August 2, 2005
There’s a med student named Ben here who did some work with a surgeon in Kenya and also worked here for 8 months on a water quality improvement project and is back to visit and check on the repercussions of his work—he happened to bring his pathology textbook with him and we had some fun looking up what the fuck is going on with my poor legs. Yes, it is impetigo, but it’s the advanced type, marked not just by pimplish things that weep honey colored crusties, but also by big blisters that you can see through to see tiny ropes of pus streaming into the weepage. Gross but totally fascinating. Terribly itchy but very contagious, so I can’t scratch them because getting the bacteria under my fingernails is the fastest way to spread it. The pustules—I think this is really interesting—are caused by a toxin made by the bacteria that separates the desmogoin molecule, which holds the layers of skin together. This is the difference between impetigo and pemphigus folliceaus, which is an autoimmune problem. Neat.
Finally found some antibiotics to treat it here in Managua. About damn time, it's nearly covering my legs, and all the Nicaraguense stare them. Funny, for once to be stared at for a reason other than simply being white. They joke that my legs are like the Sandanista flag: red (impetigo) and black (hairy). Thanks, guys, thanks. One of the pustules, I think, has caused a boil. It's right at the side of my knee and it really hurts. Hope it is relieved SOON!