Travellers' Diarrhoea
Travellers’ diarrhoea is a generalized intestinal upset caused by eating food or drinking water contaminated with bacteria, viruses or parasites. It is by far the most common illness suffered by travellers, affecting an estimated 20-50 percent of international travellers (around 10 million people) annually.
Travellers’ diarrhoea (TD) goes by a number of different nicknames, depending on the area: “Montezuma’s Revenge,” “Turista” and the “Aztec Two-Step” in Middle and South America, the “Hong Kong Dog” in the Far East, the “Pharaoh’s Curse” in North Africa, “Delhi Belly” in India and a host of other colourful names.
Travellers' Diarrhoea Causes
The cause of travellers’ diarrhoea is usually the result of ingesting food or water contaminated with faecal bacteria. However, food—not water—is the culprit in the majority of cases. High-risk food items include beverages made with local water or ice, milk, fruits, vegetables, meats and any foods that may have been sitting out too long, such as at a buffet. Local tap water and ice are still possible sources of TD, although not in as many cases as food.
There are three main causes of travellers’ diarrhoea:
- Bacterial infections are the most common, and the cause of up to 90 percent of all cases. Enterotoxigenic Escherichia coli (E. coli, or ETEC) is the most common bacteria, found to be the cause of TD in up to 75 percent of cases. Campylobacter jejuni, Shigella spp and Salmonella spp are also common bacteria found.
- Parasites, including giardia and Cryptosporidium are less common, responsible for 10 to 15 percent of TD cases.
- Viruses, including astrovirus, rotavirus and norovirus are the least common pathogens, responsible for less than 10 percent of cases.
Travellers' Diarrhoea Symptoms
Symptoms of travellers’ diarrhoea are classic, but they do vary somewhat in time between infection and onset. TD symptoms usually show within the first week of travel, lasting up to three or four days. But, depending on the specific pathogen, TD symptoms can occur at any point while travelling, and even weeks after the victim returns home.
Symptoms include four or five loose, watery bowel movements each day, accompanied by abdominal cramping, bloating, nausea, mild fever and general malaise. Appetite is significantly decreased or non-existent.
Blood or mucous in the diarrhoea, severe abdominal pain, high fever, persistent vomiting or moderate to severe dehydration may be indicative of a more serious condition, such as cholera or dysentery. If experiencing these symptoms, or if normal symptoms persist beyond a few days, see a doctor.
Young children and infants are especially susceptible to complications from prolonged diarrhoea and vomiting, so extra vigilance is important. Seek medical help if your child experiences these symptoms:
- Severe diarrhoea or blood in the stool
- Persistent vomiting
- Fever of 39C or higher
- Decreased urine volume
- Crying without tears
- Dry mouth
- Unusual drowsiness or lack of response
Travellers' Diarrhoea High-Risk Areas
Anyone travelling outside of his or her native country should be wary of the risk of contracting travellers’ diarrhoea. However, certain areas present a higher risk. High-risk areas include developing countries, such as those in Latin America, Africa, Asia and the Middle East. For backpackers and primitive campers—even when in their home country—the risk of developing travellers’ diarrhoea is just as high from lack of good personal hygiene, drinking untreated water from streams, lakes and ponds and failure to clean cookware properly as it is when travelling to a developing country.
The time of year also varies the risk of contracting TD. In the summer months, developing countries near the equator may present a higher risk, especially before the monsoon season.
Individuals at greater risk of developing travellers’ diarrhoea when travelling, even in developed countries include those with a suppressed immune system, diagnosed with diabetes, inflammatory bowel disease or who take antacids or drugs for gastrointestinal conditions, such as H2 blockers. TD poses a potentially life-threatening risk to those who are susceptible to serious infections, such as cholera or dysentery.
Travellers' Diarrhoea Prevention
Common sense hygiene and food and drink precautions will reduce the risk of getting diarrhoea.
- Drink only bottled beverages in original containers. If drinking hot beverages, try to make sure it is served as close to boiling as possible. Consider bringing a water filtration system or purification tablets with you, in case you cannot locate safe water.
- Do not buy food from street vendors. The exception to this is to buy from vendors that have a large clientele, where the food is freshly cooked as you watch.
- Do not swim in waters that may be contaminated.
- When showering, keep your mouth closed and use filtered or bottled water while brushing your teeth.
- Eat fruits that require peeling yourself, such as bananas, oranges and avocados. Avoid eating fruits that are sliced before they are served.
- Avoid any fruits or vegetables that do not require peeling, such as grapes, berries or salad greens.
- Wash your hands often, especially before eating. Use a hand sanitizer if you cannot wash your hands.
Are there any Precautionary Treatments I can obtain?
Our doctors can provide you with a free online consultation, and if suitable may prescribe a course of medication as a precautionary treatment for future use.
Antibiotics such as ciprofloxacin or azithromycin combined with an anti-diarrhoeal medicine such as loperamide can effectively be used to treat traveller's diarrhoea.
In addition Avomine can be used as an anti-sickness medication, which will also help to relieve symptoms and prevent further dehydration.
