Leishmaniasis….. Hosting parasites…. Without invite. The last moments of my travels in South America with a skin eating parasite

Here it is guys! a very messy update that I wrote while I was having treatment in Peru. Not my best writing….

Hey guys. Well it has been quite some time since my last blog. I am currently in Lima Peru, the capital city of Peru. I am currently undergoing treatment for cutaneous Leismaniasis at the Cayatano Heridia Medicine of tropical diseases in the Leishmaniases and Malaria department.

Leishmaniasis is quite a popular disease throughout the world with more than 1 million cases throughout the world. Leishmaniasis is an infection caused by a parasite that is spread to people through the bite of the female phlebotomine sand fly. The parasite exists in many tropical and temperate countries.

Leishmaniasis is divided into clinical syndromes according to what part of the body is affected most. In visceral leishmaniasis (VL), the parasite affects the organs of the body. Infections from India, Bangladesh, Nepal, Sudan, Ethiopia, and Brazil account for most cases of VL. Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis and, as the name implies, the skin is the predominate site of infection. Most cases of CL are acquired in Afghanistan, Algeria, Iran, Saudi Arabia, Syria, Brazil, Colombia, Peru, or Bolivia. In some people, CL progresses to involve the mucocutaneous membranes, a condition known as mucocutaneous leishmaniasis (ML). Mucocutaneous leishmaniasis occurs only in the New World and is most common in Bolivia, Brazil, and Peru.

More information here http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/leishmaniasis-cutaneous

http://www.google.com.pe/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=6&ved=0CEYQFjAF&url=http%3A%2F%2Fwww.jimmunol.org%2Fcontent%2F180%2F11%2F7537.full.pdf&ei=9H5JVKWQB8vBggSCsoHYCA&usg=AFQjCNFYuJcDZwFMGx3UnR0CBR3Kfqgmjw&sig2=h5L8lV8CzpgD6Z8vK2dXtg

So back to my story and how i came about finding out I had this. As you guys know I was in Oyantalltambo for one month Volunteering. On August 18th I noticed I had a really itchy bite on my lower spine and I seemed to have a lot of swelling in my spine. I went to visit the doctors however they were all on strike and had been for three months due to pay reasons. With this I visited the local pharmacist who was a nurse and he had a quick look and told me to take an antibiotic Doxycycline. I took this for the 5 days he gave me. The swelling went down and the itchyness went away so I didnt think much more of it.

18th August. When i first noticed my bite

Lesion Day 1. 18th August. When i first noticed my bite

A couple of days later I made my way to Lima to take a paragliding course with Fly Adventure in Miraflores http://www.flyadventure.net/ which was one of the most amazing experiences of my life. I will have a separate post with information and some photos while taking the course.

I met up with Jesús from couchsurfing who had offered me a place to stay while staying in Lima. He was a great host and let me stay in his home for just over two weeks. He was such a kind guy and took me out for some good food, he even let me live in his house most of the time alone as he worked a lot and was staying at his parents, Couchsurfing is one of the best options to meet people as well as saving some money on accommodation, I have met some really good friends through using couchsurfing and hope to repay other travellers when I have my place back home.

After nearly two weeks in Lima my bite on my back turned into a scab and was really itchy and I had a hard line forming across my back horizontally. This felt like a small cable under my skin. I visited a doctor and she prescribed more antibiotics which I tried, with no effect she gave me others and cleaned the wound and I also used an antibacterial cream.

5th September. First doctor visit in Lima Peru

5th September. First doctor visit in Lima Peru

I finished up my paragliding course and thought it was time to head north and see some more of Peru before heading into Ecuador. I made my way to Cajamarca the start of the Amazon region of Peru where I took a few tours before heading to Chachapoyas where I took a few more tours. While on one of the tours I met the nicest Peruvian girl from Lima who was travelling named Bianca, we got on really well and she helped me visit another doctor who gave me more antibiotics and showed me what to do to clean the open wound. By this time my wound had been opened for 2 weeks with no indication that it was healing.

Bianca suggested I come and live with her and her family in Lima while I find  treatment. I thought this was a good option as the hard lines in my back had progressed on both sides and started to make their way to my stomache in the direction of the swollen lymph node in my groin.

When I arrived in Lima I met Bianca’s family who were all super kind and never stopped giving without asking for anything. I have been super blessed to be living here for the last 5 weeks. Bianca’s mum is the best cook and we have had some amazing healthy dishes from many types of soups to lamb, guinia pig, fish… to much to mention.. I think I have put on weight.

Lesion day 36.

Lesion day 36.

I spent nearly a week visiting a local hospital where Bianca’s cousin works as a nurse and she helped me clean the wound daily. I also had a scan to check my lymphatic system. Doctors gave me a course of antibiotics via injection over 3 days and some other antibiotics. The doctors mentioned Leishmaniasis but thought it was more likely to be Shingles- Herpes Zoster however there was no pain in my lesion or around. At this point my lesion had small blister like things all around it. Still having no change apart from a lot of heart burn and signs of an allergic reaction to tape that was being used to cover the lesion.. Nothing was changing my lesion, it just was not healing.. after nearly one month of taking many different pills. It was time to find another option.

Where I am living there is a doctor who is home once in a blue moon, he works away with local communities. He said I need to visit the Tropical Medicine department of the Cayatano Heredia hospital here in Lima.

With the help of Bianca’s mother she went along with me to help me out with consultations to find out what was happening in my body. We visited the Tropical medicine department and someone had a quick look at my lesion and said I need to go to the Dermatologist first. So with a lot of running around the huge hospital we found our way to administration where they took all my information and gave me a card to keep all my appointments and medical information. From here we had to go to the pay station to pay for a consultation then we had to go back the following day for a consultation.

Hospital Cayatano Heredia. Tropical Medicine department 23 September

Hospital Cayatano Heredia. Tropical Medicine department 23 September

I visited the dermatologist who spoke very good english and this made things a lot simpler.. going through my history of where I had travelled etc.. She mentioned I should go back to Tropical medicine and have a biopsy for Leismaniesis because the results are nearly instant when they view under the microscope. She also suggested a test for tuberculosis and fungus. I made my way to see the guys in the Tropical medicine department. All of the doctors were away and I had to return the next day.

I sat down with the nurse to take a biopsy of my lesion. Wow this was painful!! needles, razors and a lot of glass slides to fill with my blood.. Even with the lesion numbed it was still very painful, I guess because of the location right on my spine. I sat down with the doctor to discuss my travel history in detail to try and determine where I recieved the bite to determine the species of the parasite. Within a few minutes the nurse came in and said my biopsy tested positive under the microscope with a high count of parasites.

Time for some pain. Taking a biopsy of my lesion

Time for some pain. Taking a biopsy of my lesion

Ok so here I was with a lesion that wouldn’t close in the most annoying part of my back with many microscopic creatures living inside me!! how fun.. took me back to my memories on the farm in the north east of Argentina when I had the two bot flies. At least with those I was able to remove them myself.

Biopsies... too many slides.

Biopsies… too many slides.

We discussed treatment options in the hospital and I returned the next day. I was given another biopsy which of course being a fresh wound hurt much more then the first one. I spoke with the boss of the department and he had a look over my Lesion and Lymphatic system. He said my case is very uncommon as most people have lesions on there arms, legs and face. I must have received the bite while I was sleeping without a shirt on. We think the bite came from Cusco or Ollantaytambo because of the time I was there. I was unaware there are sand flies in the mountains. Most you will find in tropical locations but there is also a type that lives in the mountains.

Reviewing the slides.. Confirmed a high number of parisites. Most likey the braziliensis species of Cutaneous Leishmeniesis

Reviewing the slides.. Confirmed a high number of parisites. Most likey the braziliensis species of Cutaneous Leishmeniesis

The doctors sent me for blood tests and an ECG to make sure I was healthy enough to take treatment as it has a few bad side effects. The next day we set out to start a 20 day treatment of Estibogluconto Sodio. A treatment given 6 days per week with Sunday as a rest day. I was suprised at how many people are receiving treatment. Around 30 people while I have been there, from Children at 5 months to the elderly. With the worst case I have seen is a man who has had a lesion on his leg for 10 years never finishing a treatment. It covers half of his leg and smells horrible.. he has not taking the advice of the doctors and may need his leg amputated.

The drug is given intravenously and its all over in a short time. Everytime I had a horrible metalic taste in my mouth and then felt super dizzy and quite sick.. This lasted around 10 minutes then I didn’t feel too bad. I would make my way home to sleep then eat then sleep some more. I found myself loosing energy quickly and by day 3 my viens were very sore and I also had a profuse headache with random body pains in either my bones or my muscles. The doctor gave me some Prednisone which eased the pains and within a few more days I found myself throwing up in the toilet. Thankfully there was another drug which took this away fast… I had every side effect of this drug except diahreah.

Lesion day 26 September. 2 days after Biopsy and more then one month open wound

Lesion day 40.  26 September. 2 days after Biopsy and more then one month open wound

By day 7  of treatment I wasn’t feeling too bad. I had a bad taste in my mouth but not much else. Then day 9 the nurse said they had a new supply of the drug and it may make me feel a Little sick. It was the same drug with the same brand name however made in a different factory. It felt much worse then the first time. I had a rash on my body so the doctor gave me antihistamines and told me to rest two days. Unfortunately after two days I still had a rash and needed to have a further week off treatment because the reaction was very strong.

14 October After 12 days of treatment.. healing slowly

Lesion day 58. 14 October After 12 days of treatment.. healing slowly

We got to around the 60% mark of the healing process and twelve days through the treatment with my lesion starting to heal well and the lymphatic system started to subside… ok so back to the doctor one week later and taking antihistamines I still had a rash and itching on my body. They doctor said I am too allergic to continue a treatment with Antimonials. He said its very important to complete a treatment because the parasites can live in the body for many years and possibly present themselves in different locations even 10 years later and the worst being mucocutaneous Leishmenieses which attacks the pallet of the mouth and results in some devastating disfigurement. Not what I wanted to hear.

I proceeded to contact an Infectious disease specialist in Melbourne Australia to ask for advise. He suggested to get treatment here in Peru because of the reputation the hospital has and the number of people they treat, there are also many doctors from many countries who come and study here. Whereas in Australia they do not see many cases from South America.

My doctors said there was one more option they had here and that is a drug called Amphotericin B which unfortunately has quite severe side effects, not something I wanted to hear. The usual treatment is 30-40 days but since we were at around the 60% mark the doctor said we should have a good response in 20 days, just before I am to fly home on the 18th November. They sent me for blood tests to make sure my liver and kidneys were ok to start treatment. I went back early this morning 22/10/14 with good results we proceeded with treatment.

My nurse got everything ready. They drug is given intravenously over a slow time period to try and minimise reactions. I was first given 1L of a sodium mix I guess to bring up hydration levels then another drug to help minimise a reaction. This took around 40 minutes then we set out with the 500ML bag of the medicine mix. I didnt feel too bad. A Little dizzy but at around the half way point I felt really itchy and took at look at my stomache!! well unfortutely I was covered in a huge rash so I called the nurse and she stopped the treatment.

More medicine!! super long wait 22 October

More medicine!! super long wait 22 October

Yellow fuision

Yellow fuision

And the result half way through the treatment.

And the result half way through the treatment.

The doctor came in and said I need to have a rest from all treatment for at least one month and then try again.. since I am heading home in less than one month I cannot really wait around in Lima and then try again. I am waiting for a doctor report to give to my travel insurance to see if they can bring forward my flight home. I need to wait at least one week before I can fly and visit the doctors in the hospital daily to review my reaction and make sure it is getting better.

Today after treatment I am feeling very itchy and have quite a headache. I am drinking a lot and have slept and ate a lot! I feel quite frustrated, not being able to do much. Its been a long 5 weeks here mainly just visiting the hospital for 2-4 hours each day then resting.. I wish that I was feeling better so I could paraglide more but unfortunately not.

Where we are at with the lesión 22 October.. It has healed wll but needs more.

Where we are at with the lesión 22 October.. It has healed wll but needs more.

With continuing skin allergies my doctor called in a Dermatologist to have a look, I am unsure with exactly what he said but he said I should not continue with any more treatment. He suggested Miltefosine but this drug is difficult to obtain in Peru and with little time left this was not an option.

We started a heat therapy using a simple hand warmer which heated up to 50 degrees Celsius then was applied to the lesion for 3 minutes giving deep burn. We did 4 days of burns and the doctor was not happy with the progress. He called in another doctor to perform a Thermo Therapy treatment using a machine. They set up and gave around 6 shots of anesthetic into my spine… wow this was painful. They then started to do short bursts using the machine. I couldn’t feel anything which was good. The machine is 50 degrees Celcius and burns a certain depth giving a second degree burn. I took a strong pain killer to make sure I didn’t feel to much when the anaesthetic wore off.

Lesion day 73. 30 October. After Thermo Therapy burn. 50 Degrees celcius

Lesion day 73. 30 October. After Thermo Therapy burn. 50 Degrees celcius

Lesion 75 Days. 1 November 2014, Healing nicely after Thermo Therapy

Lesion 75 Days. 1 November 2014, Healing nicely after Thermo Therapy

Doctors wanted to do a second round of Thermo Therapy but on my last day in Lima the Doctor had a problem and was unable to come to the hospital. My doctor is positive that the lesion will heal with little chance of a flare up. We are around the 90% mark of healing. I am now in Australia and will be visiting an infectious disease specialist the first week of December to double check healing etc..

Lesion day 100. 90% cured. 26 November 2014

Lesion day 100. 90% cured. 26 November 2014

Doctor report– Click to download .PDF file of detailed doctors report if you are interested.

Well here I am back in Australia!! feeling very strange… I have experienced more culture shock returning home then living in South America. I was  super lucky to live with Bianca’s family, I really would not have been able to get through this without them. They are one of my families now and I feel very strange being away from them I cannot wait to come back and visit again or have you guys over here.

Unfortunately I did miss out on the place that made me want to travel in the first place! Ecuador and Colombia… not to worry though, I will be back. Hopefully sooner then later.

I spent around $250AUD for treatments and medications during my 2 months in Lima and a further $570 for flight changes. I did have travel insurance and I have a claim in the process.

So a bit of advice for any other travellers, if you have anything strange happening in your body. See a doctor right away. I waited a little too long. I did see 4 doctors before someone suggested to go to the Infectious disease department. Try and find the biggest hospital you can wherever you are and get sorted ASAP… good luck and I hope that my post can help anyone else in the future. If you have any questions and want to know anything in more detail please let me know. I will be happy to help.

I have been blown away by the support and generosity of everyone of have met and in particular Bianca and her amazing family Yolanda, Mabel and Alejandro, no words can describe how I feel and nothing I can do will ever be enough to repay you for everything you have helped me with.

I want to take this moment to say the worlds biggest thank you to everyone who has helped me through this, you guys are such a blessing and I will never forget you guys and how much you have helped! I really could not have got through this time alone. I hope you can all visit Australia so I can repay you. Keep living as you do and giving with no expectations. You are all in my prayers and I wish for all your dreams to come true.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s