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.
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)
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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