Tick Bites and Flatworms
Rickettsial diseases are sometimes seen in those who travel to Africa during tick season (April-November). Fever, myalgia, and headache characterize the illnesses; an eschar at the site of the tick bite is another clue. Most rickettsial infections respond quickly to doxycycline.
African travelers who swam in lakes may bring home a load of schistosomes. These flatworms live in freshwater snails, which release the larvae into the water. The larvae burrow into a swimmer's skin and take up residence in the liver. After maturing (up to 10 mm long), the worms mate and move into the rectal and mesenteric veins, where they release their eggs. The eggs pass into the intestine, bladder, or rectum, and are excreted.
The worms live up to 4 years, so natives of endemic areas can have huge loads that create chronic disease. However, travelers usually come down with an acute case, called Katayama fever. Symptoms include abdominal pain, cough, diarrhea, eosinophilia, fever, fatigue, and hepatosplenomegaly. Early in the course, the patient may have urticaria and a rash where the larvae penetrated the skin.
Diagnosis is by fecal smear or urinalysis positive for the flatworm's eggs. Schistosomal antibodies can also be positive. Praziquantel is the usual treatment, Dr. Takhar said. It should probably be prescribed by an infectious disease specialist who can provide adequate follow-up.
'You're not going to see these things in businessmen who are staying in Hiltons and eating Western food.' DR. TAKHAR