Materiały źródłowe

• #1 Travelers Diarrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459348/

  Traveler’s diarrhea is a common ailment in individuals traveling to resource-limited destinations overseas. It is estimated to affect nearly 40 to 60 percent of travelers and is the most common travel-associated condition. This activity reviews the evaluation and management of traveler’s diarrhea and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients. […] Laboratory investigation is typically not required in most cases. In patients with concerning features, such as with high fever, hematochezia, or tenesmus, stool studies can be obtained. Typical stool studies include stool culture, fecal leukocytes, and lactoferrin. […] The foundation of diarrhea management is fluid repletion. In mild cases, travelers should focus on increasing water intake.

• #1 Travelers’ diarrhea: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/travelers-diarrhea-epidemiology-microbiology-clinical-manifestations-and-diagnosis

  Travelers’ diarrhea refers to development of unformed stools during or within 10 days of returning from travel; it commonly occurs in association with travel to a setting where sanitation and hygienic practices are poor and there is limited access to safe drinking water. Travelers’ diarrhea is typically self-diagnosed. […] For epidemiologic purposes, travelers’ diarrhea may be defined as passage of three or more unformed stools in a 24-hour period, accompanied by at least one of these other symptoms: nausea, vomiting, abdominal pain or cramps, fever, or blood in the stool. […] The epidemiology, microbiology, clinical manifestations, and diagnosis of travelers’ diarrhea are discussed here. […] Travelers’ diarrhea is the most common illness among individuals traveling to settings where sanitation and hygienic practices are poor and there is limited access to safe drinking water. The attack rate for travelers’ diarrhea ranges between 10 and 70 percent; estimates vary greatly between studies.

• #1 Traveler’s Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0601/p2095.html

  Acute diarrhea affects millions of persons who travel to developing countries each year. Food and water contaminated with fecal matter are the main sources of infection. Bacteria such as enterotoxigenic Escherichia coli, enteroaggregative E. coli, Campylobacter, Salmonella, and Shigella are common causes of travelers diarrhea. […] The classic definition of travelers diarrhea is three or more unformed stools in 24 hours with at least one of the following symptoms: fever, nausea, vomiting, abdominal cramps, tenesmus, or bloody stools. […] Waiting 24 hours to confirm the diagnosis of travelers diarrhea results in unnecessary discomfort and time away from activities. Therapy can be initiated after the first episode of distressing diarrhea (i.e., diarrhea that is uncomfortable or interferes with activities).

• #1 Traveler’s diarrhea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/diagnosis-treatment/drc-20352188

  Diagnosing traveler’s diarrhea typically involves taking a medical and travel history. A physical exam may be done to check for signs of dehydration. If symptoms are serious or don’t resolve on their own, a stool sample may be done to check for microorganisms. […] If you have diarrhea that is severe, lasts more than a few days or is bloody, call a doctor. […] If you have diarrhea and you’ve just returned home from a trip abroad, share that trip information with your doctor when you call to make an appointment. […] Call a doctor if you have diarrhea that is severe, lasts more than a few days or is bloody. If you are traveling, call an embassy or consulate for help locating a doctor. Other signs that you should seek medical attention include: A fever of 102 F (39 C) or higher. Ongoing vomiting. Signs of severe dehydration, including a dry mouth, muscle cramps, decreased urine output, dizziness or fatigue.

• #1 Traveler’s diarrhea – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/diagnosis-treatment/drc-20352188

  Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask: What are your symptoms? When did you first begin experiencing symptoms? Have you traveled recently? Where did you travel? Have you taken any antibiotics recently? Have your symptoms been getting better or worse? Have you noticed any blood in your stools? Have you experienced symptoms of dehydration, such as muscle cramps or fatigue? What treatments have you tried so far, if any? Have you been able to keep down any food or liquid? Are you pregnant? Are you being treated for any other medical conditions?

• #1 IDSA 2017 Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea

  https://www.idsociety.org/practice-guideline/infectious-diarrhea/

  Stool testing should be performed for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and STEC in people with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis (strong, moderate). […] Diagnostic testing is not recommended in most cases of uncomplicated travelers diarrhea unless treatment is indicated. Travelers with diarrhea lasting 14 days or longer should be evaluated for intestinal parasitic infections (strong, moderate). […] Testing may be considered for C. difficile in people 2 years of age who have a history of diarrhea following antimicrobial use and in people with healthcare-associated diarrhea (weak, high). […] The optimal specimen for laboratory diagnosis of infectious diarrhea is a diarrheal stool sample (ie, a sample that takes the shape of the container).

• #1 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Travelers’ diarrhea (TD) is the most predictable travel-related illness. […] TD is a clinical syndrome that can result from a variety of intestinal pathogens. […] The use of multiplex molecular diagnostic assays has suggested that the contribution of viruses to the overall burden of TD disease is underestimated. […] The incubation period between exposure and clinical presentation can provide clues to etiology. […] The effectiveness of a particular standby antimicrobial drug for self-treatment depends on the etiologic agent and its antibiotic sensitivity. […] Travelers’ diarrhea caused by protozoa are the pathogens more likely to be isolated from patients with persistent diarrhea. […] Consider empiric antibiotic therapy for severe watery diarrhea or evidence of systemic infection. […] In older children and teenagers, treatment guidelines follow those for adults, with possible adjustments in the dose of medication.

• #1 Traveler’s diarrhea – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/601

  Traveler’s diarrhea (TD) is defined as 3 unformed stools in 24 hours accompanied by at least one of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a destination with deficiencies in water, sanitation, and hygiene (WASH) infrastructure. It is usually a benign, self-limited illness lasting 3-5 days. […] Key diagnostic factors include diarrhea (with or without tenesmus), cramping, nausea, and vomiting, dysentery (blood and fever), and persistent diarrhea for 14 days. […] The first tests to order include stool culture and sensitivity, multipathogen molecular diagnostic (polymerase chain reaction), and protozoal stool antigens. […] Tests to consider include stool ova and parasite exam, Clostridioides difficile stool toxin, colonoscopy, endoscopy, and biopsy, and hematology, blood chemistries, serology.

• #1 Parasitic causes of prolonged diarrhoea in travellers Diagnosis and management

  https://www.racgp.org.au/afp/2012/october/parasitic-causes-of-prolonged-diarrhoea-in-travell

  Prolonged infectious diarrhoea in the returning traveller is generally caused by protozoal and occasionally by helminth parasites. […] This article provides a framework for the diagnosis, management and prevention of the diseases that cause persistent diarrhoea in the traveller. […] Determination of the cause of persistent diarrhoea follows the usual format of history, examination, targeted laboratory investigations and, very rarely, diagnostic imaging or invasive testing such as colonoscopy. […] As with all diagnostic processes, it begins with a complete history focusing on the onset and nature (volume, character, consistency) of the diarrhoea as well as the presence of blood or mucus in the stool. […] The role of laboratory investigations is twofold: first, to define the aetiological agent of the diarrhoea, and second, to delineate comorbid conditions such as malaria or thyroid disorders.

• #1 Diarrheal Diseases – Acute & Chronic | ACG

  https://gi.org/topics/diarrhea-acute-and-chronic/

  A stool sample may help define the type of diarrhea. The presence of fat, microscopic amounts of blood, and white blood cells will help determine if a fatty, inflammatory, or watery diarrhea is present. […] Endoscopic examination of the colon with flexible sigmoidoscopy or colonoscopy and upper endoscopy are helpful in detecting the etiology of chronic diarrhea, as this allows direct examination of the bowel mucosa and the ability to obtain biopsies for microscopic evaluation. […] Your doctor may prescribe antibiotics if you have high fever, dysentery, or moderate to severe traveler’s diarrhea. Some infections such as Shigella always require antibiotic therapy.

• #1 Traveler’s diarrhea laboratory findings – wikidoc

  https://www.wikidoc.org/index.php/Traveler%27s_diarrhea_laboratory_findings

  Lab findings of traveler’s diarrhea are usually related to the extent of dehydration or development of complications. Lab findings include: WBC count may be normal or elevated, elevated concentration of inflammatory markers (e.g. CRP or ESR), chloride-sensitive metabolic alkalosis and electrolyte derangement (commonly hypokalemia), relative polycythemia in cases of dehydration or hemolytic anemia in cases of hemolytic uremic syndrome, elevated BUN, elevated serum creatinine.

• #1

  https://ejournal.warmadewa.ac.id/index.php/ijbstm/article/view/10256

  Travelers diarrhea (TD) remains a prevalent condition affecting individuals traveling to regions with varying sanitation standards. The diagnosis of TD has evolved with advancements in diagnostic tools and a better understanding of its etiology. […] Traditionally diagnosed based on clinical presentation and exposure history, current approaches increasingly incorporate molecular techniques to identify causative pathogens more accurately. Recent updates highlight the integration of polymerase chain reaction (PCR) and other molecular diagnostic methods that offer rapid, sensitive, and specific detection of bacterial, viral, and parasitic pathogens. […] These advances enable differentiation between infectious and non-infectious causes of diarrhea, which is crucial for effective management and treatment. Additionally, the role of stool cultures, although less commonly used in rapid diagnostics, remains important for comprehensive pathogen identification.

• #1

  https://journals.lww.com/co-infectiousdiseases/fulltext/2019/10000/emerging_concepts_in_the_diagnosis,_treatment,_and.14.aspx

  Traveller’s diarrhea, though not life-threatening, is often a vexing problem, which impacts overall function of the traveller while on holiday. […] Increasing data is available regarding molecular diagnostic techniques, which may help obtain an early etiologic diagnosis. […] Molecular techniques for early diagnosis of traveller’s diarrhea may help with appropriate management.

• #1 Travelers’ diarrhea: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/travelers-diarrhea-clinical-manifestations-diagnosis-and-treatment

  Travelers’ diarrhea refers to development of unformed stools associated with travel to a region where sanitation and hygienic practices are poor and there is limited access to safe drinking water. It is the most common travel-associated illness; among travelers to such regions, 30 to 70 percent develop diarrhea. […] The epidemiology, microbiology, clinical manifestations, and diagnosis of travelers’ diarrhea are discussed separately. […] Most cases of travelers’ diarrhea resolve on their own within three to five days of treatment with oral fluid replacement. Antimotility agents can provide symptomatic relief but should not be used for travelers with diarrhea associated with fever or bloody stools. […] The benefit of antibiotics must be weighed against potential risks, including adverse effects and selection for resistant bacteria. These issues are discussed further below.

• #1 IDSA 2017 Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea

  https://www.idsociety.org/practice-guideline/infectious-diarrhea/

  Fecal leukocyte examination and stool lactoferrin detection should not be used to establish the cause of acute infectious diarrhea (strong, moderate). […] Serologic tests are not recommended to establish an etiology of infectious diarrhea or enteric fever (strong, low), but may be considered for people with postdiarrheal HUS in which a stool culture did not yield a Shiga toxinproducing organism (weak, low). […] Antimicrobial treatment should be modified or discontinued when a clinically plausible organism is identified (strong, high).

• #1

  https://link.springer.com/article/10.1007/s11908-003-0067-x

  Travel is a risk factor for acquiring infection with a sporeforming protozoa: Cryptosopridium, Cyclospora, Microsporidia, and Isospora. […] Patients present with persistent diarrhea and a history of recent travel to a developing country in the tropics. […] In a patient with a history of travel and persistent diarrhea unresponsive to the usual antibiotic and antidiarrhea treatment, stool studies for all four of these protozoa infections should be performed. […] Effective treatment is available for Cyclospora, Microsporidia, and Isospora. […] This experienced investigator in Cryptosporidium infection reviews the evidence that parasites cause travelers diarrhea. All four of the sporeforming protozoa are reviewed. […] Using light microscopy and PCR, nine cases of persistent diarrhea in returned travelers were found to be associated with Microsporidia infection. Only half would have been identified if only light microscopy had been used.

• #1 Impact of pre-travel consultation on clinical management and outcomes of travelers’ diarrhea: a retrospective cohort study | Tropical Diseases, Travel Medicine and Vaccines | Full Text

  https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-018-0076-2

  Pre-travel consultation has been associated with lower rates of malaria, hepatitis, and human immunodeficiency virus (HIV) infections. The objective was to study the impact of pre-travel consultation on clinical management and outcomes of travelers diarrhea. This retrospective cohort study analyzed 1160 patients diagnosed with travelers diarrhea at Mayo Clinic Rochester, MN from 1994 to 2017. More pre-travel consultation recipients were young Caucasians who had more post-travel infectious disease (ID) consultation, more stool sampling, and more antimicrobial prescriptions for travelers diarrhea compared to the non-pre-travel consultation group. The pre-travel consultation group had shorter hospital stays and reduced gastroenterology consultation rates. Pre-travel consultation was associated with higher rates of stool testing and antimicrobial prescriptions. The pre-travel consultation group did have a shorter duration of hospitalization and reduced need for gastroenterology consultation for prolonged or severe symptoms, which are positive outcomes that reflect reduced morbidity of travelers diarrhea. Travelers diarrhea is particularly important because it is so common and can affect approximately 40% of returning travelers. The hypothesis was that patients with travelers diarrhea who received pre-travel consultation would have improved clinical outcomes compared to those without pre-travel consultation. Pre-travel consultation at the TTMC follows a standardized protocol that includes education on safe food and water consumption, avoidance of high-risk travel activities, recommendations for appropriate vaccines, and provision of antidiarrheal antibiotics for self-treatment. A greater percentage of the pre-travel consultation group had stool samples sent for microbiologic testing, compared to the non-pre-travel consultation group. When diagnosed with travelers diarrhea, a greater percentage of the pre-travel consultation group had antimicrobials prescribed, compared to the non-pre-travel consultation group. The duration of hospitalization was shorter in the pre-travel consultation group compared to the non-pre-travel consultation group. The fully adjusted multivariate model showed that the pre-travel consultation group had more ID consultation, less gastroenterology consultation, more stool samples obtained, more antimicrobials prescribed, and shorter hospital stay. Pre-travel consultation was associated with higher rates of stool testing and antimicrobial prescriptions for travelers diarrhea. The pre-travel consultation group had a shorter duration of hospitalization and reduced need for gastroenterology consultation, which are undoubtedly positive outcomes that reflect reduced morbidity of disease.

• #1 Infectious Diarrhea | Choose the Right Test

  https://arupconsult.com/content/infectious-diarrhea

  Appropriate laboratory testing for diarrhea is determined by careful clinical evaluation of patient history and symptoms. […] Laboratory testing for infectious diarrhea is informed by clinical evaluation. […] For all laboratory testing, positive results must be correlated with clinical symptoms for diagnosis. […] In most cases of acute diarrhea (persisting 14 days), no testing is necessary at initial presentation because most etiologies are viral and do not require treatment. […] Laboratory testing may be indicated for patients presenting with a fever greater than 101.3F, bloody stools, or dysentery, and who are immunocompromised, hospitalized, or returned travelers. […] Comprehensive testing is appropriate for patients with chronic diarrhea or persistent diarrhea, recent travel, immigration, solid or hematopoietic transplant, and unknown etiology.

• #1 Traveler’s Diarrhea – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/gastroenteritis/traveler-s-diarrhea

  Travelers diarrhea is gastroenteritis that is usually caused by bacteria endemic to local water. Diagnosis is mainly clinical. […] Specific diagnostic measures are usually not necessary. However, fever, severe abdominal pain, and bloody diarrhea suggest more serious disease and should prompt immediate evaluation. […] Diagnosis is clinical and testing is not usually needed unless bloody diarrhea, fever, or abdominal pain is present.

• #1 Diagnosing traveller’s diarrhoea | Hospital Clínic Barcelona

  https://www.clinicbarcelona.org/en/assistance/be-healthy/travellers-diarrhoea/diagnosis

  Faecal analysis is carried out, which will serve to identify certain parasites, bacteria, or toxins of certain agents that cause travellers diarrhoea. […] It is important to remember that the causative microorganism cannot be identified in more than 50% of cases.

• #2 Travelers’ diarrhea: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/travelers-diarrhea-epidemiology-microbiology-clinical-manifestations-and-diagnosis

  Travelers’ diarrhea refers to development of unformed stools during or within 10 days of returning from travel; it commonly occurs in association with travel to a setting where sanitation and hygienic practices are poor and there is limited access to safe drinking water. Travelers’ diarrhea is typically self-diagnosed. […] For epidemiologic purposes, travelers’ diarrhea may be defined as passage of three or more unformed stools in a 24-hour period, accompanied by at least one of these other symptoms: nausea, vomiting, abdominal pain or cramps, fever, or blood in the stool. […] The epidemiology, microbiology, clinical manifestations, and diagnosis of travelers’ diarrhea are discussed here. […] Travelers’ diarrhea is the most common illness among individuals traveling to settings where sanitation and hygienic practices are poor and there is limited access to safe drinking water. The attack rate for travelers’ diarrhea ranges between 10 and 70 percent; estimates vary greatly between studies.

• #2 Traveler’s diarrhea – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/601

  Traveler’s diarrhea (TD) is defined as 3 unformed stools in 24 hours accompanied by at least one of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a destination with deficiencies in water, sanitation, and hygiene (WASH) infrastructure. It is usually a benign, self-limited illness lasting 3-5 days. […] Key diagnostic factors include diarrhea (with or without tenesmus), cramping, nausea, and vomiting, dysentery (blood and fever), and persistent diarrhea for 14 days. […] The first tests to order include stool culture and sensitivity, multipathogen molecular diagnostic (polymerase chain reaction), and protozoal stool antigens. […] Tests to consider include stool ova and parasite exam, Clostridioides difficile stool toxin, colonoscopy, endoscopy, and biopsy, and hematology, blood chemistries, serology.

• #2 Traveler’s Diarrhea: What It Is, Treatment & Antibiotics

  https://my.clevelandclinic.org/health/diseases/7315-travelers-diarrhea

  Most of the time, your healthcare provider will recognize travelers diarrhea based on your symptoms and travel history. […] But in some cases, they may want to test a sample of your poop to find out what type of infection you have. This can help them determine the best medication to prescribe, especially if they suspect a parasite. Your provider may need to test more than one sample to identify the infection.

• #2 Travelers’ Diarrhea: Symptoms, Causes, Treatment, More

  https://www.health.com/condition/diarrhea/travelers-diarrhea

  Healthcare providers can diagnose traveler’s diarrhea by asking about your symptoms, recent travels outside the country, and what you ate. For example, having acute diarrhea three or more times within 24 hours or double the amount of regular bowel movements may signal travelers’ diarrhea. […] A healthcare provider can palpate the stomach to check whether your abdomen is tender. Abdominal cramps, nausea, vomiting, and fever often accompany acute diarrhea. […] Healthcare providers do not usually require laboratory tests or imaging to diagnose travelers’ diarrhea. In contrast, a healthcare provider may acquire a stool sample if you have blood in your stool or feel like you need to pass stool even if your bowels are empty. […] In severe cases, a healthcare provider may send for X-rays of the kidneys, ureters, and bladder and an abdominal CT scan.

• #2 Infectious Diarrhea: IDSA Updates Guidelines for Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0515/p676.html

  Diagnostic testing is not routinely recommended in patients with uncomplicated traveler’s diarrhea. […] If diarrhea is accompanied by fever, bloody stools, abdominal cramping, or signs of sepsis, stool should be tested for Salmonella, Shigella, Campylobacter, Yersinia, Clostridium difficile, and STEC. […] Diagnostic testing is not routinely recommended in patients with uncomplicated traveler’s diarrhea unless treatment is needed. […] However, those with diarrhea lasting 14 days or more should be tested for intestinal parasitic infection, and those who were treated with an antimicrobial within the preceding eight to 12 weeks should be tested for C. difficile infection. […] Testing may be considered for C. difficile infection in patients older than two years who have a history of diarrhea following antimicrobial use and in those with health-care-associated diarrhea. […] One stool specimen is suggested for testing because multiple specimens do not increase diagnostic yield.

• #2 Parasitic causes of prolonged diarrhoea in travellers Diagnosis and management

  https://www.racgp.org.au/afp/2012/october/parasitic-causes-of-prolonged-diarrhoea-in-travell

  Prolonged infectious diarrhoea in the returning traveller is generally caused by protozoal and occasionally by helminth parasites. […] This article provides a framework for the diagnosis, management and prevention of the diseases that cause persistent diarrhoea in the traveller. […] Determination of the cause of persistent diarrhoea follows the usual format of history, examination, targeted laboratory investigations and, very rarely, diagnostic imaging or invasive testing such as colonoscopy. […] As with all diagnostic processes, it begins with a complete history focusing on the onset and nature (volume, character, consistency) of the diarrhoea as well as the presence of blood or mucus in the stool. […] The role of laboratory investigations is twofold: first, to define the aetiological agent of the diarrhoea, and second, to delineate comorbid conditions such as malaria or thyroid disorders.

• #2 Traveller’s diarrhoea – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/601

  Key diagnostic factors include presence of risk factors, diarrhoea (with or without tenesmus), cramping, nausea, and vomiting, dysentery (blood and fever), and persistent diarrhoea for 14 days. […] 1st investigations to order include stool culture and sensitivity, multi-pathogen molecular diagnostic (polymerase chain reaction), and protozoal stool antigens. […] Investigations to consider include stool ova and parasite examination, Clostridioides difficile stool toxin, colonoscopy, endoscopy, and biopsy, and haematology, blood chemistries, serology.

• #2 Traveler’s diarrhea laboratory findings – wikidoc

  https://www.wikidoc.org/index.php/Traveler%27s_diarrhea_laboratory_findings

  In acute non-complicated cases of traveler’s diarrhea, identification of the agent responsible for traveler’s diarrhea is usually not necessary. Diagnostic laboratory tests for traveler’s diarrhea usually include either stool culture, ELISA, or polymerase chain reaction (PCR). […] Other laboratory findings in traveler’s diarrhea are usually non-specific and may include increased white blood cell count and elevated inflammatory markers. Laboratory findings suggestive of dehydration may include relative polycythemia, metabolic alkalosis, elevated BUN and serum creatinine (suggestive of pre-renal acute kidney injury). When hospitalized, patients should also be monitored for laboratory findings that may suggest development of complications associated with traveler’s diarrhea. […] Diagnostic Laboratory Findings […] Stool cultures […] Usually considered a reliable diagnostic test with good sensitivity. The choice of culture medium depends on clinical suspicion. Stool ova and parasites (O P) test may not be performed routinely for stool culture and may be requested separately. […] Serotyping […] ELISA detects toxins in stools and antibodies in serum. […] Polymerase chain reaction (PCR) […] Detection of infectious agents and expression of endotoxins.

• #2 Infectious Diarrhea | Choose the Right Test

  https://arupconsult.com/content/infectious-diarrhea

  Diarrhea may have an infectious or noninfectious etiology. […] Laboratory testing using methods such as nucleic acid amplification (NAA), direct antigen detection, and culture can help identify the causative agent of infectious diarrhea and inform proper medical management. […] Rapid diagnosis is important for appropriate treatment and infection control measures. […] The gold standard for diagnosis of parasitic diarrhea involves manual staining and microscopic review of stool samples. […] Ova and parasite examination is a common laboratory test in patients with diarrhea, although parasitic diarrhea is relatively rare and manual ova and parasite examination is a time- and resource-consuming process with variable sensitivity. […] Due to the various shedding cycles of many parasites, collection of several stool samples during a 5- to 7-day period is recommended to maximize diagnostic accuracy.

• #2 Parasitic causes of prolonged diarrhoea in travellers Diagnosis and management

  https://www.racgp.org.au/afp/2012/october/parasitic-causes-of-prolonged-diarrhoea-in-travell

  Diagnosis of Giardia infection is via microscopy of wet preparation using fresh stool or via a concentration method. […] Diagnosis is performed using a modified acid-fast stain of preserved stool. […] Confirmation of diagnosis is by fine needle aspiration. […] Diagnosis of E. histolytica by microscopy is poor, with sensitivity ranging from 30-50% even when special staining techniques are used. […] Commercial immunoassays are available and have much improved sensitivity and specificity compared to microscopy. […] Screening for the presence of Strongyloides in returned travellers with persistent diarrhoea or with eosinophila is warranted given that co-infection is possible. […] Patients who have persistent diarrhoea despite negative screening for stool parasites should be further investigated. […] Consider nonparasitic causes of diarrhoea in your differential diagnoses, including C. difficile, coeliac disease, inflammatory bowel disease and carbohydrate malabsorption.

• #2

  https://ejournal.warmadewa.ac.id/index.php/ijbstm/article/view/10256

  Emerging research emphasizes the need for a tailored diagnostic approach considering geographic region, patient history, and symptom profile. The use of multiplex assays and metagenomic sequencing is showing promise in identifying a broad spectrum of pathogens and understanding the complex microbiological landscape of TD. […] This update underscores the importance of adopting a multifaceted diagnostic strategy to improve the accuracy of TD diagnosis, thereby enhancing patient care and contributing to the development of targeted treatment and preventive measures.

• #2 Travelers’ Diarrhea – Traveler Summary – TripPrep.com

  https://tripprep.com/library/travelers-diarrhea

  The decision to self-treat depends on the severity of the functional disability caused by TD. […] Most cases will resolve with hydration and symptomatic treatment with antimotility or antisecretory agents. […] Adding antibiotics for moderate TD may shorten the duration or severity of illness. […] All severe TD cases should receive antibiotics. […] Travelers are often in areas where prompt, effective medical care is unavailable. […] Therefore, self-treatment of bacterial diarrhea with antibiotics prescribed and purchased prior to leaving for the trip may be more practical. […] The use of antibiotics can turn a 3- or 4-day illness into a 1-day illness. […] However, antibiotic use for TD increases the intestinal carriage of antibiotic-resistant bacteria in returning travelers, especially in South Asia where 80% of travelers treated with antibiotics acquired resistant bacteria. […] Seek medical attention as soon as possible for bloody stools.

• #2 Traveler’s Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0601/p2095.html

  Antibiotic selection is based on the likelihood that an invasive organism is present and on antibiotic resistance patterns. These factors are determined largely by travel destination. […] Although blood in the stool suggests invasive disease, fever is not a sensitive indicator of dysentery. […] Rifaximin recently became available for the treatment of noninvasive diarrhea caused by E. coli. For persons traveling to destinations where noninvasive E. coli is the predominant pathogen (e.g., Mexico), rifaximin is a good choice. […] In regions where invasive pathogens are responsible for a significant proportion of travelers diarrhea, quinolones should be used. Azithromycin (Zithromax) is recommended in places where quinolone-resistant Campylobacter is prevalent (e.g., Thailand). […] Therapy that involves an antibiotic with loperamide (Imodium) often limits symptoms to one day. […] If diarrhea persists despite antibiotic treatment, medical attention should be sought. Parasitic causes should be suspected in travelers who return with prolonged diarrhea or who do not respond to antibiotics.

• #2 Traveler’s diarrhea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/symptoms-causes/syc-20352182

  Traveler’s diarrhea usually goes away on its own within several days. […] Symptoms may last longer and be more severe if it’s caused by certain bacteria or parasites. In such cases, you may need prescription medicines to help you get better. […] If you’re an adult, see your doctor if: Your diarrhea lasts beyond two days. […] While traveling internationally, a local embassy or consulate may be able to help you find a well-regarded medical professional who speaks your language. […] Call a doctor if your child is sick and has any of the following symptoms: Ongoing vomiting. […] Traveler’s diarrhea may stem from the stress of traveling or a change in diet. […] But usually infectious agents such as bacteria, viruses or parasites are to blame. […] You typically develop traveler’s diarrhea after ingesting food or water contaminated with organisms from feces.

• #2

  https://link.springer.com/article/10.1007/s11908-003-0067-x

  Cryptosporidium was the cause of 3% of acute diarrhea in travelers to Mexico in this prospective study of 127 US adult travelers. […] Two patients with diarrhea caused by Cyclospora cayetanensis following a trip to the tropics. […] Cyclospora, a new coccidium agent of travelers diarrhea: 11 cases. […] Travelers diarrhea associated with Cyclospora sp. […] Cyclospora in patients with travellers diarrhea. […] Isospora and travelers diarrhea. […] Chronic travelers diarrhea in a normal host due to Isospora belli. […] Self-limited travelers diarrhea due to a dual infection with Enterocytozoon bieneusi and Cryptosporidium parvum in an immunocompetent HIV-negative child. […] Detection of microsporidia in travelers with diarrhea. […] Identification of Encephalitozoon intestinalis in travelers with chronic diarrhea by specific PCR amplification.

• #2

  https://journals.lww.com/co-infectiousdiseases/fulltext/2019/10000/emerging_concepts_in_the_diagnosis,_treatment,_and.14.aspx

  Traveller’s diarrhea, though not life-threatening, is often a vexing problem, which impacts overall function of the traveller while on holiday. […] Increasing data is available regarding molecular diagnostic techniques, which may help obtain an early etiologic diagnosis. […] Molecular techniques for early diagnosis of traveller’s diarrhea may help with appropriate management.

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