Review of the causes and management of chronic gastrointestinal symptoms in returned travellers referred to an Australian infectious diseases service.

ABSTRACT

BACKGROUND: Thirty to seventy per cent of overseas travellers experience traveller's diarrhoea (TD), a potential cause of serious gastrointestinal (GI) sequelae. However, there is limited evidence on the optimal management of TD. OBJECTIVE: The objectives of this article are to characterise the aetiologies and management of returned travellers with ongoing GI symptoms referred to a specialist infectious diseases service. METHODS: We conducted a retrospective medical record review of patients referred to the Victorian Infectious Disease Service (VIDS) in 2013-15 with a history of overseas travel and GI symptoms present for longer than two weeks. For each diagnostic group, we compared demographic and travel characteristics, illness course, investigation results, and number of and response to treatments. RESULTS: The most common diagnosis was parasitic infection (31 out of 65 patients). Referral was made for infection with a controversial or uncommon organism; negative microbiological findings +/- failed metronidazole treatment; or severe or prolonged infections. DISCUSSION: Our results highlight the utility of ordering more than one faecal specimen for oocytes, cysts and parasites (O/C/P) examination, potential benefits of tinidazole use, and role of specialist services for uncertain diagnoses and complex and/or unusual organ-isms.