Montezuma's Revenge (illness)

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Montezuma's Revenge (var. Moctezuma's Revenge) is the colloquial term for any episodes of travelers' diarrhea or other sicknesses contracted by tourists visiting Mexico. The name humorously refers to Moctezuma II (1466-1520), the Tlatoani (ruler) of the Aztec civilization who was defeated by Hernán Cortés the Spanish conquistador.

While many gastrointestinal illnesses fall under the umbrella term "Montezuma's Revenge", approximately 80% of cases are caused by bacterial infection. The most common organisms are enterotoxigenic Escherichia coli, Shigella and Campylobacter jejuni. It is likely that residents have developed a tolerance to these organisms, but they cause sickness in visitors who consume the same food or liquids.

Symptoms range from mild to severe and may include:

• Nausea and vomiting
• Diarrhea
• Abdominal pain (cramps and colicky pain, strong bowel movements)
• Malaise and weakness
• Fever

It is estimated that 40% of foreign traveller vacations in Mexico are disrupted by the infection.[1] Most cases are mild and resolve in a few days with no treatment. Severe or extended cases, however, may result in extensive fluid loss and/or dangerous electrolytic imbalance which pose a severe medical risk and may prove fatal if mismanaged. The oversight of a medical professional is advised.

Mild cases are best treated by drinking liquids to replace fluid loss, combined with a light diet. It is important to include sources of electrolytes in the diet as drinking water alone in large amounts incurs the risk of hyponatremia which can be quite dangerous.

Treatment of traveler's diarrhea includes antibiotics and antidiarrheal medications. A typical regimen would include a loading dose of loperamide (Imodium) and a fluoroquinolone antibiotic such as ciprofloxacin or levofloxacin. Over the counter anti-diarrheal medications do not cure the underlying illness but may provide temporary relief allowing the traveler to enjoy brief sight-seeing episodes or endure a plane trip home.

To avoid Montezuma's revenge travellers are recommended to avoid food and drink that can harbor bacteria cultures. Dry, processed, or cooked foods are safe, as long as they have not been handled or rinsed with local water. Bottled beverages are safe if they come from a major manufacturer, although ice cubes added to the drink may make it unsafe - this depends on the source of the water in the ice. Fruit drinks pose a risk if they are prepared with unfiltered water or by fresh squeezing. The traveler should also refrain from ingesting any water while showering or brushing their teeth. If the traveler has a significant underlying disease, antibiotic prophylaxis may be in order while in country. Antibiotics such as ciprofloxacin and trimethoprim-sulfamethoxazole are effective.

Not all water supplies in Mexico are contaminated and many hotels have water purification systems that eliminate risk. Certain resort destinations also have large-scale water purification systems which provide safe water city-wide. The best advice is to ask other experienced foreign travellers or to exercise caution when in doubt. Roadside and popular food stalls specifically should be avoided.