Traveller's diarrhea among Austrian tourists to warm climate countries: II. Clinical features

Abstract

The syndrome "Traveller's Diarrhea" (TD) is important for tourists travelling to warm-climate countries. In this study a worldwide survey on the clinical features of enteritis among 1,455 Austrian tourists is reported. The clinical parameters of TD show that this disease exhibits a very uniform clinical course which is not influenced by different regions with considerable differences in aetiology or by travel-associated parameters such as accommodation, travel style and individual dietary hygiene: TD starts mainly at the end of first week of the stay and the average duration of illness is 3.6 +/- 2.7 days. Watery and mucous stools were reported by 99% of patients with a frequency of 4 bowel movements per day, while bloody diarrhea occurred very rarely. However, 57.2% of patients suffered from abdominal cramps, less than one third of patients reported nausea and/or vomiting and fever accompanied the acute disease in 13%. Symptoms indicate that TD should not be considered a severe disease. The diarrheal illness will show the characteristics of an enteroinvasive disease only in rare cases. Treatment of TD is discussed: symptomatic or other non-antibiotic agents are preferable as antibiotics will only occasionally be necessary for treatment of an illness with a self-limiting character. For prophylaxis of TD, the preferable way to resolve the problem of TD in international travel, very few effective preparations are currently available, emphasizing the need for extensive research in this field.

Epidemiology of Traveler's Diarrhea

“…Although there is still a risk of illness occurring in subsequent weeks and for up to 2 years even after episodes of traveler's diarrhea [21,33], it appears that some immunity is gradually developed [34]. The average duration of untreated traveler's diarrhea is ∼4 days; 50% of patients who experience traveler's diarrhea are free of symptoms within 48 h [4,5]. Patients with fever or other symptoms suggestive of severe traveler's diarrhea and patients in whom pathogens are identified tend to have a longer duration of illness [35].…”

“…Classic traveler's diarrhea is usually defined as у3 unformed bowel movements occurring within 24 h and accompanied by other symptoms, most often cramps, nausea, fever, blood admixed to the stools, and vomiting [2][3][4][5]. Fecal urgency is usually also associated with traveler's diarrhea.…”

Probiotics in infectious diarrhoea in children: are they indicated?

“…At least three placebo-controlled studies with lactobacilli have been performed, all with negative results [25,32,45]. One trial with S. boulardii reported a clinically small but statistically significant preventive effect in a specific subgroup, suggesting geographical differences in efficacy [34].…”

Traveller's diarrhoea

“…2 Symptoms may be more severe in small children. Commonly associated symptoms include abdominal cramps, nausea, bloating, urgency, fever and malaise.…”