Exotic holidays sometimes come with a hidden price tag. Health Editor Barry Nelson meets a traveller who came back with more than he bargained for.

AFTER the holiday of a lifetime in sunny South Africa, John Paul Morrissey flew back elated to the North-East. "I had a fantastic time, I hadn't been before but South Africa is really tremendous," says the 23-year-old.

During his trip John Paul, who comes from Yarm, but now lives in Gateshead, combined outdoors activities like walking and pony trekking with sightseeing in Johannesburg. One of the highlights was a horse ride through the African bush in Swaziland and he remembers one of the tour leaders saying something before they set out about looking out for African horse ticks.

Like many young Brits in South Africa, John Paul - who works as a legal clerk in Newcastle - was dressed for comfort in the hot weather and was wearing shorts. "When you are in a place like South Africa, you get into the holiday mood... I suppose I was wearing shorts most of the time," he says.

In hindsight, though, it would have been better if he had been wearing long trousers. As his pony pushed through thigh-high long grasses a tiny tick attached itself to the inside of John-Paul's leg.

He noticed he had been bitten by something which had left a small, dark, mole-like mark on his skin but thought nothing of it, partly because of all the other bites he had had. "When I was in Swaziland there were a lot of insect bites. Everybody was being shredded," he recalls.

A few days after the trek., John Paul moved on to the big city attractions of Johannesburg. "I didn't feel unwell and just carried on with the holiday," he says.

After three weeks, he flew back home and threw himself straight into work. "The first day back, I felt pretty ropey. I thought it was jet lag at first," says John Paul, who experienced flu-like symptoms.

After his first week back he still felt unwell, falling asleep listening to a football commentary on the radio and, by the time Monday came around again, John Paul realised he had to do something. "I felt dreadful, I had no energy at work and couldn't even focus on the computer screen."

He tried and failed to get an urgent appointment at his GP's so decided to go to the walk-in NHS treatment centre at Newcastle General Hospital. "By then I was a bit worried. I wondered whether it might be malaria."

What he didn't expect was to be instantly admitted to the hospital's infectious disease ward. "When I explained what had happened that was it for about four days," he says. "They admitted me to a ward where I was confined until they could figure out what was wrong with me."

John Paul was seen by Dr Mike Snow, a consultant in infectious diseases at Newcastle General Hospital, who explained that he had developed the early stages of African tick typhus, an illness which attacks the liver and can be serious if not tackled promptly."Apparently, it only affects about five people a year in the UK," says John Paul.

The consultant prescribed a powerful antibiotic and kept his patient under observation for a few days until he felt well enough to leave.

John Paul says he has learned his lesson from a frightening experience, which has left him with a small scar on his leg. "Certainly, if I were to ride another horse in a place like South Africa, I would wear long trousers," he says, ruefully.

Dr Snow is used to seeing people who have been to far-flung holiday destinations and come a cropper in various ways. In many cases, many of his patients could have avoided any problem by thinking ahead or being aware of environmental hazards which are not present in the UK.

"We do see people after holidays in distant places but also people from the North-East who work abroad," says Dr Snow.

His team at Newcastle General sees a wide range of conditions, from severe food poisoning to malaria, to rare conditions like 'rickettsia conorii', the insect-borne disease which afflicted John Paul.

As with so many things in life, the key is to plan ahead.

"One of the problems is that people do not always prepare themselves very well for travel. This is particularly true of people who go on last minute holidays. Many go away inadequately prepared and equipped in terms of immunisation and other appropriate preparations," the consultant says.

Malaria, spread by mosquitoes, is an ever present danger in many parts of the world. Dr Snow advises travellers to areas affected by malaria to take prophylactic pills before, during and after the holiday. If anyone is uncertain whether they are going somewhere where malaria may be a problem, they should ask their GP or check whether their local hospital has a travel clinic or look at a range of websites on the Internet.

"Pills and vaccines are not the whole answer," says Dr Snow. "Travellers also need to take precautions to avoid environmental factors such as avoiding swimming in fresh water in African countries where disease such as bilharzia occur, and watching what they eat and drink. People also need to take care to avoid getting bitten by insects, such as mosquitoes, ticks and sandflies."

The infection rickettsia conorrii, which affected John Paul, is spread by blood-sucking ticks from animals to humans.

"If you are in an area where ticks are around and you walking in the bush or long grasses, you should wear long trousers and keep your arms covered," says Dr Snow.

The idea of preventing infection by placing a barrier between you and the outside world is the same principle which applies in preventing sexually transmitted disease.

Malaria remains a frighteningly potent disease in the developing world and western visitors are not immune if they do not take precautions.

Every year an estimated 2,000 UK travellers return from overseas wit malaria. Worryingly, the number of deaths among British travellers doubled in 2003, jumping to 16 from eight in 2002.

Dr Snow urges anyone travelling to malarial parts of the world to try to avoid being bitten by keeping legs and arms covered when mosquitoes are at their most active, usually at dusk. "Even with tablets, if you are bitten enough by infected mosquitoes it can overcome the prophylactic drug," he says.

Travel clinics also urge holidaymakers to use insect repellent to keep unwanted pests at bay.

But despite the scare stories Dr Snow says Brits who develop malaria are often those who have not taken any form of prophylactic or who have failed to go to a doctor despite feeling ill during the early stages of the disease.

"If you fall sick when you return from somewhere exotic like Africa, India, the Far East or South America, make sure you tell your doctor where you have been. What you think is flu may be something like malaria or typhoid," says Dr Snow.