Traveler's Diarrhea

Traveler's diarrhea, also known as turista, is an illness that most commonly affects people from industrialized nations who travel to areas with poor hygiene standards. It is transmitted through contaminated food or water and exceptionally through direct person-to-person contact. The risk of developing the illness depends on several factors including the destination, the duration of stay and type of travel, the season and the travelers themselves. Most episodes are not severe and resolve on their own within 1 to 5 days.

Symptoms

Traveler's diarrhea is characterized by frequent loose stools (3 or more within 24 hours). Other symptoms can include:

• Abdominal cramping or pain
• Nausea
• Vomiting
• Fever
• Pus, mucus or blood in the stool

Prevention

The best preventive measures are common sense and good sanitation and hygiene practices. Here are some tips that may help you avoid traveler's diarrhea:

• Only eat fruits and vegetables that have been freshly peeled or freshly cooked. Avoid salads and lettuce.
• Only eat meat, fish or seafood that has been well cooked and that is served hot.
• Avoid hot and cold buffets, unless you only choose foods that are well cooked and still hot.
• Avoid eating foods or drinking beverages purchased from street vendors.
• Avoid sauces (e.g., salsa, ketchup).
• Only drink beverages that are bottled and sealed (water, soft drinks, juice, beer, wine).
• Do not add ice to beverages.
• Drink pasteurized milk that has been properly refrigerated.
• Brush teeth with purified or bottled water.
• Do not trust the food handling practices in place at your resort or hotel, even if it is a luxury establishment.
• Avoid swimming in bodies of water that are polluted or contaminated.
• Wash hands thoroughly with soap and water before eating, drinking, preparing food and after using the toilet. If soap and water are not available, use an alcohol-based hand sanitizer.
• Before you leave, talk to your healthcare provider as preventive treatments, if indicated, may be suggested (e.g., vaccine, medication). Your healthcare provider may also recommend that you take certain products with you, in case you need them during your trip.

Treatment

Despite taking precautions, you may still develop traveler's diarrhea. The following measures may help limit its effect:

• Avoid alcohol, coffee/tea and sweetened beverages (e.g., soft drinks and fruit juices).
• To prevent dehydration, drink plenty of fluids such as electrolyte solutions that contain salt, sugar and water (e.g.,Hydralyte or Pedialyte). Regardless of the severity of the infection, hydration is key.
• Take antidiarrheal medication (e.g., Imodium) to slow down the passage of stool through the digestive tract.
• Take antibiotics (e.g., azithromycin, ciprofloxacin) to kill the bacteria responsible.

The following table indicates which treatments to start depending on the severity of the diarrhea.

Recommended treatment based on diarrhea severity

Diarrhea severity		Oral rehydration solution	Antidiarrheal drug (e.g., Imodium)	Antibiotic (e.g., azithromycin, ciprofloxacin)
Mild :	tolerable and does not interfere with planned activities.	Yes	As needed	No
Moderate :	intense enough to interfere with certain planned activities.	Yes	Yes	Usually not necessary
Severe :	incapacitating or prevents all planned activities. Any blood mixed in with the diarrhea (not just blood on toilet paper) is considered severe.	Yes	Yes (only if taken with an antibiotic)	Yes

When should I see a medical professional?

• You have a high fever.
• You have severe abdominal pain.
• You have bloody stool or severe vomiting.
• Your symptoms do not improve within 24 to 48 hours of starting antibiotics.
• You present signs of dehydration (e.g., darker coloured urine, decreased frequency of urination, increased thirst, dry mouth and tongue, dark circles under the eyes and confusion). Monitor young children closely as they tend to become dehydrated more quickly.
• You are sick for more than 10 to 14 days.

For more information:

• Public Health Agency of Canada - Travel Health