This information will help you understand what causes traveller’s diarrhoea (TD), how to protect against getting it, and (in case you do get TD) how to treat your illness to limit its impact on your travel schedule. While it is important to take preventive measures against TD, those measures cannot be relied on to be 100% effective, especially in high-risk environments where 40% or more of all travellers will get TD.

Diarrhoea is a change in one’s normal stool pattern in which the stool becomes more frequent and less formed. It can occur by itself or along with abdominal cramps, bloating, nausea, vomiting and fever. When diarrhoea occurs, the normal function of the intestine is disrupted. Instead of absorbing fluids and nutrients from the material passing through, it reverses that process and secretes body fluids back into the intestine and passes them out of the body.

Traveller’s Diarrhoea is the term used to describe the diarrhoea that strikes international travellers from countries with good hygiene to countries that have poor public sanitation and hygiene. It is caused by infection with one of a number of bacteria, protozoa or viruses that are ingested by eating food or drinking water that has been contaminated by stool.

It is an unfortunate aspect of holiday complaints, that all too often, the label of TD or viral infection is attached to mass illness. By jumping to such a quick conclusion, the true cause of the illness remains undiscovered. Ill holidaymakers often arrive back in the UK, returning to their field of work, in some cases extending the field of contamination.

Dysentery is a more severe form of diarrhoea in which white cells and mucus - and occasionally blood - appear in the stool. It usually includes cramps and fever. Dysentery should not be thought of as a separate disease, but simply one end of the spectrum of diarrhoeal disease.

To understand the risks consider the following example, as you do so think of areas in our own country where living or commercial standards are not so high:

Imagine a hotel in some far off destination. The high wall just behind the hotel makes a convenient shield for local people who don’t have toilets in their homes to sneak out for their daily evacuation. If they have diarrhoea, as is frequently the case, their trips may be more numerous. The wall forms one side of a narrow path that some of the hotel kitchen employees use on their way to work.

The odour from the “outdoor toilet” attracts many flies that lay eggs in the stool. Hungry flies are attracted to the odours emanating from the hotel. Their feet covered in stool, like those of the hotel employees who walked down the path, the flies also head for the kitchen.

In the kitchen, flies move about freely. The work surfaces are soon strewn with raw meat, most of which is covered with bacteria present in the animals when they died.

When the kitchen workers are finished cutting up the meat; they move on to the vegetables, often on the same surface, not recognising the danger of bacterial contamination. One of the employees has diarrhoea and has to make frequent trips to the toilet, where he cleans himself without toilet paper.

By now, the workers’ hands are covered with organisms from the raw meat, from themselves and from their shoes.

They finish cooking the lasagnes and quiches for the day, testing their cooling temperatures with an expert (but unfortunately heavily contaminated) finger, inoculating a few thousand bacteria onto the surface, which is now around body temperature (optimum growing temperature for the bacteria).

The bacteria grow the rest of the morning and on into the afternoon, dividing regularly and doubling every 20 minutes. By dinner time, the area of inoculation is still completely microscopic in size, but contains more than a billion bacteria. The lasagne is sliced, and heated slightly, but not enough to kill the bacteria. Like a game of Russian roulette, one of the diners will get the infected piece.

The traveller who orders the lasagne takes care to not drink the water that is served along with his meal. He doesn’t take ice in his drink, and he refrains from eating the green salad served with the meal. He goes to sleep feeling well fed and confident, only to be awakened at 1:30 a.m. with the urge to vomit, and followed rapidly by profound diarrhoea. The rest of the night passes in a repetitive haze of cramps, vomiting and diarrhoea. And all the time the hapless traveller thinks, “But I followed all the rules!”

By using the medicines available today, the traveller with TD can respond quickly to this illness, limit its discomfort and shorten its course-often to no more than a few hours in moderate cases.

Your destination is the most important determinant of risk. People who travel from developed countries to developing countries are at risk to accidentally ingest infectious organisms that can cause diarrhoea. Studies usually show that 30-40% of people get an episode of diarrhoea in the first 2 weeks of travel in high-risk destinations. Almost all developing countries in Latin America, Africa, the Middle East and Asia are considered high risk. Most countries in Southern Europe and most Caribbean islands are deemed intermediate risk. Low risk areas include the United States, Canada, Northern Europe, Australia, New Zealand and a few of the Caribbean islands.

This entry was posted on Wednesday, January 9th, 2008 at 3:58 pm and is filed under Disease and Infection, Prepare, Travel Advice. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.