Tropical diarrhoea: new developments in travellerʼs diarrhoea

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Abstract
Traveller's diarrhoea is the most common illness acquired by visitors to developing countries, affecting 20-50% of the 35 million people who travel from industrialized countries each year. Important risk factors include point of origin and destination of the traveller, host factors, and exposure to contaminated food and water. The most common causes of traveller's diarrhoea in adults in developing countries include infection with Escherichia coli, Shigella spp., Salmonella spp., Campylobacter spp., Vibrio parahaemolyticus (in Asia), rotavirus (in Latin America), and protozoa (Giardia, Cryptosporidium and Cyclospora spp., and Entamoeba histolytica). No pathogen is identified in over half of patients with traveller's diarrhoea, however. The primary objectives of treatment of traveller's diarrhoea are to reduce the symptoms and duration of diarrhoeal illness, to reduce inconvenience caused by such illness and to prevent cancellation of planned activities. These important objectives are best accomplished by empirical self-therapy with a combination of antimicrobial agents and loperamide. Since the first use of ciprofloxacin, fluoroquinolones have become the drugs of choice in empirical therapy for moderate-to-severe traveller's diarrhoea in adults. The options for children include nalidixic acid, trimethoprim-sulfamethoxazole (along with erythromycin if Campylobacter infection is a possibility) and furazolidone. Education on hygiene and safe food preparation help to prevent many diarrhoeal diseases, including traveller's diarrhoea.