What are the symptoms of traveler's diarrhea?

Symptoms of Traveler's Diarrhea

Traveler's diarrhea is characterized by the sudden onset of abnormally loose or liquid, frequent stools that can range from being tolerable to completely incapacitating, depending on severity. 1

Primary Symptoms

• Diarrhea: Three or more loose or liquid stools per day, or more frequently than normal for an individual 2
• Stool characteristics: Watery, loose consistency (Bristol stool types 5-7) 2
• Abdominal cramps: Often accompany the diarrhea 3

Classification by Severity

Traveler's diarrhea can be classified based on functional impact rather than just stool frequency 1:

1. Mild (acute):

   • Diarrhea that is tolerable
   • Not distressing
   • Does not interfere with planned activities

2. Moderate (acute):

   • Diarrhea that is distressing
   • Interferes with planned activities

3. Severe (acute):

   • Diarrhea that is incapacitating
   • Completely prevents planned activities
   • All dysentery (passage of grossly bloody stools) is considered severe

Associated Symptoms

• Fever: Present in up to 30% of patients with traveler's diarrhea 1
• Nausea/vomiting: May accompany diarrhea 4
• Abdominal pain: Common accompanying symptom 4
• Blood in stool: Indicates dysentery, which is considered severe and requires medical attention 1

Duration and Impact

• Typical duration: 3-5 days if untreated 5
• Activity limitation: Approximately 24% of affected travelers stop planned activities due to symptoms 4
• Hospitalization: About 2% of cases may require hospitalization 4
• Persistent diarrhea: Some cases (approximately 10%) may develop persistent diarrhea lasting more than 2 weeks 1, 6

Warning Signs Requiring Medical Attention

Medical attention should be sought if any of the following occur 1, 2:

• Dysentery (bloody stools)
• High fever (above 38.5°C/101.5°F)
• Severe vomiting leading to dehydration
• Signs of dehydration
• Diarrhea persisting beyond 3 days
• Severe abdominal pain

Clinical Pearls

• The severity of traveler's diarrhea is best assessed by its functional impact rather than just stool frequency. Even a small number of stools with fever and severe cramps may be more disabling than multiple watery stools without other symptoms 1.

• Dysentery should be distinguished from hemorrhoidal bleeding. True dysentery involves gross blood mixed with stool, while hemorrhoidal bleeding typically appears as streaks of blood on toilet paper with normal-appearing stool 1.

• Travelers from developed countries visiting developing countries have a >60% risk of experiencing traveler's diarrhea 3, with the highest proportion reported in young adults aged 15-24 years (46%) 5.

• While typically self-limiting, traveler's diarrhea can occasionally lead to post-infectious irritable bowel syndrome in some patients 6.