As per definition, TD comprises the passage of three or more unformed stools within 24 hours and at least one of the following symptoms: fever, nausea and vomiting, abdominal pain or cramps, fecal urgency, tenesmus, mucoid stools or hematochezia [8]. Borborygmi and bloating are often reported. Despite the frequent elimination of watery stools, TD is rarely severe enough to cause dehydration. However, dehydration may be observed in hot climates and patients who don't take the appropriate measures to rehydrate.

Although disease severity varies largely, most cases are self-limiting within three to five days [4]. Though, in up to 3% of cases, symptoms may persist for more than a month. If differential diagnoses are ruled out, these patients may possibly be diagnosed with post-infectious irritable bowel syndrome [9].

• Pain

  When to See a Healthcare Provider If diarrhea is bloody, or if you have a fever or abdominal pain, see a healthcare provider immediately. Do not take over-the-counter drugs. [webmd.com]

  The presence of fever, bloody stool, abdominal pain, or profound dehydration indicates a more severe infection requiring medical attention. [ncbi.nlm.nih.gov]

  Travelers who ingest contaminated food or drink may experience a range of symptoms, including watery diarrhea, nausea, vomiting, fever, and abdominal pain, that can last for 3-7 days. [winchesterhospital.org]

  This can cause symptoms such as: Long-term diarrhea Belly pain and cramping Bloating What can I do to prevent traveler's diarrhea? You can take steps to prevent traveler's diarrhea. [hopkinsmedicine.org]

• Malaise

  Other commonly associated symptoms are nausea, vomiting, diarrhea, abdominal cramping, bloating, low fever, urgency, and malaise, and usually the appetite is low or non-existent. [web.archive.org]

  The typical symptoms of traveler’s diarrhea include: Abrupt onset of diarrhea Nausea and vomiting Bloating Urgent need to have a bowel movement Malaise (weakness or discomfort) Explosive and painful gas Cramps Loss of appetite Traveler’s diarrhea usually [my.clevelandclinic.org]

  Travelers’ diarrhea refers to an acute illness of sudden onset with watery diarrhea, abdominal cramps, mild nausea without much vomiting, and general malaise. [washington.providence.org]

  Please contact our office upon returning from your travel if you are experiencing any discomfort such as abdominal complaints, fever, malaise, feeling weak or tired. [travelandhealth.com]

• Fatigue

  TD starts suddenly and in addition to diarrhea may include fever, vomiting, stomach cramps and fatigue. Most cases of TD last only a few days and are not life threatening, though some cases may last up to a month. [pennmedicine.org]

  Salmonella bacteria, one of many causes of travelers’ diarrhea Here are some warning signs; you should see a doctor if you have any of these high fever severe abdominal pain severe vomiting unable to eat/drink mucous-bloody stool fainting, severe fatigue [thaitravelclinic.com]

  A normal course of traveler's diarrhea lasts about 3 to 7 days, and may be accompanied by: nausea bloating urgency fatigue loose, watery stools Recommendations: Prevention of traveler's diarrhea: You can decrease your risk of developing traveler's diarrhea [childrensal.org]

  Symptoms The symptoms of traveler's diarrhea include: Abdominal pain Cramping Feeling bloated Continual feeling of needing to use the bathroom Nausea Loose, watery stools Fatigue Slight fever Rehydration tips The biggest problem with diarrhea is dehydration [worldnomads.com]

  So do simple things like jet lag, fatigue and a change of environment. [web.archive.org]

• Disability

  […] is committed to providing equitable, culturally competent care to all individuals served, regardless of race, age, sex, color, national origin, religion, height, weight, marital status, political affiliation, sexual orientation, gender identity, or disability [kalcounty.com]

  Severe diarrhea is diarrhea that is disabling or completely prevents planned activities. [urmc.rochester.edu]

  […] pseudomembranous colitis and its associated severe, unrelenting diarrhea.Antibiotic may be warranted in special situations where benefits outweigh the above risks, such as immunocompromised travelers, chronic intestinal disorders, prior history of repeated disabling [en.wikipedia.org]

  Self-Diagnosis and Self-Treatment The decision to self-treat depends on the severity of the functional disability caused by TD. Increased fluid intake is necessary to correct dehydration. [tripprep.com]

  Prophylaxis should be used only in travelers who are immunocompromised and in those with chronic intestinal disorders or a history of disabling bouts of TD. [uspharmacist.com]

• Diarrhea

  Acute diarrhea is the most common illness among travelers. [aafp.org]

  Travel destination is the most significant risk factor for traveler's diarrhea. The efficacy of pretravel counseling and dietary precautions in reducing the incidence of diarrhea is unproven. [ncbi.nlm.nih.gov]

  Aemcolo was not shown to be effective in patients with diarrhea complicated by fever and/or bloody stool or diarrhea due to pathogens other than noninvasive strains of E. coli and is not recommended for use in such patients. [fda.gov]

• Nausea

  Other frequent stomach ailments, including nausea, upset stomach, indigestion, and heartburn caused by food or drink, also can spoil a trip. [pepto-bismol.com]

  Although nausea after dosing is uncommon, it is more frequently associated with azithromycin than with levofloxacin. [ncbi.nlm.nih.gov]

  Nausea, vomiting, abdominal cramping, and diarrhea can occur with any degree of severity. The diagnosis is usually based on the doctor's evaluation, but sometimes stool is tested for organisms. [msdmanuals.com]

  We also found that azithromycin administered in a single 1000-mg dose caused more postdose nausea than did levofloxacin administered at a dose of 500 mg, but associated nausea was rare (occurring in 7.6% of patients). [doi.org]

• Abdominal Cramps

  Watery and persistent diarrhea, fever, and abdominal cramps were common complaints. [ncbi.nlm.nih.gov]

  Travelers' diarrhea is defined as three or more unformed stools in 24 hours, commonly accompanied by abdominal cramps, nausea and bloating. [medical-dictionary.thefreedictionary.com]

• Abdominal Pain

  The presence of fever, bloody stool, abdominal pain, or profound dehydration indicates a more severe infection requiring medical attention. [ncbi.nlm.nih.gov]

  When to See a Healthcare Provider If diarrhea is bloody, or if you have a fever or abdominal pain, see a healthcare provider immediately. Do not take over-the-counter drugs. [webmd.com]

  Dehydration, the primary risk of turista The symptoms of traveler’s diarrhea generally appear in the very first days of a trip: multiple evacuations of liquid stool (at least 3 times per day), often along with nausea, abdominal pain, and loss of appetite [biocodexmicrobiotainstitute.com]

• Acute Diarrhea

  The use of nonspecific antidiarrheals, especially loperamide, is safe for most cases of acute diarrhea. [web.archive.org]

  Abstract Stool specimens from 124 international travelers with acute diarrhea were tested for the presence of enteropathogens. [ncbi.nlm.nih.gov]

• Tinnitus

  In some cases it can cause constipation, nausea and, rarely, ringing in your ears (tinnitus). [mayoclinic.org]

  BSS commonly causes blackening of the tongue and stools and can cause nausea, constipation, and tinnitus. [uspharmacist.com]

  BSS commonly causes blackening of the tongue and stool and may cause nausea, constipation, and rarely tinnitus. [wwwnc.cdc.gov]

  In some cases it can cause constipation, nausea and, rarely, ringing in your ears (tinnitus). Treatment Traveler's diarrhea may get better without any treatment. [drugs.com]

• Irritability

  Abstract A total of 564 travelers were enrolled in a study aimed at investigating the influence of traveler's diarrhea in the development of irritable bowel syndrome. [ncbi.nlm.nih.gov]

  Although not statistically significant, the frequency of new-onset irritable bowel syndrome, a long-term consequence of travelers' diarrhea, was three times greater in placebo than vaccine recipients. [newswise.com]

The diagnosis of TD is based on anamnestic data and clinical symptoms. Since the majority of cases is self-limiting, additional diagnostic measures are rarely carried out. Nevertheless, it may be necessary to rule out more severe gastrointestinal disorders in cases of persistent diarrhea, hematochezia, or atypical complaints. Here, the following measures may be helpful:

• Bacteriological examination of stool samples, stool cultures. If anamnestic data and clinical presentation are consistent with TD, Enterobacteriaceae or Campylobacter spp. are most likely to account for the disease. Still, the patient's travel destination and medical history may indicate the need for an expansion of the diagnostic range.
• Microscopic examination of stool samples to reveal the presence of parasites.
• Persistent diarrhea is indicative of parasitic disease; fever, enhanced serum concentrations of C-reactive protein, and fecal leukocytes are more frequently associated with bacterial TD [10].
• Viruses may be detected in stool samples employing electron microscopy, antigen detection assays, or molecular biological techniques, among others.
• Testing of stool samples for Clostridium difficile toxin, particularly if the patient has recently taken broad-spectrum antibiotics.

• Candida

  […] manifestations and reccurence of infections produced by patogens like Enterococcus faecalis, Clostridium perfringens or difficile, Helicobacter pylori, Campylobacter proteus, Escherichia coli, Salmonella, Yersinia, Haemophilus influenza, Klebsiella, Candida [hyllan.ro]

  Activated charcoal and betonite clays may be offered to help absorb excessive fluids and bacterial endotoxins without artificially halting diarrhea. 27,28 Some intestinal pathogens, including P aeruginosa, Staphylococcus, E coli, and Candida albicans, [ndnr.com]

  The development of antibiotic-resistant pathogens, severe reactions such as Stevens-Johnson syndrome or anaphylaxis ( 136 ), candida vaginitis ( 37 ), Clostridium difficile -associated diarrhea, and photosensitivity reactions are all potential disadvantages [doi.org]

• Colitis

  Miller: Sometimes when they take antibiotics, they actually come back with the C. difficile colitis and it's not traveler's diarrhea. They've self-induced the problem and so after diagnostics, you figure out, "Oh, my gosh. [healthcare.utah.edu]

  Convert to ICD-10-CM : 009.2 converts approximately to: 2015/16 ICD-10-CM A09 Infectious gastroenteritis and colitis, unspecified Approximate Synonyms Infectious diarrheal disease Travelers diarrhea Traveler's diarrhea Applies To Diarrhea: dysenteric [icd9data.com]

  Differential Diagnosis Pseudomembranous colitis Ischemic colitis Vipoma Radiation-induced colitis Food poisoning Staging New Guidelines for Traveler's Diarrhea Travelers should be advised against the use of prophylactic antibiotics In high-risk groups [ncbi.nlm.nih.gov]

  Mucosal biopsy is helpful in differentiating infectious colitis from inflammatory bowel disease. Imaging studies may be required in patients with severe disease in order to rule out intestinal perforation, ileus or evidence of colitis. [web.archive.org]

Algorithmic approach to the treatment of traveler’s diarrhea Information from references 33 and 34. Approach to the Treatment of Traveler’s Diarrhea Figure 1. [aafp.org]

Empiric treatment of traveler's diarrhea with antibiotics and loperamide is effective and often limits symptoms to one day. [ncbi.nlm.nih.gov]

Latest Travel Health News What is the prognosis for travelers' diarrhea? The prognosis for travelers' diarrhea is usually good. Most cases resolve within 2 days without treatment. [medicinenet.com]

Prognosis: Course Most cases of Traveler's Diarrhea are self limited and last Images: Related links to external sites (from Bing) Ontology: Traveler's diarrhea (C0277528) Concepts Disease or Syndrome ( T047 ) SnomedCT 186165000, 367091004, 11840006 English [fpnotebook.com]

Pathogens associated with TD comprise [6] [7]:

• Escherichia coli spp., especially enterotoxigenic strains, enteroaggregative strains
• Shigella spp.
• Salmonella spp.
• Campylobacter spp.
• Aeromonas spp.
• Plesiomonas spp.
• Vibrio spp.

• Entamoeba histiolytica
• Giardia lamblia
• Cryptosporidium spp.

• Norovirus
• Rotavirus
• Enteric adenovirus

SUBJECTS: To investigate epidemiology and impact, 30369 short-term visitors completed a questionnaire just before boarding their homebound aircrafts. To investigate etiology, 322 patients (hotel guests) with TD provided stool samples. [ncbi.nlm.nih.gov]

References 1 World Health Organization ., Food safety and foodborne illness, 2002 Geneva World Health Organization Fact sheet 237 2 Epidemiology, etiology, and impact of traveler' diarrhea in Jamaica, JAMA, 1999, vol. 281 (pg. 811 - 7 ) 3 Epidemiology [doi.org]

Experimental evidence suggests that chronic inflammation following acute bacterial infection has a pathophysiological role in the development of PI-IBS. [ncbi.nlm.nih.gov]

Intestinal electrolyte fluid movement explains the pathophysiology of most cases while in certain situations osmotic diarrhea or altered intestinal motility may lead to passage of unformed stools. [karger.com]

Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 6th ed. Philadelphia, PA: WB Saunders; 1998:128–152. Gangarosa RE, Glass RI, Lew JF, Boring JR. [web.archive.org]

Prevention and self-treatment of travelers’ diarrhea. Prim Care 2002;29:843–55. Department of Health and Human Services. Centers for Disease Control and Prevention. Travelers’ Diarrhea. [racgp.org.au]

CONCLUSIONS: The WC/rBS cholera vaccine prevents TD in 2 out of 7 travelers (preventive fraction: 28%). The number needed to vaccinate (NNV) to prevent 1 case of TD is 10. [ncbi.nlm.nih.gov]

Traveler's diarrhea (TD) is an unspecific term referring to distinct types of gastrointestinal infections that affect travelers and result in acute diarrhea, i.e., the passage of three or more unformed stools within a period of 24 hours [1]. It is the most common travel-related illness [2] and typically occurs within the first two weeks of traveling. Bacteria account for most cases of TD, but parasites and viruses may also trigger the disease. Pathogens are generally ingested with contaminated water or food, and first symptoms manifest within hours or few days after exposure. Patients are not necessarily aware of risky behavior since an infection may result from seemingly insignificant actions like cleaning one's teeth with a brush rinsed in non-potable water. Symptoms may persist for several days.

Oral rehydration is the mainstay of treatment and aims at compensating for water and electrolyte loss [3] [4]. Furthermore, self-treatment of TD often includes the use of antimotility drugs like loperamide, but patients should be advised on the potential risks of such therapy [4]. Antibiotics may be indicated in case the disease is caused by bacterial pathogens, but this therapeutic approach is associated with considerable disturbances of the normal intestinal flora. Thus, the use of antibiotics is not generally recommended unless a patient suffers from moderate to severe TD [5].

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4. Kollaritsch H, Paulke-Korinek M, Wiedermann U. Traveler's Diarrhea. Infect Dis Clin North Am. 2012; 26(3):691-706.
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9. Connor BA. Sequelae of traveler's diarrhea: focus on postinfectious irritable bowel syndrome. Clin Infect Dis. 2005; 41 Suppl 8:S577-586.
10. McGregor AC, Whitty CJ, Wright SG. Geographic, symptomatic and laboratory predictors of parasitic and bacterial causes of diarrhoea in travellers. Trans R Soc Trop Med Hyg. 2012; 106(9):549-553.