What’s Wrong With Me?

A med­i­cal mys­tery re­solved. SYD­NEY LONEY

Reader's Digest (Canada) - - Contents - BY SYD­NEY LONEY ILLUSTRATION BY VIC­TOR WONG

IN NOVEM­BER 2015, Ge­or­gia re­turned from a two-week hol­i­day in Peru and no­ticed an itchy in­sect bite, about the size of the eraser on a pen­cil, on her left calf. She slathered it with aloe vera, then tried to for­get about it. In­stead of go­ing away, the bite got big­ger and more in­flamed. It was red and puffy, so Ge­or­gia went to see her fam­ily doc­tor, who thought it was an in­fected mos­quito bite. But af­ter two weeks of broad­spec­trum an­tibi­otics, the wound was no bet­ter. The doc­tor pre­scribed a sec­ond two-week course of the same medicine, with­out re­sults.

Ge­or­gia was be­gin­ning to worry. The ul­cer was still grow­ing (it was now the size of a quar­ter) and had started ooz­ing pus. Con­sid­er­ing the pa­tient’s re­cent travel his­tory and the fact the sore hadn’t re­sponded to treat­ment, her doc­tor re­ferred her to the Hospi­tal for Trop­i­cal Dis­eases, part of the Univer­sity Col­lege Lon­don Hos­pi­tals sys­tem.

There, Ge­or­gia saw Dr. Diana Lock­wood, who ex­am­ined the ul­cer, not­ing that the edges were raised, firm and in­flamed, which made her sus­pect cu­ta­neous leish­ma­ni­a­sis, a par­a­site trans­mit­ted by sand­flies. She did a punch skin biopsy, us­ing a cir­cu­lar tool to re­move a very small, tube-shaped piece of skin and un­der­ly­ing tis­sue, and sent the sam­ple off to the lab. Two weeks later, her di­ag­no­sis was con­firmed by a lab tech­ni­cian who could see the par­a­site un­der the mi­cro­scope. Another

THE PA­TIENT: Ge­or­gia, a 29-year-old of­fice man­ager in Lon­don, U.K.

THE SYMP­TOMS: In­fected in­sect bite THE DOC­TOR: Dr. Diana Lock­wood, a con­sul­tant in in­fec­tious dis­eases at the UCLH Hospi­tal for Trop­i­cal Dis­eases in Lon­don.

lab test was able to iden­tify the bug’s DNA in the tis­sue sam­ple.

“I see this type of in­fec­tion quite reg­u­larly when I ex­am­ine ul­cers,” Lock­wood says, adding that there are many species of the par­a­site, which fall into two cat­e­gories: those found in the Old World (Asia, Africa, south­ern Europe and the Mid­dle East) and those found in the New World (Mex­ico, Cen­tral Amer­ica and South Amer­ica). There are up to 1 mil­lion new cases of cu­ta­neous leish­ma­ni­a­sis world­wide an­nu­ally.

In­fec­tions caused by Old World leish­ma­ni­a­sis typ­i­cally re­solve on their own, although it may take up to a year. Those caused by New World species, mean­while, can make their way through the blood­stream and de­stroy tis­sue in the nose and lar­ynx, po­ten­tially lead­ing to scar­ring or dis­fig­ure­ment (this usu­ally takes sev­eral months). Ge­or­gia had the lat­ter. An avid bird­watcher, she was likely bit­ten while hik­ing. The sand­fly is found in wooded ar­eas (not beaches), and the risk of a bite is high­est from dusk to dawn be­cause the flies typ­i­cally feed at night and dur­ing twi­light hours.

Ge­or­gia doesn’t re­call be­ing bit­ten. Sand­flies are just one-third the size of mos­qui­toes, and don’t make any noise. Af­ter her di­ag­no­sis, she went back to the hospi­tal each day to have sodium sti­boglu­conate in­jected into her blood­stream, which kills the par­a­site. The treat­ment takes 21 days. The sole side ef­fect of the in­jec­tions is gen­eral mus­cle stiff­ness; the pa­tient found she had dif­fi­culty play­ing ten­nis as a re­sult. “You feel a bit poi­soned af­ter­wards,” Lock­wood says.

The best pro­tec­tion against sand­fly bites is an in­sect

re­pel­lent with DEET.

Half­way through the treat­ment, Ge­or­gia no­ticed that the ul­cer was fi­nally be­gin­ning to heal. By the time she had her last in­jec­tion, the ul­cer had dis­ap­peared com­pletely, though she’ll al­ways have a loonie-size scar. She also had to re­turn to the hospi­tal three, six and 12 months af­ter the end of treat­ment to en­sure the par­a­site was erad­i­cated and the ul­cer hadn’t resur­faced. Had the par­a­site sur­vived, Ge­or­gia would have un­der­gone an ad­di­tional course of in­jec­tions.

The best pro­tec­tion from sand­fly bites is the lib­eral and reg­u­lar ap­pli­ca­tion of an in­sect re­pel­lent that con­tains DEET, Lock­wood says. “It’s im­por­tant to be aware that sand­fly bites are com­mon, and the par­a­site they carry af­fects nu­mer­ous peo­ple each year,” she says. “If you’ve been trav­el­ling and no­tice a bite that looks in­fected, you should see a trop­i­cal dis­ease spe­cial­ist right away.”

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