Infection from Tiny, Unwanted Travel Companions

A 50 year old woman presented at surgery on return from a holiday in Tanzania. She was complaining of multiple, small red, very itchy, lesions scattered round her waist line, on the inside of thighs and upper arms. She had been scratching these areas and there was now reddened skin, with lacerations on her thighs, seeping of the wounds and small patches of sepsis. On questioning she stated that her flight from Dar as Salaam had been delayed 24 hours and as local hotels were full, she had been forced to stay overnight in an insanitary and overcrowded hostel. On examination the lesions were typical of flea bites, with secondary bacterial infection.