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.

Now that the MicroGnome can reliably get lecture notes onto this Blog, here is the Malaria series for students of tropical medicine:

The subject of expedition stress was covered during the ACTM-WA/PathWest/Rural Clinical School day conference on Wilderness & Expedition Medicine last month.

Here’s a copy of the presentation for those who were too stessed to get there on the day.

11th to 14th June 2010.

• ACTM 19th Annual Scientific Meeting
• 25th AIMS Annual North Queensland Conference, Queensland Tropical Division
• James Cook University 40th Anniversary

There is still time to jump on the bandwagon: pre-conference workshops are not all fully booked. There is also room for a few more delegates during the weekend conference, which is packed with good tropical medicine, pathology, medical science and tropical public health [programme].

James Cook University Anton Brienl Centre; Friday 11th June, 2010

Conference highlights

• Keynote Address: Emeritus Professor David Warrell – Snake bite envenoming: 100 years of Australian contributions to combating the world’s most neglected tropical disease
• Robert Steffen: Risk and prevention of neurological infections in travellers
• Rod Campbell AM: The Robert Hirst Memorial Lecture: Modern microbiology in the tropics
• Santanu Chatterjee: Destination India

[conference or workshop registration]

]]> http://micrognome.priobe.net/2010/06/celebrating-100-years-of-tropical-medicine-in-townsville/feed/ 1 http://micrognome.priobe.net/2010/04/barefoot-answers/ http://micrognome.priobe.net/2010/04/barefoot-answers/#comments Tue, 06 Apr 2010 23:57:24 +0000 micrognome http://micrognome.priobe.net/?p=438

What is the infection?

Cutaneous larva migrans (CLM).

This is caused by infection with animal hookworm larva (typically a dog or cat species,  eg Ancylocystoma braziliense).

Infection is acquired via direct inoculation when a human comes into skin contact with faeces containing the larva (often on a beach or a riverbank). The larva cannot complete its usual life cycle in a human, hence it wanders around the epidermis causing an intense pruritic reaction. CLM, sometimes known as creeping eruption or “ground itch”, is common in tropical regions including northern Australia. It most commonly affects the feet, but can occur on any part of the body.

Secondary bacterial infection is not uncommon

What is the treatment?

CLM will eventually resolve without treatment when the larva(e) dies, but this can take many weeks. Systemic therapy options include albendazole, ivermectin or thiabendazole.

Topical therapies include:

• Cryotherapy (eg ethyl chloride, liquid nitrogen) or other trauma to the leading edge of the lesion (to kill the migrating larva)
• Thiabendazole cream applied to the lesions (not available on prescription in Australia; may be available via compounding pharmacies).

MMWR Morb Mort Wkly Rep. Outbreak of Cutaneous Larva Migrans at a Children’s Camp — Miami, Florida, 2006 (December 14, 2007 / 56(49);1285-1287.

The Stafinator, 7th April.