Traveler's diarrhea history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Traveler’s diarrhea is a clinical diagnosis. It is diagnosed when the following criteria are met: passage of ≥3 unformed stools per day plus ≥1 associated enteric symptoms, such as abdominal pain or cramps, occurring in a traveler after arrival, usually in a resource-limited destination. History-taking should focus on the presence of risk factors for the development of traveler's diarrhea. A positive history of recent travel to a developing country within the past month is required for the diagnosis of traveler's diarrhea. Symptoms of traveler's diarrhea include diarrhea (either watery or bloody), nausea, vomiting, abdominal pain, and bloating with or without fever. Less common symptoms may be related to complications of traveler's diarrhea and may include spontaneous bruising, oliguria/anuria, and painless gross hematuria.

History

• Traveler's diarrhea is defined as the passage of ≥3 unformed stools per day plus ≥1 associated enteric symptoms, such as abdominal pain or cramps, occurring in a traveler after arrival, usually in a resource-limited destination.
• History-taking should focus on the presence of risk factors for the development of traveler's diarrhea:

• History of recent travel to developing country (typically within the past month) (recent travel is required for the diagnosis of traveler's diarrhea)
• Immunocompromised status
• Pregnancy
• Recent ingestion of uncooked or poorly handled vegetables, meat / poultry, raw milk, or poorly stored foods that require refrigerators (e.g. mayonnaise)
• Recent drinking from untreated water (e.g. stream or well)
• Exposure to daycare
• Exposure to healthcare settings (e.g. nursing homes or hospitals)
• Exposure to contacts with similar symptoms
• Recent history of receptive anal or oral-anal contact

Symptoms

Common Symptoms

Common symptoms of traveler's diarrhea include:

• Fever
• Sudden-onset, mild/severe diarrhea that may either be watery or bloody (typically defined as ≥3 unformed stools per day)
• Bloating
• Diffuse, cramping abdominal pain
• Anorexia
• Nausea
• Vomiting
• Tenesmus
• Thirst
• Dizziness

Less Common Symptoms

Less common symptoms of traveler's diarrhea are related to the development of complications. Symptoms may include:

• Spontaneous bruising
• Painless gross hematuria
• Oliguria/anuria