This entry is a little long but if you have the patience to stay with it you’ll be entertained by the romantic story of our amazing honeymoon, gorillas, parasitic worms, hepatits E and a lovely stay in hospital.
As you may have seen in our previous posts, we got married in South Africa at the end of 2015 and had the most wonderful honeymoon travelling around Africa. We saw so much wildlife, watched a crocodiles take wildebeest as they made their great migration to the Masi Mara, sat with the mountain gorillas of Uganda, got very close to great white sharks in South Africa and even climbed Kilimanjaro. We could not have asked for a better bucket list honeymoon.
However, when we arrived at Johannesburg airport to fly home to Australia Mike began feeling a bit unwell. He’d been fine right up until this moment so I assumed he just couldn’t be bothered with overpriced airport shopping. He said he had a bad headache, his eyes were sensitive to light and he felt hot. We assumed it was just a little bug from the road so boarded the flight hoping it would pass after a few films and some much needed rest.
When we touched down back in Perth Michael was still feeling unwell and to make matters worse he was due back at work the very next day. That night I ran him a cool bath and he lay there in the dark (as his eyes were still sensitive to light) stating that his whole body ached and felt hypersensitive to touch. I put a facecloth over his face and even that caused him pain. He seemed to be overheating but we didn’t have a thermometer so we weren’t sure what his actual temperature was. By this stage we assumed it must be a case of the dreaded man-flu.
Michael felt a little better in the morning so tried to work the next day, however he really struggled and felt miserable so eventually had to take the next couple of days off sick. He struggled to do anything due to fatigue and he was still continuing with bad headaches, feeling hot, itchy skin and sensitive eyes. Numerous times I told him we needed to make an appointment with the doctor, however the thing was, his symptoms came in ‘waves’. In other words, he would have maybe 2 days of symptoms and then 3 days without- so we often thought he was getting better when suddenly the symptoms would return with a vengeance. As a wife it was the most difficult thing in the world to watch your loved one feeling so miserable and not knowing what was going on. That night, Michael woke up in the middle of the night with severely itchy skin and proceeded to spend the next 3-4 hours itching and tossing and turning. When I woke up I saw his chest bright red from all the itching. He tried taking a shower but was in pain from the water touching his skin.
Now I was getting distressed at the symptoms and as nothing was improving, Michael finally agreed for me to make an appointment for him at the local Travel Doctor. We had been to the clinic before we headed off on our travels to stock up on medical supplies and to get up to date with our vaccinations. The Doctor we saw there was very knowledgeable and even Michael (who- clearly!- would do anything to avoid the doctor) thought he was great. So there we had it, an appointment was finally made with the doctor. We’ve lost track of the appointments but he was subsequently sent for a lot of tests. However, based on our Africa itinerary and the fact that we had gone swimming in a crater lake in Uganda, the doctor suspected Michael had Schistosomiasis (also known as Bilharzia).
Schistosomiasis can also be known as bilharzia, Katayama fever or snail fever. It is contracted by coming into contact with parasites released by freshwater snails. These parasites absorb into the skin and multiply into millions of parasitic worms which then go on to attack your vital organs (most commonly bladder and gut). It affects millions of people worldwide and symptoms include fever, itchy rash, muscle pain, fatigue and enlargement of the liver and spleen. In many cases, if left untreated it can result in paralysis, impacted brain function and death. It is treatable with the drug praziquantel, however this only kills the worms, not the eggs and so repeat treatment is usually required.
The World Health Organisation (WHO) describe schistosomiasis as the following:
- Schistosomiasis is an acute and chronic disease caused by parasitic worms.
- People are infected during routine agricultural, domestic, occupational and recreational activities which expose them to infested water.
- certain play habits of school-aged children such as swimming or fishing in infested water make them especially vulnerable to infection.
- Schistosomiasis control focuses on reducing disease through periodic, large-scale population treatment with praziquantel; a more comprehensive approach including potable water, adequate sanitation and snail control would also reduce transmission.
- Estimates show that at least 258 million people required preventive treatment for schistosomiasis in 2014.
- More than 61.6 million people were reported to have been treated for schistosomiasis in 2014.
Interestingly, Michael’s Schistosomiasis testing came back negative. His symptoms were still persisting in waves so he was occasionally going to work, but then struggling to do anything. The smallest activities of daily living were causing him difficulty. The doctor from the travel clinic decided to treat Michael for Schistosomiasis empirically without positive diagnosis and was prescribed a dose of Praziquantel. We had to order this in to the local chemist as it’s not something they usually stock. Michael had to take something like 4 tablets over 6 hours.
This was now about 6 weeks after he first experienced symptoms at Johannesburg airport.
The next morning he went to work. At about 3pm I got a call from Michael. He said he was extremely fatigued and was struggling to breathe properly so he had left work. If you have ever met Michael you will know he is the most laid back person and never gets stressed, however he now sounded a bit worried- which of course in turn panicked me! I told him I was leaving my work straight away to come and get him. In the mean time Michael was speaking to the Doctor over the phone, describing the true extent of his latest symptoms. He had essentially stopped breathing (this was likely the worms attacking his lungs) and was told in no uncertain terms to go to the emergency department straight away.
I picked Michael up then drove straight to hospital. By the time we got to ED Michael looked awful. We went through Triage where the triage officer asked him if he’d been having fevers. Michael replied “no, I don’t think so but I’ve felt a bit hot over the past few weeks”- she then took his temperature “40ºc” she said- “you’re having a high grade fever now”. This wasn’t even the hottest Michael had felt, so all this time he had been experiencing fevers but not knowing it as we had never taken his temperature!
We were taken through to a private room with a bed and Michael was put on a drip. The nurse asked us several times what countries we had been to. She held up a list of Ebola countries and asked us had we been to any of the countries. At one point she even made us promise we hadn’t been to West Africa. We told her if we had, it would be the first thing we would have told her! Every new staff member that we met got us to go through our travel itinerary and we never had any clear communication until the Infectious Disease (ID) Team took over his case. Michael spent the next 4 days in hospital and they seemed to run every test going. The consultant in charge of his case was fantastic, we could not have asked for better care or a better consultant. She was so down to earth, caring and explained everything clearly to us.
Michael’s schistosomiasis tests were still coming back negative, so at one point they suspected he had a rare form of malaria. Even though we had religiously been taking anti-malaria tablets when we were away, sometimes despite this, you can still contract malaria. However all the malaria testing also came back negative as well.
Eventually Michael was discharged without formal diagnosis as he was getting much better. He was to keep attending the outpatient clinic and tests still continued. He was greatly improving each day and becoming less and less tired, which was good as we were due to go to the Arctic very soon after he was discharged.
Through attendance at the outpatient clinic and further testing, we learned that Michael had a marker for Hepatitis E in his system! He no longer had hepatitis so the doctors said it was possibly an old illness which his body had been able to beat somehow. We suspected he got this when we were backpacking around South East Asia, as had been quite sick in Laos.
In early February, after our trip to the Arctic, we returned to the hospital’s outpatient clinic. Michael’s schistosomiasis test had now finally come back positive! It took over 3 months to show up in his tests; at least now we had a definitive diagnosis! He was prescribed a final does of Praziquantel which he took that night (just in case he still had any remaining worms in his system). His case was so rare that the doctors actually presented his case at a medical conference in Brisbane shortly after his treatment concluded.
His eosinophil levels are now back to normal and he is feeling great, thank goodness.
Next time we are in Africa, we will maybe give fresh water swims a miss (either that or take some Praziquantel with us!).
We would like to say a big thank you to everyone involved in Michael’s care, particularly Dr Adan Perse of Fremantle Travel Clinic and Dr Moira Wilson of Fiona Stanley Hospital.