It is a long weekend, watch out for Travellers’ Diarrhoea

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A traveler sitting and enjoying sunset
A traveler sitting and enjoying sunset

It affects 20-50% of all travellers and in some particularly severe cases could completely spoil your brief vacation

It is right in the middle of the Republic Day long weekend and resorts around the country may be reporting higher than average occupancy. It is also the perfect spot in your short holiday – if you are taking one – for your stomach to object to the holiday excesses.

Take heart. It is very common in travellers – in fact medicine books define a condition called Travellers’ Diarrhoea. Here’s what the books say.

Diarrhoea, a leading cause of illness in travellers is usually a short-lived and self-limiting condition but in about 40% of cases individuals need to alter their scheduled activities and another 20% become confined to bed requiring treatment. In general it affects 20-50% of travellers.

Eating foods piping hot, avoiding foods that are raw or poorly cooked (sold by street vendors) and drinking only boiled or commercially bottled beverages, particularly those that are carbonated prevents travellers’ diarrhoea.

Causative Agents:

Travellers’ diarrhoea is most commonly caused by toxigenic Escherichia coli and enteroaggregative E. coli, although Campylobacter infections are predominant in Northern Africa and Southeast Asia. Other common causative organisms include Salmonella, Shigella, Rotavirus and Norovirus ( both viruses causes outbreaks in cruise ships). Except for Giardiasis, parasitic infections are uncommon causes of travellers’ diarrhoea.

Precautions:

Eating foods piping hot, avoiding foods that are raw or poorly cooked (sold by street vendors) and drinking only boiled or commercially bottled beverages, particularly those that are carbonated prevents travellers’ diarrhoea. Heating kills diarrhoea causing organisms whereas freezing does not, and therefore ice cubes made from unpurified water should be avoided. Trouble is, the maxim “Boil it, cook it, peel it, or forget it” is difficult to follow while travelling.

Symptoms:

Diarrhoea by definition is occurrence of loose or watery stools at least three times in 24 hours. Travellers’ diarrhoea can be accompanied by nausea vomitting, abdominal cramps, bloating of stomach, urgency and fever.

Prevention:

Prevention of travellers’ diarrhoea with bismuth subsalicylate is only about 60% protective. Probiotics have been only about 20% effective as prophylaxis. A single daily dose of a quinolone, azithromycin, or rifaximin is  75-90% effective in preventing travellers’ diarrhoea during travel of less than 1 month duration for persons with a repeated history of travellers’ diarrhoea, athletes and people with chronic diseases.

Treatment:

An antibiotic is useful in reducing the frequency of bowel movements and duration of illness in moderate to severe diarrhoea. A 3 day course of a quinolone taken twice daily (once daily in case of newer formulations) is highly effective. In areas with quinolone resistance, azithromycin is a better alternative. Combining loperamide with the antibiotic is more effective if diarrhoea is not accompanied by high fever or blood in stools. However, persistent bowel problems after a traveller returns home may require attention from a specialist. Staying hydrated is of extreme importance so do not forget to pack those packets of ORS.

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