One of the attractions of infectious diseases is that there is usually a high turnover of patients. As a general rule, treatment brings about a rapid improvement and patients can return home within a few days, even if they will be receiving on-going treatment for a longer period. My experience at the Hospital for Tropical Diseases has reflected that so far: most patients have been on the wards for only two or three days.
The Viet Anh (Vietnamese-British) ward specialises in neurological infections however, and as such defies the rules. Some patients arrived here before me and unfortunately it looks like they will stay here long after I've left. One of them hasn't moved since my first ward round. He lies on his back, eyes wide open, a ventilator and tracheostomy apparently keeping him alive. The only sign of life is the perpetual twitching of his left cheek, which causes a little foam to form at the corner of his mouth.
A few months ago, he and his twin brother were working in a field outside of Ho Chi Minh City. Pausing for lunch, they noticed the pond nearby was full of snails and didn't think twice: a few raw gastropods and back to work. Unfortunately, the snails were carrying the roundworm Angiostrongylus cantonensis. This parasite usually lives in the lungs of rats, but regularly makes excursions to their gut. Once excreted into the open world, it then relies on snails and slugs to ingest it so that it can develop into new, fully-infective larvae which can colonise new rats.
As is often the case with such worms, humans are only an "incidental host" (see Half a Brain). They become infected by eating raw or under-cooked snails and slugs, or vegetables contaminated by them. Having invaded a new host (be it a human or a rat), Angiostrongylus travels first to the brain and causes an inflammatory reaction which is characterised by the presence of a specific type of white blood cell: this is eosinophilic meningitis, and this is what brought our two brothers into hospital.
Though they both suffered from headaches, nausea and vomiting, neck stiffness and the occasional seizure, only one of them had read the textbook. He got better after a fortnight, and returned home. His brother, however, slipped into a coma and he is still there now. Most patients with eosinophilic meningitis make a full recovery; it is extremely rare for it to cause brain damage as it has in this case.
At this stage, after such a long coma, there is little cause for optimism. He may yet make a miraculous recovery, but it is unlikely. His family will eventually have to decide whether they wish to keep paying for him to receive supportive treatment in hospital, or whether they would rather he came home and were released from his bodily prison.
His brother, with whom he shares so much, reminds us that when two similar people are infected with the same parasite, the outcome can still vary enormously. We still have a lot to learn about the factors which dictate who will be the lucky ones. And we still have a mountain to climb in order to prevent poor, hungry people from eating a quick, easy and free lunch.
The Viet Anh (Vietnamese-British) ward specialises in neurological infections however, and as such defies the rules. Some patients arrived here before me and unfortunately it looks like they will stay here long after I've left. One of them hasn't moved since my first ward round. He lies on his back, eyes wide open, a ventilator and tracheostomy apparently keeping him alive. The only sign of life is the perpetual twitching of his left cheek, which causes a little foam to form at the corner of his mouth.
A few months ago, he and his twin brother were working in a field outside of Ho Chi Minh City. Pausing for lunch, they noticed the pond nearby was full of snails and didn't think twice: a few raw gastropods and back to work. Unfortunately, the snails were carrying the roundworm Angiostrongylus cantonensis. This parasite usually lives in the lungs of rats, but regularly makes excursions to their gut. Once excreted into the open world, it then relies on snails and slugs to ingest it so that it can develop into new, fully-infective larvae which can colonise new rats.
As is often the case with such worms, humans are only an "incidental host" (see Half a Brain). They become infected by eating raw or under-cooked snails and slugs, or vegetables contaminated by them. Having invaded a new host (be it a human or a rat), Angiostrongylus travels first to the brain and causes an inflammatory reaction which is characterised by the presence of a specific type of white blood cell: this is eosinophilic meningitis, and this is what brought our two brothers into hospital.
Though they both suffered from headaches, nausea and vomiting, neck stiffness and the occasional seizure, only one of them had read the textbook. He got better after a fortnight, and returned home. His brother, however, slipped into a coma and he is still there now. Most patients with eosinophilic meningitis make a full recovery; it is extremely rare for it to cause brain damage as it has in this case.
At this stage, after such a long coma, there is little cause for optimism. He may yet make a miraculous recovery, but it is unlikely. His family will eventually have to decide whether they wish to keep paying for him to receive supportive treatment in hospital, or whether they would rather he came home and were released from his bodily prison.
His brother, with whom he shares so much, reminds us that when two similar people are infected with the same parasite, the outcome can still vary enormously. We still have a lot to learn about the factors which dictate who will be the lucky ones. And we still have a mountain to climb in order to prevent poor, hungry people from eating a quick, easy and free lunch.
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