It’s been described as the Delhi Belly, the Green Apple Quick Step, Montezuma’s Revenge and other guttural, though no less descriptive, terms. We’ve all had it and suffered through it. It’s a dreaded condition on cruise ships and may cause you to be quarantined on your vacation. Let’s face it, acute diarrhea is a real pain in the a**.
Approximately 180 million cases of “acute” diarrhea occur each year in the United States. Acute is medical terminology for a condition of recent onset and lasting a short time, as opposed to a long lasting or chronic condition. Diarrheal illness is a bit more common in kids, and it can be devastating in older frail patients. If the infection involves the stomach and small intestine, vomiting is also a common symptom.
Most community diarrheal illnesses are due to norovirus infection. This virus can be a big problem in nursing homes or on ships. Interestingly, another viral pathogen called the rotovirus is becoming less common in recent years. Speculation is that vaccination of children to prevent this viral syndrome has led to less illness in adults.
Viral infections of the gastrointestinal tract are usually short-lived, and therapy focuses on hygiene and fluids to treat dehydration. A useful tip (doctors refer to these as clinical pearls, as in pearls of wisdom) is that significant dehydration is uncommon in adults with diarrhea of less than twenty-four hours. Of course there are exceptions and vomiting with diarrhea lasting more than twelve hours should be reported to your doctor.
Bacterial infection can cause acute diarrheal illness. Salmonella and shigella are associated with the term “dysentery.” Similarly, E. coli bacteria can also cause diarrhea, but all these bacterial infections are less common in America due to our sewage treatment infrastructure and clean water. For unknown reasons, some aggressive E. coli strains and those producing toxins may actually be increasing.
Most of the time we never find a cause for acute diarrheal illness. Obviously, someone whose immune system has been damaged from chemotherapy, or has traveled to foreign lands changes the equation. Furthermore, the probability of a serious problem is increased when blood is present in the diarrhea. I once treated a patient for severe diarrheal due to the bacterium campylobacter. This agent is associated with animals, but the pieces of the diagnostic puzzle fell into place when the patient informed me he had been frog-gigging in a pond after a heavy rain. Years before I had convinced him to stop smoking and instead he often chewed tooth picks. Obviously, his hands were less than sterile after removing frogs from his lance, apparently contaminating the tooth picks. The picture became clear when he recalled a dog kennel on a hill above the pond.
In medical school they taught us that the patient’s history is the most important aspect of diagnosis and care. I wonder if they still teach this, or if doctors will have enough time in the “new order” to ask the right questions. Another patient of mine presented with more long standing diarrhea, nausea and abdominal cramps. He was an avid hiker and outdoors man. He didn’t contemplate a protozoan infection with giardia after drinking from a mountain stream. And apparently he didn’t taste the beaver waste from the upstream inhabitants.
The news is abuzz with Ebola and the latest outbreak of this viral gastrointestinal illness in Western Africa. Apparently, the latest wars in the Middle East, the war in eastern Ukraine, and the invasion of our southern border are insufficient to fill the twenty-four news cycle. I read a book about twenty years ago called “The Hot Zone” by Richard Preston which described the Ebola and Marburg hemorrhagic viral diseases. These Old World infections have been present in Africa probably for eons. However, because people in Africa are isolated, terrible infections quarantine themselves and burn-out in the jungle. All the same, if you concentrate people in cities, remove borders, or put them on airplanes, latent infections can become epidemics.
I believe the two American’s with Ebola infection pose little risk to America since they are quarantined, and the Ebola virus is only spread by body fluids. Experts are caring for these courageous missionaries who risked their lives treating others and spreading the Gospel. I’m more concerned by the twelve airline flights from Africa who land daily in America. And I’m terrified by the invasion of our country by desperate people, some of whom come from Africa. Furthermore, statistics say we only stop one in ten.
Quarantine measures were used effectively at Ellis Island when we had controlled immigration. We have neither now. Even astronauts were quarantined after walking on the airless moon. And did you know that the United States closed its borders to further immigration between 1925 and 1965 to allow immigrants time to assimilate and become Americans?
Despite what you may have heard, the majority of “native Americans” in the New World were killed by exposure to measles, small pox, and other Old World diseases rather than by Spanish Conquistadors or Old Hickory. The latter were brutal, but bacteria and viruses are lethal. The immune systems of the American Indians were not prepared for the onslaught of these infectious scourges of the Old World. Recently, the internet reported an isolated aboriginal tribe in the Brazilian rain forest who came in contact with agents of civilization and promptly came down with influenza. The Indians have refused further contact. We should overcome our political correctness and not let our our hubris bring us destruction.
I’ve read that the major stumbling block for a spiritual perspective is the notion of Divine Justice. In other words, if God is omnipotent, omniscient and omnipresent, why do bad things happen to good people? The Greek Epicurus asked this same question 2500 years ago. I could argue that if there is no Absolute Ideal then the notion of good or bad is a relative concept of man. However, I’m at the end of my column and I’ll leave you with this thought by the great 5th century Church father and philosopher Augustine. He said, “If there is no God, why is there so much good in the world?”
I hope that these Godly missionaries will be helped by the CDC and Emory Hospital. I hope this promising anti-viral agent developed from a rapid growing Kentucky tobacco plant will lead to an effective treatment for the Ebola hemorrhagic gastroenteritis. I hope that America and Western civilization will survive this war of cultures, because if Hamas, ISIS, Al Qaeda, and radical Islam win, there will be no place left to go.