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Parasites Outdoors

By Dr. Mark Wise

Barefoot Walking || Fresh Water Swimming

There’s nothing like kicking off your shoes and going for a walk on the beach. Just keep in the back of your mind that there are sometimes microscopic worms, fleas, men (and women) -of-war waiting to puncture your skin.

Cutaneous larva migrans, or "Creeping Eruption", is an interesting infection caused by dog and cat hookworms. These larva which might have been left on the beach by the local pet can penetrate your unbroken skin. This usually occurs on your foot, though it can happen anywhere, depending upon how you choose to sunbathe. It will cause an itchy, blistered, serpiginous rash, which seems to be advancing a few centimetres a day. It does not creep anywhere else, such as your brain, liver or wife!

It can usually be recognized by a doctor who has seen it before. It is treatable with a drug called Albendazole. Try to avoid doctors who are anxious to freeze the worm, or worse still, cauterize it. I would not go as far as telling people not to walk barefoot, but try to avoid places where the local dogs, cats, and sometimes people, have left their droppings! Staying close to the water’s edge is a bit safer, as the tide can wash away anything harmful.

In addition to animal hookworms, there are also human hookworms that might be lurking in the soil where proper sanitary facilities are lacking. These can also penetrate your bare feet. Hookworm is a major cause of iron deficiency anemia in those who are constantly exposed to such conditions. So beware of where you tread , and wear your sandals.

Schistosomiasis. It might not roll off the tip of your tongue, but it is an infection that affects more than 200 million people worldwide in the tropics. It is caused by a tiny worm, whose eggs are passed by humans in their urine or feces, depending upon the species(of worm, that is). Assuming our human has no access to toilets or latrines, then the local freshwater river or lake is the next best spot. These eggs will then inhabit certain types of snails, and after a month there, are released into the water.

Local people with freshwater exposure become infected when these immature worms penetrate the unbroken skin. After a complicated migration in the human body, they develop into adult worms, and go about producing more eggs. The eggs can cause damage to various organs, including our liver, bowel or bladder.

And that is why we suggest to people that they avoid swimming in fresh water, particularly in rural areas of Southeast Asia. If you have no choice, i.e. the lake looked too inviting, then try to swim in the deeper water where there are no snails (assuming you know how to swim). Fast moving streams, which is where whitewater rafters get exposed, are probably less of a risk. If you do think you have been exposed, rubbing your skin down vigourously with a towel will lessen the risk of larval penetration.

© Copyright 2000 Dr. Mark Wise

Dr. Mark Wise is the director of The Travel Clinic (TM)) in Thornhill, Ontario, Canada and the Medical Director of The Travel Wise (TM) Clinic in Scarborough, Ontario, Canada. He is a family physician with training from the London School of Tropical Medicine in Tropical Diseases. He is a parent himself and often see potential adoptive parents in his clinic. Dr. Wise gives lectures and writes articles on the subject of travel medicine, for both medical and non-medical groups.

Adoption Health

Travel Health in Asia
Travel Health

Before You Go
Vaccinations for Southeast Asia

On the Road
Jet Lag
Motion Sickness
Too Much Sun

Traveler's Diseases & Parasites
Honey - I Passed A Worm!
Parasites Outdoors
Tuberculosis (TB)

Back Home
Upon your return

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