By Barry C. Fox, M.D., University of Wisconsin
There are many ways in which our gastrointestinal tracts can be affected. Some of these are infections from food. There are also intestinal bacterial inflammations to contend with. And, a recent infection is caused by the overuse of antibiotics. Let’s take a look.
More than 80 percent of seafood, and more than 50 percent of fresh produce is imported into the United States. Foods imported to the US come from more than 200,000 foreign facilities in more than 200 different countries. Many of these foreign food-producing countries may lack food safety standards as strict as those in place in the US.
For example, in 2008, there was an outbreak caused by contaminated hot peppers imported from Mexico. More than 1,000 people had documented illness, and many others likely went underreported. In 2003, a massive outbreak of viral hepatitis-A was linked to imported green onions from Mexico.
Traveler’s diarrhea or tourista is the most common illness in persons traveling from developed to developing regions of the world. The concern is well-founded; about 50 percent of travelers develop diarrhea. Most episodes occur between 4 and 14 days after arrival.
Traveler’s diarrhea is nearly always benign and self-limited. However, the dehydration can occur and may be more severe and pose more of a challenge than the illness itself. The most common germ is yet another species of E. coli, known as enterotoxigenic E. coli.
Learn more about germs that matter.
Treating Traveler’s Diarrhea
Travelers should be aware that food items on airplanes are usually obtained at the city of departure. The treatment of traveler’s diarrhea includes three different approaches. First, fluid replacement—meaning, keep yourselves well-hydrated with bottled drinks, especially if you can use rehydration salts that contain sodium and potassium.
Secondly, anti-motility agents like Imodium or Pepto-Bismol. These agents can slow down the volume of fluid loss by acting on the nerve receptors of the intestine, and sometimes antibiotics if necessary, but not very commonly.
Antibiotics are usually prescribed under the guidance of a traveler’s clinic. They may be warranted for treatment in travelers who develop moderate to severe diarrhea. However, it’s important to know that medical help may be needed if you develop a high fever, worsening abdominal pain, or bloody diarrhea while traveling.
Learn more about antibiotics.
The Sushi Scene
Sushi has entered America’s gourmet restaurant scene, and it’s becoming more popular. It started in the 1960s as the ‘California roll’ which contained crab and avocado and has branched out to numerous other delicacies. Did you know that the word sushi actually refers to the sweetened, vinegarized rice that the sushi is served on, and not the raw fish itself?
In the US, the good news is that sushi eaters don’t typically need to be concerned about getting sick, since sushi restaurants take special steps in handling and preparing their fish. A required step involves freezing the fish at temperatures of −4 degrees Fahrenheit for seven days, or frozen at −31 degrees Fahrenheit for 15 hours, which will kill any parasites.
But, be aware that in other countries, these strict safety criteria may not be met, and you may place yourself at risk of acquisition of parasites in raw fish.
This is a transcript from the video series An Introduction to Infectious Diseases. Watch it now Wondrium.
Appendicitis and Diverticulitis
Appendicitis is a common condition, but what exactly is it? The appendix is a non-essential organ located in the right lower quadrant of the abdomen. Blockage or obstruction of the opening of the appendix leads to bacteria being trapped inside. This leads to inflammation and infection and right-sided lower abdominal pain. Appendicitis in older individuals is usually more serious because 60 to 90 percent are found to be ruptured at the time of surgery.
Now what is diverticulitis? In the distal colon, outpouchings known as diverticula are common. These diverticula occur in approximately 30 percent of population over the age of 45, and 60 percent of those over the age of 70. It’s estimated that 10 to 20 percent of people with diverticuli will develop an infection when bacteria get trapped, similar to appendicitis. Ruptures can also occur.
Both of these conditions occur because our own normally good bacteria end up in the wrong place at the wrong time.
So, what happens when our gut gets over-run with bad bacteria?
You could end up with Clostridium difficile, often abbreviated C. diff. Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing germ. Now listed by the CDC as one of the top emerging infectious disease threats, Clostridium difficile can be the cause of antibiotic-associated colitis and can be life-threatening.
Antibiotic use is the most widely recognized and modifiable risk factor for this disease. Alteration of normal intestinal bacteria due to antibiotic therapy allows this germ to overgrow, with patients having diarrhea of increasing intensity and severity.
Cures for Clostridium difficile
Clostridium difficile is capable of elaborating toxins that bind to the surface of intestinal cells, and this leads to inflammation, the formation of pus, and watery diarrhea. Outside the colon, the germs can survive as spores, which are resistant to destruction, and once the spores are in the colon, they can convert to bacterial forms that produce toxin.
Even if the condition is successfully treated with special antibiotics, up to 25 percent of patients may have recurring symptoms weeks later, with 10 percent of these having yet another occurrence.
A new treatment for this condition is known as fecal microbiota transplantation. It takes a healthy person’s intestinal microbiota and transplants it into the afflicted patient, hoping to repopulate the intestines with the appropriate bacteria to restore a healthy state. In some cases, it has turned around patients with multiple recurrences in a matter of hours, after being extremely ill for weeks. This procedure has an approximate 90 percent success rate.
Well, you can see that the infectious disease world of the gastrointestinal tract is a very busy one.
Common Questions about Internal and External Sources of Gastrointestinal Illness
Tourista is another name for traveler’s diarrhea. It is the most common illness in persons traveling from developed to developing regions of the world.
Blockage or obstruction of the opening of the appendix leads to bacteria being trapped inside. This leads to inflammation and infection and right-sided lower abdominal pain. This is called appendicitis.
In the distal colon, outpouchings known as diverticula are common. It’s estimated that 10 to 20 percent of people with diverticuli will develop an infection when bacteria get trapped, similar to appendicitis. Ruptures can also occur.
Clostridium difficile or C. diff. is an anaerobic gram-positive, spore-forming, toxin-producing germ. C. diff. can be the cause of antibiotic-associated colitis and can be life-threatening.