By MARK PALMER How that bout of flu could actually be a skin infection
. . . and put you in hospital if you don’t get help
LAke COMO was looking glorious in the dappled autumn sunlight. Trees were changing colour, walkers were getting into their stride and a motor launch was ferrying holidaymakers to Bellagio, diverting close to George and Amal Clooney’s palatial villa.
But all of this passed me by, for I was huddled under a duvet in a darkened hotel room, my head feeling as if it was going to explode. In fact, I wanted my head to explode, hoping it might bring some respite.
I thought it was just a head cold, though a nasty one. There had been a lot of sniffling at the office and several colleagues had been off work for a day or two.
Yes, it was unfortunate to be feeling wretched on a weekend break with friends, but these things happen, I told myself.
Wrap up warm, drink plenty of fluids and take paracetamol every few hours was my plan. except it didn’t work. not in the slightest.
After 24 hours, I felt as if a slab of concrete was cementing me to the bed. I was shaking and so shivery that at one point I got fully dressed and then put on the hotel’s bathrobe before slipping back under the covers. I started sweating; then the shivers returned.
The hotel must have known something was untoward after noticing the Please Do not Disturb sign on permanent display. On day two there was a gentle knock at the door.
‘Would you like to see a doctor?’ asked a member of staff.
‘Thank you very much, but I am fine — and due to fly back to the Uk tomorrow.’
On returning to bed, I noticed I had a violentlooking rash above my right ankle. Closer inspection revealed a series of faint red streaks going up my leg and into the lymph glands near my groin.
The area around my inner thigh was inflamed, swollen and increasingly uncomfortable.
But I dismissed it all as a spin- off from the head cold. More rest was required and, anyway, in less than 24 hours I’d be back in my own bed with a hot water bottle and hot toddy.
WhenI got home, my wife — who had not travelled with me because of her work commitments — was sympathetic, but also of the view that my ‘bug’ would pass.
She agreed there was no need to see a doctor, not least because getting an audience with the Pope is easier than securing an on-the-day appointment at our surgery in South-West London.
But at 4.30am the next day — almost four days after feeling poorly — I could stand it no longer. The rash above my calf clearly was an angry infection; the tracking up my leg was more visible than ever and the tenderness in the glands around my groin was acutely painful.
My wife took me to A&e at Chelsea and Westminster hospital (5am is a good time to go — there was only one other person waiting). I saw a junior doctor almost immediately.
he took one look at my leg — which was scarlet — and said I had contracted cellulitis as well as tracking lymphangitis, which meant nothing to me, though I was aware of cellulite, that great enemy of women of a certain age.
After taking my temperature and samples of blood, the junior doctor wanted a more senior colleague to check me out. I was surprised how quickly this happened. This was both concerning and comforting.
‘You are fortunate you didn’t leave this any longer,’ he said.
‘ This can be fatal if the infection spreads to the bloodstream. We need to give you a big dose of antibiotics and hope it does the trick.’
I liked the way he put it and asked what would have happened if we were living pre-1928 — in other words, before Alexander Fleming discovered penicillin. ‘To start with, we would have amputated your leg just above the infection near your calf.
‘If that didn’t work we would have removed your leg above the lymph nodes in the groin — but I suspect neither of these would have resolved it and you would have died,’ he said.
This was troubling and I felt deeply grateful to Mr Fleming.
Cellulitis is an infection of the skin and deep underlying tissues that causes fever, chills and a general sense of illness.
In Britain, one person in every 500 contracts it each year and those tend to be the middleaged or elderly, whose immune system less easily clears bacteria from the body.
Tracking lymphangitis is an inflammation of the lymphatic system (a network of tiny vessels that drain fluid, waste and bacteria from the tissues and into the bloodstream).
The painful, red streaks were a sign of the inflammation moving through my lymph vessels.
You can get cellulitis and tracking lymphangitis in a number of ways — from an animal or insect bite, a sting, bedbugs or simply from natural bacteria on the skin getting into the tissue via a cut or graze.
It often appears on the lower leg or on the arm because this is where you are most likely to suffer a scratch or bite.
I have no idea how I contracted it. I have no recollection of being bitten or stung. Dr Shabnam Iyer, a consultant microbiologist at the Royal Berkshire hospital, says that from her experience, cellulitis is on the increase ‘because the strains of bacteria that cause the infection are constantly evolving.
‘It’s the survival of the fittest, whereby strains keep finding a way around the antibiotics.’
The good news is that it is rare for people to die from cellulitis, according to Dr Anton Alexandroff, a consultant dermatologist at nuffield health hospital in Cambridge.
‘But we need to be more aware of it so people can recognise the symptoms early and be treated orally with antibiotics rather than being admitted to hospital,’ he says.
And if you have a severe form of the infection you are more likely to get it again because cellulitis can cause permanent damage to the lymph vessels.
If the lymph vessels are damaged, they are less able to deal with future infections.
Joanna McCall, 61, has had cellulitis four times — the worst bout occurred after a holiday in Barbados, when she was bitten by sandflies.
‘When I got home I had a high temperature and splitting sores down my leg from which a straw-like liquid was coming out,’ says Joanna, a designer’s assistant from newbury, Berks.
‘My leg was visibly swelling and you could see the redness creeping up my leg.
‘I went to the hospital and was kept in overnight and given intravenous antibiotics. I still have three or four scars on my legs.’
her most recent bout was this spring after she cut her hand while gardening.
She carries antibiotics with her at all times just in case — ‘especially if travelling abroad. I know what to look out for, but if you don’t it can be frightening’.
Some people who have had it before are prescribed antibiotics on a long-term basis to protect against cellulitis.
Losing weight also helps because it will help improve blood circulation and so protect the body from infection.
Susceptible patients should make sure cuts or grazes are kept clean and wash hands regularly, particularly when treating a wound or skin condition.
And don’t be fooled if there is only a small visible infection.
‘It could make you feel much worse than it looks,’ says Dr Justine hextall, a consultant dermatologist at Western Sussex hospitals nhS Trust.
Shebelieves there are things everyone can do to prevent cellulitis. ‘Don’t use too much soap and make sure you apply moisturiser every day,’ she says.
‘ If your skin is dry and inflamed, the skin barrier is less effective and more vulnerable to infection.
‘If your legs swell, for example, after a long walk, try to elevate them to lessen the swelling.
‘This reduces congestion in the veins and stops blood products leaking out, which causes inflammation of the skin and can further damage the skin barrier.’
Fortunately, in my case, I did not have to stay in hospital, but went every day to outpatients to be given antibiotics intravenously for a week, as well as having a week’s course of another oral antibiotic.
By the middle of the week, I was 1,000 times better. But I have been advised to be vigilant for future attacks: Once bitten, twice shy.