- Travelers' diarrhea (TD) is the most
common illness affecting travelers. Each year between 20%-50% of
international travelers, an estimated 10 million persons, develop
diarrhea. The onset of TD usually occurs within the first week of travel
but may occur at any time while traveling, and even after returning home.
The most important determinant of risk is the traveler's destination.
- High-risk destinations are the developing
countries of Latin America, Africa, the Middle East, and Asia.
- Persons at particular high-risk include
young adults, immunosuppressed persons, persons with inflammatory-bowel
disease or diabetes, and persons taking H-2 blockers or antacids. Attack
rates are similar for men and women. The primary source of infection is
ingestion of fecally contaminated food or water.
What are common symptoms of travelers' diarrhea?
Most TD cases begin abruptly. The illness usually results in increased
frequency, volume, and weight of stool. Altered stool consistency also is
common. Typically, a traveler experiences four to five loose or watery
bowel movements each day. Other commonly associated symptoms are nausea,
vomiting, diarrhea, abdominal cramping, bloating, fever, urgency, and
malaise. Most cases are benign and resolve in 1-2 days without treatment.
TD is rarely life-threatening. The natural history of TD is that 90% of
cases resolve within 1 week, and 98% resolve within 1 month.
What causes travelers' diarrhea?
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).
ETEC produce watery diarrhea with associated cramps and low-grade or no
fever. Besides ETEC and other bacterial pathogens, a variety of viral and
parasitic enteric pathogens also are potential causative agents.
What preventive measures are effective for
travelers' diarrhea?
Travelers can minimize their risk for TD by practicing the following
effective preventive measures:
o Avoid eating foods or drinking
beverages purchased from street vendors or other establishments where
unhygienic conditions are present
o Avoid eating raw or undercooked meat
and seafood
o Avoid eating raw fruits (e.g.,
oranges, bananas, avocados) and vegetables unless the traveler peels them.
If handled properly well-cooked and packaged foods usually are safe.
- Tap water, ice, unpasteurized milk, and
dairy products are associated with increased risk for TD.
- Safe beverages include bottled carbonated
beverages, hot tea or coffee, beer, wine, and water boiled or
appropriately treated with iodine or chlorine.
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