Travelers’ diarrhea (also known as Montezuma’s Revenge or Delhi belly) is defined as 3 or more episodes of diarrhea in 24 hours with at least one another accompanied symptoms including 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 travelers’ diarrhea.
An estimated 30% to 70% of travelers experience travelers’ 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 in a cruise) and parasites can cause traveler’s diarrhea.
Causes of Travelers’ Diarrhea
Enterotoxigenic E.coli (ETEC)
Other organisms are:
- Enteroaggregative coli
- Campylobacter jejuni
- Salmonella spp
- Shigella spp.
- Giardia lambalia
Most etiology causes self limiting diarrhea with symptoms lasting 1-5 days.
Rehydration is the cornerstone of the management of acute diarrhea regardless of the etiological agent or and the severity of the infection. Empiric anti-microbial therapy is not indicated in mild cases as most episodes of travelers’ diarrhea are self limited.
As most cases of infectious diarrhea are self limited stool cultures are not always necessary. But stool culture may be necessary in following conditions:
- Individuals with severe illness
- Bloody diarrhea
- High fever
- Persistent symptoms or
- Patients with co-morbidity such as HIV
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 travelers’ diarrhea which includes but not limited to:
- Eating cooked food served hot
- Eating fruits and vegetables you have washed in clean water or peeled yourself
- Drinking bottled water that is sealed