Outbreak of Type II dengue

I guess now I know why the mosquito guy is out spraying all the houses.

http://www.nicanet.org/?page=blog&id=21790

The more aggressive and fatal Type II dengue has sickened 87 people in recent days, three of them seriously. The three grave cases are geographically dispersed in Managua, Chinandega, and Matagalpa with less severe cases reported even more widely. Seven fatalities from Type II dengue have been reported in Honduras. Type II dengue presents few symptoms different from Type I and piggybacks on other ailments suffered by its victims. Doctors recommend that people go to medical centers upon the first sign of fever as Type II dengue can cause hepatitis, myocarditis and other serious diseases. P Meanwhile, nationwide, affiliates of the Local Systems of Integral Attention to Health (SILAIS) were carrying out abatement campaigns against the mosquito which carries dengue as the first weeks of the rainy season mean that there are more places for the insects to lay their eggs. (Radio La Primerisima, June 24; El Nuevo Diario, June 20)

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Interesting map here

http://www.healthmap.org/dengue/index.php

Zoom in to see Nicaragua, El Salvador, and Honduras.

Rebecca Brown

Strange How Things

fall into place.

Talking to some people here about the "mosquito" problem, I find out that the word for our mosquitos is zancudos (which we all knew), but they call no-seeums "moskitos".

Does this mean that one of my all time favorite movies, Harrison Ford in Moskito Coast should be called No-Seeum Coast ? When I first saw the title, I assumed it referred to the prevalent mosquitos, later I assumed it was the Indians of the region who were the Moskitos (I've seen the movie a few times).

I notice the map is from Boston Children's Hospital . not a dengue hot spot . . .. I don't doubt that you COULD be well supported in Nicaragua, but one of the highlights of the country is the inconsistency. Even Pellas has taken some hits on quality of patient care.

The other problem I see with medical care in Nicaragua (beyond the lack of consistency) is the utter lack of accountability and transparency. I don't doubt that stellar Nicaraguan physicians and surgeons are available. But, how do you know you're getting the stellar one, and not the son of a local Sandinista functionary who bought his diploma?

The small insect problem you're having

They're sandflies, not the northern insects that are the no-see'ms in Maine. https://en.wikipedia.org/wiki/Leishmaniasis has too much information if you're a hypochondriac.

I've met doctors who were sons of doctors in the US who were incompetent, too. My Cuban-trained doctor has a very low opinion of the US fad in my childhood for ripping out tonsils for money. Your US doctors will waste time running up as many tests as possible, too.

If you went back to the US before showing enough rash or projectile vomiting enough to be barred from the flight, it could be anything from dengue to food poisoning to the flu. Or a stroke if the only presenting symptom is a blinding headache behind the eyes.

And if it is a stroke or a heart attack, you're simply not going to be able to run back to the US in time.

The Kazakh saved a friend's dog twice (house calls, one time repairing damage the dog did to herself after the first emergency C section. If you listened to one of the expats here, that vet is a dog killer. Some (not all) expat chatter about how bad things are here compared to the US is false memories of home and cherry picking the evidence here.

cherry picking

I am not sure if it is cherry picking or just different. You mentioned that doctors in the US order way to many test and exams. I agree people in the US are over treated, but this is largely due to legal concerns the doctors have. Now, USANOS have come to expect this type of over treatment as the norm. Are more exams and test better? They probably catch rare conditions that almost no one catches, but I think for most people they are not necessary. I think this is one point of contention with Obama care. I think this expectation, that USANOS have, extends to their pets as well. I take my pets to the vet and would like to see more time taken and a more thorough exam given, but they are all alive and healthy.

1st Capt. Ron

(Title by Miskito Alan)

I omitted an anecdote

I had a dog who had Lyme Disease, and the University of Pennsylvania Emergency Animal Clinic didn't catch that when I bought him in with mandibular neuropathy. And the dog's regular vet didn't catch it. Vets in Annadale, just ordinary clinic vets tested for Lyme Disease and the dog took the usual course of antibiotics.. Given what I've read, he probably got it in Philadelphia as nerve damage can be part of the presenting picture, but since Philly wasn't thought of as a common place for White Tail Deer and their ticks, that wasn't thought of as a possible diagnosis. The dog recovered from the neuropathy, but he continued to have some joint problems until after the antibiotics.

Basically, even if the doctors in the US knew what they were looking at was a case of dengue, the med teams here have more experience treating it, just as my quite ordinary vet in Annandale knew more about Lyme Disease than the UPenn vets or the dog's usual vet.

Me, on this one, I want to have a medical team that knows what they're looking at and has had experience with it, rather than a med team that might be going into heroic crisis mode because they've never seen this before. I know two people who've had dengue -- they were sick but didn't need heroic treatment. Maybe someone would need heroic treatment, but it would be nice to know if you didn't rather than getting it anyway by people who had no experiences with dengue and were operating in crisis mode just to be safe.

Rebecca Brown

indians

I believe they are Miskito Indians, not Moskito Indians. So, you movie might be referring to no-seeums

/p>1st Capt. Ron

(Title by Miskito Alan)

Yes, You Are Right

of course.

I'd like to get over to the east coast and meet some Miskito, Suma and Rama before they are all gone.

Do the maps refer to it as the Miskito Coast ?

Plenty of no-seeums to go around in any case. I fogged this morning at dawn and am presently enjoying a no-seeum-free zone. Zancudos have been a minimal problem for quite some time. With my high walls and unfriendly terrain I believe the zancudos stay at the neighbors. No-seeums are a different story. They are so light, they blow in with every breeze. It was the same in Key West, they were by far the most obnoxious pest and came right through the screens.

It won't last . . .like middle east terrorists they just keep coming. And I'll just keep fogging. Some wars are wars of attrition; you never see a clear victory.

Just don't let them know

Don't tell the no-seeums if you are going to pull out.

1st Capt. Ron

(Title by Miskito Alan)

Dengue Classico is the more benign version

The MENSA people were spraying all of the rainy season in Jinotega last spring through fall, and putting granules in any sink or place where water could stand. I heard that it was in every barrio in Jinotega. Time to hang the mosquito net, I suppose.

With supportive medical treatment, the worst variety that causes the bleeding is about less than 1% lethal. Don't know if this one is that, but the bleeding variety was in Jinotega last year and the MENSA staffers looked like they'd been working quite intensely in the city.

Dengue spreads from area to area generally traveling in an infected human. Also, don't take aspirin. Acetaminophen is okay (and is the most common OTC pain reliever in Nicaragua).

https://en.wikipedia.org/wiki/Dengue_fever has probably more than people would like to know about the disease.

Vaccine may be available by 2015.

Rebecca Brown

I Wonder What

is in the granules?

I doubt the sink drain would be stagnant long enough . . A lot of people do keep water here in open barrels because of the water interruptions. If you have a barrel of water you can take a bucket bath or flush a toilet. I suspect these might be breeding sites.

Pilas have standing water too, but I doubt that it stands long enough in most cases.

All the wash water, kitchen drain water, and much bath water here drains into street gutters, and initially I though that would be a problem, but again it's not still long enough as it's constantly flowing.

They've been promising, and testing, vaccines for the last two-three years.

Getting supportive medical treatment in the sense we understand it might be difficult here. If you're well enough to get on a plane to Miami or Houston,,, that might be the best solution. Don't wait too long, if you're too sick they won't let you on the plane.

I think that

all the plastic trash around here would trap and retain water as well. It doesn't take much water just a spoonful or so.

1st Capt. Ron

(Title by Miskito Alan)

Some of the drains goes straight down to the sewer system

...and there's no trap in the US style, but some water in a part of the drain with a top to make sort of a seal. Also, people tend to have stuff in their patios that collect water. The MENSA teams also fog down into the storm drains. My neighbors were less thorough than I was about standing water and had some tires out in the back, and water in plastic tubs. Mosquitos larvae can develop in very small amounts of water.

The granules are, I think, something like the bacteria used on various pests in the US, but specific to mosquitos. Don't know about dengue mosquito larvae, but some kinds of mosquito larvae can live in wet leaf litter. We had a low spot on the porch that always got the granules. If there's a dip in someone's drain and they don't shower more than once a week, then that's a point, too.

For things like dengue, you're going to have a more knowledgeable medical team here for that than in most of the US. The support includes knowing when and when not to give you a blood transfusion. Here, they can keep you hydrated; they've got opiates if the pain is really bad; they have whole blood if you need that.

Cookshow had some posts on the other site about his experiences with dengue and how now if he hears it's in the area, he gets out the mosquito net.

If you get AC, that takes care of the danger for that room.

Rebecca Brown

Air Conditioner

Be aware of the condensation from the air conditioner. The drain tube and puddles can make a nice home for mosquitoes. I have even seen them living in the cool air exhaust vents if there is a sponge filter installed. As soon as the Air conditioner was turned on, a flock (?) of them would come swarming out.

1st Capt. Ron

(Title by Miskito Alan)

Ah yes, the inverted egg cup style trap...

They sit in a ring of water to make a seal except they most often don't.

I used to do this: Just as the last of the water was going down the shower drain I would put an upside down margarine container or similar over the drain and let the suction pull it down. I proved to the landlord where the smell was coming from!! and kept anything down there.

I had to move anything copper

...from over the sink drains on the concrete sink inside the other house. Have a copper mixing bowl (mostly used for decoration) and it would get quite nasty if I hung it over that sink.

Current house seems to have modern enough traps.

Rebecca Brown