Can traveler's diarrhea (TD) present with vomiting only?

From the Guidelines

Travelers' diarrhea can sometimes present as only vomiting, though this is not the typical presentation. Most commonly, travelers' diarrhea manifests as loose or watery stools, often accompanied by abdominal cramps, nausea, and sometimes vomiting. When vomiting occurs alone without diarrhea, it may still be caused by the same pathogens (typically bacteria like E. coli, Salmonella, or viruses like norovirus) that cause the more classic presentation.

Key Considerations

• Treatment for vomiting-predominant travelers' illness includes maintaining hydration with oral rehydration solutions (such as Pedialyte or WHO oral rehydration salts mixed as directed) 1.
• Antiemetics like ondansetron (4-8mg every 8 hours as needed) may help control symptoms 1.
• Bismuth subsalicylate (Pepto-Bismol, 2 tablets or 30ml every 30-60 minutes up to 8 doses daily) can also help with nausea and vomiting 1.

Recommendations

• If symptoms are severe, persist beyond 48 hours, or are accompanied by fever above 101°F (38.3°C) or bloody vomit, medical attention should be sought 1.
• Azithromycin should be considered the first-line agent in cases of dysentery or acute watery diarrhea with greater than mild fever 1.
• The isolated vomiting presentation may reflect differences in how individuals respond to gastrointestinal pathogens, with some people experiencing predominantly upper GI symptoms rather than lower GI symptoms 1.

Treatment Approach

• Most if not all travelers should be provided with loperamide and an antibiotic for self-treatment 1.
• If the traveler is going to SE Asia, azithromycin should be prescribed 1.
• A FQ, azithromycin or rifaximin can be used in all other regions 1.

From the Research

Travelers Diarrhea Presentation

• Travelers diarrhea is typically defined as experiencing at least three unformed stools per day during a stay abroad or within 10 days of returning from the destination 2
• However, there is no direct evidence to suggest that travelers diarrhea can present as only vomiting in the provided studies

Symptoms and Treatment

• The symptoms of travelers diarrhea can include diarrhea, nausea, and vomiting, but the primary symptom is diarrhea 3, 4, 5, 6
• Treatment for travelers diarrhea usually involves antibiotics such as fluoroquinolones, azithromycin, and rifaximin, as well as antimotility agents like loperamide 3, 4, 5, 6

Vomiting as a Symptom

• While vomiting can be a symptom of travelers diarrhea, there is no evidence to suggest that it can be the only symptom 3, 4, 5, 6
• In one study, azithromycin use was associated with more nausea in the 30 min after dosing, but no vomiting or other adverse events were noted in either group 3