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travelers-diarrhea

Traveller's Diarrhea

Traveler’s diarrhea is one of the most common and predictable travel-related illnesses. Depending of the destination, season and some others factors, 30%-70% of international travelers are affected it.

Medication

Traveler´s diarrhea usually goes away in some days and fortunately, is not so serious. However, it can be unpleasant and it is a good idea to have doctor-approved medications in case you are going to an area that the climate or sanitary practices are different than you are used to at home and if the diarrhea persists and doesn’t go away.

What is traveler’s diarrhea?

Traveler’s diarrhea is a type of digestive tract disorder; commonly causes abdominal cramps and stools. Usually, happens when you drink water or eat food that your body is not familiarized with.

This is not a serious disease but it is always good to know ways to avoid it and how to treat it, in case it takes longer than expected. You can have traveler’s diarrhea, anywhere, but it is more common while you are visiting, high-risk destinations, as follows:

  • Asia (except Japan);
  • Africa;
  • Mexico;
  • South America;
  • Central America;
  • The middle East;

It can be caused by a virus, bacteria or parasites.  It can cause dehydration, which can be dangerous especially in children and It can be contagious but depends of the cause and from person to person. 

What are the symptoms?

There are more common and universal symptoms of traveler´s diarrhea, which are:

  • Abdominal cramps;
  • Watery stools;
  • Nausea;
  • Vomiting;
  • Excessive flatulence;
  • Loss of appetite;
  • Fever;
  • An urgent need to defecate;

Usually, you will feel these symptoms during the travel or a few days later after you have returned back home. In most of the cases, in some days,  the symptoms will get better without treatment. In within one week, it will be completely cleared up. However, please pay attention if you have the following symptoms stated below:

  • Dehydration;
  • Fever more than 39˚C;
  • Severe and intolerable abdominal pain;
  • Bloody stools;
  • Severe pain in rectum;
  • Persisting vomiting for more than a few hours;

If you or your children have one or more of these symptoms mentioned above you should see a doctor immediately. 

When it is important to see a doctor?

If you are an adult

Traveler´s diarrhea is not a serious disease, but some symptoms are serious and if the common symptoms take more than 3 days, you should make an appointment with your doctor. The condition can be more serious depending if it is caused by organisms such as bacteria. If you do not know which doctor to go to, you can go to the local consulate and they will help you, indicating a GP, who can speak your language.

The doctor will do physical test first, take your temperature and press your abdomen. To check for tenderness in your abdominal area. After this, it is more likely to ask for a stool test to see if there are parasites and a blood test for possible infections.  He can also confirm if you are dehydrated or not.

If your children have the symptoms

If your children have the symptoms below, you should go to a doctor because they can dehydrate fast and it can be serious:

  • If you see unusual signs of sleepiness, unresponsiveness or drowsiness;
  • Fever with 39˚C or more;
  • Crying without tears or dry mouth;
  • Vomiting for more than some hours;
  • Severe diarrhea;
  • Bloody stools;

Which can cause Traveler´s Diarrhea?

When you go to a foreign country and drink contaminated water or eat a contaminated food, you can suffer from traveler´s diarrhea. You can also have it because of stress or a change in your diet. However, usually an infectious agent produces this disease. These organisms, as mentioned, can be bacteria, parasite or virus and they enter your digestive tract and overpower the defense mechanisms that combat pathogens, resulting in  diarrhea.

The most common cause of it is the bacteria called Enterotoxigenic Escherichia coli (ETEC).  These bacteria can cause abdominal pain and cause diarrhea because they can attach in your intestine and release toxins. 

Why are the natives usually not affected in the same way?

The native people get used to the bacteria and have immunity for them. That is why, every year, millions of people that travel to other places, especially the high-risk areas suffer from  traveler´s diarrhea. Of course, the place you are going can determine if you will have it or not, but there are also, some groups of people that are more predispose to suffer from it, as follows:

  • People who have a low immunity system: this can increase the chances to have  infections;
  • People who have cirrhosis of the liver, diabetes or inflammatory bowel disease: can increase the chances to have infections;
  • Young adults: It is uncertain why, but young adults are more predispose to have infections, probably because of the diet or the places that they usually choose;
  • People who take acid blockers or antacids: can also have more chances to have the infections because they can reduce the stomach acids, making bacteria and other organisms to be able to multiply itself in your organism. 

What are the complications related with traveler´s diarrhea?

The traveler´s diarrhea can cause loss of salts, minerals and fluids, which can cause dehydration. This is the most common complication, and when it comes with vomiting or nausea, it can be worst. You need to pay attention to be able to avoid dehydration, especially with children. It can cause serious complications such as shock, coma and multiorgan damage. The signs and symptoms for dehydration can be, as follow:

  • Intense thirst;
  • Dry mouth;
  • Extreme weakness;
  • Little or no urination;
  • Dizziness;
  • Headache;
  • Confusion;

Please pay attention on these symptoms, especially if the traveler´s diarrhea is caused by a parasitic infection. They can be more serious and probably, you will need some medication to treat it. They can cause fever, seizures, allergic reactions or bacterial infections. 

How can you treat traveler´s diarrhea?

The treatment against traveler´s diarrhea depends on the cause. The first step, when the diarrhea is mild, is to avoid dehydration. You should drink more fluids and avoid alcohol and caffeine. When the traveler´s diarrhea is serious, you can also take oral re-hydration to replace the fluids.

Besides this, you can eat foods that your body is familiarized with or food that have a lower  risk of contamination, for example: white rice, toast, bananas and apple. These type of foods will also help your stools gain a harder consistency avoiding dehydration. Do not forget to wash your hands properly before and after preparing food.  After this, the next step is to have over-the-counter (OTC) medicines that are recommend in mild cases of illness.

Bismuth subsalicylate (Pepto-Bismol) and Imodium are examples that can be effective. If these medicines do not work, your doctor will prescribe a medicine according to the cause of the illness. If you have parasites, the doctor will prescribe oral antiparasitic drugs and depends which kind of parasite you have. If you have a bacterial infection, the doctor will prescribe antibiotics like doxycycline (Acticlate) or ciprofloxacin (Cipro).

Usually the traveler´s diarrhea takes from 2 to 3 days to stop, but depending on the severity it can last up to 7 days to clear up. It is important during these days to avoid contaminated food and water, so you will recover faster. 

How to prevent the traveler´s diarrhea?

The traveler´s diarrhea, usually, is not a serious disease, but can be unpleasant during your trip. If you take some steps, you can decrease the chances of suffering diarrhea, here are some recommendations you should follow:

Foods

During the travel, avoid:

  • Foods sold on the street;
  • Food that is not cooked or is not served hot;
  • Food in buffets;
  • Fruits or vegetables that you did not wash or peel by yourself;
  • Food with unpasteurized milk, including ice cream;

Drinks and water

During the travel, avoid:

  • Drinks that are not from factory-sealed containers;
  • Unsterilized water, for example, tap water. If you consume tap water, boil it for three minutes before consuming it.
  • Iced cubes with or juices made from tap water;
  • Tap water to brush your teeth;
  • Avoid swimming in water that can be contaminated, and when you are showering close your mouth;
  • Please pay attention in all hot beverages, as coffee or tea and be sure that they were steaming hot;

Wash your hands

During your travel, wash your hands always before you eat and when you use the bathroom. Please pay attention on your children, and try that they don’t put their hands in their mouth. Wash your hands with soap and water. If you do not have water or soap, you can also use alcohol-based hand sanitizer with at least 60% of alcohol. 

Other tips and preventive measures

If you still suffer from these symptoms after taking all the precautions needed to avoid traveler’s diarrhea,  you should take the medicine mentioned above, but be sure to pay attention that it is not recommended to take certain medicines with  other types because of probable dangerous interactions. Be sure to not take bismuth subsalicylate (Pepto-Bismol) for more than 3 weeks or if you are pregnant, if you are allergic to aspirin or if you are taking other while you are taking some medications like anticoagulants. 

What are some common side effects?

The common side effects are dark stools, black-colored tongue and the possibility to have constipation, nausea, and in very rare cases you may present tinnitus or a ringing sound in your ears. When you are traveling it is recommended to have OTC medicines in your reach, but take it with precaution because it may contribute to the development of antibiotic-resistant bacteria.

Sources:

  • https://wwwnc.cdc.gov/travel/page/travelers-diarrhea
  • https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/symptoms-causes/syc-20352182
  • https://www.healthline.com/health/travelers-diarrhea#preventio