Makindo Medical Notes

Travellers Diarrhoea: Antibiotics given for E. coli enterohaemorrhagic fever increase the risk of Haemolytic uraemic syndrome.

About

• Affects 20-30% of travellers.
• Typically caused by ingesting contaminated food or water.

Aetiology

• E. coli infection.
• Campylobacter: Acute abdomen-type picture, often with bloody diarrhoea.
• Amoebic dysentery: Abdominal pain, bloody diarrhoea.
• Clostridium difficile.
• Giardia: Symptoms beyond 7 days.
• Cryptosporidium: Symptoms beyond 7 days.
• Cyclospara: Symptoms beyond 7 days.

Clinical

• Diarrhoea +/- Blood, Nausea, Vomiting.
• Cramps, fever, dehydration.

Investigations

• FBC, U&E, LFTS, CRP.
• Stool exam and culture for ova, cysts, and parasites.
• Colonoscopy if diarrhoea persists.

Differential

• Inflammatory bowel disease.

Prevention

• Avoid unboiled water, bottled water is best.
• Avoid foods washed in potentially contaminated water, such as salads.
• Practice hand washing.

Prophylaxis

• Ciprofloxacin/Metronidazole for certain groups.
• Ileostomy, immunocompromised, CKD.

Management

• Rehydrate with clean water - bottled may be best when source unclear.
• Ciprofloxacin/Metronidazole indicated after discussion with ID consultant.
• May develop irritable bowel syndrome after resolution.

Foodborne Diseases Table

Organism	Common Name of Illness	Onset Time After Ingesting	Signs & Symptoms	Duration	Food Sources
Bacillus cereus	B. cereus food poisoning	10-16 hrs	Abdominal cramps, watery diarrhoea, nausea	24-48 hours	Meats, stews, gravies, vanilla sauce
Campylobacter jejuni	Campylobacteriosis	2-5 days	Diarrhea, cramps, fever, and vomiting; diarrhoea may be bloody	2-10 days	Raw and undercooked poultry, unpasteurized milk, contaminated water
Clostridium botulinum	Botulism	12-72 hours	Vomiting, diarrhoea, blurred vision, double vision, difficulty in swallowing, muscle weakness. Can result in respiratory failure and death	Variable	Improperly canned foods, especially home-canned vegetables, fermented fish, baked potatoes in aluminum foil
Clostridium perfringens	Perfringens food poisoning	8-16 hours	Intense abdominal cramps, watery diarrhoea	Usually 24 hours	Meats, poultry, gravy, dried or precooked foods, time and/or temperature-abused foods
Cryptosporidium	Intestinal cryptosporidiosis	2-10 days	Diarrhea (usually watery), stomach cramps, upset stomach, slight fever	May be remitting and relapsing over weeks to months	Uncooked food or food contaminated by an ill food handler after cooking, contaminated drinking water
Cyclospora cayetanensis	Cyclosporiasis	1-14 days, usually at least 1 week	Diarrhea (usually watery), loss of appetite, substantial loss of weight, stomach cramps, nausea, vomiting, fatigue	May be remitting and relapsing over weeks to months	Various types of fresh produce (imported berries, lettuce, basil)
E. coli	E. coli infection (common cause of “travellers’ diarrhoea")	1-3 days	Watery diarrhoea, abdominal cramps, some vomiting	3-7 or more days	Water or food contaminated with human feces
E. coli O157:H7	Haemorrhagic colitis or E. coli O157:H7 infection	1-8 days	Severe (often bloody) diarrhoea, abdominal pain and vomiting. Usually, little or no fever is present. More common in children 4 years or younger. Can lead to kidney failure.	5-10 days	Undercooked beef (especially hamburger), unpasteurized milk and juice, raw fruits and vegetables (e.g. sprouts), and contaminated water
Hepatitis A	Hepatitis	28 days average (15-50 days)	Diarrhea, dark urine, jaundice, and flu-like symptoms, i.e., fever, headache, nausea, and abdominal pain	Variable, 2 weeks-3 months	Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters
Listeria monocytogenes	Listeriosis	9-48 hrs for gastrointestinal symptoms, 2-6 weeks for invasive disease	Fever, muscle aches, and nausea or diarrhoea. Pregnant women may have mild flu-like illness, and infection can lead to premature delivery or stillbirth. The elderly or immunocompromised patients may develop bacteremia or meningitis.	Variable	Unpasteurized milk, soft cheeses made with unpasteurized milk, ready-to-eat deli meats
Noroviruses	Various, called viral gastroenteritis, winter diarrhoea, acute non-bacterial gastroenteritis, food poisoning, and food infection	12-48 hrs	Nausea, vomiting, abdominal cramping, diarrhoea, fever, headache. Diarrhea is more prevalent in adults, vomiting more common in children.	12-60 hrs	Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler; shellfish from contaminated waters
Salmonella	Salmonellosis	6-48 hours	Diarrhea, fever, abdominal cramps, vomiting	4-7 days	Eggs, poultry, meat, unpasteurized milk or juice, cheese, contaminated raw fruits and vegetables
Shigella	Shigellosis or Bacillary dysentery	4-7 days	Abdominal cramps, fever, and diarrhoea. Stools may contain blood and mucus.	24-48 hrs	Raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler
Staphylococcus aureus	Staphylococcal food poisoning	1-6 hours	Sudden onset of severe nausea and vomiting. Abdominal cramps. Diarrhea and fever may be present.	24-48 hours	Unrefrigerated or improperly refrigerated meats, potato and egg salads, cream pastries
Vibrio parahaemolyticus	V. parahaemolyticus infection	4-96 hours	Watery (occasionally bloody) diarrhoea, abdominal cramps, nausea, vomiting, fever	2-5 days	Undercooked or raw seafood, such as shellfish
Vibrio vulnificus	V. vulnificus infection	1-7 days	Vomiting, diarrhoea, abdominal pain, bloodborne infection. Fever, bleeding within the skin, ulcers requiring surgical removal. Can be fatal to persons with liver disease or weakened immune systems.	2-8 days	Undercooked or raw seafood, such as shellfish (especially oysters)

References

• CDC: Foodborne Illnesses
• WHO: Foodborne Diseases