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 . 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 . 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 .
Entire Body System
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]
TAKE IMODIUM OR PEPTO BISMOL Moderate Diarrhea: Moderately loose or frequent stools with cramps and nausea. Distressing or interferes with planned activities. [healthcenter.indiana.edu]
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. [merckmanuals.com]
Other frequent stomach ailments, including nausea, upset stomach, indigestion, and heartburn caused by food or drink, also can spoil a trip. [pepto-bismol.com]
- Abdominal Cramps
Watery and persistent diarrhea, fever, and abdominal cramps were common complaints. [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]
- 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]
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. [symptoma.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]
Causes: Acute Diarrhea ( No cause is identified in up to 50% of Acute Diarrhea cases Incubation periods Most are 1-3 days Shigella may incubate for up to 7 days, and Giardia up to 25 days after exposure Parasite s also tend to incubate for weeks Most [fpnotebook.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 .
- 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.
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  :
- Escherichia coli spp., especially enterotoxigenic strains, enteroaggregative strains
- Shigella spp.
- Salmonella spp.
- Campylobacter spp.
- Aeromonas spp.
- Plesiomonas spp.
- Vibrio spp.
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. [web.archive.org]
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]
Dis 2002;34:628-33. (6) Steffen R, Heusser R, DuPont HL: Prevention of travelers’ diarrhea by nonantibiotic drugs. Rev Infect Dis; 1986;8(suppl 2);S151-9. (7) McFarland LV: Meta-analysis of probiotics for the prevention of traveler’s diarrhea. [endomune.com]
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 . It is the most common travel-related illness  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  . 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 . 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 .
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