Los Angeles Times - August 10, 2003
Kathleen Doheny*

The nightmare began two weeks later, when they noticed painful, pimple-like areas on their scalps and shoulders.

"They had seen several doctors who weren't sure what it was," says Dr. John Cahill, a director of travel medicine clinics in Providence, R.I., and New York City.

His diagnosis: cutaneous myiasis. "Basically, what happens is, certain species of flies lay their eggs on your skin," Cahill says. "Then they hatch under the skin." The treatment is simple. Cahill applied a little petroleum jelly to the bump to coax out the larvae, then removed them.

The case illustrates the importance of vigilance after a trip, when even veteran travelers can fall sick but may not immediately connect the symptoms with the journey.

Most travelers who come down with infections, whether viral, bacterial or parasitic, become ill within six weeks of returning home from international travel, according to the federal Centers for Disease Control and Prevention. But not always. Malaria, for instance, might not show up for six months to a year after return, the CDC says. Travelers should share their trip history with their doctors.

Patients sometimes forget, says Dr. Brian Terry, a travel medicine physician in Pasadena. One of his patients, a frequent traveler to Belgium, had red eyes and a fever when he returned to New York. When the emergency room doctor quizzed him on his whereabouts, the traveler told him he had been in Belgium. The man forgot to mention that he had also recently been in Africa.

Lacking that information, the doctor diagnosed him with conjunctivitis, an inflammation of the mucous membrane that lines the inner eyelid and the eyeball's exposed surface, and prescribed topical antibiotics.

"The man's eyes went from red to yellow," Terry recalls. "Back to the emergency room he went, this time with bad body aches."

This time the doctor changed the diagnosis, after prodding the man's memory and learning about the Africa trip. The new diagnosis was leptospirosis, a group of infectious diseases contracted by exposure to water or soil contaminated by infected animals. The disorder is more common in tropical climates. The man had taken a dip in fresh water.

"Tell your doctor everywhere you have traveled," Terry says.

A fever after your return is a clue that you've caught something. "It can be nothing, or it can be horrible," he says. "If you get a high fever, over 102 degrees, you should probably see your doctor. If you have a fever and your skin is yellow, that could be jaundice, and you could have hepatitis." Fever might also suggest malaria, he says.

It generally takes at least six days after initial exposure for malaria symptoms to develop, he adds. Symptoms of malaria can be mild, the CDC says. Besides fever, you may suffer headache, muscle aches, vomiting and diarrhea.

"Any traveler who returns with fever and chills should seek medical advice," adds Cahill.

The same advice goes for anyone who has bloody diarrhea or diarrhea lasting more than two days, Cahill says.

Travelers who have had a blood transfusion abroad, except for Western Europe, Australia or New Zealand, should see a doctor upon their return and be screened for infections such as HIV, Cahill advises. Travelers who engaged in high-risk behavior should be screened for sexually transmitted diseases, he adds.

Although rashes may not be serious, they also deserve attention. "Lots of strange rashes can occur" after returning home, Terry says.

If he sees a rose-colored rash on the trunk, he suspects typhoid fever until he rules it out, Terry says. Typhoid fever is caused by a bacterium that is transmitted by contaminated food and water in areas with poor sanitation. Besides the rash, symptoms include fever, headache, loss of appetite and malaise.

A rash might also just be contact dermatitis, from sensitivities to bedsheets, for instance, or a bug bite.

*Healthy Traveler appears twice a month. Kathleen Doheny can be reached at kathleendoheny@earthlink.net.

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