Travelers' diarrhea

Case report:

A 32-year-old patient came to the practice of their family doctor and complains of the last three days existing diarrhea with up to seven, liquid stools daily. The patient reported that she had returned two days ago from a holiday in Egypt and during their stay with a tour group already several other travelers have complained of such symptoms. There was no increase of temperature or fever has been observed and also when the stools no mucus or blood admixtures were noted. However, there was a clear feeling of illness and also a considerable weight loss, nausea and increased thirst.
The physical examination of the patient results in a moderately meteoristisch abdominal distension without unambiguous localized tenderness, liver and spleen are not enlarged and palpable except for a tachycardia at 100 / min at a pressure of 110/60 mm Hg blood are no other abnormalities.

Diagnosis:

The history, the described symptoms and examination findings suggest a travelers' diarrhea. Since no severe disease is present, no blood and mucus were observed and also the microscopic slide no leukocytes in the stool can be detected, is dispensed with a bacteriological diagnosis initially.

Pathogenesis:

Diarrhea is a very common disease in travelers to developing countries. Approximately 20-60% of travelers complain of such complaints and at least 20% of those affected are forced to bed rest as a result of the complaint symptoms. As exciting enterotoxin-producing E. coli and entero adhesive be detected mainly, other pathogens affecting campylobacter, shigella and salmonella. Viral causes have been relatively few identified and parasitic infections are rare. The mean duration of the non-treated travelers' diarrhea is four to six days; However, complications such as reactive arthritis, postinfectious enteropathy and very occasionally occur that Campylobacter jejuni-associated Guillain-Barre syndrome.

Therapy:

When still young and a total of not seriously ill patient to bed rest and intense hydration is advised. Antibiotic therapy with e.g. Cotrimoxazole (EUSAPRIM et al) or ciprofloxacin (CIBROBAY among others) should be administered only in severe disease or existing underlying diseases. So-called anti-diarrheal agents [e.g. Loperamide (IMODIUM et al)] should not be administered if possible, since this reduces the spontaneous healing and the elimination of pathogens is more delayed.