I have been ill since returning from Namibia last Saturday. I do not know if I have a low grade infection or a very bad case of jet lag. I was just foggy in the head upon my return on Saturday and on into Sunday but by Monday I was a wreck.

I am suffering from fatigue, loss of appetite (10lb weight loss), anxiety, insomnia, inability to concentrate, a few chills in the evening but no fever, vomiting, or diarrhea. I have no skin rashes but I do have a couple of small bites around my ankles that seem slow to heal. I am tired all day but then have difficulty falling asleep at night. I have to take a sleeping pill at 9:00PM and will sleep until about 3-4 AM. I finally get out of bed at 6AM as the sky starts to lighten up. In the morning I feel a little better but by 7PM each evening I have to go lie down.

I started taking Malarone on the day of my departure from the US and will continue to take it until 7 days after my return. We visited Etosha and the Okavongo River at Mahango Game Park in the Caprivi. I felt fine while in Namibia.

I visited the Emergency Room Monday night because I was so confused that I thought that I had cerebral malaria. My vital signs were fine and I did not have a fever. They did a few basic blood tests (electrolytes, liver function tests, and CBC) which were normal except my potassium was a little low at 3.3. They decided that I was suffering from severe jet lag and was also having an anxiety attack. I was treated with IV fluids and a sedative before being sent home with instructions to continue taking my sleeping pill (Ambien) each evening until my sleep pattern improves.

I have now been home for 5 days and am thinking that if I have jet lag, it should be gone.

Does anybody have any thoughts? This is my 3rd trip to Africa and I have done 4 trips to South America. I have never felt jet lag previously.

Try a clinic/doctor that does a lot of travel medicine.

Get it checked out.

Don

Ron L

It does not seem that you have any tropical infection at all but I am no doctor, all I can do is relate how it effects me occasionally when I travel worldwide ///

Jet lag can be quite severe in some instances and for some people BUT you might be having or close to having an anxitey type attack I believe ...

Have you had any elevated stress of late and or any major traumatic event occur as it sounds like some form of stress related affliction and loss of sleep or bad sleep will only compound the problem ...

I personally am very bad with jet lag and if I lose my normal sleep pattern for longer than say a week I am a bit of a cot case till it returns.

Personally I dont like sleeping pills per se I prefer a mild dose ( 250 mcg) of xanax to get me back on an even keel and sleep pattern, seems to work for me anyhow

Peter

I experienced very similar symptoms after returning in May. I chalked it up as severe jet lag also. My sleep patterns were effected for 1.5 weeks after returning. I work in the medical field so the group opinion was that it was severe jet lag. I took a very mild sleep aid, Sonata for a few days and drank plenty of fluids avoiding caffeine. If you are really concerned or if your symptoms worsen you should be seen by another physician.

Any swelling around those bites? If so, take some benedril. I'm betting that once the Malarone is finished you'll see a marked recovery.

Rich Elliott

sounds like tick-bite-fever... without the fever.

Get a blood test for all forms of riketsia (sp) There are 7 different "tick bite" diseases in Zim and probably others in Namibia, two common - viz tick bite fever, Rash, headache etc, and "tick Fever", headache (but not progressing to coma) often no rash but gums go very pale... etc. A dose of Doxycycline fixes all but one of them.

Namibia, being more sandy than zim, has a whole bunch of little biting critters extra- Tampan ticks, sand fleas etc which all inject funny protiens when they bite you. - same as tsetse flies here- Generally no harm is done and you come back to an even keel once your body has a) recovered from the jet lag and b) dealt with the strange protiens in your blood stream. Normally only takes a couple of days but jet lag can really slow things down.

You may have picked up a parasite.

Normal U.S. blood tests wont pick that up.

I'm surprised that the E room doctor didnt' call in a infectious disease specialist, since you just returned from Namibia.

Also could be the onset of meningitis, which can only be detected with a spinal tap.

Good luck and keep us informed!

AR is good for a lot of things. But some things you need to seek expert medical advice from a specialist.

Take the advice of many and contact a doctor who specializes in tropical diseases. This is nothing to mess around with.

I would be more concerned about the visit to the Caprivi area than the Etosha area. Be sure to tell him that you visited the Caprivi area. It is so drastically different from the rest of Namibia.

Get well soon my friend you are the last person I know that needs to lose 10lb !!!!
Just Jim

Thanks for the advice and encouragement. I live in a small town so a tropical disease specialist would be a long drive. My family physician has sent me home from work to rest for the next few days. He thinks that it is just jet lag. If I am still have symptoms on Monday. he will consult a tropical disease specialist and start an extensive workup.

In the mean time, he told me to read a book, work on the computer, go for a walk outside, or watch TV but not to sleep during the day. the bad news is no caffeine or alcohol.....

I will start another topic and post a few pictures of our hunt.

quote:

Originally posted by cropduster:
Get well soon my friend you are the last person I know that needs to lose 10lb !!!!
Just Jim

You mean he is as fat as I am?

Ron,
I wish you a speedy recovery. Please keep us informed.
Take care
Lorenzo

Have you had your stool checked for an intestinal parasite? Some of your symptoms point in that direction.

Ron L,

Make the long drive today. Understandably enough, getting these things diagnosed in N.A. can take a while so best to get things started now. If you get the tests now and start to feel better, great. But, if your condition lingers or goes away and flares up you'll just feel bad for longer, and it might start to have a negative impact on your life. Early this spring I got back from a trip and went down for a day with sweats, chills and aches and pains. It went away and I thought it was jet lag or the flu. It has been coming back every 3 or 3 1/2 weeks ever since. I didn't see a doctor until the 3rd outbreak and am regretting not going sooner. Still no firm diagnosis and I'm due for another bout while on a paddling trip we're taking on Ellesmere Island. Really not looking forward to that.

All the best,
Dean

(BTW the one specialist is betting on a combination of malaria and a G.I. parasite, another guesses straight malaria.)

Ron L: get well soon. We need you here to beat Lorenzo in another weekend´s game. The rascal says that he suffers the cold too much.

Saeed my friend how are you!!! That is a true statement you made. Also like you a true hunter ( KILLER ) He is a great wing shot & shot 2000 rounds a day with Jon A in January of this year.
Just Jim

You may have tick fever, sounds like it to me. where were you hunting? Go on Doxycycline...but first be sure to be tested for Malaria...

Your symptoms sopund like the ones my father-in-law had after we returned from SA last year, turned out to be tick fever (we don´t get jetlag as we are in the same time zone). Be sure to consult someone who has insights in tropical medicine.

Ron,

Two friends who hunted Namibia came back weith illness. The first had tick bite fever, and it made him seriously ill. The second picked up some kind of fly parasite (larvae under the skin).

I agree on the tropical medicine specialist, and quickly!

jim

Ron,

Forgot to add, studies show that jet lag is much harder going west to east, and much easier to handle east to west. This is my experience too. Flying from Namibia to USA sahould be easier for you.

jim

Weekly


November 13, 1998 / 47(44);950-2




African Tick-Bite Fever Among International Travelers -- Oregon, 1998
In May 1998, the Oregon Health Division received a report from a local physician that nine persons developed annular skin lesions accompanied by influenza-like symptoms within 8 days of leaving southern Africa. All nine persons were members of a 34-person group from Oregon that traveled to Swaziland in April 1998 to participate in a 3-week humanitarian construction project. This report describes two cases of African tick-bite fever (ATBF) diagnosed in this group and underscores the importance of pretravel counseling about vectorborne illnesses and post-travel recognition of imported rickettsial diseases.

Case Reports

Case 1. A 61-year-old man developed an annular skin lesion 1.5 cm in diameter on his right lower leg 4 days after leaving the Swaziland construction site. The lesion had a dark center with an erythematous border. He also noted acute onset of fatigue, chills, and fever, but denied having other rashes or skin lesions. The patient was evaluated in Oregon by his physician, tickborne illness was diagnosed empirically and treated with 100 mg of doxycycline twice daily for 10 days. His systemic symptoms resolved completely within 24 hours of onset; however, full resolution of his skin lesion required more than 2 months. A serum sample obtained 6 days after symptom onset revealed antibodies reactive with Rickettsia rickettsii (the organism that causes Rocky Mountain spotted fever) at a titer of less than 1:8. A convalescent antibody titer obtained 4 weeks after symptom onset was 1:256. During his 3-week stay in Swaziland, the patient worked indoors and outdoors at two construction sites. He did not use insect repellent and did not notice or remove ticks from his body.

Case 2. A 56-year-old woman developed two erythematous annular skin lesions with dark centers 8 days after leaving the Swaziland construction site. The lesions were 1-2 cm in diameter and were on her back and right side. She also noted acute onset of fever, fatigue, chills, sweats, headache, myalgia, and arthralgias. She denied having other rashes or skin lesions. The patient was evaluated in Oregon by her physician, who noted a diffuse lymphadenopathy. Serologic titers for antibodies to rickettsial organisms were not obtained. She was empirically treated with 100 mg of minocycline twice daily for 10 days. Her systemic symptoms resolved 4 days after onset, but complete resolution of her skin lesions required more than 2 months. The patient worked indoors at the construction site. She did not use insect repellent and reported no tick bites or tick removals during her stay.

Summary of Cases

Eight of the nine reported ill persons were available for interview. Median age was 54 years (range: 41-65 years); five were male. All eight case-patients interviewed reported developing one or more annular skin lesions, 0.5-3.0 cm in diameter, characterized by dark centers and erythematous borders within 8 days of leaving southern Africa. Six developed skin lesions accompanied by fatigue, chills, and fever. Rash, other than the annular lesions, was uniformly absent. Median symptom duration was 4 days (range: 1-15 days), and no patient required hospitalization. Six had pretravel contact with a health-care provider, but none recalled counseling about tickborne diseases endemic to southern Africa. No ill person recalled a tick bite or tick removal during their stay, and none reported consistent use of insect repellent. Ill persons sought medical attention after returning to the United States, and all were treated with antimicrobial medications. Case-patient 1 had serologic results consistent with acute rickettsial infection. For another case-patient, acute and convalescent (collected after he completed treatment with doxycycline) serologies did not reveal elevated levels of antibody reactive with R. rickettsii.

You should get a tropical/infectious disease person to look into this. What I've read about tick fever is that you might expect a substantial lesion around the bite, fever, and aches/pains resembing the flu. What you describe isn't a clear match. Getting a more clear diagnosis is a good idea before you start any med. Bob

A number of our guests have mentioned Doxycycline

This ALL brings up an interesting point // and I dont want to sound like (a know all) or stir up a hornets nest BUT

With regards Malaria /

Whenever I go to a Malarial zone in Africa I ONLY take Doxycycline as a preventive, it is in fact an antibiotic BUT good for Malaria prevention as well, it does not have side effects like a lot of the more well known drugs do. Some people can get a minor suseptability to sunburn and I think pregnant women cant use it. It has nor sun burn effects on me

Seeing it is good for the other afflictions mentioned by the guests I think it is vastly superior to the other malaria prophlactics, some of which can have beastly side effects for a select band of individuals.

Also you dont need to take Doxy in advance of enterning a Malaria Zone, just the day of arrival and each day whilst there, so it is simple and easy to prepare.

What one has to remember ( I am no doctor) but common sense tells me that the various Malaria strains are (evolving continually) and if your medical doctor is not an expert in the field and he just prescribes some (general readily available medication) without researching the specific zone you are entering in Africa it could be useless and not have any help against the particular mosquito within that zone ... NOT all mosquitoes are the same strain, just be circumspect and aware of that fact and tell your XPERT doctor exactly where you will be going

Peter

Peter,

I agree with you completely! I take doxy when traveling south and keep a surplus of the stuff around for other stuff just in case. Had a goofy eye infection a while back and my cousin who is a doctor was like "just up the doxy dose and you are good to go". Worked like a champ. Further, the stuff I have read shows that, when combined with daily use of DEET, the efficacy of Doxy in preventing Malaria is for all practical purposes good enough. It is certainly good enough when considering the lack of side effects and other uses for the medication.

JMHO,

JohnTheGreek

Peter,
I was informed by my son this weekend that Doxy is what the US Army is using as a Malaria preventative in Iraq so you're in good company. I heard from a client today who was told to use it as well. This by someone in the Atlanta CDC.
So...it must be good stuff! All I ever used it for was intestinal problems.

Rich Elliott

quote:

Originally posted by Rich Elliott:
Peter,
I was informed by my son this weekend that Doxy is what the US Army is using as a Malaria preventative in Iraq so you're in good company. I heard from a client today who was told to use it as well. This by someone in the Atlanta CDC.
So...it must be good stuff! All I ever used it for was intestinal problems.

Rich Elliott

Hi Rich

Hope you and family are all keeping well in the USA.

Basically to cut a long story fairly short, I will say /

When I was a young boy I lived in Rhodesia, as as a teenager I went fishing to the Shangani River ( those of knowledge ) will remember that famous river, it from where Allan Wilson and his troopers fought their last stand against the Matabele, all were wiped out by the Zulu Impi.

Anyhow I got bloody Malaria there at the river and was (horribly sick) with complications and it turned into (blackwater fever) and I was in cuckoo land for a while ( some say ) I am still in cuckoo land

In those days (late 50's) all we had was QUININE as the main malaria meds.

WARNING // PLEASE Dont get black water fever as it is very very serious to say the least, one of the reasons it is called that is because when you pass water it is the same colour as coke a cola

BLACKWATER FEVER - A condition that results from the presence of hemoglobin in the urine (hemoglobinuria) following infection with Falciparum malaria. Symptoms include fever, tender and enlarged liver and spleen, dark urine, abdominal pain, nausea, vomiting, and jaundice.

Now that was fortunately the only time I have ever to date contracted Malaria/Blackwater fever in all my years of being born and living in Africa // I really thought I was gone and in with the angels at the time

What set me onto Doxy is when I went to Zambia some 5 years ago my doctor here in NZ looked up in depth malaria information and said to me the mozzies in the particular region of Zambia where I was travelling were proving to be resitant to (most all of the current medication) on the market and he said TRY DOXY, so that is what I did, and that is all I use now ...

In Summary:

What our esteemed guests need to also be very clear of and remember is that NO MEDICATION offers 100% protection ... we all need to use the other common sense information being, wear long sleeves and long trousers in late afternoon evening time and early mornings, use a good repellant like DEET, and sleep under a mozzie net ( without holes in it ) Also your PH can burn a coil in the chalet prior to you retiring to sleep as that all help ... prevention is better than cure

Take care in Africa, dont temp fate anf laugh about Malaria like some of the locals do ///

I know some people ( nutters) whom will wait till they get Malaria then [HIT IT HARD] with the three pill FANSIDAR treatment, those are MAD DOG people in my book, proberbly a bit like WALTER

FANSIDAR:

Since sulfadoxine and pyrimethamine combination may cause some serious side effects, it generally is used only to prevent or treat serious malaria infections in areas where it is known that other medicines may not work.


Peter

Peter- Don't have your range of experience, but used Doxy the last trip and won't use the others now. I do take the "cure" dose of Malarone in my kit in case....Anyway, have tried all three and it's Doxy for me. I take it at dinner and use good sunscreen.

PS- To last post. Just finished treating my hunting clothes for our trip. I used 18 ounces of REPEL on 3 tops and pants, seven pairs of socks,1 pair gaitors , 1 cap, 1 pair gloves and 1 pair New Balence shoes.It really is worth the effort.

You aren't that far from Atlanta. You might want to check with Center for Disease Control.

Ron, If you are good for it, hear is my free well meant advice.Forget the pain of travel and propable significant additional cost.Get your but to an infectious disease physician,best if he/she has some knowlledge of tropical diseases.I think most dont, we simply dont see them here that much - so lack of experienec.What is indicated is a routine battery of blood test,maybe urine + stoll too.
Today most these diseases can be picked up that way.
Ricketsia often dont show early symptoms but when not treated soon -you will live with it for life - very unplasant.

So the simple advise: move your but and stop thinking and procrastinating.
When I came back last year.I simple went to see the infect d doc again,actually just had the battery of blood test ordered- simply a safety measure ,as its more desirable to know and treat early than late.

Because Doxycycline is dirt cheap I also take a 2 week course when back,simply to nip Ricketsia in the butt.

As far as Doxy as prophylactic for Malaria as many here espouse:
I think there is ample literature to disagree with that.Doxy is better than nothing but its effectiveness does not compare to Larium or Malarone. Many areas during the right season have little chance for Malaria, so its :"OK" to make a half hearted treatment with Doxy, but be aware its not the optional choice for Malaria infested season/land.

Let us know how things come out, we are all constantly learning

You really do need to exclude gut parsites-with the right type of stool culture and analysis-and you really do need to exclude "Rickettsial"
diseases.
Next trip use doxycycline plus chloroquine as malaria prophylaxis and you will avoid most of the problems.

Ron L

I would visit a good tropical diseases or travellers clinic.

Forget the local quack.

I came back with a bug from Africa in 1994 and the local quack was useless. The travellers medical clinic had some good experienced doctors and diagnosed it quickly.

Turned out to be common glandular fever but there were other more serious possibilities for the symptons. Not that glandular fever wasn't bad enough as I had it off and on for three years.

See someone who knows what they are doing.

Peter,
I used to could get Fansidar in the US and always kept a 3 pill ( killer) does on hand. I've brought some of our guys ( workers) back from the dead with that stuff. I think one can still get it in Europe but it's not imported to the USA any more. No malaria here I guess.
I hear that there's a new drug out by the same company (Searle ?) called Fansifed that's even better. While on the subject, a German company makes a test kit for Malaria that even tells one what kind of Malaria it is. Of course, we can't get that here either.

Rich Elliott

This info got me to thinking and I sent it to a friend in London. He sent me this link.
http://www.rgs.org/category.php?Page=mainpublications

Book on medicine etc. on top of list. I have not seen it but will pick up a copy when I am there and ck it out.
Ron, hope you get well soon.
Gene

Any light sensitivity or neck pain? Still no problems with fever? I would go see an internal medicine MD who specializes in infectious disease.

Don't wait. Most malaria's present with fever. Usually, but not always, the malarial parasites will be picked up on your CBC, but your MD should probably tell the lab tech to look for malaria on the blood smear.

Any light sensitivity and/or neck pain/stiffness can point toward meningitis onset. usually you'll have fevers too. In the News yesterday, Brad Pitt, having just returned from Ethiopia, was treated for viral meningitis. Very early symptoms will be flu like.


Plus, a good MD should have ordered stool samples to rule out intestinal parasites if your having intestinal issues.

Go see a dr.

Good luck, and keep us posted.

Gentlemen

Thanks for all the concern and advice. I am now much better. It would seem to have been a case of severe jet lag combined with a daily hangover from the Ambien. I am now back eating, I actually slept last night for 8 hours but woke up 4 times, I can concentrate again, and my energy level is returning.

I made a few mistakes when returning from my trip. I will pass these on as advice on what not to do.

I returned on a Saturday from Namibia and that gave me Sunday to recover. I had been out of the country for 2 1/2 weeks and I was quite tired. I avoided caffein and alcohol on the 36 hour journey back to the U.S. I stayed hydrated by bringing an additional liter of fluid on the flight and always drinking water or juice when the stewardess offered it.

My mistake was that I spent all of Saturday afternoon and all day Sunday inside of my home unpacking and catching up on email/business. I received no sunlight to let my body know that I was in a different time zone. I had no physical activity outdoors upon my return. I should have gone on a walks or done some yard work on Saturday and Sunday.

I continued to take 10mg of Ambien every evening to force myself asleep. It was giving me a hangover the next day that I did not recognize.

I was scheduled to work a 24 hour shift Monday rather than my usual 8 hour shift. Big mistake on my part for not getting that changed. I completely broke down by 10PM Monday night. My mind just gave up and said enough is enough.

Thanks again for your help.

Thanks for letting us know, Ron. Glad you are better.

Your work habits sound like mine, so I'm glad to know what NOT to do.

Glad to hear that you're feeling better!

Still, lots of good advice in this thread about prevention and treatment of diseases for us yet to have traveled to Africa.

Glad to see you are ok again!!
L

Good to hear you are better. I had less than 24 hours at home before I had to drive 4 hours to DFW and then fly a 25 hour 4 day trip. My body clock was so screwed up I did not know what time zone I was on.