7/2/2023 0 Comments Clindamycin cream side effects![]() ![]() ![]() In more temperate regions, seasonal variations in diarrhea risk can occur. A cohort of expatriates residing in Kathmandu, Nepal, experienced an average of 3.2 episodes of TD per person during their first year. In short-term travelers, bouts of TD do not appear to protect against future attacks, and >1 episode of TD can occur during a single trip. TD occurs equally in male and female travelers it is more common in young adult travelers than in older travelers. Several pathogens are discussed in their own chapters in Section 5. Dientamoeba fragilis is a flagellate occasionally associated with diarrhea in travelers. The risk for Cyclospora is highly geographic and seasonal: the most well-known risks are in Guatemala, Haiti, Nepal, and Peru. Entamoeba histolytica and Cryptosporidium are relatively uncommon causes of TD. Giardia is the main protozoal pathogen found in TD. Viral diarrhea can be caused by several pathogens, including astrovirus, norovirus, and rotavirus. Surveillance also points to Aeromonas spp., Plesiomonas spp., and newly recognized pathogens ( Acrobacter, enterotoxigenic Bacteroides fragilis, Larobacter) as potential causes of TD. coli pathotypes also are commonly found in cases of TD. Overall, the most common pathogen identified is enterotoxigenic Escherichia coli, followed by Campylobacter jejuni, Shigella spp., and Salmonella spp. Infectious Agents Bacteriaīacteria are the most common cause of TD. In toxin-mediated illness, both vomiting and diarrhea can be present symptoms usually resolve spontaneously within 12–24 hours. What is commonly known as “food poisoning” involves the ingestion of infectious agents that release toxins (e.g., Clostridium perfringens) or consumption of preformed toxins (e.g., Staphylococcal food poisoning). 7, Persistent Diarrhea in Returned Travelers). Infections with protozoal pathogens are slower to manifest symptoms and collectively account for ≈10% of diagnoses in longer-term travelers (see Sec. Intestinal viruses account for at least 5%–15% of illnesses, although the use of multiplex molecular diagnostic assays demonstrates that their contribution to the overall burden of TD disease is probably greater than previously estimated. Bacteria are the predominant enteropathogens and are thought to account for ≥80%–90% of cases. TD is a clinical syndrome that can result from a variety of intestinal pathogens. Poor hygiene practices in local restaurants and underlying hygiene and sanitation infrastructure deficiencies are likely the largest contributors to the risk for TD. Traditionally, TD was thought to be prevented by following simple dietary recommendations (e.g., “boil it, cook it, peel it, or forget it”), but studies have found that people who follow these rules can still become ill. Attack rates range from 30%–70% of travelers during a 2-week period, depending on the destination and season of travel. Travelers’ diarrhea (TD) is the most predictable travel-related illness. ![]()
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