Dtsch Med Wochenschr 2013; 138(33): 1673-1686
DOI: 10.1055/s-0033-1343306
CME | Review article
Gastroenterologie, Infektiologie, Reisemedizin
© Georg Thieme Verlag KG Stuttgart · New York

Reisediarrhoe

Travelers’ diarrhea
G. D. Burchard
1   Sektion Tropenmedizin, 1. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf
,
M. Hentschke
2   Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf
,
T. Weinke
3   Ernst-von-Bergmann Klinikum, Klinik für Gastroenterologie und Infektiologie, Potsdam
,
H. D. Nothdurft
4   Abteilung für Infektions- und Tropenmedizin, Ludwig-Maximilians-Universität, München
› Author Affiliations
Further Information

Publication History

11 January 2013

16 May 2013

Publication Date:
02 August 2013 (online)

Zusammenfassung

Mehrere Millionen Touristen erkranken jedes Jahr an einer Reisediarrhoe. Ursächlich sind meist Bakterien, vor allem enterotoxigene Escherichia coli, Campylobacter, Shigellen, Salmonellen, seltener Aeromonas, Plesiomonas und Nicht-Cholera-Vibrionen. Unter Umständen ist eine antibakterielle Therapie mit Ciprofloxazin, Azithromycin oder Rifaximin erforderlich. Viren wie z. B. Noroviren führen meist nur zu kurzen Episoden von Übelkeit und Erbrechen, an parasitäre Erkrankungen wie z.B. an eine Giardiasis ist insbesondere bei chronischen Diarrhoen zu denken. Die Möglichkeiten der Prophylaxe sind beschränkt, wichtig ist daher eine gute Information des Reisenden über eine eventuelle Selbsttherapie während der Reise.

Abstract

Travelers diarrhea affects millions of tourists each year. Most cases are caused by a variety of bacterial enteropathogens: toxigenic Escherichia coli, Campylobacter, Shigella, Salmonella, Aeromonas, Plesiomonas and non-cholera vibrios. Treatment may include antibacterial therapy with either ciprofloxacin, or azitrhomycin, or rifaximin. Viral pathogens such as norovirus usually cause short-term illness that typically resolves before travelers seek medical attention. Chronic gastrointestinal disease inreturning travelers often is caused by parasitic pathogens like Giardia lamblia. The impact of prevention of travelers diarrhea is limited, therefore travelers should be informed about early self-treatment.

 
  • Literatur

  • 1 Adachi JA, Jiang ZD, Mathewson JJ et al. Enteroaggregative Escherichia coli as a major etiologic agent in traveler's diarrhea in 3 regions of the world. Clin Infect Dis 2001; 32: 1706-1709
  • 2 Alajbegovic S, Sanders JW, Atherly DE et al. Effectiveness of rifaximin and fluoroquinolones in preventing travelers’ diarrhea (TD): a systematic review and meta-analysis. Syst Rev 2012; 1: 39 doi: DOI: 10.1186/2046-4053-1-39.
  • 3 Al-Mashhadani M, Hewson R, Vivancos R et al. Foreign travel and decreased ciprofloxacin susceptibility in Salmonella enterica infections. Emerg Infect Dis 2011; 17: 123-125
  • 4 Apelt N, Hartberger C, Campe H et al. The prevalence of Norovirus in returning international travelers with diarrhea. BMC Infect Dis 2010; 10: 131 doi: DOI: 10.1186/1471-2334-10-131.
  • 5 Christopher PR, David KV, John SM et al. Antibiotic therapy for Shigella dysentery. . Cochrane Database Syst Rev 2010; (08) CD006784
  • 6 DuPont HL. Approach to the patient with infectious colitis. Curr Opin Gastroenterol 2012; 28: 39-46
  • 7 DuPont HL, Ericsson CD, Farthing MJ et al. Expert review of the evidence base for self-therapy of travelers’ diarrhea. J Travel Med 2009; 16: 161-171
  • 8 Irving PM, Gibson PR. Infections and IBD. Nature Clin Pract Gastroenterol Hepatol 2008; 5: 18-27
  • 9 Janda JM, Abbott SL. The genus Aeromonas: taxonomy, pathogenicity, and infection. Clin Microbiol Rev 2010; 23: 35-73
  • 10 Jiang ZD, Dupont HL, Brown EL et al. Microbial etiology of travelers' diarrhea in Mexico, Guatemala, and India: importance of enterotoxigenic Bacteroides fragilis and Arcobacter species. J Clin Microbiol 2010; 48: 1417-1419
  • 11 Kendall ME, Crim S, Fullerton K et al. Travel-associated enteric infections diagnosed after return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2009. Clin Infect Dis 2012; 54: 480-487
  • 12 Kozicki M, Steffen R, Schär M. 'Boil it, cook it, peel it or forget it': does this rule prevent travellers' diarrhoea?. Int J Epidemiol 1985; 14: 169-172
  • 13 Layer P, Andresen V. Review article: rifaximin, a minimally absorbed oral antibacterial, for the treatment of travellers' diarrhoea. Aliment Pharmacol Ther 2010; 31: 1155-1164
  • 14 Levine MM, Robins-Browne RM. Factors that explain excretion of enteric pathogens by persons without diarrhea. Clin Infect Dis 2012; 55: 303-311
  • 15 Luangtongkum T, Shen Z, Seng VW et al. Impaired fitness and transmission of macrolide-resistant Campylobacter jejuni in its natural host. Antimicrob Agents Chemother 2012; 56: 1300-1308
  • 16 Müller S, Tappe D, Frosch M et al. Resistance to ampicillin, third-generation cephalosporins, ciprofloxacin, co-trimoxazole and azithromycin in clinical isolates of Salmonella enterica subsp. enterica from Germany: real problem or sporadic circumstance?. Scand J Infect Dis 2011; 43: 389-391
  • 17 Murphy H, Pandey P. Pathogens for travelers' diarrhea in Nepal and resistance patterns. Curr Infect Dis Rep 2012; 14: 238-245
  • 18 Neuberger A, Saadi T, Shetern A et al. Clostridium difficile infection in travelers – a neglected pathogen?. J Travel Med 2012; 20: 37-43
  • 19 Norman FF, Pérez-Molina J, Pérez de Ayala A et al. Clostridium difficile-associated diarrhea after antibiotic treatment for traveler's diarrhea. Clin Infect Dis 2008; 46: 1060-1063
  • 20 Ouyang-Latimer J, Jafri S, VanTassel A et al. In vitro antimicrobial susceptibility of bacterial enteropathogens isolated from international travelers to Mexico, Guatemala, and India from 2006 to 2008. Antimicrob Agents Chemother 2011; 55: 874-878
  • 21 Paredes-Paredes M, Okhuysen PC, Flores J et al. Seasonality of diarrheagenic Escherichia coli pathotypes in the US students acquiring diarrhea in Mexico. J Travel Med 2011; 18: 121-125
  • 22 Pitzurra R, Fried M, Rogler G et al. Irritable bowel syndrome among a cohort of European travelers to resource-limited destinations. J Travel Med 2011; 18: 250-256
  • 23 Safdar N, Said A, Gangnon RE et al. Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis. JAMA 2002; 288: 996-1001
  • 24 Sherwood RA. Faecal markers of gastrointestinal inflammation. J Clin Pathol 2012; 65: 981-985
  • 25 Sirinavin S, Garner P. Antibiotics for treating salmonella gut infections. . Cochrane Database Syst Rev 2000; (02) CD001167
  • 26 Swaminathan A, Torresi J, Schlagenhauf P et al. A global study of pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travellers. J Infect 2009; 59: 19-27
  • 27 Taneja N, Mewara A, Kumar A et al. Cephalosporin-resistant Shigella flexneri over 9 years (2001-09) in India. J Antimicrob Chemother 2012; 67: 1347-1353
  • 28 Weinke T, Liebold I. Intestinale Protozoeninfektionen. Dtsch Med Wochenschr 2013; 138: 709-711