, so if you need to take aspirin for health reasons, limit the use of bismuth subsalicylate. If you are allergic to aspirin, are pregnant, or have a history of kidney disease, ulcers, or other bleeding disorders, consult your doctor before taking bismuth subsalicylate.

Do not take antibiotics to prevent diarrhea unless your doctor tells you to. Antibiotics can have side effects, including sensitivity to sun, allergic reactions, and vaginal yeast infections.

Treatment

Dehydration is the biggest danger of traveler's diarrhea, so replacing fluids is extremely important. If you have mild diarrhea, drink broth and diluted fruit juice or sport drinks. Alternate salty and sweet beverages (such as tomato juice and fruit juice) to replace your body's electrolytes. Electrolytes are the charged particles that make up salt. Electrolytes such as sodium, potassium, chloride, calcium, and magnesium play a crucial role in many functions of your body's cells.

If you have severe diarrhea (more than five unformed stools a day), it's best to drink an oral rehydration solution to replace the electrolytes you're losing. Pharmacies in most countries carry these products, which can be mixed with clean drinking water. You also can make your own solution by adding a half-teaspoon of salt, a half-teaspoon of baking soda and 4 tablespoons of sugar to 1 liter of clean water.

Keep in mind that fruit juice, broth, and sports drinks do not contain the right concentration of electrolytes for this purpose.

In most cases, traveler's diarrhea ends within three to five days without antibiotic treatment. However, it is a good idea to get a prescription from your doctor, and bring the antibiotic medication with you in case you need it. The general advice is to take antibiotics if you develop moderate or severe symptoms, such as fever, more than four episodes of diarrhea per day, or blood or mucus in the stool.

If you develop milder symptoms, taking a single dose of antibiotic may lead to faster improvement of your symptoms.

Antimotility medications such as loperamide (Imodium) may help to decrease the frequency of bowel movements, but they cannot prevent diarrhea and they do not get rid of the infection. They are useful for long bus or car trips or other situations where access to a bathroom is unavailable or inconvenient. These drugs may actually prolong the duration of symptoms with certain bacterial infections.

When to call a professional

Get medical attention if traveler's diarrhea does not end within five days, or if you develop a high fever, bloody stool, or severe abdominal pain.

Prognosis

Traveler's diarrhea is inconvenient, but it is rarely serious. The most worrisome complication is severe dehydration.

Additional info

Centers for Disease Control and Prevention
https://www.cdc.gov/travel/