Infection from Tiny, Unwanted Travel Companions

A 50 year old woman presented at surgery on return from a holiday in Tanzania. She was complaining of multiple, small red, very itchy, lesions scattered round her waist line, on the inside of thighs and upper arms. She had been scratching these areas and there was now reddened skin, with lacerations on her thighs, seeping of the wounds and small patches of sepsis. On questioning she stated that her fl ight from Dar as Salaam had been delayed 24 hours and as local hotels were full, she had been forced to stay overnight in an insanitary and overcrowded hostel. On examination the lesions were typical of fl ea bites, with secondary bacterial infection.

A 50 year old woman presented at surgery on return from a holiday in Tanzania

Fleas
Pulex irritans (human fl ea) There is no fl ea specifi c to humans, and only a fraction of all fl eas regularly come into contact with humans. Many however, associate with domesticated animals. The human fl ea has a cosmopolitan distribution and is mistakenly named, as it attacks many different mammals, including guinea pigs, domestic dogs, cats, rats, and goats. Infestations can reach phenomenal levels, where residents share dwellings with livestock, or where corralled animals are adjacent. Backpackers and budget travellers often frequent these locations, sometimes the only overnight shelters available in rural areas and are exposed to frequent bites. Sleeping accommodation on trains and lodging houses can also be home to these unwanted residents. Flea bites can be a risk in hostels and better quality hotels, if bed sheet laundering is not scrupulous. Travellers are often exposed to their bites, which may only be a nuisance but can potentially bring serious disease. Prevention. Insect repellent containing DEET (on skin or clothing) or permethrin (to clothing or equipment).

Bedbugs (Cimex lectularius):
Are blood-sucking insects that live in cracks and crevices. Their presence is not determined by the cleanliness of the living conditions where they are found.Attracted by body heat and carbon dioxide, they crawl out at night to bite exposed skin and feed on blood, and People develop itchy red bumps. 15 to 30 minutes after being bitten, which can last for several days. Bites are usually occur on the face, neck, hand or arm and ankles and are often mistaken for mosquito bites but bedbug bites often occur in straight lines [4].
Although bedbugs are intensely itchy, they do not transmit human diseases. Adult bedbugs look like lentils and up to 5mm long,are visible to the naked eye and vary in colour.They are very resilient, can survive for up to a year without feeding and may be found in all types of housing, but are more common in hotels or hostels. They prefer to inhabit crevices in fabric or wood over plastic and metal, and often hide under mattresses or along bed headboards and joints.

Management
· If clothes or bedlinen have become infested, wash them at 60C, or put them in a dryer on a hot setting for 30 minutes to kill the bugs · To kill bugs, use insecticide spray specially designed for bedbugs -Insecticide sprays may be becoming less effective as the bugs build resistance to them. Ordinary insect repellent for mosquitoes and ticks is not effective · Antihistamine tablets and ointment to relieve pruritus.
Ticks: Ticks are small, blood-sucking arthropods related to mites. They feed on the blood of different animal hosts with some feeding on human blood. The one most likely to bite humans in Britain is the Sheep tick, Ixodes ricinus [5]. It is sensitive to climatic conditions, requiring a relative humidity of at least 80% to survive during off-host periods, and is restricted to wood/heathland moorland, rough pasture, forests and urban parks. Other ticks in Europe and In America carry different diseases. In the USA the highest risk comes from the Deer tick, Ixodes scapularis [5].
The tick bite is usually initially painless, then after 12 hours becomes itchy. People are often only aware they have been bitten when they see a feeding tick attached to skin. The risk of infection increases the longer the tick is attached, but this can happen at any time during feeding, with Lyme borreliosis and Rickettsiosis possibilities. in people with early Lyme disease is highly effective Resolution of signs and symptoms have been reported in up to 90% of people with early Lyme disease in randomized controlled trials [8,9].