Of Travelers' Diarrhea

EDITORIAL

www.nature.com/clinicalpractice/gasthep The ‘upside’ of travelers’ diarrhea: a personal case report Stephen B Hanauer

The Hanauer family enjoys traveling together I now have a and was able to maintain his hydration. The during the winter holidays, with recent biking much greater afternoon of his second day of illness, however, excursions to northern Thailand, the Atacama he alerted me to new symptoms: along with a desert in Chile, and North and South Vietnam, respect for sore throat from retching, he had dysphagia as well as white-water rafting in Costa Rica. the potential and crepitus (from his jaw to below his clavi- While traveling we all enjoy local cuisine, and complications cles). He had no dyspnea, no tactile fever and although we practice appropriate malaria of travelers’ his throat was clear aside from some hyper- prophylaxis and drink bottled water, have not diarrhea emia. Chest examination was clear to percus- been overly concerned about gastroenteritis. We sion and auscultation (with ears only). Clearly, consider ourselves as having ‘strong stomachs’. the retching had caused a potentially fatal per- This winter we went on an adventuresome foration of his esophagus—Booerhaave’s syn- biking trip to Laos. Upon arriving at the World drome—and we were on holiday in a Laotian Heritage site of Luang Prabang, our first day town with a population of 15,000 and only was spent accommodating jet lag, discovering limited medical care available. the local environs of the town, and enjoying a Fortunately, my diagnosis of an upper esopha- Laotian feast. The second day entailed a rigor- geal tear was incorrect (not being an esophagol- ous, 50-mile bike ride through the countryside, ogist). I was primarily concerned that my son followed by massages and, afterwards, dinner maintained his hydration and avoided an infec- with two other families at one of the ‘nicer’ tious complication. Hospital evaluation, with the hotel restaurants. Our group included parents potential for nonsterile needles and intravenous and young adults; some of our party indulged fluid administration, was not an option. I gave in the local cuisine while the rest craved more him ciprofloxacin and continued to nurture him ‘Western’ dishes, including fresh salads. with tea, decarbonated cola from cans, boiled The next morning I was notified that we had rice, bananas and blended fruit drinks. He two Hanauers ‘down’ with urgent diarrhea and could swallow small amounts and maintain his that several members of the other families were hydration. Over the next five days, he gradually also affected. In total, 8 of the 13 diners devel- recovered without sequelae. oped profound, nonfebrile, nonbloody diarrhea. The esophageal tear wasn’t the only ‘upside’ A brief epidemiologic survey determined that of this experience—I now have a much greater the ‘Western’ salads were the culprit, as those respect for the potential complications of of us who ingested only the local cuisine were SB Hanauer is Editor- travelers’ diarrhea, although it won’t put us spared the gastroenteritis. Fortunately, over in-Chief of Nature off traveling. For our next holiday, we plan to the next 24 hours most of the victims improved Clinical Practice travel to Myanmar (Burma), but we will make Gastroenterology with symptomatic treatment (loperamide or bis- sure that our son, in his more vulnerable state, & Hepatology. muth sub salicylate) and a limited diet, without avoids fresh salads. the need for antibiotics. Competing interests And for those of you who are interested in Unfortunately, one of my sons had diarrhea The author declared finding out more about travelers’ diarrhea, a competing interests; go to and vomiting associated with profound retch- the article online for details. Review by Herbert L DuPont in this issue looks ing that continued over the next day. He was at the current and future antibacterial drugs for www.nature.com/clinicalpractice nurtured with tea, rice and blended fruit juices doi:10.1038/ncpgasthep0139 its prevention and therapy.

APRIL 2005 VOL 2 NO 4 NATURE CLINICAL PRACTICE GASTROENTEROLOGY & HEPATOLOGY 161