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Tropical diseases...some like it hot (and humid)!

Following on from the latest edition of our monthly newsletter, Worse Things Happen at Sea, this is the second blog taking a closer look at the most common tropical diseases that you might encounter. Last week we focused on Malaria, this week it’s the turn of Dengue Fever, Tuberculosis and the rather delicious sounding Cutaneous Larva Migrans!

Dengue Fever

Dengue is a viral infection, with four different types, spread by infected mosquitoes, usually the Aedes aegypti and Aedes albopictus varieties. It can’t be spread from person to person.

The mosquitoes bite during the day, usually early morning or in the early evening just before dusk. They're often found near still water in built-up areas, such as in wells, water storage tanks or in old car tyres.

While we’re not at risk in the UK, it’s widespread in many parts of the world such as Southeast Asia, the Caribbean, the Indian subcontinent, South and Central America, Africa, the Pacific Islands and Australia. There is no vaccination or specific treatment available, so it’s important to take steps to prevent infection in the first place.

Dengue normally presents as a mild infection that develops suddenly, around 5-8 days after being infected, and passes in around a week with no lasting damage other than maybe feeling tired and a bit unwell for a few weeks. So it can normally be managed without needing hospital treatment by managing the symptoms. But occasionally it can become life threatening and in rare cases, severe Dengue can develop after the initial symptoms.

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. 

Guest blog: Jordan Lin

by Rachel Smith • 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!

That Lightbulb Moment!

by Rachel Smith • 24 Apr, 2024
At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.

Worse Things Happen at Sea… a salty tale of dysentery, haemorrhoids, accidents, depression and death!

by Rachel Smith • 03 Apr, 2024
You might wonder about the title of this month’s guest blog, as Worse Things Happen at Sea is also the name of our monthly newsletter. But this month, we’re delighted to introduce Andrew Edwards as our Guest Blogger, and we felt his amazing story about life at sea really deserved a dramatic headline… Dysentery... In the summer of 1966, I was a cadet on a cargo ship that loaded in the UK for 9 ports in West, South and East Africa. Our first port of call was Luanda, the capital of Angola – which was then a colony of Portugal. Next, 300 miles down the coast we called in to Lobito – also in Angola. In Lobito two of the ship's company contracted dysentery; myself and a big Irishman called Reg. The shoreside Doctor we saw simply diagnosed the condition (amoebic dysentery) and said, ‘sorry but I have no antibiotics for this!’. Thankfully the ship’s purser stood our corner and demanded that the Doctor find some. The following day the antibiotics were flown in from the Belgian Congo. The Doctor gave us no advice as to how to deal with the condition, not a word about how contagious it was, not a word as to the importance of thoroughly washing our hands and maintaining scrupulous personal hygiene. Thankfully both Reg and I were quartered just a short sprint from the heads, and we were left to get on with it by our shipmates. It took about a week to get over the dysentery, by which time I had lost several stone in weight and was as weak as a kitten. By the time we arrived in Walvis Bay, South West Africa (now known as Namibia), a further 1000 miles south, I was just about fit enough to play football for the ship against a local team. Their football ground had a main road going right through the middle of it which made for some challenging moments, but they still beat us comfortably and they were playing in bare feet!

How does the Easter Bunny avoid Diabetes?

by Rachel Smith • 20 Mar, 2024
As it’s Easter, we thought that it would be a very appropriate time, what with all that chocolate around, to take a closer look at the subject of Diabetes and why it’s such a huge problem in the UK and across the world. The Easter Bunny always looks so cute and cuddly, but is he a diabetes case waiting to happen? Or does his diet of grass and all that hopping around for the rest of the year make an important difference? According to the WHO, diabetes is a chronic, metabolic disease which is characterised by elevated levels of blood glucose (or blood sugar). Over time, this leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, and it usually develops with a late onset in adults. It occurs when the body becomes resistant to insulin or doesn't make enough insulin. Worryingly, in the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels and is closely linked to obesity, poor diet, and an unhealthy lifestyle. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes (need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue), but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Normal onset is in younger people, but can also be in adults. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 1 diabetes cannot currently be prevented. It’s thought to be caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin. It can also be caused by genetics, viruses, trauma, tumours, removal of the pancreas or other damage to the pancreas. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. But the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The starting point for living well with type one or type 2 diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications. A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet to facilitate early treatment.

Reflective Practice and why it’s so important

by Rachel Smith • 21 Feb, 2024
Well, we’ve made it to February! How are your goals for the year going so far? As you’ll know, we do love a bit of goal setting at Red Square Medical HQ. But, we also understand the importance of Reflective Practice too. Especially in relation to setting goals. Want to know more? Please read on…

Guest Blog - Sam Kelly MSA

by Rachel Smith • 07 Feb, 2024
Today we start the first in a series of blogs in conjunction with our friends at the Maritime Skills Academy, and kicking it all off is a Guest Blog from MSAs Head of Training, Sam Kelly. Sam is 37 and lives in southeast Kent, in the quaint seaside town of Deal with with his wife, two children and a ‘Golden Doodle’ called Pringle. He has lived in the area ever since his father, a serving Royal Marine at the Deal Depot, and mother decided this was the place to raise their family. And it is, quite frankly, an excellent place to live. Here is his story… I’m the Head of Training for the Maritime Skills Academy, based in our head office in Dover. I oversee a team of Maritime Safety Instructors who deliver all STCW training for seafarers. Outside the Dover base, we have MSA Gibraltar. This location is operated in partnership with the University of Gibraltar and delivers Basic Safety Training and most recently Operational Firefighting, We are actually in the process of building a state-of-the-art Fire Training Module on ‘the Rock’.

Dry January!

by Rachel Smith • 17 Jan, 2024
So Christmas seems like years ago, and we’re all well into the New Year now. Did you make any resolutions? Some love to, some don’t. At Red Square Medical HQ, we love a goal or two and think the turn of the years can be a good prompt to make some positive changes. But, it’s well known that New Year resolutions don’t last. Forbes magazine tells us that 21% don’t make their resolution stick for even a month. While 34% state that it lasted for between one and three months. Is that a failure though? Or could it be all it takes to make some small changes that have a lasting impact? We thought it would be good to take a closer look at one of the most popular resolutions… Dry January! Now, let’s get one thing straight, the Red Square Medical team are not averse to a tipple or two! But as medics, we’re very aware of the short and long term benefits of giving our livers a little breather every so often. Of course, everyone responds differently to stopping drinking for a month, so the timeline below is just a guide. But it might help you to decide whether it’s a good idea to give the booze a break for a while, or work towards reducing your intake - we know it’s easy for it to creep up over time!

12 months since I left the NHS

by Rachel Smith • 03 Jan, 2024
What I miss most about the Ambulance Service… It’s been 12 months since I left the Ambulance service after 8 years of working frontline, and to be honest it’s flown by. A few weeks ago the team at Red Square Medical HQ were chatting about how life has changed in that time and what, if anything, I was missing from my former life! The list might just surprise you… Most of all, I miss my old colleagues and I definitely miss the patient contact. And driving on blue lights… that was one of the best parts of the job! Working in the ambulance service with regular partners who you get on well with really does create friendships for life. Or even doing a tricky job with someone you don’t know well provides a common bond forever. Every day you’re facing stressful situations and sometimes split second, life changing decisions. You rely on each other totally and make sure you keep each other safe in some difficult and challenging situations. I worked with 3 very different partners most of the time for my last few years and I miss them all. Happily though, I have some great new colleagues at Red Square Medical and Outreach Rescue, the other company that I work for.

Guest Blog - Rachel Smith

by Rachel Smith • 03 Jan, 2024
I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding. Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me. I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel. I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!

Are they wearing a beer jacket??

by Rachel Smith • 20 Dec, 2023
Christmas is coming and the season of parties is upon us. Of course this means that most of us will overindulge in large amounts of luscious food and, of course, a tipple or two. At Red Square Medical HQ, we have a method of categorising drunk people. During our combined careers, we’ve dealt with more drunks than we can remember; it’s easily running into several hundred. What we’ve learnt, amongst other things, is that most people who are drunk fall into one of these categories. Now please don’t judge as it is purely observation and also makes for an interesting chat when delivering the STCW Medical training, because we all know at least one person from each category and sometimes… a person can be in multiple categories depending on many other factors, or, we might even have been there ourselves! Once we have established these categories there is a serious note to this blog so please do keep reading.
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