Planning to travel to an exotic or adventurous destination? While travelling can be an exciting experience, it also comes with health risks that you should be aware of. One particular risk is the chance of returning home with a parasitic infection! Parasites can get into your body through contaminated water, food, bug bites, or poor hygiene, and if you don't take the right measures, they can be very harmful to your health.^1,2 Some of the most common parasitic infections that you may be familiar with include malaria, giardiasis, and schistosomiasis.² In order to reduce the likelihood of being infected with a parasite before, during, and after their trips it is important for you to be aware of the most frequent parasite infections and how they are spread.

Understanding Parasitic Infections

What are parasitic infections?

Parasites are organisms that survive themselves in another organism, known as the host. These parasites could be so tiny to be found only under a microscope, such as giardia or could be visible to the naked eye, like head lice.³  When these parasites invade your body to live and feed on your body, it can result in infections.³

Types of parasitic infections

Parasitic infections are typically categorised into three main types based on the causative agent:

Protozoa – these are single-celled organisms that have the ability to multiply inside your body.

• Plasmodium (causing malaria)
• Giardia (causing giardiasis)
• Entamoeba histolytica (causing amoebiasis)
• Trypanosoma brucei (causing African sleeping sickness)
• Leishmania (causing leishmaniasis)

Helminths – these are larger, multi-celled organisms, commonly referred to as worms. These include:

• Ascaris lumbricoides, or roundworm (causing ascariasis)
• Taenia solium, or pork tapeworm (causing tapeworm infection)
• Schistosoma, or blood fluke (causing schistosomiasis)
• Ancylostoma duodenale, or hookworm (causing hookworm infection)

Ectoparasites – These are parasites like lice, ticks, and fleas. They usually live on the skin and can transmit infections when though biting.¹

Some of the most common parasitic infections you are likely to develop include giardiasis, cryptosporidiosis, and cyclosporiasis. Vector-borne infections such as malaria and leishmaniasis are more prevalent, whereas chagas disease, lymphatic filariasis, and African sleeping sickness are less commonly encountered.²

How do these infections spread?

There are many routes through which you can get infected by a parasite. It depends on the type of parasite. Among the most popular routes are:

• Contaminated Water – If you drink or swim in contaminated water, this can lead to infections like giardiasis or schistosomiasis
• Insect Bites – Mosquitoes, sandflies, and tsetse flies can transmit diseases like malaria, leishmaniasis, and sleeping sickness through their bites
• Undercooked Food – Eating improperly cooked meat or contaminated fruits and vegetables can introduce parasites such as tapeworms or roundworms into your body
• Poor Hygiene and Sanitation – If you have poor hygiene, like lack of handwashing or contact with contaminated surfaces, these can increase the risk of hookworm infections^4,5,6

Pre-Travel Preparations

In order to prevent the chance of getting a parasitic infection, you should be cautious if you are travelling to tropical and subtropical areas with poor sanitation and healthcare facilities.⁷

Consultation with Healthcare Providers

While there is plenty of useful information available on the internet, it is always a better idea to consult with a healthcare provider or travel medicine specialist to discuss potential health risks specific to your destination. They can provide personalised advice if you are travelling to high-risk areas for parasitic infections. This may include vaccinations or prophylactic medications to prevent diseases like malaria. They can also offer information on necessary immunizations and ensure your routine vaccines are up-to-date. By getting the right medication before travel, you can significantly reduce the risk of infection.⁸

Researching the Destination

It is crucial to understand the health risks associated with the region you are travelling to. Concerns about parasites vary depending on the area, so being prepared allows you to take the appropriate measures. It is important to consult reliable resources, such as the World Health Organization (WHO) or the Centers for Disease Control and Prevention (CDC), for information on travel health advisories and parasite infections.⁸

Preventive Measures During Travel

Protection Against Insect Bites

Insect bites, especially from mosquitoes, are one of the main ways parasite diseases like dengue fever and malaria are spread.⁹ Therefore, to reduce the risk of insect-borne infections, you could:

• Use insect repellents that contain DEET, picaridin, and the oil of lemon eucalyptus. You can apply them to any exposed skin, especially during peak mosquito activity times, like dusk and dawn
• You can also treat your clothes with an insecticide called permethrin. This insecticide can be applied to clothes, hats, and even tents to deter mosquitoes and other biting insects⁹

Water and Food Safety

It is possible to get several parasites into your body from contaminated food or water, including schistosomiasis, amoebiasis, and giardiasis. Thus, following safe consumption steps can aid in the prevention of parasitic infections.¹⁰ These include:

• Avoid drinking contaminated water. Always drink bottled water or boiled water. You could also use water purification tablets or filters
• Avoid eating raw or undercooked food, particularly seafood and meat
• Avoid eating fruits or vegetables that could have been washed in unsafe water
• Avoid consuming food from unhygienic street vendors and ensure your meals are prepared in clean environments¹

Proper Hygiene

Maintaining good hygiene practices is essential to avoid contracting parasitic infections through contaminated surfaces or direct contact with unsanitary environments:

• Hands should be routinely washed with soap and clean water, especially after using the toilet and before eating. To keep your hands clean when soap and water aren't accessible, use hand sanitisers with alcohol in them
• Lakes, rivers, and ponds are examples of contaminated sources; stay away from them as they may include parasites like schistosomes
• If swimming or wading are necessary, make sure you completely dry yourself, and keep your head out of the water to reduce your parasite exposure^1,7

Post-Travel Care and Follow-Up

Monitoring Symptoms

Once you return from a trip, it is essential to carefully monitor any unusual symptoms. Some of the common signs of parasitic infections to check include:

• Diarrhea
• Nausea and vomiting
• Stomach pain
• Unexplained weight loss
• Increased hunger
• Muscle pain
• Fever
• Chills
• Difficulty sleeping (insomnia)
• Tiredness
• Weakness
• Skin rash/itching¹

Seeking Medical Attention

It is critical to seek medical assistance if you encounter any of the following symptoms following travel. By sharing details about your travel history and any potential exposure to contaminated food, water, or insect bites, you can aid in the accurate diagnosis of any infection.¹

Diagnostic Tests

Your doctor will check your body for bite marks, rashes, or evidence of extreme itching. Depending on the kind of infection, they could also search for obvious parasites on your skin, hair, or clothes.¹

Fecal Exam (Stool Culture)

These help diagnose intestinal parasites by checking the stool samples for parasites or their eggs.¹

Endoscopy or Colonoscopy

If a faecal examination yields no clear results, your doctor can suggest an endoscopy or colonoscopy. During these procedures, the digestive tract is examined using an endoscope, which is a flexible tube equipped with a camera. A colonoscopy examines via the anus, whereas an endoscopy looks through the mouth to investigate the small intestine.¹

Blood Test

Blood is drawn and placed on a slide for microscopic examination to detect parasites.¹

Serology

This test looks for antigens or antibodies in your blood that point to particular parasite infections.¹

Imaging Tests

In order to evaluate any organ damage resulting from parasite-induced lesions in your intestines, your physician could prescribe imaging tests such as CT, MRI, or X-rays.¹

Treatment of Parasitic Infections

While many infections resolve on their own without treatment, some are treated with antiparasitic drugs. These medications can specifically target parasites or reduce worm populations. Furthermore, certain parasite infections can be successfully treated with specific antibiotics and antifungal medications.⁷ Some of the treatment options for common parasitic infections include:

• Metronidazole, tinidazole, or nitazoxanide are usually prescribed for the treatment of Giardia infections
• Chagas disease is usually treated with benznidazole or nifurtimox
• Tapeworm infections are treated with medications including praziquantel, albendazole, and nitazoxanide
• Roundworm infections are treated with mebendazole, albendazole, and ivermectin⁷

Summary

Traveling to high-risk areas can expose individuals to parasitic infections, which may be contracted through contaminated water, food, or insect bites. Therefore, before planning any traveling to regions with high risk of infections, it’s crucial to consult a healthcare provider for personalised advice, vaccinations, or prophylactic medications. Moreover, during travel, it is crucial to take measures like following safe hygiene practices, consuming only uncontaminated food and water, and applying insect repellent. Additionally, after returning from traveling, it is important to keep an eye out for symptoms. If you have any symptoms, getting medical help can help with early diagnosis and treatment depending on the kind of infection.