Traveler's diarrhea: prevention and treatment

Traveler's diarrhea is a disease that affects people traveling to other climatic zones. Such diarrhea is diagnosed in 20-50% of travelers who travel to other countries.

The disorder occurs within 1-2 weeks after arrival, which is associated with the use of local food or water. The risk of developing the disease increases in people visiting Africa, Asia, Latin America.

Etiology of indigestion

Travelers' diarrhea develops against the background of the penetration into the tourist's body of strains of lamblia, E. coli, which are unusual for him, and infection with a local virus.

Most often, travelers' diarrhea is caused by Escherichia coli. These bacteria live in the presence of oxygen in the environment.

They are resistant to drying out and can live for a long time in water, soil and faeces.

Factors provoking an upset stomach in a tourist:

• unusual food;
• non-standard salt composition of water;
• consumption of a seasonal product;
• stress against the backdrop of a new climate.

Traveler's diarrhea often develops after eating local fruits, vegetables, salads, meat products without heat treatment, and seafood.

According to statistics, the maximum number of cases of the ailment in question was registered in African countries, followed by the countries of the Middle East, South Asia, Australia, North America.

Clinical picture

Traveler's diarrhea has varying degrees of symptoms, depending on the pathogen and the body's response to toxins:

• ETKP - provoke an acute disorder. Incubation is 16-72 hours. Body temperature can reach subfebrile, manifesting itself for a long period. Patients complain of general malaise, migraines, and abdominal pain. This clinic is often joined by nausea, vomiting, rumbling. Diarrhea bothers often - up to 15 times a day. The disease itself lasts 5-10 days;
• EIKP - provokes a disease similar to dysentery. Incubation is 6-48 hours. The patient complains of chills, muscle pain, migraine. The temperature rises to 39 degrees. The stool is frequent, initially watery, and then mucus appears in the stool. If travelers' diarrhea is severe, the stool becomes "rectal spit". It manifests itself with fever for 2 days, sometimes longer;
• escherichiosis - incubation - 1-7 days. The patient complains of acute abdominal pain, diarrhea. On the 4th day, the patient's condition worsens, blood appears in the stool. Severe diarrhea provokes symptoms of uremia, anemia, acute PN;
• Giardia - this kind of traveler's diarrhea develops after the tourist returns home. Incubation - up to 20 days. At the initial stage, the disease manifests itself acutely.

In some patients, the pathology in question provokes symptoms of irritable bowel. Patients complain of irregular bowel movements, diarrhea alternates with constipation.

The culmination of travelers' diarrhea falls on the 7-10th day of being in the new state, while the following clinic is observed, regardless of the pathogen:

• diarrhea;
• fever;
• joint and muscle pain;
• vomit;
• chills.

More often, the pathology has a favorable prognosis. Its duration is 14 days. Rarely, travelers' diarrhea is accompanied by the following clinic:

• gastric pain;
• change of frequent and delayed bowel movements;
• bloating.

In medical practice, cases have been identified when travelers' diarrhea turned into Guillain-Barré syndrome.

Patient examination

To confirm the tourist's diarrhea, the doctor examines the clinic of the disease, as well as the data of the epidemiological history. This takes into account the fact of being in a subtropical and tropical country.

If the patient's symptoms persist for more than 2 weeks, laboratory diagnosis is required.

The material is examined prior to etiotropic treatment. Seeding needs to be done on Endo Wednesday. From immunological methods, RA, RNGA are used.

If the doctor suspects a protozoal disease, a microscopic examination of the stool is indicated.

If grade 2-4 dehydration is observed, the CS electrolyte level is assessed. In severe cases, the internal organs, the state of the GM are examined, for this, CT and MRI are prescribed.

Therapies

Traveler's diarrhea is treated in a hospital if clinically and epidemiologically indicated. Patients in moderate and severe condition are subject to hospitalization. Mild diarrhea is treated at home.

When a patient seeks medical attention, the physician should watch out for the inflamed form of tourist diarrhea. The acute course of the disease requires a sparing diet.

Mild traveler's diarrhea requires oral rehydration therapy:

• Glucosalan;
• Regidron;
• Humana Electrolyte.

This treatment is effective in 95% of cases with grade 1-2 dehydration. The solution must be drunk 150 ml every 15 minutes. Patients undergoing hospital treatment suffer from grade 2-3 dehydration.

They are shown intravenous administration of rehydration agents. For this, solutions Chlosol, Acesol are used.

Traveler's diarrhea is treated in 2 steps:

• elimination of dehydration;
• correction of current water loss.

With the considered diarrhea, the solution is administered at a rate within the range of 60-80 ml / min, taking into account the degree of dehydration. Inpatient treatment also includes the intake of enterosorbents:

• Polyphepan;
• Polysorb;
• Enterodesis;
• Enterosgel.

This therapy lasts 3 days. The patient is shown enzyme therapy for tourist's diarrhea:

1. Festal.
2. Panzinorm.
3. Creon.
4. Festal.

Treatment of tourist's diarrhea includes taking medications that regulate the balance of intestinal flora - probiotics:

• Bactisubtil;
• Beefi-form;
• Bifidumbacterin;
• Bifidumbacterin Forte No.
• Linex;
• Probifor.

Therapy with the above drugs lasts 7-10 days. Loperamide is often treated for travelers' diarrhea.

This drug helps to reduce the tone and motor function of the intestine by binding to the opioid receptors in the intestine. In this case, there is an antidiarrheal effect.

At the initial stage of therapy, the patient is prescribed 4 mg of the drug, and then its dosage is reduced twice. The maximum daily dosage is 16 mg. Loperamide is contraindicated in invasive diarrhea.

The patient may also be prescribed Bismuth Subsalicylate at a dosage of 528 mg. The drug is taken every 60 minutes, with a maximum daily dosage of 4.2 mg.

This medication is contraindicated in pregnancy and in patients taking anticoagulants or Doxycycline.

With the disease under consideration, antibiotics are indicated. Due to the difficulty of conducting laboratory tests at the first stage, doctors prescribe empirical therapy.

In this case, the prescribed drug should have a broad effect, reaching a maximum concentration in the intestine.

Before carrying out such therapy, the doctor must know the sensitivity of the pathogen to the medication in this region.

If more than 80% of the strains are sensitive to the prescribed medication, it is included in empirical treatment.

Prevention of tourist departure to sanitary regions, as well as treatment of already developed travelers' diarrhea, includes antibiotic therapy.

Chemoprophylaxis is carried out with the following drugs:

• Ofloxacin 300 mg;
• Ciprofloxacin 500 mg;
• Norfloxacin 400 mg;
• Levofloxacin 500 mg;
• Rifaximin 200 mg twice a day.

Such prevention is carried out before the departure of the tourist and its duration should not exceed 30 days. Antibacterial prophylaxis is indicated for those persons who have an immunodeficiency.

It is also prescribed to patients who are not inclined to adhere to the rules of hygiene and nutritional regimen on a trip.

Scientists have found that in Thailand there are strains resistant to drugs of the pharmacological group of fluoroquinolones. Therefore, for the treatment of the condition in question, Azithromycin is used.

Antibiotic treatment is retained if the patient has a temperature above 39 degrees, while the clinic of intoxication is growing, and there is blood with mucus in the stool.

In such cases, the following medications are indicated:

• Rifaximin or Alfa normix 200 mg three times a day or 400 mg twice a day. Therapy with these drugs lasts 3 days;
• Ciprofloxacin, Ciprolet or Tsiprobay are prescribed at a dosage of 500 mg twice a day. The treatment lasts 1-3 days;
• Ofloxacin at a dosage of 300 mg is taken twice a day for 1-3 days;
• Norfloxacin 400 mg is taken twice a day for 1-3 days;
• Levofloxacin 500 mg is taken once, but for 1-3 days;
• Azithromycin or Sumamed is prescribed in a dosage of 500 mg once every 1-3 days.

If the patient has lamblia, therapy with Tinidazole 2 g throughout the day is indicated.

In Mexico, the disease in question is more often provoked by Escherichia, therefore, Rifaximin is included in the treatment for patients who have arrived from this country.

In Thailand, the defeat of the gastrointestinal tract is more often provoked by Campylobacter, therefore, patients arriving from this country are prescribed Azithromycin.
Forecast

Traveler's diarrhea is not a life-threatening illness. Her prognosis is positive. A severe course of the disease can be observed in patients with weak immunity and in people with concomitant gastrointestinal diseases.

Children and pregnant women are also at risk. A patient with diagnosed traveler's diarrhea recovers within the first week in 90% of cases and within a month in 98% of cases.

Preventive measures

An important principle of disease prevention is personal hygiene, including food intake while traveling. Tourists who leave for a tropical and subtropical country should be informed about the possible illness.

It is recommended that you refuse to eat food that is sold on the street. Salads and cold snacks are especially dangerous for tourists. Also, you can not eat meat and other foods that have undergone poor heat treatment.

It is forbidden to brush your teeth with tap water. On a trip, it is better to drink tea and coffee, eat fruits that can be peeled.

Persons who need to visit countries that are at risk for the course of tourist diarrhea should take with them medicines that stop the main clinic of this disease.

Antibiotics are taken with them, taking into account the regional characteristics of the spread of the pathogen that causes the tourist's illness.

To conduct chemoprophylaxis for the development of travelers' diarrhea, drugs such as Ofloxacin, Norfloxacin, Rifaximin are used.

Most often, the pathology under consideration is provoked by non-invasive strains, including E. Coli. In such cases, the reception of Rifaximin is indicated.

When the above clinic manifests itself, it is recommended to consult with an infectious disease specialist.

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