Traveler's diarrhea causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are many causes of diarrhea and it is important to recognize which ones are serious and which are not. Infectious agents are the primary cause of TD. Bacterial enteropathogens cause approximately 80% of TD cases. The most common causative agent isolated in countries surveyed has been enterotoxigenic Escherichia coli (ETEC). In infants and children it is estimated that nearly 70% of diarrhea is due to viruses

Causes

The most common causative agent isolated in countries surveyed has been enterotoxigenic Escherichia coli (ETEC). Enteroaggregative E. coli is increasingly recognized and many studies do not look for this important bacterium. Some bacteria release toxins which bind to the intestines and cause diarrhea; others damage the intestines themselves by their direct presence. In infants and children it is estimated that nearly 70% of diarrhea is due to viruses; for adult travelers, this drops to around 30%. Diarrhea caused by viral agents is usually self-limited. Pathogens implicated in travellers' diarrhea are:

E. coli, enterotoxigenic	20-75%
E. coli, enteroaggregative	0-20%
E. coli, enteroinvasive	0-6%
Shigella spp	2-30%
Salmonella spp	0-33%
Campylobacter jejuni	3-17%
Vibrio parahemolyticus	0-31%
Aeromonas hydrophila	0-30%
Giardia lamblia	0 to less than 20%
Entamoeba histolytica	0-5%
Cryptosporidium sp	0 to less than 20%
Rotavirus	0-36%
Norwalk virus	0-10%

Common Causes

• Campylobacter jejuni

• Cryptosporidiosis
• Dysentery
• Entamoeba histolytica
• Enterotoxigenic Escherichia coli
• Escherichia coli
• Giardia lamblia
• Rotavirus
• Salmonella
• Shigellosis
• Staphylococcus aureus
• Vibrio parahaemolyticus
• Viral haemorrhagic fever
• Visceral leishmaniasis
• Yersinia enterocolitica

Causes by Organ System

Cardiovascular	Gangrene, kawasaki disease, superior mesenteric artery occlusion, organophosphates,abetalipoproteinaemia, viral haemorrhagic fever, autonomic neuropathy, selenium
Chemical / poisoning	No underlying causes
Dermatologic	Kawasaki disease, mercury, pellagra, celiac disease, acrodermatitis enteropathica, staphylococcal toxic shock syndrome, systemic sclerosis, Degos' disease, kwashiorkor
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Autoimmune adrenalitis, Glucagonoma, Hyperthyroidism, Selenium
Environmental	Arsenicals, Carbon monoxide toxicity, Organophosphates
Gastroenterologic	Superior mesenteric artery occlusion, organophosphates, glucagonoma, bacterial overgrowth of small intestine, bile acid malabsorption syndrome,Brainerd diarrhea, celiac disease, cholestatic jaundice, collagenous colitis, colonic villous adenomata, colorectal cancer, crohn disease, faecal impaction, faecal incontinence, graft versus host disease, hirschsprung disease, intususception of intestine, irritable bowel syndrome, Large bowel obstruction, Laxative abuse, Lymphocytic colitis, Malabsorption syndrome, Nausea and vomiting, Postgastrectomy syndrome, protein losing enteropathy,short bowel syndrome, sucrase-isomaltase deficiency, ulcerative colitis, acrodermatitis enteropathica, lactase deficiency, abetalipoproteinaemia,meckel diverticulitis, pernicious anaemia, bacillary dysentery, bacillus cereus, campylobacter jejuni, cytomegalovirus, dysentery, entamoeba histolytica, enterotoxigenic escherichia coli, escherichia coli, giardia lamblia, isosporiasis, legionella pneumophila, trichuriasis, tropical sprue, systemic sclerosis, whipple disease, autonomic neuropathy, Degos' disease, kwashiorkor
Genetic	Pancreatitis, chronic, acrodermatitis enteropathica, iduronate-2-sulfatase deficiency, lactase deficiency, Rapadilino syndrome
Hematologic	Celiac disease, abetalipoproteinaemia, meckel diverticulitis, pernicious anaemia, viral haemorrhagic fever, entamoeba histolytica,HIV-1 disease, vitamin B12 deficiency, somatostatinoma
Iatrogenic	No underlying causes
Infectious Disease	Bacillary dysentery, bacillus cereus, balantidiasis, campylobacter jejuni, capillaria, clostridium welchii, cryptosporidiosis,cyclospora cayetanensis, cyclosporiasis, cytomegalovirus, dengue fever, dientamoeba fragilis, dysentery, entamoeba histolytica, enterotoxigenic escherichia coli, escherichia coli, giardia lamblia, HIV-1 disease, hymenolepiasis, isosporiasis, legionella pneumophila, microsporidiasis,penicillium marneffei, pneumatosis cystoides intestinalis, pseudomembranous colitis, rotavirus, salmonella, sapporo-like virus, shigellosis, small round structured virus, staphylococcal toxic shock syndrome, staphylococcus aureus, streptococcus suis, strongyloidiasis, trichinella spiralis,trichuriasis, tropical sprue, typhoid fever, vibrio parahaemolyticus, visceral leishmaniasis, yersinia enterocolitica, adenovirus
Musculoskeletal / Ortho	Rapadilino syndrome, Viral haemorrhagic fever, Dengue fever, Systemic sclerosis, Whipple disease
Neurologic	Mercury, pellagra, hirschsprung disease, pernicious anaemia, staphylococcal toxic shock syndrome, autonomic neuropathy, Degos' disease, ethylmalonic encephalopathy, vitamin B12 deficiency, zinc deficiency
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Colorectal cancer, large bowel obstruction, small bowel lymphoma, somatostatinoma
Opthalmologic	Hyperthyroidism, adenovirus
Overdose / Toxicity	Arsenicals, carbon monoxide toxicity, mercury, organophosphates, pancreatitis, chronic, paraquat, thallium
Psychiatric	Irritable bowel syndrome
Pulmonary	Systemic sclerosis, severe acute respiratory syndrome
Renal / Electrolyte	Autoimmune adrenalitis, laxative abuse, legionella pneumophila, staphylococcal toxic shock syndrome, systemic sclerosis
Rheum / Immune / Allergy	No underlying causes
Sexual	HIV-1 disease, zinc deficiency
Trauma	Pancreatitis, chronic
Urologic	Organophosphates, malakoplakia
Dental	No underlying causes
Miscellaneous	Brainerd diarrhea, complement 5 deficiency, copper salts, functional disorders

Causes in Alphabetical Order

Abetalipoproteinaemia Acrodermatitis enteropathica Adenovirus Arsenicals Autoimmune adrenalitis Autonomic neuropathy Bacillary dysentery Bacillus cereus Bacterial overgrowth of small intestine Balantidiasis Bile acid malabsorption syndrome Brainerd diarrhea Campylobacter jejuni Capillaria Carbon monoxide toxicity Celiac disease Cholestatic jaundice Clostridium welchii Collagenous colitis Colonic villous adenomata Colorectal cancer Complement 5 deficiency Copper salts Crohn disease Cryptosporidiosis Cyclospora cayetanensis Cyclosporiasis Cytomegalovirus Degos' disease Dengue fever Dientamoeba fragilis Dysentery Entamoeba histolytica Enterotoxigenic Escherichia coli Escherichia coli Ethylmalonic encephalopathy Faecal impaction Faecal incontinence Functional disorders Gangrene Giardia lamblia Glucagonoma Graft versus host disease Hirschsprung disease HIV-1 disease Hymenolepiasis Hyperthyroidism Iduronate-2-sulfatase deficiency Intususception of intestine Irritable bowel syndrome Isosporiasis Kawasaki disease Kwashiorkor

Lactase deficiency Large bowel obstruction Laxative abuse Legionella pneumophila Lymphocytic colitis Magnesium salts Malabsorption syndrome Malakoplakia Meckel diverticulitis Mercury Microsporidiasis Nausea and vomiting Organophosphates Pancreatitis, chronic Paraquat Pellagra Penicillium marneffei Pernicious anaemia Pneumatosis cystoides intestinalis Postgastrectomy syndrome Protein losing enteropathy Pseudomembranous colitis Rapadlino syndrome Rotavirus Salmonella Sapporo-like virus Selenium Severe acute respiratory syndrome Shigellosis Short bowel syndrome Small bowel lymphoma Small round structured virus Somatostatinoma Staphylococcal toxic shock syndrome Staphylococcus aureus Streptococcus suis Strongyloidiasis Sucrase-isomaltase deficiency Superior mesenteric artery occlusion Systemic sclerosis Thallium Trichinella spiralis Trichuriasis Tropical sprue Typhoid fever Ulcerative colitis Vibrio parahaemolyticus Viral haemorrhagic fever Visceral leishmaniasis Vitamin B12 deficiency Whipple disease Yersinia enterocolitica Zinc deficiency

References

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