American Medical Association Family Medical Guide - American Medical Association [654]
Some people who are bitten by a bacteria-carrying tick may not develop ehrlichiosis. However, older people, people who have an impaired immune system, and people who have had their spleen removed (splenectomy) are at increased risk of developing a severe infection. If you find a tick embedded in your skin, remove it as quickly as possible (see page 943).
Symptoms
The initial symptoms of ehrlichiosis may develop 5 to 10 days after a bite from an infected tick and include fatigue and a general feeling of illness. Other symptoms include fever, headache, and muscle and joint aches. People who develop a severe infection may also have nausea, vomiting, diarrhea, and a rash.
Diagnosis and Treatment
To diagnose ehrlichiosis, your doctor will take a detailed health history. He or she also may perform blood tests to check for antibodies (proteins the body produces to fight the bacterium) or for the bacterium itself. The doctor also may test your blood for a decrease in platelets (sticky cell fragments that enable blood to clot) and infection-fighting white blood cells. The blood test is performed when the symptoms begin and again 4 to 6 weeks later. A doctor will prescribe antibiotics to treat ehrlichiosis. Be sure to follow your doctor’s instructions when taking the antibiotic to make sure you eliminate the infection.
Travelers’ Infections
If you are planning a trip out of the country, make sure that you are adequately protected against any diseases that can occur in your country of destination. Many developing countries do not have adequate water or sewage systems. For this reason, diseases linked to contaminated water supplies—such as dysentery (see page 948), typhoid (see page 948), and polio (see page 695)—are common in many developing countries.
About 6 weeks before you leave on your trip, find out from your doctor which vaccinations are necessary for entry into the country and which are recommended. The US Centers for Disease Control and Prevention (CDC) is also a good source of information (www.cdc.gov). At least 1 month before you travel, see your doctor or go to a clinic that specializes in travelers’ health and get any immunizations you may need; many vaccinations are not immediately available or must be taken well in advance of a trip. For example, if you plan to visit (even if only for a few hours) any of the countries in which malaria (see next page) is endemic (always present), you should begin antimalarial drug treatment before your trip and continue it after you leave the malaria-infested country. The length of the treatment time depends on the drug used. You can be immunized against typhoid and polio.
Depending on your destination, you may be advised to have one or more of the following vaccinations:
• Hepatitis A and B
• Yellow fever
• Meningococcal meningitis
• Rabies
• Polio booster
• Tetanus booster
• Measles booster
Tropical countries have insects, including mosquitoes and flies, that transmit diseases such as yellow fever (see page 949). If you swim or bathe in developing countries, or walk barefoot there, you risk becoming infested with parasitic worms such as schistosomes or hookworms. Schistosomes, or blood flukes, can be found in fresh water and can enter your body through the skin. In some cases, these parasites cause only a skin condition called dermatitis (see page 1062). In other cases, infestation with schistosomes results in a disease called schistosomiasis, or bilharziasis. In this disease, the parasites travel from the skin to the bladder and the intestines, from where they may spread to other parts of the body. The severity of the disease depends on the number of parasites that enter your body.
Hookworms are parasitic roundworms that are found in developing