Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- diarreia (com ou sem tenesmo), cólicas, náuseas e vômitos
- disenteria (sangue e febre)
- diarreia persistente por >14 dias
Other diagnostic factors
- diarreia sem doença
Risk factors
- viagem para um destino de alto risco
- idade <30 anos
- uso de inibidor da bomba de prótons
- viajantes com residência prévia em um local de alto risco visitando amigos e parentes
- viagem durante estações quentes e úmidas
- populações de militares destacados
- falta de cautela na seleção de alimentos e água
Diagnostic investigations
1st investigations to order
- coprocultura e sensibilidade
- diagnóstico molecular de vários patógenos (reação em cadeia da polimerase)
- antígenos de fezes para protozoários
Investigations to consider
- exame de ovos e parasitas nas fezes
- Toxina do Clostridioides difficile nas fezes
- colonoscopia, endoscopia e biópsia
- hematologia, química sanguínea, sorologia
Treatment algorithm
profilaxia antes da viagem
adultos não gestantes: diarreia leve
adultas não gestantes: diarreia moderada
adultos não gestantes: diarreia grave
gestante
crianças
Contributors
Authors
Daniel T. Leung, MD, MSc
Associate Professor
Division of Infectious Diseases
University of Utah School of Medicine
Salt Lake City
UT
Disclosures
DTL receives authorship royalties from UpToDate, Inc, for a chapter on travel medicine. DTL is an author of upcoming chapters on traveller's diarrhoea for the US CDC Yellow Book. DTL is the president-elect of the American Committee on Clinical Tropical Medicine and Travelers' Health - Clinical Group within the American Society of Tropical Medicine and Hygiene. DTL is an author of some of the references cited in this topic.
Jakrapun Pupaibool, MD, MS
Associate Professor
Division of Infectious Diseases
University of Utah School of Medicine
Salt Lake City
UT
Disclosures
JP declares that he has no competing interests.
Acknowledgements
Dr Daniel T. Leung and Dr Jakrapun Pupaibool would like to gratefully acknowledge Dr Mark Riddle and Professor Gregory Juckett, the previous contributor to this topic.
Disclosures
MR has given talks on the management of traveller's diarrhoea for the International Society of Travel Medicine (ISTM), the CDC Foundation, the American College of Gastroenterology (ACG), and the American College of Preventive Medicine. MR has led the development of guidelines for traveller's diarrhea for the ISTM, the ACG, and the Department of Defense. This work has been unpaid but support for travel has been accepted. MR is employed with Pfizer Inc., and is working on their Lyme disease vaccine programme. While this is not in conflict with traveller’s diarrhoea, Pfizer also makes azithromycin, which is an antibiotic recommended for the treatment of traveller’s diarrhoea. MR does not work in the area of Pfizer that develops, markets, or distributes azithromycin. MR is an author of several references cited in this topic. 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl 1):S57-74.Full text Abstract
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 2: preparing international travelers - travelers’ diarrhea. May 2023 [internet publication].Full text
De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea. Cochrane Database Syst Rev. 2000;(3):CD002242.Full text Abstract
Johnson PC, Ericsson CD, DuPont HL, et al. Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. JAMA. 1986 Feb 14;255(6):757-60. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Intoxicação alimentar
- Síndrome do intestino irritável
- deficiência secundária de dissacaridase (ou outra deficiência alimentar)
More DifferentialsGuidelines
- CDC Yellow Book 2024: travelers' diarrhea
- 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea
More GuidelinesPatient information
Diarreia em adultos
More Patient information
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