The Most Disgusting Diseases in the World (and How to Catch Them) – part 2

Following on from part one, and in the same vein for which Punch magazine was known, I bring you four more of the most disgusting diseases in the world.

I had to include acromegaly as the insistence of my son whose interest in endocrinology began at the tender age of four when we were on holiday in Switzerland and happened on a particularly florid case of the condition. By then, the diagnosis could have been made from a cable car 50 metres away (which it was).

“Mummy, why are that man’s hands so big? And why has he got pillows instead of shoes?” He pointed, I told him not to, and so on, until I noticed the man in question who really was sporting pillows strapped to his feet.

I explained about the pituitary gland and growth hormone, and my youngster thereafter abandoned Postman Pat books in favour of the British Medical Journal.

However florid acromegaly may become, the onset is invariably subtle, with coarse skin, greasy hair, an increase in hat size, a little deepening of the yodel, and difficulty making watches or doing up lederhosen. To avoid resembling our Alpine acquaintance, it’s best to seek help while you can still fit into your ski boots.

Even pillows may not be roomy enough if you’re infected with wuchereria bancrofti. Everyone seems to have heard of elephantiasis but there are two important things to note: you don’t catch it from elephants, and it usually begins with just a few enlarged lymph glands on the groin. Walking is therefore still possible, for a while. Swelling sets in later, often only in one leg, and sometimes in the scrotum too, should you possess one.

Eventually the skin develops rough folds and warty outgrowths, and the scrotum, if affected, can hang down to the knees, which poses problems at the tailor’s, and elsewhere. Prevention is key. Use a mosquito net, and avoid falling into Burmese septic tanks if you want to wear both legs of your trousers at the same time.

If you dislike rodents, you’ll hate Lassa fever. Transmitted by rats, it was discovered in the Nigerian village of the same name, which you might like to make a note to avoid on your travels.

After it was first described in 1969, the department of health send circulars so that no GP would miss this diagnosis.  As the years passed, I never saw a case, but the bumph was useful for wobbly dining tables.

Lassa has an insidious onset with symptoms that resemble other conditions, like fever, malaise, a flushed face, red eyes, nausea, and vomiting. Later, the nose, gums, mouth, stomach, and lungs bleed spontaneously – a plague of blood, with a high mortality rate. As I recall, Lassa is similar to other haemorrhagic fevers such as Marburg-Ebola, Green Monkey Disease, and Crimean-haemorrhagic-Congo-Hazara fever, though I’d have to check under the dining table to be sure.

Anyone who’s unconscious when arriving by plane from West Africa runs the risk of his drunken state being mistaken for Lassa fever, with the result that masked attendants whisk him off to a plastic tent in the nearest isolation unit until the tests are back. I need hardly add that the outlook is far worse when Lassa fever is mistaken for excess alcohol.

Next up is typhus, not to be confused with typhoid. Typhus is caused by germs called rickettsiae which breed in the gut of the louse, and spread to humans via louse faeces. Louse bites are itchy, and scratching them rubs infected droppings into the skin.

Weakness is one of the early symptoms, and it all goes downhill from there, eventually, if untreated, leading to multiple organ failure.

As alarming as typhus is, Tsutsugamushi fever (aka scrub typhus) is much more popular with medical students, because it has so many syllables and because it forms a painless but picturesque ulcer covered with a crust. More importantly, unlike other forms of typhus, an attack of Tsutsugamushi gives no immunity against further infection. Medics can therefore imagine repeated episodes of scrub typhus at each outbreak of acne, and some of them have been known to scratch for years after exposure to a single lecture.

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them): head, shoulders, knees, and toes.

You may also like to catch up on The Most Disgusting Diseases part one.

The Most Disgusting Diseases in the World (and How to Catch Them) – part 1

Putting my decades of medical practice to use, I bring you the chance to brush up on all the gruesome diseases you don’t remember, especially if they’re ones you never knew about in the first place.

It’s tongue in cheek, but, if you’re squeamish or easily offended, you may prefer a blog about macramé instead.

Feeling out of sorts lately? If friends think you look tired, colleagues call you burnt out, and Great-Aunt Frieda reckons you need a tonic, better check out your appearance in the bathroom mirror. Are your fancy new glasses slipping down your nose? If so, either you’ve been too busy to pop into Specsavers to get them adjusted, or that jaunt to South America didn’t agree with you.

You may have got New World Leishmaniasis. Don’t let the name fool you. It’s as old as the hills, and it’s still a neglected disease. The parasite finds a sandfly to hang out in, until the sandfly finds you. Within 18 months or so, the bridge of the nose collapses. Leishmaniasis also destroys the mouth and tongue, so that bottle of Gevrey-Chambertin you’ve been saving tastes just like British sherry. Soon, however, you will no longer care.

The cause of all the trouble is the innocent-looking leishmania parasite with a cute little tail. Rather like a spermatozoon, actually. But, unlike pregnancy, leishmaniasis can be avoided by simple measures such as sleeping on the roof. Sandflies can’t fly much higher than three metres. 

What could be worse than leishmaniasis, apart from income tax, baldness, and wheel clamps? It’s the infection so dreadful that doctors often refer to it as Hansen’s disease to avoid inducing panic in the waiting room. The condition starts with a bit of catarrh then progresses to muscle pains, enlarged lymph nodes, and sometimes a patchy rash.  If you’re any kind of hypochondriac at all, you’ll suspect from the very first sneeze that this is leprosy.

Soon you lose a little pigmentation, then a few fingers because they’re numb and you chop them up with the celery. By the time leprosy bacilli gets into their stride, the face is covered in boils and bumps, and friends are apt to be too busy to see you. There may be other complications including inflamed testicles and a spleen the consistency of sago. But enough. More details might be in poor taste.

Leprosy is highly infectious. Or else it isn’t. The experts don’t all agree. If your doctor rushed out of the consulting room, you’ll know which school of thought she favours. One study showed that the only sure way of contracting leprosy is to share a bed for twelve years with a leprosy patient. So there’s really no need to avoid waiting rooms, though you might want to steer clear of lactating ladies with leprosy because they shed the bacilli like there’s no tomorrow.

Actually, there is a tomorrow because leprosy is curable. Too bad that treating an entire village for a month costs nearly as much as a good lunch for four, not including service. 

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them), I’ll be talking about conditions affecting hands, feet, and other members.

My earlier version of this series originally appeared in Punch, an iconic magazine that eventually succumbed to circulation problems.

The Disease Nobody Knows About Until it’s Too Late

If you know much about sepsis, chances are the condition has affected your family.

Sepsis has a high mortality and kills 37,000 people a year in the UK, about 1,000 of them kids. So this week I’m parking the levity and using my blog to sum up what you need to know about sepsis. Photo by Jean Scheijen FreeImages.com/Jean ScheijenUnderstand what it is.

Sepsis is when the body responds to severe infection in such a way that it attacks its own organs and tissues. Without treatment, this quickly leads to organ failure and death.

Most people have heard of blood poisoning (septicaemia) which is much the same thing. But doctors now prefer the term sepsis because there isn’t always blood poisoning in this condition.  

Sepsis isn’t exactly a household name – yet. Personally I think ‘sepsis’ sounds weaker than either septicaemia or blood poisoning, but we’re stuck with the term that scientists agree on.

Know the signs.

The symptoms depend on age, but the main point is that there isn’t any one specific sign like, say a swollen jaw with mumps. A child with sepsis can have a high fever, or an abnormally low one. The younger the child, the vaguer the symptoms.

Here are some signs to look out for in children (from the UK Sepsis Trust’s Paediatric Pocket Guide):

symptoms of sepsis in children

And here are some signs to watch out for in adults (from the UK Sepsis Trust’s excellent Symptom Checker card):

symptoms of sepsis in adults

If I could highlight just two consistent points about sepsis, they would be these:

You or your youngster will be more unwell than expected.

Things get rapidly worse, especially in children.

Understand who gets it.

Anyone can develop sepsis from a bacterial infection (or sometimes a virus or fungus). But some are more at risk, like the very young, very old, pregnant women, diabetics, and people on long-term steroids.

The initial infection can be a serious one like meningitis, or seemingly trivial, like a horse-fly bite.

Surgery can be linked with sepsis, especially emergency operations on those in poor health, or with peritonitis or bladder infections.

scalpel

Know what to do.

Sepsis is a medical emergency and needs urgent hospital care. Don’t waste a single moment.

Sepsis isn’t one disease, but rather a syndrome that cuts across almost every medical speciality. The first doctor you see could be a paediatrician, a gynaecologist, an orthopaedic surgeon, or your GP, and sepsis may not feature at the top of their list. That’s why it’s so important for you to mention it. When you see the doctor or nurse, make sure you say, “I’m worried about sepsis.”

Thanks for bearing with me.

Litmann type stethoscope

Here’s a selection of further reading if you’re interested.

The UK Sepsis Trust is a charity founded to save lives and improve outcomes for survivors of sepsis by instigating political change, educating healthcare professionals, raising public awareness and providing support for those affected. For their general factsheet on sepsis, click here

Sepsis Awareness Month: Rory’s Story. One mother’s personal account.

Three and a Half Heartbeats by Amanda Prowse. A novel of love, loss, and hope about a family devastated when their child dies of sepsis. And proceeds go to UK Sepsis Trust.

Plunkett A, Tong J. Sepsis in Children.  BMJ 2015;350:h3017. A detailed medical article from the British Medical Journal.