II. Epidemiology

  1. Incidence: 20-50% per short visit to endemic area (affects 10 million patients annually)
  2. Endemic Regions: Developing countries
    1. Africa
    2. South Asia
    3. Latin America
    4. Middle East

III. Risk Factors

  1. Lowered gastric pH from Antacid use (H2 Blocker, PPI)
  2. Travel to endemic regions as above
  3. Younger age (children and young adults)
  4. Immunosuppression (e.g. Inflammatory Bowel Disease, Diabetes Mellitus)
  5. Contaminated food or water exposure
    1. See Foodborne Illness
    2. See Waterborne Illness

IV. 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. Diarrhea lasts >4 weeks in <2% of cases
    5. 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

V. 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

VI. Causes: Acute Diarrhea

  1. Most common Bacteria
    1. Escherichia coli (most common)
      1. Enterotoxigenic E. coli (36%)
      2. Enteroadherent E. coli (5%)
      3. Enteroinvasive E. coli (3%)
    2. Campylobacter jejuni (3%)
    3. Shigella (4%)
  2. Other Bacterial and viral causes
    1. Nontyphoidal Salmonella (1%)
    2. Rotavirus (2%)
    3. Vibrio parahaemolyticus (seafood) (2%)
  3. Parasitic causes
    1. See Chronic Diarrhea causes below (which may present acutely)
    2. Entamoeba histolytica (2%)
    3. Giardia lamblia (2%)

VII. Causes: Chronic Diarrhea

VIII. Differential Diagnosis

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Ontology: Traveler's diarrhea (C0277528)

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