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August 20, 2003

Tropical scrud
Posted by Teresa at 03:32 PM *

Anyone here acquainted with tropical medicine? Mark Frauenfelder has been bitten or infected or something while on a tropical island, and has developed a nasty-looking lesion. He doesn’t know what to make of it, so he’s posted a photo and is asking for helpful suggestions. Look a lot like a spider bite, IMO.

Comments on Tropical scrud:
#1 ::: James D. Macdonald ::: (view all by) ::: August 20, 2003, 05:08 PM:

He should see a health-care professional, sooner rather than later.

Consider he has cellulitis secondary to an insect or spider bite. He needs broad-spectrum IV antibiotics.

Meanwhile, if he has oral antibiotics, take them. Elevate it (higher than his heart) to minimize swelling, and apply warm, moist compresses.

Watch for swollen lymph nodes, fever, chills, sweats, drowsiness, lethargy, blistering at the site, or red streaks extending from it. Keep track of the size of the lesion. If it isn't getting smaller, he's getting in deeper and deeper trouble.

The entire episode will probably be over in seven to ten days, one way or the other.

#2 ::: David Bilek ::: (view all by) ::: August 20, 2003, 05:26 PM:

If he were in a temperate zone rather than tropical, I'd say he better get on anti-Lyme antibiotics RIGHT NOW. You Do Not Want to develop late-stage Lyme disease. Trust me.

Exactly what "tropical location" is he at? Without that information it's impossible to even guess what that bite could be. Depending on where he is, it could be a Brown Recluse bite. If so, he'll know soon enough when the entire area goes black and necrotic.

Hell, it could be topical anthrax for all we know.

If he hasn't yet seen a doctor, what is he waiting for? The leg to fall off?

#3 ::: James D. Macdonald ::: (view all by) ::: August 20, 2003, 05:56 PM:

David is right. It's been fifteen years since I lived in the tropics, and that was the Latin American sector. There's all kinds of great stuff in Africa, Asia, wherever it's too darn hot and humid. There's no way to diagnose this over the Internet. You can't rule out spider bites, fungi, viral or bacterial infections, or parasites.

Still, elevation and warm moist heat is the general solution while going to a medic.

Any open wound in the tropics is going to get a bacterial infection sooner or later.

If I had this, I would worry.

And here's a Just For Fun:

#4 ::: Teresa Nielsen Hayden ::: (view all by) ::: August 20, 2003, 06:04 PM:

In the comments thread on BoingBoing I already told him to see a doctor, and to do so before he leaves the area.

The last time I had something like that turn up on my skin, it was followed by a walloping case of Lyme Disease, a recurrence of Lyme Disease some months after the first round had supposedly been cured, a lot of down time, and joints that have never been the same since.

#5 ::: James D. Macdonald ::: (view all by) ::: August 20, 2003, 06:12 PM:

Lyme disease ain't nothing compared to what you see in the tropics. See, for example, Leishmaniasis. (That photo is a two weeks.) That's a parasite. If not treated immediately, it will travel to the nasal/oral mucosa, remain dormant for a number of years, then become active with devastating effects, up to and including death.

Here it is at one week:

No way really to tell. Go see a medico.

#6 ::: Josh ::: (view all by) ::: August 20, 2003, 08:26 PM:

David: He's in Rarotonga. He's got a separate diary/weblog about it.

#7 ::: Teresa Nielsen Hayden ::: (view all by) ::: August 21, 2003, 12:52 AM:

I know Lyme disease ain't nothing compared to what you see in the tropics -- Panama, for instance.

Re Leishmaniasis: Ick! You're not kidding about that one being potentially devastating.

#8 ::: Jo Walton ::: (view all by) ::: August 21, 2003, 02:52 AM:

"Lyme disease is nothing" -- what are you saying? Lyme disease is the Black Death!

#9 ::: Rachel Brown ::: (view all by) ::: August 21, 2003, 03:42 AM:

His web page didn't say whether or not the island has a doctor; if it does, he needs to run to the doctor instantly (boy am I sorry I looked at Jim's linked photos.) If the island doesn't have a doctor, then moving his kids there in the pursuit of a slower life may not be something they will thank him and his wife for when they grow up.

I speak as one whose parents whisked me off to an isolated backwater ashram in India. They thought it would be a cross between _Woodstock_ and _Siddhartha_, and it turned out to be more like _The Mosquito Coast_.

Back to the topic, while I was there I once got a tiny scratch which got infected and ate a hole the diameter and depth of a quarter into my thigh in a shockingly quick time. I still have a scar. And as Jim pointed out, it could have been much worse.

#11 ::: Tom Whitmore ::: (view all by) ::: August 21, 2003, 09:09 AM:

All this discussion of tropical parasites brings to mind William Sleator's book PARASITE PIG, a sequel to INTERSTELLAR PIG. Sleator is a Peculiar Writer, not always pleasant and I'm not quite sure why I like most of his books; PARASITE PIG is basically a science-fictional expansion of the life cycle of an intelligent fluke that affects the mind of its human host. Not for the squeamish.


#12 ::: Chris Noto ::: (view all by) ::: August 21, 2003, 09:11 AM:

Latest word, via BoingBoing: Mark is using medication for ringworm, and things are looking better.

#13 ::: Jeff Crook ::: (view all by) ::: August 21, 2003, 10:15 AM:

All this reminds of the time I was working for a flower shop and handling armloads of tree branches recently arrived from god knows what tropical country (used for making artificial trees, btw). The next morning, I awoke with a pancake-sized red splotch on the inside of my right bicep and a red streak running up to my armpit.

I was lucky. All it did was turn me into a superhero. Actually, it damaged the sweat glands of my right armpit, but that was all. Musta been one of the lesser nasties.

#14 ::: Jeff Crook ::: (view all by) ::: August 21, 2003, 10:18 AM:

That white band around the sore is particularly worrisome - I seem to have read about that somewhere, but I can't remember where. The slow progress of the wound seems to say infection/parasite more than insect bite.

#15 ::: Stefan Jones ::: (view all by) ::: August 21, 2003, 12:22 PM:

Tom: Interstellar Pig rocked, and I never knew there was a sequel. Thanks!

IP appears to be based on the popular Sci-Fi* card game Cosmic Encounter.

* Use deliberate.

#16 ::: Teresa Nielsen Hayden ::: (view all by) ::: August 21, 2003, 01:21 PM:

Chris Noto, last I looked, someone had already pointed out that the fact that the lesion began with an oddly loose, crusty scab, which then fell off, is enough to differentiate it from ringworm. Does Mark not know what "differentiate" means in that context?

...I just went over there and told him so. He's in the Cook Islands, which have a rich assortment of what are politely known as arthropod-borne diseases. His initial lesion seems to be healing over? Great! I'd have said exactly the same thing about the insect bite that gave me Lyme disease -- at least, until I got sick I would.

Jo: Have I confused you? I know I once told you the story about how I briefly had buboes during the worst of the Lyme disease, and Lyme and the plague are both insect-borne spirochetes; but they're not, thank god, the same disease.

This is easily sorted out: You catch Lyme disease in the Northeast. You catch the plague out West, especially in Northern Arizona and New Mexico. If promptly recognized and treated, Lyme disease can be anything from a mild and transient experience to a thoroughly miserable and insufficiently transient experience. But the plague -- famous for its 50%-90% death rate when untreated -- has a 15% death rate even when we hit it with everything in modern medicine.

Not to worry, though. The entire U.S. averages maybe a dozen cases of plague a year, almost all of them in the Four Corners area, and they're sporadic and rural. We haven't had an urban epidemic of plague since the 1920s. All you really have to remember is that the cute little rodents in the Intermountain West should be admired from a distance.

The tropics really are worse, like a permanent incubator. They have bugs there whose life cycles wouldn't be imaginable anywhere else.

#17 ::: Claudia ::: (view all by) ::: August 21, 2003, 02:31 PM:

I hear a lot of people develop tape worms anywhere in the body sometimes even in the brain from being infected in a tropical environment. He should seriously consider seeing a doctor.

#18 ::: Teresa Nielsen Hayden ::: (view all by) ::: August 21, 2003, 02:35 PM:

Tape worms in your brain? I thought they were digestive tract.

#19 ::: David Bilek ::: (view all by) ::: August 21, 2003, 02:37 PM:

Ditto what Teresa said about Lyme disease and "If promptly recognized and treated."

Unfortunately, it isn't uncommon for Lyme disease to go unrecognized and untreated for months to years. In those cases things can get very ugly.

I do have one quibble: The death rate from plague is actually very low with prompt treatment. Less than 5%, certainly. Most deaths will be among the very young, very old, or people with compromised immune systems.

#20 ::: Tom Whitmore ::: (view all by) ::: August 21, 2003, 03:38 PM:

PARASITE PIG was a 2002 hardback from Dutton. No pb yet that I've seen. And have you seen his autobiography ODDBALLS?


#21 ::: Jo Walton ::: (view all by) ::: August 21, 2003, 04:46 PM:

Teresa: OK, you confused me. Though I had an uncle (first cousin twice removed by marriage, to be specific) who died of Lyme's Disease.

Tom: _Parasite Pig_ has a paperback by Penguin Firebird in the US, and I believe a copy of it is waiting for Sasha at home for Sasha to review for them. Nothing would induce me to read it, I am a squeamish grown-up in these contexts.

#22 ::: Sean ::: (view all by) ::: August 21, 2003, 06:45 PM:

Tapeworms make their home in all sorts of organs, in all sorts of countries. You can get some really horrendous tapeworm infections (such as hydatid disease) everywhere from Alaska to Australia; and this particular variety can form large, worm-filled cysts in the liver, brain or lungs. This is the best reason you'll ever need for staying away from dog faeces, especially if there are sheep around.

Sure, you can get some nasty bugs in the tropics. But malaria and yellow fever were Great American Diseases for a very long time, and were only eradicated after decades of effort, uncountable deaths and vast amounts of money. They'll probably be back some time, and they won't be any less terminal than anything you might pick up in the South Pacific, or India, or the Amazon. The reason people get sicker in tropical countries than they do in the West isn't that they're hot, or inherently malevolent; it's because tropical countries typically don't have the money for disease control programs that we do.

#23 ::: Damien Warman ::: (view all by) ::: August 22, 2003, 02:29 AM:

I seem to recall there being some recent debate about bubonic plague being the same disease as the Black Death. Hmm. Gotta be a library around here somewhere.

#24 ::: David Goldfarb ::: (view all by) ::: August 22, 2003, 04:47 AM:

William Sleator's brother Daniel was one of the people who ran the Internet Chess Server back when it had not yet gone commercial. He had a manuscript version of Oddballs up for anon-ftp, and I downloaded it, printed it out, and read it. (Nowadays I wouldn't bother printing it out, but back then I didn't have a computer at home, let alone a handheld.)

It's a very fun book, and it was extremely interesting seeing what got changed in the final book (including the excision of both an anecdote about shoplifting and one entire chapter about a high school teacher).

#25 ::: jane ::: (view all by) ::: August 22, 2003, 07:00 AM:

There have now been reported cases of Lyme Disease in the Scottish Highlands. Sigh.


#26 ::: Teresa Nielsen Hayden ::: (view all by) ::: August 22, 2003, 07:24 AM:

Jo, how did your uncle die of Lyme disease? And Jane, how the devil did it migrate to the Scottish Highlands?

If Lyme disease were capable of being passed from person to person, rather than just by tick bites, we could have had a really ugly situation on our hands. As it was, the disease had emerged years before it was recognized; and since the first stage of the infection could mild or even asymptomatic (a lot of people thought they'd had flu), what tipped us off that we had a problem was people hitting the tertiary stage. If Lyme could pass between people, that discovery could have been on a pandemic scale.

#27 ::: Graydon ::: (view all by) ::: August 22, 2003, 07:35 AM:

All it takes is an infected person getting bit by the right sort of tick while in the Highlands, I'd suspect; there's certainly a deer population there to provide the rest of the life cycle.

#28 ::: Debbie Notkin ::: (view all by) ::: August 22, 2003, 05:38 PM:

All joking aside, tropical bites are not always funny.




Karen Joy Fowler's daughter Shannon was spooning on a secluded tropical beach (in South Asia somewhere) last summer with her brand-new fiance.

Something bit him on the leg.

Three minutes later, he was dead, and Shannon was alone on a tropical beach with a corpse.

Tell Mark to see a doctor.

#29 ::: Kip W ::: (view all by) ::: August 22, 2003, 05:48 PM:

And Jane, how the devil did it [Lyme Disease] migrate to the Scottish Highlands?

On a tiger perhaps. Sounds like a MacGuffin failure.

#30 ::: Teresa Nielsen Hayden ::: (view all by) ::: August 22, 2003, 07:14 PM:

Mark Frauenfelder says he's going to see a doctor. I'm much relieved to hear that. If it turns out to be ringworm after all, we'll all be happy about that, too.

#31 ::: cd ::: (view all by) ::: August 23, 2003, 11:36 AM:

Isn't the Four Corners area home to Hantavirus-carrying rodents, too?

#32 ::: Maria ::: (view all by) ::: August 24, 2003, 11:40 AM:

Hi, I have an aunt who is no stranger to problems with her veins. But, on a return trip from Aguada, Puerto Rico. She started to have a problem with her right leg and I believe a little of her foot. It swells up, but from the area of about the ankle to half way of the calf, it has gotten kind of skinney, very dark. The skin almost looks necrotic. It is extremely painful. The black area or should I say purplish red, almost black area, started out as red and enflamed looking. The doctors ruled out anything to do with her veins, but can't figure out what it is. I saw a special on cable about parasites from the tropics, her leg reminds me of some of the things I saw. If you can direct me to anyone that could help her, I would be most grateful. Honestly, it looks like if she does not do something about is soon. It will dry and have to be cut off...... Thanks much ahead of time, Maria

#33 ::: Tom Whitmore ::: (view all by) ::: August 24, 2003, 03:47 PM:

Maria, where does she live, and what kind of health coverage does she have? Each will affect what you should do. It sounds like she needs a tropical parasite specialist.... Contacting your local state medical association may help you find a specialist.

#34 ::: Maria ::: (view all by) ::: August 24, 2003, 05:11 PM:

Thank you for your quick response. She lives in Chicago. I'm not sure what type of insurance she has. I believe it may be disability (Medicare) or Public Aid. I do know that she has been to see a Dermatologist, and a few other doctors. She also recently had an MRI done. The findings were inconclusive. This is my reason for looking on the internet, in hopes of finding different ways to get to the bottom of this. I would sure hate to see her loose that leg. I will try getting in contact with our state medical association as you suggested. Thanks again so much. Maria

#35 ::: Tom Whitmore ::: (view all by) ::: August 24, 2003, 07:10 PM:

I am not a doctor. I wouldn't try to diagnose over the internet. The things you're talking about going on in her leg sound serious. It could be a parasite, it could be a necrotizing spider bite, it could be a lot of things -- it's clear the doctors need to know where she was traveling (and when!). I would not have thought a dermatologist should be the first specialist looking at this, myself -- what you describe does not sound at all like a skin problem, but something more systemic involving the lymphatic system _at least_! But then, I'm not actually an expert; I just know if I saw something like that as a massage therapist, I wouldn't go near working on it without a doctor's okay (and that means I'd want to know exactly what it was before working) and I'd tell the person to get medical help immediately and be very insistent about them not accepting "I don't know" as a final answer.... It's a great intermediate answer, but this sounds very time-bound.


#36 ::: Eloise Mason ::: (view all by) ::: September 03, 2003, 01:38 PM:

All this discussion of tropical parasites brings to mind William Sleator's book PARASITE PIG, a sequel to INTERSTELLAR PIG. Sleator is a Peculiar Writer, not always pleasant and I'm not quite sure why I like most of his books; PARASITE PIG is basically a science-fictional expansion of the life cycle of an intelligent fluke that affects the mind of its human host. Not for the squeamish.

Not completely dissimilar is 'Brain Plague,' by Joan Slonczewski (sp?), at least in that it has intelligent microorganisms that start communicating with their hosts. I think 'The Children Star' has something to do with the superbugs, too, but it's been a while since I read it.

#37 ::: Manuel L. Iravedra ::: (view all by) ::: December 01, 2003, 11:39 PM:


Your aunt may suffer from Filariasis, transmitted via a mosquito bite. It's a condition also known as Elephantiasis.

The boing-boing image sore is what we call a "target" type lesion, with a reddish center, a whitish areola, and a surrounding inflammed area. I don't exactly remember, but I think it was a characteristic sign of Leishmaniasis.

#38 ::: Teresa Nielsen Hayden ::: (view all by) ::: December 02, 2003, 12:57 AM:

Very good. Thank you for the information. I'll forward it to Maria, just in case she isn't checking here.

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