Diarrhea

Question 1

Travelers diarrhea etiology

Answer 1

Bacterial: 80 to 90%
- enterotoxigenic E. coli, campylobacter, salmonella, Shigella, eneroaggregative E colu, aeromonas, pleisimonas, etc

Viral: 5 to 15%
- Norivirus, rhinovirus, Astrovirus, supivirus, 

Parasitic: 10%
- Giardia, cryptosporidium, Cyclospora, entamoeba histolytica, cystoisispora belli

Question 2

Travelers, diarrhea: non-antibiotic

Answer 2

Bismuth compounds
Preventive: two tabs Q ID
Not for children, less than 12, Renal insufficiency or gout
Oral rehydration solutions
Anti-motility/anti-secretory agents
Looeramide- not absorbed. Not for less than six years old 

Question 3

Giardia

Answer 3

Incubation, one to two weeks, gradual onset of symptoms

Diarrhea – bowel, smelling, greasy stools
Abdominal cramps, bloating, gas, “sulfa burps “
Anorexia, fatigue, weight loss

Question 4

Bacterial pre-formed toxins

Answer 4

Symptoms within a few hours
Staph, Bacillus, cereus, C perfingins

Question 5

Norovirus / Sapovirus

Answer 5

 nausea, vomiting, and diarrhea (6 to 72 hours)

Question 6

Bacterial diarrhea

Answer 6

Sudden onset of relatively uncomfortable diarrhea

Incubation 6 to 72 hours

Question 7

Parasitic diarrhea 

Answer 7

Incubation often at least 7 to 10 days

Exception might be Cyclospora in high risk area like Nepal (pre-monsoon)

Question 8

Able to survive, chlorinated, pool water

Answer 8

Cryptosporidium

Question 9

Skin rash after swimming in Lake Victoria

Answer 9

Schistosoma mansoni

Question 10

Bullous cellulitis and soft tissue necrosis after seawater exposure

Answer 10

Vibrio vulnificis
Gram neg bacteria
Risk- alcoholic, cirrhosis, salt, water, exposure 

Question 11

Encephalitis after swimming in stag freshwater

Answer 11

Naeglera fowlera

Question 12

Contact with urine of infected animals – rodents, dog, cattle, wild animals, or contaminated water

Answer 12

Leptospirosis
Spirochetes
Vescan and mucous membranes
Incubation approximately 10 days after exposure(range 2 to 26 days)