An article written for a medical student friend about the disease.AS TROPICAL DISEASES go, a concise description of leishmaniasis has the ability to make you sit up and listen. The incredibly rare, potentially fatal, flesh-eating disease sounds like every gap year parent’s worst nightmare. Unheard of in Britain bar the small handful of soldiers and travellers who succumb to it every year, leishmaniasis does its worst damage, however, to the world’s poorest people.
Unable to get their hands on the expensive, under-researched drugs necessary to treat it, the majority of the twelve million people who suffer will have no choice but to sit back and watch as the protozoan eats away lesions on the site of the sandfly bite which, if left untreated, will spread. In some cases, the disease will spread to the throat (mucocutaneous leishmaniasis) or the internal organs (visceral) possibly leading to fatality.
Thankfully, I live in the UK and though it took five Manchester GPs four months to realise that the stagnant, unhealing lesions were not down to an infected hair follicle, I am lucky to have access to Infectious Diseases departments able to administer the sodium stibogluconate necessary to combat the disease. This highly toxic, eighty year old drug, which can riddle the patient with side-effects, is the best available as research money simply will not go towards treating a disease that infects people without wealth.
My own experience began with a lump near my groin and a dark patch on my lower back. Worried primarily about the lump, I saw a GP who told me that it was a swollen lymph node and nothing to worry about. The dark patch would disappear. A week later I was in A&E. The dark patch had clearly become infected and was now described as a crater. For the next four months, the lesion was dressed three times a week, initially with Aquacel which had no effect—the lesion quickly grew to 7cmx5cm which it has remained ever since—and then later with Mepilex Ag, a soft pad embedded with the antibacterial properties of silver. This cleaned up the
Staph. aureus infection that had been making the lesion so painful and from then on, I would barely notice it.
It was not until a second lesion appeared that I had to persuade GPs that I needed to be referred to a specialist. A dermatologist excitedly but tentatively diagnosed it as leishmaniasis and referred me to Infectious Diseases. In the weeks in between consultations I learnt a huge amount about the disease. My consultant was keen to reassure me though unable to mollify some of my worries as the exact strain was, and still is, unknown.
As the treatment is so severe, doctors were not keen to give the twenty one daily doses of sodium stibogluconate by intra-venous injection without confirmation of the strain, or indeed the presence of leishmania. Biopsies were duly taken. A ten-week wait ensued which included the work of scientists in Manchester and London and then the country’s top histopathologist. When he came back with a null result, all other avenues closed and so the decision was made to begin the treatment, without a shred of lab evidence that it would help, and assuming that I had the most severe cutaneous form
Leishmania viannia.
I’m now a week into the treatment and the lesions have begun to flare up, confirming that leishmania is present. Though it has been an agonising nine months, I realise that I am one of the luckier people to suffer from the disease and so would like to raise awareness of it, if only so that no one else has to be told for months on end that they have an infected hair follicle which will soon heal.
