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Mar 2012 - BITE!!!

So you realise that you have been bitten...

...now what do you do ? That was the dilemma I faced in early November 2011 in China. It is so easy in hindsight as to what I should have done, but at the time there was little available guidance.

The following is based on personal experience and there may be other solutions.

Well it occurred in Burkina Faso, West Africa, I think as I was walking through a mealie/corn field of tall stalks looking at the planned infrastructure sites for a new mine. I recall thinking "what was that ?" as something brushed my inside lower right leg, and looked back but could not see anything sticking out and assumed that I must have mis-footed into a stalk. I was not looking at the ground for a baby snake, spider or tick and was wearing mine boots that covered the ankles, thick socks and long thickish pants/trousers, ie no exposed skin, and was taking the anti-malarial drug "Malarone".

It was fortunate that I was taking Malarone as it undoubtedly affected what happened next, because it is also an anti-bacterial drug. As in the bite only appeared one week later as two increasingly sore red-rimmed white-heads ~7mm apart, on a long distance flight from Amsterdam to China, the day after I had stopped taking the Malarone.

What happened next after I had later broke them through the skin before going to bed was to wake up in the morning with two white and black (necro) rimmed holes, surrounded a staph(ylococcus) rash that had spread down to the ankle. I had used boiling water to clean it with and savlon (an anti-septic ointment), followed when I saw the rash by paw-paw (an anti-bite/rash) ointment.

It increasingly did not look great and remained painful. So, the choice as I saw it was to see a doctor in China or get back to Australia, knowing that there could be translation difficulties, most people go to Hong Kong for treatment if they can (ie not in China), and they might say "you cannot fly".

So I caught a bullet train from Tianjin to Beijing and managed to catch an earlier flight (3 days' early) to Australia. Where I saw my GP, had various courses of antibiotics (Keflex and dicloxacillin); and lastly Doxylin 100 (an anti-malarial / anti-bacterial) which appeared to have cured the infection, almost 3 months' later, leaving just the damaged nerve endings to gradually heal.

The staph rash itself faded with the Keflex over about 6 weeks, and two layers of skin peeled off of the rash area (like sunburn). Everyone I saw (doctors/specialists etc) said that they have never seen anything like it before. The swab taken by the GP came back unknown/not recognisable in Australia (which was positive in that it was not identified, but negative in that there was no course to follow for the treatment).

The reason why the bite appeared ~one week later was the combination of stopping to take the Malarone and flying long-distance. On high long-distance flights the blood pools, hence resulting for some people in DVT, but also provides a breeding ground for bacteria. People I later spoke to, have said that China would probably not have allowed you to fly, and returning to Australia/not having any treatment in China was probably one of the best decisions you could have made.

As to the cause of the bite, it depends on the consultant/doctor : the GPs (I saw two of them) say snake, the scanners say spider (mainly based on the downwards direction and style of the staph rash - a snake bite should have spread up the veins in the leg), and the infectious diseases doctors I saw say a type of tick (based on the blood taken ~10 weeks or so later showing antibodies similar to a tick bite - provided that you ignore the bite itself, unless it was two ticks close together that bit, dropped off and did not cause any immediate pain).

Fortunately I was taking the Malarone. As one of the scanners said " you should have collapsed and been on a drip in hospital whether it was a spider or a snake". Fortunately that did not occur, as the nearest hospital was up to 5 hours' drive away. As another commented, "there is a reason why no one has seen that particular type of bite and rash....snake and spider bites are often fatal....but you were taking Malarone".

As others have said "if you are a native in the bush and get bitten, you lie down and don't move for 2 days, after which either you will get up or you won't". While one of the scanners said "if you are a native on a beach and get bitten, you get into the sea and then apply ash - to draw the bacteria out".

As they say, it is so easy in hindsight, but what should I have done ?

  • When the bite occurred (if aware of it) : pour vodka or whisky over it.
  • When the bite (possibly even rash) is visible, breaks through or is broken through the skin : pour vodka or whisky over it (to draw out the bacteria - the bacteria is operating quite happily in your skin, pouring vodka over it provides an alien environment which the bacteria has come out and fight [note : using vodka after a bite does actually work]).
  • When back in Australia (or your home country) : see a GP and get a referral to the infectious diseases section of a hospital, so that they can do a biopsy to identify the cause (take a sample with a needle, not a swab), and blood test to identify the antibodies. So as to determine the appropriate treatment.

What else could I have done : stayed on the Malarone until I was back in Australia.

So in conclusion : don't leave for malaria-type places without taking enough Malarone (it used to be called Melanil in South Africa) with you, and perhaps a mini shampoo-sized bottle of vodka in your carry-on luggage.

Disclosure and Disclaimer : This article has been written by Keith Goode, the Managing Director of Eagle Research Advisory Pty Ltd, (an independent research company) who is a Financial Services Representative with Taylor Collison Ltd.

  • Written by: Keith Goode
  • Friday, 02 March 2012

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