Traveler's Diarrhea

Dr. Joseph Wu, M.D. 

Internist

For the travelers and expatriates in a foreign land, the Chinese phrase “ Sui Tu Bu Fu “ ----“ Not accustomed to the water and soil “ is most applicable and manifests as what is called “Traveler’s Diarrhea”. In areas where water purification is lacking or inadequate, E. Coli, a ubiquitous organism which thrives in the colon of mammals, becomes the likely cause of gastrointestinal infection. This leads to damage of the intestinal lining, causing body fluid to ooze into the intestines in large quantities and be expelled through the rectum. Symptoms occur within hours of contamination and manifest as nausea, vomiting, abdominal cramps, diarrhea and, in more serious cases, fever and blood in stools. The presence of fever suggests the bacteria have spread to the blood stream, and blood in the stool suggests ulcerations in the intestinal lining.

The extent of infection correlates to the amount of ingested bacteria (inoculum) and the immunological status of the patient. Thus not everyone sitting at the same table will suffer the same degree of illness. If the symptoms are mild, lasting hours only, fluid replenishment ( frequent sips throughout the day to minimize triggering the nausea mechanism ) of an electrolyte enhanced liquid : boiled water with a squeeze of lemon or orange, a spoon of sugar and a pinch of salt in an 8 ounce glass, is adequate. Over the counter medicines such as Bismuth and Loperimide (Pepto Bismol and Lomotil in the U.S.) are also helpful but should be used moderately. If the symptoms do not resolve within a day, or there is fever or blood in the stool, or the victim is weak and prostrate, then medical attention is needed for timely and definitive treatment, which may include intravenous fluids and antibiotics. Broadly speaking, besides E. Coli and related colon flora, viruses and parasites may also be culprits of infectious diarrhea. The former tend to be milder and brief and self-limiting, while the latter are more chronic and lingering. The point to watch for is to avoid dehydration and electrolyte imbalance, especially in the very young, and to seek medical attention when the condition does not resolve or worsens after a day.

To prevent contracting such infections, avoid street vendor foods, fruits that have been already cut or peeled, and cold foods on display at room temperature. Drink and use boiled or bottled water, and eat thoroughly-cooked and preferably still-hot foods. Ice, unless made with boiled water, may not be safe. It should be noted that beer is not a substitute for water and may aggravate dehydration if consumed excessively.

As a side note, food poisoning with symptoms of nausea, vomiting and diarrhea--similar to infectious diarrhea--is a result of ingestion of spoiled foods, especially dairy and seafood that have been allowed to sit (inside or outside the refrigerator) too long. It contains a bacterial toxin that damages the intestine. It is universal in occurrence and is not related to geographic regions. This type of gastroenteritis may be avoided by consuming fresh food products and patronizing eateries with high customer turnover.