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Diseases & Parasites spread by ingestion

Dealing with Gut Problems

We all have to eat and drink and by taking a few simple precautions we can avoid most diseases and parasites spread by food and drink such as Travellers Diarrhoea (E.Coli ~40%, Bacillary Dysentery, Salmonellas, ETEC, Campylobacter jejuni, Shigella, Giardia, Amoebic Dysentery, Viruses & Others), Typhoid, Cholera, Intestinal Parasites (Worms), Hepatitis A, Polio and Guinea Worm.

AVOIDANCE = CLEAN WATER & FOOD

Clean Water

Your choices for ensuring clean water are:

- Bottled water - Always check the sell-by date, the seal and that there is no algae growing inside the bottle
- Boiled water - Remove any organic matter, bring to the boil and boil vigorously for 5 minutes
- Chemically sterilised water (iodine, chlorine, silver) Always remove organic matter and cloudiness prior to treatment as it will prevent the chemical sterilising the water.
- Water Purifiers - Be careful not to block the purifier with sediment and always carry a spare filter
- Do not be tempted to have ice in drinks and avoid ice cream made from an unsure water supply or with unpasteurised milk. - Always clean your teeth in 'clean' water.

Clean Food
You can still partake of the most exotic foods if the following simple precautions are taken:

Good:

- Freshly cooked dishes which are hot
- Peelable fruits and vegetables
- Can/packet food
- Local dishes are usually safer than 'westernised ones'

Bad:

- Salads/buffets
- Seafood
- Unwashed/unpeeled fruit and vegetables
- Dairy products which are unpasteurised
- Sauces
- Dirty cutlery or plates (clean with wet wipes before use or carry your own)

Food prepared by yourself or your group is the safest of all. Wash fruit and vegetables in clean (boiled or treated) water. Do not allow persons with gut problems to prepare food. Try to maintain a good standard of hygiene in food preparation.

DEALING WITH GUT PROBLEMS

The most common complaint for travellers abroad is diarrhoea. Most cases are due to the ingestion of contaminated food or water. This brief account deals with the appropriate use of the medical items that you should be carrying in your medical kit. Always attempt to have these conditions diagnosed by a medically qualified person before commencing antibiotic treatment. Always thoroughly read the dosage and instructions on labelling.

Rehydration

This is most important when dealing with diarrhoea as the principal danger of diarrhoea is dehydration. Use electrolyte solutions e.g. Dioralyte, Electrolade. If the diarrhoea is mild and not very watery, then all that is required for most healthy adults is to drink plenty of non alcoholic fluids. In all forms of moderate to severe diarrhoea the use of these solutions is strongly recommended. They contain the correct balance of components to allow the bowel to reabsorb the maximum volume of fluid. They should be taken regularly as stated on the label. If you are dehydrated and too ill to drink, medical advice must be sought immediately.

Making your own electrolyte solution:
In an emergency you can make your own solution using eight level teaspoons of sugar with half a teaspoon of salt in one litre of water. Alternatively there is a measuring spoon available. However, ready made preparations should be used where possible.

Seeking medical attention:
Always attempt to seek medical attention if there are any of the following:
- Blood mixed in with the diarrhoea
- Diarrhoea lasting more than 10 days
- A large amount of fluid is lost in a short time
- Fever

Don't forget that in a hot climate, particularly if you are running a fever, you lose a lot of fluid in sweat making it more likely for diarrhoea to cause severe dehydration.

Anti Diarrhoea Tablets

These will slow up the diarrhoea and therefore relieve the symptoms. Unfortunately, anti diarrhoea tablets can also cause more problems than they cure, as slowing the flow of diarrhoea may hold the offending organism in the bowel which will prolong the infection. For this reason it is very important that you continue to drink lots of fluids and not exceed the recommended dose. They must never be taken by children under 10 years of age.

Diagnosed Gut Infections

There are two antibiotics which may be of use:

Metronidazole (or Tinidazole)
Effective against 2 organisms:
- Amoebic Dysentery Symptoms: diarrhoea lasting more than 10 days, blood in the stools, pain on defecation, gradual onset.
- Giardiasis Symptoms: diarrhoea lasting more than 10 days, no blood in the stools.

Ciprofloxacin (or Trimethoprim)
Used mainly for:
- Bacillary Dysentery Symptoms: fever, watery diarrhoea of sudden onset, lasts more than 10 days, blood in stools.
- Also for diarrhoea caused by other bacteria.

Remember - Always attempt to have these conditions diagnosed by a medically qualified person before commencing antibiotic treatment.