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Travelers' diarrhea in the new millennium: consensus among experts from German-speaking countries


Steffen, R; Kollaritsch, H; Fleischer, K (2003). Travelers' diarrhea in the new millennium: consensus among experts from German-speaking countries. Journal of Travel Medicine, 10(1):38-45.

Abstract

Travelers’ diarrhea (TD) of varying severity grades
continues to be a very frequent health problem among
travelers originating from industrialized countries and visiting
developing countries (Fig. 1).1,2
Fresh-water resources, particularly in densely populated
areas, including recently developed tourist centers
are often contaminated.3,4 Contaminated food and
improper food handling also play an important role.
High-risk destinations with incidence rates of 20 to
90% of TD for a 2-week stay include most parts of
Africa, Asia, and Latin America, some islands in the
Caribbean, including the Dominican Republic and Haiti,
and some remote destinations in Eastern Europe.
Intermediate-risk destinations with incidence rates of 8
to 20% of TD include South Africa, some destinations
in Southern Europe, Israel, Japan, most destinations in the
Caribbean, Argentina, and Chile.
TD is associated with fecally contaminated food
and beverages. The most frequent etiologic agents
detected at most destinations are enterotoxigenic
Escherichia coli (ETEC) and enteroaggregative E. coli
(EAEC), mainly active in the small bowel.5 Many other
bacterial pathogens are frequently detected, but viral
and parasitic agents also play a certain role.Cryptosporidia,
ranking among emerging pathogens, are increasingly
detected.6 Speculations about noninfectious causes for TD
are usually unwarranted.
TD is frustrating at times of high expectations, such
as a vacation, honeymoon, or a business trip; however, it
is hardly ever life threatening in adults. Besides diarrhea
and fecal urgency, the leading symptoms are abdominal
cramps, nausea,vomiting, and general malaise. This results
in incapacitation often costing more than 10% of the total
time abroad.1 Differentiation into classical, moderate,
and mild TD is arbitrary because often travelers treat
themselves at an early stage, and, furthermore, chronology
and etiology in the various severity forms of TD suggests
identical causes.

Abstract

Travelers’ diarrhea (TD) of varying severity grades
continues to be a very frequent health problem among
travelers originating from industrialized countries and visiting
developing countries (Fig. 1).1,2
Fresh-water resources, particularly in densely populated
areas, including recently developed tourist centers
are often contaminated.3,4 Contaminated food and
improper food handling also play an important role.
High-risk destinations with incidence rates of 20 to
90% of TD for a 2-week stay include most parts of
Africa, Asia, and Latin America, some islands in the
Caribbean, including the Dominican Republic and Haiti,
and some remote destinations in Eastern Europe.
Intermediate-risk destinations with incidence rates of 8
to 20% of TD include South Africa, some destinations
in Southern Europe, Israel, Japan, most destinations in the
Caribbean, Argentina, and Chile.
TD is associated with fecally contaminated food
and beverages. The most frequent etiologic agents
detected at most destinations are enterotoxigenic
Escherichia coli (ETEC) and enteroaggregative E. coli
(EAEC), mainly active in the small bowel.5 Many other
bacterial pathogens are frequently detected, but viral
and parasitic agents also play a certain role.Cryptosporidia,
ranking among emerging pathogens, are increasingly
detected.6 Speculations about noninfectious causes for TD
are usually unwarranted.
TD is frustrating at times of high expectations, such
as a vacation, honeymoon, or a business trip; however, it
is hardly ever life threatening in adults. Besides diarrhea
and fecal urgency, the leading symptoms are abdominal
cramps, nausea,vomiting, and general malaise. This results
in incapacitation often costing more than 10% of the total
time abroad.1 Differentiation into classical, moderate,
and mild TD is arbitrary because often travelers treat
themselves at an early stage, and, furthermore, chronology
and etiology in the various severity forms of TD suggests
identical causes.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2003
Deposited On:06 Jul 2009 08:36
Last Modified:06 Dec 2017 20:07
Publisher:Wiley-Blackwell
ISSN:1195-1982
Additional Information:The definitive version is available at www.blackwell-synergy.com
Publisher DOI:https://doi.org/10.2310/7060.2003.30672
Official URL:http://www3.interscience.wiley.com/journal/119925163/issue
PubMed ID:12729511

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