Travelers’ diarrhea (turista)

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What is it about ?

Traveller’s diarrhea is a loose, watery stool that occurs while traveling abroad or shortly after returning from a trip. It is often a country where hygiene leaves much to be desired. Diarrhea is of varying severity. Sometimes there is a fever. In severe cases, there may be blood mixed with the stool. The main pathogens are bacteria, but viruses and parasites can also cause diarrhea. The average duration of infection is 3 to 5 days. In over 90% of cases, it is a mild to moderately severe disease that resolves on its own.

What is its frequency?

Travelers’ diarrhea affects about half of travelers who stay in the tropics or subtropics for at least a month.

How to recognize it?

During your trip or soon after, you have diarrhea with or without other symptoms. You can feel very sick. Pain in the stomach, loss of appetite, bloating and / or severe cramps may occur. In severe cases, there is a fever. Diarrhea can be mixed with blood and / or phlegm.

How is the diagnosis made?

The doctor will ask you when the diarrhea started, how severe it is, if there is blood in the stool, if you have a fever and general symptoms. He will also look for signs of dehydration. Then he will examine you. Since the disease usually resolves spontaneously, a stool sample is not always necessary.

What can you do ?

Prevention
Prevention, namely good hand and food hygiene, is very important. Wash your hands with soap or alcoholic hand sanitizer after each trip to the toilet and before eating. Eat only cooked foods and fruits that you have peeled yourself. Drink water from closed bottles or drinks that have been boiled beforehand.

Avoid the following foods:

  • street food,
  • salads with mayonnaise and foods containing eggs,
  • undercooked meat, fish or seafood, served cold or lukewarm,
  • cold meat dishes,
  • fruits and vegetables that cannot be washed or peeled,
  • cold desserts,
  • milk, cream, ice cream, butter, cream cheese, which are not packaged,
  • tap water and ice cubes in soft drinks.

If it is not possible to have clean water, try to disinfect the available water by boiling it for 5 minutes, even at a certain altitude where the water boils at temperatures below 100 ° C. . Chemical disinfection is also possible by adding 2 drops of 5% iodine solution to a liter of water and waiting for half an hour. For the giardia cysts, a parasite, it takes 5 drops and a waiting time of one hour. It takes two hours if the water is very cold. To improve the taste, you can add thiosulfate. There are also disinfectant tablets on the market.

There is no vaccine against usual traveller’s diarrhea. There are two types of typhoid fever vaccines: the injectable vaccine and the oral vaccine. Protection begins the third week after vaccination and lasts about three years. The protection is not total. Hygiene measures are therefore extremely important. Vaccination is recommended for travelers who travel for more than three weeks to the Indian subcontinent (India, Pakistan, Bangladesh, Nepal, Maldives, Sri Lanka). Vaccination should be considered for stays longer than three weeks in an area where the disease is permanently present (eg countries of North and West Africa).

    Processing
    It is essential to drink enough (hydrate). Possibly, and certainly if there is a risk of dehydration, an oral solution called ORS, or ORS for “Oral rehydration solution”) is recommended. These are sachets of powder containing sugar and salt to be dissolved in water (1 sachet for 500 ml of water). This helps maintain the balance of water and salt in the body. Rehydration is thus faster. You can optionally prepare the solution yourself by putting in a liter of clean water 1 level teaspoon of salt and 8 level teaspoons of sugar.

    Without fever, it is enough to treat the symptoms. In the majority of cases, antibiotics are not necessary, except in cases of severe diarrhea with the presence of blood in the stool and fever.

    It is not recommended to take loperamide. If it is still necessary, take no more than a few days. Children under 12 should not take it, nor should people with fever or blood in their stools.

    What can the doctor do?

    In the case of mild illness, the doctor avoids prescribing antibiotics because they do more harm than good. They are nevertheless sometimes necessary in cases of serious illness with fever and bloody diarrhea. The drug of choice is azithromycin 1 g once. In children, the dosage is 10 mg / kg, once a day for 3 days.

    Sometimes you should consider including antibiotics in the travel pharmacy if you are planning a trip of more than 2 weeks to risk areas. Discuss this with your GP.

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