All About Diseases

Dengue

During the rainy season, you might be excited to send your children back to school to continue their adventures in learning, as well as social growth and interaction; but you might also be just as scared because of all the diseases that your children can contract when the rain starts pouring. Aside from the simple cold and cough caused by the erratic weather – spread by contact with others who have it that can worsen into a terrible flu – diseases can also be carried around and spread by animals and insects.

One of these diseases is Dengue.

What is Dengue?

Dengue is one of the most common viral infections and it is spread by infected mosquitoes like the aedes aegypti mosquito which is a female mosquito. This vector-borne disease is widespread in tropical and sub-tropical countries, as well as in areas where huge populations of mosquitoes can be found. Dengue is caused by any of these four serotypes of the virus: DEN-1, DEN-2, DEN-3, and DEN-4.

How Can You Be Infected with Dengue?

The dengue virus is carried by mosquitoes. The aedes aegypti is a daytime feeder and an intermittent biter. This means that it bites several people during its feeding period, which is during the early morning and at night, before dusk.

Once an infected mosquito bites a person, that individual becomes infected. This disease cannot be transmitted from one person to another. In order to be infected, you have to be bitten by the infected mosquito yourself. However, an infected person can spread the disease to other mosquitoes. This happens when a mosquito bites an infected person; in a week, that mosquito can spread the disease when biting another individual. Once you are infected, the symptoms of the disease will start appearing in 3 to 14 days.

Symptoms of Dengue

If you are infected with dengue, you will experience flu-like symptoms. To know if you contracted this disease, watch out for the following symptoms:

• High fever (40°C or 104°F)
• Nausea
• Vomiting
• Muscle pains
• Rash
• Pain behind the eyes

The problem, however, is that fever is quite common and it can be caused by a myriad of factors. How will you know if dengue is the cause of your fever? If your fever is unusually high – more than 39°C – then it might be caused by dengue. Also, if it lasts for five to seven days, then dengue might be the reason for your fever.

Another symptom of dengue is reduced blood platelet count. If you think you have this disease, have a health professional check your blood platelet count. If it dropped significantly, this might mean that you have dengue.

If after experiencing the mentioned symptoms, your temperature starts to drop, beware. This does not mean that you are on your way to recovery. Instead, this might be a sign that your condition is worsening. If you are restless, your gums are bleeding, and you start to vomit blood, then you might be developing severe dengue. Visit your doctor immediately because this condition might lead to organ impairment and excessive bleeding if left untreated.

Do You Think You Have Dengue?

If you experienced the symptoms stated above and you suspect you have dengue, you should visit a health professional immediately. Your doctor will test your blood and evaluate the symptoms that you experienced. In some instances, the doctor will also review your travel history. If you just got back from a dengue endemic country, then it is possible that you contracted this disease during your visit.

How Can Dengue be Treated and Avoided?

Unfortunately, there is no known vaccine or specific cure for dengue. In spite of this, your doctor might still prescribe some medications that will help you manage the symptoms. In most occasions, patients are advised to stay in bed and drink plenty of fluids. Depending on your doctor’s diagnosis, you might be prescribed to drink paracetamol to reduce the pain in your joints, as well as bring down your fever. Do not drink ibuprofen or aspirin because these medicines might increase the bleeding.

Protect yourself from dengue by wearing long-sleeved clothes and applying mosquito repellents. Install door and window screens to prevent mosquitoes and other insects from entering your home. At night, you can use mosquito nets when sleeping to avoid insect bites. Most of all, you should stop these insects from breeding in your home. This means eliminating or covering any possible breeding sites like water storage tanks, trash cans, plastic containers, and potholes – basically anything that might collect water.

Please remember that prevention is better than cure. By taking these steps and keeping in mind what kind of diseases the rainy season might bring, you protect yourself, your family, and even your friends from contracting not just dengue, but a range of other diseases that might be worse.

Chagas Disease

The triatomine bug is a type of reduviid bug which can be found mostly in South and Central America. It can cause an inflammatory disease called Chagas disease. Read below to learn more regarding this infectious health problem!

What is Chagas Disease?

A parasite can be found in the excrement of triatomine bugs. This parasite is called Trypanosoma cruzi (T. cruzi) and this is what causes the Chagas disease. It can be contracted by anyone, even animals. In spite of this, children are the usual victims of this disease. Since the bugs that carry this disease mainly live in South America, most people infected with this disease reside in that area. In some instances, they do not even know that they are already infected with this disease. This is problematic especially because, when left untreated, it might result to various health complications.

How do You Get This Disease?

Triatomine bugs conceal themselves in the walls or roof of a house. At night, they come out and bite the inhabitants of the household, sucking their blood. Afterwards, these insects defecate on the animal or individual that they bit. The T. cruzi parasite, which lives on their excrement, breaks through skin membranes in order to infiltrate the victim’s body. In some occasions, this disease is transferred through organ transplants and blood transfusion.

What are the Symptoms?

The Chagas disease has two phases: acute and chronic. The symptoms of Chagas disease’s acute phase include fever, fatigue, headache, nausea, vomiting, and enlargement of liver or spleen. If you experience these things for weeks or months, then it is likely that you have this disease and it is in its early stage. Meanwhile, the signs of the chronic phase of Chagas disease are enlarged esophagus, abdominal pain, and heart problems. The symptoms of the chronic stage of this disease might manifest years after the parasites entered your body.

Can it be Treated?

Chagas disease can be cured. Your doctor will prescribe medications that would help obliterate the parasite and aid you in coping with the symptoms. Benznidazole and nifurtimox are the common medicines prescribed by doctors to treat the acute phase of this disease. Unfortunately, Chagas disease cannot be treated once you enter the chronic phase. However, you should still visit the doctor because he or she can prescribe drugs which will slow down the disease and other complications that you are experiencing.

West Nile Virus (WNV)

Mosquitoes are infamous for spreading various diseases. Among them are dengue and malaria. However, these are not the only diseases that mosquitoes spread. Be careful, especially during the rainy season, because mosquitoes can also transmit the West Nile Virus (WNV).

Photo by: Cynthia Goldsmith

What is West Nile Virus?

West Nile Virus is a disease (WNV) that can cause neurological problems such as meningitis – which is the inflammation of the brain, as well as the spinal cord’s, lining – and encephalitis – which is the swelling of the brain. In some occasions, WNV can also lead to death. This disease is detected in various areas of the globe such as Europe, Africa, Australia, and some parts of Asia as well as America. It is commonly transmitted by infected mosquitoes.

How Can You Be Infected with WNV?

A person might be infected with West Nile Virus through the bite of infected mosquitoes. How does a mosquito become infected? When they bite infected animals, most especially birds, mosquitoes become infected with the virus. The virus will then circulate in the insect’s body for days until it reaches the salivary glands. Later on, that mosquito can transmit the disease once it feeds on humans and other animals.

You can also contract this disease through organ transplant and blood transfusion. A mother can also transmit the disease to her baby through her breast milk or during pregnancy. Fortunately, the disease cannot be passed from one person to another through mere casual contact, as long as proper precautions are followed.

What are the Symptoms of this Disease?

People who are sick with West Nile Virus may or may not experience symptoms of the disease. While most people who are infected with WNV do not experience any symptoms, some experience the following:

West Nile Fever. Aside from fever, you will experience headaches, body and joint pains, rash, nausea, and diarrhea. Your lymph glands might also swell. Although you will get better eventually, you might feel tired and weak for weeks or months since you were infected.

Neurological Conditions. In some occasions, a person who contracted this disease experience serious neurological problems such as meningitis and encephalitis. Aside from those, you will also experience fever, stiff neck, headache, tremors, seizures, and paralysis. Only a few people infected with this disease experience neurological conditions. These problems may last for weeks or months. Unfortunately, for some, the condition is permanent. At least 10% of people with neurological problems due to WNV do not survive.

What are the Treatments?

Unfortunately, there are no known treatments to fight the disease or vaccines to prevent WNV. People who do not experience serious symptoms recuperate on their own. However, there are medications available to help relieve the symptoms. People with a severe case of West Nile Virus are often hospitalized. There, they shall receive supportive treatment including intravenous fluids.

How Can You Avoid Getting Infected with WNV?

Since there are no known treatments or vaccines, you can prevent getting infected with this disease by avoiding mosquito bites. Use mosquito repellents at all times, wear long sleeves and pants especially during the night, and remove mosquito habitats in and around your home. You should also observe the animals around you – especially birds – to determine if they are infected with this virus or not

Typhus

Fleas are capable of tormenting both animals and humans. Aside from sucking the every person and pet in your household, it can also transmit diseases. One of the illnesses that one can contract through fleas is Typhus.

What is Typhus?

Typhus is a bacterial disease that is caused by the Rickettsia bacteria. It can be transmitted by fleas and other infected arthropods like mites and lice. Often, these insects contract the disease from other animals such as rats, cats, and raccoons. A person might contract this disease when an infected lice or flea bites them. When the individual scratches and breaks the skin, Rickettsia enters the bloodstream and starts reproducing.

What are the Different Types of Typhus?

Typhus has two main types:

Endemic Typhus

Also known as murine typhus, the endemic typhus originates from rat and cat flea. Sometimes, this type of typhus is also referred to as ‘jail fever’. Mostly, people contract this disease when they reside in unclean areas that rats might inhabit as well. Individuals who live around animals like cats, raccoons, and skunks are likely to contract this disease as well.

Epidemic Typhus

The epidemic typhus is sometimes referred to as sporadic typhus. This type is more severe and it is caused by Rickettsia prowazekii. Usually, this disease is carried by lice and rats. People who live in overpopulated and dirty areas where lice infestation might develop are usually the ones who contract this disease.

What are the Symptoms of Typhus?

The symptoms of endemic typhus are fever, chills, rashes, and headache. Meanwhile, below are the signs that a person has epidemic typhus:

• Confusion
• Rash that starts on people’s back or chest and spreads throughout their bodies.
• Hypotension
• Sensitive eyes especially in bright environments
• Bad headaches
• Extreme muscle pain

What are the Treatments?

Typhus can be treated through antibiotics. Doxycycline is usually the type of medicine that is prescribed to treat this disease. The antibiotic prescribed to pregnant women with typhus is chloramphenicol. Ciprofloxacin and tetracycline are other antibiotics that can cure this disease. However, the latter is usually for adults only.

Yellow Fever

Mosquitoes spread various diseases; among them is a viral infection called yellow fever.

What is Yellow Fever?

Yellow fever is a serious viral hemorrhagic infection that can be contracted through mosquitoes. This disease is widespread in certain parts of the world such as South America, Carribean, and Africa. It got its name from the fact that two of its most noticeable symptoms are fever and jaundice or yellowing of the skin. Jaundice occurs because yellow fever damages the liver and causes hepatitis as well.

How Can You Contract This Disease?

One can contract yellow fever when an infected mosquito bites them. Both humans and monkeys can be infected by this disease. Mosquitoes can also contract this disease from an infected host. For instance, if a mosquito feeds on an infected monkey, it will contract the disease and spread it to the next host it feeds on. The disease cannot be transmitted through casual contact. However, yellow fever can be transmitted through contaminated needles.

What are the Symptoms?

Some people who were infected with this disease do not feel any symptoms, however, some do. Usually, yellow fever has three phases. You will experience the first phase three to six days since the mosquito bite. Here, you will experience headaches, muscle and joint pains, chills, fever, as well as vomiting.

After the initial symptoms, your body will try to recover. This is the second phase of the disease. If you are fortunate, your condition will continue to get better from here on out.

Unfortunately, there is a chance that you will enter the third phase of yellow fever afterwards. You will know that you entered the toxic phase if you start to experience headaches again, accompanied by severe abdominal pain, vomiting, high fever, and bleeding in the mouth, eyes, nose, or stomach. This is the phase where your skin will also start to turn yellow because of the disease’s negative effect to your liver. Hepatitis and multi system organ failure are other symptoms of the third phase of the disease. At least 15% of patients who were infected with this disease enter the last phase and almost half of them pass away within a week. Half of them wins the battle and ends up recovering.

What are the Available Treatments?

If you are sick with yellow fever, you should consult your doctor immediately. Unfortunately, there are no known cures for the disease itself; however, its symptoms can be managed. You might have to be hospitalized so that the doctor can monitor your condition closely. Medications will be prescribed to you to help alleviate the symptoms but you have to avoid non-steroidal anti-inflammatory drugs to prevent bleeding. More importantly, you have to be protected against mosquito exposure to avoid infecting uninfected mosquitoes.

Filariasis

One should be very careful during the rainy season, especially because diseases caused by mosquitoes are widespread during this time. One of the diseases that these infamous insects spread is filariasis.

What is Filariasis?

This is a tropical disease that you can contract from mosquitoes. In spite of this, this parasitic disease is actually caused by thread-like worms which mosquitoes transfer to people when they bite them. The worms stay in the lymph system – a very important group of organs and tissues that help defend the body against infections, as well as maintain fluid balance. Wuchereria bancrofti and brugia malayi are two species of worms that are often linked with Filariasis.

What are the Symptoms of Filariasis?

The signs and symptoms of filariasis include fever, body pain, headache, chills, and swollen lymph nodes. Skin exfoliation and the swelling of the genitals and limbs are also some of the signs that you have filariasis. The swelling is caused by the infection in the lymph system, which renders the body incapable of defending itself from infections. As a result, bacteria attack the skin and lymph system, causing the skin to grow stiff and thick. This condition is also called elephantiasis. With women, their breasts and genitals will swell. Meanwhile, when men have filariasis, their scrotum, sperm duct, and sperm track are inflamed.

Can it lead to Complications?

Aside from elephantiasis, this disease can also lead to numerous health complications. Tropical pulmonary eosinophilia (TPE) syndrome is one of the health problems caused by filariasis. Cough and difficulty in breathing are some of the symptoms of TPE. In addition, this tropical disease can also cause fluid to accumulate in the scrotum or hydrocele.

 What Are the Treatments Available?

Filariasis can be treated by taking prescribed medications that would help get rid of the worms that are causing the disease. Some of the drugs that are used to treat this disease are diethylcarbamazine, ivermectin, suramin, mebendazole, flubendazole, and albendazole. These drugs act to kill the adult worms, get rid of the larvae, and/or stop adult worms from reproducing.

Surgery is performed to treat the complications caused by filariasis like hydrocele, for instance. It is also used to remove the remains of dead adult worms in the body, in order to avoid further complications. Surgery is often not used to treat elephantiasis; instead, you will be advised to rest for a while, elevate the swollen limb, and bind it in compression bandages. The patient should also keep the affected limb clean at all times.

Sleeping Sickness

Flies are insects that carry various diseases. One of them is the sleeping sickness – a disease that affected numerous people in 1960s before it was controlled is once again reappearing. Know more about this fatal disease here.

What is Sleeping Sickness?

Also known as Human African trypanosomiasis, sleeping sickness is a parasitic disease that is can be transmitted to an individual through the bite of an infected tsetse fly – a type of fly that can be only be found in sub-Saharan Africa. Once the infected insect bites you, the infection spreads in your body through your blood. It can also affect animals.

What are the Two Forms of African Trypanosomiasis?

This disease takes two forms:

Trypanosoma brucei gambiense – This type affects at least 24 countries in Africa. People who are sick with this form of African trypanosomiasis typically do not experience symptoms of the disease for months or even years. Once the signs start to appear, it usually means that the disease is already in an advanced stage and that it is already affecting the patients’ central nervous systems.

Trypanosoma brucei rhodesiense – This type is more widespread in the eastern and southern parts of Africa. It is more fatal compared Trypanosoma brucei gambiense. Individuals who are sick with this form of African trypanosomiasis will immediately experience the symptom. The development of the disease is swift and it quickly affects the central nervous system.

What are the Sypmtoms?

The symptoms of this disease have two stages; in the first stage, you will experience the following:

• Fever
• Headache
• Drowsiness even in the morning
• Weakness
• Joint Pain

Since the mentioned symptoms can be linked to numerous diseases, it is sometimes difficult to diagnose if they are caused by African trypanosomiasis. If you are not treated immediately, the disease will continue develop and start to affect the nervous system – this is the second stage. Here, you will experience more particular symptoms such as convulsions, confusion, insomnia, mood changes, and anxiety.

Can the disease be treated?

Like most diseases, it is easier to fight African trypanosomiasis if it was diagnosed at an early stage. During that time, medications can be administered easily. Once the disease is treated, you will have to visit your doctor again after 24 months for another check-up to ensure that the parasites did not reproduce the disease once again. The drugs that are used to treat the first stage of this disease are Pentamidine and Suramin.

Meanwhile, these are the medications that are used by doctors to treat the second stage of the disease: Melarsopol, Eflornithine, and Nifurtimox.

Tularemia

Insect bites can be dangerous, especially since these little pests carry numerous diseases. Without you knowing, an insect might transmit illnesses to you. One of them is tularemia.

 

What is Tularemia?

This is a bacterial infection that commonly infects affects mammals including rodents, rabbits, dogs, and cats. There are two primary ways to contract this disease; first, if your skin comes in contact with an infected animal and second, through insect bites. In some occasions, you can also be infected with this disease if you end up eating the meat of an infected animal or through laboratory exposure. Tularemia is mainly caused by a bacterium called Francisella tularensis. It is contagious and – in some situations – fatal.

What are the Symptoms?

If you are infected with this disease, the symptoms will start to appear three to five days since you contracted it. On rare occasions, the symptoms only emerge after 14 days. There are different types of tularemia, depending on how and which part of the body served as an entry point for the bacteria. Each of them has different symptoms:

Ulceroglandular Tularemia – Most people contract this form of tularemia. Its symptoms include skin ulcer in the area where the infection began, aching lymph glands, fever, headache, and chills.

Glandular Tularemia – Like ulceroglandular, this one is usually caused by insect bites. It also has the same symptoms. The only difference is that people with glandular tularemia don’t experience skin ulcers.

Oculoglandular Tularemia – This is the form of tularemia that you might contract if the bacteria entered your body through your eyes. Its symptoms include aching, swollen, and red eyes, as well as ulcer inside the eyelids and sensitivity to light.

Oropharyngeal Tularemia – You might contract this form of tularemia if you eat or drink contaminated and poorly cooked meat or water. This one affects the digestive tract and mouth. Its symptoms include fever, pain in the throat, mouth ulcers, diarrhea, sore tonsils, inflamed lymph nodes, and vomiting.

Pneumonic Tularemia – Out of all forms of this disease, this is the most severe. Its symptoms are somewhat similar to the signs of pneumonia. They include dry cough and chest pain. People with pneumonic tularemia may also experience difficulty breathing.

Typhoidal Tularemia – This is the rarest form of tularemia. Its symptoms are high fever, diarrhea, vomiting, enlarged liver and spleen, and pneumonia.

How Can Tularemia Be Treated?

If you start to experience the symptoms of any form of tularemia, consult your doctor immediately. Most probably, you will be prescribed some antibiotics to fight the disease. Streptomycin and gentamicin are some of the antibiotics that are usually prescribed by doctors; these are injected straight to your vein or muscle.

Malaria

Malaria is one of the many diseases that mosquitoes transmit. Learn more about this infamous disease!

 

What is Malaria?

This is a fatal disease that is transmitted to humans by female Anopheles mosquitoes. It is caused by parasites that enter the body through insect bites. If not treated immediately, malaria might cause further health complications that might lead to the death of the patient. This disease is more common in tropical and subtropical areas such as Asia, Central America, and Africa. Fortunately, the disease cannot be transmitted through physical contact. However, it can be passed by a pregnant woman to her baby. In addition, one can also transmit the disease through blood transfusion, organ transplant, and by using infected needles/syringe.

What are the Symptoms?

In some cases, the symptoms start to appear 7 days after the mosquito bite. However, in other instances, the symptoms show almost a month since the patient was bitten. Usually, this disease is categorized into two. The first is more uncomplicated and its symptoms include the following:

• High Fever
• Headache
• Chills
• Vomiting
• Muscle Pain
• Diarrhea

Since the symptoms can be attributed to various diseases, it is sometimes difficult to pinpoint if they were caused by malaria.

The second category is more severe. As a matter of fact, it might affect several organs in the body. Its symptoms include:

• Severe anemia
• Hemoglobinuria
• Acute kidney failure
• Different neurologic abnormalities
• Hypoglycemia
• Metabolic acidosis

What are the Treatments?

It is important to detect malaria early on so that it can be treated immediately. Otherwise, the situation might quickly become worse. Before prescribing medications, your doctor must see what type of parasite infected you first. The most common type of treatment for this disease is artemisinin-based combination therapy (ACT).

Unfortunately, some parasites resist medications. In this case, consult your doctor so that they can change your medications.

How Can I Prevent Malaria?

Currently, there are no vaccines for malaria yet. If you need to travel in continents where this disease is widespread, schedule an appointment with your doctor; they can prescribe medications that would help you prevent the disease.

If you live in an area with malaria is widespread, use mosquito nets when sleeping. This is the most cost-effective way to prevent this disease. You may also use insecticides and bug sprays.

Leishmaniasis

Like mosquitoes, sand flies also carry a host of various diseases and one of these is leishmaniasis. What is this and how can you prevent it? Read further to find out!

What is Leishmaniasis?

Leishmaniasis is a parasitic disease that is carried by infected sand flies and caused by a parasite called Leishmania, which dwells on the sand flies’ bodies. One can contract this disease by getting bitten by an infected female sand fly. Leishmaniasis has three common forms: cutaneous leishmaniasis, visceral leishmaniasis, and mucosal/mucocutaneous leishmaniasis.

What is the Difference Between Cutaneous, Visceral, and Mucosal/Mucocutaneous?

• Cutaneous leishmaniasis is the most common form of this parasitic disease. This is characterized by skin ulcers alone. Skin ulcers are sores that may appear on your skin weeks or months since you were bitten by a sand fly. Usually, they start as lumps before developing into skin ulcers – round sores with raised edges and sunken centers. Often, the appearance of these sores imply that you have swollen glands near the sores. Fortunately, it is not as fatal as the other forms of this disease.
• Visceral leishmaniasis, on the other hand, is more dangerous compared to cutaneous. This form affects your internal organs as well as your immune system. If left untreated, it can be fatal. It does not manifest until months or years since you were bitten by the infected sand fly. Visceral leishmaniasis results to swollen spleen and liver, weight loss, anemia, leukopenia, and even thrombocytopenia.
• Mucosal/mucocutaneous Leishmaniasis is the rarest form of this disease. It is believed to be the more fatal subcategory of cutaneous leishmaniasis especially since it often occurs months after the sores caused by cutaneous are cured. In spite of this, it does not affect the skin; instead, it affects the mucous membranes of the mouth, throat, and most especially, the nose. To prevent this from occurring, you have to ensure that the sores caused by cutaneous are properly treated.

What are the Symptoms of Leishmaniasis?

The symptoms of this disease vary depending on the form of Leishmaniasis that you contracted. If you have cutaneous leishmaniasis, your symptoms will mainly be skin sores which might appear weeks, months, or years, since the sand fly bite. Skin ulcers are also a symptom of mucosal/mucocutaneous leishmaniasis. However, with this form, the infection appears around the lower face area, meaning in the mouth, lips, or nose. Stuffy or runny nose, difficulty breathing, and nose bleeds are other signs of mucosal/mucocutaneous.

Visceral leishmaniasis have various symptoms including:

• Loss of weight
• Cough
• Fever that lasts for long durations of time
• Swollen spleen and liver
• Decline in the production of red blood cells
• Weakness
• Night sweats
• Thinning hair
• Bleeding
• Skin turning scaly
• Darkening of skin

What are the Available Treatments for Leishmaniasis?

Most of the time, the skin infection caused by cutaneous leishmaniasis heals on its own. In spite of this, undergoing treatment is still advised by most doctors because it accelerates the healing process while reducing the risk of scarring. However, if the sores disfigured an area in your face or body, you will be advised to undergo plastic surgery.

On the other hand, if you have visceral leishmaniasis, you will most likely be required to undergo various treatments especially since this form has numerous symptoms that should be addressed as well. Conventional amphotericin B deoxycholate and pentavalent antimonial (Sbv) are two therapies that are used to treat this form of leishmaniasis. Liposomal amphotericin B and miltefosine are also prescribed by doctors to help individuals infected with this disease.

Unlike the skin ulcers caused by cutaneous, the sores that mucosal/mucocutaneous leishmaniasis incite do not heal on their own. Instead, your doctor will prescribe you to avail drugs such as liposomal amphotericin B – which is also used to treat visceral leishmaniasis – and paromomycin.

How Can Leishmaniasis Be Prevented?

This disease can lead to life-threatening complications, especially visceral leishmaniasis. This is why it is important to avoid contracting this disease. Although there are no known vaccines or preventive drugs at the moment, you can still prevent being infected by avoiding sand fly bites. To do this, you should wear long sleeves and pants to cover your skin and apply insect repellant especially before going to bed or when you are heading outside. Sleeping on higher areas can also help as sand flies will not be able to reach those areas since they are poor fliers. You can also use bed nets and air conditioning units to avoid sand flies. Lastly, refrain from going outside during dusk and dawn because those are the times when these insects are very active.