Summary
Definition
History and exam
Key diagnostic factors
- diarrhea (with or without tenesmus), cramping, nausea, and vomiting
- dysentery (blood and fever)
- persistent diarrhea >14 days
Risk factors
- travel to a high-risk destination
- age <30 years
- proton-pump inhibitor use
- travelers with prior residence in higher-risk destination visiting friends and relatives
- travel during hot and wet seasons
- deployed military populations
- lack of caution in food and water selection
Diagnostic tests
1st tests to order
- stool culture and sensitivity
- multipathogen molecular diagnostic (polymerase chain reaction)
- protozoal stool antigens
Tests to consider
- stool ova and parasite exam
- Clostridioides difficile stool toxin
- colonoscopy, endoscopy, and biopsy
- hematology, blood chemistries, serology
Treatment algorithm
Contributors
Authors
Daniel T. Leung, MD, MSc
Associate Professor
Division of Infectious Diseases
University of Utah School of Medicine
Salt Lake City
UT
Disclosures
DTL receives authorship royalties from UpToDate, Inc, for a chapter on travel medicine. DTL is an author of upcoming chapters on traveler's diarrhea for the US CDC Yellow Book. DTL is the president-elect of the American Committee on Clinical Tropical Medicine and Travelers' Health - Clinical Group within the American Society of Tropical Medicine and Hygiene. DTL is an author of some of the references cited in this topic.
Jakrapun Pupaibool, MD, MS
Associate Professor
Division of Infectious Diseases
University of Utah School of Medicine
Salt Lake City
UT
Disclosures
JP declares that he has no competing interests.
Acknowledgements
Dr Daniel T. Leung and Dr Jakrapun Pupaibool would like to gratefully acknowledge Dr Mark Riddle and Professor Gregory Juckett, the previous contributor to this topic.
Disclosures
MR has given talks on the management of traveler's diarrhea for the International Society of Travel Medicine (ISTM), the CDC Foundation, the American College of Gastroenterology (ACG), and the American College of Preventive Medicine. MR has led the development of guidelines for traveler's diarrhea for the ISTM, the ACG, and the Department of Defense. This work has been unpaid but support for travel has been accepted. MR is employed with Pfizer Inc., and is working on their Lyme disease vaccine program. While this is not in conflict with traveler’s diarrhea, Pfizer also makes azithromycin, which is an antibiotic recommended for the treatment of traveler’s diarrhea. MR does not work in the area of Pfizer that develops, markets, or distributes azithromycin. MR is an author of several references cited in this topic. GJ declares that he has no competing interests.
Peer reviewers
Andrea Summer, MD
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
Disclosures
AS declares that she has no competing interests.
Phil Fischer, MD
Professor of Pediatrics
Department of Pediatric and Adolescent Medicine
Mayo Clinic
Rochester
MN
Disclosures
PF is an author of a reference cited in this topic.
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