Going on vacation is always an exciting journey. You look forward to having a good time, discovering new places, local food and culture. However, for those who travel from developed to developing countries such as Africa, the Middle East, Latin America, and parts of South East Asia, some may experience Traveller’s Diarrhoea. This illness can occur at any time during the trip, or even after the person gets home.

What is Traveller’s Diarrhoea?

It is short lived alterations in bowel habit of an individual, especially loose stool, is a common occurrence among travellers. As many as 50 percent of travellers can suffer from diarrhoea of low severity. Usual cause of Traveller’s Diarrhoea is food or water borne gastrointestinal infection. Although recent review of travelier’s diarrhoea showed poor correlation between food ingestion and diarrhoea, dietary indiscretion such as eating/drinking from street vendors or in unmonitored restaurants should be discouraged to minimize the occurrence of diarrhoea during travel to South East Asia.

What Is The Cause Of This Condition?

The most common cause is water or food borne bacterial infection with Enterotoxigenic Esch. coli and less commonly Enteroaggressive Esch. Coli, Less severe forms of diarrhoea can be caused by viruses such as Rota or Noro. Other common causes are bacteria such as Salmonella, Shigella, Campylobacter etc and among the parasites, Giardia is an important cause.

Who is at risk of being affected by Traveller’s Diarrhoea?

Young adults and children are more susceptible to Traveller’s Diarrhoea. Although less common, it affects very young children, elderly and pregnant females more severely. Pregnant travellers must avoid dehydration at all costs to maintain adequate blood flow to the placenta.

How Is The Condition Different From Food Poisoning? What Are The Signs And Symptoms Of Traveller’s Diarrhoea?

More often than not Traveller’s Diarrhoea presents with increased frequency of bowel movement with loose stools and only mild abdominal cramping pain and no vomiting. Acute food poisoning usually presents with severe cramping abdominal pain, nausea, vomiting, fever and loose stools. Symptoms are generally more severe in acute food poisoning. Examination can reveal signs of dehydration where it is usually milder in Traveller’s Diarrhoea but more pronounced in acute food poisoning :

• Mild dehydration: Thirst, dry mouth, dry arm pits, darker than usual and low volume urine.
• Moderate dehydration : Fall in blood pressure (BP) with dizziness on standing up, tenting of the skin on pinching it, sunken eyes.
• Severe : Dizziness even when lying down, dry and parched skin and high pulse rate and low blood pressure even in lying posture.

When A Tourist Is Travelling To Countries Where Sanitation And Hygiene Standards Are Poor, What Are Some Of The Steps They Can Take ?

Have your own bottle of boiled water to drink in your possession at all times. Eat only piping hot food straight out of the oven. Well sealed and packed chips and nuts are okay to eat. Resist, effectively, braving around and sampling ‘clean’ looking eatables displayed attractively over the windows of common, roadside eateries. They may be attractive externally but there are a lot of hidden nasty bugs internally. It’s good habit to carry some sealed packets of dry food stuffs with you at all times.

How Can One Ensure That The Food And/ Or Drinks He Or She Consumes Is Safe?

There is actually no way of knowing the safety level of food unless cooked or boiled in front of your eyes.

If A Person Is Experiencing Symptoms Of Traveller’s Diarrhoea, What Should He Or She Do Next?

Immediately acquire 2 or 3 litres of bottled or boiled water and buy (if you do not have it) oral rehydrating salts from the street pharmacy and prepare oral rehydrating solution by following the instructions on the packet and start drinking this solution to prevent dehydration, 200 ml every 10-15 minutes.

Seek medical help as soon as available.

If travelling and medical help not available immediately take Lomotil to slow down the diarrhoea. If vomiting, swallow 8 mg tablet of Ondansetron to ward off vomiting. If symptoms get worse open your medical kit and start Azithromycin 500 mg daily and continue for three days. Most importantly, see a medical care provider as soon as possible!

Prevention Is Better Than Cure

To ensure that Traveller’s Diarrheoa does not affect your holiday, here are some preventive tips :

1. Avoid dietary indiscretions and do not eat or drink from street vendors or any other unmonitored food and drink provider.
2. “Boil it, cook it, peel it or forget it” about any drink, food-stuff or fruit is the universal maxim to minimize Traveller’s Diarrhoea.
3. Even in good highly recommended eatery place inspect the food properly before eating. Is it piping hot, does it not smell odd, is it well cooked, in case of meat, does it have pink appearance on separating the meat from the bone? These are important questions to answer before eating.
4. Do not touch green salads even in big Five-Star hotels and restaurants, in developing countries generally. They are a big ‘No, No’!
5. Do not drink water that has not been brought to a rolling boil for 1-2 minutes. Bottled water and beverages are normally safe. Make sure the seal has not been broken. Avoid ice-cubes made from unpurified water. If not sure, avoid ice cubes altogether.