Related Experiment Videos
Persistent diarrhea in travelers
1University of Texas Health Science Center, Houston, USA.
Abstract:
Most patients with traveler's diarrhea can be efficiently treated with available pharmacological agents. A more difficult problem is the persistent diarrhea (lasting > or = 14 days) that occurs in approximately 3% of travelers who have acute diarrhea. In the initial evaluation of these patients, ideally three stool samples should be obtained for examination for pathogens. If an agent is not identified or the patient has not responded to specific therapy, he or she may be empirically treated with an antimicrobial drug directed toward common bacterial enteropathogens, if such treatment has not already been administered. For those patients whose conditions do not respond, antiprotozoal therapy may be employed empirically. If diarrhea continues, then an endoscopic evaluation is indicated, and specific treatment can be given if an agent or condition is identified. A proportion of patients will continue to have diarrhea following empirical therapy and a gastroenterologic workup. These individuals are best given symptomatic treatment and reassured that the prognosis is good.
Insights
Persistent traveler's diarrhea affects 3% of travelers. Initial evaluation involves stool samples, followed by empirical antimicrobial or antiprotozoal therapy for refractory cases. Symptomatic treatment offers reassurance for persistent symptoms.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Travel Medicine
Background:
- Traveler's diarrhea (TD) is common, with most cases resolving with standard treatment.
- A subset of patients (approximately 3%) develop persistent diarrhea lasting 14 days or longer.
- Managing persistent TD requires a structured diagnostic and therapeutic approach.
Purpose of the Study:
- To outline an effective management strategy for persistent traveler's diarrhea.
- To guide clinicians in the evaluation and treatment of prolonged diarrheal illness in travelers.
Main Methods:
- Initial diagnostic step: collection of three stool samples for pathogen examination.
- Empirical treatment: antimicrobial therapy for bacterial enteropathogens if not previously administered.
- Further management: antiprotozoal therapy, endoscopic evaluation, and symptomatic treatment for refractory cases.
Main Results:
- Early identification of pathogens through stool samples is crucial.
- Empirical antimicrobial and antiprotozoal therapies are key steps for non-responsive cases.
- Endoscopic evaluation is indicated for persistent diarrhea unresponsive to empirical treatments.
- Symptomatic treatment and reassurance are recommended for individuals with continued diarrhea after comprehensive workup, with a good prognosis.
Conclusions:
- Persistent traveler's diarrhea necessitates a stepwise diagnostic and therapeutic approach.
- Empirical therapies and endoscopic evaluation play vital roles in managing refractory cases.
- Most patients with persistent TD, even those requiring symptomatic treatment, have a favorable long-term outlook.