Traveler's diarrhea (Turista)
Quick facts
Traveler's diarrhea (turista) is an infection that combines diarrhea, nausea and vomiting. It is common among people who travel to areas of the world where water purification is inadequate.
Traveler's diarrhea can be caused by bacteria, parasites or viruses.
The organisms responsible for the symptoms are often acquired through ingestion of food or water, particularly in countries where water supplies may not be adequately treated.
Nausea, vomiting, abdominal cramps and diarrhea of varying severity may be observed.
Diagnosis is usually based on the doctor's assessment, but a stool test is sometimes performed.
Treatment consists of drinking plenty of fluids, and sometimes taking antidiarrheal medication or antibiotics.
Preventive measures include drinking only bottled soft drinks, avoiding undercooked fruit and vegetables, avoiding ice cubes and using bottled water for brushing teeth.
Turista occurs when people come into contact with bacteria, viruses or, less frequently, parasites to which they have had little previous exposure and against which they have no immunity. These organisms are generally acquired through ingestion of food or water (including water used to wash food).
Traveler's diarrhea is mainly observed in countries where water supplies are not adequately treated.
The Escherichia coli (E. coli) bacterium is the most frequent cause of traveler's diarrhea, especially the types ofE.coli which produce certain toxins and certain viruses such as norovirus, which is a notable problem on some cruises.
Travellers who avoid drinking local water can still become infected by brushing their teeth with an improperly rinsed brush, adding ice cubes made from local water to bottled drinks, or eating food that has not been properly handled or washed with local water. People taking medications that reduce stomach acid (such as antacids, H2 blockers and proton pump inhibitors) are at risk of developing more severe disease.
Traveler's diarrhea symptoms
The following symptoms of traveler's diarrhea may occur alone or in combination, and with any degree of severity:
Nausea
Vomiting
Intestinal bleeding
Abdominal cramps
Diarrhea
Fever
These symptoms begin within 12 to 72 hours of ingesting contaminated food or water. Nausea, headache and muscle pain are particularly common in norovirus infections. In rare cases, diarrhea can be bloody.
Most cases are mild, and symptoms disappear without treatment in 3 to 5 days.
Diagnosis of traveler's diarrhea
Clinical examination
Stool analysis in rare cases
Diagnostic tests are rarely necessary, but sometimes stool samples are analyzed for bacteria, viruses or parasites, usually in people who present with fever, severe abdominal pain and bloody diarrhea.
Treatment of traveler's diarrhea
Fluids
Medications to stop diarrhea (antidiarrheals)
Sometimes antibiotics or antiparasitics
At the onset of symptoms, treatment consists of drinking large quantities of fluids and taking anti-diarrheal drugs such as loperamide.
These drugs should not be given to children under 18 with acute diarrhea. Antidiarrheals are also not given to people who have recently taken antibiotics, who have bloody diarrhea, who have small amounts of blood in the stool invisible to the naked eye, or who suffer from diarrhea and fever.
Antibiotics are not necessary to treat mild cases of turista.
However, if diarrhea is more severe (at least 3 loose stools over 8 hours), antibiotics are often administered. Adults can take ciprofloxacin, levofloxacin, azithromycin or rifaximin. Children can take azithromycin. Antibiotics are not prescribed if a virus is the cause of the disorder.
Antiparasitics are administered if a parasite is identified in the stool.
Travelers are advised to seek medical attention if they develop a fever or blood in their stools.
Preventing traveler's diarrhea
Consumption of safe food and water
Travelers should only eat in restaurants with a reliable reputation, and should not consume food or drink from street vendors. Cooked food that is still hot when served is generally safe. Vegetable or fruit salads and salsa sauces left on the table in open containers should be avoided. Fruit should always be peeled.
Travelers should only drink bottled soft drinks or drinks made from boiled water. Even ice cubes must be made from boiled water.
Fast-food and buffet restaurants pose a risk of infection.
Preventive antibiotics are recommended only for people who are particularly susceptible to the consequences of turista, such as those with weakened immune systems, chronic inflammatory bowel disease, HIV infection, organ transplants and severe heart or kidney disease. The antibiotic most often administered is rifaximin. Some travelers take bismuth subsalicylate rather than antibiotics as a preventive measure.
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