The germs of travel...Health awareness on infections during travelling

DR GITAMATHAI, TT, 21 Nov 2018: The holiday season has started and elaborate plans are being made for pilgrimages, trips to holiday resorts and visits to exotic locations. Unfortunately, 40-60 per cent of travellers will be exposed to disease-causing "bugs", which result in sundry infections. Of these, "travellers diarrhoea" is the most common and incapacitating. It forces sightseeing and travel to be put on hold, as the search for a toilet becomes a priority.

The diarrhoea usually sets in within two to seven days of travel. It is watery and may be associated with other symptoms like nausea, vomiting, abdominal pain and urgency. The good news is that it is self-limiting. It usually subsides within two or three days with or without treatment. One of the critical features of the traveller's diarrhoea is that local hosts are immune to it. Their intestines have developed resistance over the years to the offending organism.

Viruses belonging to the enterovirus and rotavirus family, bacteria (especially E.coli) and protozoa-like giardia can all cause travellers diarrhoea. In 70 per cent of the patients, no one agent has been found to be responsible. There is therefore no universal cause and no common cure.

Although the disease is self-limiting and usually subsides on its own, it is essential to prevent complications like dehydration. Fluids, such as correctly reconstituted, commercially available packets of ORS (oral rehydration solution), homemade ORS (1 litre of water, 1/2 tsp salt and 6 level tsp of sugar), salted rice gruel, khichdi, bananas, lightly salted buttermilk and lime juice with sugar and salt can be consumed for hydration. Alcoholic drinks and caffeinated, carbonated beverages are not recommended. It is also best to avoid milk. Keep in mind that rehydration will not reduce the frequency or quantity of the stool. It will only prevent complications.

The frequency of diarrhoea can be reduced with anti-motility agents such as loperamide (imodium). More than 4-8 tablets should not be used as it can cause dizziness and bloating. These tablets are not advised for children under six years of age. Antibiotics are not routinely prescribed, as often the diarrhoea is due to viruses or protozoa which do not respond to these medications. Also, inappropriate antibiotic treatment does not reduce the frequency and duration of diarrhoea. It is only likely to produce side effects like monilial overgrowth and resistant organisms. Superinfection with some of these organisms can be life-threatening. If the diarrhoea persists for seven days or more, antibiotics may be required with a medical consultation. A short threeday course is usually sufficient. Taking random antibiotics before travel to prevent diarrhoea will also not work.

If the diarrhoea persists for 10 days or more after travel, it needs to be investigated. If it is associated with belching, bloating and large unformed stools, it may be due to giardia. If there is blood and mucous, organisms like shigella or cryptococcus many be responsible. If the diarrhoea persists a month or more, and no infectious agent can be SUMAN CHOUDHURY found, it may be due to a noninfectious cause or a complication that has set in, such as IBS (inflammatory bowel disease) or milk allergy.

Here are precautions you can take to reduce the likelihood of diarrhoea -

- Drink only boiling hot tea or coffee. Avoid juice as ice used in it may not be sterile. 

- Drink bottled water or water that has been boiled for three minutes. Even teeth have to be brushed with bottled water in some countries. 

- Avoid cut fruits and vegetables such as in salads. 

- Some diarrhoeas due to rotavirus, cholera and typhoid can be avoided with timely immunisation. 

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in.