TRAVELLER’S DIARRHOEA: FROM DELHI BELLY TO MONTEZUMA’S REVENGE
Summer is a time where many like to go on holiday to all sorts of destinations, from exciting city breaks to adventurous trekking routes. Unfortunately, we know this because they then pop in to see our Private GP's at London Doctors Clinic upon their return, suffering from one of numerous traveller's illnesses! Our Private Doctors aim to raise awareness for some of the more common diseases that could be contracted during one of these trips, including preventative and management measures.
One of the most common infections seen in holidaymakers is traveller’s diarrhoea. This is characterised by prolonged diarrhoeal symptoms (loose bowel movements) and can often occur in travellers who have spent 2 or more weeks abroad. Most cases of traveller’s diarrhoea are short-lived and tend to resolve on their own.
Causes of traveller's diarrhoea
They are usually caused by bacterial or parasitic infection. Common bacteria that cause traveller’s diarrhoea include;
- Escherichia Coli (E. Coli)
- Shigella spp
The most common causal parasite is the protozoan Giardia.
It was reported that there are approximately 3500 cases of giardiasis each year in England and Wales alone, although this number is probably an underestimation, seeing as many cases will not be diagnosed.
One of the most common causes of traveller's diarrhoea is the tiny parasite Giardia
Symptoms of traveller’s diarrhoea/giardiasis
- Frequent diarrhoea
- Sometimes accompanied with:
- Abdominal cramps
Often, traveller’s diarrhoea caused by bacteria causes a sudden onset of symptoms, whilst that caused by Giardia usually causes a slower, more gradual onset of symptoms. These presentations can arise during travel or fairly soon after arriving home.
Note that it is possible to have traveller’s diarrhoea more than once on a single holiday – contracting the illness once does not mean it cannot happen again in a short period of time.
How is traveller's diarrhoea contracted? How do I avoid it?
Traveller’s diarrhoea is usually acquired by ingesting faecally contaminated food or water. This means, an infected person has handled food after using the toilet and not properly washing their hands! To prevent traveller's diarrhoea, it is best to avoid items such as:
- Raw fruit and vegetables
- Undercooked or raw meat
- Unpasteurised milk
- Tap water
In the UK, many people drink tap water without thinking twice, however it is best to avoid this whilst going abroad, as water may be contaminated in certain areas.
Raw fruit and vegetables, such as in salads, may be contaminated with bacteria or giardias parasites responsible for traveller's diarrhoea
Where am I most likely to contract traveller's diarrhoea?
The extent and severity of traveller’s diarrhoea depends on the destination and season of travel.
Low risk areas include the USA, Canada, New Zealand and countries in Northern and Western Europe. These more developed countries usually have high food hygiene standards, limiting any risk of spreading the infection via contaminated food.
Intermediate risk areas include Eastern European countries, South Africa and some Caribbean islands.
High risk areas include most countries in Asia and Africa, the Middle East, Mexico and central and South America. In India, diarrhoeal conditions suffered by travellers are known colloquially as "Delhi belly".
Montezuma's revenge is the colloquial term for traveler's diarrhoea contracted the high risk region of South America, especially Mexico.
Avoiding traveller's diarrhoea
Traveller’s diarrhoea/Giardiasis is believed to occur equally between sexes, but appears to be more common in younger travellers. Preventative measures include avoiding risky foods (as detailed above) and paying attention to hygiene whilst consuming food/drink. If you do develop any of the above mentioned symptoms, it’s worth a visit to your private GP; we recommend a patient visit us after a week of unresolved diarrhoea.
These cases usually resolve themselves and rarely do complications arise - if you're acutely unwell, our experienced private doctors may recommend other private blood tests to rule out any other illnesses. In some instances, antibiotic treatment may be required. In some cases, doctors may recommend empirical antibiotic treatment (meaning treating for the suspected cause, before confirmation), as stool samples tests may take 2-3 days for results - to prevent unnecessary further discomfort!
By Vivekka Nagendran