Those whose diarrhoea started a few days before return, present with acute diarrhoea of leaving. The most common identified pathogens are outlined in Table 4. Inflammatory diarrhoea is usually caused by Campylobacter, Shigella or Salmonella infection. Clinical features include fever, cramping abdominal pain, pus blood in the stool. Amoebic dysentry, another cause of inflammatory diarrhoea, is less common in returned travellers.
Diagnosis requires special stain, early examination of specimens and an experienced operator.
When diarrhoea persists beyond 10 days additional causes need to be considered. If it is associated with crampy abdominal pain, flatulence and weight loss Giardia lamblia infection should be suspected. An enteric infection may exacerbate or precipitate symptoms of irritable bowel syndrome or inflammatory bowel disease in the absence of continuing infection Post-infective irritable bowel syndrome is a common reason for presentation to travel medicine clinics. The common causes of persistent diarrhoea are listed in Table 5 . Chronic diarrhea - selected causes Bacteria Campylobacter spp.