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Infectious Diseases
Dengue Fever
There is no preventative drug available for this mosquito-spread disease which can be fatal in children. A sudden onset of fever, headaches and severe joint and muscle pains are the first signs before a rash develops. Recovery may be prolonged.
Simple things like a change of water, food or climate can all cause a mild bout of diarrhoea, but a few rushed toilet trips with no other symptoms is not indicative of a major problem.
Dehydration is the main danger with any diarrhoea, particularly in children or the elderly as dehydration can occur quite quickly. Under all circumstances fluid replacement (at least equal to the volume being lost) is the most important thing to remember. Weak black tea with a little sugar, soda water, or soft drinks allowed to go flat and diluted 50% with clean water are all good. With severe diarrhoea a rehydrating solution is preferable to replace minerals and salts lost. Commercially available oral rehydration salts (ORS) are very useful; add them to boiled or bottled water. In an emergency you can make up a solution of six teaspoons of sugar and a half teaspoon of salt to a litre of boiled or bottled water. You need to drink at least the same volume of fluid that you are losing in bowel movements and vomiting. Urine is the best guide to the adequacy of replacement - if you have small amounts of concentrated urine, you need to drink more. Keep drinking small amounts often. Stick to a bland diet as you recover.
Lomotil or Imodium can be used to bring relief from the symptoms, although they do not actually cure the problem. Only use these drugs if you do not have access to toilets eg if you must travel. For children under 12 years Lomotil and Imodium are not recommended. Do not use these drugs if the person has a high fever or is severely dehydrated.
In certain situations antibiotics may be required: diarrhoea with blood or mucous (dysentery), any fever, watery diarrhoea with fever and lethargy, persistent diarrhoea not improving after 48 hours and severe diarrhoea. In these situations gut-paralysing drugs like Imodium or Lomotil should be avoided.
A stool test is necessary to diagnose which kind of dysentery you have, so you should seek medical help urgently. Where this is not possible the recommended drugs for dysentery are norfloxacin 400 mg twice daily for three days or ciprofloxacin 500 mg twice daily for five days. These are not recommended for children or pregnant women. The drug of choice for children would be co-trimoxazole (Bactrim, Septrin, Resprim) with dosage dependent on weight. A five-day course is given. Ampicillin or amoxycillin may be given in pregnancy, but medical care is necessary.
Amoebic dysentery
Amoebic dysentery is more gradual in the onset of symptoms, with cramping abdominal pain and vomiting less likely; fever may not be present. It will persist until treated and can recur and cause other health problems. Treatment is the same as for giardia.
Diphtheria can be a skin infection or a more dangerous throat infection. It is spread by contaminated dust contacting the skin or by the inhalation of infected cough or sneeze droplets. Frequent washing and keeping the skin dry will help prevent skin infection. A vaccination is available to prevent the throat infection.
Giardiasis is another type of diarrhoea. The parasite causing this intestinal disorder is present in contaminated water. The symptoms are stomach cramps, nausea, a bloated stomach, watery, foul-smelling diarrhoea and frequent gas. Giardiasis can appear several weeks after you have been exposed to the parasite. The symptoms may disappear for a few days and then return; this can go on for several weeks. Tinidazole, known as Fasigyn, or metronidazole (Flagyl) are the recommended drugs. Treatment is a 2 gm single dose of Fasigyn or 250 mg of Flagyl three times daily for five to 10 days.
Hepatitis is a general term for inflammation of the liver. It is a common disease worldwide. The symptoms are fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and the whites of the eyes may turn yellow.
Hepatitis A is transmitted by contaminated food and drinking water. The disease poses a real threat to the western traveller. You should seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. People who have had hepatitis should avoid alcohol for some time after the illness, as the liver needs time to recover.
Hepatitis E is transmitted in the same way, it can be very serious in pregnant women.
There are almost 300 million chronic carriers of Hepatitis B in the world. It is spread through contact with infected blood, blood products or body fluids, for example through sexual contact, unsterilised needles and blood transfusions, or contact with blood via small breaks in the skin. Other risk situations include having a shave, tattoo, or having your body pierced with contaminated equipment. The symptoms of type B may be more severe and may lead to long term problems.
Hepatitis D is spread in the same way, but the risk is mainly in shared needles.
Hepatitis C can lead to chronic liver disease. The virus is spread by contact with blood usually via contaminated transfusions or shared needles. Avoiding these is the only means of prevention.
HIV, the Human Immunodeficiency Virus, develops into AIDS, Acquired Immune Deficiency Syndrome, which is a fatal disease. HIV is a major problem in many countries. Any exposure to blood, blood products or body fluids may put the individual at risk. The disease is often transmitted through sexual contact or dirty needles - vaccinations, acupuncture, tattooing and body piercing can be potentially as dangerous as intravenous drug use. HIV/AIDS can also be spread through infected blood transfusions; some developing countries cannot afford to screen blood used for transfusions.
If you do need an injection, ask to see the syringe unwrapped in front of you, or take a needle and syringe pack with you.
Fear of HIV infection should never preclude treatment for serious medical conditions.
Intestinal Worms
These parasites are most common in rural, tropical areas. The different worms have different ways of infecting people. Some may be ingested on food including undercooked meat and some enter through your skin. Infestations may not show up for some time, and although they are generally not serious, if left untreated some can cause severe health problems later. Considering having a stool test when you return home to check for these and determine the appropriate treatment.
Japanese B Encephalitis
This viral infection of the brain is transmitted by mosquitoes. Most cases occur in rural areas as the virus exists in pigs and wading birds. Symptoms include fever, headache and alteration in consciousness. Hospitalisation is needed for correct diagnosis and treatment. There is a high mortality rate among those who have symptoms; of those that survive many are intellectually disabled.
This serious and potentially fatal disease is spread by mosquito bites. If you are travelling in endemic areas it is extremely important to avoid mosquito bites and to take tablets to prevent this disease. Symptoms range from fever, chills and sweating, headache, diarrhoea and abdominal pains to a vague feeling of ill-health. Seek medical help immediately if malaria is suspected. Without treatment malaria can rapidly become more serious and can be fatal.
If medical care is not available, malaria tablets can be used for treatment. You need to use a malaria tablet which is different to the one you were taking when you contracted malaria. The treatment dosages are mefloquine (two 250mg tablets and a further two six hours later), fansidar (single dose of three tablets). If you were previously taking mefloquine then other alternatives are halofantrine (three doses of two 250mg tablets every six hours) or quinine sulphate (600mg every six hours). There is a greater risk of side effects with these dosages than in normal use.
Travellers are advised to prevent mosquito bites at all times. The main messages are:
  • Wear light coloured clothing
  • Wear long pants and long sleeved shirts
  • Use mosquito repellents containing the compound DEET on exposed areas (prolonged overuse of DEET may be harmful, especially to children, but its use is considered preferable to being bitten by disease-transmitting mosquitoes)
  • Avoid highly scented perfumes or aftershave
  • Use a mosquito net impregnated with mosquito repellent (permethrin) - it may be worth taking your own
  • Impregnating clothes with permethrin effectively deters mosquitoes and other insects
Meningococcal Meningitis
This very serious disease attacks the brain and can be fatal. There are recurring epidemics are Sub-Saharan Africa, Mongolia, Vietnam, the Amazon area in Brazil, northern India and Nepal.
A fever, severe headache, sensitivity to light and neck stiffness which prevents forward bending of the head are the first symptoms. There may also be purple patches on the skin. Death can occur within a few hours, so urgent medical treatment is required.
Trekkers to rural areas of Nepal should be particularly careful, as the disease is spread by close contact with people who carry it in their throats and noses, spread it through coughs and sneezes and may not be aware that they are carriers. Lodges in the hills where travellers spend the night are prime spots for the spread of infection.
Treatment is large doses of penicillin given intravenously, or chloramphenicol injections.
Schistosomiasis (Bilharzia)
Also known as bilharzia, this disease is carried in water by minute worms. They infect certain varieties of freshwater snails found in rivers, streams, lakes and particularly behind dams. The worms multiply and are eventually discharged into the water.
The worm enters humans through the skin, attaches itself to your intestines or bladder. The first symptom may be a tingling sensation and a light rash around the area where it entered. Weeks later a high fever may develop. A general feeling of being unwell may be the first symptom, or they may be no symptoms. Once the disease is established, abdominal pain and blood in the urine are other signs. The infection often causes no symptoms until the disease is well established (several months to years after exposure) and damage to internal organs irreversible.
Avoiding swimming or bathing in fresh water where bilharzia is present is the main method of preventing the disease. Even deep water can be infected. If you do get wet, dry off quickly and dry your clothes as well.
A blood test is the most reliable test, but the test will not show positive in results until a number of weeks after exposure.
Sexually Transmitted Diseases
Gonorrhoea, herpes and syphilis are among these diseases; sores, blisters or rashes around the genitals, discharges or pain when urinating are common symptoms. In some STDs, such as wart virus or chlamydia, symptoms may be less marked or not observed at all especially in women. Syphilis symptoms eventually disappear completely but the disease continues and can cause severe problems in later years. While abstinence from sexual contact is the only 100% effective prevention, using condoms is also effective. The treatment of gonorrhoea and syphilis is with antibiotics. The different sexually transmitted diseases each require specific antibiotics. There is no cure for herpes or AIDS.
Typhoid fever is a dangerous gut infection caused by contaminated water and food. Medical help must be sought.
In its early stages sufferers may feel they have a bad cold or flu on the way, as early symptoms are a headache, body aches and a fever which rises a little each day until it is around 40\*C (104\*F)or more. The victim's pulse is often slow relative to the degree of fever present - unlike a normal fever where the pulse increases. There may also be vomiting, abdominal pain, diarrhoea or constipation.
In the second week the high fever and slow pulse continue and a few pink spots may appear on the body; trembling, delirium, weakness, weight loss and dehydration may occur. Complications such as pneumonia, perforated bowel or meningitis may occur.
The fever should be treated by keeping the victim cool and giving them fluids as dehydration should also be watched for. Ciprofloxacin 750 mg twice a day for 10 days is good for adults.
Chloramphenicol is recommended in many countries. The adult dosage is two 250-mg capsules, four times a day. Children aged between eight and 12 years should have half the adult dose; and younger children one-third the adult dose. Chagas' Disease In remote rural areas of South and Central America this parasitic disease is transmitted by a bug which hides in crevices in the walls and thatched roofs of mud huts and on palm fronds. It bites at night and a hard, violet-coloured swelling appears in about a week. Chagas' disease can be treated in its early stages, but when untreated infection can led to death some years later.
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