A patient returns from an adventure with fever and myalgia

He drank only bottled water and took malaria prophylaxis, so what happened?

Joel, 26, presents three days after returning from a 12-month trip to South America and the Caribbean.

martha-brae river jamaica rafting

He started his trip with two weeks in Brazil, followed by nine months adventuring in Bolivia, Peru and Ecuador.

The last 10 weeks were spent in Cuba and Jamaica, where he took part in jungle walks and swam in freshwater swimming holes.

Joel consumed bottled water and took doxycycline for malaria prophylaxis during his time in the Amazon rainforest.

He stayed predominantly in hostels with

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