Table 5.
Tropical diseases associated with gastrointestinal symptoms
| Disease | Etiologic Pathogen | Geographic Regions | Vector or Exposure | Incubation Period | Presentation | Diagnosis | Management |
|---|---|---|---|---|---|---|---|
| amebiasis | Entamoeba histolytica | Worldwide | Fecal-oral, contaminated food or water | Days–weeks | Abdominal cramps, watery or bloody diarrhea, weight loss, liver abscess with abdominal pain | Microscopic evaluation of stool, serologies | Antimicrobial therapy (metronidazole + iodoquinol or puromycin) |
| Campylobacteriosis | Campylobacter jejuni, Campylobacter coli | Worldwide | Contaminated foods (raw poultry) and water, unpasteurized milk, fecal-oral | 2–4 d | Abdominal pain, fever, bloody diarrhea, nausea and vomiting, pseudoappendicitis, reactive arthritis, Guillain-Barre syndrome | Stool culture, darkfield microscopy, NAAT | Supportive care, antimicrobial therapies (fluoroquinolone, macrolide) |
| Chagas disease | T cruzi | Central and South America | Reduviid bug, contaminated food or water, blood transfusion | 7 d | Chagoma (eg, Romaña sign), ventricular arrhythmias, megacolon, megaesophagus | Microscopic evaluation of blood smear, IgM ELISA, PCR (acute disease only) | Antimicrobial therapy (benznidazole, nifurtimox) |
| Cholera | Vibrio cholerae O-group 1 or O-group 139 | Africa, Caribbean, Southeast Asia | Aquatic plants, brackish water, shellfish | 5 d | Profuse, watery diarrhea, nausea and vomiting, muscle cramps, hypovolemic shock | Stool culture | Supportive care, antimicrobial therapy (azithromycin, doxycycline) |
| Cyclosporiasis | Cyclospora cayetenensis | Worldwide | Contaminated produce and water | 2–14 d | Watery diarrhea, anorexia, weight loss, abdominal cramps, myalgias, vomiting | Microscopic evaluation of stool for oocysts | Antimicrobial therapy (trimethoprim-sulfamethoxazole) |
| Echinococcosis | Echinococcus species | Eurasia, Central and South America, Africa | Contaminated dog feces, contaminated food or water | 5–15 y | Hydatid cysts in liver and lungs, abdominal pain, liver failure | Imaging (ultrasound, computed tomography scan), serologies | Supportive care, surgical excision if cyst >10 cm, antimicrobial therapy (albendazole, praziquantel) |
| Traveler’s diarrhea | Enterotoxigenic Escherichia coli (ETEC) | Worldwide | Fecal-oral, contaminated food or water | 9 h–3 d | Abdominal pain, watery diarrhea | Clinical diagnosis, NAAT | Supportive care, antimicrobial therapy (ciprofloxacin, azithromycin) |
| Fascioliasis | Fasciola hepatica and F gigantica | South America, Middle East, Southeast Asia | Watercress or other aquatic plants, freshwater | 6–12 wk | Intermittent, fever eosinophilia, abdominal pain, weight loss, urticaria, biliary colic, liver failure | Microscopic evaluation of stool, serologies, liver imaging | Antimicrobial therapy (triclabendazole) |
| Giardiasis | Giardia intestinalis | Worldwide | Fecal-oral, sexual contact, contaminated water | 1–2 wk | Abdominal pain, anorexia, foul-smelling diarrhea, flatulence, nausea, reactive arthritis | Microscopic evaluation of stool, DFA | Antimicrobial therapy (metronidazole, tinidazole, nitazoxanide) |
| Peptic ulcer disease | Helicobacter pylori | Worldwide | Fecal-oral, oral-oral | Unknown | Epigastric pain, nausea and vomiting, anorexia, gastric cancer | Fecal antigen assay, urea breath test | Antimicrobial therapy (proton pump inhibitor + clarithromycin + amoxicillin) |
| Pinworm | Enterobius vermicularis | Worldwide | Fecal-oral, contaminated objects | 1–2 mo | Perianal pruritus | Scotch tape test, microscopic evaluation of fingernails | Antimicrobial therapy (albendazole, pyrantel pamoate) |
| Sarcocystosis | Sarcocystis species | Worldwide, especially Southeast Asia | Undercooked beef or pork | 2 wk | Fever, malaise, myalgia, headache, cough, arthralgia, nausea and vomiting, diarrhea, palpitations | Microscopic evaluation of stool, PCR, muscle biopsy | Antimicrobial therapy (trimethoprim-sulfamethoxazole) |
| Soil-transmitted helminths | Ascaris lumbricoides (roundworm), Ancylostoma duodenale (hookworm), Necator americanus (hookworm), Trichuris trichiura (whipworm) | Worldwide | Fecal-oral, skin penetration with contaminated soil (hookworms) | Variable | Abdominal pain, malnutrition, bowel obstruction, anemia, cough, chest pain | Microscopic evaluation of stool | Antimicrobial therapy (albendazole, mebendazole) |
| Strongyloidiasis | Strongyloides stercoralis | Worldwide | Auto-inoculation, skin penetration | Variable | Pruritic rash at penetration site, serpiginous rashes (larva currens), respiratory symptoms (Löffler-like pneumonitis), abdominal pain, diarrhea, severe disease if immuno-compromised | Microscopic evaluation of stool other body fluids if disseminated (eg, sputum, CSF) | Antimicrobial therapy (ivermectin, albendazole) |
| Taeniasis | Taenia solium (pork) and T saginata or T asiatica (beef) | Central and South America, Africa, South and Southeast Asia | Undercooked contaminated pork or beef | 8–10 wk for T solium, 10–14 wk for T saginata | Abdominal discomfort, weight loss, anorexia, perianal pruritus, insomnia, weakness | Microscopic evaluation of stool for eggs | Antimicrobial therapy (praziquantel, niclosamide unless symptomatic neurocysticercosis) |
| Visceral leishmaniasis | Leishmania donovani and L infantum-chagasi | South America, Central and Southwest Asia, East Africa | Phlebotomine sand fly, blood transfusions | Weeks–months | Fever, weight loss, hepatosplenomegaly, pancytopenia | Light-microscopic evaluation of specimens, culture, molecular methods | Antimicrobial therapy (amphotericin B, miltefosine) |
| Yersiniosis | Yersinia enterocolitica | Japan, Northern Europe | Undercooked contaminated pork, contaminated water, unpasteurized dairy | 4–6 d | Fever, abdominal pain (pseudoappendicitis), bloody diarrhea, necrotizing enterocolitis in infants, reactive arthritis, erythema nodosum | Stool culture (or other body sits; eg, CSF, blood) | Supportive care, antimicrobial therapy if severe (trimethoprim-sulfamethoxazole, fluoroquinolones, aminoglycosides) |
Abbreviations: CSF, cerebrospinal fluid; DFA, direct fluorescent antibody.
Adapted from Centers for Disease Control and Prevention. The yellow book: health information for international travel 2018. Philadelphia: Oxford University Press; 2017. p. 704. Available at: https://wwwnc.cdc.gov/travel/page/yellowbook-home. Accessed July 25, 2017; with permission.