is travellers diarrhoea?
Montezumas revenge, Delhi Belly, whatever the name, travellers
diarrhoea is by far the most common cause of ill health in travellers. Travellers'
diarrhoea is a syndrome characterised by a twofold or greater increase in the
frequency of unformed bowel movements.
are the symptoms of travellers diarrhoea?
Commonly associated symptoms include:
- Four to five loose or watery stools per day.
- Abdominal cramps.
- Nausea, bloating.
The median duration of diarrhoea is 3-4 days. Of all cases, 10% last longer
than one week, approximately 2% last longer than one month and fewer than 1%
last longer than three months.
are the causes of diarrhoea?
Travellers from industrialised countries to developing countries frequently
develop a rapid, dramatic change in the type of organisms in their gastrointestinal
tract. Those who develop diarrhoea have ingested a quantity of virulent organisms
that is sufficiently large so as to overcome individual defence mechanisms,
resulting in symptoms.
Even with the application of the best current methods for detecting bacteria,
viruses and parasites, 20-50% of cases of travellers diarrhoea remain
unaccounted for. Diarrhoea caused by an infection may result from:
- Parasites, such as: Cryptosporidium parvum, Cyclospora cayetanensis, Entamoeba
histolytica, Giardia lamblia, microsporidia.
- Bacteria, such as: Campylobacter, Clostridium difficile, Escherichia coli,
Listeria monocytogenes, Salmonella enteritidis, Shigella
- Viral infections, such as: HIV, rotavirus, Norwalk agent.
is diarrhoea spread?
Travellers diarrhoea is usually contracted through ingestion of contaminated
food or water. Both cooked and uncooked foods may be implicated if improperly
handled. Especially risky foods include raw or undercooked meat and seafood,
and unpeeled raw fruits and vegetables.
Tap water, ice and unpasteurised milk and dairy products may be associated
with an increased risk of diarrhoea. Safe beverages include bottled carbonated
beverages (especially flavoured beverages), beer, wine, hot coffee or tea, or
water boiled or appropriately treated with iodine or chlorine. The place food
is prepared appears to be important. Private homes are safe, restaurants less
so and street vendors the most risky of all.
Travellers' diarrhoea is slightly more common in young adults than in older
people, with no difference between males and females and is usually acquired
through ingestion of food and water contaminated with faeces.
It usually lasts from three to seven days. It is rarely life threatening. The
most important determinant of risk is the destination of the traveller. Attack
rates of 20-50% are commonly reported.
is the cause of diarrhoea diagnosed?
To detect parasites, bacteria and viruses, most physicians recommend that three
or more stool samples be examined. Special stains may be required to look for
some parasites. If these initial tests do not reveal the cause of your diarrhoea,
additional tests may include radiographs (x-rays) and endoscopy. Endoscopy is
a procedure in which a tube is inserted into the mouth or rectum so that the
doctor, usually a gastroenterologist, can look at the inside of the intestine.
is diarrhoea treated?
Most episodes of travellers diarrhoea resolve in a few days. Travellers
should seek medical help if:
- Diarrhoea is severe or bloody.
- Does not resolve within a few days.
- If it is accompanied by fever and chills.
- If the traveller is unable to take fluids and becomes dehydrated.
The key to treating chronic diarrhoea is to determine its cause. Diarrhoea
caused by an infection can often be treated with antibiotics. However, the correct
diagnosis must be made by a doctor so that the proper medication can be prescribed.
Diarrhoea not caused by an infection is more difficult to diagnose and treat.
Long-term medication or surgery may be required. Specific treatment for chronic
diarrhoea not caused by an infection should be discussed with your GP.
For diarrhoea where the cause has not been determined, follow these important
treatment guidelines to relieve symptoms:
- Prevent dehydration. Serious health problems can occur if you dont
maintain your bodys proper fluid levels. Diarrhoea may become worse
and hospitalisation may be required if dehydration occurs.
- Dehydration can be dangerous at any age but is particularly so in small
- Cholera can cause extremely rapid and large losses of water and salts through
profuse vomiting and diarrhoea, even in adults.
- For severe dehydration, the use of an oral rehydration solution containing
salt and glucose can help. Oral rehydration to replace salt and water losses
must be particularly quick and abundant; in severe cases medical care should
be sought since intravenous therapy may be required. Many oral rehydration
solutions such as Dioralyte and Rapolyte are available at chemists. Ask your
pharmacist or health care provider for the product best for you. Fruit juices,
soft drinks (preferably without caffeine) and salted crackers are advised.
- Do not drink beverages containing caffeine, such as tea, coffee and soft
- Do not drink alcohol, as it causes dehydration.
- Do not rely on sports drinks alone to maintain adequate fluid balance. They
should not be used to treat severe dehydration.
- Maintain well-balanced nutrition. Doing so may help you recover more quickly.
Avoid dairy products and all beverages that contain water of questionable
- Antimicrobial drugs may shorten the length of illness. Antidiarrheals can
decrease the number of episodes of diarrhoea but can cause complication for
persons with serious infections. Consult your physician for prescription and
can diarrhoea be prevented?
There are four possible approaches to prevention of travellers diarrhoea.
They include instruction regarding:
- Food and beverage consumption.
- Use of non-antimicrobial medications.
- Use of prophylactic antimicrobial drugs.
The best way to prevent travellers diarrhoea is by paying meticulous
attention to choice of food and beverage. Physicians usually do not recommend
use of antibiotics to prevent travellers diarrhoea because they can cause
additional problems. Steps which can be taken include:
- Drink clean or purified water.
- Use proper food handling techniques.
- Maintain proper hand-washing habits.
are the high risk destinations for infection?
High-risk destinations include most of the developing countries of Central
America, Africa (Southern, Central, East, West and North), the Middle East and
Asia (East, Southeast, and the Indian subcontinent). Intermediate-risk destinations
include most of the Southern European countries (Eastern and Western) and a
few Caribbean islands. Low-risk destinations include Northern Europe, Australia,
Canada, New Zealand, the United States and a number of the Caribbean islands.
to top of page