Makindo Medical Notes

💩 Traveller’s Diarrhoea ⚠️ Do NOT give antibiotics in enterohaemorrhagic E. coli (EHEC) → risk of Haemolytic Uraemic Syndrome (HUS).

🌍 About

• Affects 20–30% of travellers, usually within the first week of travel.
• Caused by ingestion of contaminated food or water.

🦠 Aetiology

• E. coli (esp. ETEC = commonest cause).
• Campylobacter → acute abdomen picture, bloody diarrhoea.
• Amoebic dysentery (Entamoeba histolytica) → abdominal pain + blood.
• Clostridioides difficile (post-antibiotics).
• Giardia → foul-smelling, greasy stools, >7 days.
• Cryptosporidium → prolonged watery diarrhoea, esp. immunocompromised.
• Cyclospora → relapsing/prolonged watery diarrhoea.

🤒 Clinical

• Watery or bloody diarrhoea, nausea, vomiting.
• Cramps, fever, dehydration.
• Severe → electrolyte imbalance, HUS (EHEC).

🧪 Investigations

• FBC, U&E, LFTs, CRP.
• Stool MCS + OCP (ova, cysts, parasites), PCR if available.
• Colonoscopy if persistent (rule out IBD, colitis).

🔍 Differential

• Inflammatory bowel disease (Crohn’s, UC).
• Food poisoning (short duration, meal-related).
• Viral gastroenteritis (24–48 h, self-limiting).

🛡️ Prevention

• 💧 Drink boiled/bottled water; avoid ice.
• 🥗 Avoid salads/raw fruit washed in unsafe water.
• 🧼 Strict hand hygiene before eating.

💊 Prophylaxis

• Rare; consider in high-risk groups:
• Ileostomy/short bowel.
• Immunocompromised (HIV, transplant).
• CKD or significant comorbidity.
• Agents: Ciprofloxacin or Metronidazole (per ID advice).

⚕️ Management

• 💧 Rehydration = cornerstone (ORS; IV fluids if severe).
• 💊 Antibiotics: – Ciprofloxacin / Azithromycin for severe/prolonged cases. – ❌ Avoid in EHEC (HUS risk).
• 🚫 Antimotility (e.g. loperamide): safe in mild watery diarrhoea, avoid if bloody diarrhoea or fever.
• 🔄 Watch for post-infectious IBS.

🥘 Foodborne Diseases – Quick Reference

🦠 Organism	💡 Illness	⏱️ Onset	🤒 Symptoms	📆 Duration	🍽️ Sources
Bacillus cereus	Food poisoning	10–16h	Cramps, watery diarrhoea	24–48h	Meats, stews, sauces
Campylobacter jejuni	Campylobacteriosis	2–5d	Fever, cramps, bloody diarrhoea	2–10d	Poultry, unpasteurised milk
Clostridium botulinum	Botulism	12–72h	Neuro → blurred vision, weakness	Variable	Improperly canned foods
Cryptosporidium	Cryptosporidiosis	2–10d	Watery diarrhoea ± fever	Weeks–months	Contaminated water
Giardia	Giardiasis	1–3w	Greasy, foul stools	Weeks	Contaminated water
E. coli (ETEC)	Traveller’s diarrhoea	1–3d	Watery diarrhoea, cramps	3–7d	Water/food contaminated with faeces
E. coli O157:H7	Haemorrhagic colitis	1–8d	Bloody diarrhoea, HUS risk	5–10d	Undercooked beef, unpasteurised milk
Norovirus	Viral gastroenteritis	12–48h	Vomiting, cramps, diarrhoea	12–60h	Raw produce, shellfish
Salmonella	Salmonellosis	6–48h	Fever, cramps, diarrhoea	4–7d	Eggs, poultry, dairy
Shigella	Dysentery	1–7d	Bloody/mucus diarrhoea, fever	2–7d	Contaminated food/water
Vibrio vulnificus	Severe gastroenteritis	1–7d	Diarrhoea ± sepsis, ulcers	2–8d	Raw seafood (esp. oysters)

📚 References

• CDC – Foodborne Illnesses
• WHO – Foodborne Diseases