Dog Days and Bug Bites and Swimming Issues

http://reference.medscape.com/features/slideshow/bug-bites?src=nl_slide

Above is an interesting and picture laden summary of several bug bite lesions. A few quick reminders that were spurred by the pictures:
1. When confronted with an "odd" rash" or fever, don't forget to document any travel history. While a full workup for say, malaria, would be best started in the emergency room ( better lab access to a "thick" blood smear, easier blood culture attainability), it is important to maintain your clincial suspicions.
2. Make no mistake,I am amazed by the number of "red bugs" or chigger bites in this region. Explain to patients that because the chiggers may have been residing on one clump of grass or brush, it is not unusual for only one person in the outdoor party to be affected, even when doing similar activities, such as hiking together.
3. For all our patients enjoying ocean and lake activities (and for those taking board recertifications!) don't forget the difference between "swimmers itch" and "seabathers eruption". The itch is when non-human schistomsomes (often from birds and small mammals) invade the EXPOSED skin. As such, the "itch" is on non swimsuit covered areas, such as arms and legs. Usually the swimmer's itch is freshwater. In contrast, the seabathers eruption is from 2 saltwater animals, and get "caught" under swim clothing. So, people return from their beach trip with an itchy rash that affects only areas UNDER their clothing. Both respond to topical/systemic itch relief. Note that the swimmer's itch is a different schistosome from the human parsitic schistosomes that infect the bladder and other sites from exposure in areas like the Nile in Africa.

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