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E. Coli Diarrhea - Traveler's Diarrhea





 Introduction

Traveler's diarrhea refers to diarrheal disease caused by toxins produced by a number of different strains of Escherichia coli and other bacteria.
What is going on in the body? 
Traveler's diarrhea begins when a person swallows E. coli or other bacteria. This happens through close contact with feces from an infected person or animal. It can also come from ingesting food or water that has been contaminated with the bacteria. There have been numerous outbreaks of E. coli illness linked to unpasteurized contaminated cow's milk or undercooked hamburger meat. The disease can also pass from person to person, especially between children still in diapers.
What are the causes and risks of the disease?
Traveler's diarrhea is caused by certain bacteria, such as E. coli. Travelers generally come into contact with these bacteria by ingesting contaminated food or water. Travelers to the following countries are at particular risk:
  • Central America, including the islands of the West Indies
  • the developing countries of Africa
  • the Middle East
    • Any raw food can be a source of these bacteria. However, the following foods and beverages pose the highest risk:
  • certain fish, particularly tropical fish
  • raw meat
  • salads
  • shellfish
  • uncooked vegetables and fruit
  • unpasteurized fruit juice
  • unpasteurized milk and milk products
  • untreated water
    • Traveler's diarrhea is more common in younger people but can occur at any age. People with immunodeficiency disorders, such as HIV, are at higher risk.  


    What are the signs and symptoms of the disease?
    The type of bacteria causing the infection determines the symptoms of the disease. Symptoms of traveler's diarrhea may include:
  • abdominal cramping
  • diarrhea with or without blood
  • fever
  • malaise, or a vague feeling of illness
  • nausea  

    • How is the disease diagnosed?
    Diagnosis of traveler's diarrhea begins with a medical history and physical exam. The bacteria can be cultured from an infected person's stool. A special test can be done to detect E.coli O157:H7   

    What are the treatments for the disease?
    Oral fluids, including rehydration solutions, are important to prevent dehydration. In most cases, antibiotics are not needed. However, they may be useful in the treatment of very young infants or with certain types of E.coli. They may also be recommended for immunocompromised individuals, or those with weak immune systems.
    Medicines to control diarrhea should not be administered to children with diarrhea, especially if the diarrhea is bloody. They could cause the diarrhea to last longer or to make it worse.
    Traveler's diarrhea may be treated with the same drugs used to prevent it. In addition to the medicines listed earlier, loperamide may reduce the diarrhea.
    What are the side effects of the treatments?
    The medicines used to treat traveler's diarrhea can cause allergic reactions. They may also make the person more sensitive to sunlight and increase the risk of sunburn. Drugs for diarrhea may also cause nausea.
    What happens after treatment for the disease?
    Traveler's diarrhea usually goes away, with or without treatment, within 1 week. Hemorrhagic colitis is more serious and lasts longer, especially if HUS develops. Kidney failure may develop in as many as 50% of children. Severe kidney failure can lead to high blood pressure. HUS may recur with repeated infections but not usually after the first year. Most children with HUS have a nearly complete recovery. Up to 1/3, though, have lasting evidence of some kidney damage.  

    Reference 
     Scientific American Medicine 10(VII):6-7, 2000

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