Traveller's diarrhea: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 11, 2023

Traveller’s diarrhea, as it is commonly referred to, is the most common illness that can strike while travelling. It affects between 20 and 30 percent of international travelers each year, i.e. something like 10 million people

The onset of the disease usually occurs within the first week but could occur at any time during the trip, and even after returning home.

The most important element of risk is the travel destination

The highest-risk destinations are developing countries in Latin America, Africa, the Middle East and Asia.

People at increased risk include young adults, the immunosuppressed, people with inflammatory bowel disease or diabetes, those taking H2 blockers or antacids.

The attack rate is similar in men and women. The primary source of infection is ingestion of faeces-contaminated food and water.

What are the most common symptoms of traveler’s diarrhea?

In most cases, the onset is sudden.

The disease usually leads to an increase in the frequency, volume and weight of bowel movements.

Changes in stool consistency are also common.

Typically, a traveler has 4 to 5 large, watery bowel movements each day.

Other common associated symptoms are nausea, vomiting, diarrhea, abdominal cramps, bloating, fever, urgency, and malaise.

Most cases are benign and resolve in 1-2 days without any treatment.

Only rarely is traveler’s diarrhea life-threatening.

The natural history of traveler’s diarrhea resolves itself in 90% of cases within a week, and in 98% of cases it resolves within a month.

What causes traveler’s diarrhea?

Infectious agents are the main causes.

Bacterial enteropathogens cause traveler’s diarrhea in approximately 80% of cases.

The most common causative agent isolated in the countries studied is the enterotoxigenic Escherichia coli (Etec).

Etec produces watery diarrhea associated with cramps and low or no fever.

In addition to Etec and other bacterial pathogens, there are a variety of viral agents and enteric parasites among the potential causative agents.

Are there effective preventative measures?

Travelers can minimize the risk of traveler’s diarrhea by taking the following preventative measures:

1-avoid food and drink purchased from street vendors or other places where unsanitary conditions exist

2-avoid eating raw or undercooked meat or fish

3-avoid eating raw vegetables without peeling them

Well cooked and stored foods are usually safe.

Tap water, ice, unpasteurized milk and food products are also associated with the risk of traveler’s diarrhea.

Safe beverages include bottled sparkling water, hot tea and coffee, beer, wine, and water boiled or suitably treated with iodine or chlorine.

Is traveller’s diarrhea prophylaxis recommended?

In the US, the Centers for Disease Control (CDC) do not recommend any antiomicrobial drugs to prevent the disease.

Some studies show a decrease in the incidence of traveler’s diarrhea associated with the use of bismuth subsalicylate and with the use of an antimicrobial chemoprophylaxis.

The mechanism of action of bismuth subsalicylate appears to be both antibacterial and antisecretory: however, its use should be avoided during pregnancy, by people who are allergic to aspirin and by those who are taking certain other drugs, such as anticoagulants.

Additionally, people need to be made aware of potential side effects, including black tongue and stools, and (rarely) ringing in the ears.

Due to potential side effects, bismuth subsalicylate prophylaxis should not be taken for longer than three weeks.

Some antibiotics in daily doses can be effective in preventing 90% of cases of traveler’s diarrhea, but the use of antibiotics for prophylaxis is not recommended.

In addition, routine antimicrobial prophylaxis increases travellers’ risk of adverse reactions and infections with resistant pathogens.

Since antimicrobials can increase susceptibility to resistant bacteria and thus provide no protection against viral pathogens and parasites, they can give travelers a false sense of security.

In conclusion, it is encouraged to follow the preventive measures, which could be accompanied by the use of bismuth subsalicylate in case some prophylactic intervention is necessary.

What treatments are effective for traveller’s diarrhea?

It is usually a disease that resolves itself without specific treatments; however oral rehydrations are often helpful in restoring lost fluids.

Travelers who experience three or more episodes of diarrhea in an 8-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever or blood in the stool, may benefit from antimicrobial therapy.

Antibiotics are usually prescribed for 3-5 days.

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