Leishmaniasis

September 7, 2008
(The pictures below are not for the weak-stomached)

Jeff was asked by Pedro if he could do a house call on his neighbor, a 75 year old man who has “bumps all over his body”. Come to find out, after Jeff paid him a visit, the bumps are the least of his worries.
For 1 ½ years Karai Sixto has been developing sores all over his body. Jeff diagnosed him with leishmaniasis, a skin infection characterized by nodular and ulcerative skin lesions caused by sand flies. (FYI: leishmaniasis can also infect dogs. We have had several mission dogs put down because of the disease). The lesions on a human can vary from small, non-ulcerated papules to large ulcers with well-defined, raised, indurated margins (Karai Sixto definitely has the latter). If left untreated, leishmaniasis can spread to the nasal passages and roof of the mouth and utterly destroy them. He already has signs of advancing disease in the nose and the palate.

Karai Sixto lives alone and because his hygiene is less than adequate (no running water or well on his property) and his mental status is altered, the sores have had no chance to heal and every chance to get infected. Jeff describes the wounds as crawling with maggots. The bottoms of his feet are covered with piques making it difficult for him to walk. A pique is a small, 1 mm flea that burrows under the skin and lays eggs. We get them all the time and they are easy to pick out with a needle if you find them when they are small. But if left alone it will keep growing under the skin. Someone will need to take a needle to his feet and remove all the egg sacs. Karai Sixto also has scabies all over his body. It would be useless to treat him until he has his clothes and sheets washed in HOT water.

Leishmaniasis can be treated with routine IV medication over a four week period. Monday Jeff went to Caazapa (45 minutes away) to bring pictures of Karai Sixto to SENEPA (the department of health that gives out the medicine). They said that they cannot give the medicine to anyone over 60 years of age unless they see them personally and even then they may not be able to help. Since it is a huge ordeal to get Karai Sixto to Caazapa Jeff asked SENEPA to some to San Francisco. They agreed. His neighbors said SENEPA did come and said they’d be back later. I hope that is a good sign.

In the mean time, some of the church folks went to his house last week to clean his yard, spray for bugs and burn his trash. Jeff went to clean out his maggot infested wounds and properly dress them. We have heard that the doctor in charge of the national leishmaniasis program will be in a town 25 miles away at the end of the week. We are hopeful that he can make it out this way to visit Karai Sixto, or at least Karai Sixto can be put on the bus with a family member. This will be his only hope of getting treatment.