Dysentery - advice from a Tropical Medicine Doctor

Amoebic dysentery (amoebiasis) is an infection of the intestine ) caused by an amoeba called Entamoeba histolytica, which can cause severe diarrhoea. Amoebae are parasites that are found in contaminated food or drink. They enter the body when contaminated food or drink are swallowed. The amoebae are then able to move through the digestive system and lodge in the intestine where they cause infection. The most dangerous, Entamoeba Histolytica, are tropical species which can cut through the intestinal wall and spread through the bloodstream to infect other organs, such as the liver, lungs and brain.

It exists ass free amoebae (known as 'trophozoites') or as infective cysts, which are groups of amoebae surrounded by a protective membrabe excreted by human or animal. The cysts are protected from stomach acids and very dangerous. When cysts reach the intestine, amoebae are released amd attack the intestine. They are passed on by negligent food treatment where contaminated food or drink have not been made hot enough by cooking to kill them off. Salads, fruits or seafood washed with dirty water are a common source..

Amoebic dysentery may not show symptoms for months or even years. However it can still be infectious to others. The amoebae bite into the walls of the large intestine, causing ulceration and bleeding. Initial symptoms are stomach cramps, painful passage of stools and bloody, slimy foul-smelling diarrhoea,. If the amoebae break through the intestinal wall and its lining or peritoneum, they cause peritonitis. Amoebae are carried in the bloodstream to the liver and other organs and produce a high temperature. The amoebae can form enormous cysts in the liver and other organs.causing weight loss and severe illness.

Avoiding infection

The way to avoid infection with amoebic cysts is to ensure that all food and drink has been washed, boiled, peeled or sterilised and cooked to a high temperature. Drinking water can be made safe by boiling it for 10 to 15 minutes (a little longer at high altitudes), and then cooling it rapidly and keeping it sealed, by adding water-purifying tablets at least 15 minutes before drinking, or by buying bottles of sealed water.

Avoid eating food such salad, unpeeled fruit and ice cream or ice cubes .

Anyone with bloody diarrhoea should see a doctor an tell hime where they have been. Diagnosisis is straightforward with a stool inspection. But complications may need ultrasound. Bloody diarrhoea is seen in many illnesses, but in tropical areas it is most oftwen a sign of either amoebic dysentery or shigellosis (bacillary dysentery which is caused by bacteria).

Treating yourself

Amoebic dysentery is treated with metronidazole (eg Flagyl tablets). Complications, such as perforation of the intestinal wall or the presence of abscesses within the body's organs, require specialist hospital treatment. In an emergency, for instance if you have bloody diarrhoea and are on holiday and cannot get medical help, you can treat yourself with metronidazole, eg two 400mg tablets, three times a day for five days. This is the dose for adults who are neither pregnant nor breastfeeding. It is important to avoid drinking alcohol during treatment. Even if you have to treat yourself, it is important to see a doctor to ensure that the treatment has been truly effective.As metronidazole requires a prescription, you could ask your own doctor to write a prescription in advance if you know that you will be travelling where access to a doctor or hospital may be difficult.

Report by: Dr Charlie Easmon MBBS, MRCP MSc Public Health DTM&H DocMed, specialist adviser in travel medicine, Travel Screening Services, 1 Harley Street, London, and specialist registrar in public health, North Thames.

C from Scotland caught it at a Riu

"My partner and I have just returned to the UK after a holiday at a Riu. Both of us were ill with sickness & diarrhoea and bad fevers. My partner also ended up having to go on a drip for the dehydration, which cost us in the region of £300. On return to the UK we saw our doctor as we were both still ill and have now been diagnosed with Dysentery! We had to stay off work for an extra week until we were both showing clear samples and we also had a visit from environmental health as it's a notifiable disease. We are seeking compensation from Thomsons.

I don't know what happened to cause it but there were hundreds of kids around. I'd be willing to bet that they helped to spread the illness, they had their hands in the ice cream etc. Not nice when you think of all the people eating there in all complexes! I would urge anyone who stayed in either of the complexes who are still experiencing symptoms to go and see your doctor. If you have picked up Dysentery as I did it is very contagious and is a notifiable illness."

A from Cambs caught it at the Riu in Sal

"I got severe stomach cramps and the runs from day 3 for the rest of the holiday. Two nights I actually thought I was going to pass out as my tummy was that bad and I cried on the last night cause I was so upset about it all! My boyfriend fell ill as well. We could not go on any of the trips or into the town cause we had to know there was a toilet near us all the time within running distance as we were only getting about a 30 second warning if you know what I mean!!!A few nights he was up all night with it as well but I only had it during the day thank god! Kept listening in to other peoples conversations around the pool (like you do) and there was alot of it going about. Complained to the rep on the last night cause it's not got enough for the amount of money we spent to go there! She didnt think it was anything to do with the hotel though! We have been back 1 week tomorrow and are still not right.I tried to publish this exact same review on the tour operator website but they have not published it - what does that tell you?"

The Daily Mail reported on an outbreak at a Riu

"British tourists infected with the virus ended up on intravenous drips in their hotel rooms. In a statement, they claim their symptoms were misdiagnosed as 'tummy upset' and that they were given 'wholly inappropriate' medication. One mother is quoted as saying, 'It was horrendous. Used needles and drips were just dumped in bins in the hotel room and we never saw the doctor or nurse wash their hands before or after treatment.'

Legal action against the hotel includes cases in June 2010, 84 cases in 2008 and 4 cases in 2009 which involved confirmed cases of Salmonella, Shigella and E coli. The owner of Thomson, tour operator Tui UK Ltd, has admitted liability for previous cases.