Reisediarrhö

Zusammenfassung

Die Reisediarrhö ist die häufigste Reise-assoziierte Krankheit. Die Inzidenz hängt stark vom Reiseziel ab und variiert zwischen ca. 2,5 % (Nordamerika, Australien) und rund 30 % (Afrika). Kinder sind deutlich häufiger betroffen als Erwachsene. Kleinkinder haben mit durchschnittlich 40 % Durchfallhäufigkeit in den beiden ersten Urlaubswochen das Maximum aller Altersgruppen. Die Reisediarrhö ist eine klassische fäkal-orale Infektion. Das Erregerspektrum unterscheidet sich erheblich zwischen den Urlaubsregionen. Enterotoxische E. coli, Campylobacter, Salmonellen, Shigellen, Rotaviren und Noroviren sind die häufigsten Verursacher bei Erwachsenen. Dass bei Kindern eine Reisediarrhö häufig durch Rotaviren verursacht wird, wird vermutet, ist aber nicht bewiesen. Während die Reisediarrhö bei Erwachsenen meist eine benigne und selbstlimitierende Erkrankung ist, sind bei Kindern schwere und protrahierte Verläufe häufig. Für eine Selbsttherapie am Urlaubsort sind eine orale Rehydrationslösung und Probiotika optimal. Bei Jugendlichen kann mit einer Einmaldosis eines Motilitätshemmers im Notfall ein Reisetag überbrückt werden, an dem nur ein beschränkter Zugang zu einer Toilette besteht. Eine spezifische präventive Maßnahme ist die Rotavirusimpfung. In Ermangelung anderer effektiver präventiver Maßnahmen spielt die Expositionsprophylaxe die entscheidende Rolle. Diese bedingt eine ausführliche Beratung der Eltern durch den Pädiater vor Reiseantritt.

Summary

Travellers diarrhoea is the most frequent travel-associated disease. The incidence largely depends on the travel destination and varies between ca. 2.5 % (North America, Australia) and about 30 % (Africa). Children are significantly more often affected than adults. With a two-week incidence of 40 %, small children have the highest disease burden of all age groups. Travellers diarrhoea is a classical faecal-oral infection. The spectrum of infectious agents varies between travel destinations. Enterotoxic E. coli, campylobacter, salmonella, shigella, rotavirus and norovirus are the most frequently isolated pathogens in adult travellers. The assumption that rotavirus is a frequent cause of travellers diarrhoea in children needs to be ascertained. Whereas in adults travellers diarrhoea is usually a self-limiting and benign disease, in children a severe and prolonged disease is common. Oral rehydration fluid and probiotics are optimal for self-medication during a travel. In adolescents, a single dose of an antimotility agent can be administered as an emergency measure during a day with limited access to a toilet. Due to the lack of other effective preventive measures, exposure prophylaxis is essential. The paediatricians should instruct parents how to avoid exposure in a comprehensive counseling interview before the departure.

Schlüsselwörter

Reisediarrhö - Epidemiologie - Ätiologie - Therapie - Prävention

Keywords

Travellers diarrhoea - epidemiology - etiology - therapy - prevention

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