In my second year at the University of Manchester I studied parasitology, and the terrifying images of dramatic lesions and extreme elephantiasis are burnt vividly into my memory. Of course, I never considered that one day I would become one of those horror stories. In July I was diagnosed with a tropical flesh-eating parasite called Leishmaniasis, and for the past 10 weeks I have been battling to regain my health. We never fully appreciate how lucky we are to be healthy, and unfortunately I learnt this lesson the hard way.
What is Leishmaniasis?
Leishmaniasis is a disease caused by the protozoan parasite Leishmania. There are actually 21 different species of leishmania, and they are found throughout Asia, Africa, South/Central America and Southern Europe. The parasite can be found in many different mammals, but the only way for it to be transmitted to a human is through the bite of an infected sandfly. When an infected sandfly bites a human, the parasite is transmitted into the body and replicates within the human macrophage cells. I was diagnosed with a type of infection called cutaneous leishmaniasis, which basically means that the disease appears as a lesion on the skin at the site of the original sandfly bite. This wound then continues to grow, and can spread to other areas of the body. Often, it will infect the mucosal lining of the mouth, nose and ears causing serious disfigurement. In minor cases, the infection heals itself within a year, however in most cases (including mine) treatment is needed.
Leishmaniasis and sloths
Unfortunately, sloths are often thought of as being dirty, lazy animals that transmit diseases and parasites. One of the many diseases that people blame sloths for is leishmaniasis. Many local people are terrified of sloths for this reason, and sadly they pass this fear down through generations. I have lost count of the number of people that have asked me if a sloth can give them leishmaniasis. The simple answer is no. This misconception stems from a few scientific studies that have found sloths to test positive for the leishmania parasite. They are, in scientific terms, a ‘reservoir’ for leishmania, but so are many mammals – including dogs! There is no way a sloth can transmit leishmaniasis to a human – this only happens through the bite of an infected sandfly. It is just one of the many negative myths that the sloths are burdened with!
I remember the sandfly that bit me. I was walking my new puppy on the beach at dusk and was annoyed by the itchy bump that later appeared on my arm. I forgot about it and only really noticed something unusual when the bite was still there two weeks later. Nobody seemed particularly concerned by the little scab on my arm, and I probably left it far longer than I should before seeking a diagnosis. We watched the little hole in my arm slowly grow for 4 weeks before deciding to have it tested. Within 24 hours, the doctor had called and told me that I had tested positive for leishmaniasis and should begin treatment immediately. I didn’t know it at the time, but that was just the tip of the iceberg.
As it turned out, there are no nice treatment options. The Costa Rican method involves up to 60 injections of glucantime – a toxic chemical that kills the parasite but also comes with a high risk of liver and heart damage. That didn’t sound like much fun, so I decided to seek treatment in the UK since I had been due to return during August anyway. When I finally arrived at my doctors office and presented him with a flesh-eating parasite, he looked at me like I had two heads. I was advised to go to the emergency room at the Liverpool School of Tropical Medicine to find more specialised help. I don’t think that many people turn up at the hospital claiming to have leishmaniasis, since doctors of all shapes and sizes turned up to see the girl with the flesh-eating parasite. It’s safe to say that many people looked at me like I had two heads that day.
I was finally introduced to the wonderful Dr Tim O’Dempsey. He took a biopsy of my arm (much to my horror) and told me the bad news: the UK treatment options aren’t much better than the toxic Costa Rican injections. Furthermore, I had to wait 5 days for the biopsy results before I could do anything at all – we had to just sit and watch the hole continue to grow in my arm. It was an overwhelmingly creepy feeling knowing that something was munching through the flesh on my arm and I couldn’t do anything to stop it! Depending on the species of leishmania I was infected with, I now had two treatment choices:
1) I could be admitted to hospital for three weeks of intravenous medication (chemotherapy), which basically involves the same toxic chemicals as the Costa Rican injections (think heart problems and liver failure). Famously, TV presenter Ben Fogle endured this treatment after contracting leishmaniasis in Peru, and he ended up bed-bound with pneumonia – no thank you!
2) OR I could trial a new oral medication from Germany called Miltefosine. This horrifically expensive drug comes with a bunch of awful side effects, including sickness so severe that many people simply can not finish the treatment. This option wasn’t guaranteed to work either, and had never before been used to treat leishmaniasis from Costa Rica. Furthermore, this medication is only effective against one subspecies of the parasite – the most dangerous subspecies.
As it turned out, fate made the decision for me. I was diagnosed as having the dangerous subspecies (one that is prone to infecting the mouth and nose causing disfigurement) and so I was prescribed 4 weeks worth of Miltefosine pills. I began treatment immediately and initially, things looked promising. The hole in my arm stopped growing, and the pills weren’t making me too nauseous. Unfortunately, I didn’t realise it at the time but this medication takes a huge toll on the immune system. My arm was healing but I was becoming weaker every day. Within three weeks, strange painless lumps had started to appear all over my arm and my lymph nodes were inflamed. By this point I had returned to Costa Rica and was looking forward to getting back to normal – but normal was a long way off.
The lumps grew, and one in particular became very sore. It turns out that these were abscesses growing under my skin as a result of a staphylococcus infection. Within a few days I was feverish, my heart rate was up and my blood pressure dropped – all very bad signs of a systemic infection. I was rushed to a local doctor who prescribed antibiotic injections and bed rest. The rest was a roller-coaster. The injections (that were unfortunately in my bum cheek) left me with a second infection, which quickly developed into a large abscess leaving me unable to walk or sit down. I was forced to waddle everywhere. After one of the most uncomfortable weeks of my life, the doctor surgically drained 10 ml of pus from the abscess, and prescribed stronger antibiotics. I then developed further infections in my eye and mouth, all requiring treatment. And then to top everything off, a final infection in my left arm that also had to be surgically drained and my arm stitched up.
So today I am writing this, finally feeling like my roller-coaster ride is coming to an end. The leishmaniasis on my arm is healing, and the infections are finally going away. I still have stitches in my left arm and I have a few days of antibiotics left – but I have gone almost a week now without any new symptoms developing, and I am finally beginning to regain my energy (and most importantly, I don’t need to waddle anymore)! It has been a horrific journey, but I will never again be taking my good health for granted.
Now, I am finally ready to put my snake boots on and get back out in the jungle! It’s been a while since I have been able to follow up on the Sloth Backpack Project, so it’s time for me to get productive.