Do you have a moving lump under your skin after a trip abroad?

Posted: 26/10/2015

26 October 2015 - RPS Partnership

These are the rarest (and scariest) tropical travel diseases, according to Dr Ron Behrens of London's Hospital for Tropical Diseases. RPS shares Katie Amey's article, published in the Mail with you...

Getting the runs or being hungover are the main concerns as far as holiday illnesses go for most travellers.
However, if you venture to exotic climes more sinister ailments lurk.

Here MailOnline Travel, with the help of Dr Ron Behrens of the Hospital for Tropical Diseases in London, puts some of the rarest travel diseases under the microscope, including larvae that grow under the skin, ulcers that destroy tissue and an infection that leads to the extreme swelling of limbs.

Disease: Leishmaniasis

Leishmaniasis is a chronic skin ulcer, contracted through the sand fly, which then passes on a parasite.

Where It Comes From: Many parts of the world, including the Mediterranean. Primarily, however, it's found in South America, Bolivia, and parts of the Amazon. Can also occur in India and parts of Africa.

What It Is: 'It's a chronic skin ulcer,' Dr Ron Behrens, NHS Consultant in Tropical and Travel Medicine at the Hospital for Tropical Diseases in London, tells MailOnline Travel. 'It's contracted through a sand fly, which passes on a parasite. It exists as a growing ulcer. There are different types, but the skin form is the most common. We usually see about one case per month at the hospital.'

Although leishmaniasis can occur in many parts of the world, it's more often found in South America and Bolivia. Treatment: 'It sometimes disappears or cures itself, but we usually give sufferers quite powerful drugs to eliminate the parasite from the body,' Dr Behrens explains. 'The patient will need to come in daily for 21 days to receive treatment.'

Prevention: Use insect repellent of 50% DEET and take all precautions to prevent yourself from being bitten.

Disease: Lassa fever

Where It Comes From: West Africa.

What It Is: According to the World Health Organisation, it is 'an acute viral haemorrhagic illness' caused by the Lassa virus. It is transmitted to humans via contact with food or household items that have been contaminated with rodent excreta.

Symptoms begin with fever and general weakness, though headache, sore throat, chest pain, nausea, diarrhoea and abdominal pain may follow. WHO also specifies that in severe cases, 'facial swelling, fluid in the lung cavity, and bleeding from the mouth, nose, vagina or gastrointestinal tract' may develop. Death usually occurs within 14 days of onset in fatal cases.
Lassa fever is an acute viral haemorrhagic illness, originating in West Africa (pictured) though it is often difficult to distinguish from illnesses such as Ebola.

Lassa fever is an acute viral haemorrhagic illness, originating in West Africa (pictured) though it is often difficult to distinguish from illnesses such as Ebola.

Treatment: Because the symptoms are so varied and non-specific, diagnosis may prove difficult with WHO noting that it is 'difficult to distinguish from other viral haemorrhagic fevers such as Ebola virus disease.' The antiviral drug ribavirin is reportedly an effective treatment if given early on in the course of clinical illness.

Prevention: There is currently no vaccine that protects against Lassa fever, according to the World Health Organisation, although travellers are encouraged to be aware of and promote 'good community hygiene' while in endemic regions.

Disease: Leptospirosis

Where It Comes From: Everywhere, including many Western countries.

What It Is: 'It's a bacterial infection that you catch from rats' urine,' Dr Behrens tells MailOnline Travel. 'Usually its passed through contaminated water, so we tend to see it in travellers who go white water rafting or canoeing.' Symptoms include feeling generally unwell, fever, lethargy and jaundice.

Treatment: 'It's quite difficult to diagnose because the symptoms are quite common, can take weeks to present and the patient's treating doctor needs to understand that they've been in contact with water,' he says. 'It primarily effects the liver, though it does impact other organs as well. Travellers will need antibiotics over five to seven days, though they usually do get better quite quickly.'

Leptospirosis is a bacterial infection passed on through rats' urine - and can occur anywhere, including many Western countries. 

If untreated, theoretically, the patient could go into liver failure. 'It's rare, but it can probably happen,' Dr Behrens adds.
Prevention: There's no real way to prevent and sewage workers are just as much at risk as travellers. However, it is rather rare, with Dr Behrens explaining that he will usually only see three to four cases per year.

Disease: Chagas disease

Where It Comes From: Mostly in Latin America.

What It Is: Also called, American trypanosomiasis, it's a disease spread by contact with triatomine bugs through contaminated blood products and contaminated food and drink. The parasites are mainly transmitted by contact with the faeces/urine of the infected blood-sucking bugs, according to the World Health Organisation.

Chagas disease is spread through triatomine bugs, most often found in the cracks of poorly-constructed homes in rural or suburban Latin America. 'The New AIDS' which 300,000 Americans don't know they have.

Typically, the bugs live in the cracks of poorly-constructed homes in rural or suburban areas, becoming active at night when they bite an exposed area of skin and the bug then defecates close to the bite. The parasites then enter into the body when the person instinctively smears the bug faeces into the bite, the eyes, mouth or any other skin break.

The American Center for Disease Control reports that most people with the disease do not develop symptoms immediately, but remain infected throughout their lives. However, the most recognised symptoms are redness and firm swelling at the bite wound or swelling of the eyelid a few weeks later. Other symptoms include 'fever, fatigue, body aches, headache, rash, diarrhoea and vomiting' and 30 per cent of infected people will develop more severe symptoms later in life, including heart conditions or gastrointestinal problems. 

Triatomine bugs (pictured) pass the parasite to patients through contaminated blood products and contaminated food and drink.

Treatment: To kill the parasite, patients will be given antiparasitic drugs, however, the efficacy diminishes the longer a person has been infected.

Prevention: Travellers who go to rural areas of Mexico, Central America or South America are said to be at potential risk, and are encouraged to use insect repellent with DEET, though acquiring the disease through typical tourist travel is thought to be rare.

Disease: Onchocerciasis

Where It Comes From: West Africa.

What It Is: 'It's a parasite, which is infected by specific types of flies,' Dr. Behrens says. 'In travellers, it usually presents with itching skin and rash. The parasites live in the skin and crawl around, but they are smaller than a piece of thread and you can't see them with the naked eye. It can take months for symptoms to appear, but it just takes one bite.'
Onchpcerciasis is a parasite, which usually presents with itching skin and rash - though the parasites cannot be seen with the naked eye. For those who live in the country and have repeated exposure to these flies, it can also lead to what is known as river blindness, where the parasite gets into the eye. 'It's the amount of infection that dictates what the damage is,' he adds. 'And it's rare - we only see three or four instances per year.'

Treatment: Light infections will probably disappear on their own, though patients are also given a drug to attack the parasites.

Prevention: Use insect repellent while abroad.

Disease: Lymphatic filariasis (elephantiasis tropica)

Where It Comes From: Africa, Central and South America, South Asia, and the Pacific Islands.

What It Is: This 'neglected tropical disease' is a parasitic infection caused by microscopic, thread-like worms transmitted to humans via mosquito bite, according to the International Association for Medical Assistance to Travellers. The disease targets the body's lymphatic system as the larvae reproduce and mature over a period of one year.

Lymphatic filariasis can be found in many countries throughout the world and is characterised by extreme swelling of limbs or genitals. The infection is typically characterised by extreme swelling of limbs or genitals, though the majority of cases are asymptomatic. However, the worms can damage kidneys and lymph nodes even if a person does not exhibit external symptoms.

Treatment: Anthelmintic drugs will expel the parasitic worms from the patient's body.

Prevention: Although there is a greater risk for long-term travellers or humanitarian workers, all tourists are encouraged to use insect repellent containing DEET.

Disease: Cutaneous myiasis

Where It Comes From: Africa and South America, but the flies that infect you can occur anywhere.

What It Is: 'It's when the larvae of a certain type of fly is deposited on the skin and it grows into a larvae under the skin, so you have, quite literally, a larvae growing under the skin,' Dr Behrens explains. 'People notice a lump, which moves. But you never know when you get the parasite and you can often get more than one - you only really notice when it starts moving.'

While in Africa, travellers should protect themselves against flies - particularly to avoid cutaneous myiasis
Treatment: 'Either by suffocating the larvae - by covering it in Vaseline and blocking its breathing apparatus - or by surgically extracting it,' he tells MailOnline Travel.

Prevention: Use insect repellent of 50% DEET.

Disease: Buruli ulcer

Where It Comes From: Africa, South America and Western Pacific regions.

What It Is: The bacterial infection is caused by Mycobacterium ulcerans, an organism which belongs to the same family of bacteria that causes tuberculosis and leprosy, writes the World Health Organisation.

A Buruli ulcer is a bacterial infection which feeds on the skin and soft tissue of the arms and legs
Infection leads to 'destruction of skin and soft tissue with large ulcers usually on the legs or arms.' M. ulcerans needs a temperature between 29 -33 degrees Celsius and a low oxygen concentration to grow, though the exact mode of transmission is still unknown.

Treatment: Standard treatment consists of a combination of antibiotics over the course of eight weeks. Early diagnosis and treatment is key, as patients who are not treated early suffer long-term functional disability.

Prevention: Since there is no knowledge of how Buruli ulcer is transmitted, there are no preventative measures to take.

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Photo: RPS Ivory Coast

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