Traveler's diarrhea natural history, complications and prognosis

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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

In the general population, traveler's diarrhea is usually self-limited with an excellent prognosis in the majority of cases. In bacterial and viral traveler's diarrhea, symptoms typically last within a few days to several days after exposure. In protozoal traveler's diarrhea, the incubation period may last up to 1 to 3 weeks, and symptoms may persist for several weeks / months. Complications of traveler's diarrhea are generally related to the dehydration associated with severe diarrhea. Other complications are related to the infectious agent responsible for the disease.

Natural History, Complications and Prognosis

• In the general population, traveler's diarrhea is usually self-limited with an excellent prognosis in the majority of cases.
• The following table summarizes, the natural history, complications, and prognosis of the common infectious agents responsible for traveler's diarrhea.

Agent	Incubation Period	Natural History	Common Complications	Prognosis in the General Population
Bacteria
E. coli	1 day to 10 days	Fever uncommon Acute watery diarrhea and abdominal pain Diarrhea may convert to bloody diarrhea (if EHEC or EIEC infection) Symptoms may last a few days to more than a week. Usually self-limited	Dehydration Hemolytic uremic syndrome TTP Acute kidney injury	Excellent
Campylobacter jejuni	1 day to 7 days	Fever, acute watery diarrhea (may be bloody), abdominal pain Symptoms last 2-5 days Usually self-limited	Guillain-Barre syndrome	Excellent
Salmonella	6 hrs to 3 days	Fever, acute watery diarrhea, vomiting, abdominal pain. Symptoms usually last between a few hours to 3 days Usually self-limited, but patients may become chronic carriers	Reactive arthritis Chronic carriage	Excellent
Shigella	1 day to 3 days	Fever, acute bloody diarrhea, abdominal pain Symptoms usually last 4-7 days Usually self-limited	Dehydration, hemolytic uremic syndrome, TTP, acute kidney injury	Excellent
Viruses
Norovirus	12 hrs to 2 days	Acute watery diarrhea, vomiting, abdominal pain Symptoms usually last 1-3 days Usually self-limited	Dehydration Acute kidney injury	Excellent
Rotavirus	12 hrs to 2 days	Acute watery diarrhea, vomiting, abdominal pain Symptoms usually last 3-7 days Usually self-limited	Dehydration Acute kidney injury	Excellent
Protozoa
Giardia	7 days to 21 days	Chronic watery diarrhea, bloating, and weight loss Symptoms persist if not treated	Failure to thrive Ocular complications Myopathy Chronic fatigue syndrome	Excellent
Entamoeba histolytica	7 days to 21 days	Chronic watery diarrhea, bloating, and weight loss Symptoms persist if not treated	Amebic liver abscess Other extraluminal involvement (cerebral, pleuropulmonary, cardiac)	Excellent
Cryptosporidium	2 days to 10 days	Fever, watery diarrhea, and vomiting In immunocompetent patients, symptoms usually self-limited, last 1-2 weeks	Gall bladder disease (acalculous cholecystitis, sclerosing cholangitis)	Excellent

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