Traveller's diarrhoea
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
Other diagnostic factors
- diarrhoea without illness
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
pre-travel prophylaxis
non-pregnant adults: mild diarrhoea
non-pregnant adults: moderate diarrhoea
non-pregnant adults: severe diarrhoea
pregnant
children
Contributors
Authors
Mark Riddle, MD, MPH&TM, DrPH, C Trop Med, Certificate in Travel Health
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. MR is an author of several references cited in this topic.
Acknowledgements
Dr Mark Riddle would like to gratefully acknowledge Professor Gregory Juckett, the previous contributor to this topic.
Disclosures
GJ declares that he has no competing interests.
Peer reviewers
Andrea Summer, MD
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
Disclosures
AS declares that she has no competing interests.
Phil Fischer, MD
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.
Differentials
- Irritable bowel syndrome
- Secondary disaccharidase (or other dietary) deficiency
- Malabsorptive conditions
More DifferentialsGuidelines
- CDC Yellow Book: travelers' diarrhea
- 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea
More GuidelinesPatient leaflets
Diarrhoea in adults
More Patient leaflets
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