Traveler's diarrhea is a common problem among travelers, typically caused by the consumption of contaminated food or water. Predominantly caused by bacteria.
Prevention strategies include careful selection of food and beverages, though these are not fail-safe. Prophylactic antibiotics are not recommended for most travelers.
Management is self-diagnosis while still traveling, followed by hydration, medications for symptom relief, and possibly, antibiotics. Antibiotic therapy is generally reserved for moderate to severe infections.
In healthy patients, resolution is typically within 3 to 5 days even without antibiotic treatment.
Traveler's diarrhea (TD) is defined as ≥3 unformed stools in 24 hours accompanied by at least 1 of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a low- or middle-income country. It is usually a benign self-limited illness lasting 3 to 5 days.
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
- 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
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
nonpregnant adults: mild diarrhea
nonpregnant adults: moderate diarrhea
nonpregnant adults: severe diarrhea
- Irritable bowel syndrome
- Secondary disaccharidase (or other dietary) deficiency
- Malabsorptive conditions
- CDC Yellow Book: travelers' diarrhea
- Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report
Diarrhea in adultsMore Patient leaflets
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