Traveler’s diarrhea (also known as Montezuma’s Revenge or Delhi belly) is defined as three or more episodes of watery (non-bloody) diarrhea in 24 hours with at least one accompanied symptom (abdominal cramping, nausea, vomiting, or fecal urgency). Individuals who travel to areas of poor sanitation and limited access to clean water are at greater risk of developing traveler diarrhea.
Traveler’s diarrhea is prevented by eating only cooked food and drinking boiled water.
An estimated 30% to 70% of travelers experience diarrhea, depending on where they go and what time of year. The most important determinant of the causative organism and risk for travelers’ diarrhea is travel destination and poor hygiene practice in local restaurants of such destinations.
High-risk destinations include most of Asia, the Middle East, Africa, Mexico, and Central and South America.
Travelers’ diarrhea is most commonly caused by a bacterial pathogen. In some circumstances, viruses (e.g. norovirus gastroenteritis outbreak on a cruise) and parasites can also cause traveler’s diarrhea.
Causes of Travelers’ Diarrhea
Enterotoxigenic E.coli (ETEC)
Escherichia coli is most frequently associated with traveler’s diarrhea. E. coli, which causes traveler’s diarrhea, is acquired by ingesting food or water contaminated with human feces. Enterotoxigenic E. coli is the most common cause of traveler’s diarrhea.
Other organisms are:
- Enteroaggregative E. coli
- Campylobacter jejuni
- Salmonella spp
- Shigella spp.
- Giardia lambalia
Most etiology causes self-limiting diarrhea with symptoms lasting 1-5 days.
As most cases of infectious diarrhea are self-limited, stool cultures are not always necessary. But stool culture may be necessary for the following conditions:
- Individuals with severe illness
- Bloody diarrhea
- High fever
- Persistent symptoms or
- Patients with co-morbidity such as HIV
Rehydration is the cornerstone of managing acute diarrhea regardless of the etiological agent or the severity of the infection. Empiric anti-microbial therapy is not indicated in mild cases as most episodes of travelers’ diarrhea are self-limited. Traveler’s diarrhea is often treated with bismuth subsalicylate (Pepto-Bismol) or loperamide (Imodium).
Good hand hygiene prevents the spread of infectious organisms. Wash your hands often with soap and water or use an alcohol-based hand sanitizer. Sticking to safe food and water habits helps to prevent traveler’s diarrhea which includes but is not limited to:
- Eating cooked food served in hot
- Eating fruits and vegetables, you have washed in clean water or peeled yourself
- Drinking bottled water that is sealed
Traveler’s diarrhea can sometimes be prevented by the prophylactic use of doxycycline, ciprofloxacin, trimethoprim-sulfamethoxazole, or Pepto-Bismol. According to CDC, “Adults may also take a bismuth-containing antacid medicine, which can decrease the incidence of travelers’ diarrhea up to 50%”. Find more about travelers’ diarrhea here.