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Persistent travellers diarrhoea

September 2nd, 2013
Giardia is a common parasitic cause of travellers diarrhoea

Giardia is a common parasitic cause of travellers diarrhoea

Approximately 2-3% of travellers with severe travellers’ diarrhoea will develop persistent diarrhoea – ie symptoms lasting more than four weeks.

To get this sorted, it is strongly recommended the sufferer seeks medical attention from a doctor familiar with this condition. The doctor will take a history, make an examination and often order stool and blood tests.

 

Possible causes of persistent gut symptoms are

  • A bacteria or parasite in the gut ( this becomes less likely after 3 months )
  • Damage to bowel wall from the initial episode/s of infection while away
  • Inflammatory Bowel disease set off by the episode
  • Unveiling some other condition that was going to happen sometime

 

There are many possible germs that can cause persistent gastro-intestinal symptoms:

Giardia, E. histolytica , D. Fragilis , cyclospora, cryptosporidium, I belli, C. difficile

 

While travelling, with limited access to modern medicine, it is common and reasonable to take antibiotics in the hope of guessing the cause and affecting a rapid cure. However, when you get home, it is not the best treatment to take antibiotics (like tinidazole or flagyl) ‘just in case’ — the antibiotics can interfere with the accuracy of stool testing. The best plan is to get professional help.

I have seen patients with persistent diarrhoea, who have been suffering for months, who are rapidly cured by modern medical attention.

The longer a germ persists, the more potential damage it can do, so don’t wait, get it checked.

 

Stool test

Several stool tests are recommended to accurately identify germs that may be causing trouble in the bowel. ( Ideally 3 tests are recommended, but the Australian Medicare system will only fund 2) The detection rate is lower if only one test sample is investigated.

There are some germs that are often not recognized from a regular stool test. If the stool sample is mixed with preservative – at the time of testing, these germs are easier to find, and a more accurate diagnosis can be made. This is why it is often recommended that persosn with persistent diarrhoea have a stool test with fixative. This is not difficult; a small amount of faecal matter is placed in the watery looking fixative immediately after the sample is passed. This is in addition to the regular stool test.

 

If a person takes multiple sample, each stool samples should be taken from separate stools on different days, and ideally should be delivered to the lab within 30 minutes. The samples are examined under a microscope and also placed in a culture material to see what will grow. This process takes time, so an accurate test may take up to a week for a result to be available. Various other molecular tests are often undertaken on stool tests.

 

Sometimes doctors will recommend antibiotics after the stool test has been sent to the lab, but before the results have been provided.

 

Further tests

Depending on the result of the stool test, some persons may be recommended blood tests, or referral to a gastroenterologist who can use a special camera to examine the wall of the bowel ( endoscopy or colonoscopy ) and take small samples (biopsies). These biopsy samples can be examined under a microscope, to aid in diagnosis and treatment of the problem.

Calprotectin test

Calprotectin is a protein occurring in large amounts in white blood cells of the immune system. It is an amazing chemical and has antibiotic properties and helps the white cells to kill invading germs.

Calprotectin can be found in stool tests and has been shown to help doctors determine how much inflammation is occurring in the bowel. It is useful to help diagnose some types of bowel problems such as ulcerative colitis, Crohn’s disease, and may help patients avoid having unnecessary endoscopies or colonoscopies

 

A final note

I have seen patients with persistent diarrhoea, who have suffered for months, but are cured by modern medical attention. The longer a germ persists, the more potential damage it can do, so if the symptoms have persisted longer than 4 weeks, don’t wait any longer, get it checked.

 

For a list of Australian doctors with expertise in this problem click here.

One Response to “Persistent travellers diarrhoea”

  1. Caroline says:

    “Unveiling some other condition that was going to happen sometime”

    That statement really got my attention. A few years ago I sat near a lady at work who got sick on her honeymoon. It was a second marriage for both and they went to the Bahamas. At first she thought it was something she ate, then she thought maybe it was a ‘bug’ as she was just tired and couldn’t get back to normal. She went to several doctors and no one could find anything wrong. She knew I traveled a lot, so she asked me how to find out if there was something ‘going around’ there that she may have picked up. So I gave her some info regarding where she might call their department of health there and they said there was nothing. Finally, she went back to her GP and he sent her to yet another doctor who did a different test and found that she had a very difficult to detect, due to location and rather advanced colon cancer. They did surgery and chemo, etc. but she, sadly, was sick the whole time they were married. She was a very young woman in her 30s when she passed, leaving two early teenaage children and her new husband gladly said he’d take the responsibility for their care.

    I often thought it was interesting that at the happiest time of her life, the disease became evident.

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