LeishMan 9: Leishmaniasis: an unpleasant guest.August 8, 2018
Development of a parasite (and all those gross pictures you’ve been waiting for).
Leishmaniasis is a flesh-eating parasite common in tropical areas all around the world. It is a protozoa that lives within sand flies, which are one-third of the size of mosquitoes and very hard to trace. The protozoa enters the skin when a sand fly carrying the parasite bites a warm-blooded animal. The white blood cells attack the foreign body but then are not defeated. Within the white blood cells the protozoa propagate, rendering the body’s basic defensive mechanisms useless. With the local immune system inoperative, the body fails to recognize the immunological needs of the infected area. As dead skin and dead white blood cells evacuate the area until the irritation ruptures the skin so the excess can escape outside of the body. The death of skin cells continue, but is not replaced by new, healthy skin since the body’s detection of the infliction is impaired by the deactivation of white blood cells, and so the wound increases in size, oozing.
This of course is only the friendliest, cutaneous, form of Leshmaniasis. Sometimes Cutaneous Leishmaniasis simply goes away on its own; in fact in the Middle East the parasite is so common and mild they are diagnosed as “Israeli Buttons” and doctors assure the infection will go away on its own. The next step in severity of the parasite is the muco-cutaneous variety. After the infectious inception via the sand fly’s bite upon the skin, the free trip through the blood stream (riding the dead white blood cells) brings the protozoa to sinuses. Leisions can form within the nostrils, the mouth, or even further up inside the SINUS SPACE. Finally, along these lines comes the Visceral Leishmaniasis, which are variations of the parasite that moves on to infect the lungs, bone marrow, muscles, and other organs. This deadly variety is most common in parts of Africa and India and is a painful, slow death.
Although most people have never heard of Leishmaniasis, it is a common affliction – limited to the tropics. The parasite has abundant opportunities to propagate with the aid of sand flies, and is difficult to prevent and detect. It is not surprising that worldwide about 2 to 3 million people become infected by Leishmaniasis each year. I think the lack of global awareness to this epidemic is easily attributed to the fact that most of the people who are affected live in rural regions of undeveloped countries: the Amazonas, the Dark Continent, the jungles of Southeast Asia. Indigenous peoples all over the jungle live with it; in most cases it might go away, in many cases the wound continues to grow and the parasite spreads until a secondary infection takes the host. Some people live with it for years. In Peru we learned that the indigenous people apply a hot poultice of herbs. As the parasite actually prefers mammals with a lower bodily temperature than we have as humans, this “heat it out” technique has been adapted by Western medicine as well.
But of course for those of us fortunate to be graced with the blessings of our industrial military investments, there is an expensive, chemically divined, prescription drug company cure. When American soldiers started getting the parasite fighting in Korea and Vietnam, the military research came up with Pentostam to get their Joes back on their feet. Still today, most of the 50-100 Americans infected with Leishmaniasis each year get it in Afghanistan and Iraq. Since, however, this occurrence is such a low volume, the FDA has not officially approved the medication to treat the parasite, and so I found out that I had to use experimental medicine to cure my case of Leishmaniasis.
But first I had to prove to the Center for Disease Control that I did in fact have Leishmaniasis. They don’t just hand that shit out, so to speak. Even though my lab results lead to the diagnosis, I had to get another biopsy. The CDC would grow this sample large enough so they could determine which specific species it was, and then to test its resiliency to any medication. For the third time, I had a scalpel put to the increasingly larger would on my cheek.
What was worse, much worse, was my doctor’s concern for my scratchy throat. I initially thought I had caught a cold from Shalynn. As my throat worsened, I thought I had strep throat due to my compromised immune system. My doctor was worried the Leishmaniasis had spread to my throat, so he recommended me to an Ear, Nose and Throat specialist to collect a sample. The Olyarntologist did the normal sick throat routine with a tongue depressor, I opened wide and said “awwwww,” but then he snapped my head back and choked me with a numbing agent called “Hurricane Spray.” He lit my digestive system on fire! As I coughed, burned, and drooled a horribly bitter taste all over myself, hoping I didn’t drown in my lack of throat control, the doctor proceeded to take long tweezers and tug until chunks of my infected throat ripped off.
Now the waiting began. We sent off samples of my cheek and my throat to the CDC and would simply have to wait for their designation. My Infectious Disease Doctor said it would take two weeks, but I wasn’t going to die, so to be patient. I slept in late, looked for jobs, and returned the sympathy always washing over me from friends of room-mates with a dutifully ashamed and morose response. I just wanted to ignore it and pay my time. But with a large, ugly, oozing, scabbed infection on your face, it is hard for others not to notice, and then to not say anything or not act concerned or be considerate of the problem or be curious. It was an interesting adversity because I knew people wanted to ask and I was comfortable letting them indulge in that itching curiosity as well as to let them fulfill their need to tell me they felt bad for me and to wish me a good recovery. But then several people seemed to only be politely interested in that, receive my gracious “yeah it’s tough, but it doesn’t hurt that bad, my throat is the worst part – I have to spray my throat numb to eat or talk or laugh… the smell gets me, yeah I have to deal with this…” and it would repeatedly put me in a very negative self-evaluation. But if they didn’t say anything then I would be bothered, knowing that they wanted to ask but didn’t respect my confidence enough to ask or something. I became depressed. A little bit in spurts, but it was a consuming affliction of energy and doubt and worry and what if and what is the scar going to be like and when can I start treatment. Have you ever been to a job interview with a pimple on your nose and felt embarrassed? Try it with a cherry-sized festering wound!
Two weeks turned into three weeks. I went running a few times but had to stop because the sagging motion of my swollen cheek would make my face hurt. I played soccer with a friend and a chest trap went bad and bounced too high and hit me dead on the wound. The scab flopped off and was hanging by an oozing tether.
I tried to make fun of myself, sarcastically played the “sorry guys, I can’t go swimming because I have leishmaniasis,” or “yeah I know what you mean because I have leishmaniasis.” In the shower, shielding the wound from the streams of water, I would sing Phantom of the Opera nonstop (“This face, which earned a mother’s fear and loathing. A mask – my first unfeeling scrap of glory. Pity comes to late, turn around and face your fate; an eternity of this before your eyes.)
Despite these distractions, the parasite worked me. It continued to grow throughout May as I waited for the CDC. I would startle myself with my own reflection, get drawn in to staring at the volcanic texture of the scab. I slept in more, rationalizing that I needed my strength, and couldn’t focus to get anything done. I was killing time, hoping that each week I’d be able to start a draining treatment that would damage my liver and threaten my heart. I told my doctor about a new symptom – he delicately told me that impotence should not be a side-effect of Leishmaniasis. I was depressed. I looked in the mirror and saw a wound of a half of a softball on my face. I despaired that my dreams of hosting a travel show about volunteering, about getting married, about surviving, were all ruined.
I couldn’t have been more wrong about those fears. Throughout this whole process, Shalynn had proven to be an even more amazing woman than I could have dreamed. She cheered me up, encouraged me to be active, joked with me about how awful things had gotten, and compassionately consoled my insecurities. She was an amazing inspiration of strength. Sure, we weren’t going to get married this summer, but the bonding that we shared in sickness, and the meek acceptance of my dependence on her, drew us together stronger than any of the challenges our relationship had already overcome.
At the end of May the CDC finally got back to us. They figured out that I have Leishmaniasis Braziliensis and that it is not resistant to any medication. One option was Pentostam, which causes heart and liver problems, and another option was Ambizome, which damages kidneys. Finally! I could progress to destroying my kidneys!