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Itâ€™s the CCFP SOO exam – youâ€™re about to enter the next station â€¦ Your station has a 23-year-old male coming in for travel advice. He is going to Jamaica and wants to know what he can do to prevent getting travellerâ€™s diarrhea. What are you going to ask? Are you confident about what medications he needs? What investigations may be needed once the patient has returned home if the symptoms persist?
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This blog is a summary of the Canadian Family Physicians’ article on travellerâ€™s diarrhea. The article can be found here.
â€œDoc, what is travellerâ€™s diarrhea?â€
Travellerâ€™s diarrhea (TD), the quick onset of loose or liquid stools during travel, is a prevalent problem that can impact your travel plans. TD occurs when travellers consume food or beverages that are contaminated, typically by a bacteria pathogen (e.g., enterotoxigenic Escherichia coli, enteroaggregative E. Coli, or Campylobacter).
â€œDoc, what symptoms should I watch out for?â€
Symptoms can include cramps, stomach pain, urgent stools, fever, vomiting, and dysentery (bloody diarrhea). They tend to last 2-4 days.
â€œWhat steps can I take to reduce my risk?â€
You can advise the following:
- Frequent handwashing with either soap or sanitizer
- Eating only foods that are fully cooked and still hot
- Using bottled water to drink and to brush teeth
- Avoiding ice cubes, salad, and raw vegetables
- Eating only fruits that can be peeled (peel your own fruit)
- Taking bismuth subsalicylate 4x per day during travel (if desired/necessary)
Tell the patient to pack the following:
- Oral rehydration solution (e.g., Gastrolyte)
- Loperamide (e.g., Imodium)
- An antibiotic (e.g., Azithromycin)
â€œOkay Doc, I will pack what you suggested. When do I take these medications?â€
- If you have diarrhea, start the oral rehydration right away
- Take loperamide for mild, moderate, or severe diarrhea (do not take if you have bloody diarrhea)
- Take antibiotics for moderate or severe TD
- Seek medical attention for TD that doesnâ€™t improve within 24-36 hours
â€œWhat happens if my symptoms persist despite your recommended treatments?â€
- Up to 10% of those who get TD suffer from complications
- You may need stool testing for severe diarrhea or symptoms that last > 2 weeks
- In rare circumstances, you may need a colonoscopy to diagnose a post-infectious colitis
- You may experience joint pain and muscle weakness – you should be aware of rare but serious complications such as reactive arthritis and Guillain-BarrÃ© syndrome
Written by Maria Veinberg. Reviewed by Dr. Prokubovskaya & Dr. Premji.