History and exam

Key diagnostic factors

common

diarrhea (with or without tenesmus), cramping, nausea, and vomiting

Typical symptoms of TD include cramping, nausea, vomiting, and diarrheal stools, with resolution in 3-5 days.

uncommon

dysentery (blood and fever)

Bloody stools indicate an invasive organism and a serious, potentially systemic infection.

persistent diarrhea >14 days

Parasitic infections do not respond to antibiotics and usually persist.[29]​ Giardia is characterized by gassy diarrhea and belching with an odor of hydrogen sulfide. Amebic dysentery is associated with a mucoid bloody diarrhea.

Secondary lactose intolerance or bile acid malabsorption can occur, as well as tropical sprue. Symptoms lasting >30 days may indicate new-onset gastrointestinal disorder or unmasking of preexisting organic or structural disease.

Other diagnostic factors

common

diarrhea without illness

Often termed "loose motions in travel".

Excess gas or an occasional loose stool without feeling ill could be related to new foods, changes in the normal timing of meals, stress, and changing bacterial flora.

Risk factors

strong

travel to a high-risk destination

High-risk destinations include: South and Southeast Asia; Central and South America; and East, West, and North Africa.[4][11]​​

age <30 years

Younger age is associated with increased risk-taking behavior and greater propensity for adventure travel in areas with high exposure to food and beverages from unhygienic sources.[2][9]​​

travelers with prior residence in higher-risk destination visiting friends and relatives

Travelers visiting friends and relatives are less likely to exercise food and water precautions, and may not recognize that any previously acquired TD immunity is short-lived. These travelers are also much less likely to seek pretravel counseling.[21]

travel during hot and wet seasons

The risk may vary depending on the time of year. Hot and wet climate conditions are generally believed to support increased transmission risk for many of the common bacterial pathogens.[2][12]​​​

deployed military populations

A higher prevalence of TD has been noted in deployed military populations and can lead to a decline in job performance or loss of duty days.[4][13][14]

lack of caution in food and water selection

Unsafe items include ice, tap water, salads, previously peeled fruits, and raw foods. Unpackaged condiments and sauces, such as guacamole, often pose a potential risk. Food from street vendors and buffets with poor food turnover also pose a significant notable risk. Safe items include thoroughly cooked food served while still hot, boiled or bottled (properly sealed) water, commercially packaged foods, fresh breads, and fruits peeled by the traveler.

weak

proton-pump inhibitor use

Proton-pump inhibitors may facilitate the survival of bacteria contaminating food or water during transit through the stomach. However, few studies are available to directly evaluate this risk in travelers.[9]​ Consideration may be given to discontinuing use of these medications during travel, unless they are necessary for symptom control.

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