Hazel Southam - Journalist

The holiday bug that could be more sinister than you think

The Daily Mail 4 August 2014: Waiting at Frankfurt airport, my head started to spin. Then, as I got on the plane, I collapsed. I remember begging the purser to let me fly home, but to no avail. ‘You’re too sick for us to look after,’ he said, and called an ambulance.
I’d been in Ethiopia for a week, working as a reporter, and, as is normal on these occasions, I’d been bitten by mosquitoes and had also developed diarrhoea.
But I’d been covering foreign stories for nearly 20 years, so exhaustion, mosquitoes and travellers’ tummy were familiar territory. Yet nagging away at my brain was the idea that this time something wasn’t right.This time I was running a temperature, had a rash, a splitting headache, and ached all over.
But with interviews to be done, I pushed the worry away and got on with work. It was just normal travel problems, I told myself.
Even collapsing at the airport didn’t change this view. The German doctor at the airport clinic asked some questions, including about where I’d been, and diagnosed diarrhoea and dehydration.
He put me on a drip to rehydrate me and I lay there for five hours, drifting in and out of consciousness. I was then passed as OK to travel and flew home. It was the start of nearly two months of misdiagnosis.
The experience has left me wondering how likely is it that British airport staff or medics will be able to spot or diagnose Ebola – and just what the implications are of that.
It was September 2011 when I collapsed en route from Ethiopia. Once we arrived in Britain, my colleague, photographer Clare Kendall, voiced her concerns: ‘Your eyes are full of blood and your head’s swollen.’
But we had a trip to Nicaragua a month later to prepare for, so after a few days’ rest I was working again.
Only I couldn’t work properly. After one meeting, I wrote in my diary that I was ‘overtaken by bone-aching weariness and had to go to bed for two hours’. And so it went on until, just a few days before we were due to fly to Nicaragua, I collapsed in the back garden.
I rang my GP practice and was given an emergency appointment at my local hospital, where the doctor said I had a urinary tract infection. Hugely relieved, I took the tablets he prescribed and went home confident that I’d be well enough to fly.
But I wasn’t. ‘When I stand up or walk, I feel lightheaded and everything spins round,’ I wrote in my diary. I rang NHS Direct, who said it might be vertigo. They told me to ring my GP.
I missed the Nicaragua trip because, essentially, I couldn’t stand up. Or think. Or do anything much.
Towards the end of October 2011, I collapsed again and the GP referred me for extensive tests at the hospital. These took six hours.
On October 29, I received a letter saying that the tests showed I had antibodies for not one but three conditions: West Nile virus (which is carried by mosquitoes), dengue fever (another mosquito-borne illness, with similar symptoms) and tick-borne encephalitis (spread by ticks, and which can spread to the brain).
No wonder I didn’t feel well. All three conditions are potentially fatal, and after reading the letter, I sat in the kitchen and shook.
Then I rang a friend who had studied medicine. His view was that I currently had West Nile virus and dengue fever. (The encephalitis antibodies were the result of a trip to Jordan two years before, when flu-like symptoms had developed into meningitis.)
I had the full list of classic symptoms of both West Nile virus and dengue fever: a fever, pain behind the eyes, aching bones, muscle pain, feeling sick, a skin rash, sore throat, diarrhoea and blood in my stools.
Presumably, my condition had been hard to diagnose because cases of West Nile virus and dengue fever are fairly rare both at Frankfurt airport and in leafy Hampshire, where I live.
The misdiagnosis had meant I didn’t seek medical help more quickly. There is no specific treatment for West Nile virus and dengue, apart from rest, fluids and paracetamol, and by then I was over the worst. But early diagnosis is important if you are to be alert for any complications. Dengue fever, for instance, can lead to catastrophic bleeding.
It had been a salutary lesson – and one that last year I was grateful to have learned. I’d returned from a trip to Shanghai where, again, a mosquito had bitten me.
A week after my return I was still feeling rough, so this time I immediately rang my GP and said: ‘I’m not well. I’ve been in Shanghai. A mosquito bit me. I’ve had dengue fever. What do you think?’
Malaria, she said, probably. She sent me straight to hospital where a truly wonderful consultant kept me in for 24 hours and did lots of blood tests. They were all sent to the labs at Porton Down, the Government’s military science facility (this is where all UK tests for tropical diseases are sent). This both worried and reassured me.
The consultant was concerned that I was going to start bleeding. So was I. Having heard of people who’ve bled to death in just days, I didn’t want to be one of them.
Dengue haemorrhaghic fever, as it is known, is a risk if you have antibodies in your blood system from a previous infection; other risk factors are being aged under 12, female and Caucasian. I fit three out of four of those.
I spent a night in an emergency medical ward. After 24 hours, and with the reassurance that some of the test results had already come back clear, I was discharged.
Two weeks later, confirmation came through that I hadn’t got dengue fever but I did have some unknown Chinese virus. Again, there was no specific treatment, but this time I was back to full health after three weeks.
But all this leads me to conclude that it’s very difficult for both patient and doctor to know what’s wrong with you when you return from foreign travel with a list of symptoms – and, as a patient, it’s hard to know when to seek help, and how much to push for it, when you don’t know what’s wrong.
David Mabey, professor of communicable diseases at the London School of Hygiene and Tropical Medicine, agrees, and says this is why it’s important to seek expert advice early on.
‘If you are feeling sick and have come back from somewhere tropical, the first thing is to get help,’ he says – and make a point of mentioning you’ve been on holiday, and where.
If you have a fever, ask your GP to check it’s not malaria. ‘There are plenty of other viral infections that are self-limiting and aren’t going to kill you, but you can die of malaria very quickly,’ says Professor Mabey. ‘However, it’s easily treatable.’
International travel means more of us are returning home with tropical diseases such as dengue. Some 2,000 cases of malaria are reported in the UK every year: in 2013, seven people died.
And according to Public Health England (PHE), dengue fever is on the rise. In 2011 (the year I caught it) there were 223 cases; in 2012, there were 343, a 54 per cent rise.
‘There’s a lot more malaria and we still see leprosy, which is misdiagnosed because people don’t think of it,’ says Professor Mabey. ‘And we see the odd case of sleeping sickness [caused by a parasite]. But none of these are common.’
For GPs all of this presents an enormous challenge because they are simply not experienced in these rare, though sometimes deadly, health problems.
Even Professor Simon de Lusignan, a GP and director of the Royal College of GPs Research and Surveillance Centre, which keeps an eye on outbreaks of everything from flu to Ebola, says he’s seen only three or four cases of tropical illness in his 27-year career.
‘It is difficult to diagnose tropical diseases,’ he says. ‘Flu-like symptoms could be so many things. But when these symptoms go on, you start excluding things.’
What does this mean for a virus such as Ebola, with an incubation period of up to 21 days?
The current outbreak has been centred on Liberia, Guinea, Nigeria and Sierra Leone, but the concern is that, with international travel, the virus could spread.

Read more: http://www.dailymail.co.uk/health/article-2716070/The-holiday-bugs-sinister-think-As-Ebola-highlights-hidden-dangers-exotic-trips-VERY-cautionary-tale.html#ixzz3B8UZRoT3
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About Hazel

Hazel Southam is an award-winning journalist who reports on religious affairs, international development and the environment. She has covered four G8 Summits.

She wrote for The Sunday and Daily Telegraph for 10 years. Her work has also appeared in The Guardian, The Independent, The Independent on Sunday, The Daily Mail and The Evening Standard.

Reporting assignments have taken her to places including Bosnia, Zimbabwe, Mongolia, Albania, Nagorno-Karabakh, Senegal and the Arctic Circle.

In the UK, she has also delivered media training to the MOD and leading businesses.

Contact Hazel