Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- diarrhoea (with or without tenesmus), cramping, nausea, and vomiting
- dysentery (blood and fever)
- persistent diarrhoea >14 days
Risk factors
- travel to a high-risk destination
- age <30 years
- decreased stomach acidity
- prior TD susceptibility
- chronic disease, immunocompromise
- travellers with prior residence in developing country visiting friends and relatives
- travel during hot and wet seasons
Diagnostic investigations
1st investigations to order
- stool culture and sensitivity
- stool occult blood
- multi-pathogen molecular diagnostic (polymerase chain reaction)
- stool ova and parasite examination
Investigations to consider
- protozoal stool antigens
- Clostridium difficile stool toxin
- colonoscopy, endoscopy, and biopsy
- haematology, blood chemistries, serology
Treatment algorithm
Contributors
Authors
Professor and Chair
Department of Preventive Medicine & Biostatistics
Uniformed Services University of the Health Sciences
Bethesda
MD
Disclosures
MR has given talks on the management of traveller's diarrhoea for the International Society of Travel Medicine (ISTM), CDC Foundation, American College of Gastroenterology (ACG), and American College of Preventive Medicine. MR has led the development of guidelines for traveller's diarrhoea for the ISTM, ACG, and the US Department of Defense. This work has been unpaid but support for travel has been accepted.
Dr Mark Riddle would like to gratefully acknowledge Professor Gregory Juckett, the previous contributor to this topic.
Peer reviewers
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
Disclosures
AS declares that she has no competing interests.
Professor of Pediatrics
Department of Pediatric and Adolescent Medicine
Mayo Clinic
Rochester
MN
Disclosures
PF is an author of a reference cited in this topic.
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