Gastroenterology and Hepatology Department, Geneva University Hospital, Geneva, Switzerland
Therap Adv Gastroenterol. 2009 Nov;2(6):367-75. doi: 10.1177/1756283X09346668.
Traveler's diarrhea (TD) strikes 20-60% of travelers visiting developing countries. It occurs shortly after the return and can be distinguished into two categories: acute and persistent TD. Acute TD, mostly caused by bacterial and viral pathogens, is usually mild and self-limited, and deserves empirical symptomatic and/or antibiotic therapy in selected cases. Fluoroquinolones are progressively superseded in this indication by azithromycin, a well tolerated macrolide active against most bacteria responsible for TD, including the quinolone-resistant species of Campylobacter jejuni that are now pervasive, especially in Southeast Asia and India. Persistent TD in the returning traveler is much rarer than its acute counterpart and may be associated with three types of causes. Persistent infections, among which Giardia and possibly Entamoeba predominate, account for a significant proportion of cases. Postinfectious processes represent a second cause and comprise temporary lactose malabsorption and postinfectious irritable bowel syndrome, now considered a major cause of persistent TD. Finally, apparently unrelated chronic diseases causing diarrhea are occasionally unmasked by TD and represent a third type of persistent TD, among which the well established case of incident inflammatory bowel disease poses intriguing pathogenesis questions. This review discusses recent advances in the field and provides practical recommendations for the management of TD in adult, immunocompetent returning travelers.
旅行者腹泻（TD）影响 20-60%前往发展中国家的旅行者。它通常在旅行归来后不久发生，可以分为两类：急性和持续性 TD。急性 TD 主要由细菌和病毒病原体引起，通常症状较轻且具有自限性，在某些情况下值得进行经验性对症和/或抗生素治疗。氟喹诺酮类药物在该适应证中逐渐被阿奇霉素取代，阿奇霉素是一种耐受性良好的大环内酯类药物，对大多数引起 TD 的细菌有效，包括现在普遍存在的、尤其是在东南亚和印度流行的对氟喹诺酮耐药的空肠弯曲菌。返回旅行者中的持续性 TD 比急性 TD 少见得多，可能与三种类型的原因有关。持续性感染，其中贾第虫病和可能的肠内阿米巴病占很大比例，占很大比例。感染后过程代表第二种原因，包括暂时的乳糖吸收不良和感染后肠易激综合征，现在被认为是持续性 TD 的主要原因。最后，一些不明原因的慢性腹泻疾病偶尔会因 TD 而被发现，这是持续性 TD 的第三种类型，其中已确立的炎症性肠病病例提出了有趣的发病机制问题。这篇综述讨论了该领域的最新进展，并为成人免疫功能正常的返回旅行者 TD 的管理提供了实用建议。
