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UNDERSERVED

You can’t get that here... maybe

By Jeffrey J. Meffert, MD

In the August 2011 San Antonio Medicine I explained how popularity of adventure vacations also may bring exotic dis-
those bio-warfare weapons anthrax and tularemia could be eases into your waiting room.
acquired in the Texas Hill Country, usually by hunters going Houston remains a “hot spot” for new cases of malaria being
after deer or feral hogs. In April 2013 I discussed that biblical diagnosed. The majority of these are immigrants and visitors
scourge Hansen’s disease (leprosy) and the fact that your who acquired the disease abroad, but a cluster of cases in the
friendly neighborhood armadillo carried the disease. One homeless and in infants occurred in the 1990s among those
might wonder if there are other “tropical diseases” that the who acquired the disease in Texas from mosquitos who fed first
San Antonio on untreated im-
physician needs migrants. Insect-
to worry about. rich Texas already
In short, “you has the vectors for
betcha!” many so-called
In the days of tropical diseases; all
ocean travel, by we need to do is in-
the time a ship troduce the infec-
arrived, any in- tions themselves.
cubating dis- Chagas disease
eases had (trypanosomiasis)
already started is a major problem
to express in South and Cen-
themselves, and tral America. Ini-
cautious immi- tially presenting
grations offi- with swollen bites,
cials could sometimes around
enforce quaran- the eyes where it
tine until the causes massive
patient was re- swelling (Ro-
covered or ex- mana’s sign), it
pired. This is leads to fever and
no longer the malaise before it
Researchers at the University of Texas at Austin say 11 Texas counties are at particular risk for Chagas
case. Many San disease: Bee, Bexar, Brooks, Cameron, DeWitt, Goliad, Hidalgo, Jim Wells, Kenedy, Kleberg and Nue- spreads and dam-
Antonio area ces. Map courtesy University of Texas at Austin. ages major viscera
physicians have like the colon and
military experience and are attuned to the fact that traveling the heart. It is transmitted by the reduvid bug, and 11 South
patients may bring back a variety of diseases not normally Texas counties, including Bexar, are already considered en-
seen in your community. The ease of rapid air travel and the demic for the disease. Diagnosis is usually made serologically

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16 San Antonio Medicine • February 2014