By 
Montezuma’s Revenge – Aztec Two Step – whatever nickname it’s called, if you’ve experienced it, you know exactly what I’m talking about. Traveler’s Diarrhea (TD) is the most common medical problem that people complain of while traveling to less developed countries.
High-risk destinations (attack rates of up to 60% during the first 2 weeks) include Mexico City, the Dominican Republic and Haiti, and developing countries in Africa, South and Central America, the Middle East and Asia . Lower risk countries include Australia, countries in Europe, Japan, South Africa, and countries in North America.
Traveler’s diarrhea is not a specific disease, but rather describes symptoms caused by certain microorganisms that are transmitted through contaminated food and water. Bacteria are by far the most common cause of TD, with approximately 85% of cases being bacterial. Parasites and viruses are the cause of DT 10% and 5% respectively.
Bacterial causes of TD include; Salmonella, Shigella, Campylobacter, various E. coli stains, and Vibrio (the cause of cholera).
Parasitic causes include Giardia and Entamoeba histolytica (amebiasis). Viruses such as rotavirus and norovirus have been implicated.
TD is commonly seen with the following symptoms; an abrupt onset of loose, watery, or semi-formed stools associated with abdominal cramps and rectal urgency. Other symptoms such as nausea, bloating, and fever may also occur. Vomiting can occur in up to 15% of those affected. Traveler’s diarrhea is usually self-limiting and lasts 3-4 days even without treatment.
How can you prevent TD on your next trip abroad? Here are some common sense tips:
o Do not buy food from street vendors.
o Avoid raw foods. In particular, salads, raw vegetables and unpasteurized milk and dairy products such as cheese, and eating only cooked and still hot foods or fruits that the traveler can peel personally (bananas and oranges).
o Also avoid raw or undercooked meat, fish, or shellfish.
o Do not use tap water to wash fruits and vegetables or to make ice cubes. Avoid fruit juices reconstituted with tap water.
o When you are in areas where the water is not chlorinated; Bottled water is a safe alternative as long as the bottle is not open and sealed.
o Use bottled water to brush your teeth.
o Keep your mouth closed while showering.
o Make sure eating utensils and dishes are clean and dry before using them.
o Boiling water is the best way to make water safe to drink. Boil over high heat for at least one minute.
o The use of iodine or chlorine tablets is effective against most pathogens. However, they are ineffective against some parasites such as Cryptosporidium.
o The use of water filters is effective against most pathogens.
o The use of prophylactic antibiotics may be especially helpful for short-term travelers. Quinolones and rifaximin are commonly prescribed antibiotics for this reason.
o Pepto-Bismol can lower your chances of getting TD.
o In Europe and Canada there is an approved cholera vaccine that can be administered before travel.
o Sanitizing and hand washing gels reduce the incidence of diarrhea (as well as respiratory diseases).
Most cases of TD do not require treatment and will resolve on their own. However, in cases where bloody diarrhea or high fever is present, antibiotic treatment should be given. If you get TD, drink plenty of fluids. Certain infections such as cholera can be life-threatening due to fluid loss. In some cases, intravenous fluid replacement may be required.