Cutaneous Leishmaniasis

Cutaneous leishmaniasis is a parasitic disease transmitted through the bite of a female sandfly. It is found on nearly every continent in the world with the exeption of Australia. Common symptons are the presence of chronic ulcers on the skin that do not heal or take an exeptionally long time to heal. A more common name for the disease is flesh eating disease. Oh and by the way... did I mention I had it?

The first precense of these sores on my leg occurred after a memorable day of skiing France, in the wettest conditions I've ever experienced. When I took my boots off I poured about a cup full of water out of them and noticed three open wounds on my right leg where the top of my boot meets my calf muscle. Two looked like abrasions and the other a large boil. I chalked it up to the friction between my leg and boot and possibly an ingrown hair or something. By the next day the boil had ruptured and I was stuck with three quarter-sized ulcers on my calf. At the time I didn't know they would still be there four months later.

My repeated attempts at basic first aid continued to fail week after week and I tried to change my methods. At first I kept them covered with bandages, when that didn't work I tried to leave them open to the air to dry out. All the while smaller ulcers would begin to appear like ulcers around the original ones. These would rupture and heal eventually while the three main ones underwent little change. After nearly two months I decided to get some blood tests done in England to see what was really the matter with me.

Before visiting the doctor I sought Dr. Google to see if I could self-diagnose myself. As a joke I searched for flesh-eating disease (afterall, I have been in some crazy places on this trip) and to my astonishment images matching the sores on my leg came up alongside worse, much worse images of patient's legs rotten to the bone and faces that resembled hedge apples or cauliflour. All of a sudden my motivation to be healed increased by a hundred times! As a non European citizen I had to pay fifty pounds to see the nurse at the clinic where she told me, after looking at my leg, I should get some blood tests done. Isn't that why I'm here? Let's do it. Apparently I was at a clinic and not a doctor's office. To get the blood tests I would have to see a general practicioner. She happily put a bandage on my leg and told me if I kept it covered it would probably heal up on its own. I didn't have the heart to tell her that if it didn't work the first six weeks it probably would't work now. So I walked out of the clinic with my $75 band-aid thinking, "This is exactly why I haven't seen a doctor until now."

Fast forward one week and across the Atlantic Ocean where I was staying with a friend in Buenos Aires, Argentina. His family took great care of me and arranged a doctor's visit on my behalf. Cutaneous leishmaniasis isn't very common in Buenos Aires. They say they only see about 300 cases a year. In my mind, that's about one a day, if I saw one of anything every day for a year I think I'd be pretty familiar with it wouldn't you? (Compare this with less than a 100 cases a year for the whole of the USA, the majority being returnees from the Middle East.) Anyway, I was told to leave it alone as it looked to be healing-in reality it was looking to get smaller and they had dried out significantly-if I wasn't a new man in a week or so I was to see a doctor again.

Two weeks later I was volunteering at a wildlife sanctuary in Bolivia and my leg had gotten worse. The staff in the clinic recognized the disease and agreed it probably was leishmaniasis. The president of the sanctuary proudly showed me a baseball-sized scar above his ankle where he had a run in with the disease years earlier. He said it took over a year for it to heal completely. The next morning I was first in line at the hospital!

This was my Bolivian hospital experience. I approached a window where my name and birthdate was recorded and given a reciept to take to the adjacent window where I paid 5 bolivianos for my consultation. That's about $0.70!! I waited for the nurse to call me in where he took my weight, pulse and blood pressure then was ushered to another waiting area where the doctor would see me shortly. And it really was "shortly." I chatted with the doctor, showed him my leg and he seemed convinced it was leishmaniasis also (yay for Dr. Google!) he wrote down my history and drew a picture of my leg on a paper and told me to go to the lab for a test and to come back when I was done.

I walked to the other side of the hospital-which is about the size of an elementary school-to the lab where I was told to go to the pharmacy to buy some soap and gauze and to come back after I had cleaned my leg. Huh? I'll be honest, sometimes I understand the words people say in Spanish but don't comprehend at all what they are saying to me. Confused, I went to the pharmacy and bought the stuff and took it back to the lab where the lady told me to come back after I had cleaned my leg. But where? I found out where, outside in the corner of the courtyard was a water spout where I rolled up my pant leg, took off my shoe and lathered up my leg! Nobody looked at me funny so I suppose it is normal procedure. Back at the lab, the nurse broke a toothpick in two and dug it in and around the edges of each of the three sores on my leg, wiping the blood onto a microscope slide. It felt a little worse than how it sounds, believe me. Satisfied, she had me wait for the lab results. Thirty minutes later it was confirmed, I had cutaneous leishmaniasis. Wonderful.

Back to the doctor's office where he was watching music videos on his laptop computer, he told me this; the good news is, it is totally curable. To which I thought, "Good news? Usually good news precedes bad news!." The bad news is, he continued, I will need a series of injections over the next twenty days. Oh, well that's not so bad. Just a small jab each day right? Not exactly. I was to receive 17.2 mL intramuscularly each day. (Your average hepatitis shots are between 0.5 and 1.0 mL.) He gave me a written prescription and told me I had to go to the hospital in the next village because they didn't care the treatment here.

I went there the next day but didn't bring enough money for the whole prescription so I had to come back the following day. (My taxi got two flat tires, one on the way there and another on the way back.) The nurse counted out 20 syringes and enough vials of medicine for the entire treatment and instantly took pity on me. Even moreso when I handed over the 700 bolivianos (about $100) to pay for it. Fortunately, the sanctuary where I was working had a vet clinic where every afternoon before leaving I received my injection from a veteranarian. When I left the sanctuary I still needed about ten more injections. A friend I'd met at the sanctuary accompanied me, along with her boyfriend, to tour the pampas along the Amazon tributary and gave me the shots while we traveled together. After that I was on my own, giving myself a shot in the butt and in the arm every day.

Here's a video of my last shot.



I'm happy to say my leg is all cleared up and the injections are complete. Yay! No more shots!!!

Here are some pictures of the later progress once I arrived in Argentina.


Taken my last night in Europe


After removing the bandage I got at the clinic in Nottingham.



A few days later.



Series of ulcers on my calf. The large one in the middle was the original boil.



Same shot as above a few days later. The surrounding sores have healed while the original gets worse.



Afternoon ritual.