World Cup fever

Enjoying the World Cup? Wish you were there? It is estimated that over half a million tourists will make the trip. There is plenty of available advice to visitors to avoid some of the health pitfalls of travelling to a major event in a foreign country. Thank fully widespread reported concern of epidemics of Dengue fever affecting visitors have not been borne out. Dengue normally presents with sudden onset high fever, aching bones and muscles “breakbone fever”, headache, typically behind the eyes, and a rash. Rarely pulmonary complications can occur such as ARDS and Bronchioloitis with respiratory Failure.

Other risks to health for visitors to Brazil include gastrointestinal infections, Hepatitis A, Yellow fever, Malaria, Leishmaniasis, Shistosomiasis and Rabies. Brazil is also a TB high-burden country with about 50 cases per 100 000 population with risk factors associated with urban areas, population density, poor economic conditions, household crowding, and non-white population. 6% are resistant to isoniazid and 1.4% to both isoniazid and rifampicin.

We have picked out some of the more unusual conditions occurring in Brazil, that might take your breath away! Enjoy the football!

Hantavirus infection is transmitted to humans by wild rodents and the most common clinical form in Brazil is the Hantavirus Pulmonary Syndrome (HPS). After a prodromal phase with an acute febrile illness lasting about three days a dry cough that turns productive occurs with increasing dyspnoea progressing to respiratory failure with cardiogenic shock. Case-fatality rate in Brazil ranges from 33% to 100%.

Leptospirosis is a spirochete zoonosis caught from direct contact usually with rats urine. It can cause major urban epidemics, in Brazil about 10,000 cases being reported each year in all major cities. The incidence of pulmonary involvement varies from 20% to 70%, and has been reported to be increasing in the last years. Alveolar haemorrhage occurs presenting as dyspnea, cough, pleuritic chest pain and hemoptysis. There is increasing prevalence of the severe form with profuse alveolar haemorrhage with mortality as high as 74% and death within 72 hours.

Paracoccidiodomycosis is a sub acute or chronic systemic mycosis occurring in most South America countries, with a highest incidence in Brazil. Lesions occur in the oropharyngeal mucous membranes with gingivitis, bleeding, loose teeth then typical painful granulomas, ‘‘mulberry-like’’ ulcers, that can involve the lips, tongue, gums, palate, larynx and vocal chords. Pulmonary involvement is present in over 90% of chronic cases with recurrent respiratory infection, cough and sputum, breathlessness, haemoptysis.

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