Malaria in Swaziland

75% of Swaziland is Malaria free. Only in the eastern parts of the country (mainly Big Bend, Mhlume, Simunye and Tshaneni) there is a risk of ‘catching the bite’ and prophylactics should be taken. When purchasing these, please tell your doctor or pharmacist that you intend visiting the lowveld. Start your course at least one week before entering the eastern parts of Swaziland and continue taking the pills for six weeks after leaving the country. If you suffer from side effects, try taking your malaria prophylactics at night after dinner, as this usually minimizes the effect of the symptoms. Precautionary measures that you can take to prevent contact with mosquitoes are: sleeping under a bed net or in a room/tent with mosquito proofing (remember to keep the flaps zipped at all times), making use of a mosquito repellent lotion or stick and wearing long sleeve clothing and socks when outside at night.

Snakebite in Swaziland

For many people, one of the scariest parts of Swaziland is the possibility of encountering a snake! Yes, there are 83 different species, and yes, 7 of them are poisonous. So the vast majority of our snakes are harmless and even the poisonous ones are more afraid of you than you of them! Misconceptions surrounding snakes have contributed to a general decline in their numbers. Venomous snakes need to be treated with respect, particularly the Black Mamba, Spitting Cobra, Snouted Cobra, Puff Adder and Boomslang. Other snakes commonly found in Swaziland include the non-venomous African Rock Python, Spotted Bush snake, the mildly venomous Olive Whip snake, Tiger snake and Brown House snake. The chance of an encounter with a venomous snake is very slim indeed. However, sensible precautions should be taken such as wearing boots or lace up shoes when walking in bush or grass. In the event of encountering a snake, stay dead still! Snakes will bite only if provoked. With eyes positioned half an inch off the ground, they can't see distant detail, but have excellent perception of movement. So if you stand still, you are no threat! A snake coming into your space may be scared away by making a disturbance from a distance. Eg, tap the branches well ahead of a climbing snake to turn it away. Give the snake the opportunity to escape by staying out of its escape route. Do not try to kill or catch the snake: If you are close enough to kill a snake, it is close enough to kill you! Please do not be the hero around snakes: When a snake has entered a home or office, call someone qualified to remove the snake unless you are positive that it is harmless, or you know how to catch snakes. And on that note, never try to remove a snake if you have had alcohol or drugs of any kind. Snakebites are often associated with alcohol use! Teach young children to stay away from snakes, too many of our children get killed whilst trying to kill a snake. General advice in the event of a bite: Snake bites are infrequent. Snake handlers, children playing with snakes or agricultural workers are at higher risk than the general public. Here are a few Do’s and Don’ts : • Do get a good description of the snake to identify whether it was harmless or not • Do look for help • Do wash the wound • Do elevate the limb (not for Mamba bite) • Don’t panic! This will only make matters worse. • Don’t use a tourniquet (unless the snake was definitely a Mamba!) • Don’t cut the wound or burn the wound • Cobras can spit venom into eyes. Irrigate the eyes with water as soon as possible. • Snakebite needs observation in hospital. Anti-venom is used in about 1 in 10 cases of venomous snake bite. • Anti-venom is the only specific cure for a lethal dose of snake poison. Do not wait for a bite to happen before finding out if your doctor keeps a supply of antivenom. Since it is expensive and needs refrigeration, many rural clinics do not keep anti-venom stock. When indicated, it should be administered very carefully. For snake identification and advice on removal of snakes, Thea Litschka is most helpful. (00268- 7602 5088). She also stocks anti-venom. For the ultimate snake experience, you could do a snake handling course!

African Tick Bite Fever

What is tick bite fever? Tick bite fever is caused by a bacterial infection transmitted by ticks. This condition occurs in many areas of the world and is often known by a variety of names. The organism belongs to the Rickettsial family of bacteria, a relatively small organism that lives inside cells. They are found in certain wild and domestic animals, and ticks acquire the organisms when they feed on these animals. When the tick bites a human, the bacterium is transmitted in the saliva. In Swaziland, the cause of tick bite fever is either R. conorii or R. africae. The organisms are transmitted in the saliva of an infected tick (Amblyomma, Dermacentor or the Rhipicephalus family) when it bites humans, usually in rural areas when camping, hiking in long grass etc. Symptoms and signs of tick bite fever The incubation period is five to seven days. The typical triad of symptoms includes fever, headache and a rash. There is often an eschar at the site of the tick bite. This is a small ulcer (2-5mm in diameter) with a black centre that may look something like a spider bite. The eschars can be single or multiple and can be difficult to find. It usually appears once the fever appears, as does the headache and malaise (general feeling of ill-health). Lymph nodes near the eschar may be enlarged. A rash is sometimes present: Typically starting on the limbs, spreading to the trunk, and even the entire body, including the palms of the hands and soles of the feet. African tick bite fever is usually mild; death and serious complications are very uncommon How is tick bite fever diagnosed? The diagnosis is suggested by a history of typical symptoms in someone with recent exposure to ticks. The presence of the rash and an eschar is a very strong diagnostic sign. Other conditions that may be confused with tick bite fever are meningitis, malaria, measles and German measles. Antibodies to the bacteria can be detected in the blood, but the tests may only become positive after a couple of weeks, so while they may help to confirm a diagnosis, they are not always immediately helpful early on in the infection. If you have typical symptoms, your doctor may decide to treat you before results of the serological tests are known. How is tick bite fever treated? Tick bite fever is fairly mild and self-limiting – people may get better on their own without specific treatment. This can take up to two weeks however, and treatment with an antibiotic can shorten the duration of symptoms and reduce the chance of a serious side effect. The antibiotic doxycycline is the preferred agent for treating tick bite fever. Alternatives include chloramphenicol, and ciprofloxacin. Can tick bite fever be prevented? The easiest may to prevent tick bite fever is to avoid being bitten by ticks. Avoiding rural or wilderness areas is one way to achieve this, but not a great solution if you enjoy hiking and camping. Other measures are generally common sense, such as wearing insect repellents and long trousers and sleeves. There is no vaccine against tick bite fever, and taking prophylactic antibiotics (as one does for malaria) has never been shown to be effective or necessary. Dr J Pons