This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Majority of travellers diarrhoea episodes are generally short-lived and self-limiting (mean duration 4 days). The onset of diarrhoea is usually early in the trip (peak on third day).

  • bacterial and viral agents
    • incubation period is around 6–48 hours
    • symptoms range from mild cramps and urgent loose stools to severe abdominal pain, fever, vomiting, and bloody diarrhea (in norovirus, vomiting may be more prominent)
    • untreated bacterial diarrhoea lasts 3–5 days while viral diarrhoea resolves in 2–3 days
  • protozoal diarrhoea,
    • incubation period is around 1-2 weeks (rarely present in the first few weeks of travel with the exception of Cyclospora cayetanensis, which can present quickly in areas of high risk.)
    • generally has a more gradual onset of low-grade symptoms, with 2–5 loose stools per day.
    • persist for weeks to months if not treated (1)

In general four clinical syndromes can be seen in enteric infection of travellers.

  • acute gastroenteritis (10%)
    • consider Noroviruses, preformed toxins of Staphylococcus aureus or Bacillus cereus
    • vomiting is the predominant feature
    • incubation period for viral gastroentritis is more than 14 hours while for the intoxications, the incubation period is 2–7 h, often less than 4 h.
  • acute watery diarrhoea (80%)]
    • consider all agents, including ETEC, EAEC, Shigella, Salmonella, noroviruses
    • patients present with acute watery diarrhoea with abdominal pain and cramps
  • dysentric diarrhoea (1-9%)
    • consider ShigellaCampylobacter, less commonly Salmonella spp, non-cholera Vibrios and Aeromonas spp
    • presents with bloody stools, often with associated fever,
  • persistent diarrhoea and post infectious irritable bowel syndrome
    • persistent diarrhoea (2–10%)
      • diarrhoea lasting two weeks or longer
      • consider Giarda, Cryptosporidium, E. histolytica, Microsporidium, Cyclospora etc
      • commonly seen in persons living close to the locals including peace corps volunteers and medical missionaries.
    • post infectious irritable bowel syndrome (5–10%)
      • caused by invasive/inflammatory bacteria in a genetically susceptible host which appears to unmask an underlying propensity or worsen the pre-existent condition
      • risk factors include - severity of bout of acute diarrhoea, virulence properties of the infecting organism, age <60 years and female gender
      • pateints have chronic gastrointestinal illness with abdominal pain and discomfort associated with change in stool form resembling irritable bowel syndrome (2)


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.