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25th April 2016

Brett’s diagnosis came in the nick of time

When a 16-year-old aid worker returned from Uganda feeling tired and ill, it took days to diagnose malaria and begin urgent treatment. The delay almost cost him his life.

Feeling tired after a long-haul flight is what you can expect. But two days after his return, Brett Becker was feeling even worse than when he stepped off the plane and began to complain of fever.

Brett was just back from East Africa where he had been helping to build a community centre for children with special needs. At the tender age of 15, he had decided to devote himself to the cause after spending two months volunteering in Central Uganda.

After two years of fundraising, Brett took several trips to Uganda where he immersed himself in community projects. But his determination to change the world for the better exposed him to the infectious diseases that put locals, travellers and aid workers at risk.

When his fever spiked, Brett’s mother took him to a nearby clinic, fearing he may have had malaria.

High fever

At the clinic, Brett’s blood was tested for malaria but he was told the results would take two days. Meanwhile, his symptoms worsened. His temperature hit 40˚C, peaking every two hours.

As the waves of high fevers washed over him, his mother, Amy, grew increasingly concerned. It was Saturday when the clinic called with the results: Brett had malaria.

However, he was advised to wait until the following morning because Saturday nights can be hectic at the local hospital.

The following morning was frightening. Brett’s condition had deteriorated so his mother rushed him to the emergency department. His bad luck was compounded by bad timing: the hospital was on high alert because Ebola was rife in West Africa – and was all over the news. Such was the fear that medical staff was reluctant to examine Brett, wearing full protective clothing when entering his room in case he was infected with the dreaded Ebola virus.

A race against time

Valuable time was slipping away. More minutes were lost while the emergency team was looking for  someone willing to take a blood sample from Brett. Eventually, a paramedic stepped in, drew blood and it was sent for analysis.

The results suggested Brett now showed signed of severe malaria. He was given a prescription and discharged from hospital.  Again, the timing was bad. It was Sunday evening and no local pharmacy could provide the medication he needed.

The next day, his mother knew the situation was dire. She called five local infectious disease specialists before reaching the office of a doctor who was within driving distance. “I have a 16-year–old son who just came back from Uganda and I think he’s dying,” she said, according to the CDC website.

Intensive care

The doctor, Alvaro Lopez, recognised the urgency of the situation. “He was falling asleep mid-sentence and looked pretty awful,” he said. Just a few hours later, Brett was admitted to an intensive care unit (ICU).

The seriousness of malaria is measured by the level of malaria parasites in the blood. Anything above 5% is considered severe and life-threatening – a lab test conducted upon admission to ICU showed Brett had reached 19%.

The next two days were filled with worry for Brett’s family. Doctors were concerned about his low blood pressure, his jaundiced pallor and the risk of brain damage and kidney failure. They also feared for his life.

But after those two stressful days in ICU, Brett turned a corner and began to show signs of improvement. He was then moved to a normal ward for observation and, after another four days in hospital, was free to leave – tired, weakened, but relieved.

A month later, Brett was back to his old self, playing basketball with friends and studying. Did the experience put him off doing aid work in Africa? Not one bit!

Brett took a six-month break from travel but has since returned twice to continue his work. The only difference now is that he is a little more diligent about taking malaria-prevention medication and sleeping under insecticide-treated bed nets.

Faster diagnosis, prompter treatment

Brett’s story is a cautionary tale about the importance of early diagnosis. Waiting days before treating severe malaria significantly increases the risk of death.

Researchers are constantly searching for new, faster ways to detect the disease so that doctors can swiftly initiate the right treatment. For example, a new urine test from scientists in Nigeria can diagnose malaria in just 25 minutes.

Therapies are evolving rapidly too. Scientists in the US are working on a new magnetic device that would change how infectious diseases are treated. Researchers use magnets to remove bacteria, viruses and other toxins from the blood, and then return ‘clean’ blood back to the patient’s body. Studies in rats show promise and doctors hope the same technology can be applied in humans to treat diseases like sepsis and Ebola.

Malaria is particularly well suited to this kind of magnetic ‘cleansing’ as the parasite that causes the disease is much larger than the viruses that cause diseases such as Ebola, making it easier to remove.