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]
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]
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]
Acute diarrhea is the most common illness among travelers. [aafp.org]
What is traveler's diarrhea? Traveler's diarrhea is a common medical problem for people traveling from developed, industrialized countries to developing areas of the world. [web.archive.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]
Although nausea after dosing is uncommon, it is more frequently associated with azithromycin than with levofloxacin. [ncbi.nlm.nih.gov]
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). [dx.doi.org]
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]
- Abdominal Cramps
Watery and persistent diarrhea, fever, and abdominal cramps were common complaints. [ncbi.nlm.nih.gov]
- 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]
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]
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]
- Acute Diarrhea
Abstract Stool specimens from 124 international travelers with acute diarrhea were tested for the presence of enteropathogens. [ncbi.nlm.nih.gov]
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.
Among 3 members at risk, only the patient was positive for HLA-B27. Data from 3 similar families support the hypothesis that susceptibility to RS is genetically transmitted. [ncbi.nlm.nih.gov]
[…] with insulin-dependent diabetes mellitus, congestive heart failure, advanced cancer, human immunodeficiency virus (HIV) infection, inflammatory bowel disease or other bowel abnormalities, reactive arthritis, reduced gastric acidity, or those who are HLA-B27 [racgp.org.au]
Other complications include Guillain-Barré syndrome after Campylobacter enteritis, Reiter’s syndrome (especially in persons who are HLA-B27 positive), Clostridium difficile colitis after antibiotic use, and postinfectious irritable bowel. [aafp.org]
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.
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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