II. Epidemiology
- Incidence: 20-50% per short visit to endemic area (affects 10 million patients annually)
- Timing
- Peak Incidence for travelers from U.S. in October and June
- Ages affected
- Most common among younger patients (children, teens and young adults)
- Endemic Regions
- Developing countries in Africa, South Asia, Latin America, Middle East
- Highest risk countries
- Kenya
- Tunisia
- Morocco
- Egypt
- Mexico
- Honduras
- Thailand
- India
III. Risk Factors
- Lowered gastric pH from Antacid use (H2 Blocker, Proton Pump Inhibitor)
- Travel to endemic regions as above
- Younger age (children and young adults)
- Immunosuppression (e.g. Inflammatory Bowel Disease, Diabetes Mellitus)
- Participation in low-budget travel or adventure vacations
- Visiting family or friends in endemic regions
- Contaminated food exposure
- See Foodborne Illness
- Food washed in tap water (e.g. fresh fruit and raw vegetables)
- Food from street vendors (food storage without cooling, washed in tap water, unsafe hygiene)
- Salads and unpealed fruit or vegetables
- Raw seafood or meats
- Custard or cream dessert
- Contaminated water exposure
- See Waterborne Illness
- Tap water (including ice)
- Frozen drinks
IV. Course
- Onset in first two weeks of travel (usually first week)
- Duration: Short
- Medical Care
- Local physician seen in 4% of Traveler's Diarrhea
- Hospitalization in <1% of Traveler's Diarrhea
V. Symptoms
VI. Causes: Acute Diarrhea (<14 days)
- No cause is identified in up to 50% of Acute Diarrhea cases
- Incubation Periods
- Most common Bacteria
- Escherichia coli (most common)
- Enterotoxigenic E. coli (up to 36% in Latin america, Carribean and Africa)
- Enteroaggregative E. coli (Up to 25-35% in Latin america, Carribean and Africa)
- Enteroadherent E. coli (5%)
- Enteroinvasive E. coli (3%)
- Campylobacter jejuni (Up to 25-35% in Asia, <5% in Africa, Latin America)
- Shigella (5-15%)
- Escherichia coli (most common)
- Other Bacterial and viral causes
- Nontyphoidal Salmonella (5%)
- Rotavirus (5-15%)
- Vibrio parahaemolyticus (esp. seafood, 2%)
- Parasitic causes
- See Chronic Diarrhea causes below (which may present acutely)
- Entamoeba histolytica (2%)
- Giardia lamblia (<5%)
- Cryptosporidium
- Microsporidium species
VII. Causes: Chronic Diarrhea (>14 days)
- Cyclospora
- Cryptosporidium
- Giardia lamblia
- Cysticercosis (pork)
- Hookworm (barefoot)
- Cystoisospora or Isospora belli (esp. HIV)
VIII. Differential Diagnosis
IX. Labs
- Not indicated in most cases of Traveler's Diarrhea
- Lab Indications (red flag findings)
- Fever > 101.3 F (38.5 C)
- Suggestive of Shigella, Salmonella, Campylobacter, Norovirus
- Bloody Diarrhea or Dysentery
- Moderate to severe Dehydration (e.g. Cholera-like Diarrhea)
- Sepsis
- Chronic Diarrhea (>14 days)
- Fever > 101.3 F (38.5 C)
- Labs when indicated
- Complete Blood Count
- Comprehensive metabolic panel
- Blood Cultures (indicated for fever)
- Stool Cultures (e.g. SSCE) or Stool Nucleic Acid (NAAT)
X. Management
XI. Prevention
XII. Complications
- Chronic postinfectious Irritable Bowel Syndrome in 3-17% of cases
XIII. Prognosis: Course
- Most cases of Traveler's Diarrhea are self limited and last <5 days without Antibiotics
XIV. Resources
XV. References
- Wayman (2017) Crit Dec Emerg Med 31(6): 3-10
- (2005) Med Lett Drugs Ther 40(1025): 47 [PubMed]
- Steffen (2015) JAMA 313(1): 71-80 +PMID:25562268 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Disease or Syndrome (T047) |
SnomedCT | 186165000, 367091004, 11840006 |
English | Travelers' diarrhea, Travellers' diarrhoea, Traveller's diarrhea, Traveller's diarrhoea, traveller's diarrhoea, traveller's diarrhea, diarrhea travelers, turista, diarrhea traveler's, diarrhea travelers', diarrhoea travellers, travelers' diarrhea, traveler's diarrhea, Travellers' diarrhoea (disorder), Travellers' diarrhea, Traveler's diarrhea, Turista, Traveler's diarrhoea, Traveler's diarrhea (disorder) |
Dutch | reizigersdiarree |
French | Diarrhée du voyageur |
German | Reisediarrhoe |
Italian | Diarrea del viaggiatore |
Portuguese | Diarreia do viajante |
Spanish | Diarrea del viajero, diarrea del viajero (trastorno), diarrea del viajero, turista |
Japanese | 旅行者下痢, リョコウシャゲリ |
Czech | Průjem cestovatelů |
Hungarian | utazók hasmenése |