Malaria, DVT, liver disease… What you don't want to bring home from your holiday



21:13 GMT, 1 September 2012

Feeling flat and tired now summer’s over and the schools are about to go back It’s likely to be simply the usual post-holiday blues, but there’s a small chance it signifies something a lot more serious.

If you get an upset stomach or an injury on holiday, you usually realise immediately. But some less well-known conditions take a while to present any symptoms, so you need to know what to watch for. Travel health expert DR BEN MACFARLANE details the key post-holiday nasties to be on alert for . . .

Hospital stay: Cheryl Cole caught malaria while in Tanzania and was hospitalised on her return to the UK

Hospital stay: Cheryl Cole caught malaria while in Tanzania and was hospitalised on her return to the UK

SYMPTOMS: Lethargy, nausea and yellow-looking skin two to six weeks after coming home.

Hepatitis A – a viral liver infection endemic in parts of Africa, Asia
and Central and South America. It’s usually transmitted via dirty food,
so be extra vigilant if you get food poisoning.

The yellowing of the skin – jaundice – can be masked by a holiday tan, so check the whites of eyes, which will also be yellow.

It is possible to fight it off with bed rest but hepatitis A can be
fatal. ‘If you develop bruising, bleeding, confusion or sleepiness, you
should seek medical attention immediately,’ says Dr Ashley Brown,
consultant hepatologist at St Mary’s Hospital in London.

Severe headaches behind the eyes – which start up to a fortnight after a
holiday – plus fever and extreme joint pains. Up to five days after the
onset of the fever, you might also start to show a bright red rash.

Dengue fever, another mosquito-borne illness common in tropical and
sub-tropical holiday destinations such as Costa Rica, Singapore and the

Speak to your GP. In most cases you’ll be able to recover with bed rest
at home, but hospitalisation may be required in severe cases or if you
have underlying health problems.

Malaria is transmitted by mosquitoes

Malaria is transmitted by mosquitoes

SYMPTOMS: Fever, shivering, joint pains and vomiting, between one week and several months after returning.

IT COULD BE: Malaria – and you can’t assume you’re safe because you took anti-malarial drugs before visiting a risk area and didn’t seem to get bitten by any mosquitoes.

Travellers who took anti-malarial medication can take some time to show symptoms.

Cheryl Cole had been back from her holiday in Tanzania for two weeks when she was hospitalised with malaria in 2010.

WHAT TO DO: Seek help. Severe cases can lead to fits, anaemia, kidney failure, fluid on the lungs, loss of consciousness and even death. Treatment depends on the region you visited and which anti-malarial medication you took.

‘If you experience symptoms after
your holiday, tell your GP that you have visited a malarial zone so they
can do the relevant blood tests,’ says Dr Janice Main, consultant in
infectious diseases at St Mary’s Hospital in London.

‘The more dangerous strains of malaria can take hold very quickly, so if you can’t get a GP appointment or you feel ill over a weekend, go to A&E.

‘Early symptoms are non-specific and often flu-like, so make sure the doctors know you have visited a “danger zone” and don’t be fobbed off.’

Some anti-malarial medications have to be taken for up to a month after you return from a malarial area. As malaria bugs can lurk in your system, it’s important to complete the course.

A ‘bull’s-eye rash’ – a bright red patch of skin which then fades in
the centre, perhaps coupled with muscle and joint pain, fever, headaches
and fatigue.

IT COULD BE: Lyme disease. This was first described in Lyme, Connecticut, but it is widespread in central Europe.

High-risk areas in the UK are popular
holiday spots such as the Scottish Highlands and the New Forest. It’s
transmitted by bites from tiny insects called ticks, and diagnosis can
be confused as the rash can take up to a month to appear and won’t
necessarily be at the bite site.

See your doctor. ‘If untreated, late complications include nerve
damage, arthritis and damage to the rhythm control of the heart,’ says
Dr Janice Main.

‘Blood tests can confirm the
diagnosis and antibiotics given early can prevent more serious
complications. Prevention is important, so if you are hiking through an
area known to have infected ticks, wear long trousers instead of

DVTs are more likely when travelling from a hot climate

DVTs are more likely when travelling from a hot climate

SYMPTOMS: Swollen, red or painful calf muscles on one leg within a week or so of your flight home.

Deep-vein thrombosis (DVT). These are blood clots that form in leg
veins that can dislodge and travel to the heart or lungs, causing a
fatal blockage.

DVTs are more likely when travelling
from a hot climate, as dehydration leads to the blood clotting more

Pregnant women, overweight people, the elderly, smokers, and
women taking the Pill or on HRT are most at risk.

See your GP. If DVT looks likely, a quick scan at hospital can confirm
it. Heparin injections can stop a clot growing, while compression
stockings can lower the risk of recurrence.

SYMPTOMS: Severe breathlessness, chest pain and coughing up blood up to a week after flying home.

IT COULD BE: A pulmonary (lung) embolus (blockage) caused by DVT.

WHAT TO DO: This is an emergency, so dial 999. Scans will show whether the artery to the lung is blocked. Surgery may be required.

SYMPTOMS: Recurrent bouts of severe diarrhoea, exhaustion and smelly burps.

IT COULD BE: Giardiasis. This stomach bug, widespread in Africa, Turkey and former Eastern bloc countries, is usually transmitted through infected water in drinks, ice cubes, food or even from swimming in lakes or rivers. Once you’ve been infected, the parasites will be busy multiplying in your intestines for some time before the worst symptoms strike.

WHAT TO DO: Medication called antiprotozoals can kill the bugs. If you don’t get proper treatment, the disease can recur so you should obtain medical help early and tell your GP or practice nurse where you’ve been on holiday.