Friday, September 7, 2012

Entamoeba Histolytica

Entamoeba Histolytica

The Valdmanis family vacation to Maine was extended this summer by about three weeks, thanks to a one-celled creature that fell in love with Richard's liver. This was wonderful in a lot of ways - the kids got to spend more time with their cousins, aunts, uncles and grandparents on the beach. But it came at a cost.

Entamoeba Histolytica lives in water in the tropics and then hitches a ride with whoever is unlucky enough to drink it. Unfortunately, Rich managed to pick up some of these amoebas somewhere in West Africa during his travels for work. Its unclear where or how, exactly, as these things can hide undetected for a long time. But he started to notice it once we arrived in Maine for our annual summer visit. Needless to say, it cast a bit of a shadow over things.

It started as a mild belly pain that just wouldn't go away and it developed slowly as the days went by into a light fever, tremors, night sweats, and fatigue. It didn't immediately stop Rich from having fun -- two camping trips to Richmond Island, some good striper fishing, lots of lobstering, and days building sandcastles with the boys. But after July 4 it got to the point where a hospital visit seemed prudent.

"Have you been drinking alcohol lately?" the doctor asked.
"Well, yes, but..."
"How about barbequed food," he asked, raising an eyebrow.
"There has been some barbequeing, yes, but..."
"You have gastritis and maybe a virus of some kind," he said, dismissively before condemning Rich to a life without beer, chocolate, coffee, wine or anything remotely enjoyable.
"But I live in Africa, and I think I might have a..."
"Let's not get carried away, let's rule out the simple causes first," he said.

Needless to say he was wrong. On Rich's second visit to the ER a few days later  -- which happened immediately after he gave a speech on the dangers of a life in West Africa to an audience at the Scarborough Library (they all laughed when he wiped his brow and said he was headed to the emergency room later that evening) -- doctors advanced the diagnosis only slightly, by doing some additional tests.

"We have good news, Mr. Valdmanis, you have cryptosporidium," said a lady who called with results the next morning. "Its a protozoa that can cause stomach pain and fever. You can cure crypto with pills. You have an appointment with the infectious disease specialist first thing tomorrow and they'll take care of you," she said in a cheery tone.

Crypto! That was indeed good news. A diagnosis that seemed reasonable, and which had a name similar to the glowing green rock that troubled Superman. If you're going to be sick, its nice to have something cool-sounding to point to as the cause.

As it happened, we were headed out to Chebeague Island when we got that call. We'd planned to spend a night at the Chebeague Island Inn to celebrate our anniversary, and we weren't going to let a little illness get in the way. More reason to celebrate, now! 

Unfortunately the Crypto was not about to let Rich have much wholesome fun. After a brief reprieve while sipping sundown cocktails on the Inn's giant porch, Rich started getting the chills. Dinner became impossible. In fact standing upright shortly became impossible. We went up to the room, debating whether to take the boat back to Portland through the darkness, but in the end we decided to tough it out. The fever was quite insane that night, sort of a Hollywood version of a malarial fit. It was not something that gastritis would bring on. Damned crypto.

This picture was taken a few days before Rich was admitted to the hospital.  The ameba was thriving.

The next morning, the infectious disease specialist broke the news that Crypto, while present, was also unlikely to be the root of Rich's troubles. Our spirits sunk. More tests were ordered. 

We went home and Rich went straight to bed where he proceeded to shiver and shake and sweat for another 20 hours. When he rose, he looked pretty terrible. "I'm getting worse and no one knows what's wrong," he said. We were meant to move out of our house within 24 hours. We'd been there for a month already. We were days away from our flight back to Dakar. None of it seemed possible.

We called the infectious disease specialist who took a quick look at the previous day's blood test and said it was time for another visit to the emergency room. "Tell them to admit him until they find out what's wrong. Things look very serious," he told Kelly. Rich's blood test was essentially catastrophic.

"You've got the whole ER's attention," one of the nurses said as teams of doctors came in and out of the room trying different things. One of the rather barbaric tests was for typhoid: the doctor tied a tourniquet around Rich's arm and left it there for five minutes while the fingers on his hand turned pink, then blue, then deep purple, then black. "Nope, you don't have typhoid. You would've gotten a rash on your wrist," the doctor said as Rich struggled to revive his throbbing digits.

Rich got a catscan later that night, a much more comfortable experience, and then was sent up to a room in the ACE (Advanced Care for the Elderly) unit, a spot carved out for him because there's no 'Undiagnosed Tropical Diseases' unit at Maine Med yet.

At about 2 in the morning, a doctor came in, a bolt of light from the corridor shooting past his head, and said, "We've got it. The catscan showed you have an abscess on your liver the size of a tennis ball. You have entamoeba histolytica, a water-borne parasite that has attacked your liver. We'll begin treatment right away." (Kelly's sister, btw, was very concerned about Rich and managed to diagnose his illness a few hours earlier, using Web Md.)

Rich called Kelly. It was a very happy and emotional moment.

Entamoeba histolytica is Africa's second-most deadly parasite behind malaria and generally kills when, undiagnosed and untreated, it eventually explodes one's liver.  Apparently we're all evolved from amoebas, which begs the question why these ones are so hostile.

The next few days involved a surgical procedure and a lot of morphine for Rich, while Kelly sorted out the move and Uncle Rob rescheduled the flights (a time- and patience-consuming task for which he deserves a medal of honour).

It was another three weeks before Rich was healthy enough to fly. But those days were like an unexpected gift in a lot of ways.


  1. In case you didn't see it, it's recently been discovered that the old arthritis drug auranofin is highly effective against E. histolytica in animal models.

  2. Thank you Paul! Sounds promising. Will keep fingers crossed it's officially approved.

  3. What a story, it must have been terrifying. Glad to hear you're all doing well!
    We were at Higgins' 2 weeks ago, 7 beautiful days on Harmon's Island (in the marsh). I was delighted to find the latest Picnic album at the market, and enjoyed it today in my car.
    Love to you all.
    Carl and Janice.

  4. I am so glad we caught ours early. Many hugs -- I hope all is well now.
    We caught ours through our Naturalpath -- when our mild to moderate GI symptoms didn't go away, he ordered a GI Panel. And boom, caught it.

    Best wishes!