Traveler's Diarrhea

Overview

What is traveler's diarrhea?

Traveler’s diarrhea is a common illness that affects people who visit certain hot, humid countries. Bacteria, viruses and parasites in contaminated water or food cause the illness. In addition to diarrhea, you may also have severe abdominal pain, cramps and vomiting. Some people refer to it as Montezuma’s revenge, named for Mexico’s last Aztec emperor.

Who might get traveler’s diarrhea?

You can get traveler’s diarrhea anywhere. But you’re more likely to get sick when you travel to countries with hot, humid climates. Visitors to these areas are most at risk:

  • Africa.
  • Asia (excluding Japan and South Korea).
  • Central America.
  • Mexico.
  • Middle East.
  • South America.

How common is traveler’s diarrhea?

Approximately 40% to 60% of oversea travelers develop diarrhea at some point. Traveler’s diarrhea is the most common travel-related illness.

Symptoms and Causes

What causes traveler’s diarrhea?

E coli bacteria most commonly cause 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.

You can get sick from drinking untreated water or eating raw foods rinsed in it. Residents of these countries grow up drinking the water. They often develop immunity to the organisms that make travelers sick.

Other causes of traveler’s diarrhea include:

What are the symptoms of traveler’s diarrhea?

Most people who get traveler’s diarrhea experience mild symptoms that improve within three to five days. Symptoms typically can appear within six to 24 hours after a bacterial or viral infection depending on the infection load. It may take one to three weeks for signs of an intestinal parasite infection to show up.

You may have traveler’s diarrhea if you experience three or more loose stools within 24 hours or your number of usual bowel movements doubles. You may also have one or more of these symptoms:

Diagnosis and Tests

How is traveler’s diarrhea diagnosed?

Your healthcare provider can diagnosis traveler’s diarrhea based on your symptoms and travel history. In some cases, your provider may need to test stool samples for bacteria, viruses or parasites.

Management and Treatment

What are the complications of traveler’s diarrhea?

Dehydration is the biggest concern. If E. coli or other bacteria caused the illness, you may be at risk for dehydration, renal failure or even sepsis. Sepsis can be life-threatening in some cases. Having traveler’s diarrhea may also increase your risk of developing post infectious induced irritable bowel syndrome (IBS) later on.

How is traveler’s diarrhea managed or treated in adults?

Treatments for traveler’s diarrhea include:

  • Fluid and salt replacement: Oral rehydration salt (ORS) solutions prevent dehydration by replenishing lost fluids and restore key electrolytes. Most stores and pharmacies in developing countries carry ORS packets approved by the World Health Organization (WHO). You can also drink bottled or boiled water and electrolyte beverages.
  • Antidiarrheal medications: Medications, such as loperamide (Imodium®) and atropine/diphenoxylate (Lomotil®), can reduce the diarrhea symptoms but does not treat the infection and thus should only be taken with caution. Children under 12 and anyone who is immune compromised shouldn’t take these drugs without consulting their healthcare provider.
  • Antibiotics: If you have severe diarrhea (three or more loose stools within eight hours), your healthcare provider may prescribe antibiotics. These medications include azithromycin (Zithromax®), ciprofloxacin (Cipro®), doxycycline (Vibramycin®) and rifaximin (Xifaxan®).

How is traveler’s diarrhea managed or treated in children?

Children are at particular risk for dehydration and serious problems caused by traveler’s diarrhea. You should check with your healthcare provider before giving a child any antidiarrheal medication. Certain drugs aren’t safe for children.

Treatment for children focuses on keeping them hydrated. Infants who are breastfeeding should continue to nurse. Formula-fed babies may benefit from formulas that have little, if any, lactose. This milk sugar can cause an upset stomach. Older children should be encouraged to eat and drink normally. Drinks with electrolytes or ORS can also help.

Contact your provider if your child has diarrhea and these symptoms:

  • Bloody diarrhea.
  • Fever higher than 102° F (38.9° C).
  • Persistent vomiting.
  • Signs of dehydration (sunken eyes, dry mouth and skin, confusion).

Prevention

How can I prevent traveler’s diarrhea?

You can take two ounces or two tablets of bismuth subsalicylate (Pepto-Bismol®) four times a day before and during travel. Studies show this precaution may decrease your chance of getting traveler’s diarrhea, but don't take for longer than two weeks. Pregnant women, young children, people with kidney problems, people taking anti-seizure medications and those who are immunocompromised and taking anti-rejection medications shouldn't take bismuth subsalicylate without talking to their healthcare provider.

If you’re traveling overseas to a high-risk area, these steps may help prevent illness:

  • Avoid food buffets. Eat only hot, thoroughly cooked foods.
  • Don’t drink from lakes, streams or rivers.
  • Don’t eat raw fruits or vegetables unless you can safely wash them in treated water. (Peeled fruits and vegetables should be fine.)
  • Drink canned or bottled beverages, and skip the ice. Or boil water to make it safe to consume.
  • Wash hands often. Use hand sanitizer when soap and water aren’t available.
  • Use bottled water to brush your teeth.

Outlook / Prognosis

What is the prognosis (outlook) for people who have traveler’s diarrhea?

Most people with traveler’s diarrhea get better in a few days. Antidiarrheal medications can relieve some symptoms. The elderly and young children are most at risk for dehydration or side effects from antidiarrheal medications.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Fever and chills.
  • Rectal bleeding.
  • Severe, bloody diarrhea that doesn’t improve in a few days.
  • Signs of dehydration.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • Why did I get traveler’s diarrhea?
  • What is the best treatment for traveler’s diarrhea?
  • When will symptoms improve?
  • How can I keep from getting traveler’s diarrhea again?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Traveler’s diarrhea is a relatively common plight of people who travel to countries that have untreated water supplies. Many of the organisms that cause this illness live in contaminated water or food. If you’re traveling to a high-risk area, talk to your healthcare provider about how to lower your risk of getting sick and what to do if you get sick. With some precautions, you can safely leave the bathroom and enjoy your travels.

Last reviewed by a Cleveland Clinic medical professional on 07/11/2016.

References

  • American Family Physician. Infectious Diarrhea: Infectious Diseases Society of America (IDSA) Updates Guidelines for Diagnosis and Management. (https://www.aafp.org/afp/2018/0515/p676.html) 2018;97(10):676-7. Accessed 12/1/2020.
  • Centers for Disease Control and Prevention. Chapter 2: Preparing International Travelers. (https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea) Accessed 12/1/2020.
  • Centers for Disease Control and Prevention. Travelers’ Diarrhea. (https://wwwnc.cdc.gov/travel/page/travelers-diarrhea) Accessed 12/1/2020.
  • Dunn N, Okafor CN. Travelers Diarrhea. (https://www.ncbi.nlm.nih.gov/books/NBK459348/) [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Accessed 12/1/2020.
  • Giddings SL, Stevens AM, Leung DT. Traveler’s Diarrhea. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764790) Medical Clinics of North America. 2016;100(2):317-30. Accessed 12/1/2020.
  • InformedHealth.org. Traveler’s Diarrhea. (https://www.ncbi.nlm.nih.gov/books/NBK373093/) Accessed 12/1/2020.
  • Merck Manual. Traveler’s Diarrhea. (https://www.merckmanuals.com/home/digestive-disorders/gastroenteritis/traveler%E2%80%99s-diarrhea) Accessed 12/1/2020.

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