Mighty blow of tiny mite packs a killer punch

Published on Monday 9 February 2009 19:24

CHILLS, fever, nausea and stomach pains in sub-Saharan Africa don't automatically mean malaria. Tickbite fever is also a possibility, and you could end up in hospital – if you're lucky.

What should have alerted me was, the bite went black.

Since moving to Zimbabwe a few years ago, I've got used to mosquito bites. In the rainy season, we sleep under a net, and sometimes, a mosquito manages to get inside and we wake covered in angry red lumps.

But this bite had a TicTac sized black centre. I thought I'd scratched it so much that I'd formed a blood blister, so I bathed it in salt water for a day or two and left it at that.

A few days later I woke in the middle of the night with a pounding headache and a fever. By morning, my lips were blue and I was so weak I could hardly walk. Malaria, I thought.

"No, I think that's tickbite fever," said the doctor when I stumbled into her consulting room. "And your chest sounds like you're not far off pneumonia. I'd put you in hospital but..." She shrugged her shoulders.

This was November 2008 and Zimbabwe's cholera epidemic was in full swing. Hospitals – the few still open – were overstretched and understaffed. I was, she implied, safer at home.

Back then, I knew very little about tickbite fever, a bacterial disease spread by ticks. They get it by sucking blood from infected animals and then inject it via their saliva into humans. The African strains are notoriously difficult to confirm so the doctor insisted I have a blood test to see if I had antibodies to the disease.

Falling ill in crisis-wracked Zimbabwe these days is a nightmare. My husband half-carried me to Harare's medical laboratories, only to be told they only accepted Zimbabwe dollars. When he protested we didn't have the billions of dollars the laboratory demanded to carry out the test, the woman behind the desk slipped him the address of a second laboratory. This one took the huge risk of accepting foreign currency against strict government regulations.

But even though the doctor said she needed the result in an hour, the lab took 24 hours to process my sample. I spent the night shaking in bed with a raging temperature.

With the results finally with her the next morning, my doctor confirmed I had a "horrific case" of tickbite fever and drug treatment could begin.

I was prescribed a 14 day course of the antibiotic doxycycline, the standard treatment for tickbite fever in southern Africa. I'd already been given antibiotics for the near-pneumonia, paracetamol to bring down the fever and told to rest.

But we couldn't go home: the flat we rent in Harare had no running water, a dangerous state of affairs in a time of cholera. The owner of the guesthouse we moved to took one look at me as I swayed outside his door: "Tickbite fever? You can die of that!"

I didn't need convincing. If I went a few minutes over the four-hour gap permitted between paracetamols, the blinding headache came back.

I sweated so much my bedsheets were soaked. My joints ached. Little by little though, my strength appeared to return.

A month later, I was out of bed long enough for my husband to suggest a trip to convalesce on the coast of Mozambique.

This was a mistake. A day after we arrived, I had a relapse. This time I felt even worse.

Back in Zimbabwe, I got pins and needles in my feet, legs and arms. My neck muscles ached. I had periods of breathlessness so severe that one puzzled doctor who could find no evidence of a chest infection thought I might be developing emphysema. (I'm in my mid-thirties and have never smoked).

I then developed a racing heartbeat and chest pains that sent me scuttling to a heart specialist. He confirmed that occasionally tickbite fever causes a serious infection to sit on a heart valve. Luckily that wasn't in my case, but it appeared the disease had temporarily affected my heart and respiratory system. I was given a course of chloramphenicol to try to clear up it up for good.

Three months (and four doctors) later, I'm finally starting to feel better. The headaches have gone but I've been warned the tiredness will likely last for another month. Unlike malaria, tickbite fever can take a long time to fully recover from.

How did I get it? It turns out my bite with the black centre – an eschar – was a pretty reliable sign of impending tickbite fever. I hadn't seen my tick and I couldn't work out where it had come from. We hadn't been near the bush for several months. I thought ticks lurked in long grass or in the wilderness.

I was wrong. Doctors say, in sub-Saharan Africa it's possible to contract tickbite fever in suburban areas and even from pets. There's a reason why many Zimbabweans don't pet their companion animals. In an area where there's a risk of tickbite, cats and dogs shouldn't really be on your knees and certainly nowhere near your bed.

Did one of our cats leave a tick on a cushion that then sunk itself into me? I'll never know, but I have learnt that if you see a tick on your skin, you must never scratch it off. Doing so risks leaving the head embedded. Neither should you smother it in Vaseline, or burn it with a match. Instead you should tweezer out the tick, taking care not to squash its belly – this could make it regurgitate bacteria straight into your bloodstream.

One of the nasty things about the disease is it attacks your white blood cells, making you vulnerable to any other bug doing the rounds. That accounts for my near-pneumonia when I was first diagnosed.

This is confirmed by tickbite veterans I have since spoken to: Tracy, who runs a shop importing foodstuffs from South Africa, got tickbite with measles. Malcolm got tickbite fever and hepatitis, and as I write, a neighbour is on a drip (at home) with two different strains of tickbite fever and a kidney infection.

Tickbite fever can make you very ill, though with treatment it's rarely fatal these days. Longtime Zimbabwe residents speak of tickbite in the days before doxycycline, when "you either survived it or you didn't."

From now on, I'll be checking myself and my family a lot more regularly for ticks.