When you return from a week-long vacation in the Caribbean, you might expect a decent tan, an album's worth of beach selfies, and a rare sense of calm. You probably don't expect to come back with a small army of parasitic worms making your foot their new home, but that's exactly what happened to Katie Stephens, 22, and Eddie Zytner, 25, earlier this month.
The Canadian couple from Ontario contracted hookworms while holidaying in the idyllic beach town Punta Cana, on the eastern tip of the Dominican Republic. Warning: the images below are not for the faint of heart.
Hookworms are normally contracted by people walking barefoot on contaminated soil or sand, as was the case with Stephens and Zytner, who developed the condition after a romantic stroll on the beach. The parasite enters the human body as larvae, penetrating the skin of the foot before migrating to the small intestine.
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The first signs of infection are itching and localized rashes, as the couple discovered during their week in Punta Cana in the IFA Villas Bavaro Resort. They dismissed the discomfort, presuming it was the result of a few harmless bug bites. But things grew worse and Stephens and Zytner sought hospital attention when they developed severe swelling, blisters, and red marks. (The latter shows the larvae's movements through the body.)
The first two doctors didn't recognize the symptoms. It was only after a third trip to the hospital that a doctor was able to diagnose the couple with cutaneous larva migrans (CLM), which is the skin disease in humans caused by hookworm larvae. The doctor remembered a similar case from a traveler who had recently returned from Thailand.
According to the NHS, the majority of infections occur in Africa, the Americas, China, and Southeast Asia. Hookworms tend to be found in hot, moist countries – like the Dominican Republic and Thailand.
Even with the diagnosis, Stephens and Zytner had difficulty getting hold of the medication they needed. Ivermectin and albendazole (the drugs used to treat CLM) are on Health Canada's Special Access Programme. This means they need federal approval, which is decided on a case-by-case basis. Apparently, the couple's case was not deemed serious enough.
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“I don’t know how much worse it has to be for them to approve it,” Zytner told the Windsor Star.
Luckily for Stephens and Zytner, a doctor with a dual-nation license was able to source the medication from the US. They are now recovering and the infection is expected to subside in the next few weeks. The healing of the skin of the foot, however, may take a little while longer.
It is thought that 576 million to 740 million people are infected with hookworm worldwide.
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