E. coli organisms are commonly present in the water supplies of areas that lack adequate water purification. Infection is common in persons traveling to some areas of Mexico and Latin America, the Middle East, Asia, and Africa. Travelers often avoid drinking local water but become infected by brushing their teeth with an improperly rinsed toothbrush, drinking bottled drinks with ice made from local water, or eating food prepared with local water. Symptoms, Signs, and Diagnosis Nausea, vomiting, borborygmi, abdominal cramps, and diarrhea begin 12 to 72 h after ingesting contaminated food or water. Severity is variable.
Some people develop fever and myalgias.
Most cases are mild and self-limited, although dehydration can occur, especially in warm climates. Prevention and Treatment Travelers should dine at restaurants with a reputation for safety and avoid foods and beverages from street vendors. The role of prophylactic antibiotics is controversial. Iodochlorhydroxyquin, which may be available in some developing countries, should not be used, as it may cause neurologic damage. A 3-day course of treatment is usually recommended, although shorter courses may be sufficient.