Travellers are being warned of the risks of walking barefoot on a beach “somewhere tropical” after a Canadian couple contracted a hookworm infection on holiday in the Dominican Republic.
The young pair from Ontario were staying in Punta Cana earlier this month when they returned from a stroll on the beach and noticed their feet were “incredibly itchy”. Upon their return to Canada, what they assumed were harmless bug bites developed into painful swollen blisters and unusual bumps on their toes.
The couple consulted two doctors who were unable to identify the cause of their condition, before they were seen by a third doctor who diagnosed the contraction of larva migrans – more commonly known as hookworms. The parasitic worms are found in soil contaminated with faeces, typically in countries with poor sanitation and a warm, moist climate.
“The hookworm larvae can infect people if their bare skin comes into contact with the soil – for example, if you’re walking barefoot,” the NHS notes.
The third doctor claimed he had seen a similar case in a tourist who returned from a trip to Thailand. Most hookworm infections occur in Africa, the Americas, China and south-east Asia, according to the NHS.
“For a lot of our trip, we found that we were scratching our feet quite a bit,” 25-year-old Eddie Zytner told Canada’s CTV News. “Sand fleas we had heard about so we kind of assumed it was that at first.”
“If your feet become incredibly itchy please get it checked out right away since we simply thought it was just bug bites and it became worse as each day passed,” 22-year-old Katie Stephens warned in a post, with accompanying photos, on Facebook.
The couple, who are currently on medication (a drug called ivermectin) and walking on crutches, have said they’ve seen an improvement since their treatment began.
“They [my feet] feel better,” Mr Zytner said last Friday. “They looked a little bit better yesterday. We’re getting our bandages changed again… so we’ll have another chance to look at them and see how it’s progressing.”
Between 576 million and 740 million people in the world are estimated to be infected with hookworms.
At a glance | The symptoms of a hookworm infection
How do you spot a hookworm infection?
“Typically there is a linear rash that follows the track of the migrating larva. It can become almost unbearable itchy, much worse than an insect bite, which is an important clue. There’s a local allergic reaction, which can then blister, making the line pattern harder to spot,” explains Dr Richard Dawood, Telegraph Travel’s health expert, who also contracted hookworms in Florida a few years ago.
“I haven’t seen many cases lately though”, he adds.
How is it treated?
“There are a number of different anti-parasitic treatments that work, either taken as tablets, or made into a cream and applied locally. The larvae can sometimes also be killed using cryotherapy to freeze them. Blisters or scratching can easily lead to infection (as possibly in the aformentioned case), necessitating antibiotic treatment,” Dr Dawood said.
“An infection can be treated with anthelmintic (anti-worm) medication, such as albendazole or mebendazole, which your GP can prescribe,” the NHS states.
“You’ll need to take the medication for one to three days. The medications are usually effective and have few side effects.”
How can it be prevented?
“On a beach, the safest place to walk or sit is below the high water line – on sand that has been recently ‘washed’ by the sea. This is especially important in parts of the world where there are many dogs roaming around on the beaches – as is common in Asia and Africa. This also applies in the Caribbean – but really anywhere where sand can be contaminated with faeces,” Dr Dawood warns.
“If you’re travelling to a tropical or subtropical region of the world where hookworm infections are common, avoid walking barefoot in areas where there may be contaminated soil, and don’t touch soil or sand with your bare hands,” the NHS says.
“Good hygiene standards and effective sewage disposal systems are the reason hookworm infections aren’t commonly seen in developed countries such as the UK, although they may still be a problem in some Mediterranean countries.”