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Source: Leggat PA, et al. J Travel Med. 2001;8:41-45.
With the burgeoning worldwide economy, tourist travel to South Africa is booming. More than 5.7 million people visited South Africa in 1998. This review article, which should be mandatory reading for travel medicine providers (and for travelers to the area), presents an excellent discussion of the potential dangers of visiting wildlife areas and steps to improve your personal safety. Helpful clues include how to select a good trail guide, rent the appropriate vehicle and mobile phone, and how not to get eaten by lions.
Serious injuries or fatalities while vacationing in African reserves due to altercations with wildlife are unusual. Leggat et al identified only 14 serious injuries and 7 deaths during the past 10 years as the result of wild mammal attacks on tourists in South Africa. Most occurred because of foolish behavior on the part of a few individuals—such as leaving the vehicle or wandering unprotected into potentially dangerous areas. Animals seldom attack vehicles—only 2 elephant attacks have occurred, one because the elephant was miserable with a foot abscess and another elephant was interrupted during sex. Good preparation, common sense, and following a few basic rules can lead to a safe vacation. Now you only hope the elephants have read the same journal article.
Source: EIN Epi: CDC Foot-and-Mouth Advisory, March 20, 2001.
As the result of the ongoing outbreak of foot-and-mouth disease (FMD) in the United Kingdom and Ireland, the CDC has released new guidelines for travelers to these countries. FMD can be readily transmitted by agricultural products, dirt and fomites, clothing, and other objects. Although travel from the United States to the United Kingdom has not been restricted, travel within these countries may be more difficult, and travelers may be disappointed to find that access to rural areas, camps, country roads and foot paths, and certain parks have been restricted.
As a result, the CDC recommends the following: 1) Do not visit any rural areas, parks, farms, or zoos within 5 days of return; 2) Bathe thoroughly and launder or dry clean all clothes worn during your trip before your return; 3) Wipe clean all objects and luggage in your possession using a bleach solution (5 tbsp bleach to 1 gallon water); 4) Agricultural products, unpasteurized dairy products, and meats from swine and ruminants (cows, pigs, sheep, goat, or deer) are banned from the United States, as are any other products from swine and ruminants.
Travelers should be warned that Customs Officials are on the lookout for these products, and persons attempting to circumvent these restrictions may be fined. Useful web sites include: www.maff.gov.uk and www.cdc.gov/travel.
Source: de Barros N, et al. Radiology. 2001;218:517-520.
De barros and associates report 5 Brazilian women who each presented with a palpable breast lump of 2-4 weeks duration, each were associated with some degree of inflammation. One patient described serous drainage coming from the lump, and one complained of pain. In all 5 cases, mammography revealed an ill-defined mass, measuring 0.7-2.0 cm in diameter, 3 of which were associated with 2 linear microcalcifications near the periphery of the mass. One mass had a clear radiolucent stripe adjacent to the microcalcifications. Ultrasonagraphy in 3 patients showed a hyper-echoic mass surrounded by a hypoechoic area. The mass was seen moving in 1 patient. (To visualize, try: http://radiology.rsnajnls.org/cgi/content/full/218/2/517).
Answer: Cutaneous myiasis occurs when certain species of Diptera fly lay eggs in clothing or on the underbelly of another blood-sucking arthropod, like a mosquito or tick. Larva emerging from the eggs that come in contact with exposed skin can burrow through the epidermis, where it reaches maturity in the subcutaneous tissues by creating a small elongated cavity with an opening to the skin that allows it to breathe and eliminate waste. Mature larva can measure up to 3.0 cm in length and have 2 small pharyngeal bones, which act as a hook (the linear microcalcifications seen on mammography).
In the United States, cutaneous myiasis is usually found in travelers recently returned from Mexico, Central or South America, or possibly Trinidad, and is caused by the botfly, D hominis. Infection of the human breast is unusual, but any area of exposed skin (typically the scalp) can be affected. Patients may note a swelling similar to a mosquito bite within 1 week after infection. Within 2-3 weeks, a red subcutaneous nodule develops.
The larva can be extracted through the opening or by obstructing the opening, which forces the larva out of its home in order to breathe. Any number of substances have reportedly worked to obstruct the opening (bacon is a favorite), but a little petroleum jelly or op-site would work. The lesions usually heal without problem over several weeks but occasionally become superinfected, in which case antibiotics should be administered.