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This diarrhoeal disease can cause rapid dehydration and death. Cholera is caused by a bacteria, Vibrio cholerae. It's transmitted from person to person by direct contact (often via healthy carriers of the disease) or via contaminated food and water. It can be spread by seafood, including crustaceans and shellfish, which get infected via sewage. Cholera exists where standards of environmental and personal hygiene are low. Every so often there are massive epidemics, usually due to contaminated water in conditions where there is a breakdown of the normal infrastructure.
The time between becoming infected and symptoms appearing is usually short, between one and five days. The diarrhoea starts suddenly, and pours out of you. It's characteristically described as 'ricewater' diarrhoea because it is watery and flecked with white mucus. Vomiting and muscle cramps are usual, but fever is rare. In its most serious form, it causes a massive outpouring of fluid (up to 20L a day). This is the worst case scenario - only about one in 10 sufferers get this severe form. It's a self-limiting illness, meaning that if you don't succumb to dehydration, it will end in about a week without any treatment.
You should seek medical help urgently; in the meantime, start re-hydration therapy with oral re-hydration salts. You may need antibiotic treatment with tetracycline, but fluid replacement is the single most important treatment strategy in cholera.
Prevention is by taking basic food and water precautions, avoiding seafood and having scrupulous personal hygiene. The currently available vaccine is not thought worthwhile as it provides only limited protection for a short time.
To prevent diarrhoea, avoid tap water unless it has been boiled, filtered, or chemically disinfected (e.g. with iodine tablets); only eat fresh fruits and vegetables if cooked or peeled; be wary of dairy products that might contain unpasteurised milk, and be highly selective when eating food from street vendors.
If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral re-hydration solution containing lots of salt and sugar. A few loose stools don't require treatment but, if you start experiencing more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, or persists for more than 72 hours, or is accompanied by fever, shaking chills or severe abdominal pain you should seek medical attention.
Sweating liberally, probably washing less than usual and going longer without a change of clothes mean that long-distance walkers risk picking up a fungal infection, which, while an unpleasant irritant, presents no danger.
Fungal infections are encouraged by moisture, so wear loose, comfortable clothes, wash when you can and dry yourself thoroughly. Try to expose the infected area to air or sunlight as much as possible (without causing offence) and apply an antifungal cream or powder.
This travellers favourite is caused by a parasite, Giardia lamblia, which you acquire by ingesting food or water contaminated by the hardy cysts of the parasite. Giardia can also infect animals, and may be found in streams and other water sources in rural areas, especially on trekking routes. The illness usually appears about a week after you have been exposed to the parasite, but it can appear several weeks after. It may cause a short-lived episode of typical 'travellers diarrhoea', but it can cause persistent diarrhoea. You often notice weight loss with giardiasis, as it can prevent food from being absorbed properly in the upper part of your gut.
Giardiasis can start quite suddenly, with explosive, watery diarrhoea, without blood. More often you get loose, bulky, foul-smelling faeces that are hard to flush away (assuming you have the luxury of flushing, of course), with lots of gas, bloating, stomach gurgling and cramps. You can sometimes get a mild fever and often feel nauseated, with little or no appetite, 'indigestion' (heartburn) and rotten-egg burps. Although all these symptoms commonly occur in giardiasis, note that they are nonspecific symptoms and can occur in other types of diarrhoea too - eg you can't assume you've got giardiasis just because you've got rotten-egg burps.
You should ideally have a laboratory test to diagnose your illness before starting a course of antibiotics, but if you are in a remote area away from medical help, you could take either metronidazole (250mg three times daily for five to 10 days) OR tinidazole (2g single dose -tinidazole is not currently available in the USA).
Several different viruses cause hepatitis; they differ in the way that they are transmitted. The symptoms in all forms of the illness include fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes.
There are 6 known types of viral hepatitis:A, B, C, D, E and G. G is not dangerous. A and E are passed on by the fecal-oral route of transmission; there is a vaccine. Seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. A and E cause an acute illness, but you will recover fully from it.
B and D are passed on via blood, saliva, semen and vaginal fluids. They can be passed on by close contact, sexual contact, and blood-to-blood contact. The symptoms of hepatitis B may be more severe than type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or a long-term carrier state. There is a vaccine.
Hepatitis C is only passed on from blood-to-blood contact. There is no vaccine.
This serious and potentially fatal disease is spread by mosquito bites. If you are travelling in endemic areas it is extremely important to avoid mosquito bites and to take tablets to prevent this disease. Symptoms range from fever, chills and sweating, headache, diarrhoea and abdominal pains to a vague feeling of ill-health. Seek medical help immediately if malaria is suspected. Without treatment malaria can rapidly become more serious and can be fatal.
If medical care is not available, malaria tablets can be used for treatment. You should seek medical advice, before you travel, on the right medication and dosage for you.
If you do contract malaria, be sure to be re-tested for malaria once you return home as you can harbour malaria parasites in your body even if you are symptom free.
Travellers are advised to prevent mosquito bites at all times. The main messages are: wear light-coloured clothing; wear long trousers and long-sleeved shirts; use mosquito repellents containing the compound DEET on exposed areas (prolonged overuse of DEET may be harmful, especially to children, but its use is considered preferable to being bitten by disease-transmitting mosquitoes); avoid perfumes and aftershave.Use a mosquito net impregnated with mosquito repellent (permethrin) - it may be worth taking your own.
Not every headache is likely to be meningitis. There is an effective vaccine available which is often recommended for travel to epidemic areas. Generally, you're at pretty low risk of getting meningococcal meningitis, unless an epidemic is ongoing, but the disease is important because it can be very serious and rapidly fatal. You get infected by breathing in droplets coughed or sneezed into the air by sufferers or, more likely, by healthy carriers of the bacteria. You're more at risk in crowded, poorly ventilated places, including public transport and eating places.
The symptoms of meningitis are fever, severe headache, neck stiffness that prevents you from bending your head forward, nausea, vomiting and sensitivity to light, which makes you prefer the darkness. With meningococcal meningitis, you may get a widespread, blotchy purple rash before any other symptoms appear. Meningococcal meningitis is an extremely serious disease that can cause death within a few hours of you first feeling unwell. Seek medical help without delay if you have any of the symptoms listed earlier, especially if you are in a risk area.
If you've been in close contact with a sufferer it's best to seek medical advice.
Also known as enteric fever, typhoid is transmitted via food and water, and symptomless carriers, especially when they're working as food handlers, are an important source of infection. Typhoid is caused by a type of salmonella bacteria, Salmonella typhi. Paratyphoid is a similar but milder disease.
The symptoms are variable, but you almost always get a fever and headache to start with, which initially feels very similar to flu, with aches and pains, loss of appetite and general malaise. Typhoid may be confused with malaria. The fever gradually rises during a week. Characteristically your pulse is relatively slow for someone with a fever. Other symptoms you may have are constipation or diarrhoea and stomach pains.
You may feel worse in the second week, with a constant fever and sometimes a red skin rash. Other symptoms you may have are severe headache, sore throat and jaundice. Serious complications occur in about one in 10 cases, including, most commonly, damage to the gut wall with subsequent leakage of the gut contents into the abdominal cavity.
Seek medical help for any fever (38°C and higher) that does not improve after 48 hours. Typhoid is a serious disease and is not something you should consider self-treating.
Re-hydration therapy is important if diarrhoea has been a feature of the illness, but antibiotics are the mainstay of treatment.
Yellow fever is transmitted through the bite of an infected mosquito. There is an effective vaccine against yellow fever, so if you have been immunised, you can basically rule this disease out. Symptoms of yellow fever range from a mild fever which resolves over a few days to more serious forms with fever, headache, muscle pains, abdominal pain and vomiting. This can progress to bleeding, shock and liver and kidney failure. The liver failure causes jaundice, or yellowing of your skin and the whites of your eyes - hence the name.
There's no specific treatment but you should seek medical help urgently if you think you have yellow fever.
