여행자 설사 Traveler’s diarrhea

여행자 설사 Traveler’s diarrhea

• 외국을 방문하는 여행자들에게 설사병이 더 생길 수 있다.
• 이런 설사 병을 통틀어 여행자 설사병이고 한다.
• 여행자 설사병의 발생률이 2세 이하 영유아들에게는 60%정도이다.
• 북 아프리카, 멕시코, 인디아, 라틴 아메리카 등의 지역을 방문 할 때 여행자 설사병이 가장 잘 생긴다.
• 여행자 설사병에 걸린 환자들의 19%는 침대에 누워 안정을 취하면서 앓을 정도로 심하게 설사하고 전체 여행자 설사병의 환자의 5%가 의사의 진단 치료를 받았고, 1%는 병원 입원 치료를 받았다고 한다.

여행자 설사의 원인 

여행자 설사의 약 80%는

 ① 장독성 대장균 감염 Enterotoxigenic E. coli,

 ② 살모넬라 Salmonella,

 ③ 시겔라 Shigella,

 ④ 캠필로박터 제주나이(Campylobacter jejuni)

 ⑤ 예르시니아(Yersinia) 등의 박테리아 위장염,

 ⑥ 노로바이러스(Noroviruses)

 ⑦ 로타바이러스(Rotavirus) 등의 바이러스 감염병과

 ⑧ 람불편모충(Giardia lamblia)

 ⑨ 아메바(Entamoeba histolytica) 등의 기생충, 원충 감염병으로 생긴다. 

여행자 설사의 증상 징후

• 구토, 설사와 복통, 열, 탈수, 점액 변, 혈변을 동반할 수 있다.

여행자 설사의 예방

• 이상 열거한 병원체에 오염된 음식물 또는 음료수를 섭취하지 말아야한다.
• 수도꼭지에서 흘러나오는 식수, 그런 물로 요리한 음식물을 먹지 말고, 얼음이나 얼음물을 먹지 말고 껍질을 벗기지 않은 과일이나 끓이지 않고 요리한 생선 음식물을 먹지 만다.
• 저온 살균 처리 우유, 허가 받은 병 음료수, 소다수는 음료하기에 안전하다.
• 음식물을 먹기 전에 손을 적절히 씻는 것도 중요한 예방 방법이다.

여행자 설사의 치료

• 경미한 여행자 설사병이 시작되면 경구 포도당 전핵질액 재수화 치료를 곧 시작한다.
• 경구 재수화 전해질 용액용 분말을 여행응 떠나기 전에 사가지고 가서 필요할 때 사용한다.
• 경구 재수화 전해질 용액용 분말은 요즘 거의 어느 나라에서든지 의사의 처방 없이 구입할 수 있다.
• 스포츠용 수화 용액, 과일 주스, 소다수에는 설탕이 많이 들어 있기 때문에 수화치료에나 재수화 치료에 부적절하다.
• 구토로 경구 포도당 전해질 수화 치료 용액을 먹일 수 없을 때는 정맥용 포도당 전해질 수화 치료를 한다.
• 그렇지 않으면 소량 경구용 수화 치료용 전해질 용액을 경구로 주어 치료할 수 있다. 어디까지나 의사의 지시에 따른다.

여행자 설사를 경구 포도당 전해질 용액 수화치료를 하는 방법의 예를 들면

• 1분에 1~5cc 정도를 숟가락이나 드로퍼(dropper)로 재수화 치료를 할 수 있다.
• 물론 나이와 체중, 탈수의 정도에 따라 적절히 양을 조절한다.
• 예를 들면, 많이 탈수되면 체중 450g 당 30~45cc를 2~4시간 내에 경구로 섭취해 재수화 치료를 한다.

여행자 설사의 항생제 치료

• 일반적으로 소아 여행자 설사치료에 Azithromycin이란 항생제를 흔히 쓰고, 성인 여행자 설사병 치료에는 Ciprofloxacin이나 Levofloxacin으로 치료한다. 
• Azithromycin에 부작용이 생기면 Fluoroquinolone으로 대치 치료를 할 수 있다. 
• 여행자 설사병의 원인이 되는 세균이 MP/SMX(Trimethoprim/sulfamethoxazole)에 내성이 많이 생겨 일반적으로 이 항생제는 요즘 잘 쓰지 않는다. 
• Lactobacillus GG 등 유산균제(Probiotics) 치료는 Rotavirus 감염병 관련 설사 치료에 효과가 있다. 그러나 널리 쓰이지 않는다. 
• 최근 신약으로 알려진 Rifampin으로 치료하기도 한다. 
• Bismuth subsalicylate와 Loperamide을 성인 여행자 설사 치료에 쓸 수 있으나 소아 여행자 설사치료에 Loperamide를 써서는 안 된다. 
• Bismuth subsalicylate(Pepto-bismus)는 소아 여행자 설사병 치료에 쓸 수 있다. 
• 외국을 방문할 때 여행자 설사병을 잘 예방하고 병이 발생되면 치료할 수 있는 적절한 약물을 의사의 처방에 따라 가지고 여행가면 좋을 것이다.

Traveler’s diarrhea 여행자 설사

• Diarrhea may occur more among travelers visiting foreign countries.

• All of these diarrhea diseases are referred to as traveler’s diarrhea.

• The incidence of traveler’s diarrhea is about 60% for infants under the age of two.

• Tourist diarrhea is most prevalent when visiting regions such as North Africa, Mexico, India, and Latin America.

• 19% of patients with traveler’s diarrhea have diarrhea severely enough to get sick while lying in bed, and 5% of all patients with traveler’s diarrhea are diagnosed with doctors, and 1% have been hospitalized.

Causes of traveler’s diarrhea About 80% of traveler’s diarrhea is

① Enterotoxigenic E. coli, infected with enterotoxic E. coli,

② Salmonella, ③ Shigella, ④ Campylobacter jejuni

⑤ Bacterial gastroenteritis such as Yersinia,

⑥ Noroviruses

⑦ Virus infectious diseases such as rotavirus

⑧ Giardia lamblia

⑨ It is caused by parasites such as Entamoeba histolytica, and protozoal infectious diseases.

Symptoms signs of traveler’s diarrhea

• May be accompanied by vomiting, diarrhea and abdominal pain, fever, dehydration, mucous stools, and bloody stools. Prevention of traveler’s diarrhea • Do not consume food or drink contaminated with the pathogens listed above. • Do not eat drinking water from taps, food cooked with such water, do not eat ice or ice water, eat unpeeled fruit or uncooked fish food.

• Pasteurized milk, licensed bottled beverages and soda water are safe to drink

• Proper hand washing before eating is also an important preventive measure. Treatment of traveler’s diarrhea

• If mild traveler’s diarrhea begins, oral glucose pronuclear fluid rehydration therapy will be started soon.

• Take the powder for oral rehydration electrolyte solution before going on a trip and use it when necessary.

• Powders for oral rehydration electrolyte solutions are now available in almost any country without a doctor’s prescription.

• Sports hydration solutions, fruit juices, and soda water contain a lot of sugar, so they are not suitable for hydration or rehydration treatments.

• Intravenous glucose electrolyte hydration treatment is given when vomiting prevents oral glucose electrolyte hydration treatment solutions.

• Otherwise, a small amount of oral hydration therapy electrolyte solution may be given orally to treat. Follow your doctor’s instructions to the last. Examples of how to use oral glucose electrolyte solution hydration for traveler’s diarrhea

• Rehydration treatment can be done with a spoon or dropper about 1~5cc per minute. • Of course, adjust the amount appropriately depending on your age, weight, and degree of dehydration.

• For example, if you are very dehydrated, take 30 to 45 cc per 450 g of body weight orally within 2 to 4 hours for rehydration treatment. Antibiotic treatment for traveler’s diarrhea

• In general, an antibiotic called Azithromycin is commonly used to treat pediatric traveler’s diarrhea, and Ciprofloxacin or Levofloxacin is used to treat adult traveler’s diarrhea.

• If azithromycin has side effects, replacement treatment with fluoroquinolone can be given.

• As the bacteria that cause traveler’s diarrhea are highly resistant to MP/SMX (Trimethoprim/sulfamethoxazole), these antibiotics are not commonly used these days. • Treatment with probiotics such as Lactobacillus GG is effective in treating diarrhea related to Rotavirus infection. However, it is not widely used.

• It is also treated with Rifampin, which is recently known as a new drug.

• Bismuth subsalicylate and Loperamide can be used to treat adult traveler’s diarrhea, but Loperamide should not be used to treat pediatric traveler’s diarrhea.

• Bismuth subsalicylate (Pepto-bismus) can be used to treat pediatric traveller’s diarrhea.

• When visiting a foreign country, it would be a good idea to take a trip with a doctor’s prescription to prevent traveler’s diarrhea and take appropriate medications to cure the disease if it occurs.

• Diarrhea may occur more among travelers visiting foreign countries.

• All of these diarrhea diseases are referred to as traveler’s diarrhea.

• The incidence of traveler’s diarrhea is about 60% for infants under the age of two.

• Tourist diarrhea is most prevalent when visiting regions such as North Africa, Mexico, India, and Latin America.

• 19% of patients with traveler’s diarrhea have diarrhea severely enough to get sick while lying in bed, and 5% of all patients with traveler’s diarrhea are diagnosed with doctors, and 1% have been hospitalized.

Causes of traveler’s diarrhea About 80% of traveler’s diarrhea is

① Enterotoxigenic E. coli, infected with enterotoxic E. coli,

② Salmonella,

③ Shigella,

④ Campylobacter jejuni

⑤ Bacterial gastroenteritis such as Yersinia, ⑥ Noroviruses

⑦ Virus infectious diseases such as rotavirus

⑧ Giardia lamblia

⑨ It is caused by parasites such as Entamoeba histolytica, and protozoal infectious diseases.

Symptoms, signs of traveler’s diarrhea

• May be accompanied by vomiting, diarrhea and abdominal pain, fever, dehydration, mucous stools, and bloody stools. Prevention of traveler’s diarrhea

• Do not consume food or drink contaminated with the pathogens listed above.

• Do not eat drinking water from taps, food cooked with such water, do not eat ice or ice water, eat unpeeled fruit or uncooked fish food. • Pasteurized milk, licensed bottled beverages and soda water are safe to drink.

• Proper hand washing before eating is also an important preventive measure. Treatment of traveler’s diarrhea • If mild traveler’s diarrhea begins, oral glucose pronuclear fluid rehydration therapy will be started soon.

• Take the powder for oral rehydration electrolyte solution before going on a trip and use it when necessary.

• Powders for oral rehydration electrolyte solutions are now available in almost any country without a doctor’s prescription.

• Sports hydration solutions, fruit juices, and soda water contain a lot of sugar, so they are not suitable for hydration or rehydration treatments.

• Intravenous glucose electrolyte hydration treatment is given when vomiting prevents oral glucose electrolyte hydration treatment solutions.

• Otherwise, a small amount of oral hydration therapy electrolyte solution may be given orally to treat. Follow your doctor’s instructions to the last. Examples of how to use oral glucose electrolyte solution hydration for traveler’s diarrhea

• Rehydration treatment can be done with a spoon or dropper about 1~5cc per minute.

• Of course, adjust the amount appropriately depending on your age, weight, and degree of dehydration.

• For example, if you are very dehydrated, take 30 to 45 cc per 450 g of body weight orally within 2 to 4 hours for rehydration treatment. Antibiotic treatment for traveler’s diarrhea

• In general, an antibiotic called Azithromycin is commonly used to treat pediatric traveler’s diarrhea, and Ciprofloxacin or Levofloxacin is used to treat adult traveler’s diarrhea.

• If azithromycin has side effects, replacement treatment with fluoroquinolone can be given. • As the bacteria that cause traveler’s diarrhea are highly resistant to MP/SMX (Trimethoprim/sulfamethoxazole), these antibiotics are not commonly used these days.

• Treatment with probiotics such as Lactobacillus GG is effective in treating diarrhea related to Rotavirus infection. However, it is not widely used.

• It is also treated with Rifampin, which is recently known as a new drug. • Bismuth subsalicylate and Loperamide can be used to treat adult traveler’s diarrhea, but Loperamide should not be used to treat pediatric traveler’s diarrhea.

• Bismuth subsalicylate (Pepto-bismus) can be used to treat pediatric traveler’s diarrhea. • When visiting a foreign country, it would be a good idea to take a trip with a doctor’s prescription to prevent traveler’s diarrhea and take appropriate medications to cure the disease if it occurs.

출처 및 참조 문헌 Sources and references

• NelsonTextbook of Pediatrics 22ND Ed
• The Harriet Lane Handbook 22ND Ed
• Growth and development of the children
• Red Book 32^nd Ed 2021-2024
• Neonatal Resuscitation, American Academy Pediatrics

• www.drleepediatrics.com제7권. 소아청소년 감염병
• Red book 29th-31st edition 2021
• Nelson Text Book of Pediatrics 19^{th –} 21st Edition
• The Johns Hopkins Hospital, The Harriet Lane Handbook, 22nd edition

• Childhood Emergencies in the Office, Hospital and Community, American Academy of Pediatrics
• Emergency Medical Service for Children, By Ross Lab. May 1989. p.10
• Emergency care, Harvey grant, and Robert Murray
• Emergency Care Transportation of Sick and Injured American Academy of Orthopaedic Surgeons
• Emergency Pediatrics A Guide to Ambulatory Care, Roger M. Barkin, Peter Rosen
• Immediate care of the acutely ill and injured, Hugh E. Stephenson, Jr
• The Critically Ill Child, Diagnosis and Management, Edited by Clement A. Smith
• Emergency Medical Services for Children: The Role of the Primary Care Provider, America Academy of Pediatrics
• Quick Reference To Pediatric Emergencies, Delmer J. Pascoe, M.D., Moses Grossman, M.D. with 26 contributors
• Manual of Emergency Care
• 응급환자관리 정담미디어
• 소아가정간호백과–부모도 반의사가 되어야 한다, 이상원
• Neonatal Resuscitation American heart Association
• Neonatology Jeffrey J.Pomerance, C. Joan Richardson
• Pediatric Resuscitation Pediatric Clinics of North America, Stephen M. Schexnayder, M.D.
• Pediatric Critical Care, Pediatric Clinics of North America, James P. Orlowski, M.D.
• Preparation for Birth. Beverly Savage and Dianna Smith
• Infectious disease of children, Saul Krugman, Samuel L Katz, Ann A. Gershon, Catherine Wilfert
• The Harriet Lane Handbook 19th Edition
• 소아과학  대한교과서
• 제1권 소아청소년 응급의료 참조문헌과 출처
• Other

Copyright ⓒ 2015 John Sangwon Lee, MD., FAAP

“부모도 반의사가 되어야 한다”-내용은 여러분들의 의사로부터 얻은 정보와 진료를 대신할 수 없습니다.

“The information contained in this publication should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your doctor may recommend based on individual facts and circumstances. “Parental education is the best medicine.”