Neonatal HSV, Verruca Plantis and Epidermolysis Bullosa - oh my!

Today was our first day in clinic. It was very nice to go out our door and walk 100 feet to work. I could get used to this commute! Kate and I were each paired with a doctor and saw patients from about 8am - 5pm. There were 4 doctors working today who saw over 100 patients total. It was a busy day not only because all of our patients have HIV, but also because at least 10 of them were REALLY sick -- I think more than 5 ended up getting admitted to the government hospital in Mbabane. The little emergency/urgent care room was overflowing most of the day. If you think your Monday clinic days are busy...you should check out this place.

The first patient I saw with the doctor I was working with had a rip roaring case of pneumonia and was breathing 60+ times a minute - that's a lot for a 10 year old who probably breaths 15 times per minute usually. Her family lives 2 hours away and started their trip at 5am to get her to the Baylor clinic. She was so weak that she couldn't walk. And that was just the beginning...

Kate saw a 10 day old baby with HSV (herpes simplex virus). She had tight, raised vesicles all over her forehead, around her eyes and one in her mouth. She most likely got it from her mom when she passed through the birth canal and it's possible that it could go everywhere in her body -- bad news.

I saw one of the leaders of the teen club, which is held once a month for teens living with HIV. He is usually very smiley but today was feeling badly. It was an upper respiratory/sore throat type deal so probably just your run-of-the-mill bronchitis or mononucleosis case. He has been on ARVs (anti-retroviral drugs) for years and has a relatively strong immune system, so this was just like a primary care doctor visit for him. But...he has verruca plantis (flat warts) all over his face, especially around his mouth. It is caused by an HPV virus, and the reason we don't all walk around with it is that most of us have fully functional immune systems. His constant low-level immune suppression allow this virus to stick around and cause what looks like a white-ish, flat rash.

Kate and I both saw these two ADORABLE kids - one 3 and the other 5 years old - with what we think is Epidermolysis Bullosa on the soles of their little feet. It is a blistering disease with a genetic component which gets worse with trauma - a.k.a. little kids running around barefoot. I gave the 5 year old a book and she read it to her little brother in a combination of English and Siswati (so cute!).

Here is what it looks like on light-colored skin. We didn't think it was kosher to start snapping pictures on our first day...but maybe once we get to know some of the patients and families.

So, all and all a very busy and interesting first day. I'm excited for a very infectious disease filled month! :)