Costa Rica (Lonely Planet, 9th Edition) - Matthew Firestone [505]
Typhoid
Typhoid fever is caused by ingestion of food or water contaminated by a species of salmonella known as Salmonella typhi. Fever occurs in virtually all cases. Other symptoms may include headache, malaise, muscle aches, dizziness, loss of appetite, nausea and abdominal pain. Either diarrhea or constipation may occur. Possible complications include intestinal perforation, intestinal bleeding, confusion, delirium or (rarely) coma.
Unless you expect to take all your meals in major hotels and restaurants, a typhoid vaccine is a good idea. It’s usually given orally, but is also available as an injection. Neither vaccine is approved for use in children under the age of two.
The drug of choice for typhoid fever is usually a quinolone antibiotic such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), which many travelers carry for treatment of traveler’s diarrhea. However, if you self-treat for typhoid fever, you may also need to self-treat for malaria, since the symptoms of the two diseases may be indistinguishable.
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TRAVELER’S DIARRHEA
To prevent diarrhea, you should only eat fresh fruit or vegetables if cooked or peeled; be wary of dairy products that might contain unpasteurized milk; and be highly selective when eating food from street vendors. Tap water is generally OK, but when you’re off the beaten path it’s best to drink bottled and avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets).
If you develop diarrhea, be sure to drink plenty of fluids, preferably with an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment, but if you start having more than four or five stools a day, you should begin taking an antibiotic (usually a quinolone drug) and an antidiarrheal agent (such as loperamide). If diarrhea is bloody or persists for more than 72 hours, or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.
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ENVIRONMENTAL HAZARDS
Animal Bites
Do not attempt to pet, handle or feed any animal, with the exception of domestic animals known to be free of any infectious disease. Most animal injuries are directly related to a person’s attempt to touch or feed the animal.
Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, followed by application of an antiseptic such as iodine or alcohol. The local health authorities should be contacted immediately for possible postexposure rabies treatment, whether or not you’ve been immunized against rabies. It may also be advisable to start an antibiotic, since wounds caused by animal bites and scratches frequently become infected. One of the newer quinolones, such as levofloxacin (Levaquin), which many travelers carry in case of diarrhea, would be an appropriate choice.
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Insect Bites
No matter how much you safeguard, getting bitten by mosquitoes is part of every traveler’s experience in the country. While there are occasional outbreaks of dengue fever (Click here) in Costa Rica, for the most part the greatest worry you will have with bites is the general discomfort that comes with them, namely itching.
The best prevention is to stay covered up – wearing long pants, long sleeves, a hat and shoes (rather than sandals). Unfortunately, Costa Rica’s sweltering temperatures might make this a bit difficult. Therefore, the best measure you can take is to invest in a good insect repellent, preferably one containing DEET. (These repellents can also be found in Costa Rica.) This should be applied to exposed skin and clothing (but not to eyes, mouth, cuts, wounds or irritated skin).
In general, adults and children over the age of 12 can use preparations containing 25% to 35% DEET, which usually lasts about six hours. Children between two and 12 years of age should use preparations containing no more than 10% DEET, applied sparingly, which will usually last about three