When Travelers Bring Skin Infections Back as Souvenirs

Years ago we travelled to Jamaica with a friend. At some point a few days into the trip, he complained of a sting while swimming - in his foot, between two toes. It looked like a small red spot. We didn't work much but It did not get better. We spent the better part of two weeks visiting Jamaican MDs getting various pieces of advice from " Take this (unidentified pill)," to "Just piss on it." Seriously. By the time we returned to NYC, his foot was too swollen to wear his shoe and thick blue veining and redness was running up his leg. He went to a Dermatologist who after some head scratching, sent him to a tropical medicine specialist at NYU Medical Center. Apparently a worm of some type had entered his foot and was rapidly proceeding up to his heart. He had to be hospitalized while receiving toxic levels of parasite killing medication. We never got the details, but he fully recovered after about ten days in the hospital on IVs and several week recuperation. We vacationed in Jamaica at least twenty times over 40 years with no ill effects. Needless to say he never went back.

Athletes foot. I spend about 300 nights a year in hotels. Once or twice, a battle with bed bugs or spiders. Athletes foot infections are relentless. They don’t occur as often now that I use TSA precheck. It doesn’t seem to matter whether it’s a courtyard or a Ritz. I now travel with flip flops and plenty of extra socks. The Clotrimazole is always within reach in my travel bag.

My son and his family have visited India several times to visit his wife's family. Her father, a pediatrician, always insists that everyone is up-to-date on shots. Chiggers are also prevalent in the American South and the same precautions should be taken against them there as in "wilder" places.

The warnings in this article are all the more concerning in our time of antibiotic resistance, irrational failure to vaccinate and a warming climate that is changing the map of endemic infectious disease. Right up there with the hellishness of flying - and why I don’t travel for pleasure. Central Park can be endlessly entertaining.

Intestinal parasites as well. I begged a journalist I know who writes a health column to address the issue of parasites. She doesn't feel that it's newsworthy. But the problem is growing.

We traveled to Europe...Germany, Austria and Switzerland. When we returned home my husband started itching and seeing a pattern of welts and sores that changed almost daily. Some days bad. Other days less so. When we went to see a dermatologist at a University hospital, she was confused. 6 months later, and many consultations and tests, it turned out he had scabies. A double treatment of Ivermectin finally arrested the awfulness he had had to endure. No one thought you could get scabies in Switzerland. But, at the last B and B we stayed at, the inn keeper had practiced medicine in Africa prior to starting this B and B. He used the profits from it to fund outreach in Africa and often had visitors from Africa staying with him. All we can guess is that he washed his sheets in cold water or that the bed my husband slept in failed to get cleaned at all. The Scabies survived. The lesson? Don't assume that you can't get a third world disease in a highly developed country.

And then there’s MRSA. Sightseeing in hot weather often creates blisters that, if untreated, can lead to full blown MRSA. On top of that, getting pedicures *anywhere* - here or abroad - in a tub that does not have a plastic liner is a sure bet for MRSA. I know, from experience.

My husband has been making business trips to China. He always arrives home with a minor illness; to be expected under the amount of stress he is enduring right now. I haven't been too worried about him going to the beach or anywhere without a full set of underwear and slacks, shirt, and light or heavy over coat. He is very light skinned and sunburns easily. As far as he is concerned, the beach holds no joy. But this last time, he visited a new place in China that had surrounding forests. He said when he checked into the hotel there he noticed thousands of tiny spiders and now had sores on his legs. He doesn't go fully dressed to bed, but did kept a night TShirt on because the room felt chilled. I checked his legs and clean the bites. He told me that spiders don't bite. Uh, huh. When the doctor's office opened the next day I made an appointment for him, while he was still catching up on his jet lag. She was able to see him an she had the same suspicion I did. Those bites may not have been too bad but he had probably scratched them in his sleep. She gave a low antibiotic for the infection she saw spreading, and a cream for him or me to rub on his legs. Within a week, what I had feared was the very beginnings of cellulitis on his left leg were regressing and the rest were healing nicely. I gave him a choice: He could either start wearing PJs to bed or he could rub the very finest of coatings of Vick Vaporub on his exposed body-parts. We'll see how it goes now.

Interesting that so many comments describe bug bites and the more exotic diseases. While skin infections can indeed be dangerous, several years living in Brazil taught me that tuberculosis and hepatitis— diseases of the poor and crowding— are the most prevalent. Cleanliness and the other precautions mentioned in the article are essential. Beware especially of the common housefly!

I guess I must be misunderstanding people when I hear them say they go abroad to experience different “cultures.”

I am a physician who has practiced medicine in the tropics. I have had malaria twice (drug resistant) and have seen many patients die from malaria and other mosquito borne diseases. I would like to praise Jane Brody for producing a succinct, helpful and accurate article. I have no quibbles with any of it. I do have a quibble just a few of the comments (I think that most comments are spot on). Those who advise against ever using DEET are doing a disservice to the cause of public health. Used as directed (and I really mean use as directed), it is very safe. Don't drink it. Don't bathe in it to avoid a mosquito bite in California where the risk of mosquito transmitted disease is tiny. But, it is the most studied and most proven effective insect repellant. It works. Mosquitos transmit diseases that cause millions of deaths and untold disability annually. And that is not even including all of the other insects repelled by DEET, insects which cause so many other diseases. Be truly obsessive about avoiding insect bites when you are in an environment with a significance prevalence of insect borne diseases. This article is a good start for planning how to obsess about it.

I traveled widely for many years pre the huge tourist influxes of today. Now I travel by watching PBS travel shows. It leaves a lot smaller footprint and is less dangerous to my health.

My husband picked up a fungal infection on a visit to Asia 20 years ago. Doctors in the US were baffled. It did finally disappear after over 10 years.

Is there a reason why people from modern developed countries have to visit every infected backwater sewer on earth to their satisfaction and then carry the diseases back here.

I can only imagine the stories that visitors to upstate New York take back to their home countries! “There are so many types of ticks that carry 15 different diseases, some fatal. They can’t be avoided. If you visit wooded or brushy areas, dose yourself and your clothing with insecticide. Still expect to contract debilitating Lime disease. Get a medical checkup when you get home. The mosquitoes carry only a few fatal diseases...... “

Sheesh. So many of these comments, while valuable and informational, make me not want to travel again. Like most people, I find myself somewhere where between the mentalities of Oh My God, I am Never Travelling Again, and You Only Live Once... The moral of most of these stories is get to your shots, do some research before you travel and be prepared. Consider also that many people are refusing immunizations right here in the States so folks traveling to (and within) the US have to look out for a whole host of diseases and pests, some minor and some quite serious.

Since I found I found Bullfrog and Avon's Skin-so-Soft, sunscreens and bug repellents in one, I will never go back to using two separate products again. Bullfrog's SPF is 50 and Avon's is 30. They both work very well.

My spouse came back to the UK from playing Ultimate on the beach in Barbados about fifteen years ago and developed a rash on his foot. When dr's various treatments didn't succeed I ended up chasing through google for possibilities (long before image searches) and sent Spouse back to the dr with a rather lurid printout of what hookworm tracks looked like. A quick application to the London Tropical Diseases centre for the right treatment and it was cleared up. I'm sure doctors hate patients turning up waving info from the internet with good reason but occasionally it works.

Infections are very serious and require immediate attention. I returned from spending almost two years in South America, high near the equator with a different problem. I returned with a lesion on my face which was biopsed twice with no result. I was prescribed antibiotics which did no good. I had one doctor call it "jungle rot." After four years, it suddenly began to change color. This time, a biopsy identified a basal cell carcinoma. But the underlying lesion was finally identified as discoid lupus, a skin condition aggravated by sun and associated with a high risk of systemic lupus, a potentially fatal disease.

Gah!! I thought it was just me! I returned from Belize with the most intensely itchy Sea-bathers Eruption (from jellyfish larvae) and my lips were swollen, cracked and itchy for 4 weeks. I needed to see a dermatologist 3 times. I love animals but after reading this I’m wondering if I should stop petting EVERY DOG I SEE!

Daily use of pepto-bismol preventively for intestinal bugs is not a good idea. Pepto-bismol is constipating and turns your stool black, which can hinder correct diagnosis if you nevertheless pick up something. It is also irresponsible from a public health perspective, akin to overuse of antibiotics. Also, don’t go barefoot anywhere, not just on beaches.

Excellent article. I was stung or bitten by 'something' on a trip which caused a small hole that eventually turned into a painful purple welt three inches across. Neither of the doctors I saw had a clue what it was, but it responded well to antibiotics. But what if it hadn't? Best is to follow Jane Brody's advice and learn what might harm you and if possible, how to protect yourself in advance.

I am a dermatologist and I saw a case of tungiasis in a returning traveler who traveled on a missionary trip to Uganda where she walked with sandals. It presented as an enlarging painful solitary white papule with a dark center on the woman's posterior heel. Fortunately, she was UTD on her tetanus vaccine and infection was not widespread and easily addressed with a bedside excision. Another example of the importance of protecting bare skin from contact with soil/vegetation.

An MD with a specialty in DTM (doctor of tropical medicine) can usually spot these exotic infections. They have helped a couple of friends who had chronic diarrhea for years. I have to think that with global warming these DTM docs are going to be greatly needed.

While walking barefoot in the temples of Myanmar I got a bad fungal infection on both feet. Sox were not permitted.Three months of taking Lamisil along with having liver checks. Finally cleared up after a lot of pain and stress.

Forty years ago on a visit to the US I discovered I had “picked up” a tapeworm (please don’t ask how I made the discovery) most likely from a trip to Morocco some time before. I became an instant “celebrity” among the doctors I scrambled to consult who had never, ever seen a case before in the upscale suburbs of Washington D.C. where my parents lived. They finally sent me to a “tropical disease” specialist they found who treated me and gave me a stern lecture about being more careful about the meat I ate when traveling in “exotic” locales. I recovered fully, but I don’t think my normally fearless and unsqeamish mother ever did.

Despite wearing long sleeves, jeans tucked in my socks, a hat and use of bug spray, I returned from the jungle in Peru with two botfly larvae deposited under the skin of my scalp. The bumps went from mosquito bite size to golf ball sized over the course of two weeks. I could feel every lymph node in my neck, head, scalp and shoulders. I explained my travel itinerary to the family practice physician. Despite an article in JAMA about botfly at the same time I presented in the office, he figured it was just spider bites and gave me antibiotics. The swelling subsided in my lymph nodes and I felt better, but the bumps didn’t go away and were occasionally oozing at night. I finally went to a dermatologist, who did some research following my appointment. She called me and asked me back the next day, as she had “an idea”. I arrived in the office and she put Vaseline on my growths, and asked if I minded if a couple other doctors took a look at my scalp. I told one physician that she “needed to develop a better Poker face” after she examined me, followed by a look of horror. Just as my dermatologist was about to give up and schedule a biopsy, out popped the worms. I told her I didn’t want to see it. She gleefully ran with it into the hall to show the gathering circle of colleagues. She told me what it was, and no further treatment was required. I was lucky, I guess. One of my companions ended up hospitalized with a different intestinal infection months later. Travel carefully.

Infections can progress very quickly! The Caribbean, in particular, seems to be a Petri dish of pathogens. In Aruba, I got a tiny cut on my big toe, either from nicking it on coral or stubbing it on a rock. I cleaned the cut and applied Neosporin ointment, but hours later I woke in the middle of the night to an extremely painful, throbbing, bright-red toe that was very hot to the touch. I phoned the hotel’s front desk and described the problem, asking for a first aid kit. They sent me a uniformed medic or nurse, carrying a full emergency-treatment bag. She drowned my toe in undiluted Betadine (an iodine solution) and gave me a supply of the stuff. That cut short the infection, but I have never seen an infection advance that fast. And I say that as someone who has suffered bad cuts and lacerations while working in the garden (around composted steer manure and other muck). I’ve even been bitten by dogs and cats and have not gotten an infection. But one cut in Aruba waters and my toe nearly blew up. I also got a remarkably violent gastro-intestinal illness —unlike any I’ve had before or since — while vacationing on the island of St. John. I think it might have had to do with the army of feral cats that infested the open-air dining facility where I took my meals. Or maybe it was the wandering goats I petted. Don’t pet the strays!

Scratched by something in Italy resulted in a golf size ball under my arm. Landed in a hospital without any English speaking people trying to explain the situation. Tracking down cipro in a tiny town with a pharmacy that was closed was a interesting experience. Husband brought back parasite infection from Mexico, we could only determine from going to a waterfall and wading pool. He had to get an experienced infectious disease specialist who worked with National Geographic photographers to get a diagnosis and treatment.

What was the vaccination status for diphtheria/tetanus of the 4 patients with cutaneous diphtheria? Are they from anti vaxer families? Were they debilitated healthwise? chronic elderly malnourished alcoholics can get cutaneous diphtheria. More info please.

Is it necessary to use the chewable Pepto, or could the tablet form suffice as a traveler's diarrhea preventative?

This article does not mention another cause of skin problems: Bed bugs! They do exist and are found even in upscale resorts in "developed" countries. I was beaten in an upscale resort in Tuscany, Italy. Most recently I brought back bed bug bites from a three star hotel in Lima, Peru. They are nasty and the effects last for over a week. Examine your beds for tell-tale signs before you go to sleep lr put your case on the bed.

Telling folks to slather 50% Deet on their skin is completely wrong! Many, like me, have nasty allergic reactions, in the middle of hiking up Mount Washington for example. Also, children are regularly told to wear no more than 10% Deet and only if they must. We are talking potential liver damage and worse here. You should use Deet on your clothing only. And watch out which clothes you put it on. Because Deet melts some fabrics! Picaridin is much better, but that too must be washed off as soon as possible. Yes insects carry nasty diseases. But there are better ways to protect yourself than undiscriminating useage of powerful toxins like Deet.

I discovered to my surprise and continued discomfort that Florida has one of the worst cases of flea infestation in the U.S. A few years ago I received so many flea bites simply by walking a few steps on a lawn in Orlando that I had the bites recurring again and again months later. Treatment of the inflammation required repeated applications of a prescription of hydrocortisone. I thought it would never end.

Good advice for travelers as we approach vacation time. Remember, too, that by not contracting any infectious diseases you'll not only spare yourself a lot of grief but you'll help your most vulnerable neighbors here (the very young and the very old) from possibly getting sick. I read that the seed for the current measles outbreaks were brought in from travelers to such countries as Israel and the Philippines. Then, it was spread here by people who refused vaccination. Just last week, on my regular follow-up visit for my annual physical, I requested and received the measles vaccine. I've already had my Tdap, Hepatitis A, Pneumonia, and flu vaccines. This week, I'm getting Shingrix. Got a good vaccine? Bring it on.

During the Ebola emergency, international airports were taking the temperature of incoming travelers as a precaution against spread of the disease. Most diseases cannot be detected - quickly and cheaply - by simple means. How many outbreaks are we away from carrying your shot records to physical exams to enter a country?