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water contaminated by the urine of infected animals. Outbreaks often occur at times of flooding, when sewage overflow may contaminate water sources. The initial symptoms, which resemble a mild flu, usually subside uneventfully in a few days, with or without treatment, but a minority of cases are complicated by jaundice or meningitis. There is no vaccine. You can minimize your risk by staying out of bodies of fresh water that may be contaminated by animal urine. If you’re visiting an area where an outbreak is in progress, as occurred in Peru after flooding in 1998, you can take 200mg of doxycycline once weekly as a preventative measure. If you actually develop leptospirosis, the treatment is 100mg of doxycycline twice daily.

Gnathostomiasis is an intestinal parasite acquired by eating raw or undercooked freshwater fish, including ceviche. Note, though, that ceviche eaten on the coast will be almost certainly made from seafood.

Plague is usually transmitted to humans by the bite of rodent fleas, typically when rodents die. Symptoms include fever, chills, muscle aches and malaise, associated with the development of an acutely swollen, exquisitely painful lymph node, known as a bubo, most often in the groin. Cases of the plague are reported from Peru nearly every year, chiefly from the departments of Cajamarca, La Libertad, Piura and Lambayeque in the northern part of the country. Most travelers are at extremely low risk for this disease. If you might have contact with rodents or their fleas, however, especially in the above areas, you should bring along a bottle of doxycycline, to be taken prophylactically during periods of exposure. Those less than eight years old or allergic to doxycycline should take trimethoprim-sulfamethoxazole instead. In addition, you should avoid areas containing rodent burrows or nests, never handle sick or dead animals, and follow the guidelines for protecting yourself from mosquito bites (opposite).

Taeniasis and the more serious cysticercosis are both caused by pork tapeworm (Taenia solium). Humans become hosts to the nasty parasite by eating infected or undercooked pork. Although pork tapeworm is rare, it does turn up in Peru, so be careful when eating pork.

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TRAVELERS’ DIARRHEA

You get diarrhea from taking contaminated food or water. See opposite and Click here for ideas for reducing the risk of getting diarrhea. If you develop diarrhea, be sure to drink plenty of fluids, preferably 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 start taking an antibiotic (usually a quinolone drug) and an antidiarrheal agent (such as loperamide). If diarrhea is bloody, 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

Altitude Sickness

Those who ascend rapidly to altitudes greater than 2500m (8100ft) may develop altitude sickness. In Peru, this includes Cuzco (3326m), Machu Picchu (2410m) and Lake Titicaca (3820m). Being physically fit offers no protection. Those who have experienced altitude sickness in the past are prone to future episodes. The risk increases with faster ascents, higher altitudes and greater exertion. Symptoms may include headaches, nausea, vomiting, dizziness, malaise, insomnia and loss of appetite. Severe cases may be complicated by fluid in the lungs (high-altitude pulmonary edema) or swelling of the brain (high-altitude cerebral edema). If symptoms are more than mild or persist for more than 24 hours (far less at high altitudes), descend immediately by at least 500m and see a doctor.

To help prevent altitude sickness, the best measure is to spend two nights or more at each rise of 1000m. Alternatively, take 125mg or 250mg of acetazolamide (Diamox) twice or three times daily starting 24 hours before ascent and continuing for 48 hours after arrival at altitude. Possible side effects