Bilharzia screen

[robisa86]

Hi all, can anybody help?

My Bilharzia/Schistosomiasis ELISA result has come back as "\R\"

Does anybody know what this means? Does it like mean the test was 'Reactive' i.e. Positive?

Many thanks in advance for your help.

[mkh9]

FYI, I'm going out of town on Friday 10-24-10-27. I'll be back on Tuesday 10-28. If you get your results or want to talk then I'll be glad to hear from you.
take care,
mkh9

[mkh9]

p.s. you were taking malaria prevention pills all the time you were in Africa and India? Although they don't always work. But just wondering.
thx,
mkh9

[mkh9]

So, aside from the non-cyclic fever you do have a lot of the symptoms of malaria. I wonder if they didn't catch it on the first smear. It does go in and out of the liver cells and back into the blood.  So, I would retest that, and also look at the liver Fluke Fasciola hepatica. You could have ingested bad water especially in India where they have cows around. Babesia is another thing in the blood it is self resolving usually but may be good to get treated anyway if you have it. They should see this too but you never know. I think they have a PCR test for it because the blood smear test.  It has similar symptoms to yours. How long ago did you start getting symptoms? Do you have any swollen lymph nodes? You could get your IgM checked and also check for Trypanosomes. Then there is Leishmania. Any darkening of your skin, on face hands , feet , or abdomen? Any weight loss, diarrhea no anemia right?
That is all I can come up with. The rest you don't have symptoms for  at this point.
mkh9

[mkh9]

Hi, I just got your message. Well, I hope the test is accurate. ELISA's are not 100%. But they are pretty good. So since you haven't been tested for other parasites you should get stool O&P. Do you have any diarrhea? I wondering about a liver fluke? I am going to go re-read some of that since it has been a while and I looked back at the info you gave me. I'm trying to put things together. You may want to get a gallbladder, liver kidney ultrasound to check mostly your liver. Since you have pain in the upper right quadrant and we're thinking parasites. I'm wondering if you got a liver fluke. Also just getting a general Ova and parasite check, and may want to retest for malaria due to the frequent sweats and fatigue. You don't have any severe bone pain? Sometimes they can miss Malaria on one slide.
Let me think some more and I'll write back.
mkh9

[robisa86]

Oh and I'm with the Red Cross. I'm a nurse, most experience in emergency medicine and some in tropical/infectious diseases and public health.

[robisa86]

Doctor says the Bilharzia test was negative.  He advises doing three more urine dips plus micro to look for blood. He says if two out of the three dips show blood then I'll need an ultrasound and a cystoscopy. So frustrating. I understand that I need to be medically well before I go but now I'm sat waiting with just this sat between me and my deployment!! He also said he has no idea what the problem might be as there is no indication of an infection. Any ideas?

[mkh9]

Well, lets get you healthy first. Make sure you haven't acquired anything first ok? What type of health care practitioner are you? You have a lot more nerve than I do. I really respect this virus. It is one dangerous pathogen. It is good though that there are people out there that are willing to help these people. It is a sad situation. I hope you can educate them to prevent them from getting it. But they seem to be set in their beliefs. I sure hope you don't get it. Are you going to work with the World Health Organization or Red Cross? There have only been a couple of people in the U.S. all of the people involved that got it so I hope for the best for all the health care people involved.
mkh9
mkh9

[robisa86]

Thats what I'm doing when I'm medically cleared.  Will be working in an Ebola Treatment Centre in Sierra Leone.  

[mkh9]

It is highly unusual and I don't know if there has been any cases of Bilharzi coming from the U.S. but I am open minded. I"m interested too. But then we never had EBOLA either.
mkh9

[robisa86]

Thats really interesting.  You do hear of tropical illnesses spreading. I.e. malaria carrying mosquito as far north as Greece. I'm interested what you lab results show!!

[mkh9]

Wow, I wonder if the snails were from a country where they have Bilharzia and then they released the infective form into the water? Let us know what happens with your testing.
mkh9

[Bill_Harzia_Bilharzia]

I'm in Seattle.

...where I have contracted Bilharzia.  HERE.  [Yes, I know it's not suppose to happen that way, but, a few encounters with a few freshwater aquarium snails, and... ]

The doctors still don't believe me, but at least they've taken samples.

Now I wait -- for them to recognize the parasite -- and to prescribe the Praziquantel I need.

[robisa86]

I'm in the UK. Luckily the clinic that is covering me is one in London that has lots of experience in tropical diseases so fingers crossed we'll get to an answer.

[mkh9]

Well, then you have some testing to do. But you don't have the symptoms of malaria which has the cyclic fevers and so forth. I would probably still get tested if you can. Maybe see an infectious disease specialist. What country are you in now?
mkh9

[robisa86]

And yes, bitten by many mosquitoes despite all the standard precautions.... they just seem to be attracted to me :( Was tested for Dengue a while back but results were negative.

[robisa86]

Was tested for malaria but the results were negative. Tsetse fly and other parasites not tested either. Blood in the urine and raised eosinophiles were only identified last week on a routine medical as I was meant to be flying to Seirra Leone the following Sunday. Unfortunately that is on hold now whilst we try and resolve the cause of these test results. If it isn't Bilharzia, it could highly likely be another parasitic infection, when I think of all the places I've lived and worked in developing countries over the past ten years or so. I think I can rule out allergies and although I have mild asthma, I only use my inhaler 3-4 a year. No signs of a UTI really, no urgency, no pain, no feeling I need to go but can't.

I think I'm just going to have to wait til Monday. If the results are negative I'll be sure to get follow up tests for other parasitic infections etc. Either way, I won't be getting medical clearance to deploy for work until its all sorted!!!

[mkh9]

Early symptoms are Fever, chills, muscle aches. Also, you can get liver pain.
Like you said we'll see. Have you been tested for malaria and Tsetse fly? Were you bitten by any mosquitos or flies? I guess in general there are a lot of things in the places you visited. Were you tested for other parasites too?
take care, I hope you feel better.
mkh9

[robisa86]

The main symptom I have is extreme lethargy. I think I have got used to it as it's been going on so long but the more I think about it, the more I realise how permanently exhausted I am. Sometimes I'm so tired that I ache all over badly :( I don't know if it's just a general tiredness but I do lack energy. Maybe its related to something else. We'll see.

The only other symptoms I've had for the last few years is upper right abdo pain and frequent sweats (night and day). I mentioned the these to the GP on several occassions but he dismissed them as insignificant.

Sarah

[mkh9]

Hi, Yes you probably have a risk from the fresh water exposures you mentioned. We'll see what happens. Do you have symptoms?
mkh9

[robisa86]

Thanks for the reply. In terms of exposure, I went white water rafting in the Nile (Uganda) in 2006, I have also been to Uganda in 2007, 2009, 2010, 2011 and 2012. I was also in Rwanda in 2006 and recall paddling in Lake Kivu near the Congolese border. Kenya in 2009 and Zanzibar in 2012, although all the only water exposure on that trip was the sea, so salt water. 2013 I was in south India and was in the water occassionally.

I think the most likely exposure though was 2006, rafting in Uganda and visiting Lake Kivu. This was before I became aware of the risks of Bilharzia and have tried to avoid risk zones since then.  

[mkh9]

Yes sometimes having high Eosinophils can mean a parasitic infection. It can also mean an allergy or skin problems or some other things.  If you were in a foreign country where Shistosomiasis is prevalent such as Africa or South East Asia, Middle East, Brazil, Carribean and some other countries, and you could have been exposed then it would be good to repeat and/or at least call the doctor about the report. The red blood cells can be due to a lot of things. We'll see. It could be due to an infection. At this point I'll stay neutral.

A repeat test can be due to a variety of things. Some tests have specific things that interfere with the test or some other problem with the test. It wouldn't be because it wasn't detected. If it wasn't detected it would say Negative or N.
At least that is my take on the (R) result. I am a clinical microbiologist scientist and also worked in biotech so I understand these tests fairly well. I would give the doctor a call and see whats up.

What was your possible exposure?

Let me know how it goes.
mkh9

[robisa86]

Thanks for your reply. Just out of interest would a repeat test be because there was a problem with the initial test, i.e. how it was undertaken in the lab or would it be because Bilharzia wasn't detected? I'll call my doctor on Monday,
Many thanks.

[mkh9]

Granted your test may be different. That is why you should ask them to be sure as to what they want or what the results are. In this case it looks like it they read them and positive, negative or Invalid.
mkh9

[mkh9]

It looks to be like it means Repeat. This is because they could read the test properly in order to you an answer. So it may be invalid. I would call the doctor or lab. Which way you had the test ordered and ask them what it means or if they need another specimen. It looks like it is invalid to me going by one of the ELISA tests online. See link:
http://www.rapid-diagnostics.com/downloads/RMD%20Pamphlet%20Just%2030.09.08.pdf

Scroll down about 4 pages until you see the 4 ELISA test Paddles. It is a test much like this one. There are two tests that are invalid and it says to repeat.
mkh9