Details Of Gastroenteritis Problems In Tourists
YES, CDC IS USA BUT THEY "LOAN" SPECIALISTS IF THEIR EXPENSES ARE PAID BY THE HOST. WHAT I AM IMPLYING IS THAT AN EPIDIMIOLOGIST NEEDS TO EVALUATE THE SITUATION. TOO MANY PEOPLE SICK TO BE JUST A CHANCE HAPPENING. JUST LIKE ON THE CRUISE SHIPS.
ALL OF WHAT WAS SAID IS MOST INTERESTING IN THE PREVIOUS REPLY.
I DECIDED TO CHECK EVEN DEEPER AND CAME UP WITH THIS LONG AND SOMEWHAT BORING ARTICLE ON GASTRO/INTESTINAL PROBLEMS AND THOUGHT MAYBE A FEW READERS MIGHT GAIN SOME INSIGHT AS TO THE PROBLEMS AND THEIR CAUSES AND TREATMENTS. CONTRARY TO WHAT THE RESORT PEOPLE SAY...IT IS NOT DUE TO YOUR BEING EXPOSED TO EXCESSIVE SUN AND/OR EXERCISE, ETC. IT IS DUE TO WHAT GOES IN YOUR MOUTH! VACATION TIME IS NOT TO GET SICK! I APOLOGIZE TO THOSE THAT ARE NOT INTERESTED. JUST HIT THE DELETE BUTTON.
Gastroenteritis
: Inflammation of the lining of the stomach and intestines, predominantly manifested by upper GI tract symptoms (anorexia, nausea, vomiting), diarrhea, and abdominal discomfort.
The electrolyte and fluid loss associated with gastroenteritis may be little more than an inconvenience to an otherwise healthy adult but may be of grave significance to a person less able to withstand this loss (eg, the elderly, very young, or debilitated or those with certain concomitant illnesses).
Etiology and Epidemiology
Gastroenteritis may be of nonspecific, uncertain, or unknown etiology or of bacterial, viral, parasitic, or toxic etiology. When a specific cause can be identified, the specific syndrome name can be used, thus avoiding the less specific term "gastroenteritis."
Campylobacter infection is the most common bacterial cause of diarrheal illness in the USA. Person-to-person transmission is especially common with gastroenteritis caused by Shigella, Escherichia coli, Giardia, Norwalk virus, and rotavirus. Salmonella infection may be acquired through contact with reptiles (eg, iguanas, turtles).
Epidemics of viral diarrhea in infants, children, and adults are usually spread via contaminated water or food or via the fecal-oral route.
Certain intestinal parasites, notably Giardia lamblia adhere to or invade the intestinal mucosa and cause nausea, vomiting, diarrhea, and general malaise. Giardiasis is endemic in many cold climates (eg, Rocky Mountain states, northern USA, Europe). The disease can become chronic and can cause a malabsorption syndrome. It is usually acquired via person-to-person transmission (eg, in day care centers) or from drinking contaminated water. Another intestinal parasite, Cryptosporidium parvum, causes watery diarrhea that is sometimes accompanied by abdominal cramps, nausea, and vomiting. In healthy persons the illness is usually mild and self-limited, but in immunocompromised patients the infection may be severe, causing substantial electrolyte and fluid loss. Cryptosporidium is probably most commonly acquired by drinking contaminated water.
Intestinal flu or grippe and some types of traveler's diarrhea may be caused by bacterial enterotoxins or viral infections.
Pathophysiology
Certain bacterial species elaborate enterotoxins, which impair intestinal absorption and can provoke secretion of electrolytes and water. In some instances, a chemically pure toxin has been characterized (eg, the enterotoxin of Vibrio cholerae); pure toxin alone produces the voluminous watery secretion from the small intestine seen clinically, thereby demonstrating an adequate pathogenic mechanism for diarrhea. Enterotoxins are probably the mechanism of other diarrheal syndromes (eg, E. coli enterotoxin may cause some outbreaks of "nursery diarrhea" and traveler's diarrhea).
Some Shigella, Salmonella, and E. coli species penetrate the mucosa of the small intestine or colon and produce microscopic ulceration, bleeding, exudation of protein-rich fluid, and secretion of electrolytes and water. The invasive process and its results may occur whether or not the organism elaborates an enterotoxin.
Gastroenteritis may follow ingestion of chemical toxins contained in plants, seafood (fish, clams, mussels), or contaminated food.
Symptoms and Signs
The character and severity of symptoms depend on the nature of the causative agent, the duration of its action, the patient's resistance, and the extent of GI involvement. Onset is often sudden and sometimes dramatic, with anorexia, nausea, vomiting, borborygmi, abdominal cramps, and diarrhea (with or without blood and mucus). Associated malaise, muscular aches, and prostration may occur.
If vomiting causes excessive fluid loss, metabolic alkalosis with hypochloremia occurs; if diarrhea is more prominent, acidosis is more likely. Excessive vomiting or diarrhea may cause hypokalemia. Hyponatremia may develop, particularly if hypotonic fluids are used in replacement therapy. Severe dehydration and acid-base imbalance can produce headache and muscular and nervous irritability. Persistent vomiting and diarrhea may result in severe dehydration and shock, with vascular collapse and oliguric renal failure.
The abdomen may be distended and tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be visible and palpable. Borborygmi are audible with the stethoscope, even without diarrhea (an important differential feature from paralytic ileus). Signs of extracellular fluid depletion may be present (eg, hypotension, tachycardia).
Staphylococcal Food Poisoning
An acute syndrome of vomiting and diarrhea caused by eating food contaminated by staphylococcal enterotoxin.
Etiology and Pathophysiology
Symptoms of staphylococcal food poisoning are caused by staphylococcal enterotoxin, not by staphylococcus itself. It is a common cause of food poisoning, and the potential for outbreaks is high when food handlers with skin infections contaminate foods left at room temperature. Custards, cream-filled pastry, milk, processed meat, and fish provide media where coagulase-positive staphylococci grow and produce enterotoxin.
Symptoms and Signs
Onset is usually abrupt. Symptoms--characteristically severe nausea and vomiting--begin 2 to 8 h after eating food containing the toxin. Other symptoms may include abdominal cramps, diarrhea, and occasionally, headache and fever. Because the toxin does not cause mucosal ulceration, the diarrhea is usually nonbloody. Acid-base imbalance, prostration, and shock may ensue in severe cases. The attack is brief, often lasting < 12 h, and recovery is usually complete. Rare deaths occur as a result of fluid and metabolic stresses, especially among very young or old or chronically ill patients.
Escherichia Coli Infection
A syndrome typically characterized by acute bloody diarrhea, which may lead to the hemolytic-uremic syndrome.
Etiology and Pathophysiology
E. coli and similar strains of E. coli (termed enterohemorrhagic E. coli) produce high levels of toxins that are indistinguishable from the potent cytotoxin produced by Shigella dysenteriae type 1. These Shiga toxins are produced in the large intestine after ingestion of enterohemorrhagic E. coli. They appear to cause direct mucosal damage, have a toxic effect on endothelial cells in the gut wall blood vessels, and, if absorbed, exert toxic effects on other vascular endothelia (eg, of the kidney).
Epidemiology
Although over 100 serotypes of E. coli produce Shiga toxin, E. coli serotype O157:H7 is the most common in North America. In some parts of the USA and Canada, E. coli O157:H7 infection may be a more common cause of bloody diarrhea than shigellosis or salmonellosis. It can occur in persons of all ages, although severe infection is most common in children and the elderly. E. coli O157:H7 has a bovine reservoir; both outbreaks and sporadic cases of hemorrhagic colitis occur after ingestion of undercooked beef (especially ground beef) or unpasteurized milk. Food or water contaminated with cow manure or raw ground beef can also transmit infection. The organism can also be transmitted among persons (especially among infants in diapers) by the fecal-oral route.
Symptoms, Signs, and Complications
E. coli infection typically begins acutely with severe abdominal cramps and watery diarrhea that may become grossly bloody within 24 h. Some patients report diarrhea as being "all blood and no stool," which has given rise to the term hemorrhagic colitis. Fever, usually absent or low grade, may occasionally reach 39° C (102.2° F). The diarrheal illness may last 1 to 8 days in uncomplicated infections. Sigmoidoscopy may reveal erythema and edema, and barium enema typically shows evidence of edema with thumbprinting.
Prophylaxis and Treatment
Proper disposal of the feces of infected persons, good hygiene, and careful hand washing with soap help limit spread of infection.
Traveler's Diarrhea
(Turista)
Gastroenteritis in travelers usually caused by bacteria endemic to local water.
Etiology, Epidemiology, and Pathophysiology
Traveler's diarrhea may be caused by any of several bacteria, viruses, or parasites. However, enterotoxigenic E. coli is the most common cause. E. coli organisms are commonly present in the water supplies of areas that lack adequate water purification. Infection is common in persons traveling to some areas of Mexico and Latin America, the Middle East, Asia, and Africa. Travelers often avoid drinking local water but become infected by brushing their teeth with an improperly rinsed toothbrush, drinking bottled drinks with ice made from local water, or eating food prepared with local water.
Symptoms, Signs, and Diagnosis
Nausea, vomiting, borborygmi, abdominal cramps, and diarrhea begin 12 to 72 h after ingesting contaminated food or water. Severity is variable. Some people develop fever and myalgias. Most cases are mild and self-limited, although dehydration can occur, especially in warm climates.
Prevention and Treatment
Travelers should dine at restaurants with a reputation for safety and avoid foods and beverages from street vendors. They should consume only cooked foods that are still hot, fruit that can be peeled, and carbonated beverages without ice; uncooked vegetables should be avoided.
Bismuth subsalicylate suspensions must be taken in large doses (60 mL qid) to be protective. The role of prophylactic antibiotics is controversial. They should probably be reserved for patients particularly susceptible to the consequences of traveler's diarrhea (eg, immunocompromised patients).
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Reasons 2 and 3 why AI's are a waste of time. And some advice
