Traveller's diarrhea

Classification according to ICD-10
A09	Diarrhea and gastroenteritis, presumably of infectious origin
E86	Volume depletion with desiccosis
ICD-10 online (WHO version 2019)

As traveler's diarrhea , traveler's diarrhea or traveler's diarrhea (RD) an infectious disease of the intestine is denoted by toxins of different bacteria is caused, and usually in the first days of a trip to tropical or subtropical occurs. It is the most common travel sickness among travelers who come from temperate zones.

Pathogen

Normally, the intestinal flora (which has different regional compositions) is in equilibrium, which is disturbed to varying degrees by the sudden presence of other bacteria. Their enterotoxins (detected by ETEC, Campylobacter species, Shigella and Salmonella ) lead to an active secretion of chloride ions from the intestinal cells into the intestinal lumen (inside). These are followed passively by sodium ions and water. In addition to the disturbed absorption activity, what is known as secretory diarrhea occurs , with the latter pathogens also causing inflammatory dysentery due to direct infestation of the intestinal mucosa .

ETEC are responsible for 50% of the diarrhea in Latin America and only 15% in Asia. Campylobacter, Shigella and Salmonella are responsible for 1–15% of the diseases. The diarrhea caused by the various pathogens can hardly be distinguished clinically. In most cases, a pathogen detection is not necessary, as this has no effect on any therapy, especially in the case of the milder forms of the disease.

Incidence

The mean frequency varies depending on the travel destination:

• A high risk with an incidence of up to 50% exists when traveling to Latin America, Asia and Africa - on some Nile cruises up to 80% of the passengers are affected, which has led to synonyms such as Pharaoh's Revenge , Curse of the Pharaoh or Pyramid Sidestep . When traveling to Central and South America, people speak of Montezuma's revenge .
• There is a medium risk with an incidence of 10–20% for southern Europe, Israel, and the Caribbean
• There is a low risk with an incidence of less than 8% when traveling to Northern Europe, North America, Australia, New Zealand, and Japan.

course

Traveller's diarrhea is divided into two different forms:

Acute traveler's diarrhea

A traveler's diarrhea manifests as acute traveler's diarrhea in 90 to 95% of cases. The incubation period ranges from a few hours to a few days, which means that the majority of travelers get their diarrhea within the first four days of the trip. This is what happens (along with nausea and vomiting)

1. to have more than three bowel movements per day that
2. are of reduced consistency and are therefore unshaped or mostly watery. Blood can be found in the stool up to 10% of the time.

In around one percent of those affected, the diarrhea is so severe that hospitalization is necessary, around 20 percent are bedridden, the remaining 80 percent feel more or less restricted in their freedom of movement and are therefore only slightly ill. The mean duration of illness is three to five days. The diarrhea is usually self-terminating.

Chronic traveler's diarrhea

In 8 to 15 percent it lasts more than a week, 2–3% (up to 10%) develop chronic diarrhea that lasts for more than four weeks and is therefore often only clarified after returning home. The most commonly detected pathogen here is Giardia lamblia .

prophylaxis

Even if traveler's diarrhea is self-limiting in most cases, it is advisable to prevent the disease through appropriate prophylaxis. This can consist of:

• Vaccination : This is available against cholera , ETEC and typhus .
• Avoiding infected foods
  • Originally sealed drinks only
  • Boil and / or filter water
  • Either peel or boil food before consumption
  • only eat freshly cooked and hot food
• prophylactic medication: only in consultation with a travel doctor
• Antibiotic prophylaxis: this is not recommended at the moment, only useful in exceptional cases

literature

• Harald Kretschmer, Gottfried Kusch, Helmut Scherbaum (eds.): Travel medicine . Advice in the medical practice. 2nd, revised and expanded edition. Elsevier, Munich 2005, ISBN 3-437-21511-6 .
• Hans Jochen Diesfeld a. a .: Practical tropical and travel medicine. Thieme, Stuttgart / New York 2003, ISBN 3-13-108342-5 .
• Werner Lang u. a .: Tropical medicine in clinic and practice. Thieme, Stuttgart / New York 2000, ISBN 3-13-785803-8 .
• DJ Diemert: Prevention and self-treatment of traveler's diarrhea . In: Clin Microbiol Rev. , 2006 Jul, 19 (3), pp. 583-594, PMID 16847088 . (Review)
• J. Yates: Traveler's diarrhea . In: Am Fam Physician , 2005 Jun 1, 71 (11), pp. 2095-2100, PMID 15952437 . (Review)

Individual evidence

1. ↑ Travel advice: Travel health. fauna-reisen.de
2. ↑ Traveler's Diarrhea . ( Memento of the original from April 3, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. CDC. 
3. ↑ Christina Hohmann: No antibiotics for prophylaxis . In: Pharmazeutische Zeitung , No. 26, 2004.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !