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Friday, October 27, 2017
The Jakarta Grippe; Southeast Asia intestinal parasites; dysentery; HPV viruses diagnosis and treatments
THE 5TH ESTATE
By Robert S. Finnegan
07/18/2011
I always tell visitors to Indonesia to add on at least five days to your stay, as you WILL get sick on arrival, no matter what precautions you take.
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.
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.
This also goes for most of Southeast Asia.
Even returning Native Indonesians, if overseas for a long time and especially in a Western country will also get sick again, each and every time, as my wife did upon returning from America after a five year involuntary exile in the U.S. Your body must have time to acclimatize to the pathogens here.
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| Amoebic dysentery |
It does not matter where you eat, be it a food cart in Tebet or a Five Star hotel on Jalan Sudeirman, you are going to get nailed within 5 days of your arrival. Don't bother trying to use frozen or deep fried food, just accept the fact that you will be sick and prepare for it.
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.
This gives whatever nasty bacteria or other pathogen(s) time to really dig into your intestinal walls and they are a hardy bunch, the product of decades of being doused with every antibiotic known to man and resistant to most at some level... and the longer you wait to begin treatment the longer you are going to be out of the action. Those are the facts, and as always this old Marine had to prove it to himself, and lost big time. So did our guest from America, who after trying to stuff it spent an extra three or four days in agony and exhausted on the toilet (and if you think it's exhausting on a sit-down toilet, just try a squatter - if you are a westerner unused to the nomenclature and functionality of these beauties, you could very well wind up taking a bath in liquid shit.)
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Lean forward.. far forward
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Squat toilets outside of airports and major hotels are an affair every Westerner should experience at least once in a lifetime, it will leave you with indelible fond memories and provide hours of entertaining stories for parties and social functions.
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.
While toilet paper is sometimes provided, washing is your key to good health and a hedge against all flesh-eating bacteria. Take the time to wash off every time, no matter what. The tiniest amount of feces left to fester in the anal-crotch area just may kill your entire visit, or you. Believe me. Always try to pack alcohol swabs or a small bottle of alcohol to rub hands (and perhaps genital areas) off with after your toilet adventures. This is why the wise Indonesians and other Southeast Asian residents wash with water.
Remember: All water in Indonesia must be boiled to become potable, some not even then. Cryptosporidium is rampant, and it is better to drink carbonated water in any circumstances if you can get it.
Equil is used widely here by those that can afford it and it is well worth the price. Take it from one who knows.
Never swallow water in the shower or brush your teeth from the tap in the bathroom. Almost all hotels provide free bottled water for brushing. Make sure your ears are also completely dried out; Q-Tips do the job well. You will find that spending a few extra minutes using these cautionary procedures well worth the time and effort against spending days in a hotel bed or hospital.
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| Begin antibiotic treatment immediately |
Foods to avoid: Uncooked duck. It somehow always manages to be undercooked in all restaurants and is best avoided, however if you insist cut it open at the joints and look for signs of pink. If it is even slightly pink, don't eat it. It has the potential to kill you if you get hit away from a hospital or medical treatment. That goes also for any meat, make absolutely sure it is thoroughly cooked. Never eat rare steak, you will surely pay for it.
O.K., time for treatments. Initially, and in the absence of a hospital lab diagnosis of fecal material, start with the killer of almost all bacteria: The mighty Flagyl (Metronidazole), or Fladex Forte.
Adult dose: at onset of cramps 500mg twice a day for five days, moving to three times if symptoms continue. Use the five-day rule, even if your symptoms clear on the first. If by chance you terminate treatment because you feel great again and there are any residual bacteria left behind, they may come back with a vengeance and be twice as hard to treat and take twice as long as they are now resistant. This goes for all antibiotic regimen. Take this medication with food if possible, it really has the propensity to tear your stomach up.
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.
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.
If Flagyl does not kill it, discontinue and begin treatment with the other big guns: Trimethoprim Sulfamethozazole (Bactrim DS) or Primadex, and Ciprofloxacin (Cipro). Same regimen, dosage (most doses come in 400mg tabs) and begin at the onset of cramps. Don't wait, don't screw around. Get your ass into bed and take your medicine, it may just save your life. If you are traveling alone, have someone at the hotel look in on you every few hours. Most hotels have on-site doctors, and are more than happy to assist you in any way - the last thing they want is a dead tourist in their hotel. Use the staff to assist/monitor you, they will be more than pleased to do so.
HPV Virus "Mata Ikan" Extreme Danger For Diabetics
From Wikipedia:
Fish eye is a skin disease that usually attacks the soles of the feet. The disease is caused by the Human Papillomavirus ( HPV ) virus . These fish eye diseases generally grow on the skin surface of the feet, heels, toes, palms and fingers. The symptoms are characterized by marked by thickening and hardening of the skin.
The cause of fish eye disease is the pressure of shoes that are too narrow, how to walk, or the continuous friction of an object. Clumps of skin that harden in the palm or legs this is sometimes painful.
In diabetics who have experienced foot nerve disorders, usually fish eyes do not feel pain at all. This is very dangerous, because it can escape the attention of the injuries that can result seriously in people with diabetes mellitus.
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| Mata Ikan is especially dangerous in diabetics as neuropathy delays identification at onset, mutates during treatment and replicated overnight contaminating healthy surrounding tissue which if left untreated immediately may very well result in amputation - never ignore symptoms, seek immediate treatment |
If you want to remove the fish eye, non-diabetics can use simple and traditional medicines such as frangipani tree sap, young papaya fruit , or young papaya sap. There is also a use of pumice stone to dilute the thickened skin and use decoction of branches of broken bones.
Also, some cities like Jakarta have a multitude of rats and "garbage kitties" in residence; they are putrid, stinking, pestilent carriers of all kinds of diseases and are wild as hell to boot; never attempt to touch or feed them, ever. They are carriers of rabies and just about every known pathogen known to man. If you can, kill them and ask the garbageman (please give a healthy tip) to dispose of the bodies. NEVER touch them, dead or alive. They are extremely hard to kill though, avoiding poisoned food like a telepaths and almost impossible to hit with anything but a gun, which are outlawed in most countries in this region, including Indonesia.
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| Jakarta garbage kitties |
Better to hire someone who specializes in offing them, and it also provides an income source for the people here. To give you an idea of who rules here in this Darwinistic street hell, the cats will never mess with the rats; the dogs - when they can be found - run from both. The cats don't kill rats, making them even more worthless.
In addition, never, ever touch, feed or otherwise encourage contact with the Macaque monkeys here, in the "monkey shows" or otherwise.
They are aggressive, filthy, pestilent carriers of many blood-borne diseases, including Hepatitis, A, B, C, rabies and many types of herpes and simian HIV. Never look them in the eye - especially the males - they take this as aggression. Get bit by one of these bastards and you could be in real trouble.
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Macaque monkey
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Severe dehydration is always a huge problem with intestinal diseases and can cause hallucinations. Your hotel staff will get you medical assistance if this happens so make damn sure they are aware of the seriousness of your condition.
Again, it may make the difference between living or becoming worm food in a far-off country. The chances of getting your carcass transported back to your country of origin for burial are damn near nil. Your corpse is now contaminated, and no official in their right mind would allow it's removal from the country.
Remember, you are not in the West. Things take time to do here, so make sure you have on hand a brief medical history and next of kin contact information placed where staff can see it on a nearby table. Also list all allergies, medical conditions such as diabetes.
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| Macaque bites - chances of getting a disease are very high |
If you are immune compromised as I am, (Type 1 diabetes), make sure you check ahead for availability of insulin. The fucking TSA in America is now confiscating insulin. If they take yours, terminate travel and contact a lawyer to file a lawsuit against the bastards. You can easily make a case for attempted murder against the traitorous swine. Never leave (as I have) without your insulin. You know what will happen without it.
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.
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.
You will be able to deal easily with most intestinal parasites and infections if you are aware and act immediately upon the onset of symptoms.
Always play it safe, the life you save just may be your own.
I hate feeling sick. I’m one of those whingy blokes that always feels worse than symptoms may suggest. Yes, I’m a firm believer in the man-flu.
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
Disease is a condition an organism has or contracts that causes it to function at a less than optimal level. This disease causes a negative change in an organism’s state of health. Disease can be placed into two broad categories; infectious and non-infectious. An infectious disease is something that can be caught or transmitted, while, by definition a non-infectious disease cannot be transmitted. Non-infectious disease includes things like some cancers and genetic disorders. I will discuss non-infectious genetic disease or disorders during Unit 4. Remember that some cancers can be transmitted and are infectious, such as the Human Papillomavirus (HPV) that can lead to cervical cancer, and this is why it is important for everyone, guys and girls, to have the HPV vaccine. Why guys? What is the point of immunising everyone for this disease except for the carriers?
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.
Fungi
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.
These infections occur when a colonising cell reproduces successfully and produces many thousands of daughter cells. Enough said.
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
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 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
While traveling Northern Mali in the fall of 2010, I came down with a horrific case of amoebic dysentery. When the symptoms began, I assumed I had traveler’s diarrhea, which would last a day or two – uncomfortable and inconvenient, but nothing serious. When I started shitting blood, I realized something more sinister was at work.
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:
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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This disgusting, sex life-killing condition is a relatively common fungal infection that effects the skin of your buttocks, inner thighs, and genitals. Men and women contract the disease worldwide, although it is more prevalent in the humid tropical areas of the world and relegated mostly to men. The creeping crud may often affect only your groin, but it may also spread to include your inner thighs, genitals, and areas around your anus and rectum.
Left untreated it has been known to advance to a necrotic stage and going systemic with Pseudomonas entering the blood stream, and in rare cases causing death.
The fungus thrives in warm, moist areas. As it grows, it sometimes blisters as it spreads out. It sometimes takes on the form of a ring. At the edge of the ring, the skin is lifted up by the irritation and looks red and scaly. Many people with tinea cruris also have athlete's foot and is called tinea pedis, and can lead to debilitating foot disease ("trench foot").
The medical name for all of these types of fungal infections is a tinea infection, and the medical name for jock itch is tinea cruris (pronounced: tih -nee-uh krur -us). Being overweight and possessing multiple folds of skin does not help.
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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.
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These tenacious microscopic organisms usually stay in check
as long as your skin is clean and dry; people taking broad-
spectrum antibiotics (unfortunately sometimes unavoidable),
with weakened immune systems, or who have diabetes are
more at risk to develop the rash
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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.
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