Diarrhea and Dysentery

Everyone’s body reacts differently to the changes in diet, schedule, and stress that go along with traveling, and many visitors to Nicaragua stay entirely regular throughout their trip. Some don’t.

Diarrhea is one symptom of amoebic (parasitic) and bacillic (bacterial) dysentery, both caused by some form of fecal-oral contamination. Often accompanied by nausea, vomiting, and a mild fever, dysentery is easily confused with other diseases, so don’t try to self-diagnose. Examenes de heces (stool-sample examinations) can be performed at most clinics and hospitals and are your first step to getting better (cost is $2–8).

Bacillic dysentery is treatable with antibiotics; amoebic is treated with one of a variety of drugs that kill off all the flora in your intestinal tract. Of these, Flagyl is the best known, but other non–FDA approved treatments like Tinedazol are commonly available, cheap, and effective. Do not drink alcohol with these drugs, but do eat something like yogurt or acidophilus pills to refoliate your tummy.

Generally, simple cases of diarrhea in the absence of other symptoms are nothing more serious than “traveler’s diarrhea.” If you do get a case of Diriangén’s Revenge, your best bet is to let it pass naturally. Diarrhea is your body’s way of flushing out the bad stuff, so constipating medicines like Imodium-AD are not recommended, as they keep the bacteria (or whatever is causing your intestinal distress) within your system. Save the Imodium (or any other liquid glue) for emergency situations like long bus rides or a date with Miss Nicaragua.

Most importantly, drink water! Not replacing the fluids and electrolytes you are losing will make you feel much worse than you need to. If the diarrhea persists for more than 48 hours, is bloody, or is accompanied by a fever, see a health professional immediately.

Malaria

Risk of malaria is higher in rural areas, especially those alongside rivers or marshes, but malaria-infected mosquitoes breed anywhere stagnant pools of water (of any size, even in an empty bottle cap) are found, including urban settings. At times, western Nicaragua is declared malaria-free, at other times, the U.S. CDC recommends weekly prophylaxis of chloroquine, specifically Aralen-brand pills (500 mg for adults).

Begin taking the pills two weeks before you arrive and continue taking them four weeks after leaving the country. A small percentage of people have negative reactions to chloroquine, including nightmares, rashes, or hair loss. Alternative treatments are available, but the best method of all is to not get bitten.

The malaria bacterium (there are four different kinds) settle in your liver and begin replicating; the bacteria invades your red blood cells and causes them to burst, producing the telltale symptoms of fever followed by chills, fever, and even nausea and vomiting on a 24 hours good/24 hours bad cycle.

If you observe this pattern, seek medical attention immediately, as failure to treat malaria promptly is the primary cause for the disease becoming dangerous. They’ll most likely take a blood test and if it tests positive, prescribe you a huge dose of chloroquine. Allow time to recover your strength.

Dengue Fever

Dengue (“bone-breaking”) fever is the only thing we can think of that’s worse than malaria. You know you have it if you truly believe you will die, and you feel relief that death will make the pain stop. You probably are not going to die of course (unless you contract the rare hemorrhagic strain of dengue), but you’re going to suffer royally.

The symptoms may include any or all of the following: sudden high fever, severe headache (think of nails in the back of your eyes), muscle and back pain, nausea or vomiting, and a full-bodied skin rash, which may appear 3–4 days after the onset of the fever. Although the initial pain and fever may only last a few days, you may be out of commission for up to several weeks, possibly bedridden, depressed, and too weak to move.

There is no vaccine, but dengue’s effects can be successfully minimized with plenty of rest, Tylenol (for the fever and aches), and as much water and suero as you can manage. Dengue itself is undetectable in a blood test, but a low platelet (plaquetas) count indicates its presence. If you believe you have dengue, you should get a blood test as soon as possible to make sure it’s not the rare hemorrhagic variety, which can be fatal if untreated.

HIV and AIDS

Although to date Nicaragua has been spared a major HIV outbreak, health professionals estimate that geography, cultural, political, and social factors mean an outbreak isn’t far off. Currently, there are about 1,500 HIV-positive cases registered with MINSA (the Government Health Ministry), but one World Bank official estimated actual cases at 8,000. Exacerbating the spread of AIDS (SIDA in Spanish) is the promiscuous behavior of many married males, an active sex-worker trade, poor use of condoms, and growing drug trouble.

AIDS is most prevalent in urban populations, mainly Managua and Chinandega, and is primarily transmitted sexually, rather than through needles or contaminated blood.

We don’t recommend you have a blood transfusion, obviously, but furthermore, travelers should avoid sexual contact with persons whose HIV status is unknown. If you intend to be sexually active, use a fresh latex condom for every sexual act and every orifice. Condoms are inexpensive and readily available in just about any local pharmacy; in Spanish, a condom is called condón or preservativo.

Other Diseases

Cholera is present in Nicaragua, with occasional outbreaks, especially in rural areas with contaminated water supplies. Vaccines are not required because they offer incomplete protection. You are better off watching what you put in your mouth. In case you contract cholera (the symptoms are profuse diarrhea the color of rice water accompanied by sharp intestinal cramps, vomiting, and body weakness), see a doctor immediately and drink your suero: Cholera kills by dehydrating you.

Leptospirosis is caused by a bacteria found in water contaminated with the urine of infected animals, especially rodents. Symptoms include high fever and headache, chills, muscle aches, vomiting, and possibly jaundice. Humans become infected through contact with infected food, water, or soil. It is not known to spread from person to person and can be treated with antibiotics in its early stages.

Hepatitis B also lurks in Nicaragua. Avoid contact with bodily fluids or bodily waste. Get vaccinated if you anticipate close contact with the local population or plan to reside in Nicaragua for an extended period of time.

Most towns in Nicaragua, even rural ones, conduct a yearly rabies-vaccination campaign for dogs, but you should still be careful. Get a rabies vaccination if you intend to spend a long time in Nicaragua. Should you be bitten, immediately cleanse the wound with lots of soap, and get prompt medical attention.

Tuberculosis is spread by sneezing or coughing, and the infected person may not know he or she is a carrier. If you are planning to spend more than four weeks in Nicaragua (or plan on spending time in a Nicaraguan jail), consider having a tuberculin skin test performed before and after visiting. Tuberculosis is a serious and possibly fatal disease but can be treated with several medications.

© Randall Wood & Joshua Berman from Moon Nicaragua, 4th Edition