GERM
00:00:09.280 – 00:00:11.600
Kam Na Mauri! My name is Germ.

WORM
00:00:12.000 – 00:00:12.880
I’m Worm.

GERM
00:00:13.600 – 00:00:27.120
Welcome to episode 111 of the Germ and Worm travel health podcast, Grand Mystery in the Grand Canyon. It’s a big planet. See it in good health. I’m Dr. Paul Pottinger, also called Germ. I’m an infectious diseases specialist at the University of Washington.

WORM
00:00:27.750 – 00:00:33.270
I’m Dr. Chris Sanford, also known as Worm Family Medicine Doc, also at the University of Washington.

GERM
00:00:33.590 – 00:01:52.030
Well, Chris, here are some of the exciting and interesting questions we’re going to tackle today here on Germ and Worm. Is it safe to raft and hike in Grand Canyon with a mystery illness happening there?

Is there really an increase in West Nile virus infections this year in the United States? And what can I do about it? I’m gluten sensitive. Will I be okay during an upcoming trip to Europe?

And please give us an update on both Ebola and cyclospora outcome, outbreaks, these questions and others too. A reminder to our listeners, please contact us with your travel health questions, your stories and your tips for success.

Just Visit our website, germandworm.com or send us an email germandworm@gmail.com

As always, our medical disclaimer. This podcast is designed to inform, inspire and entertain. But before you travel, please see a qualified healthcare professional for recommendations specific to you and to your itinerary.

Folks, speaking of social media, please join us at Germ and Worm on Instagram, where you’ll find a new series put together by our own doctor, Dr. Chris Sanford. Rookie Travel Mistakes and How to Avoid Them. They’re fun, they’re snappy, they’re entertaining. And you’ll find us on Instagram at Germanworm.

Chris, here’s a first question that comes to you. This is from Carla of Overland Park, Kansas. I have gluten sensitivity. I note that I do better with bread when I’m in Europe than I do in the United States. I hear that’s a thing. What do you think?

WORM
00:01:52.510 – 00:04:00.140
Yeah, thank you, Carla, for the question. You know, I’ve heard that too, from a number of people.

I’ve talked to friends and patients who get whatever symptoms they get in the US when they eat eat bread or other gluten products and they notice that every time they go to Europe, they can eat bread either with reduced symptoms or with no symptoms at all. I have not seen scientific studies on that.

So I did a little research and basically, bottom line, first, if you have not gluten sensitivity, but if you have actual celiac disease, then no, then gluten is bad everywhere. You should not eat bread products or gluten products anywhere in the world.

But if you don’t have celiac disease, but you have gluten sensitivity, also called gluten allerg, then yeah, there’s some actual potential reasons why things might be better in Europe. For openers, US Wheat is primarily what’s called hard red wheat, and it’s high in gluten.

European wheat is primarily softer wheat, and it’s lower in gluten. So right there, that might be a reason for what some people are reporting.

In Europe, they tend to use fewer pesticides when they grow wheat, and that may or may not tie into things. Wheat processing and fermentation may be a factor here. In traditional European baking.

This is especially in France and Italy, they tend to utilize a long, slow fermentation process. And this breaks down some of the complex carbohydrates that can cause bloating or other GI symptoms. Also, lifestyle may come into this.

A lot of people, when they go to Europe on vacation, they do more walking, they have lower stress that can tie into GI symptoms. And also it’s possible that there’s some placebo effect on this. People expect to feel better, so they do.

So right now, we’re in the realm of anecdote and speculation, which doesn’t mean it’s not real, because a lot of scientific facts start with anecdote. But what I haven’t seen is a nice scientific study.

I would love to see a blinded study where people with gluten sensitivity don’t know what kind of bread they’re getting. They get one type or another, then the results are quantified and we can see if this is really a thing.

So right now I can say it may be a thing, but I would love to see controlled studies on this.

GERM
00:04:00.610 – 00:04:50.030
I totally agree. What’s interesting to me is about when traveling in Europe, you know, there’s a lot more celiac disease, genuine true gluten sensitive enteropathy.

Just in my experience, people living in England, for example, there’s just a higher risk of having that genetic condition. I was so impressed when I lived in England that foods that you buy are labeled this way.

At least back, you know, more than 20 years ago, it was easier to tell how much gluten content was in the food. Here in the United States, that’s been harder to get. I think we’re catching up with our European colleagues, so look to this questioner.

Hope you have a great time. When you go back to Europe, let us know your experience. Send us an email. Germanwormmail.com.

And if you continue to do well over there, we’d love to hear from you. And if there are things that are unexpected, please send us that information as well.

WORM
00:04:50.590 – 00:05:27.190
Also, if anyone has seen any studies on this, scientific studies or reports, I would love to see that information. All right, Paul, this comes to you.

And actually, thank you, Dr. Sheila Mackell in Flagstaff, Arizona, our pediatric colleague, for putting this story on our radar. There’s been all these reports from travelers on the Grand Canyon recently that they’ve been developing fever and other bothersome symptoms.

And Paul, can you talk a little bit about this? Is this a thing? Is this an Internet rumor? What’s going on and do we know what’s causing it?

GERM
00:05:28.250 – 00:11:21.170
Yes.

For those who don’t Happen to recall, Dr. Mackell is not only a pediatrician, but she’s also married to a world class and well renowned guide, river guide for Grand Canyon. So she knows all about what’s happening in Grand Canyon through her husband, too. Now, this is a thing. It’s quite fascinating. This is unsettled.

As of the time we record this conversation, 17th of July, 2026, I think some of the answers will come, but at the moment we don’t fully understand what’s happening.

What is clear is that back in the month of June, last month, June 2026, you know, as always, there are people who come from around the world to raft in the Grand Canyon on the Colorado River. And there’s a group that came from Lee’s Ferry to Diamond Creek, that’s one of the corridors in Grand Canyon.

And after the end of that trip, which, you know, lasted honestly between late May and late June 2026, people had a good experience on the river.

But shortly after Le Grand Canyon, a number of them realized that they had become sick in different parts of the world, including in the United States, and that they were linked to each other through this shared experience of a severe influenza like illness. When I say influenza like, I mean fever, fatigue, too exhausted to get up out of bed.

But then an additional constellation of symptoms, Chris, including what some people have described as broken bone aches, severe muscle aches. We call them myalgia is in medical term, but very severe myalgia so bad that some people had to go to emergency department to be assessed.

One interesting feature is that some people have had such severe aches and swelling in their joints that it’s almost looked like arthritis, even septic arthritis. But testing evidently has not revealed bacteria getting into their joints. Rather it’s pain and swelling without an obvious infectious cause.

And in some cases, there have been people with abnormalities in the lungs, chest X rays that show fluid in the lungs, concern for the possibility of pleural effusions or maybe even pneumonia potentially. These have not yet been written up and shared in the scientific literature.

Rather, the way this happened was a group of people were posting about this to their social media, including on Facebook. And groups that were able to analyze social media posts realized people who were independently talking about their experience.

So a group at Boston University has put out a request for information so that anybody who has been through Grand Canyon can get to the BU website and describe what they have been through. Now, to be clear, the National Park Service has started some kind of investigation to understand what’s happening here. Is it a coincidence?

Is it something in the water? Is it something in the air? Is it something that is an infection or something that’s not an infection?

We simply do not yet know what we are told by some of the survivors of this illness. And yes, everyone has survived so far that we know is that the testing has been negative. Right, Chris?

They have tested for everything, including vector borne infections, bacterial infections, waterborne infections. Nothing has actually turned up.

When I was reading these accounts, I have to tell you that the infection that came to mind immediately for me, of course, was dengue fever, because of that description of a flu like illness being outside, presumably bitten by mosquitoes. And then that breakbone fever, well, apparently they’ve sent off serology for dengue that has been negative.

The other thing that comes to mind in rafting, that’s got to be leptospirosis. Leptospirosis is a waterborne illness. We get it not by usually drinking the water, but actually through our very skin being splashed in the face.

So river rafting is a classic way to catch leptospirosis. It’s a bacterial infection that we catch when this bacteria called leptospira gets into the water from the urine of rats.

Usually it’s rats peeing in the water and then that gets splashed onto us or into our mucous membranes. And the reason I’m thinking about leptospirosis is it can do more or less what we’re seeing in these descriptions from the patients themselves.

And the testing is initially often quite negative. That’s what we call the acute serum. First of all, the incubation period of getting sick shortly after exposure, that would fit with leptospirosis.

Second of all, the early testing being unimpressive, it’s that convalescent or paired serum later that would show an immunological response. It doesn’t show up in usual bacterial cultures. You can’t see it on a gram stain. It’s a very delicate little bacteria. So we will see. I would say.

Stay tuned. Unclear what’s happening. Grateful for people who are trying to work on this.

It is an obvious case to me that we need our Centers for Disease Control to do an investigation. I’m hoping they have the bandwidth to do that. Would be an exciting thing to do.

As an epidemics Intelligence service officer, I’m hoping somebody gets assigned to the case and that we will learn more about this. If it is leptospirosis, how do we treat that? Usually these patients receive doxycycline.

And in fact, a number of these patients apparently did receive doxy. And apparently a number of them have said that after doxycycline, they’ve begun to feel better.

And so, you know, that’s exciting to me that we might actually have a case of leptospirosis. It would fit with rats peeing into the river. That particular river is not known usually for leptospirosis.

Is it possible that with global warming, the water has become warmer and more of a hospitable warm environment for this bacteria, which usually does not do well in cold water, but better in tropical or at least temperate climates. Stay tuned here to German Worm. We’ll find out about this.

If you are a ticket holder and one of those amazing pass holders, you’ve won the lottery and you get to actually float the river. I would say you should do this, but it is something you want to keep an eye on.

And you might even talk with your physician right before you go if they have new information. You could reach out to us here at German Worm.

We’ll share with you what we have learned talking with other public health experts who might be more up to date as you get close to your launch time. Chris, what do you think? Have you ever floated the the Colorado river and would this hold you back from doing so?

WORM
00:11:22.610 – 00:12:12.090
No and no. I had an excellent trip on the salmon in Idaho recently. The Middle Fork have never done the anything in the Grand Canyon or in Colorado.

In terms of what’s causing is I think it’s fascinating. And of course, I don’t know. Dengue is not number one on my list, nor yours. And one reason is dengue often happens where there’s a lot of people.

You need people for transmission, and this is not a highly populated area. Lepto is pretty high on the list.

Leptospirosis one Reason is that in past outbreaks in the United States, in addition to around the world, especially tropical areas, there have been outbreaks of leptospirosis specifically associated with whitewater rafting, with swimming, with other freshwater sports events. So like you, I’m very curious to see what upcoming testing is going to show.

GERM
00:12:12.970 – 00:12:25.690
Stay tuned, we will let you know what we learn. Chris, would you give us an update please on the Ebola Bundibugyo outbreak in Africa? What’s going on there, please?

WORM
00:12:26.010 – 00:15:40.120
Yeah, happy to heck. There’s another big outbreak in drc, Democratic Republic of Congo, formerly known as Zaire. Ebola, just to go over a few basics.

First discovered in 1976 in the same country, DRC, near the Ebola river in terms of transmission. Luckily it’s not airborne and it’s not spread by insects. So what you need is close contact with an infected person.

So like if you touch their blood, what this means of course is the two highest risk groups is not tourists and travelers, it’s family members and health workers who touch the ill. Also you can get this from consuming bush meat, you know, like monkey meat or handling fruit bats. And bats are thought to be the the reservoir for symptoms early on, fever, sore throat. Later on you may bleed.

However, the name of the disease has changed. We used to call it Ebola hemorrhagic fever. Now it’s known as Ebola virus disease because not everyone has this phenomenon of easy bleeding.

When they get this fatality is high. It’s different in different epidemics. It can be as low as 25%, as high as 90%. Overall it’s about 50%. Treatment is not great.

It’s fluids and cross your fingers. There’s some benefit with monoclonal antibodies but this is kind of a high tech intervention which is scarce in a low resource setting.

There have been a bunch of outbreaks, over 30 outbreaks over the last few decades. By far the biggest was the big West Africa outbreak 2014-16. There were over 28,000 cases and over 11,000 deaths. The current outbreak is worrisome.

It’s in DRC, primarily in the far extreme east, which is a war zone, a very rough and tumble area, area without a lot of official government presence. As of the 12th of July, there’s 1900 confirmed cases and 719 deaths. Also there have been a few cases in Uganda, all in the capital Kampala.

20 Cases and two deaths and also one case in France. There’s a few things that are worrisome about this. The biggest worrisome thing is that its rate of growth is extremely high.

Back in 2018, there was a big outbreak in North Kivu in DRC. And to reach 100%, to reach a thousand cases, it took 235 days. This outbreak reached a thousand cases in 40 days.

So this unfortunately is still ongoing. It’s getting bigger. And this is a really good place for WHO to get involved in a big way to do isolation and containment and identifying cases.

In terms of vaccine, there’s six different strains of Ebola and there was a good vaccine for the big West African outbreak that was a type known as Zaire Ebola. But this is a different strain. This one is called the Bundibugyo strain or virus of Ebola.

And that vaccine for Zaire does not work for this strain, unfortunately. So bottom line, it’s a big bad outbreak.

And I’m worried that the US not being part of WHO we are, one of the major funders, is going to contribute to the lack of control of this very frightening and devastating outbreak.

GERM
00:15:41.400 – 00:16:58.500
So many missteps and missed opportunities.

One, of course, is the recent emergency travel restriction that if U.S. citizens and passport holders travel to DRC, they’re not allowed back in the U.S. they have to stay away somewhere else overseas for at least 21 days, and that they’ll be put on a do not board list for commercial flights into the United States. And that for those who are legally permitted to fly, they have to come in through, through certain designated airports. That part I think is okay.

But you know, what we should really do is support people. Let’s say you have a physician, someone who’s a medical volunteer.

I think there’s probably a way to do that and support those people in their heroic work without saying that they can’t come home and be cared for if they should contract Bundabagio virus disease. We actually have a series of world class care centers here in the United States built to handle this.

So yet again, I think there’s opportunities for our federal government to do better and to listen to the advice of experts.

The ID Society of America, IDSA just came out with a public statement on this topic, really saying that we should be able to go where we want to go, be sensible and to be cared for if we come home sick instead of having to go to some makeshift place elsewhere where we might not get that same level of care.

WORM
00:17:04.110 – 00:17:46.290
All right, Paul, question for you. And first, let me define a tropical medicine term. And that term is autochthonous.

And what that means is basically contracted in the place where the person lives. So if you go off, you live in the US you go to South America and you get malaria and you come back to the US Then your case is not autochthonous.

But if you’re living in El Paso and you never leave and you get a disease, then that transmission is said to be autochthonous. And where I’m going with this is recently, Paul, there was a case of Chagas disease in San Diego, California that was determined to be autochthonous.

So what’s going on with that? Is this going to be the thing that we see before a whole bunch of cases or what?

GERM
00:17:47.570 – 00:23:05.100
Yeah. What is Chagas disease? I think we’ve talked about this here on the podcast.

But as a reminder, Chagas is a parasitic infection which we acquire from contact with the feces of the kissing bug. These are series of Phlebotoman bugs that typically are normally found usually in parts of South America and Central America.

So these bugs, when they feed on us in the nighttime, they do it as stealthy feeders. They’re quite big, they’re not small mosquitoes.

These are earthbound bugs and they drop down from rafters, thatched hut roofs, for example, feast on our blood as we sleep. It’s dark, they can’t see us, but they can smell our breath and find us by temperature sensors.

So they go to our mouth and our nose where we’re breathing, suck our blood, usually from the lips. That’s why it’s called the kissing bug with a hickey in the morning. Well, that’s okay.

It’s not actually the blood meal, but when they, when they binge your blood, they also purge. They poop. They poop as they feast on your blood. And that stool will contain single celled parasitic organisms called Trypanosoma cruzi.

Why is it called Trypanosoma cruzi?

Because Dr. Chagas, who discovered and described this condition, his mentor was Dr. Oswaldo Cruz, one of the great at that time, in the early 1900s, one of the great leaders of tropical medicine. So he did what anybody should do. When you make a discovery, name it after your boss. That’s how you get in and climb the academic ladder.

So anyway, Chagas disease is caused by Trypanosoma cruci.

And it’s a big deal because it’s not just a swollen lip or eye, that microorganism, in some proportion of cases, it can actually enter the autonomous nervous system, including the gut and the heart. In fact, this can lead to chronic heart failure over a period of years. There’s an acute phase where people can become very desperately ill.

In fact, some young children will die of this acute chagas, but most will then enter a dormant phase where it’s not clear what their fate will be. They may live a normal life or they may develop heart failure and in some cases also GI issues with reduced motility of the gut.

This is a huge problem, and in fact, it’s one of the leading causes of heart failure in certain parts of the world. It’s a risk for people who travel to Latin America and who may be staying in particularly rural and austere settings.

Again, thatched huts, cracks in adobe walls, places for the. The bug to live periodomestically. What’s going on in San Diego?

Well, apparently there is description, as you said, Chris, from public health authorities in San Diego, that they have a case of someone who was bitten and infected there. That person had never traveled. This really did happen, as you said, on a locally acquired basis.

That’s notable because this has not been something that we have thought about typically as a high risk factor in San D. Although I do note that other areas, including in Texas, I believe, even Louisiana, there have been cases in the past where this has happened. These bugs can travel, they can come north. The world is getting hotter.

It’s more hospitable for these bugs to get here in our contiguous 48 United States. Getting to San Diego, it’s unusual. This is the first time it’s been described. I’m not surprised.

I mean, my sense is that this is going to be something that happens farther and farther north as we get away from the Mexican border. So what’s the big deal?

Look, in the United States, it’s pretty typical for us to find people with serologic evidence of having been exposed to and infected with Chagas disease when they donate blood. If you’re a blood donor, that blood supply should be screened for the presence of Chagas.

We know that that’s true, and we think that most of those people were infected elsewhere, came to our country, they’re starting their new life. They love America so much that they literally give the blood of their own body to support their local communities.

And they get this rude surprise, hey, you actually may have Chagas disease. Please see an infectious disease specialist. This is different. This was a locally acquired case, and it’s putting people in San Diego on alert.

What do you do about this? So, first of all, try not to have a part of your house that is hospitable to the bugs. Screens on the windows are good.

Cracks in ceilings and walls should be patched and repaired. That’s usually plenty and enough to keep these bugs away.

If you do find that, you wake up with a swollen eye, a swollen lip, it looks like somebody got punched in the night, especially young kids. It may be a case of an allergic reaction to the T cruisei in the mucous membrane of the eye. We call that Romania sign.

And people should be aware that if they see this in their kid, they should take them to the doctor and say, hey, could this be Chagas disease? That’s true in San Diego. That’s true when we travel internationally. It’s true anywhere in the border states.

So it’s something that I hope will raise awareness. Is there treatment for Chagas disease? Yes, we can make a diagnosis using PCR in many cases. And we can also treat.

The treatment is more effective if it’s given early in the later stages of the illness. Treatment is less likely to provide benefit.

We do want to detect this early on, and so I’m hoping that our listeners will be aware of this when they travel to Latin America. Please do. And also if they happen to live in border states and have one of these concerns. Your impression of Chagas disease, Chris?

WORM
00:23:05.660 – 00:23:53.200
Well, first, it’s not a rare thing in the U.S. there’s estimates that there’s over 300,000 people in the U.S. who have Chagas disease. The great majority of these people contracted this in Latin America.

But locally acquired cases have been detected actually in eight states, you know, to the south, you know, Texas, California, Arizona and a few others. One risk factor for acquiring this is sleeping under a thatched roof, especially in Latin America.

So for travelers, I would recommend not sleeping under a thatched roof. If you’re in a palapa with a thatched roof, put something over you like a mosquito net so these bugs can’t get to you at night.

But even if I was staying in San Diego or Arizona, I might hold off on sleeping under a thatched roof. And that will bring your risk down somewhat.

GERM
00:24:00.160 – 00:24:11.840
Chris, Back on episode 109, we talked about Titanic diarrhea sweeping across our nation in the form of cyclosporasis. Can you give us an update, please? What do we now understand about the cyclospora outbreak?

WORM
00:24:12.000 – 00:25:45.150
Yeah, first, basically, since early May, there’s been a lot of cases. CDC has picked up over 1600 cases and the actual case count may be much larger. This is a parasite.

You pick it up through food and water and it causes explosive diarrhea, which is kind of a horrible phrase, but it’s kind of a horrible syndrome. And there’s been a recent update on this in terms of a causal agent. First, why did it take so long? Why did.

Why was it tough to play Sherlock Holmes with this? Part of it ties into the incubation period of this parasite.

If something has a very brief incubation period, then that narrows the list of suspects because there’s only a small number of things that happened recently. But with Cyclospora, often the incubation period can be a couple weeks or even longer.

So you have to consider all of your exposures, all of your meals for two weeks and more. So that has made this a lot more complicated.

Also, as Paul and I discussed, there’s been some reduction in surveillance, which is a terrible thing, which led to this being delayed in terms of. Of tying to a causal agent.

However, it just recently, within the last day or two, has been tied probably to iceberg lettuce at Taco Bell, which bums me out because I’ve had more than one good meal at Taco Bell over the years. But I have to admit that if I was in a state where Cyclospora is going on, I would not eat a taco. I would not eat any kind of lettuce.

And in fact, I’ve heard they’ve stopped serving it there. So this is an ongoing outbreak. It apparently is tied to the iceberg lettuce. We don’t know if that’s the only offender. And that’s where we are now.

GERM
00:25:45.630 – 00:26:15.030
Yeah, who knows?

It may be that based on these early descriptions, I think it may be up to half of people who have been diagnosed with this condition have some linkage back to Taco Bell. The other half do not. And so I think this is, you know, a lettuce source that has gotten not just a Taco Bell, but to elsewhere.

And there may be other food sources that are involved here too. Stay tuned. German worm will bring you this titanic diarrhea story as it breaks.

WORM
00:26:17.590 – 00:26:26.470
Paul, recently you mentioned in an episode putting maggots into people on purpose to help them. Really? What the heck?

GERM
00:26:27.750 – 00:28:28.870
So we got. I appreciate the outreach. Yeah, we did talk about this recently. That’s called. I just said this in passing. This is called maggot debridement therapy.

What it. Or mdt. What is maggot debridement therapy? So maggots are baby flies and they usually eat dead tissue.

Let’s say there’s a dead animal in the forest, the fly will lay its eggs into that carcass and it’s a great source of food. It’s actually a wonderful thing in nature because it helps to recycle dead meat that’s found in the environment.

And, you know, you end up with a fly that grows as a maggot, gets fatter and fatter, and ultimately will drop to the forest floor, pupate, turn into a flying insect. So they’re, they’re doing their own own. Their own natural business this way as medical doctors.

Yes, on rare occasions, we will use this therapeutically. And I’ll do that with someone who has a chronic wound that has a lot of dead tissue in that wound. Maggot debridement therapy.

It’s not just any fly that gets in there. We do have FDA approved flies. They’re usually the green bottle fly. That’s what I’ve used before.

And you have to order them through a special place that does nothing but this. The flies are alive, but they’re raised in a way that they don’t contain bacteria. That’s called notobiotic flies.

So you’re not likely to give someone a bacterial infection when you stick maggots in there. It’s quite the opposite. It’s an infected wound with dead tissue.

And what these maggots will do when placed in the wound and then contained under a window screen, basically, is they eat dead tissue just like they’re evolved to do. In this case, it’s the dead tissue that’s making it hard for that wound to heal.

They will liquefy the dead tissue, they consume it, and they also, you know, as they crawl around the bed of the wound, they’ll stimulate growth of healthy tissue and try to speed up the, you know, the recovery of that wound. This is often for people suffering with diabetic foot infections. That’s where I’ve used the technique.

But it can be any other wound that’s difficult to heal. These wounds often smell badly, Chris. Right. Because they have an anaerobic bacterial component.

In my experience, you put the maggots in there and that odor is gone within a day. Patients love that. It’s a demoralizing process. And the staff doesn’t like going in to take care of a malodorous patient.

The odor will be gone almost immediately as those anaerobic bacteria are consumed. And, you know, as the maggots get a little bit bigger, the wound gets cleaner.

Now you have to go back in later, within a week and fish them out and get rid of them. It’s a bit of a process. It’s a procedure. There are alternatives of course, including a number of topical dressings that can be used.

The use of something called a wound vac, it’s a negative pressure or vacuum system that can help too. So this is a rarely used thing. I’ve used it only on a handful of occasions for a variety of reasons over the years.

But it is a true fact that you can do this. And by the way, I often get questions, is this the same as putting leeches into wounds? Leeches are totally different.

We use leeches quite routinely because they thin the blood and suck blood out of. Yeah, let’s say a crushed finger or someone has a severed finger, we sew it back. You want to have good circulation to that new pedicle or stump.

And if there’s vascular congestion, that doesn’t work. So leeches can suck your very living blood and make it easier for those types of wounds to heal. They’re quite different. They’re macroscopic.

You can see them for sure. I personally have been infested with leeches when trekking in Nepal many years ago. I can tell you they don’t hurt.

And what, when you pull these leeches off, they bleed like crazy because they have an anticoagulant called Hiriodin in them. Those leeches do have bacteria. It’s a germ called Aromonas in the foregut and it’s just very difficult for us to get rid of them.

So when we do leech therapy, we do give antibiotics to reduce the chance of Aromonas causing a local infection. Anyway, not exactly travel related, but this is a technique. Yep. That we can do. Stay tuned to germ and worm for these. Germy, wormy.

Be rather unpleasant, but I honestly tell you, effective treatments.

WORM
00:30:21.640 – 00:30:33.240
Paul, a request. If I ever develop a medical condition, use your judgment as to whether maggots are appropriate or not.

But can you erect some sort of screen so I don’t have to watch these guys chewing on me?

GERM
00:30:33.880 – 00:31:25.129
It’s interesting. We, we do, it’s called the creature cage that we put on there. And you know, what are the side effects with maggot debridement therapy?

Sometimes people do feel them moving. Some people really are bothered by this. Honestly. These tend to be people with reduced neurological sensation.

That’s how they got the wound in the first place. So that’s rarely an issue. You can’t put them too deep into the body. They do need to breathe air. We don’t put them into joints.

We don’t usually let them chew on bone. We should let them chew on soft tissue.

So there’s It’s a limited series of indications where we do this and honestly it’s a bit old fashioned at this point I can only tell you in my hands it has been, it has been effective. And yes, we, we prevent people from watching it because that tends to freak them out.

Chris in the United States, what’s going on with West Nile virus? There’s rumors that we have a busy early season for West Nile. Do you agree?

WORM
00:31:25.690 – 00:32:35.950
Yeah, apparently yes. West Nile viral illness spread by mosquitoes happens every year in low numbers in the United States.

Big bad illness causes neurologic symptoms, brain symptoms. So it’s not common but it’s worrisome when it happen. And this year the numbers are not big, but they’re bigger than usual.

And the season started earlier than usual probably because of warmer temperatures. So per the CDC, as of July 14 there have been 81 human cases and out of these though a majority 57 have been neuro invasive.

So affecting the nervous system including the brain, the hot spot has been Arizona, but also Texas and some other states to the south. Doesn’t really happen very much in the extreme northeast. So Maine is not affected, Montana is not affected.

So there’s an uptick and it’s earlier than usual. If I was in Arizona or another hotspot state, I would start using bug repellent on a regular basis.

The usual bug repellent Dieter Picaritin to skin, permethrin to clothing will bring down risk of the mosquitoes that carry this. Foreign.

GERM
00:32:40.830 – 00:33:04.790
Thanks so much for joining us here on episode 111 of Germ and Worm. As always, we welcome your questions on travel health. Just send them to us or your tips for success or suggested corrections.

Send us an email germandwormmail.com or visit our website germanworm.com if you’ve enjoyed what you’ve heard here, please subscribe. Rate us favorably on your device and spread the word with friends, family, family and on the socials. Those are free ways to support this podcast. Imm Germ

WORM
00:33:04.790 – 00:33:08.550
I’m Worm. It’s a big planet. See it in good health.

GERM
00:33:08.950 – 00:33:29.680
We look forward to seeing you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish a doctor patient relationship and so it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure. The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinion opinions of University of Washington or UW Medicine.