Traveler's diarrhea

Last reviewed: 21 Apr 2022
Last updated: 02 Jul 2021

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
More key diagnostic factors

Other diagnostic factors

  • diarrhea without illness
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • stool culture and sensitivity
  • stool occult blood
  • multipathogen molecular diagnostic (polymerase chain reaction)
  • stool ova and parasite exam
More 1st investigations to order

Investigations to consider

  • protozoal stool antigens
  • Clostridium difficile stool toxin
  • colonoscopy, endoscopy, and biopsy
  • hematology, blood chemistries, serology
More investigations to consider

Treatment algorithm

INITIAL

pre-travel prophylaxis

ACUTE

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 Differentials
  • Guidelines

    • CDC Yellow Book: travelers' diarrhea
    • Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report
    More Guidelines
  • Patient leaflets

    Diarrhea in adults

    More Patient leaflets
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