Traveller’s diarrhoea: from Delhi belly to the Kathmandu quickstep to Montezuma's revenge

It’s common and it’s unpleasant but it’s usually transient and rarely life-threatening

Diarrhoea is usually accompanied by abdominal pain, nausea and cramps and, sometimes, by fever

Diarrhoea is usually accompanied by abdominal pain, nausea and cramps and, sometimes, by fever

 

Few diseases have attracted such a wide range of euphemisms as traveller’s diarrhoea. The “runs” and gippy tummy are some of the milder monikers. Some reflect bad experiences in specific locations, such as Delhi Belly and the Kathmandu Quickstep. Montezuma's revenge is quite evocative as is the Tokyo two-step and Hong Kong Dog. However, reference to the squits and back-door trots may be a step too far for the squeamish.

None of us wants to get sick on our annual getaway and the good news is that most illness while abroad is minor and self-limiting. But with Irish people taking more than 7.5 million trips abroad every year, one of the commonest ailments they face is traveller’s diarrhoea.

Usually the result of consuming food or water contaminated with bacteria, one UK study of just over 24,000 laboratory confirmed gastrointestinal infections in those who had recently travelled abroad, found that over half the infections were caused by the Salmonella bug. But as minor infections are rarely recorded it is generally accepted the incidence of traveller’s diarrhoea is hugely underestimated.

Abdominal pain

The medical definition of traveller’s diarrhoea requires that a person passes three or more unformed stools over 24 hours, with the episode starting during, or shortly after, a period of travel. Diarrhoea is usually accompanied by abdominal pain, nausea and cramps and, occasionally, by fever. Typically, symptoms begin early in a trip and last about four days. Some 10 per cent of patients affected will have bloody diarrhoea.

In up to 60 per cent of cases of traveller’s diarrhoea, no bug is identified

The likelihood of developing traveller’s diarrhoea very much depends on the destination – it’s between 20 and 50 per cent in high-risk destinations such as Africa, South America, some parts of the Middle East and most of Asia; about 20 per cent in intermediate-risk areas including southern Europe, South Africa and some of the Caribbean islands; and fewer than 8 per cent in low-risk areas such as North America, northern Europe, Australia and New Zealand.

Causes

In up to 60 per cent of cases of traveller’s diarrhoea, no bug is identified, suggesting at least some cases are due to other causes such as an unwanted effect of medication or because of a change in eating or drinking habits while on holiday.

Globally, the commonest identifiable bacterial cause is Escherichia coli. Other bacterial causes include Shigella spp, Campylobacter jejuni, as well as Salmonella. Protozoa, like Giardia lamblia and Entamoeba histolytica and viruses (such as rotaviruses) account for a smaller proportion of cases.

So what can you do to protect yourself and your family?

Wash hands after going to the toilet, and before handling or eating food; use bottled, boiled or treated water for drinking, washing food and cleaning teeth; and avoid food that is especially likely to be contaminated (for example ice made from unsafe water, salads, uncooked fruit or vegetables that cannot be peeled or shelled, food that has been kept warm). Watch out for dishes containing uncooked eggs, shellfish, unpasteurised dairy products, and be vigilant about food prepared by street traders.

Status of beaches

Check out the blue flag status of beaches as sea water may be contaminated by sewage and faecal organisms. Cryptosporidium and G lamblia cysts can survive in cool, moist conditions and both have caused outbreaks associated with swimming pools.

The main aim is to maintain your fluid and electrolyte intake

What should you do if, despite your best efforts, you are struck down with a dose of Spanish, Turkish or Adriatic tummy?

The main aim is to maintain your fluid and electrolyte intake. For healthy adults, drinking plenty of soups or sugary drinks should suffice. Young children and older people require more careful oral rehydration therapy, using a commercial preparation such as Diorylate. The antidiarrhoeal drug loperamide is useful for symptomatic relief but should not be used if diarrhoea is bloody or in young children.

Traveller’s diarrhoea is common, often disruptive, usually transient and rarely life-threatening.

May your upcoming holidays be run-free.

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