Travel Reference
In-Depth Information
often brings improvement in their status. However, typhoid fever is a long-lasting and de-
bilitating infection.
For typhoid fever, supportive care and maintenance of fluid intake are important. An-
tipyretic agents such as aspirin, ibuprofen, or acetaminophen may cause severe sweating
andmaylowerbloodpressure.Cautioususeisacceptableonlyifspongingwithtepidwater
does not control the high fever.
Ciprofloxacin (Cipro®) is the antimicrobial drug of choice for the treatment of typhoid
fever. Chloramphenicol has been relegated to second choice for two reasons: Typhoid bac-
teriafromcentralMexicoandVietnamareoftenresistanttochloramphenicol,andthisdrug
may rarely cause a potentially lethal anemia after prolonged therapy. The usual duration of
therapy is two weeks.
Prior to travel to an area where typhoid may be encountered, immunization for typhoid
and paratyphoid fever should be obtained. Although immunization does not completely
prevent infection, it does reduce the severity of the disease and reduces the incidence of
complications. Oral typhoid vaccine is now available.
Amebiasis
Amebiasisiscausedbytheinvasiveparasite
Entamoeba histolytica
.Althoughgenerally
thought of as a tropical disease, amebiasis is by no means limited to such areas.
These organisms invade the wall of the large intestine. The adults form cysts that are
passedinfecesandspreadtheinfection.Thecystsaremostcommonlyingestedincontam-
inatedwater.Foodthathasbeenfertilizedwithhumanexcreta,carelessnessinfoodprepar-
ation, and insects—particularly flies—are other sources of infestation. Iodine in appropri-
ate concentrations and boiling destroy the cysts effectively; filtration removes them.
Amebiasis is usually a very mild disorder in its early stages, and symptoms may be en-
tirely absent then. Mild diarrhea with soft stools and a moderately increased number of
bowel movements are more common. Occasional individuals develop constipation rather
thandiarrhea.Afewindividualshavemoreseveresymptoms,includingabdominalcramps
and numerous watery stools that contain mucus or blood. However, a period of mild
gastrointestinal dysfunction usually precedes the onset of the more severe stage.
Easy fatigability, low fever, and vague pains in the muscles, back, or joints are fre-
quently present. Nervousness, irritability, and dizziness occasionally develop. Typically no
abnormality can be found on physical examination, although slight tenderness in the right
lower quadrant of the abdomen is sometimes present. The chronicity and mildness of the
diarrheaandahistoryofexposuretoconditionsinwhichinfectionislikelysuggestthedia-
gnosis. Laboratory facilities are required to make a definitive diagnosis.
If amebiasis is suspected, metronidazole (Flagyl®) should be given. Occasionally, met-
ronidazole may not completely eradicate the infection.
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