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Traveler's DiarrheaAka: Turkey Trots, Montezuma's Revenge, Delhi Belly

See Also
Epidemiology
1. Incidence: 20-50% per short visit to endemic area
2. Endemic Regions: Developing countries
  1. Africa
  2. South Asia
  3. Latin America
  4. Middle East
Risk Factors
1. Lowered gastric pH from antacid use (H2 Blocker, PPI)
2. Travel to endemic regions as above
3. Younger age
4. Contaminated food or water exposure
  1. See Foodborne Illness
  2. See Waterborne Illness
Course
1. Onset in first two weeks of travel (usually first week)
2. Duration: Short
  1. Diarrhea lasts <24 hours in 20% of cases
  2. Diarrhea lasts 2-7 days in 60% of cases
  3. Diarrhea lasts >1 week in <15% of cases
  4. Longer duration associated with age under 29 years
3. Medical Care
  1. Local physician seen in 4% of traveler's Diarrhea
  2. Hospitalization in <1% of traveler's Diarrhea
Symptoms
1. Three or more loose stools per day
2. Abdominal cramping (20-60% cases)
3. Bloody stools (15%)
4. Fever (10%)
5. Nausea or Vomiting (10%)
6. Tenesmus
Etiology
1. Escherichia coli
  1. Enterotoxigenic E. coli (36%)
  2. Enteroadherent E. coli (5%)
  3. Enteroinvasive E. coli (3%)
2. Campylobacter jejuni (3%)
3. Shigella (4%)
4. Nontyphoidal Salmonella (1%)
5. Rotavirus (2%)
6. Enteroviruses, parasite
7. Entamoeba histolytica (2%)
8. Cryptosporidium
9. Isospora belli
10. Giardia lamblia (2%)
11. Vibrio parahaemolyticus (seafood) (2%)
12. Cysticercosis (pork)
13. Hookworm (barefoot)
Differential Diagnosis
1. Food Poisoning
Management
1. See Traveler's Diarrhea Prophylaxis
2. See Traveler's Diarrhea Management
Prevention
1. Traveler's Diarrhea Prevention

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:13:10 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.