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Barcoo Fever - Causes, Symptoms, Diagnosis, and Treatment

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Barcoo fever was once common in remote areas of Australia but is now sporadic. It is an enteric fever that affects the gastrointestinal tract.

Medically reviewed by

Dr. Ghulam Fareed

Published At January 31, 2023
Reviewed AtJune 23, 2023


Barcoo fever, also known as “Barcoo sickness” or “Barcoo spews.” Barcoo fever was commonly seen in travelers rather than in Australian cities or towns. It is caused due to cyanobacteria secreting toxic substances affecting the gastrointestinal tract. Generally, Barcoo fever was spread by drinking water from sources like ponds, pits, and wells.

What Is Barcoo Fever?

Hayman, in 1992 suggested that an illness in the Australian outback population known as Barcoo fever was caused by tropical cyanobacterium, “Cylindrospermopsis raciborskii.” Primarily seen in travelers in remote Australian areas, it is characterized by symptoms like fever, myalgia, diarrhea, lethargy, nausea, and vomiting. Severe cases result in death.

How Is Barcoo Fever Caused?

The ingestion of blue-green algae causes Barcoo fever. It is spread by drinking water from unsafe sources like ponds, rivers, bores, and rainwater. Boiling water does not destroy the toxins. The toxin secreted by Cyanobacteria is hepatotoxic.

Cyanobacteria (cyano= blue and bact =rod), also known as blue-green algae, is one of the most successful groups of prokaryotic, gram-negative, photoautotrophic organisms distributed all over the world. They have survived successfully for more than three billion years on Earth. Cyanobacteria have chlorophyll, similar to green plants. The Cyanobacteria are unicellular, colonial, or filamentous freshwater, marine, or terrestrial algae. A gelatinous sheath generally surrounds the colonies. They often bloom in polluted water bodies. Cyanobacteria occupy many habitats and grow wherever they get suitable moisture and temperature conditions. However, they are predominantly aquatic and occur mostly in freshwater habitats such as ponds, pools, lakes, and other reservoirs.

Some blue-green algae secrete toxins. This toxic substance is the main cause of death in aquatic animals. Thus the consumption of such water is toxic to humans also. It makes the water toxic and gives a foul odor to the water. Furthermore, the bloom-forming Cyanobacteria “ Cylindrospermopsis raciborskii” is hepatotoxin and neurotoxic, harmful to aquatic life and human health.

What Are the Symptoms of Barcoo Fever?

The following are the symptoms of Barcoo fever:

  • Fever.

  • Diarrhea.

  • The sight or smell of food aggravates nausea and vomiting.

  • Myalgia (muscle pain).

  • Severe cases can lead to death.

  • Discomfort, bloating, and nausea, are thought to originate from the upper gastrointestinal tract (dyspepsia).

  • Failure of the liver.

  • Abdominal pain.

  • Prolonged enteritis.

  • Weight loss.

  • Lethargy and malaise.

How Can Barcoo Fever Be Diagnosed?

The term bacterial poisoning is conventionally restricted to acute gastroenteritis due to the presence of bacteria. Usually in large numbers or their products (toxins) in water. Bacteriological diagnosis of enteric fever consists of the following:

1) Isolation of Bacilli - This may be done by culture of specimens like blood, feces, urine, aspirated duodenum fluid, etc. The selection of relevant specimens depends upon the duration of the illness, which is very important for the laboratory diagnosis of enteric fever.

  • Blood Culture - Blood cultures are positive in approximately 90 percent of cases in the first week of fever, 75 percent in the second week, and 60 percent in the third week. However, the positivity rate declines after that, and blood cultures remain positive in 25 percent of cases till the subsidence of fever.

  • Clot Culture - It is an alternative to blood culture. 5 ml (milliliter) of blood is withdrawn aseptically into a sterile container and allowed to clot. Then, the serum is separated and used for the test.

  • Feces Culture - Cyanobacteria is shed in the feces throughout the disease and during recovery due to lesions in the intestine. Hence, fecal cultures may be helpful in patients as well as for the detection of carriers. Feces cultures are generally positive after the second week of illness. As normal flora is present in feces, successful culture will depend on enrichment and selective media.

  • Urine Culture - Urine culture is less frequently positive than feces culture. Cultures are generally positive only in the second and third weeks. After the third week, only about 25% of cases may be positive. Repeated cultures improve the chance of isolation.

  • Other Specimens for Culture - Bone marrow culture is valuable as it is positive even when the blood cultures are negative. The culture of bile is usually positive and may be helpful in the detection of chronic carriers.

2) Demonstration of Antibodies - It is an agglutination test for detecting agglutinins in patients with enteric fever. Bacterial antibodies start appearing in the serum at the end of the first week and rise sharply during the third week of enteric fever.

3) Demonstration of Circulating Antigen - A coagglutination test can detect the antigen. The test is rapid, sensitive, and specific but is positive only during the first week of the disease.

How Can Barcoo Fever be Prevented?

All waste that is capable of causing infection should be properly disposed of. Safe and sanitary measures for sewage disposal and water treatment can effectively control Barcoo Fever. Landfilling, deep burial, Incineration, and sewage can be used for disposal. Treatment and disposal of infectious waste into the landfilling or deep burial. Disposing of liquid waste in sewage drains.

People should not drink water from unsafe sources such as wells, ponds, rivers, etc. Precautions should be taken to avoid algae contamination in communal water supplies. In addition, one should maintain personal hygiene.

When to See a Doctor?

A person should consult a doctor if

  • An infant suffers from a high fever (102 degrees Fahrenheit).

  • The fever did not get lowered after taking over-the-counter medicines.

  • The adult has been suffering from a high fever for three to four days.

  • Any person should come in contact with the affected person.

  • Any child who has been suffering from diarrhea.

  • A person is facing difficulty in passing stool.

  • A person suffers from severe pain, which worsens as the day passes.

  • A person is facing discomfort in eating due to repeated nausea or vomiting.

  • A person is feeling tired all day.

  • Abdominal bloating worsens throughout the day.

  • A person suffers from excessive intestinal gas.

What Is the Treatment for Barcoo Fever?

Antibiotics are the drug of choice for Barcoo fever. Chloramphenicol has been the antibiotic of choice for enteric fever. Amoxicillin, Ampicillin, Furazolidone, and Cotrimoxazole are also effective. However, resistance to Chloramphenicol and other antibiotics has been reported. Fluoroquinolones and third-generation Cephalosporin are useful in multi-resistant cases.


Incidents of Barcoo fever have now vanished with the provision of safe drinking water. The average population of Australia avoids this infection by not drinking water from sources like well, ponds, pits, and rivers. Adhering to the preventive measures described above would help in preventing outbreaks. In case of an infection, a medical professional should be consulted as soon as possible.

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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology


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