Clinical features of traveler's diarrhea (TD) were studied among 126 a
dult Finnish tourists who developed this illness during or shortly aft
er a visit to Morocco. Enteric pathogens were identified in 76 (60%) o
f cases, whereas the etiology remained unidentified in 50 cases (40%).
Patients with an identified pathogen did not differ from those with T
D of unknown etiology in terms of the time of onset of illness or the
median frequency of unformed stools in the first 24 hours. In contrast
, the median frequency of unformed stools between 24 and 48 hours (i.e
., on the second day) was 1.0 among patients with no pathogen and 2.0
among those with enteric pathogens identified (P < .001). A similar di
fference was evident on the third day (1.0 vs. 2.5). Moreover, a lower
proportion of patients with no pathogen identified had watery stools
(28% vs. 55%). The durations of diarrhea and concomitant symptoms were
significantly shorter and the recovery from TD was significantly quic
ker among the patients without an identified pathogen. Patients with o
ne or more invasive pathogens had disease that was clearly more severe
than that of patients with no pathogen identified; the difference in
severity of disease was less marked for patients with invasive vs. non
invasive pathogens. Individuals with diarrhea due to Campylobacter spe
cies tended to have the most severe disease, whereas diarrhea caused b
y enterotoxigenic Escherichia coli seemed milder than that caused by o
ther agents. Unfortunately, the clinician has only a limited opportuni
ty to predict the etiology of TD and thus to assess the need for antim
icrobial therapy at the onset of disease.