Symptoms can include:

• a high temperature, feeling hot or shivery 
• a severe headache
• pain behind the eyes 
• muscle and joint pain
• feeling or being sick 
• a widespread red rash 
• tummy pain and loss of appetite 

These suggestions may help to relieve symptoms:

• Take paracetamol to relieve pain and fever. 
• Do NOT take aspirin or ibuprofen, as these can cause bleeding problems in people with dengue. 
• Drink plenty of fluids to prevent dehydration – bottled water is safer than tap water in many locations. 
• Get plenty of rest.

You should start to feel better after about a week, although it may be a few weeks before you feel your normal self again. Get medical advice if your symptoms don't improve and be aware that you can get it again if you've had it before, as you'll only be immune to one type of the virus.

In rare cases Dengue can be very serious and potentially life threatening. This is known as severe dengue or dengue haemorrhagic fever. It’s thought that people who've had dengue before are at most risk of severe dengue if they become infected again. So this makes it a bigger risk for mariners working particular routes, than for tourists or travellers.

Signs of severe dengue can include:

• Severe abdominal pain.
• Swollen or distended abdomen. 
• Vomiting repeatedly, vomiting blood.
• Bleeding gums or bleeding under the skin. 
• Breathing difficulties or fast breathing. 
• Cold, clammy skin. 
• A weak but fast pulse. 
• Drowsiness or loss of consciousness.

As we said earlier, prevention is the best attack and these actions can reduce your risk of being bitten:

• Use insect repellent – products containing 50% DEET are most effective, but a lower strength (15 to 30% DEET) should be used on children, and alternatives to DEET should be used on children younger than 2 months. 
• Wear loose but protective clothing – those pesky mosquitoes can still bite through tight-fitting clothes. Trousers, long-sleeved shirts, and socks and shoes (not sandals) are best.
• Sleep under a mosquito net – ideally one that has been treated with insecticide. 
• Be aware of your environment – mosquitoes that spread dengue breed in still water in urban areas.

Tuberculosis (TB)

The most common questions the Red Square Medical team get asked about TB are, ‘is it contagious?’ and ‘how can I get tested for it?’. But as more and more companies are introducing TB screening, we thought we’d share some ‘need to knows’ about TB.

TB is a bacterial disease that can be transmitted by breathing in the bacteria that cause it, such as minute droplets in the air coughed out from an infected person.

In most cases, the body’s immune system is able to kill the bacteria and the person remains healthy. But some people will become ill. It can take weeks, months or years to show symptoms after becoming infected and this is called ‘active TB’.

In other cases, the bacteria aren’t killed, but can live at low levels in the body. The person doesn’t get ill and isn’t infectious. This is called ‘latent TB’.

But if the bacteria start to multiply again, months or even years later, it can develop into active TB. This can happen if the person's immune system is compromised - such as chemotherapy treatment or by other diseases such as HIV. 

TB mainly affects the lungs, so the main symptoms are listed below. But it can also affect the abdomen, glands, bones and nervous system.

• Persistent cough for more than 3 weeks.
• The cough may be productive, with bloody phlegm.
• Extreme tiredness.
• Loss of appetite.
• Weight loss.
• Fever.
• Night sweats.
• Swelling in the neck

Of course, this sounds like so many other diseases, it can be hard to diagnose. So your travel history and who you have been in contact with is an important part of the background information. 

Your healthcare professional will decide if you are at high risk of contracting TB and will refer you for testing if it’s needed. There are a number of ways to test for TB.

Mantoux test: where a small amount of harmless TB protein is injected under the skin and the area checked 48-72 hours later to see if your body has reacted normally. Be warned… it stings a bit! But you can’t catch TB from this test.

Interferon-gamma release assay: this is a blood test that can be done at the same time, after or instead of the Mantoux test. A positive result means more tests are needed to find out if you have TB.

Sputum smear: a specimen of sputum that has been coughed up is examined for TB in a laboratory.

Chest X-ray: an x-ray can establish whether there is any TB in the lungs.

What happens if you do test positive for TB? 

With treatment, TB can almost always be cured and if you test positive, you’ll be started on a combination of different antibiotics to treat the bacterial infection causing the TB. The length of treatment will depend on whether it’s latent or active TB but they normally need to be taken for 6 months. Several different antibiotics are needed because some forms of TB are resistant to certain antibiotics. 

If you’re diagnosed with pulmonary (in the lungs) TB, you’re still contagious for 2-3 weeks into treatment and while you don’t need to isolate, you do need to take precautions to prevent spreading it. 

You should:

• Stay away from work, school or college until your TB treatment team advises you it's safe to return.
• Always cover your mouth when coughing, sneezing or laughing. 
• Carefully dispose of any used tissues in a sealed plastic bag. 
• Open windows when possible to ensure a good supply of fresh air in the areas where you spend time. 
• Avoid sleeping in the same room as other people. 

If you have been in close contact with someone who has TB, you may need to have tests to see whether you're also infected. 

The BCG vaccination was used routinely to protect from TB. But as TB rates are generally low in the UK, it’s no longer offered to children in secondary schools. It was replaced in 2005 with a more targeted programme for babies, children and young adults at higher risk of TB. This means that those born after 2005 won’t have been vaccinated and may have lower resistance to TB. 

And finally… drum roll please, for possibly the ‘icky-est’ of our tropical disease features!

Cutaneous Larva Migrans

Cutaneous Larva Migrans is a soil transmitted helminth and more commonly known as Hookworm which is a parasitic worm. 

It’s estimated that up to 740 million people are infected with hookworm across the world, and there are many types of hookworm for you to hook up with! 

Hookworm is most common in warm, moist climates and where sanitation and hygiene are poor and it’s normally through walking barefoot on contaminated soil, beaches or other surfaces where skin is in contact with the contaminated soil or sand. 

*Icky Alert…* Hookworms live in the small intestine and eggs are passed on in the faeces of an infected person. If the faeces lands outside (due to humans taking an ‘al fresco’ poop!), it’s used as fertiliser which helps the eggs to mature and hatch larvae. The larvae then mature into a form that can penetrate human skin. 

Most people who are infected will have no symptoms. Other symptoms include:

• Itching and a localised rash where the larvae penetrate the skin. This can appear similar to a mosquito bite.
• Abdominal pain.
• Loss of appetite.
• Weight loss.
• Fatigue.
• Anaemia in serious cases. 

Treatment is normally a short course of antibiotics over 1-3 days. 

In our example, the patient was walking barefoot on a beach in Antigua when they were bitten on the instep of their foot. The initial itchiness made them think it was nothing more than a mosquito bite. 

However the wound remained itchy and the patient sought advice after noticing that a red line had developed from the wound across the sole of their foot. The line didn’t follow the circulatory system as you would expect in the case of infection, but it was raised and firm on palpation. Hookworm was diagnosed and treated with a 3 day course of Mebendozol, an oral antibiotic. This killed the parasite and the wound healed with no secondary infection.