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.