Travellers Diarrhoea Flashcards
What is Travellers Diarrhoea?
Increase bowel motions typically 3 in 24hrs
Associated with nausea, vomiting, cramping, urgency, tenesmus and blood or mucus
Mild vs Mod vs severe vs persistent
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
Risk factors for TD?
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
What are the clinical features?
3-10 unformed stools daily for 3 to 5 days
Abdominal pain and cramps
Fever vomiting and dysentry
Usually presents on day 3
Dx of Diarrhoea?
Diarrhea lasting more than 14 days
Need O&P, stool cultures
Now multiple PCRs available
Most common bacterial cause of TD?
ETEC most common and Campylobacter
What % of parasite cause TD
2-3%
Giardia is most common
Cryptosporidium
Microsporidia
Entamoeba histolytica
Viral causes of TD?
Norovirus linked to outbreaks
Rotavirus very common
Why do some people not get better from TD?
Mixed pathogenic infection (16%)
What do you always think of in patients with TD who use abx?
C-Diff
Who do you test for TD?
Recommended in travellers with severe or persistent symptoms
Consider if you fail empiric therapy
Do not routinely test everyone
Microbiological or molecular Testing?
Microbiological testing
Molecular testing very expensive
What is most likely explanation to culture negative TD where bacterial cause is suspected?
Likely an undetected bacterial pathogen
In severe TD with the absence of dysentry what May be used in conjunction?
Loperamide
How do you tx mild TD?
May use loperamide or bismuth subsalicylates
Do not use abx
Tx Moderate TD?
May use loperamide alone and/or May use antibiotics
Tx of Severe Diarrhoea?
Antibiotics Should be used
May use loperamide but Not in dysentry
When can you use rifaxamin
Non inflammatory diarrhoea
Afebrile, non dysenteric TD
What abx do you use if worried about resistance?
Azithromycin
What % of people with TD get IBS?
3 to 17%
What abx can prevent TD?
Use Rifaxamin
Do Not use fluoroquinolones eg ciprofloxacin
Do we typically use Abx prophylaxis in TD?
Not routinely recommended
If required, use rifaxamin
What groups of people get abx prophylaxsis?
