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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).
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 is a fatal viral infection. Many animals can be infected (such as dogs, cats, bats and monkeys) and it's their saliva that is infectious. Any bite, scratch or even lick from a warm-blooded, furry animal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then apply alcohol or iodine solution. Medical help should be sought promptly to receive a course of injections to prevent the onset of symptoms and death.
TB is a bacterial infection usually transmitted from person to person by coughing or spitting, but it can also be transmitted through consumption of unpasteurised milk. Milk that has been boiled is safe to drink, and the souring of milk to make yogurt or cheese also kills the bacilli. Travellers are usually not at great risk, as close household contact with the infected person is usually required before the disease is passed on.
Also known as bilharzia, this disease is carried in freshwater by tiny worms that enter through the skin and attach themselves to the intestines or bladder. The first symptom may be tingling and sometimes a light rash around the area where the worm entered. Weeks later, a high fever may develop. A general unwell feeling may be the first symptom, or there may be no symptoms. Once the disease is established, abdominal pain and blood in the urine are other signs. The infection often causes no symptoms until the disease is well established (several months to years after exposure), and damage to internal organs is irreversible. Avoid swimming or bathing in freshwater where bilharzia is present. Even deep water can be infected. If you do get wet, dry off quickly and dry your clothes as well.
A blood test is the most reliable test, but it will not show positive until a number of weeks after exposure.
Vaccination against this serious bacterial disease is very effective, so you don't need to worry if you've been properly immunised against it. It mainly affects children and causes a cold-like illness that is associated with a severe sore throat. A thick white membrane forms at the back of the throat which can suffocate you, but what makes this a really nasty disease is that the diphtheria bug produces a very powerful poison which can cause paralysis and affect the heart. Otherwise healthy people can carry the bug in their throats, and it's transmitted by sneezing and coughing. It can also cause a skin ulcer known as a veldt sore. Vaccination protects against this form too. Treatment is with penicillin and a diphtheria antitoxin, if necessary.
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, and impregnating clothes with permethrin effectively deters mosquitoes and other insects.
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.
There are three different types of typhus, caused by insect or rodent bites. The most significant form of typhus to travellers is louse typhus: infected body lice transmit the disease through their faeces which is scratched into itchy bites they have made on the skin. After infection, the onset of the disease can vary after but symptoms can occur quite suddenly and include headaches, chills, high fever, coughing and severe muscular pain. After five or six days, dark spots develop on the upper body and spread, but usually don't show up on the face, palms of the hand, or soles of the feet. Typhus usually occurs in colder (often mountainous) regions of central and east Africa, and central and south America and Asia. While the risk of typhus is quite rare for travellers, the best prevention is cleanliness, as the disease occurs in places where there is poor hygiene and crowding. If you are visiting a high risk area, it may pay to use insecticidal powders for your body and clothing. A diagnosis can be determined with a blood test, but as the disease can be fatal, effective antibiotics will often be prescribed on the basis of symptoms alone.
