John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
The presumptive diagnosis of travelers' diarrhea is based solely on the
development of diarrhea when visiting a part of the world where this
condition is common among travelers. The diarrhea usually is mild,
self-limited, and resolves spontaneously. Symptoms usually can be
controlled with over-the-counter medications (see below.) Only
when the diarrhea is severe or complicated, and possibly when
antibiotics are contemplated, should attempts be made to identify the
exact organism responsible for the diarrhea so that the correct drug
therapy can be selected. Identification may be difficult or
impossible in undeveloped countries because of the lack of medical
laboratories. When laboratories are available, the stool can be
examined for parasites and cultured for bacteria. Identification of the pathogen
results in the definitive diagnosis.
How is travelers' diarrhea treated?
Although prophylactic antibiotics (antibiotics taken before the person is
exposed to the pathogen) are effective in preventing travelers' diarrhea, they generally are not recommended. The side effects of antibiotics, including photosensitivity (sensitivity to the sun that results in injury to the skin) and diarrhea can be major problems. Antibiotic prophylaxis can be considered in individuals with underlying medical diseases in whom diarrhea is more likely to occur or who may be profoundly affected by the diarrhea. This group includes people with previous stomach surgery,
active inflammatory bowel disease,
underlying immunodeficiency conditions, and other serious medical disorders. In
these situations drugs of the quinolone class (ciprofloxacin
[Cipro, Cipro
XR, Proquin XR], levofloxacin
[Levaquin]) have been shown to be effective.
Bismuth subsalicylate (Pepto-Bismol) in liquid or pill form also has been shown to be effective in preventing diarrhea in up to 65% of travelers although Pepto-Bismol may cause black stools and, rarely,
ringing in the ears. People allergic to
aspirin should avoid Pepto-Bismol.
When treating afflicted individuals, drugs that alleviate symptoms as well as antibiotics play a role. With moderate symptoms, the addition of Pepto-Bismol alone may suffice. Alternatively, anti-diarrheal agents such as
diphenoxylate and atropine (Lomotil) or
loperamide (Imodium) can be given. With severe disease, characterized by frequent diarrhea or dehydration, or complicated by the passage of bloody stools, Lomotil or Imodium should not be used and you should consult your doctor.
Oral fluids are a mainstay of therapy since they are important to prevent dehydration. Tips for staying hydrated are:
Small, frequent sips of clear liquids (those you can see through) are the best way to stay hydrated.
Avoid alcoholic, caffeinated, or sugary drinks, if possible. Over-the-counter rehydration products made for children such as Pedialyte and Rehydralyte are expensive but good to use if available.
Sports drinks such as Gatorade and PowerAde are fine for adults if they are diluted with water because at full strength they contain too much sugar, which can worsen diarrhea.
Try to drink at least as much or more fluid than you think is coming out
or lost with the watery diarrhea.
For mild to moderate dehydration, oral rehydration salts (ORS) may be
recommended. These are available in pharmacies in most developing countries.
Severe hydration usually requires emergent intravenous rehydration (IV).
If the affected individual cannot hold down fluids, or is losing fluids
faster than they can take them in, seek medical care immediately, because
some patients will require IV hydration.
Children and the elderly are more susceptible to dehydration. If a
person feels light-headed or woozy, feels a rapid pulse or their mouth and lips are dry,
they should consult a physician. If a child is listless, not eating or drinking and does not make wet diapers or urinate within a few hours they also should be seen
quickly by a doctor.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gastroenteritis (viral gastroenteritis, stomach flu) is an infection caused by a variety of viruses that results in vomiting and/or diarrhea. Even though it is often called the "stomach flu," it is not caused by the influenza viruses. Viruses that can cause gastroenteritis (stomach flu) include: rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Gastroenteritis is not caused by bacteria. The main symptoms of gastroenteritis include vomiting and watery diarrhea, however, headache, fever, and abdominal cramps (stomach ache) may also be present.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Giardiasis (Giardia lamblia) is a parasite responsible for a common form of infectious diarrhea. The parasite lives in two stages: trophozoites and cysts. People at risk for giardiasis are those that live in areas where there is inadequate sanitation or treatment of drinking water. Giardiasis also is a common cause of outbreaks of diarrhea in day-care centers. Symptoms of giardiasis include abdominal pain and cramping, bloating, nausea, and fatigue. Treatment for giardiasis is with antibiotic medication.
There are many types of E. Coli (Escherichia coli ). Pathogenic E. coli can cause urinary tract and bladder infections, or lead to sepsis. E coli O157:H7 (EHEC) causes bloody diarrhea and colitis. Complications of E. coli infection include hemorrhagic diarrhea, hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura. Symptoms include severe abdominal pain and bloody diarrhea. E coli O157:H7 commonly is due to eating raw or undercooked hamburger or raw milk or dairy products.
Cholera is an infectious disease characterized by intense vomiting and profuse watery diarrhea and that rapidly lease to dehydration and often death. Cholera is caused by infection with the bacteria Vibrio cholerae, which may be transmitted via infected fecal matter, food, or water.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Shigellosis is a disease caused by the Shigella bacteria. Bloody diarrhea, stomach cramps and fever are common symptoms. Mild infections usually resolve on their own. Antibiotics are used to treat more severe cases.
Drug resistance (antimicrobial resistance) is the ability of bacteria, fungi, parasites, and viruses to grow, even in the presence of a drug that would normally kill it (or limit it's growth). Drug resistance is a growing problem, particularly for infections such as MRSA, VRE (vancomycin-resistant enterococci), tuberculosis, HIV, STDs, gonorrhea, flu, pneumonia, malaria, E. coli, salmonella, Campylobacter, which causes diarrhea and gastroenteritis. Learn how to protect yourself from resistance to drugs.
Hepatitis means inflammation of the liver. Hepatitis A is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
Viral hemorrhagic fever(s), or VHFs are a group of illnesses caused by distinct families of viruses. Many of these viruses are life-threatening, and classified as biosafety level four (BSL-4) pathogens. Viral hemorrhagic fever viruses are caused arenaviruses, filoviruses, bunyaviruses, and flaviviruses. The viruses are carried in rodents and transmitted through urine, fecal, saliva, or other body excretions from the infected rodents. Symptoms of viral hemorrhagic fever include marked fatigue, dizziness, muscle aches, loss of strength, fever, and exhaustion. Severely ill patients may also suffer shock coma, seizures, delirium, kidney failure, or nervous system malfunction. There is no established cure for viral hemorrhagic fever.
Enterovirulent Escherichia coli (E. coli) are strains of related bacteria that have a strong propensity to cause gastrointestinal tract infections. Examples of strains include: EHEC (enterohemorrhagic E. coli), ETEC (enterotoxigenic E. coli), EPEC (enteropathogenic E. coli), EIEC (enteroinvasive E. coli), EAEC (enteroadherent E. coli), and EAggEC (enteroaggregative E. coli). Symptoms may vary depending on the strain the individual contracts. Infection is spread generally through contaminated food or drink.
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