Uh oh.....
I've found the first really nasty thing I'm likely to get out in Belize. Now you know how medical students are...they meet a disease for the first time and then start displaying symptoms of it - a kind of medical hypochondria...well this time it could be serious.
We've had a few patients with Leishmaniasis in clinic. One chap - a young kid from Ethiopia has intrigued the experts for months to whether he has a normal cutaneous variant of the disease or a more complicated 'Post kala azar' picture.
He doesn't care. All he knows is that the end of his nose has been eaten away and he has something terrible happening all around his mouth that might be signalling that the same might happen there too. Then there was the soldier who had been based in Belize who came back with a large ulcerated and very painful area on his forearm (you can't help but think he got off lightly compared to the boy), and then the beautiful Afghani girl from Pakistan with a giant carbuncle on the end of her nose that just started off with a pink pimple but on biopsy is chock full of Leishmania amastigotes despite weeks of intralesional (yes into the bump) of toxic painful stibogluconate.
And the reason I'm worried? It's carried by sandflies. And I'm very tasty to sandflies (if Fiji was anything to go by), and mosquitoes and most other biting things. Interestingly (well I think so) mothers in the middle east have come up with a way to immunise their children without the need for a western vaccine (which still dosen't exist). They hold the buttocks of their child near a sandfly nest and get them bitten early on in a non-cosmetically dodge place and then the kids are immune for life. I reckon a burqua would do.....with a hole cut in it at buttock level...what d'ya think?
Now if you think I'm overexaggerating and just being a bit of a drama queen about the facial disfigurement then scroll down......this guy didn't get the buttock treatment as he lived in Peru.
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