Summary
Definition
History and exam
Key diagnostic factors
- diarrhea (with or without tenesmus), cramping, nausea, and vomiting
- dysentery (blood and fever)
- persistent diarrhea >14 days
Other diagnostic factors
- diarrhea without illness
Risk factors
- travel to a high-risk destination
- age <30 years
- decreased stomach acidity
- prior TD susceptibility
- chronic disease, immunocompromise
- travelers 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
- multipathogen molecular diagnostic (polymerase chain reaction)
- stool ova and parasite exam
Investigations to consider
- protozoal stool antigens
- Clostridium difficile stool toxin
- colonoscopy, endoscopy, and biopsy
- hematology, blood chemistries, serology
Treatment algorithm
pre-travel prophylaxis
nonpregnant adults: mild diarrhea
nonpregnant adults: moderate diarrhea
nonpregnant adults: severe diarrhea
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 traveler's diarrhea 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 traveler's diarrhea for the ISTM, ACG, and the 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
- Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report
More GuidelinesPatient leaflets
Diarrhea in adults
More Patient leaflets
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