Travel Medicine Clinic at Hartshorn Health Service (970)-491-7121

It is important to be aware of the hazards that water activities can present.  Injuries, bites and disease can occur in water environments.  If you know you will be participating in water activities during your travel, consult with your travel health provider to discuss the risks.

1. Avoid walking barefoot.  Walking barefoot exposes you to poisonous plants and animals, parasitic and fungal infections, puncture wounds, cuts and bruises.  Wear shoes at all times even when wading or swimming in the ocean.
2. There are usually no lifeguards at beaches in tropical and developing countries.  Know what to do to help yourself or others if injured or in trouble.
3. Strong currents and submerged objects can cause injury and drowning.  Before diving into unfamiliar waters, check out what lies below and don't touch strange objects.
4. Be aware of potential disease such as schistomiasis and leptospirosis that can be transmitted in lakes, rivers, streams and even mud.  Chlorinated water or sea water do not carry these diseases.
5. Do not swim, wade, or walk in slow moving fresh water lakes, rivers, or streams in areas where schistomiasis is known to occur. (This is a parasite which lives in fresh water.)
6. If freshwater contact is unavoidable, dry off quickly to prevent the parasite from penetrating the skin.
7. If you must swim in a lake, use the deepest portion at the center, and avoid the edges at which snails are likely to breed.
8. Proper footwear can protect the traveler from injury (cuts, snake bites), insects (sand fleas, ticks) and parasites (hookworms, strongyloides), which are found in the same soil.

Schistosomaisis

Schistosomaisis is a parasitic disease that affects over 200 million people in 75 countries.  Infection takes place when larvae which are shed into fresh water by snails penetrate the unbroken skin of an individual who is washing, bathing, or swimming in ponds, lakes, rivers, streams or irrigation ditches in endemic areas.

After exposure there is a 4-6 week incubation period where young schistosome worms migrate to the liver and to the veins draining the intestine and bladder.  Some infections are asymptomatic but an acute illness called katayama fever can occur causing fever, headache, cough, rash, fatigue, abdominal pain, tender enlargement of the liver and spleen, weight loss and muscle aches.  Most persons will not develop katayama fever but a feeling of fatigue or ill health.  Severe infections cans last for years and cause organ damage.

Diagnosis is made based on history of exposure and stool analysis.  Treatment is dependent on the species of schistomiasis.  There is no vaccine, therefore avoiding contact with infected water is the most important preventative measure.   See your travel health professional for endemic areas.

Leptospirosis
Leptospirosis is a bacterial infection transmitted by contact with contaminated fresh water or moist soil, including jungle swamps and mud.  The bacteria enters through cuts or abrasions on the skin or exposed mucous membranes (nose, eyes, mouth).  Traditionally recognized as an occupational disease, it is becoming more frequently associated with recreational exposure such as hiking, swimming, and rafting.  Major outbreaks have occurred following heavy flooding.

Many cases are asymptomatic or mild.  More severe cases present after 7-14 days (range 2-21 days) and can cause high fever, headache, conjunctival suffusion, achiness, and a stiff neck.  Weil’s disease, the most severe and sometimes fatal from of leptospirosis, is associated with liver dysfunction and jaundice.

Treatment is with antibiotics.  Prevention consists of avoiding contaminated freshwater (rivers, lakes and streams) and soil.  Medication with an antibiotic is effective for short term, high risk activities.  See your travel health care provider if you are going to be doing water sports that could put you at risk.