Face-to-face consultations temporarily suspended:
Following the calls of the First Minister and Chief Medical Officer (24th March), TrExMed Travel Clinic has now suspended all non-essential, face-to-face consultations and vaccinations until further notice.
This is to help slow down the spread of the Coronavirus (SARS-CoV-2) among the general population, and so ease the peak burden upon the NHS of COVID-19 disease.
We are, however, still more than happy to help answer any queries regarding travel health risks and vaccinations by email (preferred method) or by telephone.
Take care and keep well, Nicky & Jim
Travellers’ diarrhoea (TD) is one of the most common travel-related health problems. The evidence shows that some people are simply more prone to it and some destinations are also a particular risk (e.g. Nepal and Madagascar).
A slight change of bowel habit or loosening of the stools is to be expected with travel, which may be partly due to the stress of catching planes, different water, shaking hands, spicy food etc. This is not true travellers’ diarrhoea...
Two working definitions for TD in adults are:
In children, a suitable, more cautious definition would be a doubling of the usual number of stools per day. Children are much more susceptible to fluid and electrolyte imbalance and tend to deteriorate more quickly.
In Europe, most cases of diarrhoea are viral in origin, so treatment is mainly supportive.
In tropical and developing countries, most TD (up to 80%) is likely to be caused by common bacteria, such as enterotoxigenic E. coli (ETEC), Campylobacter, Shigella, and non-invasive Salmonella species. Viruses typically account for about 15% of cases, and exotic protozoa (giardia, amoeba etc.) only 5%.
A couple of possible red herrings:
Diarrhoea that does not settle with rest, rehydration +/- antibiotics may be a symptom of dengue: One third of people with dengue fever present with diarrhoea, which is often mistaken (even by doctors in Asia) for gastroenteritis.
Diarrhoea may also be the presenting symptom for malaria.
In the summer months in Nepal, there are regular outbreaks of Cyclospora cayetanensis infection. There has also been an outbreak of this in 2016-17 in the Riviera Maya tourist area of Mexico. Cyclospora is a protozoal infection, which in addition to watery diarrhoea, can lead to prolonged symptoms of loss of appetite, weight loss, abdominal cramps, low-grade fever and profound fatigue lasting a few months. It needs a special stain or antibody test to confirm the diagnosis. There is a simple and effective treatment, although it is not an obvious choice for most Western doctors.
© Jim Bond, Apr 2019