Traveler's diarrhea: Difference between revisions
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*as duration of diarrhea increases, higher chance of parasitic cause | *as duration of diarrhea increases, higher chance of parasitic cause | ||
== | ==Differential Diagnosis== | ||
===Traveler's=== | |||
#Giardia | #Giardia | ||
#Cryptosporidiosis | #Cryptosporidiosis | ||
#Entamoeba | #Entamoeba | ||
#Cyclospora | #Cyclospora | ||
{{Template:Diarrhea DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 03:23, 26 June 2014
Background
- Most respond to antibiotics
- as duration of diarrhea increases, higher chance of parasitic cause
Differential Diagnosis
Traveler's
- Giardia
- Cryptosporidiosis
- Entamoeba
- Cyclospora
Acute diarrhea
Infectious
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (non-typhi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
- Inflammatory bowel disease
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[1]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
- Giardia lamblia
- Cryptosporidiosis
- Entamoeba histolytica
- Cyclospora
- Clostridium perfringens
- Listeriosis
- Helminth infections
- Marine toxins
- Ciguatera
- Scombroid poisoning
- Paralytic shellfish poisoning
- Neurotoxic shellfish poisoning
- Diarrheal shellfish poisoning
Diagnosis
- dysentery if stool bloody, fvr or wbc in stool- invasive inflamm enteropathy
- has abrupt onset, metastatic lesions, reactive arthopathies, or campylobacter assoc guillain barre- maybe flouroquinolone resis esp in SE Asia
- amoebic dysentery insidious and can get amoebic liver abscess
- if do not find infc cause of dysentery, eval pt for IBD or CA
- prolonged diarrhea and malabsorption- giardia or tropical sprue- does not respond to removal of gluten from diet- tx with tetra and folate
- also consider postinfectious disaccharidase deficiency or irritable bowel dz
- if diarrhea starts >1 mo after travel- not caused by travel
Treatment[2]
- Antibiotic
- Ciprofloxacin 750mg PO BID x 1-3 days OR
- Levofloxacin 500mg PO q24h x 1-3 days OR
- Ofloxacin 300mg PO BID x 3 days OR
- Rifaximin 200mg PO TID x 3 days OR
- Azithromycin 1000mg PO x 1 OR 500mg PO q24h x 3 days
- Antimotility agent
- Only for nonpregnant adults with no fever or blood in stool
- Loperamide 4mg PO after each loose stool (Max: 16mg/day)
Pediatrics[3]
- Azithromycin 10mg/kg/day once daily x 3 days OR
- Ceftriaxone 50mg/kg/day once daily x 3 days
- Avoid fluroquinolones