Common Ailements

Sand Flea Bites:

Sand Flea Bites

Sand fleas feed on organic and decaying plants. A favorite treat is seaweed on the beach. Whenever seaweed washes to shore, there will be a large number of sand fleas around and a sand flea bite is likely to occur. In general, the sand on the beach is a popular location for these fleas to live.

The fleas will jump onto the feet, ankles, legs, and then bite. They are very persistent and quite annoying. Because of their small size, a sand flea bite occurs before individuals even know any sand fleas were in the area. Like a mosquito, a sand flea bites to suck blood. It is the female sand fly that bites. It does this in order to get the protein from the blood that is necessary for its egg laying. The sand flea bite involves the injection of saliva to thin the blood, making it easier for the flea to take blood from its victim. This same saliva triggers the body’s immune system to react.

Despite its size, the bite from a sand flea is quite painful. In fact, most of the time the bite is more painful than one from a typically larger mosquito. In addition to pain, the bite causes a large welt or rashes on the skin that can persist for several days. A fever may also occur. The welts or hives produced from bites are very itchy. Scratching the bitten areas should be avoided in order to prevent the development of an infection. Scratching will also prolong the symptoms of swelling, itch, and skin redness.

The itching associated with flea bites can be treated with anti-itch creams, antihistamine  or hydrocortisone. Calamine lotion has been shown to be effective for itching. Also a bath with TCP and bicarbonate of soda has been found to reduce the itching.

Tourista (traveller's diarrhea)

 Tourista (traveller's diarrhea)Diarrhea is the most common affliction of travellers to developing countries occurring in 20% to 50% of those travelling to destinations in tropical and subtropical areas of Latin America, Africa, and southern Asia.  Even within the developed world, severe or temporary sewage-system failures or flooding may contaminate water supplies, and diarrheal illness may result.

Travellers' diarrhea (TD) is usually an acute illness characterized by at least three loose or semiformed stools per day.  It may be associated with other symptoms such as nausea, vomiting, and abdominal pain. The onset of illness usually coincides with travel, although it may occur during the first 7 to 10 days after returning home.

 In general, no investigations are necessary and self-treatment can be advocated for acute TD unless the patient is very ill, has a significant underlying medical illness, is immunodeficient, or has bloody stools; if any of these apply, medical assistance should be sought for investigation and management.

Some travellers may not have onset of their symptoms until after returning from travel.  This may be acute TD with a prolonged incubation period,  more than 7 days after leaving a tropical location.  

An oral vaccine exists to help prevent traveller's diarrhea (Dukoral). It must be taken two weeks before leaving and it protects up to 70% for a period of 3 months.

If you are predisposed to travellers diarrhea or are travelling for 2 weeks or more, an antibiotique can be prescribed before leaving and used as self treatment if diarrhea is present during travel.

 

Ciguatera Poisoning        

Ciguatera Poisoning

Ciguatera is a most common food poisoning associated to eating fish.  Canadian ciguatera poisoning happens most often to travelers in tropical and sub-tropical where coral can be found: especially on the islands (Cuba, Dominican Republic, Jamaica and Haiti) and the Pacific. Certain cases were also reported in Florida and Hawaii.

The ciguatera toxin is found in algae. Small fish eat this algae, bigger fish eat the smaller ones that cumulate the toxins in their flesh and visceral. Humans get intoxicated by eating these bigger fish.

There are over 400 species of ciguateric fish. The most frequent are: the barracuda, the snapper, the grouper, the amberjack, the kingfish, the surgeonfish, the mackerel and the sea bass.  Bottom feeders or deep sea fish (like tuna) are rarely ciguateric.

The toxicity of these fish is inconstant and unpredictable. The toxin does not alter taste, odor, nor the appearance of the fish. It is not destroyed by the cooking process. 

  The digestive symptoms appear les than 24 hours after eating the toxic fish and can persist a few days : nausea, vomiting, diarrhea and abdominal pains.  Neurological symptoms appear 1-2 days later and can persist for a few  months : fatigue, weakness, head aches, muscle and articular pains, dizziness, numbness around the mouth and extremities.  A burning sensation when exposed to cold temperatures is a particular symptom of this illness. The gravity of the symptoms vary and death is rare. The treatment is symptomatic. There is no specific treatment.

 The other toxins, les frequent but very serious, are related to other fish and seafood, especially shellfish (oysters, muscles, clams…) In most tropical countries there is no particular criteria for seafood quality. It is best to avoid large fish and insufficiently cooked seafood.

 Prevention consists in getting informed on the local ciguatera situation and verifying the consumption of local fish. It is suggested to avoid eating bigger fish (more than 1,5kg), the visceral, the liver, the skin fish stews or soups. In general, fish that fit in your plate are a good choice.

 

Dengue Fever

Dengue Fever

Since 1980, we have observed an impressible heightening in dengue fever cases. These cases have been observed in many areas of the globe visited by Canadian tourists. It is most frequent in Central America, South America and the CaribbeanIslands.

Dengue fever is transmitted by a mosquito infected by the virus.  This mosquito bites during the day, especially 2 hours before daybreak and 2 hours before nightfall. We find it in urban areas near homes or areas that accumulate rain water (old tires, vases…).

The classical symptoms of dengue fever are a fever, a skin rash, eye pains, muscular and articular pains that start 2 à 7 days after the bite of an infected mosquito. They usually last about one week.  A general weakness can persist for several weeks after the infection.

There is a hemorrhagic form of dengue fever. It is rare but much more severe: hemorrhages, choc and death are the common symptoms. This severe form will most often be seen in children and people infected a second time by this virus.

There is no specific treatment or vaccine for this virus. Hydration support can help prevent death in severe cases.

We should suspect dengue fever for all travelers presenting a fever during, or up to 2 weeks after being in an area of risk for dengue fever. A possibility of malaria should also be noted.

Any fever associated with a rash or bleeding, especially in children, require immediate medical advice.

 Prevention consists of mosquito prevention and should be applied at all times.

  • Bug repellant on exposed skin containing from 20 to 35% of DEET (N, N-diethyl-m-toluamide)
  • Wear long clothing of pale color and avoid perfumed products
  • Stay in dwellings with air conditioning or screens
  • Eliminate stagnant water near dwellings

Dengue fever is a disease that is more and more evident in tropical and subtropical areas but most travelers are at low risk of getting the hemorrhagic type. Precautions to avoid mosquito bites diminish the risks of getting dengue fever.