Prophylaxis for travelers' diarrhea

Salmonella infection of breast implant associated with traveler's diarrhea: A case report

We present the first case of traveler's diarrhea resulting in breast implant infection. An otherwise healthy 34-year-old female underwent breast augmentation. Five months later, while vacationing in Cancun, Mexico, she developed abdominal pain and diarrhea that progressed to include fevers and chills. Her symptoms persisted until she returned to the United States, at which point her primary care physician evaluated her on the fourth day of her illness. An abdominal CT scan was unremarkable; however, a complete metabolic panel demonstrated elevated transaminases. Her symptoms soon resolved without treatment. Fourteen days after symptom resolution, the patient developed right breast pain. She was evaluated in the surgical clinic where the breast was tender to palpation, swollen and without erythema. An ultrasound demonstrated a small amount of homogenous fluid surrounding the implant. She was prescribed amoxicillin–clavulanate 875–125 mg BID; however, she presented three days later with worsening pain, swelling and new erythema. She was taken to the operating room, where the abscess was incised, drained and the implant removed. Cultures grew Salmonella serogroup C. Patients should be counseled regarding the potential for hematogenous seeding of the breast cavity and implant following severe illness and bacteremia. It may be reasonable to provide patients with breast implants who are traveling to areas at high-risk for traveler's diarrhea or areas with limited medical resources with an antibiotic to take if moderate to severe symptoms of traveler's diarrhea were to develop while away.

Gastrointestinal Prophylaxis in Sports Medicine

Context:

Because sports participation at all levels often requires international travel, coaches, athletic trainers, and team physicians must effectively protect athletes from gastrointestinal infections. Traveler’s diarrhea is the most common travel-related illness and can significantly interfere with training and performance.

Evidence Acquisition:

A review of relevant publications was completed using PubMed and Google Scholar.

Study Design:

Clinical review.

Level of Evidence:

Level 5

Results:

Enterotoxigenic and enteroaggregative Escherichia coli are the most common bacterial causes of traveler’s diarrhea. Traveler’s diarrhea generally occurs within 4 days of arrival, and symptoms tend to resolve within 5 days of onset. There are several prophylactic agents that physicians can recommend to athletes, including antibiotics, bismuth subsalicylate, and probiotics; however, each has its own unique limitations. Decision-making should be based on the athlete’s destination, length of stay, and intent of travel.

Conclusion:

Prophylaxis with antibiotics is highly effective; however, physicians should be hesitant to prescribe medication due to the side effects and risks for creating antibiotic-resistant bacterial strains. Antibiotics may be indicated for high-risk groups, such as those with a baseline disease or travelers who have little flexible time. Since most cases of traveler’s diarrhea are caused by food and/or water contamination, all athletes should be educated on the appropriate food and water consumption safety measures prior to travel.