Monsoon maladies – Enemies in the Rain

Monsoon brings with it the much-awaited relief from the long spell of sultry,

scorching summer. When the season of rains people are all set to enjoy it to

the hilt irrespective of their age. There are people whose idea of enjoying

the drizzle is gorging on their favorite ‘pakoras’ and ‘chai’, while watching

the lovely weather from the comfort of their homes. while there are also

people who want to go out and enjoy the season dancing in the rain.

Children love to jump on the logged waters, splash it on each other and sail

paper boats. All these are such merry-making thoughts.

However the cooling showers bring with them an increased susceptibility to

a lot of diseases that are peculiar to the monsoon. It is time we get our

safeguards ready and gear ourselves up to face monsoon in its full glory.

Doctors have said that this cool climate contributes to the survival of the

ultramicroscopic infectious agents in the environment. Children are the most

susceptible to these diseases. In India, cities are developing haphazardly

thereby causing lack of sewage facilities and adequate drainage system;

due to unhygienic and poor sanitation conditions the diseases are striking.

The residents are drinking contaminated water due to leakages in the

drinking water lines.

Diseases that are spread during monsoon are basically water borne and

gastrointestinal infections. Typhoid and Diarrhea are common. Accumulation

of water on the roads promotes the growth of the mosquitoes causing

malaria and dengue. Also diseases like dryness, spasmodic pain, high blood

pressure, gas formation and gastric disturbances occur frequently. Also one

comes across cases of fever and coughs and colds.

Here are top 6 sinister monsoon-related diseases which we shall broadly

explore:

1. Fever

2. Common cold

3. Malaria

4. Dengue fever

5. Diarrhea

6. Typhoid

What is a fever?

Fever is the most common phenomena observed during monsoon. Right

from an infant to an old man, anyone can be its victim.

Fever refers to an elevation in body temperature. Technically, any body

temperature above the normal oral measurement of 98.6 F (37 C) or the

normal rectal temperature of 99 F (37.2 C) is considered to be elevated.

However, these are averages, and one's normal body temperature may

actually be 1 F (0.6 C) or more above or below the average of 98.6 F. Body

temperature can also vary up to 1 F (0.6 C) throughout the day.

Fever is not considered medically significant until body temperature is above

100.4 F (38 C). Anything above normal but below 100.4 F (38 C) is

considered a low-grade fever. Fever serves as one of the body's natural

defenses against bacteria and viruses which cannot live at a higher

temperature. For that reason, low fevers should normally go untreated,

unless accompanied by troubling symptoms.

Also, the body's defense mechanisms seem to work more efficiently at a

higher temperature. Fever is just one part of an illness, many times no more

important than the presence of other symptoms such as cough, sore throat,

fatigue, joint pains or aches, chills, nausea, etc. Fever of 104 Fahrenheit or

higher in adults demand immediate home treatment and subsequent

medical attention. Such high fever can result in delirium and convulsions,

particularly in infants and children.

Fever should not be confused with hyperthermia, which is a defect in body's

response to heat (thermoregulation), which can also raise the body

temperature. This is usually caused by external sources such as being in a

hot environment.

Signs and symptoms

There are different symptoms of a fever. The symptoms of a fever depend on

what is causing it. Sometimes a fever can cause a chill. A chill occurs

because when the brain raises the body's "thermostat," the body responds

by shivering to raise the temperature. Shivering produces heat in the body.

Once the temperature goes up, the person often feels warm. When the fever

goes away, the person may start to sweat.

Viral fever can remain for 3 to 4 days. The symptoms are:

• fever

• headache

• nose flow

• joint pain

• muscular pain

Risks during a Fever

The main risk of mild or moderate fevers is dehydration. When a person has

a fever, they need more fluids than usual. A fever greater than 106 degrees

Fahrenheit can result in brain damage and possibly death. Fevers greater

than 106 degrees are very unusual.

Diagnosis

A thermometer is used to measure the body temperature. The temperature

can be taken in the mouth, rectum, ear, or under the arm.

Generally, hands & foot of children remain cold during fever, but their

forehead & stomach remains hot.

What is the treatment for a fever?

Generally, if the fever does not cause discomfort, the fever itself need not be

treated. It is not necessary to awaken an adult or child to treat a fever unless

instructed to do so by your health-care practitioner.

The following fever-reducing medications may be used at home:

Ibuprofen can also be used to break a fever in patients over 6 months

of age. Discuss the best dose with your doctor. For adults, 400-600 mg

can be used every six hours.

Aspirin and Paracetamol should not be used for fever in children or

adolescents. Aspirin use in children and adolescents during a viral

illness causes prolonged vomiting, confusion, and even coma and liver

failure.

An individual with a fever should be kept comfortable and not overdressed.

Overdressing can cause the temperature to rise further. Tepid water [30 C]

baths are a home remedy that may help bring down a fever.

When and how to keep water bands

If the fever is up to 100 degree, then it can be cured at home by using water

bands. One should use normal water for bands. The bands get hot after

keeping on the body, so keep them for just a minute. If the whole body is

warm along with the forehead, then sponge the whole body with cloth

squeezed from normal water.

Prevention

Fever cannot be prevented in almost 99% cases. However, a good nutrition

can prevent it to an extent.

When should one seek medical care for a fever?

1. Any child below 3 months of age who has a temperature of 100.4 F (38

C) or greater should be seen by a physician or other health-care

worker.

2. If a child or adult has a history or diagnosis of cancer, AIDS, or other

serious illness, such as heart disease, diabetes, or is taking drugs,

medical care should be sought for a fever.

3. Otherwise, observe the person with the fever. If they appear sick or

have symptoms that would suggest a major illness, such as meningitis,

urinary tract infection, pneumonia or any other signs of a serious

illness, doctor should be consulted.

4. Other symptoms that may be indicative of a severe illness include

repeated vomiting, severe diarrhea, or skin rashes

5. Fever blisters are small blisters that turn into ulcers, usually on the

lips, mouth or tongue that are caused by a virus. When a child

contracts this virus for the first time, the symptoms and the fever

blisters can be quite severe.

6. On the other hand, if the fever accompanies a simple cold or virus,

then the fever is only a symptom of the illness. But if there are other

associated symptoms that are bothersome, doctor should be

consulted.

7. Some vaccines given in childhood can cause a low-grade fever within a

day or two of getting the injection. This fever is usually self-limited and

short-lived. If the reaction seems severe or the skin at the injection site

is red, hot, and painful, doctor’s help is needed.

Fever at a Glance

Although a fever could be considered any body temperature above the

normal 98.6 F (37 C), medically, a person is not considered to have a

significant fever until the temperature is above 100.4 F (38.0 C).

Most fever is beneficial, causes no problems, and helps the body fight

off infections. The main reason for treating a fever is to increase

comfort.

Children under 3 months of age with a temperature of 100.4 F (38.0 C)

or greater should be seen by a health-care provider. They may be quite

ill and not show any signs or symptoms besides a fever. Infants less

than 6 weeks of age should be seen immediately by their doctor.

Ibuprofen can be used to treat a fever. Aspirin and Paracetamol should

not be used in children or adolescents to control fever.

What is the common cold?

This is the most common disease that catches people cutting across age

lines. You get wet and you’ve got it. Though it is difficult to forgo the

temptation of dancing in the rain, this joy is likely to get you common cold.

Common cold is observed during the initial period of monsoon due to the

sudden change in weather.

The common cold, also known as a viral upper respiratory tract infection, is a

self-limited contagious illness that can be caused by a number of different

types of viruses

The common cold is the most frequently occurring illness in India, and it is a

leading cause of doctor visits and missed days from school and work.

Causes

More than 200 different types of viruses are known to cause the common

cold. Because so many different viruses can cause a cold and because new

cold viruses constantly develop, the body never builds up resistance against

all of them. For this reason, colds are a frequent and recurring problem. In

fact, children in preschool and elementary school can have three to 12 colds

per year while adolescents and adults typically have two to four colds per

year.

Symptoms

Symptoms of the common cold usually begin 2 to 3 days after infection and

often include:

Mucus buildup in your nose

Difficulty breathing through your nose

Swelling of your sinuses

Sneezing

Sore throat

Cough

Headache 

Fever is usually slight but can climb to 102 degrees Fahrenheit in infants and

young children. Cold symptoms can last from 2 to 14 days, but like most

people, you’ll probably recover in a week. If symptoms recur often or last

much longer than 2 weeks, you might have an allergy rather than a cold.

How does common cold spread?

The common cold is usually spread by direct hand-to-hand contact with

infected secretions or from contaminated surfaces. For example, if a person

with a cold blows or touches their nose and then touches someone else, that

person can subsequently become infected with the virus. Additionally, a cold

virus can live on objects such as pens, books, telephones, computer

keyboards, and coffee cups for several hours and can thus be acquired from

contact with these objects.

What is the difference between the common cold and

influenza (the flu)?

Many people confuse the common cold with influenza (the flu). Influenza is

caused by the influenza virus, while the common cold generally is not. While

some of the symptoms of the common cold and influenza may be similar,

patients with the common cold typically have a milder illness. Patients with

influenza are usually sicker and have a more abrupt onset of illness with

fever, chills, headache, body aches, dry cough, and extreme weakness.

Though differentiating between the common cold and influenza can be

difficult, there is laboratory testing available to confirm the diagnoses of

influenza.

Treatment

There is no cure for the common cold. Home treatment is directed at

alleviating the symptoms associated with the common cold and allowing this

self-limiting illness to run its course.

But one can get relief from your cold symptoms by:

Resting in bed.

Drinking plenty of fluids.

Gargling with warm salt water or using throat sprays or lozenges for a

scratchy or sore throat.

Cough drops and cough syrups

Using petroleum jelly for a raw nose.

Saline sprays and a humidifier may also be beneficial.

Are antibiotics a suitable treatment for the common cold?

Antibiotics play no role in treating the common cold. Antibiotics are effective

only against illnesses caused by bacteria, and colds are caused by viruses.

Not only do antibiotics not help, but they can also cause allergic reactions

that can be fatal (1:40,000). Furthermore, using antibiotics when they are

not necessary has led to the growth of several strains of common bacteria

that have become resistant to certain antibiotics). For these and other

reasons, it is important to limit the use of antibiotics to situations in which

they are medically indicated.

Though occasionally a bacterial infection, such as sinusitis or a middle ear

infection can develop following a cold, treatment with antibiotics should be

left at the discretion of your physician or health-care practitioner.

When should a doctor or other health-care practitioner be

consulted?

Generally speaking, the common cold can be treated at home and managed

with over-the-counter medications. However, if one develops more severe

symptoms such as shaking chills, high fever (greater than 102 F), severe

headache or neck stiffness, nausea, vomiting, difficulty breathing or chest

pain, physician or health-care practitioner should be consulted immediately.

If there are sore throat and a fever with no other cold symptoms, then one

should be seen by your physician. This illness may be strep throat, a

bacterial infection requiring treatment with antibiotics.

Finally, if one notices facial pain or yellow/green drainage from your nose

accompanied by a fever, it is possible that they have a sinus infection

(sinusitis) that would benefit from a medical evaluation and a possible course

of antibiotics.

Prevention

The most important measure to prevent the common cold is frequent hand

washing, as this can destroy viruses that you have acquired from touching

contaminated surfaces. Also, try to avoid sharing utensils and try to use

disposable items (such as disposable cups) if someone in your family has a

cold. Finally, lifestyle modifications such as smoking cessation and stress

management may decrease your susceptibility to acquiring the common

cold.

Common Cold at a Glance

The common cold is caused by many different viruses.

Being in cold weather does not cause the common cold.

There are effective over-the-counter medications for treatment of the

common cold.

Antibiotics do not help the common cold.

The common cold can generally be managed at home.

What is Malaria?

Malaria is an infectious disease caused by a parasite, Plasmodium, which

infects red blood cells. Malaria is characterized by cycles of chills, fever, pain

and sweating. Historical records suggest malaria has infected humans since

the beginning of mankind. The name "mal 'aria" (meaning "bad air" in

Italian) was first used in English in 1740 by H. Walpole when describing the

disease. In 1889, R. Ross discovered that mosquitoes transmitted malaria. Of

the four species of malaria, the most serious type is Plasmodium falciparum

malaria. It can be life-threatening. The other three species of malaria (P.

vivax, P. malariae, and P. ovale) are generally less serious and are not life-

threatening.

Malaria is still a very deadly disease that affects many areas of the world,

including India. Malaria is spread by parasite-carrying mosquitoes. Malaria

causes fever, chills, sweats, headache, body ache, nausea, vomiting and

fatigue.

How is malaria transmitted?

The life cycle of the parasite is complicated and involves two hosts, humans

and Anopheles mosquitoes. The disease is transmitted to humans when an

infected Anopheles mosquito bites a person and injects the malaria parasites

(sporozoites) into the blood. Sporozoites travel through the bloodstream to

the liver, mature, and eventually infect the human red blood cells. While in

red blood cells, the parasites again develop until a mosquito takes a blood

meal from an infected human and ingests human red blood cells containing

the parasites. Then the parasites reach the Anopheles mosquito's stomach

and eventually invade the mosquito salivary glands. When an Anopheles

mosquito bites a human, these sporozoites complete and repeat the complex

Plasmodium life cycle. P. ovale and P. vivax can further complicate the cycle

by producing dormant stages (hypnozoites) that may not develop for weeks

to years.

Symptoms

Symptoms of malaria can begin as early as six to eight days after a bite by

an infected mosquito. They include:

High fever (up to 105 degrees Fahrenheit) with shaking chills

Profuse sweating when the fever suddenly drops

Fatigue

Headache

Muscle aches 

Abdominal discomfort

Nausea, vomiting

Feeling faint when you stand up or sit up quickly 

Incubation period

The period between the mosquito bite and the onset of the malarial illness is

usually one to three weeks (seven to 21 days). This initial time period is

highly variable as reports suggest that the range of incubation periods may

range from four days to one year. The usual incubation period may be

increased when a person has taken an inadequate course of malaria

prevention medications. Certain types of malaria (P. vivax and P. ovale)

parasites can also take much longer, as long as eight to 10 months, to cause

symptoms. These parasites remain dormant (inactive or hibernating) in the

liver cells during this time. Unfortunately, some of these dormant parasites

can remain even after a patient recovers from malaria, so the patient can

get sick again. This situation is termed relapsing malaria.

Treatment

Three main factors determine treatments:

The infecting species of Plasmodium parasite

the clinical situation of the patient (for example, adult, child, or

pregnant female with either mild or severe malaria)

The drug susceptibility of the infecting parasites.

Drug susceptibility is determined by the geographic area where the infection

was acquired. Different areas of India have malaria types that are resistant

to certain medications. The correct drugs for each type of malaria must be

prescribed by a doctor who is familiar with malaria treatment protocols.

Since people infected with P. falciparum malaria can die (often because of

delayed treatment), immediate treatment for P. falciparum malaria is

necessary. Mild malaria can be treated with oral medication; severe malaria

requires intravenous (IV) drug treatment and fluids.

Drug treatment of malaria is not always easy. There are specialized labs that

can test the patient's parasites for resistance, but this is not done frequently.

Consequently, treatment is usually based on the majority of Plasmodium

species diagnosed and its general drug-resistance pattern for the country.

Is malaria a particular problem during pregnancy?

Yes. Malaria may pose a serious threat to a pregnant woman and her

pregnancy. Malaria infection in pregnant women may be more severe than in

women who are not pregnant. Malaria may also increase the risk of problems

with the pregnancy, including prematurity, abortion, and stillbirth. Treatment

of malaria in the pregnant female is similar to the usual treatment described

above

Is malaria a particular problem for children?

Yes. All children, including young infants, living in or traveling to malaria-risk

areas should take anti-malarial drugs. Although the recommendations for

most anti-malarial drugs are the same as for adults, it is crucial to use the

correct dosage for the child. The dosage of drug depends on the age and

weight of the child. Since an overdose of an anti-malarial drug can be fatal,

all anti-malarial (and all other) drugs should be stored in childproof

containers well out of the child's reach.

How can one keep from getting malaria?

If you are traveling to an area known to have malaria, find out which

medications you need to take, and take them as prescribed. Current CDC

recommendations suggest individuals begin taking anti-malarial drugs about

one to two weeks before traveling to a malaria infested area and for four

weeks after leaving the area. Your doctor, travel clinic, or the health

department can advise you as to what medicines to take to keep from

getting malaria. Currently, there is no vaccine available for malaria, but

researchers are trying to develop one.

Precautions

If possible, avoid travel to or through countries where malaria occurs. If you

must go to areas where malaria occurs, take the prescribed preventive

medicine. In addition, the 2008 CDC international travel recommendations

suggest the following precautions be taken in malaria infested areas:

Avoid exposure to mosquitoes during the early morning and early

evening hours between the hours of dusk and dawn (the hours of

greatest mosquito activity).

Wear appropriate clothing (long-sleeved shirts and long pants, for

examples) especially when you are outdoors.

Apply insect repellent to the exposed skin. The CDC recommended

insect repellent should contains up to 50% DEET (N,N-diethyl-m-

toluamide), which is the most effective mosquito repellent for adults

and children over 2 months of age.

Spray mosquito repellents on clothing to prevent mosquitoes from

biting through thin clothing.

Use a permethrin-coated (or similar repellant) mosquito net over your

all beds.

Have screens over cover windows and doors.

Spray permethrin or a similar insecticide in the bedroom before going

to bed.

Malaria at a Glance

Malaria is an infectious disease caused by a parasite, Plasmodium,

which infects red blood cells.

The life cycle involves two hosts, humans and Anopheles mosquitoes.

Fever at regular intervals, bouts of shivering, muscle pain and

weakness are the symptoms that a patient shows while suffering from

Malaria.

The incubation period is usually one to three weeks

Since this disease is spread by mosquitoes, so mosquito repellents and

nets should be used to prevent it. Also make sure that water does not

stagnate in your area as mosquitoes breed in stagnant water.

What is dengue fever?

Dengue fever is a disease caused by a family of viruses that are transmitted

by mosquitoes. Dengue is caused by the biting of female Aedes Aegypti

mosquito. These mosquitoes have stripes like tiger on their body. They bite

in the day time, esp. in the morning. Dengue strikes people with low levels of

immunity. Because it is caused by one of four serotypes of virus, it is

possible to get dengue fever multiple times.

However, an attack of dengue produces immunity for a lifetime to that

particular serotype to which the patient was exposed. Dengue goes by other

names, including "breakbone" or "dandy fever." Dengue hemorrhagic fever is

a more severe form of the viral illness.

Types of dengue

It’s of three types:

• Classical (Normal) Dengue

• Dengue Hemorrhagic Fever (DHF)

• Dengue Shock Syndrome (DSS)

When it spreads

Dengue spreads mostly in the months of July to October because this season

has favorable conditions for their flourish.

How is dengue fever contracted?

The virus is contracted from the bite of a striped Aedes aegypti mosquito

that has previously bitten an infected person. The mosquito flourishes during

rainy seasons but can breed in water-filled flower pots, plastic bags, and

cans year-round. One mosquito bite can inflict the disease.The virus is not

contagious and cannot be spread directly from person to person. There must

be a person-to-mosquito-to-another-person pathway.

How it spreads

Dengue virus spreads very fast in the blood of dengue patient. When any

dengue mosquito bits such dengue patient and sucks his blood, then the

dengue virus enters in his (mosquito) body also. Thereafter, when such

mosquito bites any other person, then that person also get infected with the

dengue virus.

Symptoms and Signs

After being bitten by a mosquito carrying the virus, the incubation period

ranges from three to 15 (usually five to eight) days before the signs and

symptoms of dengue appear.

Classical Dengue Fever

The infection period can be of 5 to 10 days. The fever can be identified with

the help of following symptoms.

• Sudden high fever after feeling old.

• Headache, muscular pain, joint pain.

• Pain in the back area of eyes which increases with the movement of eyes.

• Extreme weakness, loss of appetite, vomiting sensation, loss of taste.

• Mild pain in throat.

• Rashes of pinkish red color on the body, esp. face, neck and chest.

Dengue Hemorrhagic Fever (DHF)

• Bleeding from nose and gums.

• Blood in vomit or stool.

• Spots of blackish blue color on skin.

Dengue Shock Syndrome (DSS)

This fever some symptoms of ‘shock’ in addition to the symptoms of DHF,

like:

• the patient feels very restless and his skin remains cold in spite of high

fever.

• He loses consciousness slowly.

• The pulse rate keeps on fluctuating. Blood pressure falls down.

Treatment

Because dengue fever is caused by a virus, there is no specific medicine or

antibiotic to treat it. For typical dengue, the treatment is purely concerned

with relief of the symptoms (symptomatic). Rest and fluid intake for

adequate hydration is important. Aspirin and nonsteroidal anti-inflammatory

drugs should only be taken under a doctor's supervision because of the

possibility of worsening hemorrhagic complications. Acetaminophen (Tylenol)

and codeine may be given for severe headache and for the joint and muscle

pain (myalgia).

Prevention

The transmission of the virus to mosquitoes must be interrupted to prevent

the illness. To this end, patients are kept under mosquito netting until the

second bout of fever is over and they are no longer contagious.

The prevention of dengue requires control or eradication of the mosquitoes

carrying the virus that causes dengue. In nations plagued by dengue fever,

people are urged to empty stagnant water from old tires, trash cans, and

flower pots. Governmental initiatives to decrease mosquitoes also help to

keep the disease in check but have been poorly effective.

To prevent mosquito bites, wear long pants and long sleeves. For personal

protection, use mosquito repellant sprays that contain DEET when visiting

places where dengue is endemic. Limiting exposure to mosquitoes by

avoiding standing water and staying indoors two hours after sunrise and

before sunset will help. The Aedes aegypti mosquito is a daytime biter with

peak periods of biting around sunrise and sunset. It may bite at any time of

the day and is often hidden inside homes or other dwellings, especially in

urban areas.

There is currently no vaccine available for dengue fever. There is a vaccine

undergoing clinical trials, but it is too early to tell if it will be safe or effective.

Early results of clinical trials show that a vaccine may be available by 2012.

There is currently no vaccine or drug available to prevent infection.

Dengue Fever at a Glance

Dengue fever is a disease caused by a family of viruses that are

transmitted by mosquitoes.

Symptoms such as headache, fever, exhaustion, severe joint and

muscle pain, swollen glands and rash. The presence of fever, rash, and

headache (and other pains) is particularly characteristic of dengue

fever.

Dengue is prevalent throughout the tropics and subtropics. Outbreaks

have occurred recently in the Caribbean, including Puerto Rico, the

U.S. Virgin Islands, Cuba, and Central America.

Because dengue fever is caused by a virus, there is no specific

medicine or antibiotic to treat it. For typical dengue fever, the

treatment is purely concerned with relief of the symptoms

(symptomatic).

The acute phase of the illness with fever and myalgias lasts about one

to two weeks.

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to

affect children under 10 years of age. It causes abdominal pain,

hemorrhage (bleeding), and circulatory collapse (shock).

The prevention of dengue fever requires control or eradication of the

mosquitoes carrying the virus that causes dengue.

There is currently no vaccine available for dengue fever.

What is diarrhea?

Diarrhea is an increase in the frequency of bowel movements or a decrease

in the form of stool (greater looseness of stool). Although changes in

frequency of bowel movements and looseness of stools can vary

independently of each other, changes often occur in both.

Diarrhea is more frequent and more liquid bowel movements than normal.

Diarrhea often is caused by an infection with bacteria, viruses or a parasite.

Bacteria cause diarrhea either by invading the intestine or by producing a

toxin that makes the intestine secrete more water. When the diarrhea is

caused by food contaminated with bacteria or parasites, people often refer

to this as food poisoning.

Types of Diarrhea

Diarrhea generally is divided into two types, acute and chronic.

Acute diarrhea lasts from a few days up to a week.

Chronic diarrhea can be defined in several ways but almost always

lasts more than three weeks.

It is important to distinguish between acute and chronic diarrhea because

they usually have different causes, require different diagnostic tests, and

require different treatment.

Symptoms

People with diarrhea usually have loose, watery stools. Less commonly,

people pass frequent, small amounts of loose stool with mucous and blood.

Other symptoms can include:

Abdominal pain and cramping

Vomiting

Fever

Chills

Bloody stools

Lack of bowel control

Frequent vomiting and diarrhea can lead to dehydration (abnormally low

levels of body water) if too much fluid is lost from the body. Signs of

dehydration include:

Dry mouth

Thirst

Dry eyes

Infrequent urination

Causes

A. Causes of acute diarrhea

The most common cause of acute diarrhea is infection--viral, bacterial, and

parasitic. Bacteria also can cause acute food poisoning. A third important

cause of acute diarrhea is starting a new medication.

Viral gastroenteritis

Viral gastroenteritis (viral infection of the stomach and the small intestine) is

the most common cause of acute diarrhea worldwide. Patients with viral

gastroenteritis usually do not have blood or pus in their stools and have little

if any fever.

Food poisoning

Food poisoning is a brief illness that is caused by toxins produced by

bacteria. The toxins cause abdominal pain (cramps) and vomiting and also

cause the small intestine to secrete large amounts of water that leads to

diarrhea.

Traveler's diarrhea

Tourists visiting foreign countries with warm climates and poor sanitation

can acquire ETEC (a kind of bacteria) by eating contaminated foods such as

fruits, vegetables, seafood, and raw meat, water, and ice cubes. Toxins

produced by ETEC cause the sudden onset of diarrhea..

Drugs

Drug-induced diarrhea is very common because many drugs cause diarrhea.

The medications that most frequently cause diarrhea are antacids and

nutritional supplements that contain magnesium.

Causes of chronic diarrhea

Irritable bowel syndrome

It is a functional cause of diarrhea or constipation. It may be caused by

several different underlying problems, but it is believed that the most

common cause is rapid passage of the intestinal contents through the colon.

Infectious diseases like AIDS often have chronic infections of their

intestines that cause diarrhea.

Bacterial overgrowth of the small intestine

When should the doctor be called for diarrhea?

Most episodes of diarrhea are mild and of short duration and do not need to

be brought to the attention of a doctor. The doctor should be consulted when

there is:

High fever

Moderate or severe abdominal pain or tenderness

Bloody diarrhea that suggests severe intestinal inflammation

Diarrhea in persons with serious underlying illness for example,

persons with diabetes, heart disease, and AIDS

Severe diarrhea that shows no improvement after 48 hours.

Prolonged vomiting that prevents intake of fluids orally

Acute diarrhea in pregnant women because of concern for the health

of the fetus

Diarrhea that occurs during or immediately after completing a course

of antibiotics

Diarrhea after returning from developing countries or from camping in

the mountains

Acute diarrhea in an infant or young child

Chronic diarrhea

Treatment

When symptoms start, try to rest more and switch to a diet of clear

liquids.

Drink water, juice, bouillon and weak tea to avoid becoming

dehydrated. Replace lost fluids and electrolytes with sports drinks.

Avoid coffee or soft drinks that contain caffeine, since caffeine

increases the loss of water and salt.

If you have nausea in addition to diarrhea, take very small sips of fluid

frequently and suck on ice chips.

As you begin to feel better, start eating solid foods gradually to

prevent stomach cramps. Start with soft, starchy foods (cooked cereal,

steamed rice, unbuttered toast, and applesauce) before returning to

your normal diet.

To ease stomach cramps, apply warmth (a hot water bottle, warm

compress or electric heating pad set on low heat) to your abdomen.

You also may consider over-the-counter medications such as bismuth

subsalicylate (Pepto-Bismol) or loperamide (Imodium). 

What tests are useful in the evaluation of diarrhea?

Acute diarrhea

Acute diarrhea usually requires few tests.

Measurement of blood pressure

Examination of a small amount of stool

If there has been recent travel to undeveloped countries or the

mountains, stool may be examined under the microscope for Giardia

and other parasites.

Chronic diarrhea

With chronic diarrhea, the focus usually shifts to the diagnosis of non-

infectious causes of diarrhea. This may require:

X-rays of the intestines

Measuring the fat in a 72 hour collection of stool.

Hydrogen breath testing also can be used to diagnose bacterial

overgrowth of the small intestine.

Blood tests and a biopsy of the small intestine.

Diarrhea at a Glance

Diarrhea is an increase in the frequency of bowel movements, an

increase in the looseness of stool or both.

Diarrhea is caused by increased secretion of fluid into the intestine,

reduced absorption of fluid from the intestine or rapid passage of stool

through the intestine.

Diarrhea can be defined absolutely or relatively. Absolute diarrhea is

defined as more than five bowel movements a day or liquid stools.

Relative diarrhea is defined as an increase in the number of bowel

movements per day or an increase in the looseness of stools compared

with an individual's usual bowel habit.

Diarrhea may be either acute or chronic, and each has different causes

and treatments.

Complications of diarrhea include dehydration, electrolytes (mineral)

abnormalities, and irritation of the anus.

Dehydration can be treated with oral rehydration solutions and, if

necessary, with intravenous fluids.

Diarrhea may be treated with absorbents, anti-motility medications,

and bismuth compounds.