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Travelers’ Diarrhea (TD)
Overview
Travelers' diarrhea (TD) refers to the development of unformed stools among individuals from resource-rich areas of the world during travel or within 10 days of returning from resource-limited areas of the world.1 TD is the most common travel-associated condition.2 Dehydration is the primary complication of TD, although severe dehydration may lead to other more serious complications.1,2
Etiology
TD may be caused by bacteria, viruses, and parasites. Bacterial sources represent the most frequent etiology in patients with acute illness; the most common bacterial cause is enterotoxigenic Escherichia coli. Other common bacterial causes of TD include Campylobacter, Shigella, and Salmonella species. The most common cause of TD varies geographically, and the causative agent is often not identified as part of diagnosis and management.1,2
Pathophysiology of TD
TD is typically spread by fecal-oral transmission of the causative organism through ingestion of contaminated food or water. The pathophysiology for TD differs according to the cause, but TD generally occurs via non-inflammatory or inflammatory pathways. Non-inflammatory agents decrease absorption in the intestinal mucosa, increasing the output of the GI tract. Inflammatory agents cause destruction of the intestinal mucosa through cytotoxin release or direct invasion. The loss of mucosal surface also results in decreased absorption in the mucosa and increased bowel movements.2
Clinical Course
Most cases of TD occur 4 to 14 days after arrival and generally last approximately 1 to 5 days. Approximately 8% to 15% of patients have symptoms lasting longer than 1 week, and as many as 2% may have symptoms that last longer than 1 month. Potential long-term sequelae, such as chronic gastrointestinal symptoms (particularly irritable bowel syndrome) have been reported.1
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References
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LaRocque R, Harris JB. Travelers' diarrhea: epidemiology, microbiology, clinical manifestations, and diagnosis. September 6, 2022. Accessed November 7, 2022. https://www.uptodate.com/contents/travelers-diarrhea-epidemiology-microbiology-clinical-manifestations-and-diagnosis
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Dunn N, Okafor CN. Travelers Diarrhea. Treasure Island, FL: StatPearls Publishing; 2022.
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