Traveler's diarrhea

Traveler's diarrhea causes abdominal cramps and diarrhea. Fever, vomiting, severe abdominal pain, and bloody diarrhea are present in some cases. The highest risk factor for travelers is likely to be the poor hygiene practices in local restaurants.

CASES/YEAR
15,750,000 (US); 315,000,000 (Global)
CATEGORY
AGENT TYPE
Mixed
OTHER NAMES
Turista
ACUITY
Acute-Moderate
INCUBATION
Onset 5-15 days after arrival; [ABX Guide]
INITIAL SYMPTOMS
Abdominal cramps and diarrhea; Fever, vomiting, severe abdominal pain, and bloody diarrhea are present in some cases. [CDC Travel, p. 115]
PRECAUTIONS
COMMENTS
About 80-90% of cases are caused by bacteria and 5-8% by viruses. Protozoa cause about 10% of cases in longer-term travelers. Enterotoxigenic Escherichia coli (ETEC) are the most common cause. "Antibiotics are effective in reducing the duration of diarrhea by about a day in cases caused by bacterial pathogens that are susceptible to the particular antibiotic prescribed." [CDC Travel, p. 115-8] Most patients have noninflammatory diarrhea. Low-grade fever is present in about 1/3. In a 2 week visit, about 50% of tourists to a tropical country develop traveler's diarrhea. Preventive measures (hand washing, water purification, and eating hot foods) may reduce the attack rate to 15%. [PPID, p. 1351-2]
DIAGNOSTIC
Often diagnosed clinically; O&P for infections >14 days; Stool cultures if dysentery, hospitalized, symptoms >7 days, or failure of empiric therapy; [ABX Guide]
SCOPE
"Poor hygiene practice in local restaurants is likely the largest contributor to the risk for TD." [CDC Travel, p. 114]
SIGNS & SYMPTOMS
  • >arthralgia
  • >fatigue, weakness
  • >fever
  • >myalgia
  • G abdominal pain
  • G blood in stool
  • G diarrhea
  • G fecal leukocytes
  • G nausea, vomiting
  • N headache
  • *arthritis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Ingestion
SOURCE
Human Fecal-Oral, Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Infected or Toxin-Containing Fish, Eating Contaminated Mollusks or Crustacean, Eating Unpasteurized Milk or Cheese, Eating Contaminated Produce, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Human
RISK FACTORS
  • Swim in contaminated water (ingestion or inhalation)
  • Travel to endemic area
REFERENCES FOR CASES/YEAR
1. (US) cases/yr = 1/20 X global cases/yr;
2. (Global) 20-50% of international travelers develop diarrhea; [Gorbach, p. 388] "More than 900 million international journeys are undertaken every year." [WHO website] Calculate: 35% x 900 million = 315 million (worldwide);