Gastrointestinal infections in returned travelers
Abstract
Gastrointestinal infections are one of the most frequent medical conditions diagnosed in patients who travel to tropical or subtropical destinations. The most common disorder occurring in up to 60% travelling people is travelers’ diarrhea (TD). The illness is defined as a minimum of three loose stools within 24 hours; in most cases TD is caused by the enterotoxigenic Escherichia coli. Its symptoms usually persist for 4–5 days and resolve spontaneously or on self-administered empirical antimicrobial therapy, but in case of an invasive infection, it is necessary to seek medical care. As most tourists travel for 1–2 weeks, the disease often persists or develops upon return; therefore, it is important to raise awareness of TD’s clinical features and treatment options among physicians from travelers’ home countries unaccustomed to this health problem. Another issue, which is gaining more and more importance in recent years, is post-infectious irritable bowel syndrome, a chronic disturbance affecting up to 17% of patients, who have had travelers’ diarrhea. This review aims to promote prophylaxis of gastrointestinal disorders and to extend knowledge about their after-effects in returned travelers.
Keywords: gastrointestinal infectionstravelers’ diarrheatreatmentprophylaxis
References
- Wyss MN, Steffen R, Dhupdale NY, et al. Management of travelers' diarrhea by local physicians in tropical and subtropical countries--a questionnaire survey. J Travel Med. 2009; 16(3): 186–190.
- Jiang ZD, Lowe B, Verenkar MP, et al. Prevalence of enteric pathogens among international travelers with diarrhea acquired in Kenya (Mombasa), India (Goa), or Jamaica (Montego Bay). J Infect Dis. 2002; 185(4): 497–502.
- Al-Abri SS, Beeching NJ, Nye FJ. Traveller's diarrhoea. Lancet Infect Dis. 2005; 5(6): 349–360.
- Korzeniewski K. Gastrointestinal disorders in returning travellers. FMR 2018; 12(4): 115–126 [in Polish.
- Vilkman K, Pakkanen SH, Lääveri T, et al. Travelers' health problems and behavior: prospective study with post-travel follow-up. BMC Infect Dis. 2016; 16: 328.
- Pitzurra R, Steffen R, Tschopp A, et al. Diarrhoea in a large prospective cohort of European travellers to resource-limited destinations. BMC Infect Dis. 2010; 10: 231.
- Greenwood Z, Black J, Weld L, et al. GeoSentinel Surveillance Network. Gastrointestinal infection among international travelers globally. J Travel Med. 2008; 15(4): 221–228.
- Steffen R, Hill DR, DuPont HL. Traveler's diarrhea: a clinical review. JAMA. 2015; 313(1): 71–80.
- Gascón J. Epidemiology, etiology and pathophysiology of traveler's diarrhea. Digestion. 2006; 73 Suppl 1: 102–108.
- Canada Communicable Disease Report: Statement on persistent diarrhea in the returned traveller. Public Health Agency of Canada. 15 February 2006, Vol. 32, ACS-1.
- Steffen R. Epidemiology of travellers' diarrhea. J Travel Med. 2017; 24(suppl_1): S2–S5.
- von Sonnenburg F, Tornieporth N, Waiyaki P, et al. Risk and aetiology of diarrhoea at various tourist destinations. Lancet. 2000; 356(9224): 133–134.
- DuPont H, Khan F. Travelers' diarrhea: epidemiology, microbiology, prevention, and therapy. J Travel Med. 1994; 1(2): 84–93.
- Lääveri T, Vilkman K, Pakkanen SH, et al. A prospective study of travellers' diarrhoea: analysis of pathogen findings by destination in various (sub)tropical regions. Clin Microbiol Infect. 2018; 24(8): 908.e9–908.e16.
- Jiang ZD, DuPont HL. Etiology of travellers' diarrhea. J Travel Med. 2017; 24(suppl_1): S13–S16.
- Vila J, Ruiz J, Gallardo F, et al. Aeromonas spp. and traveler's diarrhea: clinical features and antimicrobial resistance. Emerg Infect Dis. 2003; 9(5): 552–555.
- Launders NJ, Nichols GL, Cartwright R, et al. Self-reported stomach upset in travellers on cruise-based and land-based package holidays. PLoS One. 2014; 9(1): e83425.
- Duplessis CA, Gutierrez RL, Porter CK. Review: chronic and persistent diarrhea with a focus in the returning traveler. Trop Dis Travel Med Vaccines. 2017; 3: 9.
- Castelli F, Pezzoli C, Tomasoni L. Epidemiology of travelers' diarrhea. J Travel Med. 2001; 8(Suppl 2): S26–S30.
- Bavastrelli M, Bertucci P, Midulla M, et al. Ciguatera fish poisoning: an emerging syndrome in Italian travelers. J Travel Med. 2001; 8(3): 139–142.
- Fasano A. Toxins and the gut: role in human disease. Gut. 2002; 50 Suppl 3: III9–II14.
- Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017; 24(suppl_1): S57–S74.
- Mutsch M, Pitzurra R, Hatz C, et al. Post-infectious sequelae of travelers' diarrhea: irritable bowel syndrome. J Travel Med. 2014; 21(2): 141–143.
- Schwille-Kiuntke J, Mazurak N, Enck P. Systematic review with meta-analysis: post-infectious irritable bowel syndrome after travellers' diarrhoea. Aliment Pharmacol Ther. 2015; 41(11): 1029–1037.
- Lalani T, Maguire JD, Grant EM, et al. Epidemiology and self-treatment of travelers' diarrhea in a large, prospective cohort of department of defense beneficiaries. J Travel Med. 2015; 22(3): 152–160.
- Diemert DJ. Prevention and self-treatment of traveler's diarrhea. Clin Microbiol Rev. 2006; 19(3): 583–594.
- DuPont HL. Therapy for and prevention of traveler's diarrhea. Clin Infect Dis. 2007; 45 Suppl 1: S78–S84.
