Monday, January 17, 2011

Adventures in Tropical Medicine: Giardia

Those of you who have been following the saga of our health here in Liberia will know that I've been diagnosed with malaria seven times and with typhoid four times in the last 20 months. This high incidence of deadly tropical disease seems exaggerated, even to me. Symptomatically, I've felt achy, tired, apathetic and, well...not very happy. But I haven't been ravaged by tropical fevers, left shattered and shaking in my bed by alternating feelings of hot and cold, and truth be told, when I get sick I actually gain weight despite eating almost nothing--figure that one out. Suffice to say that at the beginning of my holiday, the only thing I wanted was medical certainty. What the hell was going on?

In times like these, I fall back on my East African heritage and think of one word: Saio.

Saio is a doctor at Nairobi Hospital, where he's been practicing tropical medicine for decades. He has his own dedicated lab, understands if you only have a few hours to spend in his office, and will make it his mission to figure out what's bothering you without wasting your time. The first thing I did when I knew we were passing through Nairobi was make an appointment.

Now, because Saio is an internationally-respected tropical medicine specialist and people come to see him from across Africa, I'm just going to write what he said. If you live in Liberia, or were just wondering what the hell was going on with all the "malaria," here's what's up:

• If you are taking malarone, it is virtually impossible to get malaria.

• The labs in Liberia, at least the ones we've been going to, breezily hand out false positive diagnoses because a) on the off chance that you do have malaria and they can't see it, they don't want to kill an expat and b) they may not know exactly what they're doing.

That was all very reassuring, as were the absence of malaria or salmonella (the genus that includes typhoid) antibodies in our systems. This means that neither of us has had either tropical fever for the last four months or so, and maybe even longer. Since I've never been full-blown symptomatic for malaria and was just getting tested because I had a little fever or felt like crap, I'm not sure I've ever had it. But anyway, it gets better.

What we did have, Saio told us, was giardia. Lots of lots of the little buggers, one of which you can see above. Doesn't it look like it's smiling? Those aren't eyes, those are suction cups. Giaridia bacteria live in the first meter of your intestinal tract, which is where you absorb most of your essential nutrients. No wonder we've been feeling so tired.

It gets more interesting: giardia is easy to find in stool tests if it's in it's active, just-infected stage, but once it goes chronic after a week or so, only the old and dead bacteria are excreted. After passing through the full length of the intestines, there's not much left for a test to find, so while my active giardia was easily picked up in a lab test, Nate's chronic giardia came up test negative. What to do? Well, if you're Saio, you invent your own test--a giardia DNA probe that tests blood, for which Nate scored a resounding positive. After 18 months of exhaustion, random fevers and general physical malaise, problem solved--all symptoms of chronic giardia, which doesn't even have to give you the shits.

Saio also pioneered a new treatment, as present-day giardia is resistant to flagyl. For two days, at 6 pm, you take two 400 mg tablets of Zentel, which prompts the bacteria's suction cups to loose their adhesive powers. Then, before you go to sleep, you kill the fuckers with four 500 mg tablets of Fasigyn. Two nights of this, when you absolutely must not drink alcohol, and you're all clear--until you get re-infected.
Giardia is one of the most common intestinal populations you can have and it's everywhere, but particularly in areas where there is poor--try non-existent--sanitation. According to Saio's lecture, which came complete with photocopied handouts and articles to read up on, giardia can live for weeks and even months in open pit latrines or anywhere there's shit on the ground. All it takes is for a fly to land on that shit and then on your food, and you're infected. Of course, the common transmission routes of poorly-washed hands is also a major culprit.

Suffice to say, we're pretty sure we'll need to take this treatment every so often. But at least it's not malaria.


  1. I was told Malarone could only be used for a month. Apparently not?

  2. Most people I know who take malarone have done so for months and even years. It helps to get a liver test done to make sure your liver can metabolize it adequately in the long term. It's the best thing out there for preventing malaria, so I take plenty of B-complex vitamins and milk thistle supplements to help out my liver.


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