Travelers' Diarrhea in the New Millennium: Consensus among Experts from German-speaking Countries*

Travelers’ diarrhea (TD) of varying severity grades\udcontinues to be a very frequent health problem among\udtravelers originating from industrialized countries and visiting\uddeveloping countries (Fig. 1).1,2\udFresh-water resources, particularly in densely populated\udareas, including recently developed tourist centers\udare often contaminated.3,4 Contaminated food and\udimproper food handling also play an important role.\udHigh-risk destinations with incidence rates of 20 to\ud90% of TD for a 2-week stay include most parts of\udAfrica, Asia, and Latin America, some islands in the\udCaribbean, including the Dominican Republic and Haiti,\udand some remote destinations in Eastern Europe.\udIntermediate-risk destinations with incidence rates of 8\udto 20% of TD include South Africa, some destinations\udin Southern Europe, Israel, Japan, most destinations in the\udCaribbean, Argentina, and Chile.\udTD is associated with fecally contaminated food\udand beverages. The most frequent etiologic agents\uddetected at most destinations are enterotoxigenic\udEscherichia coli (ETEC) and enteroaggregative E. coli\ud(EAEC), mainly active in the small bowel.5 Many other\udbacterial pathogens are frequently detected, but viral\udand parasitic agents also play a certain role.Cryptosporidia,\udranking among emerging pathogens, are increasingly\uddetected.6 Speculations about noninfectious causes for TD\udare usually unwarranted.\udTD is frustrating at times of high expectations, such\udas a vacation, honeymoon, or a business trip; however, it\udis hardly ever life threatening in adults. Besides diarrhea\udand fecal urgency, the leading symptoms are abdominal\udcramps, nausea,vomiting, and general malaise. This results\udin incapacitation often costing more than 10% of the total\udtime abroad.1 Differentiation into classical, moderate,\udand mild TD is arbitrary because often travelers treat\udthemselves at an early stage, and, furthermore, chronology\udand etiology in the various severity forms of TD suggests\udidentical causes