MAIN TRAVELLERS’ DISEASES IN PERU

March 24, 2016
problemas durante el trayecto a peru

In your visit to Peru you will have magical places to visit, without any doubt this country has hidden tourist sites. However you must take into account the risks and hazards that may occur during your trip, here are a number of diseases and dangers:

DEEP VEIN THROMBOSIS:

During flights, blood clots can form mainly due to especially to prolonged immobility: when longer the flight is, greater is the risk. Although almost all clots are reabsorbed without causing problems, some can break off and travel through blood vessels to the lungs, where it may cause fatal complications.

The main alarm signal is pain or swelling of foot, ankle or calf, usually (but not always) on one side. When a blood clot reaches the lungs, it can cause chest pain and difficulty breathing. Travellers who experience any of these symptoms should seek immediate medical attention.

To prevent the development of deep vein thrombosis on long flights, you have to move your legs often during long trips, performing isometric compressions of leg muscles (contraérselos while you are sitting), drink plenty of fluids and avoid alcohol and tobacco.

JET & DIZINESS LAG

The gap usually occurs across more than five time zones, and causes insomnia, fatigue, malaise or nausea. To avoid this, it is advisable to drink plenty of non-alcoholic fluids and take light food. Upon arrival, it is best exposed to sunlight and adjust the schedule to eat, sleep or perform other activities as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are often used as first choice to treat dizziness; its main side effect is drowsiness. Ginger, a natural alternative works very well as some travellers.

IN SOUTH AMERICA

*MEDICAL ASSISTANCE AND COST

It is more difficult to find good medical care in small towns and it is impossible in rural areas. Most doctors and hospitals expect to be paid in cash, even if you have travel insurance. If the patient suffers from a serious health problem, probably wanted to be evacuated even in medicine pointer country. This can cost tens of thousands of euros, so, before departure, he should take out insurance to cover such eventuality. It is always best planted these situations then regret for not having thought. The website of the US State Department (www.travel.state.gov/medical.html) provides information on medical evacuations and travel insurance.

INFECTIOUS DISEASES

a) CHOLERA:
It is an intestinal infection contracted through contaminated water or food. Its main symptom is such a strong watery diarrhea that it can cause fatal dehydration, so that essential treatment involves taking oral rehydration solution. Antibiotics are also used: usually tetracycline or doxycycline are administered, although quinolones such as ciprofloxacin and levofloxacin also takes effect.

Travellers contract rarely cholera. The vaccine is not required, and indeed the former one was unsufficiently efficient. The new one are safer, but many countries do not manage and are only recommended for very high risk areas.

b) DENGUE:

It is a viral infection that cases are recorded throughout South America. Transmitted by the Aedes mosquito species that stings especially during the day and is near the populated places, often indoors. They are raised mainly in stagnant water contained in jars, barrels, buckets, tanks, metal drums, plastic containers and discarded tires. Hence, dengue is often contracted in densely populated urban environments.

His symptoms appear flu; fever, muscle and joint pain, headache, nausea and vomiting, which often follows a rash. Bodily discomfort usually disappears within a few days without problems. The most severe cases occur in children under 15 infected a second time.

There is no specific treatment; you have to take painkillers such as acetaminophen / paracetamol (tylenol) and drink plenty of fluids. Severe cases may require hospitalization to receive intravenous fluids and general care. No vaccine: the key to prevention lies in being protected against insects.

The traveller should find out if there is an outbreak in the area to visit. In 2009, Bolivia suffered from the worst dengue epidemic in its history, with more than sixty thousand people infected. In Brazil (especially in Bay) also it estimated that there were 225,000 cases and 25,000 in Argentina.

CDC (www.cdc.gov/travel) reports on the latest developments. It may also help the website of Ministry of Health and Social Policy: http://www.msps.es/profesionales/saludpublica/sanidadexterior/docs/folleto_2009_lasaludtambienviaja.pdf.

c) HEPATITIS A:

It is the second most common infection related to travel, after diarrhea. It produces a virus that attacks the liver and is usually acquired by ingestion of water, ice or contaminated food, but also through direct contact with infected people. This disease occurs worldwide, but its incidence increases in developing countries. Symptoms include fever, malaise, jaundice, nausea, vomiting and abdominal pain.

Almost all cases are resolved on their own without complications, but sometimes hepatitis A can cause significant damage to the liver. Unfortunately, there is no treatment.

The vaccine is very safe and effective; if between 6 and 12 months later injected a memory lasts at least 10 years. All travellers should receive it before visiting any developing country. Its safety for pregnant women and children under two years has not been shown, so that, these groups would have to administer an injection of gamma globulin.

d) HEPATITIS B:

Such as Hepatitis A, it is a liver infection that occurs worldwide, but is most common in developing countries. It is usually acquired through sexual contact or exposure to contaminated bloods, usually through blood transfusions or blood needles. The vaccine is only recommended for travellers who stay more than six months, they intend to live in rural areas or into close physical contact with the local population; also it is advised for anyone who foresees to have sexual relations with the inhabitants of the country or believes that would need a medical treatment, dental or other, especially if it involves transfusions or injections.

The vaccine is safe and very effective. However, to achieve full immunity three injections are needed. Several countries added the hepatitis B vaccine to the list of routine childhood immunizations 1980s, so many young adults are already protected. This type of information is vital to the health of the traveller.

e) MALARIA:

Cases of this disease are recorded throughout South America except Chile, Uruguay and the Falkland Islands. They are transmitted by mosquito bites. Especially between the hours ranging from dusk to dawn. The main symptom is high fever that may be accompanied by chills, sweating, headache, weakness, body aches, vomiting or diarrhea. In severe cases, the possibility exists that affects the central nervous system, causing confusion, seizures, coma and death.

There are three types of malaria pills that work equally well; mefloquine (Lariam) is taken once a week at a dose of 250 mg. Treatment begins 1 or 2 weeks before arrival and continuing throughout the trip and for 4 weeks after return; some people (there is controversy regarding the percentage) suffer neuropsychiatric side effects from mild to severe. Atovaquone / proguanil (Malarone) is a recently approved pill that is taken once daily with food. The traveller should start medicating two days before arrival and keep doing it while travelling and for 7 days after departure; Side effects are usually few important. Doxycycline is a third alternative, but can cause serious sunburn, so it is not as recommended as the above.

Malarone seems to cause fewer side effects than mefloquine and is increasingly used, although it should be eaten daily. For long trips, it may be appropriate to take the second one, and on short term, the first.

Protecting yourself from mosquito bites is important as taking pills, since the latter are not 100% effective.

If travellers do not have access to medical care during the trip, you should carry additional emergency pills, ie when you cannot find a doctor and suffer symptoms such as high fever. One option is to eat four daily Malarone tablets for three days, although it should not take this treatment if it was already using the same drug as prevention. Another alternative is to take quinine 650 mg of tid and doxycycline 100 mg twice daily for a week. If the visitor begins to self-medicate, you have to go to a doctor as soon as possible for treatment control.

The traveller who suffers from fever after returning home, he should also go to the doctor because the symptoms of malaria may not manifest until months after it collapsed.

f) FEVER:

Humans usually acquire it through flea bites from rodents, especially when these animals bite. Symptoms include fever, chills, muscle aches and discomfort, and the development of a very bulky lymph node (bubo) that usually appear in English. Cases are reported in Peru, Bolivia and Brazil almost all year. Most travellers are at risk of becoming infected intimate; however, if they come into contact with rodents or their fleas they have to do with a bottle of doxycycline to take it as prevention during the exposure periods. All children under eight years or the allergic to this antibiotic should replace them with trimethoprim-sulfamethoxazole. In addition, avoid areas with rodent burrows or nests, never touch sick or dead animals, and follow the advice in this chapter to protect against insect bites. As always, prevention is important.

g) RAGE:

It is a viral infection of the brain and spinal cord that is almost always fatal. The virus is found in the saliva of infected animals and is usually transmitted through a bite, although contamination of any figure in the skin with infected saliva can trigger the disease, which occurs in all South American countries.

The vaccine is safe, but the whole serie requires three injections and leaves quite clear. People at high risk, such as working with animals or cavers should receive it. In addition, you also have to immunize people who begin to travel to remote areas, they may not have access to adequate medical care. Treatment after a bite is the vaccine with rabies immune globulin, very effective, but must be administered quickly. Most travellers do not need to be vaccinated. All animal bites and scratches be cleaned quickly and thoroughly with soap and water; you also need to contact health authorities to determine whether further treatment is needed.

h) TYPHOID FEVER:

Indigestion is caused by food indigestion or water contaminated by salmonella typhi. Almost always accompanied by fever. Other symptoms include headache, malaise, muscle aches, dizziness, loss of appetite, nausea, abdominal pain, diarrhea or constipation. It can also cause intestinal perforation, intestinal bleeding, confusion, delirium or, rarely coma.

Unless you will always eat at hotels and popular restaurants, the vaccine is no more. Usually it is administered orally, but is also available in injections. It is not approved for children under two years.

The drug used is usually a quinolone antibiotic such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), in many viajerosusan to treat diarrhea. However, if you are self medical against typhoid fever, you may need to also do against malaria, because the symptoms of both diseases can be indistinquibles.

i) YELLOW FEVER

It is a very large viral infection spread by mosquitoes in forest areas. The disease begins like a flu, such as fever, chills, headache, musculare and back pain, loss of appetite, nausea and vomiting symptoms. Usually, it is quite decreased in a few days, but the person every six months enters a second phase characterized by more toxic fever, vomiting, listlessness, jaundice, kidney failure and bleeding; half of these cases end in death. Unfortunately, there is no treatment, only palliative care.

The vaccine, effective for a few years, is given only at authorized centers providing international vaccination certificate ( “yellow book”) validated. It must receive at least 10 days before any possible exposure to the virus. Side effects are usually mild and may include headache, muscle pain, low fever or discomfort at the injection site. Serious reactions have been reported life-threatening, but they are extremely rare. The risk of disease because the vaccine is much less than do so due to yellow fever, so certainly it is recommended to immunize.

Travellers should protect themselves against mosquito bites to prevent this disease.

OTHER INFECTIONS

BARTONELOSIS (OROYA FEVER)

Midges are transmitted from the arid river valleys located between 800 and 3,000m of altitude, on the western slopes of the Peruvian Andes, Colombians and Ecuadorians; curiously, it is not given anywhere else in the world. The main symptoms are fever and body aches strong. Complications can include severe anemia, enlarged liver and spleen, and in some cases death. The drug used is chloramphenicol, although doxycycline is also effective.

CHAGGA-MAZZA DISEASES

It is a parasitic infection transmitted by triatomine insects (kissing bugs) that live in cracks in walls and ceilings of substandard housing in South and Central America. In Peru, most cases occur in the south. The insect leaves droppings on human skin while pricked, usually at night; Infection occurs when a person unwittingly rubs the feces against the bite wound or any other fissure. Travellers suffer from this rare disease sometimes. However, if you sleep in a house building pus, especially if it is made of clay, adobe or straw, must be protected with a mosquito net and a good insecticide.

GNATHOSTOMOSIS

It is a condition caused by an intestinal parasite acquired by eating raw or undercooked fish, such as ceviche (raw fish or seafood marinated).

HISTOPLASMOSIS

The fungus causes a land that is acquired by inhalation, often when the soil has been removed. Symptoms may include fever, chills, dry cough, chest pain, headache and sometimes pneumonia. There have been cases cavers who have visited caves inhabited by bats.

HIV/AIDS

There have been cases in all South American countries. Always use condoms when having sex.

LEISHMANIOSIS

It occurs in the mountains and jungles of all South American countries except Chile, Uruguay and the Falkland Islands. Transmit gnats, whose size is a third of a mosquito. It can attack only the skin, causing growing ulcers, slowly in areas exposed, rarely affects the bone marrow, liver and spleen. There is a possibility that copper infects particularly and seriously people with HIV. No vaccine; to protect must take the same precautions with mosquitoes, although the mesh of the screen should be thinner (pores of 0.4-0.5 mm).

LEPTOSPIROSIS

It is acquired through exposure to contaminated waters by the urine of infected animals. Outbreaks usually occur when floods occur, with the overflow of wastewater. Initial symptoms, similar to those of a mild flu, usually disappear without problem in a few days, but in the minority of cases are complicated by ictericida or meningitis. No vaccine; should not be introduced into fresh water may be contaminated by animal urine. If you visit an area that is suffering from an outbreak, you can take doxycycline 200mg once a week for prevention. If the disease is contracted, the treatment consists of 100 mg of doxycycline twice daily.

SPECIFIC RISKS

ALTITUDE SICKNESS

It is triggered when ascending rapidly to altitudes higher than 2,500 m. Being in good physical conditions offers no protection, and those who have previously contracted tend to have new episodes, so there is no person who is completely free of suffering. The risk increases as increasing the speed of ascent, altitude or effort. Symptoms include headache, nausea, vomiting, dizziness, malaise, insomnia and loss of appetite. More severe cases may have fluid in the lungs (pulmonary edema high altitude) or swelling of the brain (cerebral edema high altitude).

To prevent, it is advisable to take acetazolamide (Diamox) of 125 or 250 mg two or three times a day; treatment begins four hours before ascent and continuing for 48 hours after reaching altitude areas. You may notice side effects such as increased urinary volume, stiff limbs, tingling, nausea, dizziness, myopia and temporary impotence. Pregnant and allergic to sulfa drugs should not take acetazolamide. For those who do not tolerate, it is best to take dexamethasone 4 mg four times a day; intake should be decreased gradually to reach high areas. Dexamethasone is a steroid, so should not be given to diabetics or people for whom this contraindicated. Ginkgo is a natural alternative to drugs.

When travelling to areas of high altitude, it is important to avoid overexertion, eat light and not drinking alcohol.

If symptoms are not mild or disappear fast, you have to see a doctor because in severe cases can become fatal.

ANIMAL BITES

There is no point to caress, touch or feed any animal, except for domestic if known to be free of infectious diseases. Almost all injuries caused by animals are directly related to the intent of the person by touching them or give them food, so usually is human to blame for their own damage.

Any bite or scratch of a mammal, including bat should be cleaned quickly and meticulousness with soap and plenty of water and then apply an antiseptic such as iodine or alcohol. You should immediately contact local health authorities for possible rabies treatment, regardless of whether the traveller this or not vaccinated. It may also be desirable to take an antibiotic, such as wounds are infected. Levofloxacin (Levaquin) one of the newer quinolones many travellers use in case of diarrhea, it is a good choice.

Snakes and leeches are dangerous in some areas of South America. Faced with a venomous snake bite, it is required to keep the victim at rest, to immobilize the affected area and, without further delay, transfer the person to the nearest health facilities. Turnstiles is not recommended.

EXPOSURE TO COLD AND HYPOTHERMIA

It can be a problem in the Andes, especially at night. Bring warm clothes, keep dry and active, eating food and plenty of water, getting enough rest and avoid alcohol, caffeine and snuff. Attention should be paid to the setbacks, awkwardness in speaking and moving and grunting, signs of an imminent hypothermic. It enters this state when the body loses faster than it takes to produce heat and, consequently, its temperature drops. If you walk through areas of high altitude or just a long bus trip through the mountains, especially at night, it should take precautions is done. In the Andes, always prepare for the cold, humidity and wind, if only for a few hours. Better bring several layers of clothing and a hat, since much heat is lost through the head.

Symptoms include fatigue, numbness, chills, slurred speech, irrational or violent behaviour, lethargy, stumbling, dizziness, cramps and violent outbursts of energy. Pera treat mild hypothermia should protect the affected wind or rain, get your clothes if wet, dress it in something warm and dry, and offer hot drink alcohol and easy to digest food with many calories. Not to massage it: it has to do the same. Early detection and treatment is the only way to prevent severe hypothermia, critical prognosis.

INSOLATION

To prevent it, avoid the midday sun, wear dark glasses and a wide brimmed hat, and use sunscreen of SPF 15 or higher, with protection against UVA and UVB rays. The product should be spread generously for all unprotected parts of the body about 30 minutes before exposure to the sun, to return to apply after walking or perform strenuous activities. Travellers have to drink plenty of fluids and avoid strenuous exercise when the temperature is high.

INSECT BITES

To prevent mosquito bites, wear long must sleeves, long pants, hat and shoes instead of sandals. It is advised to take a good insect repellent, preferably with DEET, to be applied to exposed skin and clothing, but not in the eyes, mouth, cuts, wounds or irritated. Products with lower concentrations of DEET are just as effective, but for shorter periods of time. Adults and children over 12 have to use preparations containing three 25% and 35% DEET, which last for one to six hours. Children between 2 and 12 years should use not exceeding 10% DEET, apply sparingly and offer protection for about 3 hours. There have been cases of neurological toxicity caused by this substance, especially in children, although they are rare and are usually associated with excessive use of the product. The DEET compounds cannot be applied to children under two years.

Insect repellents made with certain botanical products such as eucalyptus oil and soybean discharge their responsibilities, but only last 1 and ½ to 2 hours. DEET repellents are preferred for areas with high risk of malaria or yellow fever. Citronella products are not effective.

For additional protection, you can be impregnated with permethrin clothing, shoes, shop and mosquito net; It is safe and effective for at least two weeks, although the materials are washed. It should not be applied directly to the skin.

No need to sleep with the window opened, unless mosquito net is available, highly recommended if you spend the night outdoors or in accommodation not taking action against these insects. It is preferable to apply permethrin and tucking the edges under the mattress. The mesh opening should not exceed 1.5 mm. If no other protection available, you can use a mosquito coil. Impregnated with repellent wristbands they are not effective.

PARASITES

There is the possibility of contracting intestinal parasites throughout South America; the most common are those of the genus Cyclospora, Isospora and Amoebas. Tapeworm (taenia solium) can cause chronic infection of the brain called cysticercosis. If the traveller chooses wisely meals and drinks, it will reduce the risk of infection. Should choose crowded places, to ensure that foods have not been there long. In the markets and street stalls, you have to see how the dishes and cutlery are washed. At any sign of poor hygiene, it is better to leave.

Schistosomiasis, a parasitic infection that mostly affects blood vessels in the liver, occurs in Brazil, Suriname and parts of northern and central Venezuela. It is acquired upon entering the body in contact with infected fresh water or washing with these same waters. So it is advised not to bathe in lakes, ponds, streams and rivers. Toweling reduces the risk of infection, but not eliminated. Chlorinated pools are safe.

Hydatid disease caused by parasites of the genus echinococcus, can be contracted in many countries, especially in Peru and Uruguay; usually affects people in direct contact with sheep. Paragonimus parasites gender affects the lung and are acquired eating infected raw shellfish; cases have been registered in Ecuador, Peru and Venezuela.

TRAVELER’S DIARRHEA

To prevent it, avoid refrigerator water unless it has been boiled, filtered, treated with UV rays of a SteriPEN or chemically disinfected with iodine tablets. Fresh fruits and vegetables only have to eat cooked or peeled should be wary of dairy products that may contain unpasteurized milk and finally, it is advisable to be very selective when eating purchased in markets food and street stalls. In case of diarrhea, you have to drink plenty of fluids, preferably an oral rehydration solution with salt and sugar as Gastrolyte. A few arrangements, something aqueous does not require treatment, but if they are more than three a day and are accompanied by other symptoms such as fever, cramps, nausea, vomiting and malaise, will have to take antibiotics. Norfloxacin, ciprofloxacin or azithromycin quickly kill bacteria. Antidiarrheal agents such as loperamide only stop the symptoms but do not address their cause; the latter must take medicine if blood or stool have a fever. See a doctor right away if you do not respond to antibiotics.

<h2<WATER

In general, drinking tap water is not safe. Well boil for one minute is the most effective way to sanitize; at altitudes exceeding 2,000m, it should be done in three minutes.

The novel portable water purifiers use ultraviolet light, such as cash and lightweight SteriPEN; is available online and in some stores of camping equipment. Another option is to add iodine to 2% to 1 liter of water (5 drops if the water is clear, and 10 if cloudy) and let stand 30 minutes. If the water is cold, it may take more time. There are also iodine tablets as Globaline, drinking-water and Coghlans, sold in most pharmacies, the instructions must be followed. The iodized water can only be consumed for a few weeks, and its flavour by adding vitamin C (ascorbic acid) is improved. Pregnant women who suffer from thyroid and allergic to iodine should not drink it.

There are several water filters in the market. Those with smaller pores provide greater protection, but are large and clogged with impurities. The somewhat larger pores are not effective against viruses, but eliminate other microbes. They have to follow the manufacturer’s instructions.

TRADITIONAL MEDICINE

These are some fairly common traditional remedies:

PROBLEM:                                                         TREATMENT:

Altitude Sickness                                                 Gingko

Jetlag                                                                   Melatonin

Mosquito bites’ prevention                                   Eucalyptus oil or soy

Dizziness                                                             Ginger

WOMEN’S HEALTH

It can be difficult to find obstetric care outside the major cities; moreover, it is not recommended that pregnant spend time at altitudes where oxygen is scarce. Finally, although it is recommended vaccine against yellow fever for travelling to jungle areas located at a lower altitude of 2,300m, pregnant women should not receive it because it contains a live virus that can infect the fetus.