小结
定义
病史和体格检查
关键诊断因素
- presence of risk factors
- diarrhoea (with or without tenesmus), cramping, nausea, and vomiting
- dysentery (blood and fever)
- persistent diarrhoea >14 days
其他诊断因素
- diarrhoea without illness
危险因素
- travel to a high-risk destination
- age <30 years
- proton-pump inhibitor use
- travellers with prior residence in higher-risk destination visiting friends and relatives
- travel during hot and wet seasons
- deployed military populations
- lack of caution in food and water selection
诊断性检查
首要检查
- stool culture and sensitivity
- multi-pathogen molecular diagnostic (polymerase chain reaction)
- protozoal stool antigens
需考虑的检查
- stool ova and parasite examination
- Clostridioides difficile stool toxin
- colonoscopy, endoscopy, and biopsy
- haematology, blood chemistries, serology
治疗流程
pre-travel prophylaxis
non-pregnant adults: mild diarrhoea
non-pregnant adults: moderate diarrhoea
non-pregnant adults: severe diarrhoea
pregnant
children
撰稿人
作者
Daniel T. Leung, MD, MSc
Associate Professor
Division of Infectious Diseases
University of Utah School of Medicine
Salt Lake City
UT
利益声明
DTL receives authorship royalties from UpToDate, Inc, for a chapter on travel medicine. DTL is an author of upcoming chapters on traveller's diarrhoea for the US CDC Yellow Book. DTL is the president-elect of the American Committee on Clinical Tropical Medicine and Travelers' Health - Clinical Group within the American Society of Tropical Medicine and Hygiene. DTL is an author of some of the references cited in this topic.
Jakrapun Pupaibool, MD, MS
Associate Professor
Division of Infectious Diseases
University of Utah School of Medicine
Salt Lake City
UT
利益声明
JP declares that he has no competing interests.
鸣谢
Dr Daniel T. Leung and Dr Jakrapun Pupaibool would like to gratefully acknowledge Dr Mark Riddle and Professor Gregory Juckett, the previous contributor to this topic.
利益声明
MR has given talks on the management of traveller's diarrhoea for the International Society of Travel Medicine (ISTM), the CDC Foundation, the American College of Gastroenterology (ACG), and the American College of Preventive Medicine. MR has led the development of guidelines for traveller's diarrhea for the ISTM, the ACG, and the Department of Defense. This work has been unpaid but support for travel has been accepted. MR is employed with Pfizer Inc., and is working on their Lyme disease vaccine programme. While this is not in conflict with traveller’s diarrhoea, Pfizer also makes azithromycin, which is an antibiotic recommended for the treatment of traveller’s diarrhoea. MR does not work in the area of Pfizer that develops, markets, or distributes azithromycin. MR is an author of several references cited in this topic. GJ declares that he has no competing interests.
同行评议者
Andrea Summer, MD
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
利益声明
AS declares that she has no competing interests.
Phil Fischer, MD
Professor of Pediatrics
Department of Pediatric and Adolescent Medicine
Mayo Clinic
Rochester
MN
利益声明
PF is an author of a reference cited in this topic.
参考文献
关键文献
Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl 1):S57-74.全文 摘要
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 2: preparing international travelers - travelers’ diarrhea. May 2023 [internet publication].全文
De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea. Cochrane Database Syst Rev. 2000;(3):CD002242.全文 摘要
Johnson PC, Ericsson CD, DuPont HL, et al. Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. JAMA. 1986 Feb 14;255(6):757-60. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Food poisoning
- Irritable bowel syndrome
- Secondary disaccharidase (or other dietary) deficiency
更多 鉴别诊断指南
- CDC Yellow Book 2024: travelers' diarrhea
- 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea
更多 指南患者教育信息
Diarrhoea in adults
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