Trouble in paradise

Once again, Bali has been in the news for the wrong reasons. A favoured holiday destination for so many Australians, Bali has now added a sinister new hazard to its growing list of health risks with notification of HIV infection contracted as a result of a holiday visit to a tattoo artist. Australian public health physicians have urged anyone who has recently got a tattoo while on holiday in Bali to have their HIV status checked: trouble in paradise.

The list of recently documented infection risks associated with travel to Bali and neighbouring Indonesian islands includes:

• Dengue, a common and potentially serious viral infection transmitted by mosquito bites. Cases here have almost doubled every year for five years and are mostly associated with international travel, particularly to Bali. There is currently no vaccine and no effective treatment. Control relies on avoiding mosquito bites where the disease is present.
• Gastrointestinal infections due to Salmonella, Campylobacter and E.coli. Around one third of Salmonella cases originate overseas, mostly in Bali where Salmonella Enteritidis is common.
• HIV/AIDS, and other blood borne viruses from contaminated tattoos, but can also arise from unprotected intercourse, recreational injecting drug use and other exposure to contaminated blood or body fluids. Evidence in recent case may point to tattoo but other routes of infection are possible. In recent case causal contribution of tattoo is debatable.
• Legionnaires’ disease connected with hotel air conditioning, spa baths and warm water systems. Recent cases in people staying in Kuta hotel.
• Rabies, from dog and monkey bites. More than 130 local rabies deaths in recent years. Most districts affected. A control programme has caused a fall in numbers of cases, but has not eliminated the disease. Regular reports of tourists unable to obtain or complete post-exposure vaccination in Bali due to inadequate supply. [Read Geographical Magazine's article on the Bali rabies eradication programme]
• Other infections: Japanese encephalitis can occur following mosquito bites in rural areas. Chikungunya is another mosquito-borne viral infection with an unpronounceable name. Leptospirosis can arise following exposure to contaminated inland water. Sexually transmitted infections are common when holiday-makers let their guard down, throw caution to the wind and engage in behaviour they may come to regret soon afterwards.

The current (as of 26-DEC-11) official recommendation is to reconsider travel to Indonesia, but this doesn’t seem to stop large numbers of Australian holiday makers travelling without taking professional advice or specific health precautions. General practitioners and travel medicine specialists have to pick up the pieces when holiday-makers fail to respect the hazards of mass tourism in a developing country. The risks are not the same as those of holiday travel at home. A naive she’ll-be-right approach to international travel in our region is irresponsibly dangerous.

Trop Med revision in a day? Who said it can’t be done.

Oxford Handbook of Tropical Medicine, 3rd edn

Here are some on-line resources to assist you:

1. Expedition medicine
2. Malaria
3. Fever in an international traveller
4. Arbovirus infections
5. Diarrhoeal disease
6. Enteric fever
7. Neglected bacterial diseases
8. Pneumonia
9. Snake bite
10. Envenomation
11. Leishmaniasis

Self assessment questions:

Clinical scenarios

Key information sources:

• WHO neglected tropical diseases
• CDC Yellow Book on travel health
• Oxford Handbook of Tropical Medicine
• Manson’s Tropical Diseases

Recent news on the rabies risk of your favorite holiday destination, courtesy the ABC: video clip.

• Where more than 40 people a day come in for a check up following a dog bit or lick.
• and more than half those tested for the disease have evidence of rabies.

Things that bite can do you harm in various ways:

• RABIES: FACTM rabies lecture notes
• SHARK BITE: bacterial risks from shark bites
• SNAKE BITE: neglected tropical disease

MicroGnome, 29-DEC-10.

So here it is; MicroGnome’s FACTM teaching unit on rabies.

You can find supplementary materials on the Priobe Net.

Download (PDF, 183.43KB)

ABC News, video clip on rabies outbreak in Bali, 29-DEC-10

Malaria modules 3 and 4

The μGnome has finished preparing Malaria module 3 and Malaria module 4. These cover public health, travel health and expedition medicine aspects of malaria and vector biology. The two mini-lectures are presented here to help those studying for the FACTM pt 1 exam later this year. They complement modules 1 and 2.

Download (PDF, 1.91MB)

Download (PDF, 358.12KB)

More details can be found on the excellent Malaria site run by the WHO.

Settings for which the μGnome needed professional travel health and expedition medicine advice included Brazil and Sri Lanka. Click on the links for more on those expeditions.

To supplement study materials on malaria, here is a set of notes on malaria from our MSc course.

Prior materials on malaria include:

• the malaria cycle
• self-assessment questions on malaria for the FACTM
• the malaria man; Ronald Ross
• antiparasitic agents

μgnome, 30th March.