Haitian Child

Haitian Child

Sunday, November 17, 2013

Bacterial Gastroenteritis in Nicaragua

Bacterial Gastroenteritis in Nicaragua

Montezuma's Revenge, typically caused by Entertoxigenic E coli (ETEC), is well known to travellers to Central America. The bacteria is a home grown problem too. In a 1997 study of infants in Leon, Nicaragua, ETEC were the cause of 38% of diarrhea episodes. 

Enterotoxigenic E coli, courtesy of Stanford Medicine.

There are many other bacteria that cause bloody diarrhea and abdominal cramps. The table below lists the more common causes.

Possible Source
meats, seafood
dairy, meats, poultry 
2 to 4
Cholera (Vibrio)
0 to 1
Tetracycline, Sulfa/Trimeth
E coli

1 to 3
Sulfa/Trimeth Quinolone
Enterhemorrhagic E coli
1 to 8
20 hrs
Ampicillin Sulfa/Trimeth
dairy, eggs, meats
0 to 3
Ampicillin Sulfa/Trimeth Quinolone

0 to 2
Ampicillin Sulfa/Trimeth Quinolone
Staph aureus
dairy, meats
2 to 6 hrs

0 to 6
Sulfa/Trimeth Quinolone

The "Possible Source" column clarifies why I avoid dairy (milk, cheese, yogurt, ice cream) and why I am very fussy about meat when I travel.

These bacteria include some of the classic tropical diseases such as Cholera and Typhoid (Salmonella). Shigella is one of the famous causes of dysentery in the tropics. Enterhemorrhagic E coli is the cause of Hemolytic Uremic Syndrome (Hamburger Disease), which was a huge part of my clinical life several decades ago when I was the Head of Paediatric Nephrology at the University of Calgary.

Most bacterial infections have a incubation period that lasts a few days. The exception is food poisoning with Staph aureus, which only requires a few hours of incubation. I experienced Staph aureus food poisoning in 1978 when I was competing in a 505 (international class two-man sailboat) qualifying event in Rhode Island. The local club prepared ham, cheese, and mayonnaise sandwiches for lunch and the fleet was on the water for about 6 hours. Within a few hours of eating I was nauseous and started to vomit. That day I crewed for one of Canada's Olympic Team. He didn't eat the sandwiches and he didn't get sick. My performance suffered, and he was not patient with me. On one tack I came in off the trapeze and kicked a new and very expensive watch off his wrist. A full gale blew in and we reduced sail and limped home. We finished twelfth in a fleet of about 80 boats. Four boats were lost in the gale. When we arrived back at the club, half the sailors were retching on the beach or on their way to the local hospital. I realized that we all had Staph aureus food poisoning, which is a self limited illness, so I rested on the beach, drank lots of fluids, and the episode passed as an interesting memory.

My personal preparations for the winter trips to Nicaragua will include booster immunizations for Typhoid and Cholera. While in Nicaragua, I will avoid dairy and only eat meat that I either cook or that is prepared by someone I trust.

To help treat bacterial gastroenteritis in Nicaragua, I will bring all of the medications in the list above, except Tetracycline, which is contraindicated in children.

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