From the Guidelines
Yes, traveler's diarrhea can persist for 15 days, and according to the 2017 Infectious Diseases Society of America clinical practice guidelines, travelers with diarrhea lasting 14 days or longer should be evaluated for intestinal parasitic infections 1.
Key Considerations
- Traveler's diarrhea typically resolves within 3-7 days without treatment, but persistence beyond a week, especially for 15 days, suggests a more serious infection or a different condition altogether.
- The guidelines recommend diagnostic testing for intestinal parasitic infections in cases of prolonged diarrhea, as well as testing for C. difficile in travelers treated with antimicrobial agents within the preceding 8-12 weeks 1.
- Treatment options may include antibiotics like azithromycin, ciprofloxacin, or rifaximin, and hydration is crucial to prevent complications like dehydration, electrolyte imbalances, and nutritional deficiencies.
Evaluation and Management
- A broad differential diagnosis is recommended in immunocompromised individuals with diarrhea, including evaluation of stool specimens by culture, viral studies, and examination for parasites 1.
- Clinical consideration should be included in the interpretation of results of molecular assays, as these detect DNA and not necessarily viable organisms 1.
- Medical evaluation is necessary to identify the specific cause of prolonged diarrhea through stool tests and possibly adjust treatment accordingly.
Important Complications to Consider
- Dehydration and electrolyte imbalances
- Nutritional deficiencies
- Parasitic infections like Giardia or Entamoeba
- Bacterial pathogens resistant to initial treatment
- Post-infectious irritable bowel syndrome It is essential to seek medical attention if traveler's diarrhea persists for 15 days or longer, as prompt evaluation and treatment can help prevent complications and improve outcomes 1.
From the Research
Definition and Duration of Traveler's Diarrhea
- Traveler's diarrhea (TD) is a common illness that can vary in severity and typically develops in individuals during or within 10 days of returning from travel to developing or low-/middle-income countries 2.
- Most cases of TD are self-limiting, but the duration can vary, with some cases lasting longer than others.
Persistent Diarrhea in Travelers
- Persistent diarrhea, defined as lasting 14 days or more, occurs in approximately 3% of travelers who have acute diarrhea 3.
- This suggests that it is possible for TD to persist for 15 days or more, although the exact duration may vary depending on the individual and the underlying cause of the diarrhea.
Treatment and Management of TD
- Treatment for TD typically involves a combination of an antibiotic and an antimotility agent, and in some cases, empirical anti-infective therapy may be indicated 3, 4.
- However, the management of persistent diarrhea may require further evaluation, including stool samples and endoscopic evaluation, to identify the underlying cause and guide treatment 3.