Travelers' diarrhea
Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, three or more by others) while traveling.[2][3] It may be accompanied by abdominal cramps, nausea, fever, headache and bloating.[3] Occasionally bloody diarrhea may occur.[5] Most travelers recover within three to four days with little or no treatment.[3] About 12% of people may have symptoms for a week.[3]
"Montezuma's revenge" and "Delhi belly" redirect here. For other uses, see Montezuma's revenge (disambiguation) and Delhi Belly (disambiguation).Travelers' diarrhea
Typically < 5 days[3]
Travel in the developing world
Based on symptoms and travel history
Eating only properly prepared food, drinking bottled water, frequent hand washing[4]
~35% of travelers to the developing world[3]
Bacteria are responsible for more than half of cases,[3] typically via foodborne illness and waterborne diseases. The bacteria enterotoxigenic Escherichia coli (ETEC) are typically the most common except in Southeast Asia, where Campylobacter is more prominent.[2][3] About 10 to 20 percent of cases are due to norovirus.[3] Protozoa such as Giardia may cause longer term disease.[3] The risk is greatest in the first two weeks of travel and among young adults.[2] People affected are more often from the developed world.[2]
Recommendations for prevention include eating only properly cleaned and cooked food, drinking bottled water, and frequent hand washing.[4] The oral cholera vaccine, while effective for cholera, is of questionable use for travelers' diarrhea.[6] Preventive antibiotics are generally discouraged.[3] Primary treatment includes rehydration and replacing lost salts (oral rehydration therapy).[3][4] Antibiotics are recommended for significant or persistent symptoms, and can be taken with loperamide to decrease diarrhea.[3] Hospitalization is required in less than 3 percent of cases.[2]
Estimates of the percentage of people affected range from 20 to 50 percent among travelers to the developing world.[3] TD is particularly common among people traveling to Asia (except for Japan and Singapore), the Middle East, Africa, Latin America, and Central and South America.[4][7] The risk is moderate in Southern Europe, and Russia.[8] TD has been linked to later irritable bowel syndrome and Guillain–Barré syndrome.[2][3] It has colloquially been known by a number of names, including "Montezuma's revenge," “mummy tummy,”[9] "Delhi belly"[10] and the "Thailand trots".
Signs and symptoms[edit]
The onset of TD usually occurs within the first week of travel, but may occur at any time while traveling, and even after returning home, depending on the incubation period of the infectious agent.[11] Bacterial TD typically begins abruptly, but Cryptosporidium may incubate for seven days, and Giardia for 14 days or more, before symptoms develop. Typically, a traveler experiences four to five loose or watery bowel movements each day. Other commonly associated symptoms are abdominal cramping, bloating, fever, and malaise. Appetite may decrease significantly.[12] Though unpleasant, most cases of TD are mild, and resolve in a few days without medical intervention.[13]
Blood or mucus in the diarrhea, significant abdominal pain, or high fever suggests a more serious cause, such as cholera, characterized by a rapid onset of weakness and torrents of watery diarrhea with flecks of mucus (described as "rice water" stools). Medical care should be sought in such cases; dehydration is a serious consequence of cholera, and may trigger serious sequelae—including, in rare instances, death—as rapidly as 24 hours after onset if not addressed promptly.[13]
Prevention[edit]
Sanitation[edit]
Recommendations include avoidance of questionable foods and drinks, on the assumption that TD is fundamentally a sanitation failure, leading to bacterial contamination of drinking water and food.[12] While the effectiveness of this strategy has been questioned, given that travelers have little or no control over sanitation in hotels and restaurants, and little evidence supports the contention that food vigilance reduces the risk of contracting TD,[21] guidelines continue to recommend basic, common-sense precautions when making food and beverage choices:[3]
Society and culture[edit]
Moctezuma's revenge is a colloquial term for travelers' diarrhea contracted in Mexico. The name refers to Moctezuma II (1466–1520), the Tlatoani (ruler) of the Aztec civilization who was overthrown by the Spanish conquistador Hernán Cortés in the early 16th century, thereby bringing large portions of what is now Mexico and Central America under the rule of the Spanish crown. The relevance being that Cortés and his soldiers carried the smallpox virus. The Mexicans had never been exposed to the virus. The resulting infection reduced the population of Tenochtitlan by 40 percent in the single year of 1520.[45]