Traveller’s Diarrhea

dr. Dasti Anditiarina, Sp.KP

FK Universitas Islam Al Azhar
Definisi
Onset tiba-tiba yg abnormal atau cair, frekuensi BAB sering 3x atau lebih per hari, dan
setidaknya 1 gejala gastrointestinal tambahan seperti muntah. Namun diare tetap
mendominasi & kadang disertai demam dan malaise

Terjadi selama kurang lebih 10 hari sepulang bepergian

Mempengaruhi sebagian besar wisatawan yg berasal dari infrastruktur kebersihan dan

sanitasi yg sangat maju hingga yg kurang berkembang
Incidence
The incidence of TD during 2 weeks trip remains 10% to 40% depending on
destination and travelers’ characteristics
Agent that commonly cause TD
Mainly bacteria, like E.Coli (and Campylobacter, Shigella, Salonella, and
Clostridium difficile)

Less commonly viruses (rotavirus and norovirus)

Rarely parasites (Giardia, Entamoeba histolytica and Cyclospora)

Causes of Traveler’s Diarrhea
Cause Percent Isolation
bacteria 50 – 75
Escherichia coli 5 – 70
Enterotoxigenic 5 – 70
Enteroadhesive ?
Enteroinvasive ?
Capylobacter spp. 0 – 30
Salmonella spp. 0 – 15
Shigella 0 – 15
Aeromonas 0 – 10
Plesiomonas 0–5
Food and Beverage Precautions

Boil it

Peel it

Cook it or

FORGET IT !!
Eschericia Coli: The Most Prevalent Enteric
Bacillus
Most common aerobic and non-fastidious bacterium in gut

150 strains

Some have developed virulence through plasmid transfer, other are opportunist

Causes → 70% of traveler’s diarrhea

The symptoms of TD include:
Abrupt onset of diarrhea
Fever
Nausea and vomiting
Bloating
Urgent need to have a bowel movement
Malaise (weakness or discomfort)
Explosive and painful gas
Cramps
Diagnosis of Diarrhea
Send a stool culture if fever or blood in stool indications for diagnostic
evaluation)

Stool Ova and parasites and test for Giardia and Cryptosporidium if
diarrhea persists for 10 – 14 days
Tata laksana
Profuse watery diarrhea with signs of hypovolemia
Passage of many small volume stools containing blood and mucus
Bloody diarrhea
Temperature 38,5°C
Passage of 6 unformed stools per 24 hours or a duration of illness > 48 hours
Severe abdominal pain
Recent use antibiotics or hospitalized patients
Diarrhea in the elderly (70 years of age) or the immunocompromised
Environmental risk factors
Destination
• Dates, duration, stop overs
• Seasonal considerations
Styles of travel
• Rural vs urban
• Budget vs luxury
Accomodation (hotel vs camping)
Activities
• Business vs tourism
• Adventure, safari
• Missionary/humanitarian/NGO
Destination risk factor (1)
High risk destination are countries with a TD incidence rate in the initial 2 weeks of
stay of 20% or more (South and Southeast Asia, central America, West an North
Africa, South America, East Africa)
Intermediate risk escribes rates of 8% to < 0% (Russia, China, Caribbean, S Africa)

While the rate is < 8 % at low risk destinations America, Western Europe, Australia,
New Zealand
Destination risk factor (2)
Tourist to Latin America, Africa, and Asia develop “traveler’s diarrhea commonly
due to enterotoxigenic Escherichia coli, Campylobacter, Shigella, and Salmonella
Visitors to Russia may have increase risk of Giaria associated diarrhea

Visitors to Nepal may acquire Cyclospora

Campers, backpackers, and swimmers, in wilderness may become infected with

Giardia
Other Risk Factors
Younger age
Self organized activities
Backpacking
Not staying in hotels
Not staying with friends and family
Diarrhea closely following food consumption
may suggest infection with
Salmonella or campylobacter from chicken
Enterohemorrhagie Escherichia coli from undercooked hamburger
Bacillus aureus from fried rice
S.Aureus rom mayonnaise or creams
Salmonella from eggs
Vibro species, acute hepatitis A or B from (raw) seafood
Terima Kasih