San José, Costa Rica, since 1956

Tropical infections a fact of life in Costa Rica

Before people come to Costa Rica to retire or just visit, they should be prepared for certain personal health issues that result from being in a different climate: infections from bacteria, viruses, fungi or parasites.

The reason these are of concern in Costa Rica is obvious. The country’s tropical climate means that it’s always summer here, and the lack of freezing or even near-freezing temperatures allows microbiological organisms that wouldn’t survive in colder climates to thrive year-round. Additionally, over time bacteria and viruses evolve in unique ways in different geographic areas, and in Costa Rica they have mutated their own singular biology.

As a normal part of living anywhere, we develop some level of immunity and resistance to local infections, whether fungal or viral. But when we go someplace different, we can encounter totally different strains of these pathogens. And we don’t have much, if any, natural resistance to them.

For example, people spending time in Costa Rica will frequently find themselves succumbing to what is locally called “el gripe” (the flu), an upper respiratory viral infection with symptoms resembling those of a cold. It can be caused by many different viruses; to date, more than 480 viruses have been identified worldwide as causing cold-like symptoms. This means that even though each virus creates an immune reaction that prevents us from succumbing to the same strain a second time, we could still contract the gripe six times a year for 80 years and never have the same kind twice.

Fungal infections are another irksome issue in the tropics. Opportunistic fungi that could never survive a winter up north can, in this warm, humid climate, thrive and cause all kinds of problems. They may manifest themselves as something as innocuous as simple underarm odor, develop into more serious, even life-threatening infections, or be somewhere in between.

It’s common to think that control of these noxious bacterial and viral problems should be easy; modern chemistry and advertising have told us that a simple wipe or spray with some product ends all problems before they start. And if that doesn’t work, other ads for over-the-counter drugs tell us they can quickly end the symptoms.

But sometimes these little “bugs” are not so easily controlled. Fungi, viruses and parasites to which we have no natural resistance and which are feeding on what could be called “virgin territory” can be very persistent and difficult to get rid of.

This difficulty stems partially from a worldwide increase in bacterial resistance to common cleaning and hygiene products. Worse, this resistance has also extended to some antibiotic medicines; studies have shown that many pathogens have evolved a resistance to routine medical drugs and treatments. It is believed that this may be the result of reliance on commonly used drugs for treatment of both major and minor infections in the past decades. The issue is being seen more and more frequently in hospitals and other health care settings around the world.

Another factor in increased bacterial resistance may be the everyday use of common household disinfectants like bleach, surface cleaners and detergents, and even deodorants. It has also been suggested, though some experts disagree, that the recent rise in popularity of hand-sanitizing gels is adding to the problem.

Don’t Self-Diagnose

What does all this mean to expat visitors and residents of Costa Rica? Because of increased bacterial resistance and exposure to strains of microorganisms new to us, we expats may be easily bothered by infections we have never experienced before.

As stated previously, some infections are caused by viruses and others are fungal. The two types may seem the same to the untrained eye, but there is a vast difference between the correct treatment of the two types. Bacterial and viral infections can be treated only with antibiotics, whereas fungal infections can often be cured with a topical cream. Not being able to tell the difference can lead to incorrect self-diagnosis and treatment.

According to Dr. David Porras, a U.S.-trained physician and medical director at Clínicas Médicas Sinaí in San José, “Self-diagnosis is a big problem. When sufferers go to a pharmacy and buy a product they believe worked for something in the past, it can be a bad health strategy. Mistakenly treating a fungal infection with antibiotics not only can be ineffective, but also it can help build resistance to the antibiotic, a drug that may be needed to control a future serious viral infection. Each type of infection needs to be professionally diagnosed and specific, targeted treatment administered.”

Porras also recommends proper use of antibiotic soaps, hand gels and home disinfectants.

“Every time we misuse one of these products, we can create a situation that allows the pathogens to develop more resistance,” he says. “If we want to avoid future health problems, we might need to think a little less about maintaining absolute environmental cleanliness and constant pleasant odors. Every time we misuse one of these products, we give microbiological entities the opportunity to grow stronger.”

So what is a person to do when one of the 480 versions of the gripe strikes? Dr. Mario Arias, former deputy director of San Juan de Dios Hospital, says, “Let nature take it’s course. The old saw about taking aspirin, drinking plenty of fluids and getting rest is good advice. This type of infection runs its normal course in about five days. If the illness persists or gets too severe, see a doctor. But don’t self-medicate.”

One other item needs to be mentioned here: intestinal parasites. These are much more common in tropical and semitropical countries than in northern nations. Unfortunately, Costa Rica has its share of them, most of which are types of worms.

Intestinal parasites are largely acquired by eating uncooked, unwashed or improperly prepared foods. Because government control of production and distribution of fresh foodstuffs is less rigorous in Costa Rica than in some other parts of the world, employing good hygiene practices with locally produced raw fruits and vegetables is important here. Luckily, parasitic infestations are usually cleared up with only a couple of doses of the appropriate drug. However, they can be very uncomfortable.

As unsavory as these subjects may be to read about, they are even less pleasant to live with, which is why it is important for both new arrivals and old hands to be aware of them. The possibility of encountering one or more of these health issues is a fact of life in the tropics.

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