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Diarrhoea
What is Travellers' Diarrhoea? 1
Travellers' diarrhoea is when a traveller experiences the passing of four or more watery or loose stools in a 24 hour period. It is commonly accompanied by stomach cramps, nausea and bloating and listlessness. It is the most common illness affecting travellers. Most cases of travellers' diarrhoea start suddenly, and stop after 1 or 2 days. Travellers' diarrhoea is rarely life threatening. In 1 week 90 % of the cases are resolved and 98 % of cases are resolved in 1 month.
Who gets Travellers' diarrhoea?
Over 60 % of individuals that visiting tropical or subtropical regions will develop diarrhoea.2
The most important risk factor is the destination of the traveller. High risk destinations are the developing countries of South Asia, Latin America, Africa and the Middle East.
 Figure 1.The relative rates of acquisition of gastrointestinal infection by destination2
The standard of hygiene in restaurants also contributes to diarrhoea risk. Those who travel rough and are adventurous in their eating habits are likely to be at higher risk. Traveller's diarrhoea may be especially hazardous for children due to severe dehydration and in people who are frail or immunocompromised.4
What causes travellers' diarrhoea?
Travellers' diarrhoea is caused by eating or drinking faecally contaminated food or water. High risk foods include raw or undercooked meats and seafood, unpeeled raw fruit and vegetables. Tap water, ice, non-pasteurized milk and other dairy products also can be of high risk. The riskiest sources of contaminated food are street vendors, farmers markets and small restaurants.4 Bacteria cause 80 % of Travellers' diarrhoea cases with the most common bacteria being Escherichia coli (E Coli). Other microorganisms causing Travellers' diarrhoea include: Rotaviruses, Shigella, Salmonella and Campylobacter organisms.3
Treatment of travellers' diarrhoea.1
Generally travellers' diarrhoea is self-limiting and lasts between one and several days.
Oral rehydration is often beneficial to replace lost fluids and electrolytes. Clear liquids are routinely recommended for adults. Water that is purified is best, along with oral rehydration salts to replenish lost electrolytes. Sodas which have been left out so that the carbonation fizz is gone are useful when clean water is not available.
Travellers, who develop three or more loose stools in an 8 hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools, should be treated by a doctor and may benefit from antimicrobial therapy. Antibiotics usually are given for 3-5 days. If the diarrhoea persists despite therapy, travellers should be evaluated by a doctor and treated for possible parasitic infection.
Antimotility agents e.g. Loperamide, may reduce the diarrhoea by slowing the transit time of stool in the gut, allowing for more water absorption. These agents are useful in treating travellers' diarrhoea by decreasing the duration of the diarrhoea. Some persons believe diarrhoea is the body's defence mechanism to get rid of harmful bacteria and substances. Antimotility should not be used by travellers with fever or bloody diarrhoea because they can increase the severity of the disease by delaying clearance of the causative organism.
How to prevent travellers' diarrhoea?1, 4
Travellers can reduce the risk of contracting travellers' diarrhoea by - Avoid eating foods or drinking beverages purchased from street vendors or other places where the conditions are unhygienic
- Avoid eating raw or undercooked meat and seafood
- Avoid eating raw fruits and vegetables unless the travellers peel them themselves
- Eating well-cooked and packaged forms are usually safe
- Avoid tap water, ice, unpasteurized milk and dairy products.
- Consuming safe beverages including bottled carbonated drinks, hot tea or coffee, beer, wine and water boiled or treated with water purifying treatments
- Taking a probiotic e.g. Inteflora 250® (Saccharomyces boulardii) is effective to prevent travellers' diarrhoea.4
Inteflora 250® (Saccharomyces boulardii) in the prevention of TD5
The best results to prevent travellers' diarrhoea in adults and children is achieved by:- Taking Inteflora 250®
- 2 capsules daily
- From 5 days before travelling to a high risk destination
- And continuing for the duration of the trip
This can reduce the likely hood of contracting travellers' diarrhoea by up to 59 % in risk areas.
The Inteflora 250® capsules can be taken as a single daily dose. In children who find it difficult to swallow capsules – the contents of the capsules can be sprinkled over yoghurt or porridge or in the infant formula in the bottle and administered in that way.
Inteflora 250® has an excellent safety profile and represents an ideal agent for prevention of travellers' diarrhoea.5
To find out more visit www.digesticare.co.za
REFERENCES: - Centre for disease control. Travellers' diarrhoea available online on:
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm - Greenwood Z. et al. Gastrointestinal Infection among International Travellers Globally, 2008. Journal of Travel Medicine,
2008, 15, 4221-228 - Guandalini S. Diarrhoea, Medscape updated April 2010 available online at http://emedicine.medscape.com/article/928598-overview
- McFarland LV, Meta-analysis of probiotics for the prevention of traveller's diarrhoea. 2007 Travel Medicine and Infectious Disease,
2007, 5, 97-105 - Kollaritsch H, Holst H, Grobara P, Wiedermann G, Prophylaxis of traveller's diarrhoea with Saccharomyces boulardii. Fortschr.Med;
111 (9); 152-156
 Inteflora 250 ® A11.9.2. Each capsule contains lyophilized cells of Saccharomyces boulardii 17. Ref. No. T194 (Act 101/1965). |