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Symptoms | Causes | Prevention | Treatment | Sources
Traveler's diarrhea (TD) (Dysentery) is a sudden intestinal infection that travelers often get when they are not used to microorganisms in the water supply or on the food in another country. It may be called gastroenteritis, Montezuma's Revenge, Turista, or the GI Trots.
High-risk destinations include most of the developing countries of Latin America, Africa, the Middle East, and Asia.
The diarrhea usually stops on its own within 1 to 5 days. Rarely, it lasts 2 to 3 weeks. If a fever lasts more than 24 hrs. and there is no improvement after 48 hours, you should see a doctor.
Sometimes, diarrhea is not due to infection, but perhaps too much sun, fruit or booze.
Backcountry Hiking: The Giardia parasite is the number one problem, but cryptosporidium parasites and bacteria can also be present. Viruses are infrequent.
When you are exposed to new varieties of E. coli bacteria (different than the ones in your intestine normally), the bacteria produce toxins that interfere with your intestine's ability to absorb water, thus causing diarrhea.
Cryptosporidium protozoa oocyst E. coli outbreaks have been associated with hamburger meat and unpasteurized milk. Salmonella has been associated with raw meats, poultry, eggs, milk and dairy products, fish, shrimp, frog legs, yeast, coconut, sauces and salad dressing, cake mixes, cream-filled desserts and toppings, dried gelatin, peanut butter, cocoa, and chocolate.
In secondary hosts, the parasite becomes encysted in muscle and brain tissue; only felines carry the parasite in the intestinal tract and shed oocysts that sporulate in the environment. The oocysts are 10a 12µm in diameter and can survive in water and moist soils for long periods of time.
Oocysts, the environmentally resistant transmission stage of the parasite, are shed by infected hosts with their faeces and are immediately infectious. They may remain in the environment for very long periods without loss of infectivity: a very robust oocyst wall protects the sporozoites inside against physical and chemical damage. When an oocyst is ingested by a new host, excystationa opening of the suture in the oocyst walla is triggered by the body temperature and the interaction with stomach acid and bile salts.
See Cryptosporidium Life Cycle at the CDC.
Some species of fish and shellfish can contain poisonous biotoxins, even when well cooked. The most common type of biotoxin in fish is ciguatoxin. The flesh of the barracuda is the most toxic laden and should always be avoided. Red snapper, grouper, amberjack, sea bass, and a wide range of tropical reef fish contain the toxin at unpredictable times. The potential for ciguatera poisoning exists in all subtropical and tropical insular areas of the West Indies and the Pacific and Indian Oceans where the implicated fish species are eaten. Ciguatera, a bacteria, can also come from fish.
Herbal and other medicationGarlic - Garlic has antibacterial, antiviral, and anti-fungal activity. Garlic has been demonstrated to kill parasites, including amoeba and hookworm. Garlic is a broad-spectrum antibiotic that even blocks toxin production by germs. [Journal Nutrition, March 2001] It can also benefit digestion, help with symptoms of common cold and flu, and lower cholesterol and blood pressure.
Because of garlic's anti-clotting properties, persons taking anticoagulant drugs should check with their doctor before taking garlic.
Goldenseal - Japanese research found goldenseal extract to be very effective against intestinal bacteria. It contains the alkaloid berberine, which appears to be effective even against giardia, a tenacious parasite responsible for many serious gastrointestinal infections.
Bismuth subsalicylate, taken as the active ingredient of Pepto-Bismol® (2 ounces four times a day, or two tablets four times a day), has decreased the incidence of diarrhea by about 60% in several placebo-controlled studies. (Source: CDC)
Antiperistaltic agents (drugs that slow movement through the bowel) (for example, Lomotil® and Imodium®) are NOT effective in preventing TD.
Antibiotics including doxycycline, trimethoprim/sulfamethoxazole (TMP/SMX), trimethoprim alone, and the fluoroquinolone agents ciprofloxacin and norfloxacin, when taken prophylactically have been 52% to 95% effective in preventing TD caused by bacteria. However, most doctors don't recommend taking them as a preventative unless you are at high risk.
Evidence is mounting that some of the bacteria contained in yogurt can prevent and treat diarrhea. They may also ease other ailments of the intestinal tract, and some researchers now advocate using these beneficial bacteria -- "probiotics" -- as medicine.
Some yogurt is pasteurized after fermentation which kills the bacteria. Look for the "Live and Active Cultures" seal established by the National Yogurt Association. This seal means that the product contains a significant amount of active cultures, to the tune of 100 million cultures per gram of yogurt.
Other Herbs Several other herbs are traditionally used for treatment of parasites, including male fern (Dryopteris filix-mas), tansy (Tanacetum vulgare), wormwood, black walnut green hulls (Juglans nigra), pumpkin seeds, pawpaw (Papaya) and cloves (Syzygium aromaticum).
Black Walnut May be a remedy for stomach cramps, diarrhea, and parasites. May treat acne, herpes, warts, poison ivy, fungal infections, cold sores.
There are a variety of "Para" (parasite fighting) products with a combination of herbs, such as black walnut, pumpkin seeds, pawpaw (Papaya), garlic, cloves, and others for cleansing the intestinal tract and improving the immune system such as ParaCan from General Health, Para 90, PARASystem and other products from Nature's Plus.
Local Teas - In some places you can get local herbal teas which help to avoid digestive tract problems.
iodine chlorine (cyst forming protozoa [Cryptosporidium andgiardiasis] are extremely resistant to chlorination.) Active carbon (AC) filters remove large particles and adsorb low molecular weight organics and chlorine . Micropur MP1 ClO2
TreatmentEven before the diarrhea is treated, you must try to prevent dehydration, which often follows diarrhea and can cause serious problems. Dehydration occurs when your body loses more fluids and salts (electrolytes: sodium and potassium) than it takes in. Oral rehydration therapy (ORT) is first course of action.
An antidiarrheal drug should be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period. Avoid antidiarrheals if possible, you need to clean out your system as quickly as possible. An antibiotic should only be started if you have more than 10-20 loose stools per day.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Antibiotics:Fluroquinolones such as Cipro® (ciprofloxacin) or Noroxin® (norloxacin) are the present drugs of choice for bacterial infections (except salmonella).
You may want to ask your doctor for a prescription and take it with you.
These medicines can cause side effects, including sun sensitivity, and tendon problems. Inflammation and ruptures of the shoulder, hand, and Achilles tendons have been reported.
Gabboral (250 mg.) is an antibiotic available in some Latin American countries which will work.
It is important to continue to take antibiotics for the time prescribed, otherwise the more robust bacteria may survive leading to antibiotic resistant strains.
The drug of choice for amebic dysentery is Flagyl®
(See: parasitology at McGill Univ.)
Use over-the-counter medications in foreign countries with caution.
Kaolin/pectin (Kaopectate®, K-peck) absorbs toxins.
Activated charcoal absorbs toxins. Most commonly used for poisoning, including Paralytic Shellfish Poisoning (PSP), drug overdoses and proposed for certain bioterrorism agents such as Ricin and Trichothecene. It adsorbs and inactivates a number of organic and inorganic compounds by binding them in the gut. But there is no clinical evidence that it shortens diarrhoea duration or reduces the number or volume of stools. Like other adsorbents, it also binds to and makes other drugs such as tetracycline inactive, and affects digestive enzymes and intestinal micronutrients.
Over the next few hours to 1 to 2 days, slowly add bananas, applesauce, rice, baked potato, and low-fat chicken soup with rice or noodles, and any plain noodles or pasta to your diet. After about 3 days your stools will begin to have shape an you may resume your normal diet, cautiously adding milk products and high fiber foods.
There is also evidence that yogurt taken as a treatment will help.
Sources of Information for the above:
Travelers' Diarrhea and Food and Water Precautions at the Center for Disease Control (CDC) Bad Bug Book - Foodborne Pathogenic Microorganisms and Natural Toxins Handbook at the FDA.