Traveler's diarrhea causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are many causes of diarrhea and it is important to recognize which ones are serious and which are not. Infectious agents are the primary cause of TD. Bacterial enteropathogens cause approximately 80% of TD cases. The most common causative agent isolated in countries surveyed has been enterotoxigenic Escherichia coli (ETEC). In infants and children it is estimated that nearly 70% of diarrhea is due to viruses

Causes

The most common causative agent isolated in countries surveyed has been enterotoxigenic Escherichia coli (ETEC). Enteroaggregative E. coli is increasingly recognized and many studies do not look for this important bacterium. Some bacteria release toxins which bind to the intestines and cause diarrhea; others damage the intestines themselves by their direct presence. In infants and children it is estimated that nearly 70% of diarrhea is due to viruses; for adult travelers, this drops to around 30%. Diarrhea caused by viral agents is usually self-limited. Pathogens implicated in travellers' diarrhea are:

E. coli, enterotoxigenic 20-75%
E. coli, enteroaggregative 0-20%
E. coli, enteroinvasive 0-6%
Shigella spp 2-30%
Salmonella spp  0-33%
Campylobacter jejuni 3-17%
Vibrio parahemolyticus 0-31%
Aeromonas hydrophila 0-30%
Giardia lamblia 0 to less than 20%
Entamoeba histolytica  0-5%
Cryptosporidium sp 0 to less than 20%
Rotavirus 0-36%
Norwalk virus 0-10%

Common Causes

Causes by Organ System

Cardiovascular Gangrene, kawasaki disease, superior mesenteric artery occlusion, organophosphates,abetalipoproteinaemia, viral haemorrhagic fever, autonomic neuropathy, selenium
Chemical / poisoning No underlying causes
Dermatologic Kawasaki disease, mercury, pellagra, celiac disease, acrodermatitis enteropathica, staphylococcal toxic shock syndrome, systemic sclerosis, Degos' disease, kwashiorkor
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine Autoimmune adrenalitis, Glucagonoma, Hyperthyroidism, Selenium
Environmental Arsenicals, Carbon monoxide toxicity, Organophosphates
Gastroenterologic Superior mesenteric artery occlusion, organophosphates, glucagonoma, bacterial overgrowth of small intestine, bile acid malabsorption syndrome,Brainerd diarrhea, celiac disease, cholestatic jaundice, collagenous colitis, colonic villous adenomata, colorectal cancer, crohn disease, faecal impaction, faecal incontinence, graft versus host disease, hirschsprung disease, intususception of intestine, irritable bowel syndrome, Large bowel obstruction, Laxative abuse, Lymphocytic colitis, Malabsorption syndrome, Nausea and vomiting, Postgastrectomy syndrome, protein losing enteropathy,short bowel syndrome, sucrase-isomaltase deficiency, ulcerative colitis, acrodermatitis enteropathica, lactase deficiency, abetalipoproteinaemia,meckel diverticulitis, pernicious anaemia, bacillary dysentery, bacillus cereus, campylobacter jejuni, cytomegalovirus, dysentery, entamoeba histolytica, enterotoxigenic escherichia coli, escherichia coli, giardia lamblia, isosporiasis, legionella pneumophila, trichuriasis, tropical sprue, systemic sclerosis, whipple disease, autonomic neuropathy, Degos' disease, kwashiorkor
Genetic Pancreatitis, chronic, acrodermatitis enteropathica, iduronate-2-sulfatase deficiency, lactase deficiency, Rapadilino syndrome
Hematologic Celiac disease, abetalipoproteinaemia, meckel diverticulitis, pernicious anaemia, viral haemorrhagic fever, entamoeba histolytica,HIV-1 disease, vitamin B12 deficiency, somatostatinoma
Iatrogenic No underlying causes
Infectious Disease Bacillary dysentery, bacillus cereus, balantidiasis, campylobacter jejuni, capillaria, clostridium welchii, cryptosporidiosis,cyclospora cayetanensis, cyclosporiasis, cytomegalovirus, dengue fever, dientamoeba fragilis, dysentery, entamoeba histolytica, enterotoxigenic escherichia coli, escherichia coli, giardia lamblia, HIV-1 disease, hymenolepiasis, isosporiasis, legionella pneumophila, microsporidiasis,penicillium marneffei, pneumatosis cystoides intestinalis, pseudomembranous colitis, rotavirus, salmonella, sapporo-like virus, shigellosis, small round structured virus, staphylococcal toxic shock syndrome, staphylococcus aureus, streptococcus suis, strongyloidiasis, trichinella spiralis,trichuriasis, tropical sprue, typhoid fever, vibrio parahaemolyticus, visceral leishmaniasis, yersinia enterocolitica, adenovirus
Musculoskeletal / Ortho Rapadilino syndrome, Viral haemorrhagic fever, Dengue fever, Systemic sclerosis, Whipple disease
Neurologic Mercury, pellagra, hirschsprung disease, pernicious anaemia, staphylococcal toxic shock syndrome, autonomic neuropathy, Degos' disease, ethylmalonic encephalopathy, vitamin B12 deficiency, zinc deficiency
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Colorectal cancer, large bowel obstruction, small bowel lymphoma, somatostatinoma
Opthalmologic Hyperthyroidism, adenovirus
Overdose / Toxicity Arsenicals, carbon monoxide toxicity, mercury, organophosphates, pancreatitis, chronic, paraquat, thallium
Psychiatric Irritable bowel syndrome
Pulmonary Systemic sclerosis, severe acute respiratory syndrome
Renal / Electrolyte Autoimmune adrenalitis, laxative abuse, legionella pneumophila, staphylococcal toxic shock syndrome, systemic sclerosis
Rheum / Immune / Allergy No underlying causes
Sexual HIV-1 disease, zinc deficiency
Trauma Pancreatitis, chronic
Urologic Organophosphates, malakoplakia
Dental No underlying causes
Miscellaneous Brainerd diarrhea, complement 5 deficiency, copper salts, functional disorders

Causes in Alphabetical Order


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