Returning Sick Travelers

Sick after the trip-When to seek help after traveling abroad.

Many studies have looked at travel and concluded that even though colorful stories of exotic diseases abound travel is usually very safe.

Up to 50% of people may experience traveler's diarrhea and mild illnesses. More serious accidents or illnesses are much less common.

We have put this pamphlet to help you once you return home.

A returning traveler may present with similar for different diseases.

It is important to get an accurate diagnosis of what the problem is before treating.

Many tropical illnesses have patterns of diseases that specialists are more prone to notice or are seeing lots people with same conditions. In some cases it doesn't really matter if there is a delay but in infections with malaria, schistosomiasis, and typhoid among others a delay could be lethal. It's interesting that one study showed that Canadian travelers were having 10 times the rates of malaria as American travelers. This has led educators to question if travelers are getting the right advice from travel clinics or even seeing a physician before they go.

Fever

A fever can be non-specific symptom of any infection of other medical illness. The majority of fevers are from respiratory illnesses but dangerous diseases like malaria, tuberculosis, schistosomiasis, yellow fever, dengue fever and hepatitis's are the ones not to miss.

Anyone who has been to country where malaria was present should be carefully examined if feverish for even up to 12 months later as dormant infections can erupt. Antimalarial medications, DEET insect repellents, insecticides, and netting are good to prevent malaria (and other insects also). But do not give 100% protection. All travelers should be suspicious of malaria.

Dengue fever may also present with a rash. Usually the illness is limited but if the person is infected again they can get Dengue Hemorrhagic fever which is life threatening. Yet many dengue infections go unnoticed.

Leptospirosis a dangerous infection from contact with contaminated water and must be treated promptly.

Schistosomiasis is a parasite acquired from contact with infected freshwater.

Any fever in a returned traveler from Sub Saharan Africa is always assumed to be malaria until proven.

Jaundice (yellow skin) this symptom can be from liver injury (hepatitis, yellow fever, and other infections) or other diseases like malaria. This should always be investigated.

Abdominal Pain

Cramps may be simply travelers diarrhea or menstrual but occasionally parasites and other diseases present this way.

Travelers are also susceptible to the same ailments as at home. Unexplained abdominal pain should always be seen by a doctor.

Often travelers may minimize their complaints but travelers do ignore appendicitis, ulcers, and even cancers that should have been treated earlier.

We have divided this pamphlet on a brief description of some common topics. Other pamphlets in this series dealing with prevention of these diseases can be downloaded at www.skylarkmedical.com .

Rashes

Reactive changes in the skin can be approached as one of the following:

Contact dermatitis (an allergy from something-detergent, insect, food).

Infective (bacteria, parasite, fungus or virus). Sign of underlying disease or process (dengue fever, Meningococcal meningitis, lupus, psoriasis).

Meningococcal meningitis warrants special attention since once this rash appears (a non blanchable bleeding under the skin) people survive and do much better the earlier they receive penicillin.

A relative straight foreword rash can be treated with Aloe Vera and avoiding irritants but if suspicious or persistent a review by a physician is suggested to diagnose the cause and treat the underlying condition.

Skin Cancer is a special type of “rash” since ignoring a potentially curable one can lead to a terminal case. Travelers are frequently exposed to lots of sun. Tans do not protect the skin from damage. Suntanning salons cause more cancer than the sun alone. The protective effect of suntanning is largely a myth perpetuated by an unregulated salon industry.

Any unusual changes in the skin should be checked for signs of cancer.

The Skylark Medical Clinic specializes in Sports Medicine and Emporiatris-the branch of medicine devoted to travelers' diseases and keeping travellers healthy.

We will see travelers at the last minute before their vacation or if they just returned. We understand the uncompromising urgency of our clients.

Regular visits are covered by Manitoba Health although vaccination visits are not.

Our receptionists will provide information for immunization recommendations for foreign destinations over the phone as well as the costs for these vaccines.

We will accept self-referrals. If your physician has sent you we require a letter of referral with previous tests or vaccinations done.

Lastly we will try to see all our sick patients on the same day they have returned but if we are closed or unavailable we stress that all sick patients should go to either the Health Science Centre or St. Boniface hospitals.

Skylark Medical Clinic

264 Tache Avenue

Winnipeg, MB R2H 1Z9

Tel: 453-9107 Fax: 453-9115