Setting: Beach in Martinique
Position: Tropical diseases specialist, Pitie-Salpetriere Hospital, Paris
It is my first summer holiday after joining the tropical diseases department of professor Marc Gentilini at the Pitie-Salpetriere Hospital in Paris where I will stay for nine years. I am relaxing on the beach in Martinique admiring a rocky island called “Le Diamant” (“the diamond”), which used to be a refuge for pirates in the 18th century. By pure coincidence, the young people lying next to me are a group of medical students from different cities in France. After a few jokes and local drinks, I learn that they have been on the island for 10 days and are celebrating after passing an exam that will allow them to practice and study in the best French hospitals.
As the conversation evolves, a couple comes by my side and requests to talk to me privately (a doctor is always on call!). They then disclose that they have been experiencing some ferocious itching all over their bodies for two days. They proceed to show me their skin lesions. As I examine them, they add that the symptoms get significantly worse at night and they have to take sleeping pills to get some rest. They also say they have observed that the numerous snakelike red furrows on their skin move forward a few centimeters each day. The diagnosis of cutaneous larva migrans (creeping disease) is easy to make. However, what is highly unusual in this case is that the lesions are so profusely disseminated. Generally, they are limited in number and located on the feet. After probing deeper on their experiences during this holiday, they reveal that the first night they went skinny dipping in the Caribbean Sea and frolicked in the sand between swims. What the couple didn’t realize is that wild cats and dogs defecate on the beaches, and the waste contains the eggs of hookworms. When the eggs come into contact with animal or human skin, the larvae emerge. In humans, the larvae wander aimlessly under the skin for weeks and then die. This was why the couple’s skin lesions had spread so widely.
Lesson for the doctor: Before traveling to a tropical country, brush up on your knowledge of tropical diseases.
Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.