This is three short posts, merged into one.
Yesterday, I removed an ixodid tick from the external auditory canal (fairly deep inside the ear) of a little lad. He had been scratching at it for a few days but mum couldn’t see anything wrong. I reckoned it had crawled in when the boy was sleeping with his pet dog, their normal host.
Auditory canals are tubes of cartilage, lined with skin, leading to the eardrum. They are never straight, and usually form an “S” bend. A nurse saw the tick while using the autoscope, but didn’t know what it was. I recognised it immediately. Thirty five years ago, I was bitten by an ixodid tick, and contracted African tick typhus. This is the “man flu” of typhus diseases. In Thailand, we have mainly scrub typhus, transmitted by tiny mites, and louse-borne typhus which…you guessed it.
The problem was how to remove the tick. It was attached by its mouthpiece to the skin, deep in the ear. If it had been just wandering about, we could have floated it out, by flooding the canal with oil. This technique is good for maggots and larvae as the oil blocks their spiracles (breathing pores).
I got the finest pair of tweezers in the surgical armoury and three of us held him down, and distorted the ear canal so I could see with a powerful torch. I nipped it off as close to the skin as I dared and pulled it out. Mum was most impressed. It was bleeding a bit, so we put in a wick soaked in chloramphenicol eye ointment. The trick is to get as much of the mouthpiece out as possible, to prevent infection. I think I did.
Now “Tacky”. This is a bouncy castle play area for children set up in a market shed in Maesot. Strangely, no children are playing on it. It looks grim, never mind tacky. Quite scary faces, in fact.
And finally Toe. Here is a photograph of impetiginised eczema. Dirty feet, itching, scratching, not wearing footwear, looks a real mess. Cleaning, antibiotics, anti-itch/ histamines, and some moisturising cream will sort it out promptly.
PS one for the road, another ‘toe’ showing gross clubbing in a man with advanced pulmonary tuberculosis. You can see it best on the man’s right great toe. On the left, he has an advanced fungal nail infection.