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一、雙語讀
When the Mango Bites Back
印度旅行，一隻芒果引發的腹瀉
NEW DELHI - Accepting a just-picked mango from a stranger in Lodi Gardens and then putting it directly into my mouth - skin and all - was stupid. I admit that.
新德裡——在洛迪花園從陌生人那裡接過一枚剛剛採摘的芒果，然後直接把它連皮塞進嘴裡，這太蠢了。我承認這一點。
But why did my first horrible case of traveler's diarrhea in India have to result from a mango? I love mangoes, and India's vast array of deliciously different mango varieties has been one of the great delights of moving here.
但我在印度的第一次嚴重的「旅行者腹瀉」（traveler’s diarrhea，人們在外出旅行過程中由於感染了細菌、病毒、腸寄生蟲等發生的腹瀉——譯註），為什麼是一個芒果引發的呢？我愛芒果，印度富產的品種繁多的美味芒果，正是我被外派到這裡工作的樂趣之一。
"You didn't even wash it?" Dr. Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia, asked me later.
「你不洗一下芒果就直接吃了嗎？」 後來，美國費城兒童醫院(Children’s Hospital of Philadelphia)的傳染病科主任保羅·奧菲特博士(Dr. Paul Offit)這樣問我。
No.
沒洗。
"Even by your standards, that was really stupid," Dr. Offit said.
「即使按你的標準，那也是非常愚蠢的，」奧菲特博士說。
But what about the local yogurt I had eaten and the probiotic pills I had taken - weren't my gastrointestinal flora protecting me? Since we all carry 10 times as many bacterial cells as human ones, wasn't I for all intents and purposes already more Indian than American?
但是，我已經喝了當地土產的酸奶，並且吃了帶到印度來的益生菌藥片，我的胃腸道菌群不是能保護我嗎？既然我們每個人身上攜帶的細菌在數量上十倍於自身的人體細胞，那麼無論意圖和目的，我的胃腸道菌群不是已經更印度化，而非美國化了嗎？
"Yogurt probably won't hurt you, unless it's contaminated as well," Dr. Phyllis Kozarsky, an expert on traveler's health at the Centers for Disease Control and Prevention, said in an interview. But there is no food on the planet that will protect against an onslaught of toxic bacteria, she added.
「酸奶可能不會傷害你，除非它也被致病細菌汙染了，」美國疾病控制和預防中心(Centers for Disease Control and Prevention)的旅行健康專家菲利斯·考扎斯基博士(Dr. Phyllis Kozarsky)在一次採訪中如是說。但是她補充道，地球上沒有任何食物能抵禦致病細菌的侵襲。
Despite decades of immunological research and a recent surge of interest in the bacterial garden of the human gut, diarrhea remains the most unpredictable travel-related illness. There is a grim acceptance among Western expatriates and visitors here that they will be felled by it - often on multiple occasions.
儘管經過了幾十年的免疫學研究和最近風靡的對人體腸道細菌群落的研究，腹瀉仍然是最防不勝防的遊客疾病。在印度的西方外籍人士和遊客，都無可奈何地接受了一個嚴峻現實：他們必將遭遇腹瀉，並且通常是多次腹瀉。
And there is a host of myths surrounding traveler's diarrhea, many of which I have cheerfully perpetuated to family and friends. (Well, mostly to my wife.) There are also intriguing mysteries about how natives gain immunity to the food- and waterborne bacteria that prove so toxic to non-natives.
許多傳說繚繞著旅行者腹瀉，我興高採烈地把其中不少內容傳授給親友。（好吧，主要是傳授給我的妻子。）坊間也流傳著許多令人著迷的傳說，比如印度當地人如何獲得了外國人望塵莫及的免疫力，能抵禦食源性和水源性的致病菌。
I have lived in India for four months, and I have been in gastrointestinal distress five times - roughly once a month. Part of the problem is that Indians are a very hospitable people. Almost everywhere I go, someone offers me food and drink, forcing me to quickly weigh the chance of contamination against the likelihood that a refusal would cause offense.
我已經在印度住了四個月，我經歷的胃腸道不適有五次之多——大致是一個月一次。部分原因是印度人非常好客。幾乎無論我去哪裡，都有人好吃好喝招待著我，迫使我不得不趕緊在心頭盤算究竟是冒著食物被汙染的可能性吃下去，還是冒著拒絕好意而得罪人的風險咬緊牙關就是不吃。
Beyond this coldhearted calculus is my very real desire to connect with people. The mango in question was given to me by a woman with such obvious good will that I found refusing her difficult.
在看似冷漠的權衡背後，是我真心渴望與當地人交流。引發腹瀉的芒果就是一個女人客客氣氣送到我嘴邊的，我感到盛情難卻。
I bit into the mango, putting my mouth on the peel to suck out the juice and pulp. As I did this, my brain engaged. A bird might have covered the mango in droppings. The mango might have fallen on the ground. The woman handing it to me might have been covered in toxic E. coli (more than 600 million people in India have no routine access to bathrooms).
我咬了一口芒果，把我的嘴對著扒開的那部分，吸出果汁和果肉。當我吃的時候，我的大腦轉個不停。一隻小鳥也許曾在芒果上逗留。芒果可能曾落在地上。遞給我芒果的女人可能自身攜帶著致病的有毒大腸桿菌（在印度，六億多人都沒有常規的如廁條件）。
Within hours, my stomach was in an uproar and I was seized with a fever. I knew I was in trouble because my first three cases of traveler's diarrhea had been mild enough that I managed to get through them without taking any medicines, something I considered a personal triumph mostly because it allowed me to compare myself favorably with my wife.
沒過幾個鐘頭，我的胃就開始翻江倒海，開始發燒。我知道自己麻煩大了，因為我前三次患上的旅行者腹瀉都不厲害，沒有服用任何藥物就扛過去了，那會兒我還為此頗為自得，主要是因為這令我顯得比妻子略勝一籌。
Indeed, my wife joined me for the first week of my stay here before returning temporarily to the United States, and within four days she became terribly ill. I freely dispensed what turned out to be terrible advice, suggesting in the early hours of her illness that she avoid taking one of the antibiotic pills that we had brought for just such an eventuality.
確實如此，我的妻子和我一起來到印度，待了一個星期之後，她暫時返回美國，回美國不到四天，她就病倒了。我隨隨便便給她的建議後來被證明是糟糕透頂的，我建議她在發病的最初幾個小時，避免服用抗生素藥，雖然我們手頭就有備用的抗生素應對可能會出現的旅行者腹瀉。
My advice sprang from the mistaken belief that the good bacteria in her gut had a fighting chance against the bad bacteria. "Honey, taking an antibiotic is like carpet-bombing a battlefield," I told her in confident tones. "You kill off all the good guys as well as the bad guys. Let's see if the good guys rally first."
我的建議是源於錯誤的觀念，我認為她腸道菌群中的益生菌有可能擊潰致病菌。「親愛的，服用抗生素如同地毯式轟炸戰場，」我充滿自信地告訴她：「你會把好人和壞人一古腦統統殺死。讓我們先等等，看這幫好人能不能發威。」
They did not. As it turns out, the fight against toxic bacteria is largely waged by the body's immune system, not the sweet-tempered millions found in a spoonful of yogurt.
它們不能。事實證明，有毒細菌的擊潰主要是靠人體的免疫系統，而不是靠每匙酸奶中數以百萬計、脾氣溫吞的益生菌。
"An immune response is a much more powerful agent against these bacteria than is trying to rearrange things within your intestinal flora," Dr. Offit said. The wait, of course, simply ensured that the toxic bacteria were allowed to thrive and make her very sick, delaying her return home.
「與試圖重新調理你身體的腸道菌群相比，免疫反應更能強有力地擊潰致病菌，」奧菲特博士說。自然了，等待的這段時間只會讓有毒細菌趁機發展壯大，使她病得更重，延遲了她返家的時間。
Oops.
哎呀呀。
That Indians are less likely to be sickened by the foods that felled my wife and me results less from their different intestinal flora than from years of hard-won immunologic experience, said Dr. David Relman, a microbiologist at Stanford University School of Medicine.
美國史丹福大學醫學院(Stanford University School of Medicine)的微生物學家大衛·雷爾曼博士(Dr. David Relman)說，導致我和我妻子生病的食物，印度本地人吃了之所以沒事，主要是因為他們的免疫系統久經沙場經歷了來之不易的磨練，而不是因為他們的腸道菌群與我們的不同。
"Although it may appear that a lot of adults don't seem to develop diarrheal disease, they probably had a fair bit of it as kids, and it was through those episodes that they got immunized," Dr. Relman said.
「雖然印度的很多成年人看起來不容易腹瀉，但是他們在小時候可能拉了很多次肚子，正是通過幼年的磨練，使他們獲得了免疫力，」雷爾曼博士說。
But without experience fighting these new invaders, my wife's immune system had little chance of preventing her illness. That is why quickly taking antibiotics is so crucial. They are often miraculous cures, because 80 percent to 90 percent of traveler's diarrhea cases are caused by bacteria, Dr. Kozarsky said.
但是，我們可從未實戰抵禦過這些新的入侵者，所以我妻子的免疫系統就幾乎不可能防禦腹瀉。這就是為什麼迅速服用抗生素是如此重要。考扎斯基博士說，抗生素往往是靈丹妙藥，因為80%到90%的旅行者腹瀉都是由細菌引起的。
Imodium, also known as loperamide, is effective too. Again, this was news to me. Initially, my wife decided against taking Imodium because she thought doing so would lengthen the duration of illness. I concurred. Wrong again.
同樣有效的是易蒙停(Imodium)，或稱洛哌丁胺(loperamide)。而這一點我以前也不知道。最初，我妻子決定不服用易蒙停，因為她認為易蒙停會延長病程。我同意了。我又錯了。
There is no evidence that Imodium lengthens the illness, Dr. Kozarsky said. Instead, it simply ameliorates the illness's highly disruptive symptoms - a significant benefit when the short trip to the bathroom seems like a marathon.
考扎斯基博士說，沒有證據表明易蒙停會延長病程。相反，它只會減輕翻江倒海的腹瀉症狀——在你病體虛弱不堪的時候，易蒙停的一個明顯好處就是減少了你上廁所的次數。
Still, there are risks associated with aggressive treatment of traveler's diarrhea. Antibiotic therapy can increase a patient's vulnerability to other toxic bacteria, Dr. Relman said. All the good bacteria that normally inhabit the human gut - bacteria that get decimated with antibiotics - somewhat inhibit toxic microbes from getting a foothold or flourishing, even if they cannot fight off a full-scale assault.
不過，旅行者腹瀉的過度積極治療也會有風險。雷爾曼說，抗生素治療使患者更容易感染上其它的有毒細菌。這是因為抗生素把益生菌殺滅了，人體腸道菌群中正常的益生菌即使不能抵禦毒性細菌的全面猛攻，也能在一定程度上阻止毒性細菌在腸道中安營紮寨、繁榮昌盛。
"If you take an antibiotic and then get on a plane to India, you're much more likely to develop a serious infection," Dr. Relman said.
「如果你先服用抗生素預防，然後登上飛機去印度，那麼你就更有可能患上嚴重的感染性疾病，」雷爾曼博士說。
Without those bacteria, the body may be more susceptible not only to other bacterial infections but even to viral ones like the flu, said Dr. Susan M. Huse of the Marine Biological Laboratory in Woods Hole, Mass.
美國麻薩諸塞州伍茲霍爾市海洋生物實驗室(Marine Biological Laboratory)的蘇珊·M.休斯博士(Dr. Susan M. Huse)說，如果人體缺失了這些益生菌，那麼不僅更容易遭遇其它細菌性感染，而且也更容易患上像流感這樣的病毒性感染。
Studies also have suggested that the obsessive cleanliness in the West and overuse of antibiotics may be creating a generation whose immune systems, perhaps too protected from attack in childhood, are now constantly on overdrive, resulting in far more asthma and allergies. My 7-year-old son has had both problems, and while I am hopeful that the seemingly plentiful array of different bacteria here may help him, I certainly do not wish for him to get horribly sick in the meantime.
研究還表明，在西方發達國家，過度講究乾淨和濫用抗生素的環境下成長起來的一代人，他們的免疫系統因為在幼兒時缺乏磨練，所以長大後就不斷產生過激反應，導致哮喘和過敏症的發病率猛增。我七歲的兒子就患有上述這兩種病，我雖然希望印度看似琳琅滿目的細菌種類能馴化他的免疫系統，但我當然不希望他在此期間得重病。
Indeed, repeated cases of traveler's diarrhea can damage the gut's ability to absorb nutrients and cause stunted growth in children, Dr. Relman said. Some studies suggest gut bacteria could even play a role in the development of obesity.
雷爾曼博士說，多次反覆發作旅行者腹瀉可能會損壞腸道的營養吸收能力，延遲兒童的生長發育。一些研究表明，腸道細菌甚至可能導致發胖。
If there is a benefit from exposure to bad bacteria, it most likely occurs in infancy, when immune systems are still developing, said Michael Fischbach, a microbiologist at the University of California, San Francisco. My son is probably too old for new bacterial exposures to retrain his immune responses.
美國加州大學舊金山分校(University of California, San Francisco)的微生物學家麥可·菲施巴赫(Michael Fischbach)說，如果接觸壞細菌對人體有好處，這好處最有可能發生在嬰兒期，因為這時免疫系統還在發育之中。我的兒子可能已經年歲太大了，沒法再通過接觸新的細菌來重新調教他的免疫反應。
To ward off diarrhea, Dr. Fischbach endorsed eating yogurt and other fermented foods, particularly after using antibiotics, although he said there is little evidence proving the effectiveness of this strategy.
菲施巴赫博士認為吃酸奶以及其它的發酵食品，尤其是在服用抗生素之後多吃這些食物，能預防腹瀉，不過他表示目前並沒有多少證據證明這種做法的有效性。
Dr. Kozarsky recommended daily doses of Pepto-Bismol, which can reduce the risks of contracting traveler's diarrhea during brief stays. Pepto-Bismol is not recommended for long periods, she said. Indeed, some antacid therapies can increase vulnerability to traveler's diarrhea.
考扎斯基則建議在短期旅行時每日服用一定劑量的鹼式水楊酸鉍(Pepto-Bismol)，這能夠減少患旅行者腹瀉的風險。但她不建議長期服用該藥。事實上，一些抗酸劑藥物可以增加患旅行者腹瀉的風險。
She recommended that travelers limit meals to foods that resist bacteria or those that have been well cooked. "If you eat things that are still steaming, the bacteria will be killed," Dr. Kozarsky said.
她建議外出旅行時只吃抗菌或已徹底煮熟的食物。「如果你吃的食物是熱氣騰騰的，那麼細菌就已經被消滅光了，」 考扎斯基說。
Since we live here, we cannot abandon fresh fruits and vegetables. Instead, we soak them in diluted bleach - including our mangoes. Because gut bacteria are now suspected by scientists of playing roles not only in keeping my weight down but also in protecting against a variety of chronic diseases, like autoimmune disorders and diabetes, I will continue to try to get through mild bouts of diarrhea without resorting to medication.
既然我們在印度生活，我們就不能放棄吃新鮮的水果和蔬菜。吃之前，我們先用稀釋的漂白劑浸泡果蔬——包括芒果在內。由於科學家們現在認為腸道細菌不僅能有助於體重下降，而且能有助於預防各種慢性疾病，如自身免疫性疾病和糖尿病，所以我仍然會按老辦法來，碰到輕度腹瀉時儘量不吃藥。
But if I develop a fever or really suffer, I plan immediately to take ciprofloxacin, a powerful antibiotic that is available over the counter in India.
但是，如果我開始發燒或感覺痛苦難耐，就會立即服用環丙沙星，這種強效抗生素在印度是非處方藥。
My repeated bouts of serious illness meant that I was no more robust or prepared for India than my wife, a tough blow to my ego. I have been sick more days than she. Living here will make me less vulnerable over time, but I no longer strive to become as resistant to infections as my Indian neighbors.
在印度，我反反覆覆發生嚴重腹瀉，表明在體質或適應性上，我居然比不上妻子，這沉重地打擊了我的自尊心。我生病的天數比她生病的天數更多。住在這裡，隨著時間的推移，我將越來越能抵禦感染，但我並不想在這方面趕超我的印度鄰居。
To achieve that, "you would suffer a variety of illnesses," Dr. Offit said. "And under the assumption that suffering is bad, I wouldn't recommend it."
為了達到印度本地人抵禦感染的能力，「你必須經受各種感染性疾病的折磨，」奧菲特說。「我估計受折磨終歸不是好事，所以這個方法我不推薦你使用。」
來源：紐約時報
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