THE 5TH ESTATE
By Robert S. Finnegan
07/18/2011
The simple facts are that visitors, no matter where from (with the exception of some Southeast Asians) will have their immune systems stretched to the limit here and will initially wind up flat on their backs. How long you stay down is determined by what precautions you take and what medicines you have on hand when the creeping crud strikes.
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Amoebic dysentery |
A fellow investigator from America came to visit recently, and initially scoffed at our warnings to be ready to get hit with intestinal problems and to let us know at the first signs. When it finally got him three days later, he attempted to tough it out, which the worst possible thing you can do.
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Lean forward.. far forward
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In the event you acquire an audience outside gleefully awaiting your exit, don't get angry. It provides them with hours of rapt storytelling to families and friends and is all in good nature. Most are simply curious, although the odds for getting a laugh are in their favor.
Unless you manage to escape this Western man-eating loo completely unscathed, a thorough shower and change of clothes is recommended following your ordeal. It could very well save you a trip to the hospital, or worse.
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Begin antibiotic treatment immediately |
Patients with compromised renal or liver function use half doses and discontinue if urine output slows dramatically, becomes tea or coffee-like in color or you experience pain in the right side where the liver is located. Drink plenty of water, even if you have to force it down.
HPV Virus "Mata Ikan" Extreme Danger For Diabetics
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Jakarta garbage kitties |
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Macaque monkey
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Macaque bites - chances of getting a disease are very high |
If your insulin is misplaced or stolen overseas, make sure you have a lot of test strips for your glucose meter, and if you are ambulatory, walk it off. If this is not possible, check yourself into the nearest hospital immediately. They will know what to do. DO NOT TAKE ANY CHANCES. It's going to be rough enough as it is being immune compromised.
This rant will focus on agents of disease – the things that make you sick. The term for something that causes an infectious disease is pathogen. These are usually living, such as bacteria, but can be non-living, such as prions. I’m not going to get into the ‘are viruses living or non-living debate’ here. I believe they are living but that is for another day and another blog. I’m going to divide pathogens up in this blog into micro-organisms, including bacteria, protists and fungi, macro-organisms, such as arthropods, annelids and nematodes, and non-cellular agents that will include viruses, viroids and prions.
Micro-Organisms/Bacteria
Bacteria are an amazing group of organisms. The majority of life on this planet is bacterial. It was here before all other life and I believe it will be the last form of life to finally die off on this planet, many billions of years into the future. Bacteria inhabit just about every conceivable niche this planet provides, from kilometres under the surface within rock, to near-boiling hotsprings, in hyper-saline solutions and environments without oxygen, from the Antarctic to inside your gut. Yes, your gut. We are just another habitat for some bacteria, and most of the time we get along in a happy symbiosis. Bacteria is so good at surviving that some astrobiologists have suggested that life on Earth originated from Martian bacteria getting to Earth in a meteor ejected by some Martian supervolcano.
While there is no evidence for this - there is no evidence that life once occurred on Mars in the first place - it’s still a cool little theory. The trouble with talking about bacteria as a group is that they’re not a homogenous group. There is more diversity in what we call bacteria than is all other forms of life. In general terms they are divided by shape: spherical cocci, rod-like bacillus, and spiral-shaped spirochaetes. But this is like saying a tall people are in one group, fat people in another and a third group made up by short red-heads. These gross morphological similarities do not necessarily mean they are related. Another way they are categorised is in the composition of the cell wall and how these respond to different types of dyes and stains. Those that can be stained are called Gram Positive, those that can’t Gram Negative.
The final way bacteria can be grouped is by gaseous requirements: those that require oxygen (aerobic), those that thrive in the absence of oxygen (anaerobic) and those that don’t really care either way (facultative). It is a huge group that is all clumped together. The one thing that separates them from everything else is they are all prokaryotic. Despite our near pathological fear of bacteria, most bacteria leaves us alone or is beneficial and there are relatively few bacteria that make us ill. I mean there is so much of this stuff everywhere, it’s all over our bodies, the pillows we place our heads on, the utensils we eat with, if bacteria was ‘bad’ we would be in deep, deep trouble. As a rule, bacteria becomes a problem from a human point of view when in colonises a new habitat where it normally does not occur.
An example of this may be bacteria entering a cut and forming a colony within the wound, or bacteria that is normally found in the lower intestine getting into the gut, usually by drinking water contaminated by faecal matter. Or not cooking food properly. There is a bacterium called Campylobacter sp that normal occurs in the intestines of chickens and causes them no problems at all. In fact, it is beneficial for chickens. The problem for us occurs in the processing of chooks for meat. Sometimes the meat becomes contaminated and, if you don’t cook your food properly, this bacterium is introduced into your gut. Where it will make you very sick. So how do these microscopic organisms actually make us sick? One of the key factors is the virulence of the pathogen and how quickly they reproduce. In lay terms virulence refers to how good bacteria is at spreading and making you sick.
The more virulent a pathogen is the better it is at making you sick. You need to remember here that bacteria aren’t trying to make you sick, that is not their purpose. They aren’t aware of you as anything other than habitat. Some bacteria make you sick by actively invading and destroying cells. Salmonella typhimurium will do this. We get Salmonella sp from contaminated food, and refer to its effects as food poisoning. It survives the acid of our gut and enters our colon where it destroys the epithelial cells of the intestine causing diarrhoea and vomiting. Another way that bacteria can make us sick is via their waste products. Like all life, bacteria eat and produce wastes.
Some of the wastes from some bacteria are toxins and these make us sick and trigger responses in our bodies such as fever. As the bacteria colony grows and multiplies, the amount of toxin produced increases exponentially causing the host to become sick.
Protozoans - Amoebas And Their Friends
In general terms, protozoans such as amoeba make us sick in a similar way to the bacteria previously mentioned. This Kingdom, again extremely diverse, is comprised mainly of single celled eukaryotes. The two examples I will give of disease caused by these protozoans is amoebic dysentery and ciguatera poisoning. Amoebic dysentery is caused by the amoeba Entamoeba histolytica. Humans are the host of this amoeba and it is spread by drinking water or eating food contaminated by the cysts of this protozoan.
It is much more common in developing nations. It is nasty, I’ve had it. Many years ago when travelling through Nepal I made the mistake of drinking from a mountain stream high in the Himalaya. The problem was this stream was contaminated by this amoeba. Nepal is a developing country and no matter where you go you will find people up to, and beyond, the snow line. There were no roads where I was, I had walked for days to get there. Needless to say there were no flushing toilets either. Human waste is transported by rain or snow melt into the streams and carry the amoeba cysts with it. And that’s how the cysts got into me. I was luckily back in Kathmandu when the cysts hatched and the amoeba multiplied. It affected me in a similar way to the Salmonella (sp) mentioned before, eating away at the cells lining my intestine and has the same impact on your body. I lost many kilograms over several days before I was able to crawl into a rickshaw and get to a doctor. Holidays...
To go off on a wee tangent, my favourite species name of all time belongs to an amoebia. It is called Chaos chaos.
These toxins are bioaccumulative and are magnified as they are passed up the food chain; small fish is eaten by big fish which is eaten by bigger fish until you catch yourself a large snapper or coral trout for dinner. You then ingest the toxins – which are heat resistant and not destroyed by cooking and you become sick yourself.
Apicomplexans are another protozoan that causes the disease malaria. I’ll discuss this later when I talk about vectors. Maybe, time and space dependent.
I’ve spent too long talking about stuff I wasn’t going to mention so I will keep the last of the micropathogens, fungi, to a short paragraph. Ringworm, athlete’s foot and thrush are fungal infections they colonise the external surface and digest your dead skin cells. External environment? Thrush? Thrush often occurs in the vagina and the mouth. Technically these are external environments. Vagina, etymologically speaking, means a fold and that’s what a vagina is. It is an envagination of the skins surface.
I’ve just looked at the word count and hit 1,500 so I’m going to skip over macro-organisms briefly. I’ll write another short blog about multiple-host life cycles of things like tapeworms tomorrow. Pathogenic macro-organisms are things like pubic lice, ticks, tapeworms... they are varied as are the effects and the impacts. They can be internal or external parasites. I’ll leave the details to your teacher. An interesting note though is that while rates of sexually transmitted bacterial infections such as Chlamydia are rising rapidly in the community, rate of pubic lice infections have decreased. The reason suggested? The popularity of Brazilians.
Non-Cellular Pathogens
Finally: non-cellular agents of disease. Viruses, viroids and prions. These pathogens are all non-cellular and technically non-living – remember that cells are the smallest independently functioning unit of life. I’m not going to argue that viruses are living here.
Viruses are comprised of nucleic acid (DNA or RNA) surrounded by a protein coat. Some of these are further covered in a modified membrane. Smallpox, herpes and warts are examples of DNA viruses, hepatitis, influenza and HIV are examples of RNA viruses. Usually DNA viruses are double stranded but can be single and RNA viruses are single stranded but can be double. Viruses are obligate intracellular parasites. This means they must infect a host cell to reproduce. As they lack ribosomes and other organelles they hijack these in the host cell and force the cell to make viruses. How they do this is pretty cool.
They insert their genetic information into the host cell and this interrupts the cells normal functioning. Two things can happen: the genetic information is spliced into the host’s cells genome where it lurks until later OR it forces the cell to make many, many virus particles until the cell eventually undergoes lysis (bursts) spreading these to infect new cells. I’ll use herpes as an example. The common cold sore is caused by the herpes virus. For example, if you kiss someone with a cold sore the virus passes to you where it inserts its information into your lip’s cell’s genome where it lurks. As your lip cells under mitosis and divide, the virus is also copied. This is called a lysogenic cycle. Then as a result of some trigger, your infected cells start producing virus particles, swell and burst. This is the lytic cycle and results in cold sores.
Viruses mutate and evolve regularly and rapidly, changing the markers on the outside of them to confuse your immune system. This is why it is hard to build immunity to some viruses such as influenza. Remember a few years ago we were worried about bird flu and SARS? Viruses can and do mutate and jump species. Fantastic evidence for evolution. It IS evolution.
Viroids are small virus-like pathogens that infect plants. That’s all I’m saying about them.
Prions
And to end this we have prions. Prions are abnormal proteins that change, denature, normal proteins by changing their shape. Eventually this leads to cell lysis which spreads the prions to infect other cells. Prions are usually found in neurons. The most well known prion disease is spongiform encephalitis. This disease causes huge holes in your brain Creutzfeldt-Jakob disease.
And this from Sick on the Road:
How to Prevent and Treat Amoebic Dysentery
I took ciprofloxacin, thinking it was likely a bacterial issue. 1000mg of cipro will typically decimate enough of the bacteria to normalize your stools. But the cipro did nothing. At the time, I was in Timbuktu (literally), one of the worst places on earth to come down with an intestinal issue of this magnitude. After three days of dry heaving, pooping blood, and not eating, I took a miserable 12 hour overland journey to get to Sevare, a village in the middle of Mali.
In Sevare, I went to a clinic. I was asked to give a stool sample. This involved crapping pure fluid (with some blood mixed in for good measure) into a plastic shot glass. I also had to have my blood drawn. After a few hours I had my result: amoebic dysentery.
You may remember amoebas from science class. They are nature’s single celled organisms, weirdly shaped, cute under a microscope. Inside your intestines, they are a nightmare. They destroy the intestinal wall, resulting in bloody stools. In some cases, they enter the bloodstream and travel to other organs in the body.
Treatment
For treatment, I was prescribed Metronidazole, which I took for ten days. Metronidazole destroys amoebas in the intestinal tissue. I was then instructed to take Paromomycin, which will destroy amoebas that may have invaded the bloodstream and other parts of the body.
I had never taken either of these drugs, but they were both effective. I was very grateful when the symptoms dissipated and I could sit on the toilet without fear. I had lost a lot of weight, and it took me a couple of weeks to get my strength back.
Prevention
I am pretty certain I know exactly where I got amoebic dysentery. I drank lukewarm tea that was made with water from the Niger River. I knew the water had not been boiled, but I drank it because I did not want to offend my hosts. Never again.
You can get amoebic dysentery from contaminated food and water. Like many other forms of diarrhea and dysentery, you come down with the disease after consuming someone else’s fecal matter. Nice thought, right? Here are a few standard precautions to take to avoid getting amoebic dysentery as well as any bacteria-caused diarrhoea:
Wash hands with hot soap and water, especially before eating;
Eat fruits and vegetables that are washed thoroughly, boiled, or peeled;
Eat food that is served hot and preferably, food that you can see being prepared.
In hindsight, I would have politely declined the tea, or asked for the teamaker to heat the water longer.
This is an experience I never want to repeat.
Tropical Crotch Rot
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Dermatophyte, or: Phnom Penn nut rot, Malay mauler,
Jakarta crank killer, Dubai dick destroyer,Bangkok cock
killer, Sumatran scrotum scourge and many, many others
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A particularly insidious form of blistering rot, onset:
mere hours
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It can be passed from one person to the next by direct skin-to-skin contact or contact with unwashed clothing.
Symptoms of these infections can vary depending on where they are manifested on the body. The most common etiologic agents for tinea cruris include Trichophyton rubrum and Epidermophyton floccosum; less commonly Trichophyton mentagrophytes and Trichophyton verrucosum are involved. The source of the fungus is usually dirty clothing, unfiltered water and other humans. It may also spread to the anus, causing anal itching and discomfort.
Common Symptoms
Itching and redness in your groin, including your genitals, inner thighs, buttocks and anal area;
Flaking, peeling or cracking skin in your groin;
Abnormally dark or light skin.
You may have other fungal skin rashes such as athlete's foot or ringworm on other body parts. In chronic infections, the rash becomes less itchy and less red, and the plaques may fuse together. I can guaran-damn-tee this is something you DO NOT WANT, so act immediately when symptoms become apparent.
Treatment of Tropical Crotch Rot
When all else failed, we (Marines) used JP4 aviation fuel. It kills all bacteria, but needs to be applied with a small brush and only to the infected areas. It should be used ONLY AS A LAST RESORT.
Shave all crotch hair.
Devote as much clean or treated water as possible for cleaning the area, and don't limit it to the infected patch(es), hit the whole groin or it will surely spread.
You can purify even some of the dirtiest water for this purpose using the 10oz squirt bottle of chlorine you should be carrying.
If possible let the water settle for an hour, then add 15 drops 100% chlorine per gallon for clear-semi-clear water, 30 drops for brackish. Let this set at least an hour and it should be usable for washing. After washing if at all possible, lay in the sun with the infected areas exposed for at least an hour a day. UV kills the bacteria, as does contact with oxygen.
This fungus among us is treated with one of two types of antifungal medications -- azoles or allylamines. For a mild case of jock itch, your doctor may suggest first using an over-the-counter antifungal ointment, lotion, powder or spray. However, these may just make the problem worse. Monitor your crotch hourly, to see if it is getting worse. If so, discontinue the treatment and move on to the next. You may have to try several different treatments to get the one that works the best for your condition.
Remember, keep the skin clean and dry. Sit spread-eagled in front of a fan if need be.
For at least thirty minutes each day, expose the infected areas to direct sunlight. UV kills most fungi, and has proved to be the most effective treatment for myself.
Try topical over-the-counter antifungal or drying powders, such as those that contain miconazole, clotrimazole, or tolnaftate. But be ready for failure. If the fungus spreads even more then discontinue treatment immediately and go on to the next.
Wash and then dry the area using a clean towel at least three times a day. NEVER get pissed off and use rubbing alcohol, or ground-up ciprofloxacin paste. Believe me, I know from personal experience, I was dancing around like a whirling dervish until I washed it off. Having my wife standing there laughing like hell was also humiliating and embarrassing.
Regular corn starch. This will dry it out immediately, but you have to be careful of cracking.
Tolnaftate (Tinactin, Aftate) and undecylenate (Cruex, Desenex) are well-known, effective medications, however, to some of these fungi it is like an appetizer before the main course.
Difulcan (fluconazole) is a heavy-duty antibiotic, and was what finally killed my terminal case. BE ADVISED: on ALL antibiotics, use a dosage chart off the net if available, as you may have to reduce the dosage to compensate for liver or renal disease. Be smart, always check it out before dosing yourself.
Haloprogin (Halotex) -- is also used for treatment of tinea cruris, but again, if the response is not near immediate, cancel treatment and move on to the next. Don't stick with something that does not work, it will only prolong your agony. Sit around naked and spread-eagled in the sun as much as possible, if possible, it will reduce healing time.