Travellers’ Diarrhoea, Are You Prepared?

Introduction

We all love to Travel, with the various transport methods available its never been easier to jet set to a fancy destination at no more than the cost of a train ride. Travelling abroad does come with its risks and we have all experienced this at some point, you guessed it Travelers Diarrhoea (TD), the trots, the runs, loose motions or anything else you may refer to them as. Every year 12 million cases of TD are reported. (1) Rates for TD vary from areas of high incidence (over 50%) such as to northern Africa, Latin America, the Middle East and Southeast Asia to areas of low incidence (5–10%) such as North America, northern Europe, Australia, New Zealand and the United Kingdom.(2,3,4,5) However, it is worth noting that TD can strike even at ‘‘presumed safe’’ destinations.

Some Causes of TD

TD is acquired by ingesting items contaminated with faecal matter be it food, water or other liquids. High-risk foods include raw or undercooked meats and seafood, unpeeled raw fruits 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. (6)

Most (80–85%) cases of TD are due to bacterial pathogens (Enterotoxigenic Escherichia coli, Enteroaggregative E. coli, Campylobacter jejuni, Shigella species, Salmonella species, Vibrio parahemolyticus, Plesiomonas shigelloides, Aeromonas hydrophila, Yersinia enterocolitica, Vibrio cholerae). The most common cause of bacterial TD is one of the seven types of diarrheagenic E. coli. (7,8) Other less frequent causes of TD are viruses (Norwalk or Rotavirus) and parasites (Entamoeba histolytica, Giardia lamblia, Cyclospora, Cryptosporidium). Sometimes the cause cannot be determined.

One of the reasons tourists become susceptible to illness is travel can disrupt the body’s normal defence mechanisms against infections. Stress, jet lag, unfamiliar foods and water and disrupted body rhythms can disturb the normal protective bacteria in the intestines. These protective bacteria usually fight off disease-causing bacteria and viruses by ‘‘colonisation resistance.’’ Colonisation resistance is a barrier effect that prevents attachment and colonisation by harmful microorganisms. (10)

Prevention

One of the most promising is the use of live cultures for the prevention of various types of diarrhoea. (9) live cultures can be a promising therapeutic strategy for diseases that involve a disruption of normal microflora as they act by inhibiting pathogen attachment, enhancing the immune response and assisting in re-establishing normal microflora. (11)

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References

1. Cheng AC, Thielman NM. Update on traveler’s diarrhea. Curr Infect Dis Rep 2002;4:70–7.
2. Hill DR. Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries. Am J Trop Med Hyg 2000;62:585–9.
3. Cavalcanti A, Clemens SA, Von Sonnenburg F, et al. Traveler’s diarrhea: epidemiology and impact on visitors to Fortaleza, Brazil. Rev Panam Salud Publica 2002;11:245–52.
4. Rendi-Wagner P, Kollaritsch H. Drug prophylaxis for travelers’ diarrhea. Clin Infect Dis 2002; 34:628–33.
5. Yates J. Traveler’s diarrhea. Am Fam Physician 2005;71: 2095–100.
6. Centers for Communicable Diseases, CDC. Travelers’ diarrhea. CDC. 1-8. 4-27-2004. Atlanta, Georgia, Centers for Communicable Diseases. The Yellow Book.
7. Clarke SC. Diarrhoeagenic Escherichia coli—an emerging problem? Diagn Microbiol Infect Dis 2001;41:93–8. 17.
8. Adachi JA, Ericsson CD, Jiang ZD, et al. Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico. Clin Infect Dis 2003;37: 1165–71.
9. McFarland LV. A review of the evidence of health claims for biotherapeutic agents. Microb Ecol Health Dis 2000;12:65–76.
10. McFarland L. Normal flora: diversity and functions. Microb Ecol Health Dis 2000;12:193–207
11. Elmer GM, McFarland LV. Properties of evidence-based probiotics for human health. In: Goklepe I, Juneja V, editors. Probiotics in food safety and human health. New York: Marcel Dekker, Inc.; 2005. p. 109–37.
12. Lynne V. McFarland, Meta-analysis of probiotics for the prevention of traveller’s diarrhoea. Travel Medicine and Infectious Disease (2007) 5, 97–105