What Is Shigella? Symptoms And Treatment For Travellers.

Shigella has hit the headlines recently with travellers in an Egyptian resort where two British holidaymakers died suddenly contracting the disease, but what is Shigella? What are the symptoms, and how can backpackers protect and treat themselves when travelling?  

Since two sudden and unexpected deaths of British tourists in Egypt recently, the resort they were staying at in Hurghada, Egypt, has been evacuated amongst numerous reports of tourists being unwell. The usual conspiracy theorists and doomsayers have of course had a field day once again declaring Egypt unfit to travel to, but this is highly unfair.

Latest reports suggest that other tourists at the resort may have contracted Shigella, and it is possible that this explains a raft of unexplained illnesses. But Shigella is a common, communicable disease that does affect travellers, but can also hit anyone, anywhere at any time, even at home.

This is why it is so important to just get the absolute facts about Shigella out there, discuss the potential risk to any traveller and how backpackers and travellers can protect themselves against it, and what they can do if they do contract Shigella.

What Is Shigella?

Shigella is a form of dysentery, which is an intestinal infection that causes severe diarrhoea and often vomiting. There are two main types of dysentery:

• Bacillary dysentery or shigellosis – this is caused by shigella bacteria and is the most common form of dysentery in the UK.
• Amoebic dysentry or amoebiasis – this is caused by an amoeba called entamoeba histolytica and is usually found in tropical areas so is the most common form of dysentery in travellers.

Although one is more common than the other depending where you are in the world, both can be contracted anywhere.

What Causes Shigella?

Both forms of dysentery, including shigella, are highly contagious communicable diseases. They are passed primarily from person to person through the feacal oral  route.

Put very simply, people contract shigella when contaminated poo gets into their mouths.

Sound disgusting? It is. But it is also a lot more common than people think.

When people go to the toilet and don’t wash their hands they can then go on to shake hands or touch other people, or touch a whole manner of things in public, everything from door handles to bus rails and even food at markets. When other people touch those same common things the contaminated faecal matter gets passed to their hands and then often their mouths.

There is also a chance of contracting the disease through anal sex.

For travellers, one of the biggest risk factors are when they are travelling through a country or countries where the water sanitation is poor. In many of these countries there is a chance that faeces could have contaminated the water and by extension any food – particularly uncooked food – that has been washed in it.

This is why a large proportion of shigella cases are mistaken for food poisoning, as quite often it is contaminated water or food that is the source.

With shigella being a communicable disease, meaning that it can be passed on much more easily and quickly with people who are in close contact or proximity to each other, so travellers who are staying in dorm rooms or hostels are particularly at risk.

What Are The Symptoms Of Dysentry And Shigella?

Both types of dysentery are highly infectious and can be contracted very easily if you aren’t careful. Signs and symptoms include:

• Diarrhoea containing blood or mucus.
• Stomach cramps.
• Nausea.
• Vomiting.
• A fever of 38C or above.

Treating Dysentry And Shigella.

It is important to remember that just like normal diarrhoea and vomiting, shigella will often clear up on its own within roughly 3 to 7 days, and treatment isn’t always needed.

The best thing travellers can do if they develop shigella is to get themselves a private room with an en suite toilet for at least a few days and stay in and rest. Try and stay indoors for at least 48 hours to gather your strength but also to avoid passing it onto others too, and being near your own private toilet will make you feel much better and much more comfortable.

It is absolutely essential at this time to stay as hydrated as possible because losing so many fluids over such a short period will leave you at risk of dehydration. You won’t necessarily need rehydration salts unless it is a particularly severe bout, but you should definitely drink as much fluids as possible to stay hydrated and replace any lost fluids. Water, weak diluted juice and the occassional cup of tea are best, try and avoid fizzy soft drinks, coffee and definitely alcohol.

When you feel up to it try eating some basic foods such as toast, plain pasta or bananas if you can to try and replace some energy, carbs and other minerals.

Taking the occasional paracetamol can help too if you have stomach cramps and are running a temperature, but do not take any  antidiarrhoeal medication such as Loperamide (otherwise known as the brand name Imodium), as these are not treatments, they are there to help stop the symptoms of diarrhoea in an emergency (such as if you are flying that morning) and it is much better to let things pass through naturally so your body can expel any contamination.

When Should You Seek Medical Attention For Shigella?

This is difficult to determine as in most cases shigella will clear up on its own after a few days, but there are circumstances where it can be far more severe and become a much bigger risk to your health, or in rare cases your life.

If you have had symptoms for more than a few days and they are showing no signs of clearing up (or even getting worse) by that time then it is time to call for medical attention and get some further advice.

The same is true if the symptoms you are experiencing are extreme, if your stools or vomit contain significant amounts of blood, if the frequency is excessive or if any cramps or pains are extremely heavy.

Most hostels, guesthouses and hotels will have a number for a local doctor who can do call outs, some hotels may have an in house doctor or you can always contact me to get an emergency appointment with a qualified travel nurse at my online travel clinic.

In extreme and rare cases, dysentry or shigella can lead to further systemic or intestinal complications such as intestinal perforation, toxic megacolon, sepsis, encephalopathy, malnutrition and more. It is important to remember that these are extreme cases but travellers should be aware of the possibility and seek medical advice if they think they need it.

How To Avoid Dysentry And Shigella.

Shigella is passed on very easily but the good news is that there are very easy steps you can take to avoid getting it in the first place, or avoid passing it on if you do.

Washing your hands thoroughly and carefully throughout the day is the single most important thing you can do, especially before and after any meals, after using the toilet or handling anything dirty. Always use soap and water where you can and only use alcohol gel as a back up in between hand washes.

If you are travelling in a country where the water sanitation may be poor, then avoid drinking the local water or eating any uncooked food that may have been prepared in it. Also avoid having water in your ice and cleaning your teeth with tap water.

Be careful at any food stall, restaurant or anywhere that food is served if the food doesn’t appear to be 100% fresh or has been sat out for a while too. This may or may not lead to dysentry but can give you food poisoning at the very least. This is why people often fall ill at buffets in resorts and on cruises.

Always use sterile bottled water if you can, or even better use a refillable water filter or purifier bottle. They are much better for the environment, save you a fortune in buying tons of bottled water and guarantee safe, clean water.

What Else Can Travellers Do?

Just get out there and enjoy yourself! Be careful of course and be mindful of the tips and advice given above, but remember also that people can fall ill anywhere at any time. You can take all the precautions in the world and still be unlucky. The important thing is to reduce the risk as much as possible in the first place, recognise symptoms if you do get ill, take appropriate steps to treat yourself or call for medical advice or assistance if you need to.

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