GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 263

longer in shock, they usually are able to take fluids orally. Either of the replacement solu-
tions listed in Table 19-1 is suitable.
People with cholera are severely ill and obviously require bed rest. A canvas cot with a
hole in the center through which the person can defecate without having to move improves
comfort and facilitates the collection and measuring of the stools during the first few days
oftheillness.Fecesmustbedisposedofcarefullytoavoidcontamination ofwatersupplies
and infecting others.
Tetracycline or doxycycline is the preferred antibiotic therapy for adults. In areas
wheretetracyclineresistanceisprevalent,ciprofloxacinshouldbesubstituted.Forchildren,
furazolidone is the preferred medication; TMP-SMX is the second choice. Antibiotics are
only an adjunct to therapy and cannot substitute for fluid and electrolyte replacement. Sed-
atives make care of the individual more difficult and are not useful.
Cholera is not very contagious if proper precautions are followed as it is spread prin-
cipally by feces. Sanitary disposal of feces and vomitus must be strictly enforced, and all
contaminated articles, including clothing, bedding, and utensils, must be cleaned.
The acute phase ofthe infection rarely lasts more than three tofive days.The individual
usually is able to eat a bland diet by the third day. However, several weeks are required for
full recovery.
Typhoid Fever
Typhoid fever is a systemic as well as a gastrointestinal infection caused by Salmonella
typhi . The bacterial organisms invade the wall of the small bowel and enter the blood-
stream, causing septicemia. Occasionally, people who have recovered from typhoid fever
continue to harbor the organisms (carriers) in the gastrointestinal tract and excrete them in
theirstools.Thebacteriacansurviveformonthsundernaturalconditions.Uncookedfoods,
salads, raw milk, and contaminated water are the most important sources of infection.
Theincubationperiodisseventofourteendays.Symptomsduringthefirstweekconsist
of fever, headache, and abdominal pain. The onset is usually insidious. Often there is no
change in bowel habits during the initial ten days of illness. Near the end of the first week,
enlargement of the spleen may be detectable. A brief, somewhat diagnostic rash can be
seen in 70 percent of light-skinned individuals about seven to ten days after the onset of
symptoms. The rash consists of “rose spots” that are deeply red, usually few in number, 2
to 4 mm in diameter and often present in clusters, blanch on pressure, and occur most of-
ten on the lower chest and upper abdominal wall. During the second week of illness, fever
becomes more continuous and many individuals are severely ill. A pulse rate that is often
paradoxicallyslowincomparisontotheseverityofthefeverisanimportantdiagnosticfea-
ture. Cough and nosebleeds may occur. In the third week, extreme toxicity, irrationality or
confusion, and “pea soup” diarrhea may occur. The latter may presage the dire complica-
tionsofperforationoftheintestineorintestinalhemorrhage.Forsurvivors,thefourthweek