Recent Advances in Travelers’ Diarrhea: Epidemiology, Diagnosis, and Treatment

Abstract

Introduction: One of the most common clinical syndromes affecting travelers is travelers’ diarrhea (TD). The purpose of this narrative review is to provide an overview of the key discoveries related to TD over the past two years, along with a list of future research topics.

Methods: A PubMed search was conducted to locate new data in TD research published between 2019 and 2023 compared with some reports published between 2000 - 2018. Contribution to epidemiology, etiology, diagnostics, management, and long-term consequences was also considered, along with public health, discovery, and clinical practice.

Results: A total of 218 articles were found during the initial search in the literature. We obtained 107 and examined 84 articles for potential inclusion. Despite this discovery, there is still a moderate risk of TD among students and military travelers, and it remains challenging to control food and water in large gatherings. The rise in cultureindependent testing has resulted in the continuous identification of pathogens that were previously known, as well as a higher frequency of detecting norovirus. The resistance rates to fluoroquinolones are consistently increasing due to the escalation of multipathogen infections. This necessitates considering clinical, epidemiological, and diagnostic information. It is increasingly clear that non-absorbable antibiotics may offer an alternative to current recommendations (such as azithromycin and fluoroquinolones). However, they are not advised for febrile diarrhea, dysentery, or in regions/itineraries where invasive pathogens are likely to cause illness. Recent research has explored the connection between the microbiome and the prevention and consequences of TD. Although distinct characteristics have been identified, there is still a significant level of uncertainty. The acquisition and carriage of extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) are on the rise. Lastly, ongoing research supports the post-infectious consequences, while further investigation is needed to understand the mechanisms behind reactive arthritis and post-infectious IBS.

Conclusion: The issue of TD remains an important travel health issue across the globe as we continue to learn more about it. More research is needed to mitigate risk factors associated with antibiotic use and its associated consequences.