Cutaneous Larva Migrans, Koh Chang, Thailand, june2017

3 dangers when walking barefoot in Thailand and other Tropical countries. And some security tips

As a traveller coming from a cold place (Switzerland) and being a little wilder than my fellows, I love to walk barefoot and I would do it everyday in the city if it was not dirty. Nevertheless, in Thailand and other countries in South-East-Asia, I wear shoes. I used not to, but after a while I understood why locals don’t go around barefoot (even though Thai people go barefoot in temples, homes and some shops).

In general, South East Asians would advise tourists to wear shoes to prevent accidents. What kind of accidents do they mean ?

– First risk : wounds.

This is the most typical problem, I got many of them on my feet : scratching my toe on wooden paths, on roots, on rocks,…

This is important because an open wound in the Tropics is less friendly than in a dry or a cold climate. Bacteria love heat and humidity and the wound may as well take longer to heal.

So it’s better to keep an eye on any wound you get.

Tips to take care of a wound in the tropics : first of all to disinfect it, with commercial disinfectant or what you can find. I personally used propolis (the black substance bees make to glue their homes’walls) and it was mixed with alcohol which also is disinfectant. When I didn’t have that with me, I would use turmeric (curcuma) powder, an orange root that has many properties and working good for me to stop the blood going out of my small wounds, it’s supposed to disinfect too. After disinfecting my wound, as I don’t like to wear plasters and because they are still open on the edges for anything to get inside, I usually cover my wound with clay paste (I travel with French clay rocks, useful for many things) and let it dry. This works good for me but each case depends on the people and on the type of wound.

In the handbook « Natural medicine in the Tropics » from Anamed association, I read that green papaya sap is a great disinfectant for open wounds. It requires a clean knife to make a small incision on the green papaya (still hanging on the tree if you want to use it several times), then the sap may be mixed with water, salt or sugar in different proportions to put on the wound. I haven’t tried yet.

Second risk : Insects bite or other unlucky meeting such as snakes.

It is not common, but it’s possible to step on  insects that can bite or hurt, such as ants, scorpions, centipedes, hairy caterpillars and snakes.

So far, I personally only stepped on a bee in Switzerland. But if I’m barefoot in Thailand I usually never walk in high grasses where I cannot see what I’m stepping on. If you have to walk in the jungle, in the dark or in high leaves, even with shoes, you should, at least, use a stick before you and tap it on the floor to make snakes or other go. But better stay on a path with good light.

Because insects can be bigger or more dangerous in the Tropics, locals usually don’t leave their bag, clothes or other objects on the floor, a centipede or other insect may decide to hide in there. For the same reason they may not lie in the grass as we do in Europe (oh…laying in the summer grass of Switzerland!).

I sometimes think nostalgically about the fact that in the hot countries where we could enjoy laying in the grass all year long, it can be dangerous to do so because of parasites and big insects, whereas in the safe place, as Switzerland, it’s usually too cold to enjoy long time laying on the grass.

– Third risk : Parasites and other kind of diseases or infections.

Some uninvited organisms can enter our body through a wound or directly through the skin, from the floor or from polluted rivers or water. This is like a scary story that we hear when we come to the Tropics, but we hardly meet people who got this problem. As I am so keen on learning about life, I got tested : the worm inside my foot.

I also tested dengue fever but that’s another story. Oh and Thai dog bite twice, as well as a Malay mouse bite on my toe while I was sleeping (without shoes I admit). But let’s go back to this worm.

The worm (or worms?) drawing a red sinuous line on my foot was a common one, called cutaneous larva migrans which means in Latin : larva or worm moving in the skin. It was was actually a parasite living in the stomach of dogs, cats and other animals. When the floor is dirty from infected animal’s faeces, the eggs of these parasites can stay on the floor waiting for a new host to live in. In tropical climates these eggs survive, whereas in Europe for example they should not survive.

When we step on its eggs barefoot or laying down on the beach, even with a towel I read, this parasite can then enter through the skin, without wound. This sounds very scary but the good thing about it is that this parasite cannot survive in the human body ; in fact, they cannot reach our stomach and they just die inside the skin after a few weeks. The medication is therefore optional : it makes the undesirable host die faster and helps for example preventing infections of the injury and uncomfortable skin rash. Another reason that can lead to taking medication is I would say « just in case », if the diagnostic is wrong, because some parasites, for example called visceral larva migrans, can spread in the whole body, including the brain, and lead to very serious problems such as anemia. The one infecting humans is propagated by human poo.

The cutaneous larva migrans can be of different species of nematodes, usually called hookworm, living in infected dogs, cats or wild animals. This is why, people who have a dog or a cat may treat their animal against worms and parasites, and this is why the beach can be dangerous : beach dogs having no owner they are not treated against parasites.

The little worm under my skin, Thailand, June 2017.

Thailand, Koh Chang, June 2017

The little worm inside my skin, after I took the medication for 2-3 days it made a U turn and stopped there. The yellowish top part is the newest part, the worm started his way from under my foot (sorry for the disgusting picture).

How did I get that ?

I am not sure where I got this parasite from, but I have my own idea about it.

It all started with a very itchy mosquito bite under my foot. It was so itchy that I had pain walking. As I was visiting Ayuthaya, the former capital city of Thailand with many nice ruins and temples, I kept on walking and this mosquito bite still got better after a few days. I actually wasn’t sure that it was one, remembering that it looked weird from the start, I felt the problem was inside the skin, like little dots, hard and transparent under my skin. I had this from the beach in Koh Chang where I feel like I stepped on a rock and got a tiny almost invisible wound. But in the same time, it could have been a mosquito bite and the skin under the feet could be thick from walking too.

After a few days, I had another itchy mosquito bite under the foot. In the same way, it was very itchy walking and I was thinking « damn mosquito who bit me under the feet ! ». And after some days I felt like it got bigger, like a double mosquito bite, then after more days, I saw like a red line, sort of an infection spreading. I put insect bite cream on it and after two more days it became a longer line, worm path like. At this point, I kind of understood the problem and showed it to a doctor who told me I had Cutaneous larva migrans.

He asked me if I had been walking barefoot or staying with animals. I said that 5 days before I was in Bangkok where I stayed in a dirty floor guest house. There where two young dogs sleeping inside the reception and as they could not go out, they would pee and shit on the floor and someone would clean after them. As a polite person, I took my shoes off before entering the guest house, but this one was actually a guest house where you can (or rather should) keep your shoes on. As I didn’t know at first about the dog’s situation I do have crossed this parasite risk zone barefoot.

This was my story to the doctor, but he replied that my worm hadn’t been in my foot since 5 days, but rather 10 days. 10 days before, I was at the beach…with this itchy strange inside invisible wound.

Looking again under my foot, I saw that it was possible that the worm would had been there for a while without me noticing it. The visible path was made of a line and 2-3 spots like resting stations on the way. Possibly, the first wound was the entrance, then the itchy « Bangkok mosquito bite » a resting station spot, while the worm was making his way invisibly under the thicker skin under my feet.

Is going to the beach dangerous ?

Showing my foot with its sinuous red line to local friends on the island Koh Chang (the big one near Trat), as well as to pharmacists and nurses, they all said that they had never seen this in their life. As for me, despite all the people I met in my trips in South-East-Asia, I have never seen or even heard about this happening to a traveller, a tourist or a local friend. Some of you have ?

Let’s hope that it’s not a new tendency and that we can keep enjoying walking barefoot on the beach. Street dogs staying on the beach can be cute and friendly, but if they get sick they may spread diseases. Adding the daily dog bites happening to people in Thailand (and maybe other South-East-Asian countries), I believe something should be done about them.

Anyway, don’t forget your flip flaps !

Source and interesting article:

Three clinical cases of cutaneous larva migrans, Tae-Heung Kim, Byeung-Song Lee, Woon-Mok Sohn, Korean J Parasitol. © 2006 by The Korean Society for Parasitology.



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