The most common cause of travellers diarrhoea is the notorious bacterium called Escherichia coli, abbreviated as E Coli! A small portion of infections are viral, caused by nor, rota or other similar viruses. We’ve all had it and is very common on travels, actually as much as 20-60% of travellers visiting low to middle income areas develop diarrhoea. We define this condition as 3 or more diarrhoea episodes per day.
It’s important to note that the condition in most cases is self limiting, but in rare cases can case dehydration or even sepsis and in very rare cases auto immune syndromes. We term an infection as chronic if the episode lasts more than two weeks! This type of infection may be caused by infection caused by protozoa organisms e.g. Guardia lamblia, which can be quiet persistent. With persistent condition seek immediate medical help as you may need further investigation i.e. stool sample analysis and other test to isolate the source infection and a specific treatment method to follow. Bloody diarrhoea is often associated with infections caused by Campylobacter jejune or Shigella.
Antibiotics would most probably be recommended in patients of susceptibility i.e. immune suppressed or vulnerable to sepsis. In general antibiotics may decrease the diarrhoea episodes duration from 3 days to 1.5 days.
The best advice is to avoid contamination! Stay away from:
- Uncooked meat.
- Shelled fish.
- Unrefrigerated foods.
- Avoid antibiotic chemoprophylaxis
Prevention is NB NB and do the following:
- Maintain a good level of hygiene, basic hygiene is really important esp. if you are travelling with kids. You need to watch everything that goes into their mouths.
- Boil water for consumption.
- Use straws to drink out bottles.
- Eat fruit and vegetables that you can peel open.
- Boil water >100 degrees Celsius, cook food appropriately.
- Drink bottled water where available, but you cannot beat your own filtered or boiled water.
- Purification is essential. We used Lifesaver for our family on trip and our baby has to date never been ill.
Something interesting to note, if you take chemoprophylaxis for Malaria i.e. doxycycline, a study has shown that you may decrease travellers diarrhoea caused by E Coli & Campylobacter! But remember, there’s Malaria resistance reported in areas against doxycycline.
New vaccines are in development, perhaps one day they may prove to be effective.
The most important form of treatment for all travellers diarrhoea is ORAL HYDRATION! This is particularly important with kids, get them drinking early on as they are very susceptible to dehydration, so always remember this great rehydration mixture while on the move, esp. if you do not have the appropriate rehydrate with you. See a recognised rehydrate mixture below.
- 6 level teaspoons of sugar
- half a level teaspoon salt
- 1 litre of clean water (mix the water + sugar + salt together then take orally)
Using agents like loperamide may offer quick cessation, but be care full with symptoms of blood in the stool and abdominal cramps as it’s been known to cause bowel perforation. Seek medical advice when appropriate.
Best antibiotics, quinolones like ciprofloxacin, azithromycin (may be good in the far East and where resistance occurs) which may be able to decrease the duration of the illness. Probably best to use if you are in real remote areas and probably better to use short courses only (up to three days perhaps).
Beware of worsening symptoms i.e. Colitis. Local tenderness and severe symptoms. Further emergency examinations may be needed. Remember, a bowel perforation in a remote areas will most certainly kill you if you fail to get the appropriate medical treatment urgently. Sepsis follows quickly leading to multi organ failure and death quickly. Treat a very painful abdomen with the most seriousness!
Again – Prevention, prevention, hygiene!!!!!