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Travellers' diarrhoea

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VOL: 101, ISSUE: 18, PAGE NO: 28

- Travellers’ diarrhoea is a form of gastroenteritis contracted while travelling to developing countries….

What is it?
- Travellers’ diarrhoea is a form of gastroenteritis contracted while travelling to developing countries.

Causes
- Travellers’ diarrhoea can be caused by different organisms, for example Escherichia coli, shigella, Entamoeba histolytica, salmonella, campylobacter, giardia, Cyclospora cayetanensis and Vibrio cholerae.

- All of these can be spread through the faecal/oral route.

- The highest-risk countries are in Latin America, Asia, Africa and the Middle East.

Symptoms
- Most episodes of travellers’ diarrhoea occur in the first or second week of the trip. Symptoms vary depending on what organism causes the problem but the most common symptoms are diarrhoea, fatigue, decreased appetite and abdominal cramps. Nausea and vomiting may also occur.

- Sometimes there is blood in the stools.

Diagnosis
- The diagnosis of travellers’ diarrhoea is to be considered after the passage of three loose stools in 24 hours, accompanied by nausea, vomiting, cramps and abdominal pain.

- Blood and stools can be tested for evidence of infection.

- In some cases, the infecting organism can be identified, which can lead to specific treatments.

Treatment
- Replacing fluids is very important as dehydration is the biggest danger.

- It is important that the body’s electrolyte balance be maintained as diarrhoea can deplete stocks of sodium, potassium, chloride, calcium and magnesium.

- In mild cases of diarrhoea, soup and fruit juices should be drunk. Alternate salty and sweet drinks to replace the body’s electrolytes.

- In severe cases of diarrhoea (more than five unformed stools a day), a rehydration solution should be taken in order to replace lost electrolytes.

- Usually diarrhoea improves within three days.

- Antiperistaltic agents such as loperamide can be used to slow the intestine when necessary, for example when travelling by public transport. However, they should be used with caution as they also slow the excretion of the infection and can sometimes cause complications (such as toxic megacolon). They should also be stopped in the presence of high fever or blood in the stools. They will not prevent diarrhoea and do not destroy the infection.

- If diarrhoea persists for longer than four days or a temperature of 38 degsC is reached, medical help should be sought.

Prevention
- Water should be purified by boiling for at least five minutes or using a purification system.

- Bottled water is usually safe but ice should be avoided.

- Alcohol does not sterilise water, so travellers should be advised of the risk of mixed drinks and of ice.

- Travellers should be advised to peel their own vegetables and fruit.

- Dairy products should be avoided unless pasteurised.

- Coffee and tea are usually safe.

- Undercooked meat and fish should be avoided.

- Hands should be washed in the cleanest water available or disinfected with alcohol wipes before eating.

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