It’s the souvenir you don’t want — a holiday illness no one can diagnose or treat. That’s where the Hospital for Tropical Diseases can help, as this new series reveals. Corinne Little-Williams, 54, from Tiverton, Devon, tells DIANA PILKINGTON her alarming story.
Last autumn my voice suddenly became deep and husky. My throat felt sore and dry, like sand-paper, and if I tried to talk, virtually no sound at all came out.
I thought I must just be coming down with a cold, but then I started having symptoms I couldn’t ignore.
At Christmas dinner, I started choking on the turkey and couldn’t get anything solid down, so had to make do with scrambled eggs.
Unaware of the danger: Corinne Little-Williams on holiday in Greece in 2007, where she was bitten by a sandfly. Her ‘sore throat’ nine years later turned out to be caused by tiny parasites on her vocal cords – and doctors said she would have died within six months if not treated
After that, I would choke whenever I ate — it felt like I couldn’t breathe and I’d have to fight to swallow. Every half an hour or so I’d also find myself gasping for breath, and would wake up several times a night struggling to breathe — it was scary.
In January, I saw my GP, who referred me to the ENT department at the Royal Devon and Exeter Hospital.
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The consultant looked down my throat with a camera, and said my voice box was ‘misshapen’. Then he mentioned cancer. My family (I have three grown-up children, and my wife Sarah has two) went into meltdown: we’d already lost my oldest sister and my nephew to cancer.
I had a biopsy and it was a nerve-racking wait for the results.
‘The medication made me sick nearly every day, but at least it was killing the monster inside me,’ said Ms Little-Williams (above, today)
It wasn’t cancer, which was a huge relief, obviously. But what came next was a shock: apparently, they’d seen tiny parasites on my vocal cords.
I was infected by something called mucocutaneous leishmaniasis, which can happen if you’re bitten by a sandfly.
I’d never heard of it before and had no idea how I’d caught it. I was referred to the Hospital for Tropical Diseases in London in May to see Diana Lockwood, an expert in the disease.
She said it usually starts with a sore or an ulcer, but I didn’t have any of those
Then she asked me to think back to any sores I’d had over the years, and places I’d been on holiday. That’s when I remembered a trip to the island of Zakynthos in Greece in 2007. We’ve been many times, but that year for me was a particularly bad one for insect bites.
Mosquitoes tend to attack me as soon as I step off the plane anyway. On that trip, I’d had around a dozen bites, including one on my leg that was more swollen than the others.
It was weeping, so I had put some antihistamine cream on and thought no more of it. It cleared up a couple of weeks later.
Now I realise it probably wasn’t a mosquito bite but that of a sandfly. The parasite had been dormant inside me for years, which is too horrible to bear thinking about.
I’ve been told that if I hadn’t been treated then, I could have died within six months, which is terrifying.
Professor Lockwood prescribed me a drug called miltefosine, which I had to take for 30 days to destroy the parasite.
This medication made me sick nearly every day, but at least it was killing the monster inside me. After the treatment, my periods returned; they’d stopped, which I’d put down to the menopause, but it had actually been a sign that my body was shutting down.
Now, four months on, my voice is 80 per cent back to normal, and apart from the occasional cough, my breathing is a lot better.
I’m still being monitored, as there’s a small chance that the disease could return.
The whole experience — from the choking to the sickness from the medicine — has been horrific, and I’ve made up my mind never to go abroad again.
Not all sandflies carry the parasite. But in terms of prevention, the main thing to do is protect yourself using insect repellent
The doctor
Diana Lockwood is a professor of tropical diseases and a consultant at the Hospital for Tropical Diseases. She says:
Leishmaniasis is a parasite infection that you can contract from a sandfly bite.
There are two main types of the disease — visceral leishmaniasis, which affects the liver and the spleen, and the more common cutaneous kind, which causes ulcers to form on the skin.
TV presenter Ben Fogle caught the cutaneous type in Peru, on his arm; he was one of my patients.
You sometimes hear this disease described as a ‘flesh-eating bug’, but what actually happens is that the body responds to the parasite with a lot of inflammation, which then breaks down into an ulcer.
Globally, these two forms of the disease affect around 1.5 million people a year, particularly in South America, but also Africa, India and sometimes around the Mediterranean, especially Greece and Spain.
The first sign of the disease is an ulcer, which usually forms at the site of the bite.
These tend to be chronic — lasting for up to 12 months, though they can also heal and then sometimes re-appear — with a thickened edge.
They can range in size from half a centimetre to about 7cm.
It can be hard to distinguish these ulcers from a straight-forward infected insect bite — at our hospital one in every ten infected bites we see is leishmaniasis, so it’s important to see the doctor if you develop a non-healing ulcer after visiting an affected area.
DO YOU NEED HELP?
The Hospital for Tropical Diseases in London has a walk-in clinic for travellers who are acutely unwell.
For more information, go to uclh.nhs.uk/HTD
If the ulcer doesn’t heal after two courses of antibiotics, go back to your GP.
Corinne had mucocutaneous leishmaniasis, a complication of the cutaneous type, where the disease gets into the nose, throat and vocal cords, leading to problems such as nosebleeds, stuffiness in the nose, or difficulty swallowing or breathing.
It is likely that the parasites spread from the bite on her leg through the bloodstream to her larynx (voicebox), and then lay dormant in her cells.
Because she uses a lot of steroid inhalers for her asthma, this suppressed the immune defences around her vocal cords, eventually allowing the parasite to reactivate and multiply.
If left untreated, patients with mucocutaneous leishmaniasis can get holes in the vocal cords and windpipe as a result of inflammation and eventually choke to death.
Ms Little-Williams had mucocutaneous leishmaniasis, a complication of the cutaneous type, where the disease gets into the nose, throat and vocal cords, leading to problems such as nosebleeds, stuffiness in the nose, or difficulty swallowing or breathing
Corinne didn’t realise it, but she was seriously ill — had she not sought help when she did, she would have died within six to 12 months.
Her condition used to be very difficult to treat, but now we have a new drug called miltefosine, which kills the parasite.
If it doesn’t work, there are older drugs we can give in the form of injections, but these are less convenient, more painful and require daily hospital visits. And any injection carries a risk of infection.
Not all sandflies carry the parasite. But in terms of prevention, the main thing to do is protect yourself using insect repellent.
Corinne was very unlucky — there are thousands of people who use inhalers and who go to Greece and Spain every year, yet few actually become infected with this.