Travelers' diarrhea

"Montezuma's revenge" and "Delhi belly" redirect here. For other uses, see Montezuma's revenge (disambiguation) and Delhi Belly (disambiguation).
Travelers' diarrhea
Other namesTravellers' diarrhoea, tourist diarrhea,[1] traveler's dysentery[1]
The bacterium E. coli, the most common cause of Travelers' diarrhea
SpecialtyInfectious diseases Edit this on Wikidata
SymptomsUnformed stool while traveling, fever, abdominal cramps, headache[2][3]
DurationTypically < 5 days[3]
CausesOften bacterial[3]
Risk factorsTravel in the developing world
Diagnostic methodBased on symptoms and travel history
PreventionEating only properly prepared food, drinking bottled water, frequent hand washing[4]
TreatmentOral rehydration therapy, antibiotics, loperamide[3][4]
Frequency~35% of travelers to the developing world[3]

Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, three or more by others) while traveling.[2][3] It may be accompanied by abdominal cramps, nausea, fever, headache and bloating.[3] Occasionally bloody diarrhea may occur.[5] Most travelers recover within three to four days with little or no treatment.[3] About 12% of people may have symptoms for a week.[3]

Bacteria are responsible for more than half of cases,[3] typically via foodborne illness and waterborne diseases. The bacteria enterotoxigenic Escherichia coli (ETEC) are typically the most common except in Southeast Asia, where Campylobacter is more prominent.[2][3] About 10 to 20 percent of cases are due to norovirus.[3] Protozoa such as Giardia may cause longer term disease.[3] The risk is greatest in the first two weeks of travel and among young adults.[2] People affected are more often from the developed world.[2]

Recommendations for prevention include eating only properly cleaned and cooked food, drinking bottled water, and frequent hand washing.[4] The oral cholera vaccine, while effective for cholera, is of questionable use for travelers' diarrhea.[6] Preventive antibiotics are generally discouraged.[3] Primary treatment includes rehydration and replacing lost salts (oral rehydration therapy).[3][4] Antibiotics are recommended for significant or persistent symptoms, and can be taken with loperamide to decrease diarrhea.[3] Hospitalization is required in less than 3 percent of cases.[2]

Estimates of the percentage of people affected range from 20 to 50 percent among travelers to the developing world.[3] TD is particularly common among people traveling to Asia (except for Japan and Singapore), the Middle East, Africa, Latin America, and Central and South America.[4][7] The risk is moderate in Southern Europe, and Russia.[8] TD has been linked to later irritable bowel syndrome and Guillain–Barré syndrome.[2][3] It has colloquially been known by a number of names, including "Montezuma's revenge," “mummy tummy”[9] and "Delhi belly".[10]

  1. ^ a b Ensminger, Marion Eugene; Ensminger, Audrey H. (1993-11-09). Foods & Nutrition Encyclopedia, Two Volume Set. CRC Press. p. 143. ISBN 9780849389801.
  2. ^ a b c d e f g Giddings, SL; Stevens, AM; Leung, DT (March 2016). "Traveler's Diarrhea". The Medical Clinics of North America. 100 (2): 317–30. doi:10.1016/j.mcna.2015.08.017. PMC 4764790. PMID 26900116.
  3. ^ a b c d e f g h i j k l m n o p q r Leder, K (2015). "Advising travellers about management of travellers' diarrhoea". Australian Family Physician. 44 (1–2): 34–37. PMID 25688957. Archived from the original on 2017-01-12.
  4. ^ a b c d e "Travelers' Diarrhea". cdc.gov. April 26, 2013. Archived from the original on March 13, 2016.
  5. ^ Feldman, Mark (2015). Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management (10th ed.). Elsevier Health Sciences. p. 1924. ISBN 9781455749898. Archived from the original on 2016-03-10.
  6. ^ Ahmed, T; Bhuiyan, TR; Zaman, K; Sinclair, D; Qadri, F (5 July 2013). "Vaccines for preventing enterotoxigenic Escherichia coli (ETEC) diarrhoea". The Cochrane Database of Systematic Reviews. 7 (7): CD009029. doi:10.1002/14651858.CD009029.pub2. PMC 6532719. PMID 23828581.
  7. ^ "Health Information for Travelers to Singapore - Clinician view | Travelers' Health | CDC". wwwnc.cdc.gov. Retrieved 5 February 2019.
  8. ^ Diemert, D. J. (17 July 2006). "Prevention and Self-Treatment of Traveler's Diarrhea". Clinical Microbiology Reviews. 19 (3): 583–594. doi:10.1128/CMR.00052-05. PMC 1539099. PMID 16847088.
  9. ^ "Mummy Tummy Cures and Other Travel Tips for Egypt". travelling right, travelling light. Retrieved 2024-06-21.
  10. ^ "Traveler's Diarrhea-Topic Overview". WebMD. 2013-03-27. Archived from the original on 2015-06-30. Retrieved 2015-07-02. Traveler's diarrhea is sometimes called by its more colorful names: Montezuma's revenge, Delhi belly, and Turkey trots.