Montezuma's Revenge & Amoxicillin

[The Iceni]

Hi folks,

Travellers diarrhoea, food poisoning, enteric fever or dysentery?

Can I put another perspective on this subject? I admit I have not read the reference articles but I take a somewhat different approach to that expressed here.

When on holidy in the third world few have access to a doctor and must rely on remedies such as loperamide bought OTC. These do very little to cure the infection and only mask the symptoms.

As DocVikingo states, TD is caused by a multitude of organisms, viruses, bacteria and protozoans. TD could also include dysentery which was a major cause of death in the Japanese POW camps of WWII due to dehydration.

One on my patients recently suffered a mild case of botulism food poisoning- reversible paralysis. (This is NOT helped by antibiotics, by the way).

Some of these organisms cause long term side effects, including a nasty inflammatory arthritis.

I therefore feel it is entirely appropriate to give "backpackers" a course of a quinolone antibiotic to use only if they need it. These are effective against salmonella, shigella and campylobacter, the organsisms commonly responsible for the most severe cases of TD.

As this is not prohylaxis but treatment I do not think it is irresponsible prescribing. Indeed I have saved many a holiday!

 

[DocVikingo]

.... these are broad spectrum antibiotics, the most popular band name probably being Cipro. Others include Floxin & Levaquin.

Best regards.

DocVikingo

 

[Epinephelus]

This is gonna be a little disjointed, as I want to bring in a few loosly connected points for consideration.
Like Dr. Thomas, I like having a course of broad spectrum antibiotic in my save-a-dive kit.
I will tolerate a little mild intestinal discomfort without starting antibiotics, and find that the more I travel the less I tend to have any.
If my prime objective were to avoid traveller's diarrhea I wouldn't travel.
There is risk in eating. The worst case of food poisoning I've ever had in my life - I mean fetal position just kill me to make it better for two whole days sick - was after a turkey leg at a Renaissance Fair just north of Houston!
I love Ceviche of all sorts and have never had a problem from it that I know of.
Ice can be dangerous.
I try to exercise a little common sense in selecting what gustatory delights I will or will not sample; on the other hand one cannot get the true flavor of a place without tasting it.
E. itajara

 

[The Iceni]

Epinephelus once bubbled...
I love Ceviche of all sorts and have never had a problem from it that I know of.
Ice can be dangerous.
I try to exercise a little common sense in selecting what gustatory delights I will or will not sample; on the other hand one cannot get the true flavor of a place without tasting it.
E. itajara

Hi Epi,

Is Ceviche that raw fish "cooked" in lemon juice? If so both the juice annd the fish flesh are likely to be sterile. As you say, this is certainly not the case with ice cubes (or ice cream) which should be avoided unless their provenence is known!

I reckon the cevesa is pretty safe, though.

I stayed for a short time in Verarcruz, Mexico, many, many years ago and one thing I remember is the dead dogs (and trucks!) on the roadside and the innumerable flies helping themselves at meal times!

We found the road from Puebla to Oahaca was fun! (- across the Sierra Madre at night!).

 

[Epinephelus]

Dr Paul Thomas once bubbled...
Is Ceviche that raw fish "cooked" in lemon juice? If so both the juice annd the fish flesh are likely to be sterile.

Fish, conch, octopus, squid, whatever's handy... delicious, especially with cold cervesa mas fina. If the person preparing it takes reasonable care, the ingredients themselves are quite safe, I believe. (Ciguatera excepted)
I have eaten mystery meat with secret sauce all over the world; I've been lucky, or reasonably cautious, or both, and in the process explored the local cuisine safely in some notoriously risky places (Any of you ever been to Trincomalee? Subic City? Alexandria?). Some of it was all but inedible, most delicious; all of it provided common ground with locals who would otherwise have likely remained much more remote - without trying the food I wouldn't have had the pleasure of getting to know the people.
E. itajara

 

[DocVikingo]

http://www.mdtravelhealth.com/infectious/travelers_diarrhea.html

http://scc.uchicago.edu/traveldiarrhea.htm

http://216.239.51.100/search?q=cach...sicktrav.html+ceviche+diarrhea&hl=en&ie=UTF-8 -- for original study see JAMA. 1999;281:811-817.

Cheers.

DocVikingo

 

[Epinephelus]

DocVikingo once bubbled...
Are you quite sure about ceviche?

No sir. I am only quite sure about my own experience with ceviche.
I am, however, quite sure about turkey legs.
Those suckers are liable to kill you!
E. itajara

 

[cat]

DocVikingo once bubbled...
While it is usually caused by one of a number of bacteria, most often E. coli, it can also be brought on by parasites & viruses, and from greasy, fatty & spicy foods, and items you are not used to eating.

Might want to add "water with unfamiliar mineral content" to that list, especially if you're used to drinking soft and/or low total dissolved solids water and you suddenly switch to one with a higher mineral content. It's funny - I've met a few pet owners who deliberately carry "old" water to mix with "new" water when they travel with dogs and cats (and fish!) but they forget to do the same thing for themselves. The problem also seems to be exacerbated by eating at funny times when travelling.

(I'm not an M.D. - this is just from personal experience and that of people I know)

 

[TropiGal]

Found this thread while doing a search for a thread on diarrhea prevention this morning for a newcomer to the board who will be going to Coz for the first time soon.

The thread is in Travel-Mexico-Coz Advice....

We discussed many of the points that I have just now read here in this med thread but are now curious about the use of lime juice to "cook bacteria"....

Check out the other thread and let us know your thoughts. Thanks, Bridget

 

[The Iceni]

DocVikingo once bubbled...
http://www.mdtravelhealth.com/infectious/travelers_diarrhea.html

Excellent link, DocVikingo!

I admit I am no anywhere near as adventurous as Epi, and when I had the chance to try ceviche in Mexico I was quite concerned but, like sushi, it is safely eaten by many thousands and it was prepared by my hosts with fresh ingredients.

I think, in general, it is indeed wise to avoid all food of uncertain provenance and in the case of those such as ceviche, not to "eat out". I have never been to the tourist traps on Mexico's North-East Coast but I do know that many of the hotels there have excellent reputations.

Freshly caught fish and meat, properly prepared is free of bacteria but may contain parasites (eg. measly pork) so I agree is not without risk.

Freshly squeezed lemon juice is acidic and sterile and I would aver quite risk-free. I am no food scientist but doubt it has any real sterilising activity on fish flesh and if the fillets are "off" they remain a danger. The only way to safely consume "stale" fish flesh is to cook it.

So yes, DocVikingo, there are genuine risks and no physcian could ever recommend the consumption of civeche on medical and epidemiological grounds alone but then if you want a risk-free life I would no longer recommend scuba diving or, indeed, flying or third world travel (as for the consumption of alcohol?)!

As for Epi's turkey legs. Barbeques are notorious because charcoal burns at such a high temperature it burns the surface of the drumsticks long before the meat deep within such large portions begins to cook. Whenever we have a barbie, which is not often, I tend to slow cook the chicken, sausages and burgers in the oven beforehand and use the BBQ simply to finish the portions and for "effect".

One of our national dishes is curry, a habit brought back by the army on return from India in the 19th century. The chilli and other spices were used by the indigenous population to mask the taste of rotting meat, subsequently boiled to kill off all those nasties listed by Doc Vikingo! (Curry powder is still found in British army 24-hour ration packs.)

Please note, this post is for educational and discussion purposes only and does not constitute medical advice, or a doctor-patient relationship.