AboutSudesh Samuel Expertise I take questions relating to online healthcare news, community support, web research, medical travel and medical tourism, as well as online options for becoming more informed about medical conditions, drugs and treatments.
Experience I have researched and surfed the web extensively for high quality, reputed and up-to-date sources of healthcare information. I am a licenced and practicing pharmacist specialising in the provision of healthcare communications material and drug information. I have run a drug information service at a national, tertiary, teaching hospital where my duties included managing several pharmacists in the development of continual education, providing drug information throughout the hospital and analyzing new and existing drugs for inclusion into the hospital formulary. I have been involved in several healthcare committees including patient safety, adverse drug reaction monitoring, antibiotic guidelines as well as a pharmacy and therapeutics committee. I was an on-call pharmacist with the national drug and poisons information centre. My research focus has been on medication review and I have presented findings on a renal medication review service and also published a review article on halting the allergic march in the World Allergy Organization Journal.
Organizations Institute for Medication Management - http://www.medicationreview.net
Publications World Allergy Organization Journal, Vision Reborn, Medical Grapevine, National University Hospital Pharmacy and Therapeutics Newsletter, National University Hospital Adverse Drug Reaction Newsletter, National Healthcare Group Adverse Drug Reaction Newsletter, suite101
Education/Credentials Master of Health Service Management, Bachelor of Science in Pharmacy with Honours
I was wondering if you would be able to help, or suggest any causal factors that have not yet been considered. 6 weeks ago I returned from 7 weeks working in the Ecuadorian Amazon rainforest, on my return I suffered from sweats, chills, frontal headaches, diarrhoea, nausea, fatigue, loss of appetite and noticed that one pupil would frequently be bigger than the other. I then had tests to rule out Malaria, and it was negative. The blood test results came back with signs of inflammation and very high platelets (so the doctor told me). I had the blood tests repeated 2 weeks later and the any signs of inflammation had gone down but the platelets were still high. I am having the bloods repeated this coming week.
I no longer have the symptoms I initially had, but I still have loss of appetite, sometimes pains the left hand side at the lower rib, lower exercise intolerance, nausea that hits me at least 5/6 times a day, increased thirst, pains behind my eye that feels like pressure (these pains are not debilitating, but persistent and make me aware of my eyes and sockets, plus the whites of my eyes are reddish by the evening) and my left pupil becomes larger than the right frequently. I have been sent to an eye doctor and they said my sight was fine and they checked behind the eyes and said the same. However, the pupil problem is intermittent and in the morning when I first saw the eye doctor could see there was something, but when I went back after lunch for more tests, it was reacting normal.
I am currently taking steretide 125, it should be 1x puff morning and night, however I haven’t taken it religiously recently as I only really need it when I am running a lot and due to these problems my running has increased. The eye doctor said this could be a possible reason for the differences in pupils, as apparently they can case diation of the pupils. However, I would have thought it would be in both eyes?
The GP and eye doctor are stumped, so have suggested that I have blood screening for various microbial diseases and have said that they will check my eyes again in under 2 weeks and if it is clear I should be set for a brain scan.
I don’t suppose you know of any tropical disease that you can suggest that they check for? I am really getting frustrated with this!
Kind regards,
Emily
Answer Hi Emily, your symptoms may be related to some of the infectious diseases that are known to be present in Ecuador. These include malaria, dengue fever, yellow fever and typhoid fever. Although malaria has been ruled out, other tests may also be useful in ruling out the other common potential causes. Typhoid fever for instance is linked to loss of appetite although a host of other conditions could just as easily be related to this symptom. Blood testing for the Salmonella microbe may be useful in determing whether this organism was causing typhoid fever. As for the possible eye involvement, it may be useful for your doctors to be able to rule out two specific conditions - onchocerciasis and chagas, both of which are known to occur in South America. Onchocerciasis is a parasitic infection associated with the black fly and exposure to fast running river water. This parasitic infection can, if not treated, lead to parasite multiplication in the body and concentration in core areas like the eye. Chagas is another parasitic infection involving a blood-sucking triatomine bug. This bug is known to feed off blood from the face and then defecate in the area. A tell-tale sign of the condition is known as Romaria's sign which includes swelling of the eyelids near a bite wound or where the bug's feces may have been accidentally rubbed into the eye. Treatment with specific medications can be invaluable should any of these conditions be present. Talk to your doctors about these conditions and associated treatments. Best wishes with recovery.
