Traveler’s Diarrhea


What is traveler’s diarrhea?

Traveler’s diarrhea is the passage of soft or unformed stools three times or more within 24 hours along with abdominal cramping, nausea and vomiting when a person is traveling abroad. It is a common problem that affects about 20% to 50% of international travelers. The condition is mainly a consequence of infections with certain germs and toxins produced by some microbes.

An infection is by far the most common cause. The infection is caused either by bacteria, parasites or viruses. By far, E.coli is the most common infecting organism responsible for traveler’s diarrhea. In most cases the symptoms resolve without any specific treatment other than maintenance of adequate hydration. Antibiotics are prescribed in severe and persistent cases.

Traveler’s Diarrhea Symptoms

The symptoms of traveler’s diarrhea usually appear during or after returning from a trip to a foreign country and usually disappear within a day or two. The time of appearance of the symptoms depends upon the infecting organisms. The main symptoms of traveler’s diarrhea is altered bowel movements where there is passage of loose stool three times or more within 24 hours.  Other common symptoms include :

  • Abdominal cramps
  • Nausea
  • Vomiting
  • Loss of appetite
  • Mild fever
  • Weakness

In more severe cases there may be repeated episodes of passage of watery stool with flecks of mucus and sometimes blood in the stool. There may be profuse vomiting leading to dehydration, profound weakness, confusion and in rare instances, severe dehydration can be fatal.

Causes of Traveler’s Diarrhea

An infection is the main cause behind traveler’s diarrhea of which bacterial infection accounts for about 80% of cases. The remaining 20% is caused by a virus or parasitic infection.

  • Enterotoxigenic strains of E.coli are the most common infecting bacteria but other strains of E.coli can also cause traveler’s diarrhea. Other commonly infecting bacteria include Shigella, Salmonella, Campylobacter, Yersinia and Aeromonas. These bacteria  can lead to traveler’s diarrhea in two different ways either they release toxins which after binding with the cells of the digestive tract lead to diarrhea or the bacteria themselves damage the cells of the intestine.
  • Viruses are the most common infecting organism in children suffering from traveler’s diarrhea. These viruses are largely the same as the stomach flu viruses seen in most countries.
  • Certain parasites like Giardia and Cryptosporidium may also be responsible for some cases of traveler’s diarrhea. Parasitic traveler’s diarrhea symptoms usually arise 7 to 14 days after infection, unlike bacterial or viral infections in which the symptoms appear within hours or a day or two after infection.

These germs mainly spread through the intake of contaminated food and water. The locals in the country do not usually suffer from diarrhea as they have already developed immunity against the infecting organisms due to long term exposure.

Risk factors

Traveler’s diarrhea is more common among visitors to developing countries and is less common in developed nations. Therefore the risk of suffering from this disease is mostly dependent on the country being visited. Young adults are at a greater risk. Although exact cause is not always known, it is more likely to occur when visitors to foreign countries opt for more adventurous dietary choices and ignore unhygienic settings where food is served.

Other risk factors include :

  • Immunocompromised people like HIV positive people, organ transplant patients and with the intake of anticancer drugs.
  • Uncontrolled diabetes.
  • Regular intake of antacids or acid-lowering drugs.
  • Traveling in certain months of the year especially during rainy seasons.

Treatment of Traveler’s Diarrhea

Traveler’s diarrhea does not always treatment and may resolve on its own. However, it is crucial that the appropriate supportive measures are conducted. This includes plenty of bed rest, adequate hydration and eating a balanced diet once the vomiting subsides. Antimotility drugs or antidiarrheals may be used to reduce the frequency of loose stools. Antibiotics are used for bacterial and certain parasitic infections.


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