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Malaria Prevention in Travelers Since malaria in Thailand and in South East Asia are the multi drug resistance strain. The used of antimalarial prophylaxis should be advised by qualified medical staff only. Over-the-counter antimalarial drug is not recommended. In our clinic we provide counseling on basic knowledge of malaria, epidemiology, how to prevent yourself from malaria and whether antimalarial drug is recommended for you. You should have some basic knowledge about malaria. Please read these articles
We usually have 3 options of antimalarial prophylaxis
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Diagnosis and Treatment of Tropical Diseases Travelers from the western world may acquire tropical infections while they travel in the tropics. There are many symptoms that suggest tropical infections such as fever, diarrhea, skin rash, etc. These group of patients may develop symptoms while or after their trips. They should tell the doctors about their travel history to help the doctors find the diagnosis. If you get sick in the tropics, it is strongly recommended to seek for the medical care. Since some tropical diseases such as malaria can be fatal if not received prompt treatment. We are specialized in Tropical / Travel medicine. So we can provide a comprehensive medical care in diagnosis, lab testing and treatment of many tropical diseases such as
Each diseases required different laboratory testings such as blood check, stool exam, molecular diagnosis, etc. Counseling with our staff is mandatory in this issue.
Japanese Encephalitis Compiled By : Assoc.Prof. Chukiat Sirivichayakul
Assist.Prof. Achara Asavanich Produced By : Information leaflet committee, Faculty of Tropical Medicine,
Mahidol University and Department of Disease Control, Ministry of Public Health  Japanese encephalitis (JE) virus. Transmission to man is mainly by the mosquito Culex tritaeniorrhynchus, which breeds in rice fields.
Transmission
Pigs are amplifying hosts of this virus. The JE virus multiplies rapidly, resulting in viremia, but the pig remains asymptomatic. When the mosquito vector feeds on an infected pig, the virus multiplies in the mosquito and is transmitted to man or other animals, such as horse, cattle, sheep and bird, through mosquito bite. Endemic areas
This disease was first recognized in Japan. Currently, it is found widely in East Asia, Southeast Asia and South Asia. In Thailand, high incidence is found where rice and pig farms coexist, especially in Mae Hong Son, Mukdahan, Kamphaeng Phet, Samut Sakhon and Nan provinces. Symptoms
Approximately 1 in 300 JE virus infected persons become ill. The incubation period is 5-15 days. The illness starts with high fever, vomitting, headache and weakness. One to seven days later (usually 2-3 days), neurological signs and symptoms, such as stiff neck, drowsiness, delirium, convulsions, unconsciousness, tremor and paralysis may occur for 3-6 days. Those with severe conditions may die at this stage (the mortality rate is 15-30%). Finally, the fever gradually subsides, followed by improved neurological conditions. However, about half of the survivors have severe sequelae, such as spasms, paralysis, convulsions, mental retardation, speech disorders and emotional disturbances. Diagnosis
The disease can be diagnosed by physical examination along with the history of living in or entering endemic areas. Detection of antigens and antibodies to JE virus from serum and spinal fluid are considered the most accurate. Treatment
There is no specific anti-JE drug currently available. Only symptomatic and supportive treatments are provided to prevent the complications that may occur. Prevention
After vaccination was applied in Japan, China and Korea, the number of patients in these countries was reduced dramatically. JE virus vaccine is now available in Thailand. Three subcutaneous injections are recommended. The first and second adminstrations are one week apart, and the third dose is a year later. Self-protection and reduction of man-mosquito contact by application of repellent or the use of a bed-net are advisable. Control of mosquito vectors in rice fields and pig-farming areas may require a major effort, since Thailand is considered an agricultural country. A person who has never received vaccination and plans to enter an endemic area should be vaccinated at least two doses two weeks before entry. Note: Now new JE vaccine (CD-JE vax, SA14-14-2) is available in Thailand. Filariasis Compiled By : Assist. Prof. Narumon Komalamisra
Filariasis Cause and endemic areas Clinical features of bancroftian filariasis are the enlargement of scrotum, arms, or legs. It is prevalent in Western Thailand near the Thai-Myanmar border,ie. Amphoe Sangkhla Buri, Amphoe Thong Pha Phum, Kanchanaburi Province; Amphoe Mae Ramat, Tak Province; Amphoe La-un, Amphoe Mueng, Ranong Province. The mosquito vectors of bancroftian filariasis are the Aedes niveus group, whose breeding places are tree holes and bamboo stumps. At present, another strain of bancroftian filariasis, found in immigrant workers from Myanmar, has been reported in Thailand. This strain can be transmitted by several kinds of mosquito vectors, including Culex sp., which are generally found around houses all over the country.
Symptoms Diagnosis Prevention and control Controlling and reducing mosquito populations either by Those who live in endemic areas should take chemoprophylaxis, such as diethylcarbamazine (DEC) which can be requested from local health offices of the Ministry of Public Health. FAQ (Frequently Asked Questions) About Travelers' diarrhea Complied by: Dr. Watcharapong Piyaphanee
What’s Travelers’ diarrhea? Travelers' diarrhea is the most common illness affecting travelers. Every countries is at risk for travelers' diarrhea. But most cases occur in developing countries of Latin America, Africa, the Middle East, and Asia. In Thailand, prevalence of travelers' diarrhea is much lower nowadays, due to better sanitary conditions.
What causes travelers’ diarrhea? Germ in the unclean food or drink can cause travelers' diarrhea.The most common causative agent is enterotoxigenic Escherichia coli (ETEC). Other pathogens can cause travelers' diarrhea such as campylobacter, salmonella, shigella, vibrio spp., and many kinds of intestinal parasites.
The onset of travelers' diarrhea usually occurs within the first week of travel, but it may occur at any time while traveling. It also can occur shortly after you get home.
Even without treatment, travelers' diarrhea usually subsides with in 2-5 days. Most cases are mind. Some cases may having dehydration, fatique, and high grade fever, mayrequired hospitalization. Whenever possible, you should have your stool checked to find the causative pathogen. Most travelers' diarrhea is treated with appropriate antibiotics and supportive treatment. Oral rehydration is recommended to replace the lost fluid and electrolytes. Hospitalized cases usually require intravenous fluid rehydration.
What about the antimotility drug? Antimotility agents (e.g. loperamide) can reduce diarrhea by slowing the bowel movement. Since diarrhea is the body’s defense mechanism to get rid of the pathogen from the gastrointertinal tract, therefore antimotility agents may reduce the clearance of the pathogen and lead to systemic toxicity in the patient. However, these agents may be useful in reducing diarrhea while traveling. Never use these drug in the patients with fever or mucous-bloody stool. Medical consultation is needed.
Is there any drug can be used to prevent travelers’ diarrhea? Taking antibiotics to prevent diarrhea is not recommended. Routine antimicrobial prophylaxis increases the risk for adverse reactions to the travelers and may increase resistance to the organism.
Where can I seek for medical care if I have diarrhea? All hospital in Thailand can take care travelers' diarrhea. Most patients can be treated as outpatients but some patients may need hospitalization. In our clinic, all patients will be requested to collect their stool to check for the pathogen. You may collect your stool before attending our clinic. Use small plastic container collecting device.
How can I prevent travelers' diarrhea? Travelers' diarrhea is caused by a pathogen in unclean food or drink. Here are some useful tips. - Avoid eating food or drinking beverage from uncertain origin. - Avoid eating raw or undercooked meat and seafood. - Avoid unpasteurized dairy products. - Don't drink tap water. - Bottled water is probably safe, but be sure the cap and seal are not broken. - Bottled carbonated beverages and canned drinks are normally safe. |
