Saturday, March 29, 2008

Guest post (not for the squeamish)

My friend Kyrsten has supplied me with a couple of interesting blog post subjects in the past, and I'm going to let her tell this current story in her own words. (What this essentially means is that I'm going to copy and paste (with permission) from the emails she sent me this week). Hopefully this will be her only personal contribution to my "medicine" and "freakishness" tag counts.

When I say "not for the squeamish", I do mean it. My initial response was (and I quote): "fucking hell Kyrsten, that's disgusting". It took me several hours to get to "it is kinda cool though". Of course, by the next day I was asking if I could put it on my blog! Anyway, the photos are down at the bottom so you don't have to look if you don't want to.

Take it away, KJ:
_______________

"Hi guys,

Caution, if you aren't
a medical doctor (some of you are) and thus get squeamish easily, don't read on. But you are all scientists for the most part and should find this cool like I did (now that Bob is gone!)

As some of you may know, I recently went to Belize for a week with three of my friends, and we stayed in the jungle for 3 nights and on the beach for 4 nights. In the jungle (which was amazing), we went on a small day hike. Being mostly prudent, I made sure to cover my body in DEET and wore a lon
g sleeve shirt and pants. The only area i didn't cover was my rear and near the bikini line, because those would have to be some crazy mosquitos! WELL. The jungle sure is full of bugs, as the ones of you that travel tropically well know. I come back with a few mosquito bits - in the area I didn't cover with DEET (and quite a few in the area i did cover) but don't think much about it.

I get back and everything is peachy - no one has dengue, none of us are sick, and it was a great vacation. Except I have what I pass off as an ingrown hair near my bikini line. It gets larger, and it's not healing properly. I get these weird, periodic stabbing pains that I think is a staph abscess getting worse. They are rare, but when they do happen, they make me d
ouble over in pain. They kinda freak me out after three bouts of pain, a days apart each, so I slather it in polysporin, bandage it, and go to my GP. He takes a look and proclaims it as an ingrown hair that is infected, and injects the area with lidocaine and cuts it to drain it. In an abscess, you would expect to see a pocket of pus (white blood cells that have gone to fight the infection and died), but there was no pus - which he finds odd. He gives me a prescription for cloxacillin and says to keep an eye on it and see him in a week.

I take the antibiotics as prescribed, and there isn't any more change except it's not healing. On Friday after working an 11 hr day, I sit down, and notice that there is something sticking out of the hole - looks flesh coloured like a piece of skin. I touch it when the tip of my nail and IT RETRACT
S into a 1-2 mm hole in the middle of the inflamed area. Immediately I start screaming, and D takes one look at my white face and wants to know if I'd like to go to Emerg (no clinic open at 8 pm on Good Friday). I see the R1, and he asks me some questions, and then takes the doctor in. At this point, i have no idea whether it's still bacterial or not - but I was pretty convinced it was parasitic - S. aureus doesn't 'wave' at you and retract into a HOLE! I was also so exhausted from being up since 5 am that morning that I wasn't sure if I hallucinated. The doctor is hesitant about doing anything to it, and says to stay on antibiotics and come back if it gets worse. I can't sleep at all because I have thoughts of chopping off my leg, and decide to google search parasites that might cause periodic pain, be from Belize, and cause a hole in the skin - and come up with Botfly! I find 100s of stories of people who go to Belize, Panama, Costa Rica, Brazil and come back with Botflies - most of them from Belize though. The symptoms are all eerily similar.

After sleeping a grand total of 2 hrs, I get up and take a look. Again, there is this 1 mm diameter fleshy looking thing on the top of the wound! aga
in, it retracts into the hole. D says he can't take 4 more days of me panicking and that it's time to go back to Emerg. I decide that it's coming out THAT DAY. I go to emerg, they admit me, and I start talking with the head nurse - she thought the previous night that I was misdiagnosed and that it was botfly, from what she's read. The doctor on hand is Dr. G and as soon as he hears 'parasite' he gets all excited - he used to do some tropical medicine (treated dengue in his early years). I had printed off info from what i found on the web, and he determines that most people do is suffocate the botfly as it needs to breathe to complete it's life cycle. So we slather on a petroleum product, cover with an airproof and waterproof bandage, and they send me home. I'm told to come back when the botfly stops moving. After about 1/2 hr, i can see the botfly's breathing tube moving around in the petroleum. Interestingly, it's also throwing other stuff out of the hole so the petroleum looks weird and clumpy. I decide that there is no way I'm letting the Botfly this one so I decide to wait as long as I can (I've named him Bob the Botfly at this point, a friend said his middle name should be Ro so he could be Bob Ro Botfly but that's just weird). I hang out, and decide to relax and try to breathe - not easy when you are pretty certain that there's something growing inside you.

This morning, I get up and we go to Emerg. Dr. G is there from yesterday, and this time he's got Z the R4 who's never heard of botfly. During my relaxation time yesterday I googled as much clinical in
fo as I could find, and found a great paper from Kevin Kain who runs the Tropical Infectious program at U of Toronto. Print it out and brought it in with me, highlighted the info they needed. Z took a look at it, summarized it for Dr. G - they pull off the bandage, and immediately Dr. G sees the parasite - he grabs it with the forceps and pulls it out (hurt a little because the hole was only about 2 mm, whereas the parasite at its biggest was about 4 mm in diameter. Cleans me up, puts a little bandage on and I'll continue the antibiotics I'm already on to stop any infection, but things should be fine.

I've attached a few photos of the bugger. We have an old antique microscope at home, so D and I have been taking a look at it under the microscope. pretty cool! Some of the black spines have my skin cells on them :)


I'm kinda proud of my Bob the Bot Fly. I don't have any formaldehyde here
so can't preserve him, but I think the pictures are more than enough.

Will this stop me from going to Belize again? hell no! The place was amazing and I know what to look for now :)"
_______________
A subsequent email reads:

"I am still alternating between "OMIGOD THAT WAS IN ME!" and "WOW! CHECK OUT THOSE SPINES! What evolutionary path led to THAT?!?""

Later:

"
About the blog, you can definitely talk about me on it - i'm ok. But you have to promise to put up the story of how I found the article myself and diagnosed myself :)"

I love geeks.

Anyway, here are a couple of photos
of Bob. The coin is a Canadian dime, about the same size as the US equivalent or a British 5 p coin. Judging by the series of photos on this blog post, Kyrsten was very lucky to have noticed him so early in his life cycle!




OK, I'm done grossing you out now. If you'd like to leave a comment or question for Kyrsten, I'll let her know and I'm sure she'd be happy to answer. The next post will be less disgusting, I promise!

12 comments:

  1. Ok, that is pretty cool. Kinda icky, though.

    I'm hoping that Krysten is feeling better now.

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  2. arrrgh, that's horrible. but very cool indeed

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  3. Eewww! This reminds me of the first time I read about guinea worms. Utterly revolting, but sort of fascinating.

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  4. ok, this was another of those things that reinforces me in "I will probably never see the Amazons/South america/ Asia or Africa.... those parasites...

    *shudders* I am fascinated (geeky microbiologist) but I truly think I would have used a knife on my own and just cut it out. I find it that disgusting and disturvbing that something would be "waving at me" ;)

    Hope she is doing fine now and no following infection!

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  5. I mean, after reading this passage on the link "About 5-10 weeks later, the maggot burrows into the ground, pupates, and eventually emerges as an adult bot fly. And yes, that does mean you’d have flies in you, under your skin, for over a month."

    seriously? ewwwww.... imagine they would fly away from that later on... more eww...

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  6. Wow, this is both disgusting and cool! I love the self-diagnosing geeks :)

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  7. I'm glad to say that Kyrsten seemed to be fine, if a little freaked out still, when we had lunch on Friday!

    Mad Hatter, I almost think I'd rather have the worm than the bot fly. My own personal Room 101 would be full of maggots for sure.

    Chall, I think I might agree with you on the knife! What really grossed me out is that apparently mature bot flies are very rare in collections, and infected entomologists* will let the maggot reach maturity just so they can capture the adult fly. On a similar theme, someone told Kyrsten "you're not a proper archaeologist until you've had a bot fly", which is very Indiana Jonesy and enhances the coolness of the situation. If I was her I'd use that line whenever possible.

    *I always have to look that word up to make sure I haven't confused entomology with etymology. I got it wrong in a conversation with my Dad once and was ridiculed for ages.

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  8. It wasn't as bad as you think, once you get past the idea of something growing where it shouldn't :)

    I did have a massive panic attack though when I first saw it - when we got to Emerg (it was late on Good Friday - no clinics would have been open), my blood pressure was 176/106 and the nurse asked me if I wanted Ativan. Should have taken it...

    Just so you all know, if you cut it out, it causes more problems. The reason is a) The botfly is actually thought to secrete antibiotics/antifungals while it is incubating (i've been looking for a paper on this!)
    b) if you miss part of the botfly then you can get a nasty immune reaction to the pieces you've missed. My leg is healed over now, but the area is still slightly indurated, though a LOT better than before. I think this is because some of Bob's spines are left in my leg (I'm sure they'll be assimilated soon).

    In this case, we had to suffocate the botfly and then pull him out dead. Otherwise, they just retract that breathing tube and you have to wait longer :(

    The doctor actually asked me if I wanted to wait for it to pupate, but when he saw me turn white, he agreed that suffocation was best.

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  9. They seriously suggested that?! And you STILL didn't take the Ativan? You're made of stronger stuff than me!

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  10. I've had a fear of these ever since I learned about them in undergrad invert zoology. But now that I've seen one and heard the story, guinea worm ranks way higher on my gross out list.

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  11. OK, I'll take the worm and you can have the fly ;)

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  12. And I just about pass out when I have to remove a tick, either from my dog or from my own ankle after hiking! You geeks are made of strong stuff.

    Jeanne

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