Travellers Diarrhoea

Question 1

What is Travellers Diarrhoea?

Answer 1

Increase bowel motions typically 3 in 24hrs
Associated with nausea, vomiting, cramping, urgency, tenesmus and blood or mucus

Question 2

Mild vs Mod vs severe vs persistent

Answer 2

Mild: Tolerabel, not alters plans
Moderate: Is distressing Or interferes with planned activites
Severe: Incapacitating pr completely prevents planned activities, any kind of dysentry
Persistent: Lasts more than 2 weeks

Question 3

Risk factors for TD?

Answer 3

Genetic risk factors including blood group O, SNPs in CD14
Daily use of PPI
Low budget or adventure travel
Living among inhabitants of a high risk region
Toddler or adolescent

Question 4

What are the clinical features?

Answer 4

3-10 unformed stools daily for 3 to 5 days
Abdominal pain and cramps
Fever vomiting and dysentry
Usually presents on day 3

Question 5

Dx of Diarrhoea?

Answer 5

Diarrhea lasting more than 14 days
Need O&P, stool cultures
Now multiple PCRs available

Question 6

Most common bacterial cause of TD?

Answer 6

ETEC most common and Campylobacter

Question 7

What % of parasite cause TD

Answer 7

2-3%
Giardia is most common
Cryptosporidium
Microsporidia
Entamoeba histolytica

Question 8

Viral causes of TD?

Answer 8

Norovirus linked to outbreaks
Rotavirus very common

Question 9

Why do some people not get better from TD?

Answer 9

Mixed pathogenic infection (16%)

Question 10

What do you always think of in patients with TD who use abx?

Answer 10

C-Diff

Question 11

Who do you test for TD?

Answer 11

Recommended in travellers with severe or persistent symptoms
Consider if you fail empiric therapy
Do not routinely test everyone

Question 12

Microbiological or molecular Testing?

Answer 12

Microbiological testing
Molecular testing very expensive

Question 13

What is most likely explanation to culture negative TD where bacterial cause is suspected?

Answer 13

Likely an undetected bacterial pathogen

Question 14

In severe TD with the absence of dysentry what May be used in conjunction?

Answer 14

Loperamide

Question 15

How do you tx mild TD?

Answer 15

May use loperamide or bismuth subsalicylates
Do not use abx

Question 16

Tx Moderate TD?

Answer 16

May use loperamide alone and/or May use antibiotics

Question 17

Tx of Severe Diarrhoea?

Answer 17

Antibiotics Should be used
May use loperamide but Not in dysentry

Question 18

When can you use rifaxamin

Answer 18

Non inflammatory diarrhoea
Afebrile, non dysenteric TD

Question 19

What abx do you use if worried about resistance?

Answer 19

Azithromycin

Question 20

What % of people with TD get IBS?

Answer 20

3 to 17%

Question 21

What abx can prevent TD?

Answer 21

Use Rifaxamin
Do Not use fluoroquinolones eg ciprofloxacin

Question 22

Do we typically use Abx prophylaxis in TD?

Answer 22

Not routinely recommended
If required, use rifaxamin

Question 23

What groups of people get abx prophylaxsis?