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Tropical and Travel Diseases


This page contains useful information for travelers to tropical destinations and people involved in outdoor activities.g (It features subjects like adventure, travel tips, indigenous culture, survival skills, wildlife and plants and more...)


 
  Ailment Prevention Treatment  
  Malaria Prevent mosquito bites (use deet-containing insect repellent, treat clothing with permethrin, sleep under a mosquito net.)

Prophylactic medicines: mefloquine, chloroquine, proguanil, plus-minus Fansidar standby in Central and South Americas. (check locally for resistant strains of the plasmodium).  

mefloquine, chloroquine, proguanil, quinine, quinidine, artemisinin (qinghaosu) and derivatives.

Read the Malaria Page

Read the Malaria Story

 
  Leishmaniasis Prevent sand fly bites 
(same measures as in malaria prevention).
For visceral leishmaniasis (kala azar) and severe cutaneous and mucocutaneous leishmaniasis, intravenous sodium stibogluconate (Pentostam) 20 mg/kg daily for 30-40 days is usually curative.

For mild cutaneous leishmaniasis, dapsone 100 mg twice daily for 6 weeks, or Ketoconazole 600 mg daily for 28 days has been shown good results.

 
  Amebiasis Good hand washing, boil/filter water, cook food well, avoid fly-contaminated foods. metronidazole(flagyl) 750 mg three times a day for 10 days, followed by iodoquinol 650 mg three times a day for 20 days.  
  Giardiasis Good hand washing, boil/filter water, cook food well, avoid anal-oral contact. metronidazole (flagyl) 500 mg three time a days for 7 days; quinacrine (atabrine) 100 mg three times a days for 7 days (not available in the United States); tinidazole (Fasigyn) (not available in the U.S.) 2 gm daily for 1-3 days; furazolidone (furoxone) (not available in the U.S.) 100 mg four time daily for 7 to 10 days.  
  Schistosomiasis Avoid contaminated water (fresh water), chlorinated water and sea water is safe. Heat bath water to above 50 degree C or 122 degree F for more than five minutes, or stand water more than 48 hours in a container. For Schistosoma mansoni and S. hematobium, praziquantil (Biltricide) is curative in a single dose of 40 mg/kg. For S. japonicum and S. mekongi, praziquantel 60 mg/kg is given in three divided doses 6 hours apart. Dexamethasone is a useful adjunct in the treatment of acute neuroschitosomiasis.  
  Traveler’s Diarrhea Disinfecting techniques for water and food, food hygiene, may consider prophylaxis with medications. For watery (non-bloody) diarrhea, fluid hydration is usually sufficient; for bloody diarrhea, need to start antibiotic or antiparacitic medicine in addition to prevention of dehydration. Antibiotic choices include Cipro 500 mg twice daily for 1-3 days; floxin 400 mg twice daily for 1-3 days; furazolidone(furoxone) 100mg 4 times daily for 1-3 days for bacterial infection and for 7-10 days for giardiasis; trimethoprim/sulfamethoxazole DS 1 tab twice daily for 3 days, combing with loperamide increases effectiveness; metronidazole (Flagyl) 500 mg three times daily for 5-7 days for giardiasis.  
  Yellow Fever Vaccine every 10 years, avoid mosquito bites. Supportive therapy only, no cure.  
  Hepatitis A Good hygiene, disinfections of food and water, vaccine, or immunoglobulin. No cure against the virus of hepatitis, but symptoms often disappear after a few weeks to several months. Vaccination is available for hepatitis A and B (and thus can help prevent hepatitis D as well).

Only supportive therapy for dehydration from diarrhea and vomiting, no cure. Avoid alcohol and food heavy on the liver.

 
  Hepatitis B Good hygiene, disinfections of food and water, vaccine, condoms during intercourse, avoid unscreened blood transfusion. Only supportive therapy for dehydration from diarrhea and vomiting; interferon may be useful in chronic hepatitis B, but no cure for either acute or chronic hepatitis B.  
  Hepatitis C Avoid intravenous drug use, nasal cocaine use, unprotected sex, unscreened blood products. Supportive therapy for dehydration from diarrhea and vomiting; there is no cure but interferon may be useful in chronic hepatitis C.
  Hepatitis D and E D: Same transmission as B, but usually occurs after contracting B

E: Similar to A. Epidemic often occurs during big floods.

Supportive therapy for dehydration from diarrhea and vomiting; there is no cure.  
  Fungal infections

(skin rashes)

Keep skin and clothing dry and clean. Antifungal medications.  
  Bacterial skin infections (open sores, cuts) Keep wounds dry and clean, wash wounds with clean saline for disinfections. Antibiotics—topically or orally.  
  Chagas Disease Avoid assassin (a.k.a. kissing, ruduviid) bugs which hide in the adobe hut structure (thatched roof and mud walls); avoid blood transfusion in Latin America. Acute illness can be shortened with nifurtimox, but the side effects can be severe. No treatment for chronic disease.

Other cure in the acute stage can be done with Benznidazol or Ragonil

 
  Cholera—caused by Vibrio cholerae Disinfect food and water, avoid raw or undercooked food or seafood (especially ceviche); vaccines are not recommended by WHO. Fluid re-hydration, antibiotics (Cipro 1 gm as single dose, Floxin 800 mg as single dose, doxycycline, tetracycline, or furazolidone)  
  Dengue fever Avoid mosquito bites. There is no cure for dengue fever, but usually all symptoms disappear after a week.Supportive treatment with rest, fluid re-hydration, and pain medication.  
  Filariasis (one type of roundworm) --lymphatic filariasis (bancroftian or malayan filariasis) and subcutaneous filariasis (onchocerciasis—a.k.a. river blindness) and loiasis Avoid mosquitoes, flies (especially black flies in Latin America, and red flies in Africa), and biting midges; prophylaxis with diethylcarbamazine (DEC) either weekly or monthly to prevent loiasis or lymphatic filariasis. There is no prophylactic drug for onchocerciasis. Do not use DEC if have previously been exposed to filariasis until treated and cleared of parasites. Diethylcarbamazine (hetrazan) or high-dose ivermectin (200 micrograms/kg) for lmphatic filariasis; ivermectin (150 micrograms/kg every 6 months for 1 year, then annually for 5 years) for onchoceriasis; diethylcarbamazine (75mg/kg total, but start with ¼ tablet per day and slowly work up to 3 tablets 3 times a day over a 3-week period to avoid anaphylactic reaction from destruction of the worms.) or ivermectin (400 microgram/kg) as a single dose for loiasis.  
  Typhoid Fever—caused by Salmonella typhi Disinfect food and water, good hygiene, avoid contact with infected individuals, vaccines (oral or the new one-dose injectable) Antibiotics (Cipro, Floxin, ampicillin, trimethoprin/sulfamethoxazole, ceftriaxone, and chloramhenicol)—start self-treatment with antibiotic and see medical consultation if infection suspected.  
  Tropical ulcer Avoid having open wounds, cleanse wound with saline if present, keep wound dry and clean. Antibiotic powder (not ointment) to keep wound clean and dry.  

Dehydration

Oral Rehydration Therapy:

  1. Add 1 tsp of salt and 2-3 tsp of sugar or honey to 1 liter of water.
  2. Mix 8 oz. of fruit juice with 3 cups (24 oz.) of water, and add 1 tsp of salt.
  3. Mix together: 1 liter clean water, ½ tsp table salt, ¼ tsp salt substitute (provide potassium chloride), ½ tsp baking soda (provide bicarbonate), and 2-3 tbsp of table sugar, or 2 tbsp of honey or Karo syrup. If cannot obtain baking soda or salt substitute, use 1 tsp of table salt per liter of solution.

Steps of dehydration treatment technique:

  1. vigorously drink 3-6 liters or more of full-strength oral re-hydration solution over 2-4 hours. Don’t stop as soon as thirst is quenched—drink enough to restore urine output.
  2. After re-hydration, start eating if not vomiting, and continue to drink fluids to maintain hydration. The best fluids are dilute fruit juices and water. If not able to eat, use half-strength oral re-hydration solution (ORS) as a maintenance fluid.
  3. If watery diarrhea continues after re-hydration, prevent recurrent dehydration by drinking 8-12 oz. of full-strength ORS after each watery stool. Continue to eat and also consume water as thirst dictates.
  4. Start antibiotic for traveler’s diarrhea as soon as possible.
  5. Use easy-to-digest starches as starting foods—salted crackers, lightly salted oatmeal, rice cereal, lightly salted rice or noodle soups, etc. BRAT diet (banana, rice, apple sauce, and toast) is also good. Advance diet as allowed to cooked meats and vegetables, and then normal diet.
  6. Avoid dairy products, highly sugared fluids (including Gatorade), caffeine, alcoholic drinks, and high-fat foods.

Other Exposure Related Problems

Sunburn (hat, long sleeves shirt), Heat stroke (prevent dehydration), Hypothermia (Wetsuit ).

Food Poisoning - Toxins & Chemicals

Ciguatera, … . Inquire with locals about fish most susceptible to toxins.

Mercury, PCBs, DDT and other chemicals.

Follow guidelines published in "public health advisories on fish consumption".

Poisonous plants

Che Chem (or poison wood)

Poisonous (stinging/biting) animals

snakes, scorpions, tarantulas, fish, etc. 

Medical Kit

Cipro 500 mg - General Antibiotic (for diarrhea, wounds, tooth infection, etc.). Twice daily for 1-3 days

Floxin Antibiotic (for Giardiasis Amebiasis). See table above for dosage

Powdered Antibiotic (for tropical ulcers)

Polysporin ointment (topical Antibiotic)

Clotrimazole (anti-fungal cream, for rash)

Baby powder or Talc powder (to prevent fungal infections and rash)

Steri strip (to close wounds)

Ibuprofen (Motrin, Advil) Pain killer. 800mg (1 tab. 3 times a day with food)

Benadryl (for allergies, itching and rash). 25-50mg every 6 hours as needed

Hydrocortisone cream (1%). for rash that does not respond to anti-fungal cream. (Careful, if it's a fungus, it will increase!)

Lidocaine with epinephrine for anesthesia. Inject sub-cutaneously (Do not use on extremities - blocks blood circulation)

Oral prednisone (oral steroid) for inflammation. e.g. jellyfish sting, fire coral, etc. 40-60mg at a time once a day for 5 days.

Artenam, Mefloquine, Nivaquine (Malaria medicine to take as a cure only. See note)


Treating Water

Boiling; filtering (additional iodine treatment might be necessary for viruses); iodine tablets; Chlorine liquid.

Iodine Tablets (Port Aqua or Globuline) or Iodine crystal (Polar Pure).

Tincture of iodine 2%. Wait 2 hours after treating with 5 drops per quart.

Using Liquid Chlorine (laundry bleach)

  • Laundry bleach may be used if no other active ingredients (only sodium hypochlorite) are used. Find percentage of chlorine (usually 4-6%).
  • For 1% of Chlorine use 10 drops per liter of clear water.
  • For 4-6% use 2 drops per liter.
  • For 7 to 10% use 1 drop per liter.
  • If percentage unknown, use 10 drops per liter.
  • When murky water or very cold temperature, double the dosage of chlorine.
  • The chlorine taste can be removed with some lime, lemon, tea, licorice, or powdered drinks (gatorade, tang, etc.).

Malaria, The Truth about The Traveler's Plague
Account of the malaria attacks and some insights on the disease

Health Links 

Centers for Disease Control and Prevention
World Health Organization
U.S. State Department Travel Warnings
International Society of Travel Medicine
Shoreland,Inc.
IAMAT
Outbreak
Alameda Travel Vaccination Center
Plants of the Machiguenga
University of Montana Pharmacy
The Multimedia Medical Reference Library
Department of Tropical Medicine, Tulane University

 

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