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...)
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). Read
addendum
mefloquine, chloroquine, proguanil,
quinine, quinidine, artemisinin (qinghaosu) and derivatives.
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.
Good hygiene, disinfections of food
and water, vaccine, or immunoglobulin.
No cureagainst
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, condomsduring
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.
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 fordengue
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.
Rabies
Avoid rabid animals, vaccine.
Antibiotics—see
medical consultation for specific type.
Worms
Depend on types of worms, some worms
can enter the skin by penetration, by oral ingestion such as
roundworms in raw seafood, or by oral-anal route.
Some worms require
surgical removal, some can respond to Albendazole, mebendazole,
etc., but there are many types of worms and need to seek medical
consultation for the correct antiparasitic medication.
Leptospirosis—caused
by bacteria in the urine of domestic livestock, dogs, and small
rodents
Disinfect food and water, good
hygiene.
Antibiotic (penicilline,
doxycycline).
Hanta virus
Avoid drinking
rodent infested water and being in a rodent infested area, breathing
in aerosolized virus.
Supportive
therapy only, no cure.
Cutaneous Larva Migrans (caused by
various roundworms - nematodes
Transmitted through dog or cat
feces. Skin exposure (most common through the feet).
Thiabendazoleorally
25 to 50 mg/kg/day in two divided doses for 2 days. Second course
given after 2 to 7 days if lesion continues to extend. (also high
doze of 22mg/kg twice a day for 5 days is possible).
Strong side effects (anorexia, nausea, dizziness) lead to research
of topical thiabendazole.
Myasis (infestation by larvae of
flies)
The botfly fixes its eggs on insects
bites. All insect bites could potentially lead to larvae infection.
Fillup
the lesion with petroleum or with adhesive to suffocate larvae, then
remove when dead. Treat infection. Or enlarge orifice with small
incision and extract larvae.
CutaneTungiasis
The sandflea
enters the skin where it resides in the epidermis and grows to the
size of a small pea. The posterior of the flea remains in contact
with the air. Pus-filled, itchy papules form around the protruding
posterior of the flea, often leading to secondary infections.
Cut the lesion and remove the flea with tweezers.
Dehydration
Oral Rehydration Therapy:
Add 1 tsp of salt and 2-3 tsp of sugar or honey to 1 liter of water.
Mix 8 oz. of fruit juice with 3 cups (24 oz.) of water, and add 1
tsp of salt.
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:
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.
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.
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.
Start antibiotic for traveler’s diarrhea as soon as possible.
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.
