Traveler's Diarrhea
Traveler's diarrhea is a description of acute onset diarrhea in travelers. It is the most common infection that affects travelers and can be caused by bacteria, viruses, or parasites. Most commonly the cause is euteric bacteria (ie.E.coli, Shigella, and Campylobacter bacteria) and
is what most people think of when referring to traveler's diarrhea.

Non-infectious causes of diarrhea in travelers:
Viruses
- Diarrhea from viruses are hard to distinguish from bacterial causes. Good hygiene
is the best way to control this infection.

Giardia Lambia - This parasite is found in contaminated water, has a gradual on set, and
can lead to long lasting symptoms before the correct diagnosis is made. It is frequent in
outdoor enthusiasts and also called "beaver fever."

Cyclospora - This parasite (found in Nepal) is resistant to regular antibiotics, but sensitive
to Septra.

Amoeba Histolytica - Infections with this parasite can be severe and life threatening with
liver abscesses. If blood is present in the stools (dysentery) this infection should be
suspected and treated aggressively.

Cholera - Cholera is extremely rare in travelers (2per million). The vaccination is not available in Canada (it was discontinued because it had significant side effects and did not work well).

Parasitic worms - Diarrhea from parasitic worms usually occurs at least a few weeks after infection as it takes time for the worms to grow. Some people prefer to take an anti-helmetic (anti-worm) medication after arrival. Expatriates living abroad at high risk may de-worm themselves every few months to reduce their accumulated "wormload".

Hepatitis A - This viral infection of the liver may cause diarrhea, jaundice, and death. Typhoid - A bacterial infection that causes severe illness with diarrhea. Both hepatitis A and typhoid are vaccine preventable. Similar vaccines against regular traveler's diarrhea are being developed.

Other causes of Diarrhea
Diarrhea or other changes in the stool could be a sign of inflammatory bowel disease (Crohn's disease, Ulcerative colitis) or higher risk individuals (people with compromised immune symptoms or digestive problems) bowel cancer. Diarrhea that does not respond promptly to reasonable treatment should be further investigated.
Prevention of Diarrhea
Travelers are advised to be careful of their diet. Avoiding food that has not been cooked, or prepared properly.
Traditionally dietary mistakes have been felt to be the main reason for illness, but individuals who are very careful may become sick anyway. Contamination can occur anytime the food is prepared, through unclean facilities and poor general observation of hygiene, all of which are beyond the traveler's control.

Early Prevention of symptoms
Pepto-Bismol
- Taking 2 Pepto-Bismol tablets, four times per day, starting 1 day before and continuing for up to 2 weeks, has been shown to help prevent traveler's diarrhea. People allergic to aspirin or pregnant women should not take Pepto-Bismol because of it's calculate content. The tongue and stool may become black from Pepto-Bismol. Children may take a reduced dose as well.
Prophylactic Antibiotics - are generally not recommended to PREVENT symptoms but may sometimes be used for higher risk individuals (people with compromised immune systems or digestive problems).

Early treatment of Traveler's Diarrhea
Pepto-Bismol
- may be used for mild symptoms, similar to the doses for preventing traveler's diarrhea.

Immodium - (2mg four times per day) This is used to stop cramping and retain fluids. This prevents dehydration, which can be critical in hot climates. It is important not to overdo immodium as rebound constipation can occur.

Antibiotics - are recommended for short-term treatment. Ciprofloxin (500mg twice daily for 1-2 days) is a first line treatment. Cipro is safe for pregnant women although not recommended for children under 15 years. This should significantly decrease symptoms. Other antibiotics can be used as well but Sephra, which had been used for years, has limited effects because of resistances.
Children should also be treated for traveler's diarrhea. With their smaller size they are more affected by diarrhea. They should be examined carefully since other illnesses (appendicitis can present early as diarrhea or abdominal pain). Antibiotics should cause a fast improvement in symptoms. If someone is very ill or not improving, a physician should review him or her.

Contacting a local Canadian Embassy can find you local help. Returning traveler's who are still ill should be evaluated further.

Other Considerations
Vaccines
- A vaccine against traveler's diarrhea is being developed although vaccines for Hepatitis A and Typhoid are available.

Charcoal - Activated charcoal is not currently recommended for traveler's diarrhea.

Lactobacillus - Studies are ongoing to test the benefits of taking lactobacillus to prevent diarrhea. This is safe to take but evidence of its benefit is questionable.

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