Monday 28 May 2018

Dear Dr Nina: One year after holiday bug, I'm still not well

Photo posed
Photo posed

Nina Byrnes

Nearly 12 months ago I went on holiday to south-east Asia and when I was there I came down with a serious bout of gastroenteritis which lasted for several days. I was really ill and lost over a stone in weight, and it took me several weeks to feel like myself after coming home. But my concern now is that a year after returning from my holiday, I still don't feel 100pc. I have pain from time to time in my tummy and still have relatively frequent bouts of diarrhoea, which is something that never bothered me before.

I am worried that I may have done some permanent damage to myself on holidays and I'm not sure what I can do to fix it. I'm taking probiotics, but I don't know what else to do.

Dr Nina replies: It is unfortunate you got sick while holidaying abroad but these episodes are quite common when travelling to less developed countries. Food hygiene abroad might not be as advanced and the gut is exposed to bugs and viruses it has not encountered before.

Gastrointestinal viruses can happen at home or abroad. These cause inflammation of the stomach, intestines or both. This results in abdominal pain, nausea, vomiting and diarrhoea. Diarrhoea may comes on quite suddenly and be explosive.

There may also be an associated, fever, headache or body aches and pains. Most cases are short-lived and recovery occurs within one to three days. The main danger with profuse vomiting and diarrhoea or prolonged symptoms is dehydration. Children and the elderly or those with other illness are especially at risk. It is important to watch out for dark or reduced urine, dry mouth and lips, dizziness when standing, headache, and unusual tiredness as these are tell-tale signs that the body's fluid reserves are low.

Viral gastroenteritis is extremely contagious and spreads easily among those in close contact. Infection is passed either through direct contact with someone who has the virus or by touching a surface which has become infected. The virus can live on surfaces for several days so once again strict hygiene is one of the best ways to avoid its spread.

If stomach upset occurs when travelling abroad, then other infectious causes and the possibility of a parasitic infection must also be considered. If symptoms are continuing despite travel, home tests are warranted. Your GP can send a stool sample and do some blood tests to rule these out.

It sounds like you were really quite sick and it is concerning you are still unwell. One possibility is that you have post-viral irritable bowel syndrome (IBS). This is a very well-documented phenomenon and is thought to have an incidence of 5pc to 32pc in those who experience an infectious gastrointestinal upset. The exact cause isn't clear but it is thought to be a combination of on-going inflammation and changes in gut microbes and permeability. Females and those under the age of six are at higher risk.

The risk of post-infectious IBS also correlates with the severity of the initial illness, increasing two-fold if diarrhoea lasted more than a week.

There is no doubt that on-going stomach upset can cause some stress and it is important to address any psychological upset as this too can prolong symptoms.

Post-infectious lactose intolerance is well-documented and so in those with on-going gastrointestinal upset it may be worth trying a low-lactose diet to see if this helps. There are no other specific dietary recommendations but if diarrhoea predominates, a lower residue diet (limiting high-fibre foods) may help.

Whatever the cause, it is important to note that the outlook is good overall. The large majority of people recover within two years with only a small percentage having longer-term problems. If symptoms include fever, passing blood, severe abdominal pain or weight loss, then further investigation is warranted.

Q. My 10-year-old nephew has just been diagnosed with ringworm. I'm really worried that my  own kids will pick it up from him as they play together frequently. Is it contagious? Tinea corporis or ringworm, despite its name, is not associated with a worm of any sort. It is a rash caused by fungus in the skin. It results in patches of scaling skin commonly circular in shape with sparing of the central area.

Dr Nina replies: Tinea is contagious and can spread from person to person through direct contact or contact with a contaminated surface. Clusters of infection are sometimes seen in families but direct contact is required.

Once treated, it is important to try and prevent further infection.

For mild infection, creams and powders may help. In more severe infections, anti-fungal tablets may be prescribed.

When applying creams and powders ensure your skin is dry and clean. Apply the cream to the affected area and some of the normal skin surrounding it, as some infection may not be evident.

It may take several weeks of treatment for the infection to resolve. You should keep applying the treatment for several days after the skin appears clear in order to ensure all fungi are treated.

There are a number of over-the-counter treatments that are quite effective. These include selenium sulphide or ketoconazole shampoo. Wearing loose natural fibres and avoiding humid conditions can help prevent reoccurrence. For more resistant cases, a trip to your GP may be required. Most infections are very treatable so with some care and attention skin can look normal again.

Recurrent fungal infections are more common in those with diabetes or suppressed immune systems.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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