What is traveler’s diarrhea?
Traveler’s diarrhea affects travelers and others who consume contaminated food or water. It’s a brief but unpleasant gastrointestinal infection that typically causes loose stools and abdominal cramps. Most of the time, it's caused by bacteria, but sometimes viruses or parasites are to blame. International travelers are most at risk when visiting countries that have less rigorous sanitation practices than their own.
Who gets traveler’s diarrhea?
Gastrointestinal infection can happen to anyone, anywhere. At home, we might call it food poisoning or a stomach flu. But it’s easier to get it during international travel, when you're more likely to be exposed to pathogens that may be less commonly transmitted at home. Gastrointestinal infection that occurs either during travel or shortly after returning home is easily identified as traveler’s diarrhea.
How common is traveler’s diarrhea?
Traveler’s diarrhea is the most common travel-related illness. It affects between 30% and 70% of travelers, depending on the destination and the season. It’s especially common in hot and/or humid climates, where bacteria breed more easily. Most of Asia, the Middle East, Africa, Mexico and Central and South America have this type of climate at least some of the time, so travelers there are more often affected.
What does traveler’s diarrhea do to my body?
When your immune system detects an infection in your gastrointestinal tract, it produces an inflammatory response to kill and remove the pathogen. This is what causes the uncomfortable symptoms of infection, including fever, stomach cramps and diarrhea, nausea and vomiting. It's usually short and self-limiting. The main thing to watch out for is dehydration from too much fluid loss.
Symptoms and Causes
How do you get traveler’s diarrhea?
You may be exposed to illness-causing bacteria, viruses or parasites through contaminated water or food. Many developing countries lack the resources to treat water and kill these contaminants. Residents of these countries grow up drinking the water and may have developed immunity to the organisms that make travelers sick. Food handlers might not realize the risk or practice rigorous hygiene.
What types of infections cause traveler’s diarrhea?
The most common causes are bacteria, especially E. coli.
Other common bacteria include:
Viral infections may include:
Parasite infections may include:
Is traveler’s diarrhea contagious?
The infection can spread from you to another person if they come into contact with your germs. The germs would have to travel from your gastrointestinal tract to the other person’s. Germs can spread through tiny particles of vomit or poop that linger on surfaces or transfer to food. Another person can become infected by ingesting that food, or by touching those surfaces and then touching their mouth.
What are the symptoms of traveler’s diarrhea?
Symptoms typically appear within six to 24 hours after a bacterial or viral infection. It may take one to three weeks for signs of an intestinal parasite infection to show up. This may explain traveler’s diarrhea that occurs a week or more after returning home. Symptoms are usually mild. You may have traveler’s diarrhea if you experience three or more loose stools within 24 hours. You may also experience:
How long does traveler’s diarrhea last?
Most of the time, your symptoms will start to improve on their own within two to three days. If you have a bacterial infection, which is the most common kind, you may continue to have diminishing symptoms for up to a week. Parasite infection is trickier and can last for weeks to months without treatment. If your symptoms don’t appear to be improving, you might have a parasite infection.
Can I get traveler’s diarrhea twice?
Yes. Having traveler's diarrhea once or even twice doesn’t appear to make you immune to infection. You can get the same infection twice in one trip. You can also get two different infections on the same trip, or even at the same time. You can get the same infection again when traveling to a different place. And you can get the same infection or a different one when traveling again to the same place.
What are the possible complications of traveler’s diarrhea?
The most common complication of persistent diarrhea is dehydration from loss of fluids. Mild to moderate dehydration can cause uncomfortable symptoms, but severe dehydration can be dangerous, especially for children. Children become more severely dehydrated more rapidly than adults, and they don’t recover as easily. They may need to go to the hospital to have their fluids replaced intravenously.
Signs of dehydration may include:
- Dry mouth, tongue and lips.
- Sunken eyes.
- Dark urine or too little urine.
- Muscle cramps.
- Crying without tears.
Less commonly, healthcare providers have occasionally observed that traveler’s diarrhea can trigger an underlying gastrointestinal disease. In some people, symptoms of traveler’s diarrhea persist after the infection is gone. When no other cause can be found, they are diagnosed with post-infectious irritable bowel syndrome (PI-IBS). In other cases, people who were already genetically predisposed to inflammatory bowel disease may develop their first symptoms after a bout of traveler’s diarrhea.
Diagnosis and Tests
How is traveler’s diarrhea diagnosed?
Most of the time, your healthcare provider will recognize traveler’s diarrhea based on your symptoms and travel history. However, in some cases, they may want to test a sample of your poop to find out what type of infection you have. This can help them determine the best medication to prescribe, especially if they suspect a parasite. Sometimes it might take more than one stool sample.
Management and Treatment
How do healthcare providers treat traveler’s diarrhea?
Healthcare providers have a conservative approach to treating traveler’s diarrhea. The first line of treatment is rest and hydration for both children and adults. Certain sports drinks or oral rehydration formula (ORS) can help replenish lost electrolytes. Most of the time, traveler’s diarrhea resolves on its own within a few days, but if you have severe or persistent symptoms, they might prescribe medication.
How do you get rid of travelers' diarrhea fast?
Studies have shown that over-the-counter bismuth subsalicylate (Pepto Bismol) can reduce the duration of traveler’s diarrhea, as well as the frequency of your stools. It’s not recommended for children or pregnant people. Antibiotics can also reduce the duration of the illness by about a day. However, antibiotics are only prescribed in certain cases, because organisms can become resistant to them and because, depending on severity of symptoms, they may not always provide substantial benefit.
What is the best medicine for traveler's diarrhea?
When healthcare providers do prescribe medication for traveler’s diarrhea, they prescribe two types.
Antidiarrheal medications treat your diarrhea, but not the infection itself. They can help relieve your discomfort, but they can also prolong the illness. They work by slowing down your motility — the muscle contractions that move your bowels — giving your intestines more time to absorb more water from your poop. But this also means that the infectious organisms stay in your bowels longer.
Commonly prescribed antidiarrheals include:
Your provider gives antibiotics to treat the infection in certain cases. Parasite infections may require antibiotics. More severe bacterial infections may also be treated with antibiotics. Symptoms are considered “severe” if you have a fever, if you have more than three loose stools a day or if you have blood or mucus in your stools. People with compromised immune systems may also be given antibiotics.
Commonly prescribed antibiotics include:
- Ciprofloxacin (Cipro).
- Levofloxacin (Levaquin).
- Azithromycin (Zmax).
- Rifaximin (Xifaxan).
- Metronidazole (Flagyl).
- Nitazoxanide (Alinia).
Is there a natural treatment for traveler’s diarrhea?
Natural antibiotics like oil of oregano and extract of echinacea with goldenseal can kill many pathogens, possibly the one infecting you. It’s difficult to tell how much they help with traveler’s diarrhea because the infection is usually brief anyway. These medicines may work best when used preventatively. But consult your healthcare provider first to make sure they're safe for you.
How should I take care of myself or my child while suffering through traveler’s diarrhea?
- Hydrate frequently with water, certain sports drinks or Pedialyte.
- If you or your child can’t tolerate solid foods yet, try clear soups and popsicles.
- When you’re ready to progress to solid foods, start with bland, high-fiber carbohydrates.
- The BRAT diet is commonly recommended for diarrhea: bananas, rice, applesauce and toast.
- Eat small amounts frequently rather than whole meals.
- Call the doctor when you see signs of dehydration, bloody stools or fever.
How can I prevent or reduce my risk of getting traveler’s diarrhea?
Always be cautious of the food and drinks you consume when traveling abroad. While these precautions won’t completely prevent traveler’s diarrhea, they can reduce your risk.
- Wash your hands often, especially before eating.
- Carry an alcohol-based sanitizer to clean your hands with.
- Keep children from crawling or sitting on the ground.
- Avoid swimming in contaminated water.
- Don't swallow any shower water.
- Brush your teeth with bottled water.
- Avoid drinks with ice cubes that might be made from tap water.
- Avoid fresh produce unless you can peel it yourself.
- Stick to foods and drinks that are well cooked and served hot.
- Stick to canned or bottled beverages.
Outlook / Prognosis
What is the prognosis for people who have traveler’s diarrhea?
Most people will feel better in a few days. You can pick up some bismuth subsalicylate to help with your symptoms, along with oral hydration formulas such as sports drinks or Pedialyte. Watch out for dehydration, especially in children and adults who have compromised immune systems. If you have severe or persistent symptoms, call your doctor. They may prescribe medication or suggest that you come in for testing.
A note from Cleveland Clinic
Traveler’s diarrhea is an unpleasant side effect of international travel. Most of the time, it’s not serious and passes quickly. E. coli bacteria are the most frequent offenders, followed by Salmonella. Viruses and parasites are less common. You can help reduce your risk of infection by practicing good hygiene and being cautious of what you eat and drink while traveling abroad. But even with precautions, you can still get it.
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