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Sandflies and Tropical Ulcers (Cutaneous leishmaniasis) The message here is - don't travel in the Philippines (especially Palawan) without your antibacterial ointment. Some of the beaches, especially Palawan, have sandflies. We have been bitten on the Palawan beaches of Sabang, Port Barton and El Nido. They bite in the later afternoon and you don’t necessarily notice them. Next day, the bites will come up and will be extremely itchy. The most effective preventative is to smother yourself, particularly your legs and feet, with tropical strength insect repellant. Better still is to mix the repellant with Coconut oil. The locals use only coconut oil. I was bitten on a beach near the "Big Lagoon" , El Nido in late 2003. I took my T-shirt off for about 15 minutes to get a bit of sun on my white skin and was bitten in 4 places on my upper body. They did not bite where I had applied sun-tan lotion. If you are bitten, serious lesions can develop in only a few days. The affliction is called Cutaneous leishmaniasis. By definition it is the skin sores resulting from a tropical infection by parasitic protozoa of the genus Leishmania, which are spread by (female) sandflies. You will know you have tropical ulcers developing if all normal treatment fails and the wounds become progressively bigger and finally, very painful. Infection dwells underneath the scabs and in our case was much more serious than it looked. The parasite destroys the skin cells, leaving a huge cavern underneath the scab. These wounds are not to be left for a better time to treat. They can leave permanent scars. The locals call the advanced infections "pizzas".   Immediate Treatment Mix hydrogen peroxide with betadine 50/50. Using a ball of cotton wool, dab the wound with this mix. It will dissolve the scabs and reveal what's underneath. Once the wound is open and clean, apply a 2% antibacterial ointment, using a cotton bud (Mupirocin Bactroban is the local brand). Cover with a patch of open weave gauze and tape into place. Repeat this process twice a day or more until the wounds are no longer infected and starting to heal. Repeat treatment immediately after your shower. This can take one week to 10 days +, depending on severity. Our ulcers developed over a three or 4 day period – very dramatic, but reasonably easy to cure. All of the abovementioned items would be stocked at most pharmacy stores, of which there are plenty, all over the place. Pack these things into your medical kit. They will always be handy for any wound which seems to be developing an infection. If you want to see what my sandfly bites looked like then click here. Warning - pictures are quite horrible. I still get bitten sometimes but, because I carry my antibacterial ointment, they never develop beyond a mosquito bite size.   For more information about leishmaniasis The Tropical Disease Research (TDR) centre (supported by WHO, UNICEF and others) has good information about this disease. Click on their "animated life-cycle of leishmaniasis" and see how the parasite multiplies and destroys the body cells. http://www.who.int/tdr/diseases/leish/lifecycle.htm Please note that we are not medical professionals and the above advise is based on what we have learnt from our experiences of sandfly bites. We would be pleased to hear from anyone with more knowledge on how to prevent or treat leishmaniasis.

 

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