Avoiding Tropical Disease

When it comes to getting killed by an animal, I'll take a good predator mauling any day. Mother lion guarding her cubs? Surprised grizzly? Curious Great White? Even these creatures' worst is swift and merciful compared to the lingering, addled, sweat-stricken demise visited upon travelers by nature's most successful killer of all: the mosquito.

When they stop off on your arm to get a bite, mosquitoes provide the ideal entry way for a host of diseases. The most widespread of these threats remains malaria. Though only rarely fatal, this disease, in even a mild form, can delay a trip in nightmarish fashion - shaking, cold sweats, and diarrhea straight out of Dr. Livingston's worst nightmares.

The good news: With a just a few simple precautions you can easily protect yourself, enabling you to travel where you want without fear.

The mosquito's comrade-in-arms Malaria is Public Enemy Number One when it comes to diseases spread by the mosquito. Most strains will not cause death, but can still prove difficult to cure. Early symptoms typically resemble the flu - fever, chills, sweating, headaches, muscle aches, and diarrhea, for example.

Onset of symptoms after the infectious bite typically occurs within seven days, though it can take as long as 21. Once acquired, malaria hangs on like a pit bull. Some travelers suffer malarial relapses periodically for the rest of their lives.

Of the four strains of malaria that thrive in humans, the only fatal version is Plasmodium falciparum, which causes cerebral malaria. At its worst, this disease explodes so many blood cells at once that the victim's bloodstream becomes literally choked with dead material.

When to worry Malaria parasites tend to hang out in warm, humid, lowland regions. Speaking really broadly, you should worry most about South and Central America, sub-Saharan Africa, Asia, and Melanesia. However, you absolutely must check for specific local information when planning your itinerary. A good travel agent, travel clinic, up-to-date guidebook, or the Centers for Disease Control and Prevention can help you get started.

Also, put faith only in recently updated information because malaria is on the move. Global warming trends have steadily expanded the "malaria belt" and the parasite has developed a troubling resistance to common drugs in some areas.

Protecting yourself The best precaution is this: Don't get bit. If the insects can't get at you or don't want to, they can't transmit the parasites.

• Direct barriers remain your first line of defense. Wear loose-fitting clothing that covers as much of your body as possible. A head net looks spiffy and protects your face. Pith helmet optional.
• Second, apply a high-quality insect repellent to any exposed skin. Only use a DEET-based repellent. This chemical is the standard found in all high-quality products. I've never known it to cause a skin reaction, though watch out for your plastic watchbands as it has occasionally been known to react with them.
• Sleep under an insecticide-treated bed net. This is especially important because the mosquito species that transmits malaria is most active at night.

In addition to warding off the bugs, it's also good policy to take a malarial prophylaxis. That's the fancy phrase travel docs use for drugs that prevent malaria from thriving in your system.

• Lariam (mefloquine) is the most popular antimalarial drug currently in use. It's taken once a week for a few weeks before and after your time exposed to possible malarial mosquitoes. Lariam works well, though reportedly with some rare but highly uncool side effects such as cold sweats and screaming nightmares. Those with a history of mental disturbances and depression should consider avoiding it.
• A combination of chloroquine (twice weekly) and proguanil (twice daily) remains an effective regimen for those who want to avoid the side effects of lariam or need to travel to a malaria-risk area more quickly.
• Doxycycline, an oral antibiotic, offers an alternative for travelers going to regions where malarial parasites have developed resistance to other drugs. It causes sensitivity to sunlight, however, so it may not be appropriate for travelers spending a great deal of time outdoors.

What to do if you catch malaria Get to a doctor as quickly as you can. There's not much else to it. With adequate medical care only about 2% of cerebral malaria victims die.

If you plan to travel way off the beaten track, you can obtain a course of drugs to treat yourself for the disease. However, even if you treat yourself, cut your trip short and head to a doctor immediately. A travel clinician can advise you on what kind of malaria treatment kit you should consider.