Bhutan - Lindsay Brown [224]
Typhoid
This serious bacterial infection is also spread via food and water. It gives a high and slowly progressive fever, headache and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Bhutan. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink.
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TRAVELLER’S DIARRHOEA
Traveller’s diarrhoea is by far the most common problem affecting travellers – between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better, where you are etc.
Traveller’s diarrhoea is defined as the passage of more than three watery bowel-actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell.
Treatment reequires staying well-hydrated; rehydration solutions like Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.
Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, for example if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.
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DRINKING WATER
Never drink tap water
Bottled water is generally safe – check the seal is intact at purchase
Avoid ice
Avoid fresh juices – they may have been watered down
Boiling water is the most efficient method of purifying it
The best chemical purifier is iodine. It should not be used by pregnant women or those with thyroid problems.
Water filters should also filter out viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size, eg less than four microns.
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Amoebic Dysentery
Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor quality labs. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metronidazole to kill the parasite in your gut and then a second drug to kill the cysts. If it’s left untreated, complications such as liver or gut abscesses can occur.
Giardiasis
Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardiasis, but work in Nepal has shown that they are not specific to this infection. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second-line option.
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ENVIRONMENTAL HAZARDS
Food
Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and food that has been sitting around in buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants with a high turnover of customers.
High Altitude
If you are going to altitudes above 3000m you should get information on preventing, recognising and treating Acute Mountain Sickness