what should be in your dive kit next trip J Paul Martin MD Asheville NC Mosquito Borne Disease Dengue Chikungunya Malaria Yellow Fever The Culprits Dengue Chikungunya YF ID: 528383
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Caribbean Travel Medicine – what should be in your dive kit next trip?
J. Paul Martin, MDAsheville, NCSlide2
Mosquito Borne DiseaseDengueChikungunya
MalariaYellow FeverSlide3
The Culprits – Dengue /Chikungunya/ YF
Asian tiger
mosquito
Aggressive biter
Yellow fever mosquito
Sneaky biterSlide4
FeverPolyarthralgiaLymphopeniaHeadacheMyalgiaMeasles Rash
Dengue / Chikungunya
Fever
Polyarthralgia
Neutropenia
Headache
Myalgia
Measles Rash
NO NSAIDs
“Breakbone Fever”
“that
which bends
up”Slide5
ChikungunyaSlide6
The Culprit -Malaria
Anopheles species
Malaria mosquito
Sneaky biter
Slide7
Grove Park Inn AshevilleSlide8
Groves Tasteless Chill Tonic 1885Quinine, sweet syrup, lemon flavor
Grove’s Tasteless Chill Tonic By 1890 more bottles of GTCT was sold than Coca Cola
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Groves Tasteless Chill TonicSlide10
Cinchona TreeQuinine,
cinchonine and cinchonidine are alkaloids extracted from powered cinchona barkSlide11
The Scourge of the SouthMalaria also ravaged the troops of the Union Army, its fevers killing about 10,000 recruits during the U.S. Civil War.Slide12
Malaria in the United StatesSlide13
The Scourge of the SouthMalaria affected 30 percent of the population in the region when the TVA was incorporated in 1933. The Public Health Service played a vital role in the research and control operations and by 1947, the disease was essentially eliminated. Mosquito breeding sites were reduced by controlling water levels and insecticide applications. Slide14
The Scourge of the SouthThe construction of the Panama Canal was made possible only after yellow fever and malaria were controlled in the area. These two diseases were a major cause of death and disease among workers in the area. In 1906, there were over 26,000 employees working on the Canal. Of these, over 21,000 were hospitalized for malaria at some time during their work.Slide15
The Decline of Chill TonicIn the 1940s, chloroquine
replaced quinine as the treatment of both uncomplicated and severe malaria until resistance supervened, first in Southeast Asia and South America in the 1950s and then globally in the 1980sSlide16Slide17
MalariaThe term malaria originates from Medieval Italian: mala aria — "bad air"; the disease was formerly called ague or marsh fever due to its association with swamps and marshland. Malaria was once common in most of Europe and North America, where it is no longer endemic, though imported cases do occur.Slide18
MalariaIt begins with a bite from an infected female Anopheles mosquito, which introduces the Plasmodium sporozoites through saliva into the circulatory system. In the blood, the
sporozoites travel to the liver to mature and reproduceSlide19
Female Anopheles MosquitoSlide20
Caribbean Countries with Malaria
Belize Mainland - vivax Dominican Republic - falciparum
Haiti - falciparum
Honduras -
vivax
2014 CDC WebsiteSlide21
Caribbean Countries with MalariaSlide22
Malaria ProphylaxisDoxycycline 1-2 days before and 28 days afterMalarone
(atovaquone/proguanil) 1-2 days before and 7 days afterLariam
(
mefloquine
) weekly dosing. 2 weeks before and 4 weeks after – relatively contraindicated with scuba, unless taken previouslySlide23
Yellow Fever - 2013Slide24
Mosquito resistant clothing Long sleeve shirt & hat Long pants & socks
Dengue and chikungunya vector mosquitoes bite mainly
from
dawn
to
dusk
Malaria mosquitoes
bite
mainly from dusk to dawnSlide25
Mosquito resistant clothingTreat clothing with permethrinSlide26
Mosquito repellentDeetOil of Lemon Eucalyptus
PicaridinIR3535Slide27
Mosquito repellent failureSlide28
Mosquito bed netSlide29
Mosquito Borne Disease
Dengue
Chikungunya
Malaria
Yellow FeverSlide30
Reef Fish Toxins Ciguatera
Scombroid* Shellfish Poisoning
*Slide31
Viral Illness Hepatitis A
Hepatitis B and C Norovirus
RabiesSlide32
Hepatitis A Food and water borne Fecal – oral transmission
Raw shellfish from water polluted with sewage Close contact with someone with Hepatitis ASlide33
Hepatitis B & C “Serum Hepatitis”; “Non-A Non-B” Transmitted via body fluids
Travel in 3rd World Countries – may want to carry your own sterile syringe / needlesSlide34
Hepatitis B & CSlide35
Immunizations Hepatitis A and B Tdap Influenza
TyphoidSlide36
Primary Symptomsdiarrheathrowing up
nauseastomach pain
Other
Symptoms
fever
headache
body aches
NorovirusSlide37
NorovirusSlide38
Rabies Transmitted through saliva Raccoons
, skunks, bats, foxes, and dogs Flu-like, fever, weakness leading to Anxiety, delirium, agitation
10 documented cases of human survivalSlide39
Bacterial IllnessTyphoid
SalmonellaShigellaCampylobacterE. ColiVibrio vulnificusSlide40
Travel Meds Benadryl, Hydrocortisone cream
Phenergan/Ondansetron, Maalox
Triple Antibiotic Ointment
Ciprofloxin
, Keflex, Metronidazole, Bactrim DS, Clindamycin, Doxycycline, Azithromycin
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RifaximinTravelers diarrhea due to E. coli
Not effective w Campylobacter Not absorbed, few side effects
200 mg TID x 3 days
$15/pill
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Questions?Slide44
Caribbean Travel Medicine – what should be in your dive kit next trip?
J. Paul Martin, MDAsheville, NC